Self-Management in Persons with Limb Loss: A Systematic Review

BACKGROUND

Self-management is an integral component of managing long-term conditions and diseases. For a person with limb loss, this self-management process involves caring for the residual limb, the prosthesis, and the prosthetic socket-residual limb interface. Failure to properly self-manage can result in unwanted secondary complications such as skin breakdown, falls, or non-use of the prosthesis. However, there is little evidence on what self-management interventions are effective at preventing secondary complications. To understand the impact of self-management after the loss of a limb, it is necessary to determine what the current evidence base supports.

OBJECTIVES

The purpose of this study is to examine the available literature on self-management interventions and/or outcomes for persons with limb loss and describe how it may impact residual limb health or prosthesis use.

METHODOLOGY

A systematic review of multiple databases was carried out using a variety of search terms associated with self-management. The results were reviewed and selected based on the inclusion criteria: self-management interventions or direct outcomes related to self-management, which includes the skin integrity of the residual limb, problem-solving the fit of the prosthesis, and education in the prevention of secondary complications associated with prosthesis use. The Cincinnati Childrens' LEGEND (Let Evidence Guide Every New Decision) appraisal forms were used to analyze the articles and assign grades.

FINDINGS

Out of the 40 articles identified for possible inclusion in this study, 33 were excluded resulting in seven articles being selected for this review. Three out of the seven articles focused on silicone liner management while the other four articles focused on skin issues.

CONCLUSIONS

Self-management for a person with limb loss is a key component of preventing complications associated with loss of limb and prosthesis use. There is a lack of high-quality experimental studies exploring the most appropriate intervention for teaching self-management when compared to other conditions, specifically diabetes. Further research in the area of self-management is necessary to understand how to best prevent unwanted secondary complications.

Behavioral and endocrine responses to season and social dynamics of captive male southern hairy-nosed wombats (Lasiorhinus latifrons)

Although southern hairy-nosed wombats (SHN wombats; Lasiorhinus latifrons) rarely breed in captivity, further knowledge of their reproductive physiology and behavior is likely to improve their breeding potential. This study examined the effect of seasonal variation and changes in social dynamics on the physiology and behavior of a captive population of male SHN wombats (n = 6). Seasonal changes in urinary testosterone metabolites (UTM), urinary cortisol metabolites (UCM), qualitative estimates of spermatorrhoea (QS), aggressive behavior and reproductive behavior were measured over an 11-month period. While there was no effect of month on QS (GLM ANOVA, P = 0.27), reproductive behavior (GLM ANOVA, P = 0.19) or aggressive behavior (Tukey pairwise comparisons), the secretion of UTM (GLM ANOVA, P = 0.051) was only marginally affected by season, compared to that reported for wild male SHN wombats. Mean UCM concentrations of July and August 2016 were significantly higher than those between October 2015 and January 2016 (Tukey pairwise comparisons). To examine social dynamics, two trials of animal positioning exchange with the enclosure system were implemented and behavioral data were examined for each trial over a six week period; UTM, UCM and general behaviors (n = 27) were measured for each trial. Neither UTM nor UCM concentration varied significantly (P ≥ 0.45) before and after the exchanges. "Scratching" decreased at the group level following the animal exchange in both trials, suggesting reduction in self-grooming may be a behavioral response to novel stimuli. UCM and UTM concentrations were both positively correlated with "standing still" and "body rub" behaviors. This may be evidence of a hormonal control of a "freezing behavioral response" to external stimuli and marking behavior, respectively. As there was no evidence that changing the social dynamics affected reproductive or agonistic behavior or hormone concentrations, it was concluded that captive male wombats in this study showed reduced reproductive seasonality compared to wild wombats and that animal exchange resulted in a behavioral response to novel stimuli but was not sufficient to affect testosterone or cortisol secretion, within the context of our study.

