Quality Ratings of a Hospital Foodservice Department by Inpatients and Postdischarge Patients

Objectives To examine quality of food and nutrition services using the ratings of inpatients and patients who had been discharged (postdischarge patients).Design Questionnaires were used to collect perceptions of inpatients and postdischarge patients on the quality of food and nutrition services. A 5-point scale allowed subjects to rate quality from very poor to very good.Subjects Questionnaires were completed by 252 inpatients and 437 postdischarge patients of a midwestern teaching hospital.Statistical analysis Analysis of variance was used to assess differences in quality ratings on the basis of demographic variables. Stepwise regression was used to determine variables that best predicted overall satisfaction. Paired t tests were conducted to compare matched inpatient and postdischarge ratings.Results Ratings of food and nutrition services indicated that patients were satisfied; few differences were found in ratings on the basis of patient demographics. Food quality was the best predictor of overall satisfaction for both inpatients and postdischarge patients. As patient expectations were increasingly met or exceeded, patient ratings of quality increased. The majority of patients in the matched sample gave the same ratings on the inpatient and postdischarge questionnaires.Applications Foodservice managers who desire to improve patient satisfaction should focus attention on meeting or exceeding patient expectations for food quality. J Am Diet Assoc. 1998;98:1303–1307.     

An outbreak of Pneumocystis carinii pneumonia in children with malignancy

An outbreak of Pneumocystis carinii pneumonia (PCP) in three patients within a 6 week period was reported. Two patients had acute lymphoblastic leukaemia and one had brain-stem glioma. They shared common features of immuno-suppression and absence of cotrimoxazole prophylaxis and had been nursed in the same room. The severity of PCP and its response to treatment may be related to the degree of immunosuppression. Because of the morbidity and mortality of PCP, chemoprophylaxis should be given to all at-risk cases. Furthermore, isolation of patients with PCP should be considered in view of increasing evidence of nosocomial transmission.     

Neoplastic involvement of the sacroiliac joint: MR and CT features

The radiological findings in five patients with pelvic sort tissue neo plasms directly involving the sacroiliac joint, are described. All patients had Computed Tomography (CT) examinations, two of the patients also having Magnetic Resonance Imaging (MRI). The role of imaging in this uncommon entity is discussed as well as the importance of making this diagnosis, thereby excluding unilateral sacroiliitis. The therapeutic implications of this diagnosis relate to local neural involvement, especially the sciatic nerve, and the fact that involvement of the sacroiliac joint by tumors significantly compromises chances of a successful surgical outcome. The role of MR in this condition is not yet certain, but it may prove to be the method of choice in view of its excellent depiction of skeletal neo plasms.     

Serious complications associated with Dettol poisoning

Dettol is involved in 10percnt; of self-poisoning-related hospitaladmissions in Hong Kong. Although serious poisonings and evendeaths after ingesting this common household disinfectant havebeen reported, the frequency with which these complicationsmay occur is not known. In a retrospective study of 67 casesof Dettol poisoning, we found that serious complications wererelatively common (8%) and these included aspiration of Dettolwith gastric contents resulting in pneumonia, cardiopulmonaryarrest, bronchospasm, adult respiratory distress syndrome, andsevere laryngeal oedema with upper airways obstruction. It isparticularly important that the airways are adequately protectedbefore the patient is lavaged following Dettol poisoning, andthe immediate recognition of any upper airway obstruction requiringintubation will then be lifesaving.     

Expression of Haemophilus influenzae type b idiotype 1 on naturally acquired antibodies

The Chinese population in Hong Kong has a low incidence of invasive Haemophilus influenzae type b (Hib) disease, as well as carriage of the microorganism. Likely stimuli for the natural antibodies to Hib, which might protect against Hib infection, are cross-reactive antigens of bacteria like Escherichia coli K100. Our aim was to determine the isotype and idiotype distribution and cross-reactivity of natural antibodies against Hib capsular polysaccharide (CP) in healthy Hong Kong Chinese. Titration of 20 sera by ELISA showed IgG antibodies reacting with Hib CP in all individuals. The antibodies were mainly IgG2, and their avidity index ranged widely. Isoelectric focusing (IEF) combined with immunoblotting showed patterns of IgG2 antibody clones against the CP of Hib and E. coli K100 which were similar in 10 cases. Absorption with Hib CP only eliminated some bands in two sera. Absorption with K100 CP did not remove any anti-Hib CP bands. In three sera additional clones of antibodies reacting to K100 CP only, disappeared after absorption with this CP. Spectrotypic analyses of IgG antibodies reacting with anti-Hib idiotype 1 (Id-1) revealed stronger IEF patterns with bands in differing locations compared with anti-Hib CP antibodies. The strong reactivity of serum IgG, IgA and IgM antibodies with monoclonal anti-Hib Id-1 was confirmed by ELISA. This reactivity was not abolished after absorption of the sera with either Hib CP, or K100 CP. The data indicate a high prevalence of Id-1 among Hong Kong Chinese. However, only one individual had Id-1 antibodies specific for Hib CP, judging from absorption experiments. Others had much lower activity of Id-1 anti-Hib CP antibodies compared with the total IgG Id-1, suggesting that Hong Kong subjects have Id-1-positive antibodies in their serum which are not specific for Hib CP. This is consistent with the nature of Id-1, which is a marker of A2V_L region usage rather than a marker of a Hib CP paratope. We suggest that natural antibodies reacting with Hib CP in healthy Hong Kong Chinese are the product of exposure to some cross-reactive antigen(s), different from both Hib and E. coli K100 CP.     

PRIMARY NOCARDIAL MENINGITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Nocardia is an important but often overlooked opportunisticinfection agent in immunocompromised hosts. Nocardiosis is primarilypulmonary; central nervous system involvement, usually in theform of brain abscess, is less common. Primary nocardial meningitiswithout associated brain abscess and pulmonary lesion is extremelyrare and poses a formidable diagnostic challenge. We reporton a patient with systemic lupus erythematosus who presentedwith a clinical picture of chronic meningitis which failed torespond to empirical antibiotic treatment. She deterioriatedand succumbed. Post-mortem examination showed nocardial meningitiswithout associated brain abscesses. Nocardial meningitis shouldbe considered a differential diagnosis of subacute meningitisin immunocompromised hosts. KEY WORDS: Nocardia, Nocardiosis, Immunocompromised hosts