Intermediate care: more than 'a nursing thing'.
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Biomedical subjects
A Steiner
Publications and source records attributed to A Steiner.
Intermediate care--a good thing?
In this paper, the intermediate care concept will be developed, and a new definition proposed. The evidence on effectiveness will be summarised, focusing on comprehensive geriatric assessment, admission avoidance, nurse-led units for post-acute care, and supported early discharge arrangements. It is a working premise of the paper that, in principle, intermediate care is not only a "good" but also a necessary "thing". However, with the exception of comprehensive assessment, the evidence for many services that fall under the broad rubric of intermediate care is lacking, inconclusive or negative. The implications of this for both practice and research will be discussed.
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Seasonal pattern of the excision rate of melanoma and naevi.
Based on available information that melanocytic skin lesions presenting a junctional component are more susceptible to the influence of ultraviolet radiation, this study compares the seasonal differences between the excision rates of melanocytic skin lesions with a junctional component to those without. The histological diagnoses of 1230 patients with melanocytic skin lesions were retrospectively analysed. Depending on the histological diagnosis four groups were formed: melanomas, dysplastic naevi, common naevi (junctional and compound naevi), and dermal naevi. All dates of operations were allocated to summer or winter halves of the year. The collected data were computer analysed for statistical description. The number of excisions of melanocytic lesions with a junctional component (melanoma, dysplastic naevi, common naevi) showed an impressive seasonal variation, with a peak during the summer months, while the excision frequency of dermal naevi was approximately constant during the year. In conclusion, we suggest that ultraviolet radiation may contribute to the seasonal pattern of excision of melanoma and naevi only when a junctional component is present.
Age Factors↗
[Short- and longterm results after surgical treatment of teat stenosis in the region of Fürstenberg's rosette using theloresectoscopy: 15 cases (1999-2000)].
Teat obstructions cause considerable financial loss in dairy industry. Recently, progress in teat surgery was made by the use of minimal invasive surgical instrumentation. The technique of theloresectoscopy as well as short- and long-term results of this surgical intervention are presented in this study. The clinical reports of 15 dairy cows with distal teat obstructions operated with the theloresectoscope between May 1999 and January 2000 at the clinic for ruminants, Department of clinical veterinary medicine, University of Berne were reviewed. Data collected by telephone conversation with the owners included: somatic cell count and milk flow at machine milking during the lactation of surgery (lactation 1), as well as during the lactation following surgery (lactation 2). Eighty-seven percent of the owners reported normal milk flow during lactation 1 and 93% during lactation 2. Considering the fact that only 46.7% of the cows showed negative results in the California mastitis test (CMT) during lactation 1, many owners reported a high somatic cell count being a disadvantage of this surgical technique. Normal (negative) CMT results during lactation 2, however, were reported by 80% of the owners. Isolation of Staphylococcus aureus explained the high somatic cell count in 2 of 15 cases. In conclusion, theloresectoscopy is a valuable minimal invasive surgical technique that can be fully recommended for treatment of distal teat obstructions in dairy cows.
Animals↗
A Li(10) Cage Containing the
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Journal Article↗
Lithium Binaphtholates: Chiral Chains and Clusters This work was supported by the EPSRC (studentship to J.L.M.D.).
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Journal Article↗
Effect of different doses of prostaglandin E2 on intrauterine pressure and uterine motility during diestrus in experimental cows.
