Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Given the current storage age distribution of available RBC inventory, use of a SOC arm in future studies is unlikely to result in a large exposure to "old" blood. It is feasible to randomize patients to "younger" RBCs (3-11 days) but design strategies are needed to provide "intermediate-aged" or "old" blood as a comparator.

Background While the detrimental effects of smoking among HIV positive patients have been well documented, there is a paucity of data regarding cigarette smoking prevalence among these patients in South Africa. Objectives To establish the frequency, demographics, and knowledge of harmful effects and of smoking cessation strategies among HIV-positive patients in Johannesburg, South Africa. Methods A prospective cross-sectional survey, using a structured questionnaire interview, of HIV-positive patients attending the HIV Clinic at the Charlotte Maxeke Johannesburg Academic Hospital between 1 July 2011 and 31 October 2011. Results Of 207 HIV positive patients attending an ARV roll-out clinic, 31 (15%) were current smokers (23% of the males and 7.5% of the females) and a further 45 (21.7%) were ex-smokers. Most of the current smokers (30/31 patients) indicated their wish to quit smoking, and among the group as a whole most patients were aware of the general (82.5%) and HIV-related (77.8%) risks of smoking and of methods of quitting smoking. Despite this, however, most (61.8%) were not aware of whom they could approach for assistance and advice. Conclusions Given the relatively high prevalence of current and ex-smokers amongst HIV positive patients there is a need for the introduction of smoking cessation strategies and assistance at HIV-rollout clinics in South Africa.

The objective of this study was to evaluate the performance of a low-cost method, the thin layer agar (TLA) method, for the diagnosis of smear-negative patients. This prospective study was performed in Homa Bay District Hospital in Kenya. Out of 1,584 smear-negative sputum samples, 212 (13.5%) were positive by culture in Löwenstein-Jensen medium (LJ) and 220 (14%) were positive by the TLA method. The sensitivities of LJ and TLA were 71% and 74%, respectively. TLA could become an affordable method for the diagnosis of smearnegative tuberculosis in resource-limited settings, with results available within 2 weeks.The prevalence of smear-negative pulmonary tuberculosis (TB) has been increasing in countries with a high incidence of human immunodeficiency virus (HIV), especially in low-income countries where many patients are coinfected with HIV and TB and where culture of Mycobacterium tuberculosis is often not available (3,4,5,6,13,15). The incidence of TB in Kenya is estimated at 384/100,000 inhabitants (23). Kenya ranks 13th on the World Health Organization list of 22 highburden countries for TB worldwide, and HIV prevalence in new TB cases is estimated at 52% (23). Culture is more sensitive than smear microscopy (1, 3, 7), but cultivation in Löwenstein-Jensen (LJ) medium is very slow. The thin layer agar (TLA) method has been described as a simple, rapid, and inexpensive method (11,12,18) allowing initial identification of M. tuberculosis based on colony morphology, visualized microscopically, and by incorporation of para-nitrobenzoic acid (PNB) in the medium (10,17,19). We performed a prospective study to evaluate the performance of the TLA method for detection of M. tuberculosis in smear-negative samples compared to cultivation in LJ medium.The study was conducted in Homa Bay District Hospital, Kenya. All smear-negative respiratory samples received between November 2007 and September 2008 from patients suspected of having TB were included. A total of 1,584 smearnegative samples were analyzed. Sputum was digested and decontaminated using the sodium hydroxide-N-acetyl-L-cysteine method (9). LJ cultures were examined twice weekly for up to 8 weeks (22). Cultures were considered positive for M. tuberculosis according to their morphological characteristics, positive acid-fast bacilli staining, and inhibition of growth by PNB on TLA (8). A culture was considered negative if no growth was observed after 8 weeks, and it was considered contaminated if there was growth but it was negative for acidfast bacilli. TLA plates were prepared as previously described (18) with small modifications. One hundred microliters of decontaminated sample was inoculated on a biplate petri dish of 100 mm by 15 mm (Becton Dickinson, Sparks, MD) containing 20 ml of 7H11 agar supplemented with 10% oleic acid-albumin-dextrose-catalase (Becton Dickinson) plus piperacillin, trimethoprim, and amphotericin B (Sigma Aldrich) at 0.05 g/ ml, 0.02 g/ml, and 0.02 g/ml, respectively. PNB at 500 g/ml was incorporated in one compartment. The plates were se...