Long-term measurement of body temperature in the southern hairy-nosed wombat (Lasiorhinus latifrons)

The southern hairy-nosed wombat (Lasiorhinus latifrons) is a nocturnal, fossorial marsupial that has evolved a range of physiological and behavioural adaptations to its semiarid environment. This study describes long-term core body temperature (Tb) of L. latifrons in a population with opportunities for behavioural thermoregulation through burrow use. Tb was measured hourly in 12 captive L. latifrons using implanted dataloggers over a 9-month period from late winter to late autumn. Data were examined for daily patterns, seasonal changes, sex differences and the relationship with environmental conditions (ambient temperature, den temperature and relative humidity). Tb ranged from 30.9 to 38.8°C, and had a distinct nychthemeral rhythm, with peak temperatures occurring at night in line with nocturnal activity. Females had a higher mean Tb (34.9°C) than males (34.4°C). The relationship between external ambient temperature and body temperature was negative, with body temperature decreasing as ambient temperature increased. This study is an important step towards a comprehensive picture of thermoregulation in L. latifrons, which may become vulnerable in the future if environmental temperatures rise and water availability decreases.

Use of the gonadotrophin-releasing hormone antagonist azaline B to control the oestrous cycle in the koala (Phascolarctos cinereus)

The present study examined the effectiveness of the gonadotrophin-releasing hormone (GnRH) antagonist azaline B to suppress plasma LH and 17β-oestradiol concentrations in koalas and its potential application for oestrous synchronisation. In Experiment 1, single subcutaneous injections of azaline B successfully blocked the LH response to exogenous mammalian (m) GnRH in a dose-dependent manner; specifically, 0 mg (n = 4) did not suppress the LH response, 1 mg azaline B (n = 6) suppressed the LH response for 24 h (P < 0.05), 3.3 mg azaline B (n = 8) suppressed the LH response significantly in all animals only for 3 h (P < 0.05), although in half the animals LH remained suppressed for up to 3 days, and 10 mg azaline B (n = 4) suppressed the LH response for 7 days (P < 0.05). In Experiment 2, daily 1 mg, s.c., injections of azaline B over a 10-day period during seasonal anoestrus (June-July; n = 6) suppressed (P < 0.01) the LH response to mGnRH consecutively over the 10-day treatment period and, 4 days after cessation of treatment, the LH response had not recovered. Experiment 3 was designed to test the efficacy of daily 1 mg, s.c., azaline B over 10 days to suppress plasma LH and 17β-oestradiol concentrations and ultimately synchronise timed return to oestrus during the breeding season. Although azaline B treatment did not suppress basal LH or 17β-oestradiol, oestrus was delayed in all treated females by 24.2 days, but with high variability (range 9-39 days). Overall, the present study demonstrates that the GnRH antagonist azaline B is able to inhibit the LH response in koalas to exogenous mGnRH and successfully delay the return to oestrus. However, although azaline B clearly disrupts folliculogenesis, it has not been able to effectively synchronise return to oestrus in the koala.

The use of a synthetic progesterone, levonorgestrel (LNG), to control the oestrous cycle in the koala

This study investigated the efficacy of a synthetic progestogen, levonorgestrel (LNG), to control koala ovarian activity for the purposes of oestrous synchronisation. Captive koalas were administered either saline control or a 70-mg LNG implant on Day 2 of oestrus. Urogenital cytology, oestrous behaviour and plasma oestradiol-17β and LH concentrations were monitored over a 6-week period. After LNG implant removal females were monitored to determine if the return to oestrus was synchronised. LNG-treated koalas immediately ceased displaying oestrous behaviour, showed no evidence of cornified epithelial cells in smears of urogenital cytology and exhibited low plasma oestradiol-17β concentrations throughout the implantation period. In contrast, oestradiol-17β levels in control koalas showed evidence of continued cyclic activity associated with behavioural oestrus and increased cornified epithelial cells in urogenital smears on Days 33 to 35 after saline injection. After implant removal, LNG-treated koalas exhibited oestrus at 13, 14, 17 and 30 days after implant removal. Plasma LH concentrations varied throughout the study period with no significant time (P = 0.49) or treatment (P = 0.13) effect. Overall results from this study suggest that LNG implants in koalas can inhibit oestrous behaviour and reduce circulating oestradiol-17β levels before oestrus, most likely by preventing development of the pre-ovulatory follicle. However, there was no evidence of LH suppression by the LNG implants. Removal of LNG implants resulted in the synchronous return to oestrus in three of the four treated koalas. Further studies on a larger population are required to validate these findings.

