Teaching best practice in hand hygiene: student use and performance with a gamified gesture recognition system

The use of an automated gesture recognition system to teach the commonly adopted, seven-stage hand hygiene technique to veterinary undergraduate students was evaluated. The system features moderate gamification, intended to motivate the student to use the machine repeatedly. The system records each handwash stage, and those found to be difficult are identified and reported back. The gamification element alone was not sufficient to encourage repeated use of the machine, with only 13.6 per cent of 611 eligible students interacting with the machine on one or more occasion. Overall engagement remained low (mean sessions per user: 3.5, ±0.60 confidence interval), even following recruitment of infection control ambassadors who were given a specific remit to encourage engagement with the system. Compliance monitoring was introduced to explore how students used the system. Hand hygiene performance did not improve with repeated use. There was evidence that the stages-fingers interlaced, rotation of the thumb, rotation of the fingertips and rotation of the wrists-were more challenging for students to master (p=0.0197 to p<0.0001) than the back of the hand and of the fingers. Veterinary schools wishing to use such a system should consider adopting approaches that encourage peer buy-in, and highlight the ability to practise difficult stages of the technique.

Regional distribution of clomipramine and desmethylclomipramine in rat brain and peripheral organs on chronic clomipramine administration

The tricyclic antidepressant (TCA) clomipramine has been widely used in psychiatry for over 40 years. More recently, its therapeutic potential as an antineoplastic drug has been identified. However, there are no prior data on regional distribution in the brain of clomipramine and its primary metabolite (desmethylclomipramine) after chronic oral administration. The aim of this study was to determine the concentrations of clomipramine and desmethylclomipramine in different rat-brain regions and to compare those with levels in plasma and peripheral organs after chronic oral treatment of Sprague Dawley rats (15 mg/kg) for 14 days. The levels of both parent TCA and metabolite were analysed by high-performance liquid chromatography in six brain regions (cortex, hypothalamus, hippocampus, striatum, brainstem and cerebellum), five peripheral organs and in plasma. Our data show that the cerebral cortex had the highest concentration of clomipramine (2.9 microg/mg), with successively lower concentrations in the hypothalamus, striatum, cerebellum, hippocampus and brainstem. Of the peripheral organs, the lungs and liver, had the highest levels of clomipramine, while in the heart, only the metabolite was detected. The plasma concentration (0.17 microg/ml or 0.48 microM) was comparable to that in the hippocampus and cerebellum (approximately 0.20 microg/mg). The differential distribution of clomipramine in different brain regions and the regional variation in clomipramine to desmethylclomipramine ratios have implications for the use of clomipramine in psychiatry and neuro-oncology.

Skunk and psychosis in South East London

Background:

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

Hypothesis:

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

Methods:

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

Results:

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Conclusions:

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

Animal-handling teaching at the Royal (Dick) School of Veterinary Studies, University of Edinburgh

This article describes the teaching of animal handling at the Royal (Dick) School of Veterinary Studies, University of Edinburgh, as part of an animal husbandry course during the first two years of the veterinary curriculum. Basic methods of handling and restraint appropriate for the wide range of animal species that might be encountered in veterinary practice are demonstrated in practical handling classes. Students are given opportunities to practice the techniques under supervision. Additional handling experience is available during extramural studies in animal husbandry at a variety of establishments. Students are formally examined on their ability to handle and restrain animals, and each is required to reach a threshold degree of competence before progressing to the clinical years.

CYP2D6 polymorphisms in Alzheimer's disease, with and without extrapyramidal signs, showing no apolipoprotein E epsilon 4 effect modification

BACKGROUND

Allelic variation at the CYP2D6 gene has been reported to be associated with Parkinsons' disease (PD) and Lewy body dementia (LBD), but not with Alzheimer's disease (AD). AD has been associated with apolipoprotein E (apoE) epsilon 4 allele loading.

METHODS

We examined CYP2D6 and apoE polimorphisms in a sample of 259 patients with dementia, 210 of whom had a diagnosis of AD, and 107 healthy controls.

RESULTS

We found that the allelic frequency in our AD sample did not vary from that in the controls. The debrisoquine hydroxylase poor metabolize phenotype was not more prevalent among AD cases than among controls in contrast to that reported for PD and LBD. We also found that CYP2D6 status does not modify the risk effect for AD conferred by apoE epsilon 4 alleles.

CONCLUSIONS

These findings provide some support to the notion that, at a genetic level, at least at this locus, AD could be distinct from PD and LBD.

The pharmaco-economics of atypical antipsychotics

Atypical antipsychotics are claimed to show advantages in efficacy and tolerability when compared with older, typical drugs. However, the purchase cost of atypicals far exceeds that of typical drugs. Pharmaco-economic evaluations of the use of atypical agents are used, in essence, to determine whether or not the benefit gained by using atypicals is greater than the extra cost of their acquisition. Several forms of pharmaco-economic evaluation have been developed, but none provides definitive, unarguable findings. In psychiatry, the most commonly used method is the mirror-image technique, which retrospectively compares costs and outcomes before and after the use of a particular drug. Despite the large number of phamacoeconomic evaluations undertaken and published, the cost-effectiveness of atypical drugs remains unproven. Data relating to clozapine are the most compelling, but they remain ultimately equivocal. However, ethical considerations may prevent conclusive research being conducted. Some data support the cost-effectiveness of olanzapine and risperidone, but, again, the overall picture is far from clear. Little or nothing is known of the pharmaco-economics of other atypicals. Further research is needed before any atypical can be said to be cost-effective.

