A large proportion of patients who die in hospital will be under the care of geriatric medicine. Mortality reviews have traditionally used trigger tools to try and identify preventable deaths, but the majority of hospital deaths are not preventable and lapses in care are often very complex. Over a period of 14 months we performed four PDSA cycles to change the focus of mortality meetings within care of the elderly and stroke medicine at Cumberland Infirmary to look beyond preventable deaths. The aim was to maximise learning from mortality meetings to improve patient care.We used collaborative working at a trust and departmental level, moving from trigger tool preparation to a narrative approach, and we set up strategies to focus and disseminate our learning. The mean number of cases discussed per meeting and the mean number of lessons identified per case discussed increased, as did the learning levels (trust, department, individual). Maintaining multidisciplinary input and consolidating lessons learnt was difficult because of clinical commitments and natural staff turnover.
SUMMARY A P-lactamase-producing strain of Neisseria gonorrhoeae with nutritional requirements for arginine, hypoxanthine, and uracil was isolated from the knee-joint fluid, the genital tract, and the sexual partner of a woman presenting with gonococcal arthritis.
Summary
In a study of pregnant patients with significant bacteriuria the colicine type of Escherichia coli recovered from two or more specimens of urine was constant for each patient. Faecal strains tested in the same way were of variable colicine type but detailed results on two patients were consistent with the existence of a constant and variable colicine type. The constant colicine type was the same as that found in the urine.
INFLUENZA IN DUNDEE BRITisH 913 MWICAL JOURNAL of cases the staphylococci were of the resistant type generally associated with hospitals. Second attacks of influenza within a period of seven weeks are reported. Attention is drawn to two cases of encephalitis which are possibly influenzal in origin. Measures for the treatment of influenzal pneumonia are discussed. A plea is made for further studies on the local epidemiology of influenzal pneumonia, especially from the point of view of the bacterial component. We wish to thank Professor W. J. Tulloch for facilities, and to express our gratitude to the nursing staff of King's Cross Hospital for their care of the patients and to Sister Alma Mitchell for her help in the collection of specimens for bacteriological examination. Dr. A. Isaacs very kindly typed the influenza strains submiitted to the World Influenza Centre of the World Health Organization, London. The antigens and convalescent positive sera used in the complement-fixation test were supplied by the Standards Laboratory for Serological Reagents, Colindale.
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