The importance of being 'in charge': a word from OLAW and USDA.
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Animal Welfare↗
Biomedical subjects
Patricia Brown
Publications and source records attributed to Patricia Brown.
Tackling investigator noncompliance: a word from OLAW and USDA.
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Animal Care Committees↗
Report of the ACLAM Task Force on Rodent Euthanasia.
The ACLAM Task Force on Rodent Euthanasia was appointed by President Lynn Anderson in 2002 in response to growing concerns and controversy regarding techniques that were commonly used for rodent euthanasia. Three issues were targeted as the focus of the report: euthanasia of fetal and neonatal rodents, the use of carbon dioxide for rodent euthanasia, and the impact of euthanasia techniques on data. The charge to the Task Force was to create a document that summarized in a scholarly and comprehensive manner all available data-based literature relevant to these topics, to assess the scientific merit of the design and conclusions of those studies, and to compile valid information into a concise and cohesive document that could serve as a resource for diplomates, other veterinarians, IACUC members, regulatory bodies, and research scientists. The Task Force has fulfilled this charge in an exemplary manner. During 2004-2005, the ACLAM officers and Board of Directors (BOD) reviewed and critiqued 2 draft versions of the report, and suggestions for change were incorporated into the document presented here. In July 2005, the BOD voted to forego the usual process of distributing the document to theACLAM membership for comment before release based on 2 considerations. First, the literature relevant to rodent euthanasia is continually expanding. As such, at each revision, the Task Force was compelled to incorporate new data and citations. Their consensus view was that new data would continue to emerge, and the document would require continual revision as the review process continued. Related to that, the 2nd consideration of the BOD was that information already accumulated would be of immediate utility to the stake-holders listed above. In lieu of a pre-publication comment period, the BOD and the Task Force instead invite all diplomates, as well as other parties, to comment via email or mail to the BOD liaison for this project, who will compile and maintain all remarks. After an interval deemed appropriate by the ACLAM President, a 2nd Task Force will be appointed to update and modify the Report. Comments will be considered at that time. I want to personally thank all members of the Task Force for their conscientious and comprehensive efforts in compiling this information. They have created a valuable and informative synthesis that should serve as a resource to the community for years to come.
Advisory Committees↗
Unilateral retrobulbar optic neuritis due to varicella zoster virus in a patient with AIDS: a case report and review of the literature.
Unilateral retrobulbar optic neuritis developed in a 43-year-old man with acquired immune deficiency syndrome (AIDS). This was secondary to varicella zoster virus (VZV) as confirmed by cerebrospinal fluid (CSF) polymerase chain reaction (PCR) detection of VZV in the cerebrospinal fluid. There was no typical cutaneous infection and no evidence of retinitis. The onset of unexplained visual loss due to optic neuritis in HIV positive individuals may be due to VZV infection. Prompt recognition, and early intervention with antiVZV therapy may preserve vision. Retrobulbar optic neuritis secondary to VZV infection should be considered in immunocompromised patients even in the absence of cutaneous or retinal lesions. Previous cases are reviewed and the varied nature of viral transport in the nervous system is noted.
Acquired Immunodeficiency Syndrome↗
Acute pyelonephritis among adults: cost of illness and considerations for the economic evaluation of therapy.
Urinary tract infection (UTI) is an infection anywhere in the urinary tract, most commonly due to bacteria. If infection involves the kidney, the UTI is termed acute pyelonephritis (APN). An estimated 10-30% of all patients with APN are hospitalised for treatment; in the US, the incidence of hospitalisation is 11.7 per 10,000 for women and 2.4 per 10,000 for men. Perhaps because of the generally good prognosis of APN when treated with current antibacterial therapies, there have been relatively few studies of patient management and therapeutic options for the disease, or of its epidemiology and risk factors. The most cost-effective outpatient management strategy (immediate discharge, observation followed by discharge, etc.) is currently unknown. Appropriate antimicrobial selection is clearly important, as treatment failures will increase the cost of care and result in additional morbidity for patients. The direct and indirect costs of APN are significant: an estimated 2.14 billion US dollars (year 2000 values). Cost estimates are most sensitive to hospitalisation rates, which are unknown in the US. Additional studies are needed to better define when in-hospital treatment is required. As the pathogens causing APN are increasingly becoming resistant to current therapies, not only are clinical trials in order to test the effectiveness of alternative therapies, but epidemiological studies to identify risk factors for infection with a resistant isolate and effective prevention strategies are required, especially among those with previous episodes of APN.
