Factors affecting the perception of recovery quality in horses after anaesthesia

REASONS FOR PERFORMING STUDY

A significant effect of gender, experience and background, i.e. an evaluator's relationship with horses as equine anaesthetists, orthopaedic surgeons, practitioners or owners, on perceptions of recovery quality after anaesthesia would reduce the validity of recovery quality scoring systems.

OBJECTIVES

To determine the effects of evaluator background, experience and gender on their perceptions of recovery quality; and questionnaire response rate as a function of background.

STUDY DESIGN

Cross-sectional survey.

METHODS

A total of 440 potential evaluators were invited to evaluate the video-recorded recoveries of 24 horses using a visual analogue scale (VAS) in which 0 = worst, 100 = best possible recovery. A mean score was generated for each of the 1-24 recoveries within each background group. These were compared using Spearman's rank correlation. The effect of gender and experience on VAS scores were analysed using an ordinal logistic regression after scores were categorised into 'intermediate, 'worst' and 'best' recovery categories based on median, 25th and 75th percentile VAS scores, respectively.

RESULTS

The overall response rate was 35%. The greatest was from the anaesthetists (78%) followed by surgeons (43%). The response rate among owners and practitioners was 26%. Correlation among VAS scores across all background groups was high (Spearman rank > 0.90; P < 0.001). Among the combined veterinarians, there was no significant gender (P = 0.551) or experience (P = 0.103) effect. Among horse owners, the effect of experience was not significant (P = 0.116) although gender was (P = 0.027). Male horse owners awarded significantly greater scores than females.

CONCLUSIONS

When VAS are used to grade recovery quality, neither the background nor the gender of veterinary evaluators affects quality perception. Male owners awarded greater scores than female owners, implying that they are less critical of recovery quality and a gender effect among horse owners must be considered when VAS are used to score recovery quality.

Pain flashbacks following the July 7th 2005 London bombings

Flashbacks in posttraumatic stress disorder (PTSD) are commonly experienced as visual, auditory, olfactory or tactile re-livings of a previously experienced traumatic event. We present the case report of one survivor of the July 7th 2005 London underground bombings who was diagnosed with PTSD and who experienced painful flashbacks. We present retrospective multidimensional measures of his pain using standardised instruments. The case provides further evidence that somatosensory re-experiencing of pain memories is possible. Findings are discussed with regards to memory for pain.

Oral PUVA and topical steroids for treatment of oral manifestations of chronic graft-vs.-host disease

BACKGROUND

Oral manifestations of chronic graft-vs.-host disease (cGVHD) can significantly affect the quality of life and severity often does not correlate with systemic manifestations. We evaluated the use of topical corticosteroids and the intraoral application of psoralen-UVA (PUVA) for treatment of oral manifestations of cGVHD.

METHODS

Overall, 18 patients with oral manifestations of cGVHD were treated with either intraoral PUVA (n=7) or with topical corticosteroids (n=16). Four patients received intraoral PUVA after failure of topical steroids and one patient was treated with topical corticosteroids after failing treatment with intraoral PUVA. A glass fiber extension of an UVA source was used for manual intraoral application. Treatment with topical corticosteroids consisted of 0.1 mg/ml dexamethasone mouth wash four times a day in combination with antifungal prophylaxis.

RESULTS

Four patients showed complete local response (CR) due to intraoral PUVA, two improved and one did not respond. Topical corticosteroids resulted in nine patients in CR, two improved and five did not respond.

CONCLUSION

Intraoral PUVA as well as topical corticosteroids are effective in treatment of oral manifestations of oral GVHD with few side-effects and improve quality of life in patients with cGVHD.

Epithelial plugs in radial keratotomy: the origin of incisional keratitis?

PURPOSE

Incisions in radial keratotomy (RK) patients were examined histopathologically to explore the cause of delayed infections occurring following this procedure.

METHODS

Four corneas from two successful RK patients were obtained postmortem and 1 cornea from an unsuccessful RK was collected following lamellar keratoplasty. The tissue was prepared for light and transmission electron microscopy.

