Analysis of the antibiotic resistance profiles in methicillin-sensitive s. Aureus pathotypes isolated on a commercial rabbit farm in Italy

The breeding of meat rabbits is an important sector in the livestock industry in Italy. The focus of this study was to describe the antibiotic resistance profile distribution among the Methicillin-sensitive Staphylococcus aureus isolated in a rabbit farm. From 400 animals of different ages and three farm workers, 96 randomly selected strains isolated from various anatomical sites and lesions were analysed. According to spa typing and the resistance profiles towards veterinary and human antibiotics, 26 pathotypes were identified. The highest resistance was observed against Tetracyclines (92.3%) and Macrolides (80.8%), while almost all were susceptible to Penicillins, according to the limited use of β-lactams on the farm. In total, 92.3% of pathotypes were multidrug resistant (MDRs). Two MDR pathotypes belonging to the t2802 spa type were isolated from both farmers and rabbits. Age categories harboured significantly different pathotypes (p = 0.019), while no association was found between pathotypes and lesions (p = 0.128) or sampling sites (p = 0.491). The antibiotic resistance was observed to increase with the time spent in the farm environment (age category). The selective pressure exerted by antibiotic use acted by giving advantage to more resistant strains rather than by lowering susceptibility to various drug categories within strains

Malpractice claims in interventional radiology: frequency, characteristics and protective measures Il contenzioso in radiologia interventistica: frequenza, caratteristiche ed azioni di tutela

interventistica \ue8 sensibilmente aumentato negli ultimi anni; di pari passo si \ue8 notato un incremento del contenzioso medico-legale ad esse associato. Questo studio mira a sottolineare i problemi all\u2019origine delle denunce per malapratica in radiologia interventistica, ed a valutare l\u2019importanza del consenso informato. Materiali e metodi. Sono state esaminate tutte le denunce assicurative causate da presunti errori in radiologia interventistica in un periodo di 14 anni, enuncleandole dal data-base assicurativo dei radiologi iscritti alla Societ\ue0 Italiana di Radiologia Medica (SIRM) dal 01/01/1993 al 31/12/2006. Risultati. Nel periodo in esame sono state sporte 98 denunce contro radiologi che avevano effettuato procedure interventistiche. In 21 casi (21,4%) l\u2019evento aveva causato la morte del paziente. In oltre l\u201980% dei casi l\u2019evento lesivo era occorso in una struttura pubblica. Il rischio di ricevere una denuncia per presunta malapratica per un radiologo che pratichi tecniche interventistiche \ue8 pari al 47 per mille, il che corrisponde ad una denuncia per ogni 21 anni di attivit\ue0. Discussione. La radiologia interventistica, attivit\ue0 sovrapponibile per profilo di rischio biologico alle procedure chirurgiche, espone gli operatori ad un elevato rischio di contenzioso medico-legale sia per problemi intrinseci alle tecniche usate, sia per la necessit\ue0 di operare su soggetti con gravi patologie, e in condizioni cliniche compromesse. Conclusioni. La prevenzione del contenzioso dipende in gran parte da una riduzione della percentuale di errore medico abbinata ad una corretta ed organica informazione del paziente. L\u2019adozione di buone pratiche radiologiche, la scrupolosa revisione delle procedure e dell\u2019efficienza tecnica degli strumenti usati, la verifica delle procedure organizzative e gestionali sono i fattori che riducono la probabilit\ue0 dell\u2019errore. Il miglioramento delle tecniche di comunicazione, nel rispetto dell\u2019autonomia del paziente, passa anche attraverso l\u2019adozione di procedure chiare e rigorose per l\u2019ottenimento del consenso all\u2019atto medico.Purpose. The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process. Materials and methods. The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006. Results. In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient\u2019s death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity. Discussion. Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status.Conclusions. Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient\u2019s right to autonomy also implies adopting clear and rigorous processes for obtaining the patient\u2019s informed consent to the medical procedure

Frequency of musculoskeletal symptoms in diagnostic medical sonographers. Results of a pilot survey

INTRODUCTION: We report the results of a pilot survey in diagnostic medical sonographers. Aim of the study was to evaluate the frequency of musculoskeletal disorders in sonologists and the relationship of these symptoms to ergonomic factors. MATERIALS AND METHODS: 340 sonographers (258 male, 82 female doctors; mean age 41.5 +/- 7.2 years) were given a questionnaire to fill out. The questionnaire asked questions about the sonologist's age, gender, technique of ultrasound procedure, physical activity, and work-related musculoskeletal complaints. Two symptom lists regarded carpal tunnel syndrome (CTS) symptoms (8 items) and other work-related musculoskeletal symptoms (13 items). The categorized response variables "have now" or "in the past" were provided. The symptoms experienced were categorized into three levels as no symptoms, few symptoms (1-4 symptoms), and many symptoms (> 5 symptoms). RESULTS: One third of the respondents reported having at least one or more work-related symptoms in the upper extremities. The most frequent symptoms were tingling (17.6%), numbness or finger pain (13.5%). Carpal tunnel syndrome had been diagnosed in 5 cases (1.5%). More than 60% of all respondents have experienced one or more musculoskeletal symptoms in the cervical or lumbar spine. The commonest symptom was neck and low back pain (67%). The pain was generally intermittent and occurred at the end of the workday. Motion impairment in the neck and/or back was present in 23.5% of cases. Twenty-five percent of respondents had received treatments for their symptoms and 10% reported having stopped work because of their symptoms. Data analysis showed that muscular efforts such as gripping the transducer, applying sustained pressure, and scanning with a correlated flexed or hyperextended wrist were significantly correlated with increasing severity of symptoms in the hand, wrist, and forearm area. On the other hand, low back pain appeared to be negatively correlated with correct position of the body. CONCLUSIONS: Several physical risk factors (e.g., repetitive work and force exertion, twisting of the body and poorly-adjustable chairs) have been identified for work-related upper extremity and spine disorders. Ergonomic redesign of the workstation configuration as well as allowing sufficient recovery time to body and arm muscles appear to be the main goals to achieve prevention of musculoskeletal disorders in sonographers