Injury profile of musicians in the Bloemfontein-based Free State symphony orchestra: a short report

Similar  to  professional  athletes,  musicians  are  required  to perform optimally.  Few  studies  have  been  conducted  to  clarify  the  nature of injuries associated with musicians. This study aimed to determine the types of injuries and their prevalence amongst the musicians of the Free State Symphony orchestra (FSSo), contributing factors, the musicians’ response to injury, and their perception of physiotherapy. Forty-five members of the FSSO participated in this descriptive study. Analysis of data included frequencies and percentages for categorical data and percentiles for continuous data. Thirty-eight (84.4%) participants reported injuries related to playing their instruments. Insufficient resting  periods  during playing  sessions  (70.3%),  continuing  to  play  while experiencing symptoms (63.2%) and performing the same movement repetitively (64.9%) were identified as the perceived risk factors in the development of symptoms.  Seventeen  (44.7%)  participants  indicated that they  did  nothing  to relieve their symptoms, while 34.2% sought physiotherapy treatment, 31.6% took medication to alleviate their symptoms and 31.6% reduced their playing hours. Majority of participants (75%) felt that their symptoms could be relieved by physiotherapy. Injuries amongst musicians result from a combination of factors such as posture, repetitive movements and fatigue. Possible physiotherapeutic intervention identified included educating musicians on the advantages of early management of injuries in extending their professional careers.

IRMER regulations: compliance rate of radiograph reporting by non-radiology clinicians

AIM

To assess compliance with regulation 7(8) of Ionizing Radiation Medical Exposure Regulations (IRMER) 2000 legislation amongst non-radiologists reporting radiographs in a large district general hospital.

MATERIALS AND METHODS

A prospective review of 100 consecutive radiography request cards from five different departments undertaking their specialty radiograph reporting were collected over 4 weeks. The requests were then traced to their respective case notes to assess documentation of radiographs. The five departments included chest, maxillo-facial, rheumatology, orthopaedics, and inpatients. Twenty-two case notes were gathered from chest clinics, 21 from maxillo-facial, 15 from rheumatology, 23 from orthopaedics fracture clinics, and 19 were taken from inpatients.

RESULTS

Only 53% of radiographs undertaken by non-radiologists had a documented report. The specialty most compliant with IRMER was orthopaedics 17/23 (74%) and the specialty least compliant was maxilla-facial 8/21 (38%). Of the documented radiographs, the consultant grade was the largest group of doctors [36% (19/53)] that undertook documentation, and for the undocumented radiographs, they were also the largest group of clinicians that did not document radiographs [77% (36/47)]. All radiographs that were documented in the notes also had documented interpretation of the radiograph.

CONCLUSION

Only 53% of plain radiographs were documented and reported by non-radiology clinicians even though IRMER legislation applies to all clinicians undertaking radiograph interpretation. All clinicians undertaking interpretation of radiographs should be made aware of this legislation and the responsibility to document their findings.

Are screen detected colorectal cancers asymptomatic?

OBJECTIVE

Colorectal cancer (CRC) screening aims to detect asymptomatic disease and thus provide the opportunity for early diagnosis and treatment. This study assesses the prevalence of significant symptoms in patients found to have CRC detected through the NHS National Bowel Cancer Screening Programme (NHS NBCSP) pilots.

METHOD

All patients in the NHS NBCSP pilots with a positive faecal occult blood completed a standardized symptomatology questionnaire before colonoscopy. This data was entered into the NHS BCS pilot database, data from the English arm has been analysed retrospectively.

RESULTS

There were 200 patients diagnosed with colorectal cancer. Of these, 28.5% were Dukes A, 35% Dukes B, 31% Dukes C1 and 5.5% Dukes C2. Some 81.5% reported experiencing GI symptoms. Symptoms considered significant included rectal bleeding, change in bowel habit, tenesmus and peri-anal discomfort, reported in 47.7%, 24%%, 36.5% and 15.5% of patients respectively. In addition to this, 27% reported urgency, 20.5% reported abdominal pain and 29% reported upper GI symptoms.

DISCUSSION

This data suggests a high prevalence of significant symptoms amongst patients with screening-detected CRC. It is possible that these patients would have presented via routine colorectal services if the awareness of symptoms of colorectal cancer were increased.

Vacancy clusters, dislocations and brown colouration in diamond

Following on from the idea that clusters of vacancies are the origin of the featureless absorption and brown colouration in natural diamond, dislocations are shown to exhibit sub-bandgap absorption also. The vacancy cluster idea has arisen from theoretical predictions of π-bonded chains reconstructing the cluster surfaces and has been confirmed by energy loss studies. In contrast, bandgap states at dislocations are observed in brown and colourless diamonds alike, giving rise to weak absorption, which resembles that theoretically predicted from shuffle dislocation segments. This, however, would not account for the degrees of brownness in the diamonds, but it suggests that if such shuffle segments exist, vacancies must have been present and moved to dislocations to create these configurations in the first place. The question arises, what happens to the vast number of vacancy clusters upon high pressure high temperature (HPHT) annealing, which renders the diamonds colourless. Our observations on natural brown diamonds after HPHT treatment suggest that vacancy clusters, trapped in the strain fields of dislocations, grow in size accompanied by a decrease in their numbers; this leads to much reduced optical absorption.