Seasonal oestrous cycle activity of captive female koalas in south-east Queensland

This study investigated the seasonality of behavioural oestrus in a captive koala population in south-east Queensland. A total of 33 sexually mature koalas were examined over a 4-year period (2009–12) to determine the possible influence of temperature, photoperiod and rainfall on the incidence of expression of behavioural oestrus without the confounding effect of lactation or limiting food resource availability. Although signs of behavioural oestrus were detected throughout the year, an obvious seasonality was apparent, with significantly fewer females displaying behavioural oestrus in late autumn and winter (May–August) than September to April (P < 0.0001). While average monthly photoperiod (P < 0.0001) and average monthly temperature (P < 0.0001) were significantly related to oestrous behaviour, rainfall was not (P > 0.05). A better understanding of the seasonality of reproductive function in the female koala will facilitate the use of reproductive management-assisted breeding technology to enable improved genetic management in captive populations.

Comparison of the measurement of heart rate in adult free-range chickens (Gallus domesticus) by auscultation and electrocardiography

OBJECTIVE

To compare the heart rates of adult free-range chickens (Gallus domesticus) measured by auscultation with a stethoscope with those measured simultaneously using electrocardiography (ECG).

METHODS

With each bird in a standing position, estimation of the heart rate was performed by placing a mark on paper for every 4 beats for roosters and 8 beats for hens as detected by auscultation over 30 s, while simultaneous ECG was performed.

RESULTS

Heart rates measured by auscultation showed a high correlation (r = 0.97) with those measured by ECG.

CONCLUSION

There was a high correlation between the heart rates of adult free-range chickens measured by auscultation with a stethoscope and those measured simultaneously using ECG.

Improving technical information use: what can be learnt from a manager's perspective?

Conservation practice reportedly suffers from low use of technical information. Understanding of factors that affect the influence of technical information on management decision-making is limited. We sought to identify leverage points for improved technical information dissemination in the New South Wales Parks and Wildlife Service, Australia, given the significant recent investments in monitoring and evaluation that had been made. We did so by exploring the inter-relationships between factors affecting the influence of different information types on management decisions. Results indicate that managers have a high inclination toward adaptive behavior, given they operate in an information poor environment. The most influential types of information were those that enabled interaction between information provider and recipient (e.g., staff experience and expertise). An analysis of the concordance in individuals' responses for different information types showed that neither accessibility nor organizational expectation of use was aligned with influence on decision-making. Alignment of responses also varied by work area. Raising expectations of information use or increasing access to particular types of information is therefore unlikely to result in an increase in influence on management decision-making. Rather than focussing on matching accessibility and expected use of particular information types, our results indicate that technical information uptake is best supported through existing peer networks tailored to specific work areas.

