Point-of-Care Screening Echocardiograms and their Potential Utility in the Acute Inpatient Medical Setting

Demands on echocardiography services are increasing annually. This Quality Improvement Project aimed to see whether a point of care screening echocardiography (SE) service in the acute inpatient medical setting might help reduce demand on full trans-thoracic echocardiography services (FE). The indication and results of all FE requests on the admission ward were analysed over a three-month period. Following this, it was considered whether a theoretical SE occurring prior, would have changed the on-going utilisation of FE resources. Of the 67 requests analysed, 57 underwent FE. 25% revealed no abnormality. In 47%, a SE prior may have changed the future use of FE resources. This small retrospective review highlights the potential benefits of a SE service and further work is required.

Web 2.0 and the veterinary profession: current trends and future implications for lifelong learning

The NOVICE project is an EU initiative under the Lifelong Learning Programme, which aims to develop an online, professional network to promote informal, lifelong learning within the veterinary profession, using Web 2.0 tools. To inform the development of the network, a need analysis study was undertaken with relevant stakeholders. Focus group discussions were undertaken with veterinary students and veterinarians and a survey was administered to first-year students and recent graduates. The results indicate that use of computers and the internet is ubiquitous among junior members of the profession and that use of Web 2.0 tools is increasing. Concerns raised in relation to participation in online communities include verifying the quality of information and issues around professionalism. Compared with face-to-face communities, online communities were perceived to offer a number of advantages. These include convenient access to expert advice on an international scale, as well as helping to alleviate certain barriers to participation in formal, continuing education such as time, distance and cost.

The use of information and communication technology in veterinary education

The internet provides new opportunities to deliver distance and e-learning to the veterinary profession both at undergraduate and postgraduate levels. There are now numerous examples of successful computer-based educational projects in UK higher education, which provide useful models for veterinary science. This will present challenges for academics who will need to adapt their teaching methodologies and students who will have to develop new ways of learning. The future of Information and Communication Technologies (ICT) in the veterinary sector is difficult to predict but it is likely to have far reaching effects on the profession.

The views of nurses to the conduct of a randomised controlled trial of problem drinkers in an accident and emergency department

The Trent Regional Health Authority funded a study in 1995 to train nurses in an accident and emergency (A&E) department to screen all adult attendees for alcohol problems with a view to identifying a sample of problem drinkers to participate in a randomised controlled trial (RCT). In the RCT identified drinkers were to be assigned either to health education plus brief counselling intervention or, as controls, to health education alone. Despite 16654 attendance's at A&E during the recruitment phase of the study only 20% of attendees were screened of whom a further 19% were identified as problem drinkers by the CAGE screening questionnaire. Less than half of the problem drinkers were, however, provided with feedback by the nurses, leaving a small group of 264 eligible for entry to the RCT. The great majority of this subgroup refused an initial appointment at the specialist clinic and so the trial was abandoned. A number of in-depth interviews were undertaken with the nurses in an attempt to understand ways in which the overall conduct of the study might have been improved. This paper outlines in some detail some of the reasons for the lack of success with the study which include; general environmental factors that undoubtedly led to stress and poor morale amongst the nursing team, the differences in perception between managers and clinical nurses concerning the value of research and the inadequacy of the initial training programme. The paper concludes that there are problems in the NHS which do not provide a helpful backcloth to the successful conduct of health services research.

Problems encountered with opportunistic screening for alcohol-related problems in patients attending an accident and emergency department

AIMS

To assess the value of opportunistic screening in Accident and Emergency (A&E) for patients with alcohol-related problems and provision of an intervention.

DESIGN

Screening of A&E attendees for the purpose of recruitment to a randomized trial of a counselling intervention.

SETTING

A General Hospital A&E department.

PARTICIPANTS

All 17,000 adult A&E attendees, during a 6-month period and all nursing staff working within the department.

MEASUREMENTS

Patients' self-reported alcohol consumption, responses to the CAGE questionnaire (four questions designed to identify problem drinking) and proportions offered, and taking up offer of help.

FINDINGS

Only 4663 (28%) adult attendees at A&E were actually screened and of these 2% declined and 25% were judged unable to answer. Of the rest, 86% drank alcohol, with 22% drinking in excess of current guidelines or with two or more positive answers to CAGE. Only 41% (264) of those drinking to excess were offered help and 88% of these declined it. This left 13 patients to be included in the trial.

CONCLUSION

There is a significant need for an effective intervention in this area but considerable barriers exist to testing the efficacy of potential screening strategies and interventions.

Effect of cross-transplantation on normotensive and spontaneously hypertensive rat arterial muscle membrane

Transplantation of arteries into the anterior eye chamber of rats for 8 weeks was used to test the hypothesis that the neurohumoral environment is important in establishing the altered membrane potential (observable during electrogenic ion transport inhibition) of vascular muscle in hypertension. When caudal arteries from 12- to 16-week-old spontaneously hypertensive rats (SHR) or genetically matched Kyoto-Wistar normotensive rats (KNR) were transplanted into the opposite strain, there was no change in the transport inhibited membrane potential (Em) of the arterial muscle cells from that found in freshly excised donor arteries. However, when caudal arteries from 2-week-old animals were transplanted into the anterior eye chamber, the arteries always developed the appropriate Em for the host animal. In other words, a genetically KNR artery developed the Em of an SHR artery in an SHR host; conversely, a genetically SHR artery developed the Em of a KNR artery in the KNR host. These results provide evidence that: 1) the differences between th Em of caudal arteries from SHR and KNR are not inherent in those muscle cells; 2) the change in Em is triggered in young animals preceding development of hypertension, but not after hypertension is established; and 3) the Em alteration of the caudal artery is independent of structural changes that occur in the artery as a result of increased blood pressure (because KNR transplants were not connected in series with the host anterior eye chamber vasculature and subject to the elevated blood pressures). We conclude that the arterial muscle cells up to a certain age respond to an external factor that regulates their Em and presumably their sensitivity to vasopressor agents.