The uses of helium and xenon in current clinical practice

The noble gases have always been an enigma. Discovered late in the history of chemistry and in seemingly small quantities in our atmosphere, they are some of the most unreactive elements known. However, despite being extremely inert, the noble gases (helium, neon, argon, krypton, xenon and radon) have found diverse and ever expanding applications in medicine. Of all of them, the gases that have found the greatest number of uses in the field of anaesthesia and related specialties are helium and xenon. This review focuses on the history of the discovery of both gases, their unique physicochemical properties and describes their uses in clinical practice with particular emphasis on those applicable to anaesthesia.

The incidence of work-related low back pain among currently practicing physiotherapists in Bloemfontein

Physiotherapy practice involves the performance of strenuous physical activities related to the delivery of patient rehabilitation.  No evidence of studies relating to physiotherapy work-related low back pain (WRLBP) in South Africa could be found.  The aims of this study were to retrospectively investigate the incidence of work related low back pain among currently practicing physiotherapists in Bloemfontein, to determine the contributing risk factors, and to determine the responses of the physiotherapists to injury. Eighty four physiotherapists participated in this descriptive study. The results indicated that 67% of respondents had experienced work related low back pain and the 95% confidence interval for the incidence of WRLBP among physiotherapists in Bloemfontein is [56.8%; 76.6%].  Therapists performing cardio-thoracic related tasks had the most significant confidence interval of WRLBP [2.2%; 35.1%]. Fifty eight percent of respondents who had WRLBP reported that their symptoms were exacerbated by clinical practice.  The results of the study suggest that it is the nature of the job design which predisposes physiotherapists to injury and not a lack of kinetic handling knowledge. Further research is needed to develop methods to reduce the risks of WRLBP which are inherently part of physio-therapy practice.

Results from the ARTEMIS DISK Global Antifungal Surveillance Study: a 6.5-year analysis of susceptibilities of Candida and other yeast species to fluconazole and voriconazole by standardized disk diffusion testing

Fluconazole in vitro susceptibility test results for 140,767 yeasts were collected from 127 participating investigators in 39 countries from June 1997 through December 2003. Data were collected on 79,343 yeast isolates tested with voriconazole from 2001 through 2003. All investigators tested clinical yeast isolates by the CLSI (formerly NCCLS) M44-A disk diffusion method. Test plates were automatically read and results were recorded with the BIOMIC Vision Image Analysis System. Species, drug, zone diameter, susceptibility category, and quality control results were collected quarterly via e-mail for analysis. Duplicate (the same patient, same species, and same susceptible-resistant biotype profile during any 7-day period) and uncontrolled test results were not analyzed. The 10 most common species of yeasts all showed less resistance to voriconazole than to fluconazole. Candida krusei showed the largest difference, with over 70% resistance to fluconazole and less than 8% to voriconazole. All species of yeasts tested were more susceptible to voriconazole than to fluconazole, assuming proposed interpretive breakpoints of > or =17 mm (susceptible) and < or =13 mm (resistant) for voriconazole. MICs reported in this study were determined from the zone diameter in millimeters from the continuous agar gradient around each disk, which was calibrated with MICs determined from the standard CLSI M27-A2 broth dilution method by balanced-weight regression analysis. The results from this investigation demonstrate the broad spectrum of the azoles for most of the opportunistic yeast pathogens but also highlight several areas where resistance may be progressing and/or where previously rare species may be "emerging."

A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes

BACKGROUND & AIMS

Malnutrition is common in sick elderly people on admission to hospital and in the community. We conducted a randomised controlled trial to determine if nutritional supplementation after discharge from hospital improved nutritional status and functional outcomes, or reduced health-care costs.

METHODS

Elderly malnourished subjects were randomised to 8 weeks of supplementation or no supplementation post discharge, and followed up for 24 weeks. Weight, body mass index, anthropometrics, handgrip strength, quality of life and requirements for health-care professionals' services and social services were measured throughout the study.

RESULTS

Nutritional status improved significantly from baseline to week 24 in the intervention group (P<0.05), but not in the control group. There was no significant difference in nutritional status between groups at week 24. Handgrip strength improved significantly in the intervention group during supplementation, and was significantly different from that of the control group at week 8, but decreased thereafter. There was no significant difference in quality of life or health economic outcomes between groups at week 24.

