Dental knowledge of accident and emergency senior house officers

OBJECTIVES

To determine the dental knowledge of accident and emergency (A&E) senior house officers (SHOs).

METHOD

A telephone survey of A&E departments in England with more than 30 000 new attendances per year was conducted between November 1998 and July 1999. The questionnaire covered basic dental knowledge as well as scenarios of some common dental problems encountered in the A&E department.

RESULTS

Most SHOs in this study saw between one and five dental problems each week. Of the 102 SHOs in this survey, 52% had no previous training in examination of the mouth. Only 52% knew the approximate date of eruption of a permanent upper central incisor. In the treatment of post-extraction bleeding, 36% knew the first line of treatment. When presented with a scenario of a patient with a dental infection, only 29% gave the optimal empirical treatment.

CONCLUSIONS

There is a need for better dental education among medical personnel. Guidelines or algorithms for the management of some common dental problems would also be useful as well as standard written advice sheets for patients with dental problems.

Enduring effects of environmental enrichment on novelty seeking, saccharin and ethanol intake in two rat lines (RHA/Verh and RLA/Verh) differing in incentive-seeking behavior

The Roman high- and low-avoidance (RHA/Verh and RLA/Verh) rat lines represent, respectively, low emotional/anxious and high novelty seeker vs. high emotional/anxious and low novelty seeker profiles. In the present study, RLA/Verh and RHA/Verh rats, either reared in pairs from weaning (untreated) or reared in groups of 8-10 in an enriched environment until the age of 7 months, were tested for exploratory and novelty-seeking behavior in the hole board (including novel objects under the holes), as well as for their preference for saccharin-water and ethanol-water in a two-bottle free-choice paradigm. Testing started when rats were 20 months old in order to study the long-lasting effects of differential rearing. RHA/Verh rats explored more and showed greater preference for (and intake of) saccharin as well as for ethanol than RLA/Verh rats, thus confirming their validity as a rat model for sensation/reward seeking. Environmental enrichment (EE) increased head-dipping behavior (i.e., novelty seeking) in both rat lines, without affecting locomotor activity. EE treatment increased the preference for, and volume intake of, saccharin (especially at the higher concentrations tested) in the relatively low saccharin-preferring RLA/Verh rats, and also enhanced ethanol consumption in both rat lines. Thus, the results demonstrate consistent and enduring effects of EE on incentive-seeking behavior and further the analysis of how individual differential predispositions for the need of novelty and contact with (or consumption of) rewarding substances arise through either biological (genetic) or early environmental factors, or both.

A quantitative trait locus influencing anxiety in the laboratory rat

A critical test for a gene that influences susceptibility to fear in animals is that it should have a consistent pattern of effects across a broad range of conditioned and unconditioned models of anxiety. Despite many years of research, definitive evidence that genetic effects operate in this way is lacking. The limited behavioral test regimes so far used in genetic mapping experiments and the lack of suitable multivariate methodologies have made it impossible to determine whether the quantitative trait loci (QTL) detected to date specifically influence fear-related traits. Here we report the first multivariate analysis to explore the genetic architecture of rodent behavior in a battery of animal models of anxiety. We have mapped QTLs in an F2 intercross of two rat strains, the Roman high and low avoidance rats, that have been selectively bred for differential response to fear. Multivariate analyses show that one locus, on rat chromosome 5, influences behavior in different models of anxiety. The QTL influences two-way active avoidance, conditioned fear, elevated plus maze, and open field activity but not acoustic startle response or defecation in a novel environment. The direction of effects of the QTL alleles and a coincidence between the behavioral profiles of anxiolytic drug and genetic action are consistent with the QTL containing at least one gene with a pleiotropic action on fear responses. As the neural basis of fear is conserved across species, we suggest that the QTL may have relevance to trait anxiety in humans.

Rapid sequence induction in the emergency department: a strategy for failure

BACKGROUND

Rapid sequence induction (RSI) is increasingly used by emergency physicians in the emergency department. A feared complication of the technique is the inability to intubate and subsequently ventilate the patient. Current drills based on anaesthetic practice may be unsuitable for use in the emergency department.

OBJECTIVE

To construct a drill for failed adult intubation in the emergency department.

METHODS

Literature review and consensus knowledge.

RESULTS

A drill for failed adult intubation in the emergency department is given.

SUMMARY

Failure to intubate following RSI in the emergency department is a feared complication. Practitioners must have a predetermined course of action to cope with this event. The guidelines presented here are tailored for use by the emergency physician.

