Shiga Toxin–Producing E. coli Infections Associated with Flour

Review Questions:

1. Is the report from a credible source? Examples: From which journal was the summary obtained? Did the summary go through peer review? Who are the typical readers of information from this source?
2. How might the background of the authors have influenced the focus, content, and perspectives contained in the summary? Examples: What disciplines are represented? Who the authors employed by? 
3. Was the relevance/importance of the problem being addressed clearly identified? In an era of information overload, what information could be gleaned from this outbreak report that might be useful to a busy food safety professional?
4. Were the scope of the human illness outbreak and relevant contextual issues clearly identified? Examples: timeframe, geographic extent, population(s) at risk (summaries of demographic information), severity of illnesses
5. Please describe the methods investigators used

1. How was the outbreak detected? Examples: laboratory based vs. complaint-based surveillance
2. What was the case definition?
3. Was the investigation hypothesis clearly identified? Examples: hypothesis generation and testing
4. What were the investigation methods used by each of the core disciplines?

1. Epidemiology – Examples: analytic study design (case control, cohort, or other
2. Laboratory – Examples: contribution of testing of clinical, food, and environmental samples contribute to the investigation
3. Food supply / Environmental Health Examples: product tracing investigation, environmental assessment/root cause investigation, environmental sampling

e. Where control measures clearly identified? Examples: immediate controls to stop the current outbreak and longer term controls to prevent recurrence

 6.      What were the strengths and limitations of each discipline’s contributions to this investigation? Examples: What information or evidence gathered by investigators was most clear and convincing? Where were their gaps? To what extent did evidence from one discipline complement or fill in a gap in evidence from another discipline?  

1. 1. Epidemiology
   2. Laboratory
   3. Food Supply / Environmental Health   

 7. Why was the source of contamination not identified? Example: What factor(s) might have limited the investigation team’s ability to identify where and how Shiga toxin–producing Escherichia coli (STEC) entered the flour mill or its supply chain?

 8. Do the authors make specific recommendations regarding what actions the food industry should take to prevent future flour-associated outbreaks? Example: Why do you think this was so?

9. Are the paper’s conclusions adequately supported by the cited references?  Example: To what extent do the cited references appear to be relevant and from credible sources? What where the top 1-3 references from the reference list that you were most interested in reviewing to learn more about this topic?

 10. Please identify 1-3 points in the investigation where you think the investigation team used critical thinking skills (i.e., they demonstrated effective and timely analysis, evaluation, management, and/or communication with appropriate stakeholders identify objective indicators of problem situations that the investigation team ran into. Consider alternative options investigators could have pursued to address these problems. Clearly communicate why you thought these points demonstrated use of critical thinking skills.