RESULTS

All incisions examined contained an epithelial plug. The average depth of the plugs for left and right corneas in the 2 successful cases were 142.58 microm (range: 36.46-183.04 microm) and 58.44 microm (range: 29.27-115.66 microm), whereas the unsuccessful case these measurements were 121.06 microm (range: 70.03-172.01 microm). In the successful cases, the plugs were on average 4.2 cells deep (range: 2-5) in one case and for the other the plugs were 8.78 cells deep (range: 1.5-11.5) and 2.72 cells wide (range: 2-4). In the unsuccessful case the plugs were on average 6.89 cells deep (range: 5-11) and 8.56 cells wide (range: 4-13). The average epithelial thickness, measured 200 microm on either side away from the plug, was 47.11 microm and 55.09 microm for the successful cases, and 27.52 microm for the unsuccessful case. Degenerate cells were often observed within the plug and along the overlying surface. Lamellae cut during surgery remained severed in all corneas observed. The stroma adjacent to the incision contained an elevated number of stromal cells (8%-78%).

CONCLUSIONS

Healing did not include repair of anterior limiting lamina or stromal lamellae, which all remained severed in all incisions observed. Epithelial plugs were invariably present in all incisions regardless of clinical outcome, thus, increasing the distance a basal cell travels to reach the epithelial surface by 2 to 4 times. Since the epithelial cell has a limited life, it is hypothesized that cells originating in the plug may die before reaching the surface, thus, leading to intermittent loss of surface integrity. The loss of the epithelial barrier allows invasion of microorganisms and the delayed onset of keratitis. The larger the plug the greater the possibility of surface defects and resultant infection.

Pathway to all-graduate professions may be chaotic

Should the nursing, midwifery and health visiting professions welcome the newly formed Council of Deans and Heads of UK University Faculties of Nursing, Midwifery and Health Visiting (Council of Deans, 1998) as the selfappointed ‘authoritative voice’ on all matters concerning education and research? Or should we prepare for another round of power struggles on the journey to integrated professions?

Treatment of chronic graft-versus-host disease with ultraviolet irradiation and psoralen (PUVA)

Chronic graft-versus-host disease (GVHD) remains a difficult clinical problem to treat and manage. We have reviewed our treatment of 40 patients treated at a single institution with PUVA (ultraviolet irradiation and psoralen) over a 14 year period. Thirty-five patients were treated for refractory chronic GVHD and five patients were treated at presentation of high-risk chronic GVHD. Overall, 31 of 40 patients improved on PUVA treatment. Sixteen patients achieved a complete response to PUVA added to their GVHD regimen. Four of the 15 partial responders had complete resolution of cutaneous GVHD but persistence of other systemic manifestations. The remaining partial responders had at least a 50% improvement in GVHD. We have also used PUVA with a glass fiber extension to treat intra-oral GVHD. PUVA is well tolerated with a high rate of response in the skin and mild side effects except for three patients who had therapy discontinued after phototoxicity (burn).

One-to-one midwifery

Key elements: Problems of One-to-One midwifery developing a caseload relationships with other staff--perceived 'elitism' boundaries of care for high-risk mothers long hours isolation women's unrealistic expectations of midwife, including overdependence Solutions maintain dialogue with other professionals hospital midwives invited to join OTO midwives on community visits clarify roles and responsibilities direct referral to on-call registrar partnerships with teams peer support weekly group meeting empowering women, reducing overdependence

Traumatic pseudoaneurysm of the superficial temporal artery associated with facial nerve palsy

Aneurysms of the superficial temporal artery as a result of trauma occur rarely. These pseudoaneurysms tend to present 2 to 6 weeks following initial injury with a painless swelling which may be associated with a headache, ear discomfort or other vague symptoms. Neurological complications are very rare. A thorough history and physical examination are essential. Investigations such as duplex scanning, angiography or CT scanning may be helpful in difficult cases. The most common treatment is surgical. Embolization may prove to be an alternative to surgery in some cases. We review a rare case of superficial temporal artery aneurysm associated with a facial nerve palsy which was treated surgically. A thorough review of the literature is presented.

Trichobezoars

Trichobezoars are a rare cause of upper gastrointestinal symptoms and most commonly occur in young females with trichophagia. A case, occurring in a 19 year old woman, complicated by transient pancreatitis and jejunal perforation, is presented.

Progression of basal cell carcinoma through loss of chromosome 9q and inactivation of a single p53 allele

Basal cell carcinoma (BCC) of the skin represents a unique group of tumors strongly associated with exposure to UV light. Unlike squamous carcinoma of the skin, BCC is generally indolent, noninvasive, and rarely metastatic. To study the involvement of tumor suppressor genes in these neoplasms, we analyzed 36 BCCs for p53 mutations and a subset of these tumors for loss of chromosomes 17p and 9q. Sixty-nine % of sporadic BCCs had lost a 9q allele, with the common area of loss surrounding the putative gene for nevoid BCC or Gorlin's syndrome. Forty-four % (16 of 36) of BCCs had a mutated p53 allele, usually opposite pyrimidine tracts, which is consistent with UV-induced mutations. Surprisingly, only one tumor had lost a 17p allele, and in all BCCs only one p53 allele was inactivated. This is in direct contrast to other epithelial tumors, which usually progress by the inactivation of both p53 alleles.