Effect of shade on body temperature and performance of feedlot steers

A 120-d feedlot study using 164 Angus steers (BW = 396.7 ± 7.0 kg) was undertaken in Queensland Australia (24°84' S, 149°78' N) to determine the effect of shade on body temperature (T(B)) and performance. Cattle were allocated to 20 pens: 16 with an area of 144 m(2) (8 steers/pen) and 4 with an area of 168 m(2) (9 steers/pen). Treatments (10 pens/treatment) were unshaded (NS) vs. shaded (SH). Shade (3.3 m(2)/steer) was provided by 80% solar block shade cloth. Before the study (d -31), 63 steers were implanted (between the internal abdominal muscle and the peritoneum at the right side flank) with a T(B) transmitter. Within each pen, 3 steers had a T(B) transmitter. Individual T(B) was obtained every 30 min. The cattle were fed a feedlot diet and had ad libitum access to water. Water usage and DMI were recorded daily on a pen basis. Average daily gain and G:F were calculated on a pen basis. Climatic variables were obtained from an on-site weather station every 30 min. Individual panting scores (PS) were obtained daily at 0600, 1200, and 1600 h. From these, mean PS (MPS) were calculated for each pen. At slaughter (d 121), individual HCW, loin muscle area (LMA), rump fat depth (P8), 12th-rib fat depth, and marbling score were obtained. Mean T(B) was not affected (P > 0.05) by treatment (SH = 39.58°C; NS = 39.60°C). However, during a 21-d heat wave when cattle were exposed to a mean ambient temperature (T(AM)) > 30°C for 8 h each d (T(AM) between 0800 and 1800 h = 29.7°C, and 23.4°C between 1830 and 0730 h), the T(B) of SH steers (40.41 ± 0.10°C) was less (P < 0.01) than the T(B) of NS steers (41.14 ± 0.10°C). During this period, pen-MPS were greater (P < 0.05) for the NS cattle at all observation times. Over the first 6 d of the heat wave, MPS of NS steers at 1200 h was 2.47 (P < 0.01) vs. 1.39 for SH steers. Hip height, DMI, ADG, and G:F were greater (P < 0.05) for SH cattle. Exit BW (final BW) of SH steers (596.1 kg) was greater (P < 0.05) when compared with NS steers (578.6 kg). During the heat wave, DMI was 51% less for NS steers and 39% less for SH steers when compared with the pre-heat wave period (P < 0.01). The HCW of SH steers (315.4 ± 0.8 kg) was greater (P < 0.05) than for NS steers (321.4 ± 0.8 kg). No treatment differences (P > 0.05) were found for LMA, P8, or marbling score. Access to shade improved (P < 0.05) ADG and G:F, increased HCW, and decreased MPS; however, shade did not completely eliminate the impact of high heat load.

Anthropometric measurements of the scapula, humerus, radius and ulna in Labrador dogs with and without elbow dysplasia

OBJECTIVE

To determine if anthropometric measurements of the Labrador scapula, humerus, ulna and radius, or their ratios, are related to the presence of elbow dysplasia (ED).

METHODS

Digital calliper measurements of the lengths of the left scapula, humerus, radius and ulna, and their ratios, were analysed by gender in 103 volunteer Labradors (41 dogs, 62 bitches) against the ED radiological scores derived by the International Elbow Working Group (IEWG). The IEWG score is an umbrella score used to classify for ED and includes fragmented coronoid process, osteochondritis dessicans, incongruity and ununited anconeal process, the last of which occurs rarely in Labradors.

RESULTS

Of the 103 Labradors studied, 31 were diagnosed radiographically with ED (20 bitches (32%), 11 (27%) dogs). Scapula length was significantly shorter for bitches with ED (P = 0.02), but not for dogs with ED. However, dogs showed a trend for a difference in the ulna:radius ratio (P = 0.06), which bitches did not. Although a greater percentage of bitches than dogs had ED in this study, the difference was not statistically significant.

CONCLUSIONS

Labrador bitches diagnosed with ED have a shorter scapula, which is a new finding associated with this condition. The difference in presentation associated with gender is unexpected and further research is recommended.