No effect of a dietary zinc proteinate on clinical mastitis, infection rate, recovery rate and somatic cell count in dairy cows

Forty dairy cows, paired at drying off according to expected calving date, milk somatic cell count (SCC) and previous mastitis history, and 10 heifers, paired by date of expected calving, were fed diets in the last 3 weeks of pregnancy which contained either 200 mg zinc proteinate and 60 mg inorganic zinc (Zinc group), or 260 mg inorganic zinc (Control group) per day in addition to the natural content of their feeds. After calving, the Zinc group each received 250 mg zinc proteinate and 140 mg inorganic zinc and the Control group 390 mg inorganic zinc per day above background levels. During the first 100 days of lactation there were no significant differences between the groups in terms of clinical mastitis rates, mastitis caused by environmental organisms, new infection rates or recovery rates. SCC showed no differences between the groups. Monitoring of body condition score and weight change, milk yield, blood metabolite values and fertility showed satisfactory and similar nutrition and productivity in both groups. The trial did not demonstrate any advantages from feeding proteinates to dairy cows and highlights the general absence of published controlled trial data on the subject.

Allelic association between a Ser-9-Gly polymorphism in the dopamine D3 receptor gene and schizophrenia

We examined a Ser-9-Gly polymorphism in the dopamine D3 receptor gene for allelic association with schizophrenia in 133 patients currently treated with clozapine and 109 controls. Allele 1 (Ser-9) was significantly more frequent in the patients (69%) than in the controls (56%) (P = 0.004). The 1-1 genotype was more common (43% vs 30%) and the 2-2 genotype less common (5% vs 18%) in patients than in controls. When the patient group was subdivided on the basis of clinical response to clozapine, using a 20-point improvement in the global assessment scale as cut-off, genotype 1-1 was found to be more frequent among the non-responders (53% vs 36%, P = 0.04). To place our results in the context of previous studies of this polymorphism and schizophrenia, we performed a meta-analysis of all published data including the present sample. The combined analysis shows evidence for a modest association between genotype 1-1 and schizophrenia (odds ratio 1.25, 95% confidence interval 1.05-1.49, P = 0.01). These results suggest that the Ser-9 allele, or a nearby polymorphism in linkage disequilibrium, results in a small increase in susceptibility to schizophrenia.

Cytochrome P4502D6 genotype does not determine response to clozapine

1. The atypical antipsychotic drug clozapine, used in the treatment of resistant schizophrenia, is metabolized partly by the hepatic cytochrome P450 enzyme CYP2D6. Two phenotypes with respect to the activity of the enzyme are recognized (extensive metabolisers (EM) and poor metabolisers (PM)), resulting from allelic variation in the gene, CYP2D6. 2. Genotype was determined in 123 schizophrenic patients currently being treated with clozapine, in order to determine if EM or PM status influences response to this drug. Patients were divided into responders and non-responders using the Global Assessment Scale, and genotyped for the A and B poor metaboliser mutations by digesting PCR products with HpaII or BstNI. 3. Fifty-nine patients were heterozygous for allele B and for allele A. Eight patients were determined as poor metabolisers since they were homozygous either for A and B. Poor metabolisers were equally distributed between responders and nonresponders and no correlation between CYP2D6 alleles and response to clozapine was found. 4. The results are consistent with recent findings showing that CYP1A2, rather than CYP2D6, is the major enzyme responsible for the metabolism of clozapine.

Comparison of the attitudes of hospital dentists and dental students in Glasgow, UK and Los Angeles, USA towards treatment of AIDS and hepatitis B patients

A transcultural comparison of the attitudes of hospital dental practitioners and final year dental students in Glasgow, Scotland and Los Angeles, USA was made to assess their attitudes towards treatment of AIDS and hepatitis B patients. Almost all of the respondents were aware of the facts related to spread of AIDS via saliva and blood and the major oral manifestations of AIDS. Surprisingly, a significant proportion of respondents in both countries said they will not attend their dentist if the latter treats AIDS patients and significantly more Americans thought that AIDS transmission was likely in the dental clinic. An overwhelming majority thought specially trained dentists should be employed to treat AIDS patients while the majority of Americans, as compared with Scots surmised that AIDS is a serious threat to public health. In general, the attitudes of the two survey populations towards the AIDS epidemic and attendant problems was similar although the Scots were more complacent than their American counterparts, probably due to the less immediacy of the AIDS problem in Scotland.

Homozygous osteogenesis imperfecta unlinked to collagen I genes

In a consanguineous pedigree in which a severe type of osteogenesis imperfecta was segregating as an autosomal recessive trait, analysis of genetic markers for both collagen I structural loci COL1A1 and COL1A2 showed that the phenotype was unlinked to either locus.