Anger rises over fallen Prophit

This is make or break year for nursing and, so far, all the indicators point to the latter. Recent publicity in the popular press has demonstrated once again how the selfish and evil pursuit of personal goals so often takes precedence over the common good.

Promoting caring in nursing

In his editorial Nursing models redundant in practice (Vol 1(5): 219), Francis Biley drew attention to the exploration of the ‘real essence of nursing’. Indicators of this new development are the recognition of nursing narrative as a source of knowledge, new value being attached to feminist perspectives, and the exploration of concepts such as caring.

Endothelial cells transformed by SV40 T antigen cause Kaposi's sarcomalike tumors in nude mice

Injection into nude mice of a well-differentiated SV40 T-antigen-transformed murine endothelial cell (EC) line results in widespread invasive tumors confined to connective tissues. The tumors, which do not metastasize, consist of both host-derived cells and transformed EC, displaying histologic features typical of Kaposi's sarcoma (KS). Although the EC is believed to be the cell of origin in KS, this has not been proven and is the subject of debate. The unusual tumorigenicity of this transformed cell suggests that EC-specific gene products induced by SV40 T antigen may contribute to tumorigenesis by autocrine growth stimulation and recruitment of host cells. KS-like tumors may be the result of EC alteration by any virus that induces relevant EC-derived cytokines.

The importance of internal marketing: the case of geriatric services

Hospitals seeking to become more aggressive often are tempted to introduce programs prematurely. Using the example of a geriatric services program at a large hospital, the authors illustrate the dangers of neglecting internal marketing and offer recommendations for ensuring internal coordination prior to introduction of a product externally.

Assessment of teaching by Family Medicine Programme vocational trainees

Family Medicine Programme vocational trainees are requested to assess by means of a detailed questionnaire the teaching they have received in their general practice training attachments. This paper describes the methods and presents the results of a survey of South Australian and Northern Territory trainees over a three year period. The results show that a survey by questionnaires is an effective method of measuring perceived standards of teaching in training practices.

Overlap of granulomatous vasculitis and sarcoidosis: presentation with uveitis, eosinophilia, leg ulcers, sinusitis, and past foot drop

A 24-year-old black woman with a history of pulmonary and hepatic sarcoidosis followed by foot drop presented with uveitis, eosinophilia, leg ulcers, and sinus opacification. Biopsy of the leg ulcer and review of the past lung biopsy revealed numerous epithelioid noncaseating granulomas and granulomatous vasculitis. Although her clinical presentation raised the possibility of Wegener's granulomatosis, the many discrete granulomas and lack of necrosis on her biopsies were more in favor of sarcoidosis. Although granulomatous vasculitis has been reported as part of necrotizing sarcoid granulomatosis, our patient was unique in the extent and type of her extrapulmonary symptomatology.

Specimen radiology of excised breast lesions

The value of specimen radiology in the surgical management of palpable breast lesions was assessed in 100 consecutive patients undergoing excision of a palpable breast lump. Only 41 per cent of palpable breast lesions were demonstrable as a radiological abnormality on the excised specimen. The greatest sensitivity was found for lesions which proved to be malignant. Only 27 of 88 benign palpable breast lesions were radiologically visible in the specimen. Surprisingly, only 8 of 13 fibroadenomas were identified as discrete opacities. No residual breast lump was detected on clinical examination in patients reviewed postoperatively, including those patients who had a demonstrable preoperative mammographic abnormality and a negative specimen radiograph. We conclude that specimen radiology does not contribute to the surgical management of palpable breast lesions.

The ordering of blood for elective general surgical operations

The current practice in ordering blood for common elective general surgical operations in the Prince of Wales Hospital has been studied. The numbers of patients having serum grouped and held and those having cross-matched were determined, together with the number of units cross-matched. The percentage of patients transfused and the number of units of blood given were then assessed for each procedure. The results demonstrated that blood was often ordered for patients who were most unlikely to require it. In addition, the amounts of blood ordered were frequently excessive, so that the cross-match-to-transfusion ratio (C/T ratio) for some procedures was high. We suggest that relatively simple changes in the current practice of ordering blood for operations should result in savings in costs, and most importantly, in a reduction in the wastage of blood.