A new heat load index for feedlot cattle1

The ability to predict the effects of extreme climatic variables on livestock is important in terms of welfare and performance. An index combining temperature and humidity (THI) has been used for more than 4 decades to assess heat stress in cattle. However, the THI does not include important climatic variables such as solar load and wind speed (WS, m/s). Likewise, it does not include management factors (the effect of shade) or animal factors (genotype differences). Over 8 summers, a total of 11,669 Bos taurus steers, 2,344 B. taurus crossbred steers, 2,142 B. taurus x Bos indicus steers, and 1,595 B. indicus steers were used to develop and test a heat load index (HLI) for feedlot cattle. A new HLI incorporating black globe (BG) temperature ( degrees C), relative humidity (RH, decimal form), and WS was initially developed by using the panting score (PS) of 2,490 Angus steers. The HLI consists of 2 parts based on a BG temperature threshold of 25 degrees C: HLI(BG>25) = 8.62 + (0.38 x RH) + (1.55 x BG) - (0.5 x WS) + e((2.4-WS)), and HLI(BG<25) = 10.66 + (0.28 x RH) + (1.3 x BG) - WS, where e is the base of the natural logarithm. A threshold HLI above which cattle of different genotypes gain body heat was developed for 7 genotypes. The threshold for unshaded black B. taurus steers was 86, and for unshaded B. indicus (100%) the threshold was 96. Threshold adjustments were developed for factors such as coat color, health status, access to shade, drinking water temperature, and manure management. Upward and downward adjustments are possible; upward adjustments occur when cattle have access to shade (+3 to +7) and downward adjustments occur when cattle are showing clinical signs of disease (-5). A related measure, the accumulated heat load (AHL) model, also was developed after the development of the HLI. The AHL is a measure of the animal's heat load balance and is determined by the duration of exposure above the threshold HLI. The THI and THI-hours (hours above a THI threshold) were compared with the HLI and AHL. The relationships between tympanic temperature and the average HLI and THI for the previous 24 h were R(2) = 0.67, P < 0.001, and R(2) = 0.26, P < 0.001, respectively. The R(2) for the relationships between HLI or AHL and PS were positive (0.93 and 0.92 for HLI and AHL, respectively, P < 0.001). The R(2) for the relationship between THI and PS was 0.61 (P < 0.001), and for THI-hours was 0.37 (P < 0.001). The HLI and the AHL were successful in predicting PS responses of different cattle genotypes during periods of high heat load.

An investigation into the similarities and differences governing the cryopreservation success of koala (Phascolarctos cinereus: goldfuss) and common wombat (Vombatus ursinus: shaw) spermatozoa

The aim of this study was to determine the relative cryopreservation success of koala and wombat spermatozoa and to investigate reasons for their respective post-thaw survival by examining the sperm's response to a range of osmotic media and determining the presence and distribution of F-actin. An hypothesis was proposed that F-actin may be imparting a degree of structural inflexibility to the koala sperm plasma membrane; hence, exposure of spermatozoa to cytochalasin D (5 microM), a F-actin depolymerisation agent, should result in increased plasticisation of the membrane and greater tolerance of cell volume changes that typically occur during cryopreservation. In experiment 1, koala (n = 4) and wombat (n = 4) spermatozoa packaged in 0.25 mL straws were cryopreserved using two freezing rates (fast-3 cm above liquid N2 interface; slow-6 degrees C/min in a freezing chamber) and two glycerol concentrations (8 and 14% v/v) in a tris-citrate glucose buffer with 15% (v/v) egg yolk. Wombat spermatozoa showed better (P < 0.01) post-thaw survival (% motile, % intact plasma membranes, % decondensed sperm heads) than koala spermatozoa. When exposed to media of varying osmolality, koala spermatozoa were less tolerant (% intact plasma membrane) of hyper-osmotic conditions (920 and 1410 mOsmol/kg) than wombat spermatozoa. F-actin was localised using a monoclonal antibody but only found in the wombat sperm head. When koala and wombat spermatozoa were exposed to media of varying osmolality, cytochalasin D had no beneficial effect on sperm survival (% intact plasma membranes). This study has demonstrated that wombat spermatozoa are highly tolerant of cryopreservation when compared to koala sperm but that spermatozoa from both species show greatest post-thaw survival when frozen slowly in 14% glycerol. Koala sperm are also particularly susceptible to hyper-osmotic environments but lack of detectable F-actin in the koala spermatozoan suggests that poor cryopreservation success in this species is unlikely to be associated with F-actin induced plasma membrane inflexibility.