Adult↗
Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs.
Uropathogenic E. coli have special features that allow them to take advantage of the bladder environment. There UPEC can grow to substantial numbers in pure culture that are shed frequently into the environment and have a high probability of transmission to other hosts. A better understanding of the transmission system and the host and bacterial factors influencing transmission is essential for the identification of effective prevention strategies. Although the risk of severe morbidity among otherwise healthy populations is low, the incidence is high. Further, the potential impact of antibiotic treatment on the emergence of increasingly antibiotic-resistant UPEC (the resistant mechanisms that may be transmitted to other bowel inhabitants) is high. The benefits of successfully preventing UTI are substantial.
Anti-Infective Agents↗
Converting to insulin in primary care: an exploration of the needs of practice nurses.
BACKGROUND: In order to optimize glycaemic control, substantial numbers of people with type 2 diabetes may require transfer from oral medication to insulin therapy. Although insulin conversion is traditionally a specialist secondary care function, as nursing roles change and expand there is growing pressure for this to be performed within primary care. However, little is known about the potential barriers to such a change, particularly from the standpoint of the frontline staff involved. AIMS: The study aimed to explore the views of practice nurses in the United Kingdom (UK) about converting diabetic patients from oral hyperglycaemic agents to injected insulin within primary care, and to investigate what structures and resources might be useful in supporting such a change. METHODS: Semi-structured interviews were conducted with 25 practice nurses, and interpreted using content analysis to extract key conceptual themes from the transcribed interview texts. FINDINGS: Most of the nurses felt that converting to insulin in primary care had considerable benefits for patients. However, issues of time, training, confidence about performing the change, and the adequacy of support systems, both for patient and nurse, emerged as the main perceived barriers to performing insulin conversions in primary care. Worries about legal and accountability issues surrounding the nurse prescribing elements were also raised. CONCLUSIONS: Where insulin conversion within primary care is being considered, it is suggested that specific training is provided for practice nurses and general practitioners, protected time is made available, and a team-working approach is fostered to prevent isolation and boost patient support. Formal mentoring or supervision support for practice nurses may also help them to adapt to this new approach. LIMITATIONS: These findings are based on the views of nurses from a single UK locality, and so widespread consultation is recommended before applying them in other settings.
Administration, Oral↗
Sleep-disordered breathing and stroke.
Sleep-disordered breathing (obstructive and central sleep apnea) is common in persons who have had a cerebrovascular accident (CVA). This article describes both sleep-disordered breathing and CVAs and reviews the related risk factors that link them together. In addition, the article discusses sleep-disordered breathing after CVA. The article concludes by presenting the clinical implications of this topic for nurses.
Aged↗
Long-term enteral nutrition facilitates optimization of body weight.
BACKGROUND: Optimization of body mass index (BMI) among cancer survivors is a priority. Long-term enteral nutrition is required by many head and neck cancer survivors and may be utilized to affect changes in BMI. METHODS: We used a retrospective review of head and neck cancer survivors dependent on enteral nutrition. Patients were grouped according to their BMI at initiation of enteral feeding. Patients with normal, low, or elevated BMI were assigned a goal of weight maintenance, weight gain, or weight reduction, respectively. Changes in BMI over time were recorded. RESULTS: We identified 39 head and neck cancer survivors requiring enteral nutrition. Median time on enteral nutrition was 32 +/- 39.6 months. At the initiation of enteral feeding, 51% of patients had a normal BMI and were assigned to the weight maintenance group, 84% successfully maintained a normal BMI (mean 22.4 +/- 1.7 kg/m(2)), and 18% had a low BMI and were assigned to the weight gain group. In all, 85% achieved or trended toward a normal BMI (from 16.5 +/- 1.9 to 19.2 +/- 1.6 kg/m(2); p = .02). When enteral feedings began, 31% of patients had an elevated BMI and were assigned a goal of weight reduction; all were able to reduce their BMI (from 30.2 +/- 5 to 27.3 +/- 6 kg/m(2); p < .001). CONCLUSIONS: Long-term enteral feeding facilitates body weight optimization among ambulatory head and neck cancer survivors. These findings may potentially be generalized to all ambulatory patients who are dependent on enteral nutrition.
Adult↗