Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi

INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).

METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.

RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.

CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol.

BACKGROUND:
Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50% of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice.
METHODS:
Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4.
DISCUSSION:
The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting.

Waste Not, Want Not: Managing Perishables in Small and Medium Retail Enterprises

Purpose of this paper:
Recent literature indicates that around one third of perishable products finish as waste (Mena et al., 2014): 60% of this waste can be classified as avoidable (EC, 2010) suggesting logistics and operational inefficiencies along the supply chain. In developed countries perishable products are predominantly wasted in wholesale and retail (Gustavsson et al., 2011) due to customer demand uncertainty the errors and delays in the supply chain (Fernie and Sparks, 2014). While research on logistics of large retail supply chains is well documented, research on retail small and medium enterprises’ (SMEs) capabilities to prevent and manage waste of perishable products is in its infancy (c.f. Ellegaard, 2008) and needs further exploration. In our study, we investigate the retail logistics practice of small food retailers, the factors that contribute to perishable products waste and the barriers and opportunities of SMEs in retail logistics to preserve product quality and participate in reverse logistics flows.

Design/methodology/approach:
As research on waste of perishable products for SMEs is scattered, we focus on identifying key variables that contribute to the creation of avoidable waste. Secondly we identify patterns of waste creation at the retail level and its possibilities for value added recovery. We use explorative case studies (Eisenhardt, 1989) and compare four SMEs and one large retailer that operate in a developed market. To get insights into specificities of SMEs that affect retail logistics practice, we select two types of food retailers: specialised (e.g. greengrocers and bakers) and general (e.g. convenience store that sells perishable products as a part of the assortment)

Findings:
Our preliminary findings indicate that there is a difference between large retailers and SME retailers in factors that contribute to the waste creation, as well as opportunities for value added recovery of products. While more factors appear to affect waste creation and management at large retailers, a small number of specific factors appears to affect SMEs. Similarly, large retailers utilise a range of practices to reduce risks of product perishability and short shelf life, manage demand, and manage reverse logistics practices. Retail SMEs on the other hand have limited options to address waste creation and value added recovery. However, our findings show that specialist SMEs could successfully minimize waste and even create possibilities for value added recovery of perishable products. Data indicates that business orientation of the SME, the buyersupplier relationship, and an extent of adoption of lean principles in retail coupled with SME resources, product specific regulations and support from local authorities for waste management or partnerships with other organizations determine extent of successful preservation of a product quality and value added recovery.

Value:
Our contribution to the SCM academic literature is threefold: first, we identify major factors that contribute to the generation waste of perishable products in retail environment; second, we identify possibilities for value added recovery for perishable products and third, we present opportunities and challenges for SME retailers to manage or participate in activities of value added recovery. Our findings contribute to theory by filling a gap in the literature that considers product quality preservation and value added recovery in the context of retail logistics and SMEs.

Research limitations/implications:
Our findings are limited to insights from five case studies of retail companies that operate within a developed market. To improve on generalisability, we intend to increase the number of cases and include data obtained from the suppliers and organizations involved in reverse logistics flows (e.g. local authorities, charities, etc.).

Practical implications:
With this paper, we contribute to the improvement of retail logistics and operations in SMEs which constitute over 99% of business activities in UK (Rhodes, 2015). Our findings will help retail managers and owners to better understand the possibilities for value added recovery, investigate a range of logistics and retail strategies suitable for the specificities of SME environment and, ultimately, improve their profitability and sustainability.

STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies

Incomplete reporting has been identified as a major source of avoidable waste in biomedical research.
Essential information is often not provided in study reports, impeding the identification, critical
appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy
studies, the Standards for Reporting Diagnostic Accuracy (STARD) statement was developed. Here
we present STARD 2015, an updated list of 30 essential items that should be included in every
report of a diagnostic accuracy study. This update incorporates recent evidence about sources of
bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such,
STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy
studies.