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In a breeding group of Inca terns (Larosterna inca), 14 birds died without antemortem signs of illness. Other than a poor body condition and a bloody cloaca, no symptoms were observed. Gross necropsy revealed severe segmental hemorrhagic enteritis with intralesional trematodes in most birds. Histopathologic examination revealed infiltration of lymphocytes, plasma cells, and granulocytes in the lamina propria of the duodenum and cross-sections of trematodes in the lumen. The parasites were identified as Ichthyocotylurus erraticus, a trematode of fish-eating birds. The cause of the infestation most likely was the feeding of unfrozen fresh fish. We describe the first case of a lethal I. erraticus infestation in Inca terns.

Objective: To analyze information and communication in the community pharmacy when patients collect a first dispensing for chronic medication., Methods: In 3 pharmacies in the South-West of the Netherlands, counter-based communication with patients receiving a first dispensing for chronic medication was observed and audiotaped. Each contact was analyzed by two observers using an observation checklist. An 11-item questionnaire was given to the patients., Results: 72 Patients were included. Only pharmacy technicians provided information. Average contact lasted approximately 2min. A computer checklist to support information giving was closely followed. Interactions were structured with introduction and closure. Mostly, information was given without exploring needs of the patient. Questioning showed open-ended questions (26%); check-questions and questions asking feedback (57%). A mean general score given was 5.8 (range 1-9). Of 46 responders who filled in a questionnaire, the majority felt that information was useful, clear and understandable., Conclusion: Our results show a concise and efficient way of information giving, closely related to a computer checklist. Technicians dominate the interaction. They ask few questions. Patients are satisfied about provided information and the contact., Practice Implications: We suggest a more patient-centered way of communication to increase patients' participation and to meet patients' needs for information., (Copyright © 2011. Published by Elsevier Ireland Ltd.)

Background: Lung function measurement in the general practice setting (GPS) is of growing importance. OBJECTIVE.:The aim of this study was to compare results from a lung function laboratory (LFL) with those in a GPS., Methods: Comparisons were made for decline calculated from GPS and LFL measurements and intra-individual paired measurements. Test characteristics of the spirometer used in the GPS were also assessed., Results: The mean decline in lung function was: -0.037 l/year [95% confidence interval (CI) -0.202 to 0.129] from LFL data and -0.027 l/year (95% CI -0.242 to 0.188) from GPS data. The mean intra-individual difference was -0.0025 l (95% CI -0.493 to 0.488 l). The test characteristics of the spirometer used in GPS did not meet all of the American Thoracic Society guidelines; in particular, the random error was too large. The difference in assessments between measurement in LFL and GPS were such that misclassification might occur if slopes were calculated. CONCLUSIONS. :Repeated measurement in this study showed that GPS measurements are not interchangeable with LFL measurements. Therefore, one has to be cautious when interchanging lung function data from an LFL and a GPS.