Learned fear, emotional reactivity and fear of heights: a factor analytic map from a large F(2) intercross of Roman rat strains

Anxiety-related behaviours were evaluated across various tests in a 800 F(2)-intercross of the Roman high- and low-avoidance inbred rats. These tests either evoke unlearned (open field [OF]; plus-maze [PM]; hole-board [HB]; spontaneous activity [A]; and acoustic startle reflex [ASR]) or learned (classical fear conditioning [CFC]; and shuttlebox avoidance conditioning [SAC]), anxious/fearful responses. Using factor analysis (oblique rotation), we obtained a six-fold solution with 14 variables derived from all tests. These six factors represented SAC, CFC, PM anxiety, PM and OF activity, ASR anxiety, plus a mixed whole of anxious and activity variables (from OF and A), respectively. In searching for a smaller number of meaningful factors, we applied a three-factor solution that coherently corresponded with differentiated facets of fearfulness, rather than with the tests. Results showed that (1) measures of SAC and CFC strongly loaded onto Factor 1, labelled as "Learned Fear"; (2) a blend of almost all variables loaded onto Factor 2, called "Emotional Reactivity"; and (3) open arm behaviour in the PM loaded onto Factor 3, called "Fear of Heights." After discussing limitations of this apparently consistent behavioural map of anxiety, we advance some connections between those factors with quantitative trait loci candidates (genetic markers) as detected in the same sample.

An observational survey of emergency department rapid sequence intubation

OBJECTIVES

To study the current practice of rapid sequence intubations (RSIs) in four different emergency medicine training programmes in the UK.

METHODS

Observational study design involving four regional training programmes (Wessex, North West, Yorkshire, Avon). Data were collected in real time using a previously piloted survey tool. Data were collected by specialist registrars in emergency medicine over a continuous 28 day period. Data collected included: indications for RSI; key timings of RSI procedures; details of RSI practitioner; complications and outcome of procedure.

RESULTS

Data from 60 RSIs were recorded and collected. The majority of decisions to perform RSIs were made by emergency physicians (74% cases). Over 50% of the RSIs occurred after 4 pm. Emergency physicians performed 26% of RSIs although the majority were performed by anaesthetists. Most of the given indications for RSIs were based on an assessment of airway protection. Hypoxia was an uncommon reason for RSI in this study (5%). In two thirds of cases the time taken from the decision being made to perform an RSI, to the achievement of successful intubation, was greater than 20 minutes. No failed intubations were recorded, although six other complications (all minor problems) were recorded. There was no significant difference in the response times between anaesthetists and emergency physicians.

CONCLUSIONS

This study shows that emergency physicians are currently performing RSIs in emergency departments in the UK. It also suggests improvements could be made to patient care. In particular, standards of care should be agreed for the provision of RSI in the emergency department, including the personnel involved and the appropriate training of individuals. RSI activity in emergency departments in the UK should be audited nationally using an agreed audit tool.

Transmembrane signaling through phospholipase C in cortical and hippocampal membranes of psychogenetically selected rat lines

RATIONALE

One of the major pathways for neurotransmitter signaling involves phosphoinositide-specific and G-protein-dependent phospholipase C-beta (PLC-beta), which stimulates the formation of inositol 1,4,5-trisphosphate and diacylglycerol. Serotonergic and muscarinic-cholinergic signals in the brain are largely mediated through the hydrolysis of phosphoinositides by PLC.

OBJECTIVES

The aim of the experiments reported here was to explore the potential differences in neurotransmitter receptor coupling to PLC in Roman high-avoidance (RHA)/Verh and Roman low-avoidance (RLA)/Verh rats, by examining the changes in agonist (carbachol, 5-methyltryptamine)-stimulated phosphoinositide hydrolysis in hippocampal and cortical membranes derived from the two rat lines.

METHODS

To investigate changes in receptor and G-protein coupling to PLC in the brains of these two psychogenetically selected rat lines, which differ in their emotional profiles/learning abilities, we examined GTPgammaS-, agonist (carbachol, 5-methyltryptamine)-, and calcium-stimulated phosphoinositide hydrolysis in cortical and hippocampal membranes of RHA/Verh and RLA/Verh rats.

RESULTS

The results indicated that calcium-induced increase in PLC activity was larger in the cortex and hippocampus of RHA/Ver rats, as compared to their RLA/Verh counterparts. Conversely, GTPgammaS- and agonist-induced PLC activity was less pronounced in the hippocampus of RHA/Verh with respect to RLA/Verh rats. Western blot analysis showed no significant differences in the relative values of the G-proteins alphaq/11 and betagamma subunits between both groups of rats in any brain region. However, the levels of PLC-beta1, PLC-beta3, and PLC-beta4 were significantly lower in the hippocampus of RHA/Verh than in RLA/Verh rats.

CONCLUSIONS

It is concluded that the hippocampus of RHA/Verh rats has severe deficiencies in PLC activity stimulated by guanine nucleotides and agonists, which are specifically related to a lower level of expression of the PLC-beta type isozymes, a fact that may account for the differential behavioral phenotype observed in these psychogenetically selected rat lines.