Studies in human medicine proved the important role of prostaglandin E2, which stimulates uterine contractions in vivo and in vitro and has been extensively used to ripen the cervix around labor. We wanted to demonstrate that increasing the dosage of prostaglandin E2 (1.25 mg, 2.5 mg, 5 mg and 10 mg) provokes an increase in intrauterine pressure and uterine motility in cattle. Five healthy, lactating dairy cows were used as experimental animals for this study. Intrauterine pressure was recorded during the diestrus phase (1 recording per cow and diestrus phase) by means of a transcervically placed intraluminal pressure microtransducer. Physiologic uterine motility was recorded for 30 min, then placebo or one of the prostaglandin E2- dosages was administered through an indwelling catheter in the jugular vein, followed by a 2-h recording period (eight 15-min periods). Area under the curve (AUC), mean amplitude, frequency of pressure waves and intrauterine pressure were analyzed. Furthermore, we recorded protocols for monitoring heart and respiratory rates and side effects at 9 given examination times. Significant differences were found for the AUC, the mean amplitude and the intrauterine pressure (P < or = 0.05), whereas the number of pressure waves per 15 min did not differ significantly among treatments. Peak values for AUC, mean amplitude and intrauterine pressure were found during the first 15 min after administration of 10 mg of prostaglandin E2. Dose-effect curves showed that the 2.5 mg dosage provided the optimal ratio between myometrial stimulation and undesirable side-effects.
Animals↗
Collateral ligament prosthesis for the repair of subluxation of the metatarsophalangeal joint in a jersey cow.
A two-and-a-half-year-old Jersey cow had been moderately lame in its right hindlimb for one month. Clinical and radiographic examinations revealed an incomplete lateral luxation of the metatarsophalangeal joint. The medial condyle of the metatarsal bone was locked in the condylar groove of the medial first phalanx. The subluxation was reduced, the joint carefully debrided and irrigated, and the torn ligament was replaced with a synthetic prosthesis which was fixed with titanium alloy staples. One year after surgery, the joint was slightly swollen but the cow was not lame.
Animals↗
[Recurrent severe lower gastrointestinal hemorrhage. Acute recurrent diverticulum hemorrhage in the cecum].
This 83-year-old patient was admitted to the emergency room after a sudden and abundant rectal bleeding without any other abdominal symptoms. The physical examination showed normal abdominal findings. However, digital rectal examination revealed dark red blood. Upper and lower endoscopic examination did not show an active bleeding source. A diagnosis of an acute lower gastrointestinal bleeding probably originating from a diverticulum was made. The patient was dismissed two days later without any signs of further bleeding. However, the same day he was readmitted again because of acute rebleeding. Emergency colonoscopy was not conclusive because of massive hemorrhage. Angiography of the abdominal arteries was performed which showed marked active bleeding in the coecal region. Ileocoecal resection was performed and histopathological examination showed a solitary coecal diverticulum.
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Effect of sodium butyric acid, sodium valerianic acid, and osmolarity on contractility of specimens of intestinal wall obtained from the cecum and spiral colon of healthy cows.
OBJECTIVE: To compare the effect of various concentrations of sodium butyric acid and sodium valerianic acid, as well as various osmolarities, on contractility of ex-vivo intestinal wall specimens obtained from the cecum and spiral colon of each of several healthy cows. SAMPLE POPULATION: Full-thickness preparations of intestinal wall, dissected parallel to the longitudinal smooth muscle layers, harvested from freshly slaughtered healthy cows. PROCEDURE: Specimens of intestinal wall were incubated for 5 minutes with various concentrations of sodium butyric acid and sodium valerianic acid as well as various osmolar concentrations of NaCl, using a crossover design. Isometric contractions were induced 7 times with carbachol (CH; 5 X 10(-6) mol/L). Contractility was defined as the maximum amplitude of contraction and the amplitude of contraction 2 minutes after addition of CH. RESULTS: Repeated addition of CH did not result in a significant effect on contractility of specimens from the cecum and spiral colon. Contractility after addition of CH was not significantly affected by prior incubation with various concentrations of sodium butyric acid or sodium valerianic acid or after an increase of osmolarity. Maximum amplitude of contraction was significantly higher in specimens from the spiral colon, compared with specimens from the cecum. CONCLUSIONS: Increases in concentrations of sodium butyric acid or sodium valerianic acid and increases in osmolarity did not inhibit contractility of intestinal wall specimens from the cecum and spiral colon of a group of healthy cows.
Animals↗
[Synovial osteochondromatosis (SOC) in swine: a case report].
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Animals↗
[The treatment of articular and bone infections in large animals with gentamicin-impregnated collagen sponges].
