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During June–August 2013, 25 US states reported 631 cyclosporiasis cases including Nebraska and Iowa where a regional investigation implicated common-source imported salad mix served in two chain restaurants. At least two common-origin growing fields were likely sources of contaminated romaine lettuce. Using producer- and distributor-provided data, we conducted a grower-specific traceforward investigation to reveal exposures of ill US residents elsewhere who reported symptom onset during 11 June–1 July 2013, the time period established in the Nebraska and Iowa investigation. Romaine lettuce shipped on 2–6 June from one of these Mexico-origin growing fields likely caused cyclosporiasis in 78 persons reporting illness onsets from 11 June to 1 July in Nebraska, Texas, and Florida. Nationwide, 97% (314/324) of persons confirmed with cyclosporiasis with symptom onset from 11 June to 1 July 2013 resided in 11 central and eastern US states receiving approximately two-thirds of romaine lettuce from this field. This grower's production practices should be investigated to determine potential sources of contamination and to develop recommendations to prevent future illnesses. [ABSTRACT FROM PUBLISHER]

A regional, multistate investigation into a June–August 2013 cyclosporiasis outbreak was conducted in Nebraska, Iowa, and neighbouring states. Cases were confirmed on the basis of laboratory and clinical findings. Of 227 cases in Iowa (n = 140) and Nebraska (n = 87) residents, 162 (71%) reported dining at chain A/B restaurants – 96% reported house salad consumption. A case-control study identified chain A/B house salad as the most likely vehicle. Traceback was conducted to ascertain production lot codes of bagged salad mix (iceberg and romaine lettuce, red cabbage, and carrots) served as house salad in implicated restaurants. A single production lot code of salad mix supplied by both a common producer and distributor was linked to the majority of confirmed cases in persons reporting regional chain A/B exposure. The salad mix linked to illnesses contained imported romaine lettuce from two separate single-grower fields-of-origin and ⩾1 additional field from another grower. [ABSTRACT FROM PUBLISHER]

Background Despite recommendations for adherence reporting in clinical trials involving an oral anticancer agent, the frequency and methods of adherence reporting are inconsistent. The purpose of this systematic review is to determine the frequency and type of adherence measures used in oncology and hematology clinical trials of oral anticancer agents and their association with study characteristics including quality, cancer type, stage and treatment type. Design PubMed was searched of all randomized controlled clinical trials assessing self-administered pharmacological interventions in patients with cancer and published over two years, between 1 January 2011 and 31 December 2012 were evaluated. Results We identified 70 publications in the PubMed database, comprising 45,118 total patients. Adherence reporting was present in 14 of 70 trials (20%); quantitative reporting was present in three of 70 trials (4%). Method of adherence assessment varied and included medication count, medication diaries and patient self-report. There was no association between adherence reporting and study quality or other study characteristics, although there was a trend towards increased reporting in breast cancer studies, with 46% of the studies reporting adherence (p = 0.0621). In a preliminary analysis, hematology studies (mean Jadad score 2.19 ± 1.47) were found to have significantly lower quality when compared to non-hematology trials (mean Jadad score 3.39 ± 1.37, p = 0.0034). Conclusion This systematic review demonstrates adherence reporting in clinical trials of oral anticancer agents is infrequent. When reported, adherence was not associated with overall study quality or other study characteristics. Given the potential effects of non-adherence on study power and validity, adherence reporting should be encouraged in oncology and hematology clinical trials. [ABSTRACT FROM AUTHOR]

The article describes the results of an investigation on a case of ocular and respiratory illness associated with an indoor swimming pool in Nebraska. It mentions that of 24 persons reporting illness, 20 had entered the immediate pool area and four had entered the courtyard only. The outbreak highlights the potential health risks from chemical exposure at improperly maintained pools and the need for properly trained pool operators to maintain water quality.

Patient safety is endangered by adverse events caused by human error and system design. The reasons are diverse: missing standards; organizational deficits; communication errors; time pressure. Systems ergonomics claims to optimize work systems enabling high quality (including safety) and efficiency. A systems ergonomics management concept is proposed, which is based on: (1) an interaction model (patient-staff-machine); (2) a medical task-model; (3) a recursive hierarchical task-process-task-model; 4) a strategic treatment management model. On three systems layers a patient treatment is analysed and optimized: macro-level (clinical pathways), meso-level (treatment modules), micro-level (standard operating procedures). According to the situation (patient's status and given resources), the treatment is compiled using standardized and navigated treatment components. [ABSTRACT FROM AUTHOR]

Patient safety is endangered by adverse events caused by human error and system design. The reasons are diverse: missing standards; organizational deficits; communication errors; time pressure. Systems ergonomics claims to optimize work systems enabling high quality (including safety) and efficiency. A systems ergonomics management concept is proposed, which is based on: (1) an interaction model (patient-staff-machine); (2) a medical task-model; (3) a recursive hierarchical task-process-task-model; 4) a strategic treatment management model. On three systems layers a patient treatment is analysed and optimized: macro-level (clinical pathways), meso-level (treatment modules), micro-level (standard operating procedures). According to the situation (patient's status and given resources), the treatment is compiled using standardized and navigated treatment components. [ABSTRACT FROM AUTHOR]

This article presents news from the U.S. Centers for Disease Control and Prevention (CDC). The report looks at eye and respiratory illnesses associated with one indoor swimming pool in Nebraska in 2006. A child in that state was hospitalized in intensive care for severe chemical epiglottitis and laryngotracheobronchitis after swimming in a motel swimming pool. The pool was inspected the same day and closed for health code violations. An investigation found that 24 people became ill from swimming in that one pool and it is likely their illnesses resulted from toxic levels of chloramines that had accumulated in the air in the enclosed area.