CONCLUSIONS

In already malnourished elderly subjects, it may be too late to expect to improve function or quality of life or to reduce health-care costs simply by providing nutritional supplements after hospitalisation. Prevention is key. All elderly patients should be nutritionally assessed as part of their routine care, and appropriate intervention initiated early.

Polymerase chain reaction aids in the diagnosis of an unusual case of Aspergillus niger endocarditis in a patient with acute myeloid leukaemia

Endocarditis secondary to Aspergillus niger has not been described in a leukaemic patient. We describe a case of A. niger endocarditis in a patient with acute myeloid leukaemia and refractory fever. The microbiological cause of his endocarditis was initially misdiagnosed because he fulfilled the Duke criteria for enterococcal endocarditis. A polymerase chain reaction test utilizing pan-fungal primers detected a product from an Aspergillus sp. The DNA was subsequently sequenced and was found to have 100% homology with A. niger. A postmortem revealed fungal endocarditis secondary to disseminated aspergillosis, without evidence of bacterial endocarditis. The patient was found to have a lung aspergilloma that was possibly occupationally acquired, and may have been long standing.

Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen

Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were first published by the British Committee for Standards in Haematology in 1996. Key aspects of these guidelines related to anti-infective prophylaxis, immunisation schedules and treatment of proven or suspected infection. A recent review of the guidelines was undertaken, with a view to updating the recommendations where necessary The guideline review process did not reveal any major change in patient groups considered at risk. Occupational exposure to certain pathogens may, however, be a new risk factor for some infections. The recommendations for anti-infective prophylaxis remain unchanged. New recommendations for vaccination include the use of meningococcal group C vaccine in previously non-immunised hyposplenic patients and a need to consider the use of seven-valent pneumococcal vaccine. Recommendations for treatment of suspected or proven infection have not been significantly amended, but a local protocol should take into account relevant resistance patterns. There is an identified urgent need for further research into the effectiveness of varying vaccination strategies in the hyposplenic patient, and audit of infective episodes in this patient group should continue long term. Key guidelines are summarised below, together with grades of recommendation.

Rapid identification of methicillin-resistant Staphylococcus aureus from positive blood cultures by real-time fluorescence PCR

Methicillin-resistant Staphylococcus aureus septicemia is associated with significant morbidity and mortality and requires treatment with intravenous glycopeptides. For blood cultures positive for gram-positive cocci, 24 to 48 h is required for the detection of S. aureus bacteremia and the provision of antibiotic susceptibility testing results. We describe a molecular biology-based assay that requires 2 h from the time of initial positivity of blood cultures. The assay correctly detected 96% of the S. aureus isolates including all methicillin-resistant S. aureus isolates. Clinical data collected during the study suggest that 28% of patients with S. aureus bacteremia do not receive early and appropriate treatment and that 10% of patients may initially be receiving inappropriate glycopeptide treatment.

Ocular dangers of fencing wire

AIMS

To invesitgate the incidence and severity of penetrating eye injuries caused by fencing wire in the Waikato region.

METHODS

We reviewed the case notes for all penetrating eye injuries treated at Waikato Hospital during the past six years. Parameters recorded were patient age and sex, mechanism of injury, initial visual acuity, characteristics of injury, surgery performed and final visual outcome.

RESULTS

The incidence of penetrating eye injuries in the Waikato region was 3.8 per 100,000 per year, based on an estimated catchment population of 350,000. We found fencing wire to be the third most common cause of penetrating eye injury, accounting for 8.8% of injuries, behind motor vehicle accidents and hammering which accounted for 26.3% and 20.0% of injuries, respectively. The fencing wire injuries involved men exclusively, with an average age of 41.7 years. Fencing wire injuries had worse presenting visual acuity than other injuries, involved the posterior segment of the eye more frequently and were more likely to develop bacterial endophthalmitis. They also underwent more surgical procedures and were more commonly associated with a poor visual outcome.

CONCLUSIONS

Fencing wire is an important cause of visual loss in the Waikato region. We hope to raise awareness of its potential ocular dangers and to promote the use of appropriate eye protection.

Autosomal recessive hypercholesterolemia caused by mutations in a putative LDL receptor adaptor protein

Atherogenic low density lipoproteins are cleared from the circulation by hepatic low density lipoprotein receptors (LDLR). Two inherited forms of hypercholesterolemia result from loss of LDLR activity: autosomal dominant familial hypercholesterolemia (FH), caused by mutations in the LDLR gene, and autosomal recessive hypercholesterolemia (ARH), of unknown etiology. Here we map the ARH locus to an approximately 1-centimorgan interval on chromosome 1p35 and identify six mutations in a gene encoding a putative adaptor protein (ARH). ARH contains a phosphotyrosine binding (PTB) domain, which in other proteins binds NPXY motifs in the cytoplasmic tails of cell-surface receptors, including the LDLR. ARH appears to have a tissue-specific role in LDLR function, as it is required in liver but not in fibroblasts.