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Animals↗
[Sensitivity of bovine and equine streptococci to beta-lactam antibiotics (benzylpenicillin, ampicillin, oxacillin, cefotaxime) in the agar diffusion and E-test].
368 streptococcal strains from udder secretions of cattle (Sc. agalactiae, Sc. dysgalactiae, Sc. uberis) and 191 streptococcal isolates from horse specimens (Sc. equi ssp. zooepidemicus, Sc. equi ssp. equi) originating from different agricultural regions in Germany (Lower Saxony, in particular the region of Weser-Ems, Bavaria, Altmark) were investigated for their sensitivity to 4 beta-lactam antibiotics (benzylpenicillin, ampicillin, oxacillin, cefotaxime). Two different test methods were applied: the agar diffusion test for determination of the diameter of the zone of inhibition and the E-test for determination of the minimal inhibitory concentration (MIC). According to the evaluation code of DIN 58,940, 98% to 100% of the isolates from the cow udder as well as of the Streptococcus strains from horses were sensitive to the four antibiotics tested. Only Sc. uberis was less sensitive to benzylpenicillin (79.7%) and Oxacillin (83.2%). The strains from different agricultural regions did not differ from each other concerning their sensitivity to beta-lactams. The results of the two methods of sensitivity testing were in satisfactory agreement: Compared to the MIC reference values, misclassifications occurred in the agar diffusion test only at an error rate of between 1.62% (for ampicillin) and 5.21% (for benzylpenicillin).
Ampicillin↗
Case study of the effects of atmospheric aerosols and regional haze on agriculture: an opportunity to enhance crop yields in China through emission controls?
The effect of atmospheric aerosols and regional haze from air pollution on the yields of rice and winter wheat grown in China is assessed. The assessment is based on estimates of aerosol optical depths over China, the effect of these optical depths on the solar irradiance reaching the earth's surface, and the response of rice and winter wheat grown in Nanjing to the change in solar irradiance. Two sets of aerosol optical depths are presented: one based on a coupled, regional climate/air quality model simulation and the other inferred from solar radiation measurements made over a 12-year period at meteorological stations in China. The model-estimated optical depths are significantly smaller than those derived from observations, perhaps because of errors in one or both sets of optical depths or because the data from the meteorological stations has been affected by local pollution. Radiative transfer calculations using the smaller, model-estimated aerosol optical depths indicate that the so-called "direct effect" of regional haze results in an approximately 5-30% reduction in the solar irradiance reaching some of China's most productive agricultural regions. Crop-response model simulations suggest an approximately 1:1 relationship between a percentage increase (decrease) in total surface solar irradiance and a percentage increase (decrease) in the yields of rice and wheat. Collectively, these calculations suggest that regional haze in China is currently depressing optimal yields of approximately 70% of the crops grown in China by at least 5-30%. Reducing the severity of regional haze in China through air pollution control could potentially result in a significant increase in crop yields and help the nation meet its growing food demands in the coming decades.
Agriculture↗
Use of a theloscopic triangulation technique for endoscopic treatment of teat obstructions in cows.
A method for endoscopic resection of obstructing tissue in the area of the teat canal opening into the teat sinus, using a triangulation technique, was developed. Benefits of this approach, compared with existing methods, include excellent observation of obstructing tissue, ease of manipulation of tissue flaps by use of a probe introduced through the teat canal, and precise excision of obstructing tissue by use of a pair of scissors introduced through an instrument portal. Outcomes for 12 cows treated with this technique were determined 2 weeks and 3 months after surgery. Three or more months after surgery, outcome was excellent in 10 of 12 cows, and 11 owners would opt for use of the procedure for other valuable cows in their herds.
Animals↗
Reevaluation of the ABCD rule for epiluminescence microscopy.
BACKGROUND: Epiluminescence microscopy (ELM) provides for increased accuracy in the clinical diagnosis of pigmented skin lesions (PSL). It is based on pattern analysis of ELM criteria, which requires experience. The recently introduced application of the ABCD score to ELM facilitates this by permitting lesion evaluation on the basis of predefined clinical criteria. OBJECTIVE: The present study was performed to evaluate the diagnostic performance of the ABCD rule for ELM in pigmented skin lesions testing dermatologists with varying skills from novice to expert. METHODS: Two hundred fifty electronic images of randomly selected, histologically proven PSL including 41 early melanomas (16.4%) were presented to the raters, and each image was scored according to the rules of the ABCD score and rated without the guidance of a scoring system on a scale from 1 = definitely benign to 5 = definitely melanoma. RESULTS: Our data show that the application of the ABCD rule significantly enhances diagnostic ability in less experienced dermatologists compared with rating without the guidance of a scoring system. In contrast, the diagnostic accuracy of dermatologists who are moderately to greatly experienced is not improved by use of the ABCD rule. CONCLUSION: Our experiments indicate that the application of the ABCD rule to ELM introduced by Stolz et al represents a useful enhancement for diagnosis of pigmented skin lesions in less experienced users. However, the method does fail to detect melanomas with 100% accuracy. Therefore further effort has to be made to make the diagnosis of melanoma easier and more accurate.
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Effect of two dosages of d-cloprostenol on intrauterine pressure and uterine motility during dioestrus in experimental cows.
Prostaglandins are commonly used in herd management for their luteolytic properties; however, prostaglandins also have a direct contractile effect on the myometrium. We hypothesized that different dosages (0.15 and 0.3 mg) of d-cloprostenol, a synthetical prostaglandin F2 alpha preparation, would differ as to their contractile effects on the uterus. Intrauterine pressure was recorded during dioestrus of lactating dairy cows, using a transcervically placed intraluminal pressure microtransducer. After recording of physiological uterine motility for 30 min, a placebo or d-cloprostenol at one of the two different dosages was administered intramuscularly, followed by a 2-h recording period. Significant differences were found for the area under the curve (P < or = 0.05) and mean amplitude (P < or = 0.05), whereas the number of spikes per 15 min and the baseline pressure during the last 3 min of every 15-min period did not differ significantly among treatments. Peak values for area under the curve and mean amplitude were found between 15 and 30 min after administration of the lower dosage of d-cloprostenol, and between 75 and 90 min after administration of the higher dosage. Using the higher dosage of d-cloprostenol, a steady plateau from 15 to 30 min after administration until the end of the recording session was obtained. Thus, double the luteolytic dose of the d-cloprostenol preparation gives a significantly better reaction in terms of uterine contractility than the single dose.
Animals↗
Mobility and dementia: is physiotherapy treatment during respite care effective?
BACKGROUND: Mobility problems experienced by elderly people with a dementia are associated with falls, fractures and admission to long-term care. A hospital respite care admission is therefore often seen as an opportunity to provide physiotherapy treatment. AIM: To find whether elderly people with a dementia and a mobility problem show a greater improvement in mobility skills if given physiotherapy treatment than if given non-physical activities intervention during a hospital respite admission. METHOD: A controlled randomized multicentre trial with independent blinded assessment. The Southampton Mobility Assessment (mobility score) and Two Minute Walking Test (distance walked) were undertaken at the beginning and end of the study admission and beginning of the next respite admission. Following the first assessment, participants were randomized to either physiotherapy or activities. RESULTS: Eighty-one participants, from 12 clinical centres, with a mean age of 81.9 years and CAPE I/O score of 2. During the study admission there was a non-significant trend for a lower reduction in mobility score of the physiotherapy group (Mann-Whitney; p = 0.614) and a non-significant trend for greater decrease in distance walked in the activities group (t-test; p = 0.325). DISCUSSION: The results of this trial do not support the positive changes demonstrated elsewhere. However, changes in respite care during the early stages of this trial may have produced differences between the sample for this trial and that for the pilot study. This trial was therefore underpowered. CONCLUSION: This trial suggests that future research needs to change the focus from clinical settings to presentations.
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