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Patients with severe mental illness have significantly reduced lifespans. Excepting suicide, cardiovascular risk is the biggest cause. The problem is exacerbated by psychotropic medication and poor primary care engagement. Therefore psychiatrists should maximise every opportunity to promote physical health.
We audited physical examination, investigations, and documentation of past medical history (PMH) & assessments in inpatients. We used the Royal College of Psychiatrist's Physical Health in Mental Health Scoping Group 2009 guidelines as our standard.
We audited notes of all 125 patients admitted to four wards at Ladywell unit over two months (01/07/2011- 31/08/2011). We surveyed trainees to identify training and resource needs and facilitate focussed interventions.
Physical Examination: 102/125(82%) received physical examination, 60/125(48%) on admission. Average delay before examination 12 days.
Blood tests/Investigations: 89/125(71%) received blood tests: 50/125(40%) thyroid function, 67/125(54%) liver function, 28/125(22%) glucose, 1/125(0.8%) HbA1c, 38/125(30%) lipid profile. 48/125(38%) had urine drug screening, 55/125(44%) ECG.
Documentation: The following was documented: 102/125(82%) PMH, 82/125(66%) allergies, 90/125(72%) smoking status. The following was scanned into records: 23/55(42%) ECG, 72/125(58%) physical observation chart.
Survey: The trainee survey highlighted need for training updates on physical health and problems in equipment provision.
Physical assessment is inconsistent, neglecting metabolic screening. Admission is a vital window for screening/modifying physical health.
Focussed assessment guidelines should be formulated. Following the survey, teaching led by consultant physicians has been organised on identified topics including metabolic syndrome. Lack of equipment will be addressed by creation of comprehensive equipment lists, to be distributed to ward administrators.
‘Rebound’ or ‘withdrawal’ symptoms are frequently observed after a sudden discontinuation of clozapine. We describe a patient with treatment-resistant schizoaffective disorder who developed agranulocytosis on clozapine but was successfully switched to treatment with olanzapine with no deterioration in her condition. We put forward three possible theories which may have accounted for the lack of rebound symptoms in this patient: the pharmacological profile of olanzapine, the anticholinergic effects of hyoscine hydrobromide, and the possibility that this patient may not be treatment-resistant and so have a reduced risk of rebound psychosis due to displaying a different pathophysiology.
A variety of paediatric tracheostomy tubes are available. This article reviews the tubes in current use at Great Ormond Street Hospital for Children and Evelina London Children's Hospital.
This paper outlines our current preferences, and the particular indications for different tracheostomy tubes, speaking valves and other attachments.
Our preferred types of tubes have undergone significant design changes. This paper also reports further experience with certain tubes that may be useful in particular circumstances. An updated sizing chart is included for reference purposes.
The choice of a paediatric tracheostomy tube remains largely determined by individual clinical requirements. Although we still favour a small range of tubes for use in the majority of our patients, there are circumstances in which other varieties are indicated.
Recent modelling estimates up to two-thirds of new HIV infections among men who have sex with men occur within partnerships, indicating the importance of dyadic HIV prevention efforts. Although new interventions are available to promote dyadic health-enhancing behaviours, minimal research has examined what factors influence partners’ mutual engagement in these behaviours, a critical component of intervention success. Actor-partner interdependence modelling was used to examine associations between relationship characteristics and several dyadic outcomes theorised as antecedents to health-enhancing behaviours: planning and decision making, communication, and joint effort. Among 270 male-male partnerships, relationship satisfaction was significantly associated with all three outcomes for actors (p = .02, .02, .06 respectively). Latino men reported poorer planning and decision making (actor p = .032) and communication (partner p = .044). Alcohol use was significantly and negatively associated with all outcomes except actors’ planning and decision making (actors: p = .11, .038, .004 respectively; partners: p = .03, .056, .02 respectively). Having a sexual agreement was significantly associated with actors’ planning and decision making (p = .007) and communication (p = .008). Focusing on interactions between partners produces a more comprehensive understanding of male couples’ ability to engage in health-enhancing behaviours. This knowledge further identifies new and important foci for the tailoring of dyadic HIV prevention and care interventions.
Giardiasis is a treatable disease, caused by the flagellated protozoan parasite, Giardia duodenalis (G. duodenalis). It is one of the most common enteric parasites found globally to cause gastrointestinal disturbances, and infections may result in long-term irritable bowel syndrome-like symptoms. It is a common misconception that giardiasis is associated with foreign travel, which results in locally acquired cases in the UK being underdiagnosed. This report highlights the findings from one large Scottish Health Board, arising from a change in testing methodology, which resulted in the screening of all stools submitted for enteric investigations for G. duodenalis. Previous selection criteria were restricted to patients with a travel history to specific regions of the world, or on the basis of certain clinical details. In this report, clinical details were recorded from samples shown to be positive using two methods: an ELISA-based antigen detection assay and microscopy. Clinical details were assessed for a total of 28 laboratory-confirmed positive cases against the original selection criteria. Twenty-six cases (93%) would have been excluded from Giardia testing if the previous selection criteria had been applied. Although nine cases stated foreign travel, only two had been to regions deemed to be ‘high risk’. Therefore, those seven cases that travelled to perceived ‘low-risk’ regions would have been excluded from testing for this reason. This summary highlights the need for significant improvements to the selection criteria for Giardia testing. Laboratories should be encouraged towards the testing of all routinely submitted stools for this neglected pathogen to ensure cases that are acquired locally are properly identified and treated effectively.
Notoedric mange, caused by obligately parasitic sarcoptiform Notoedres mites, is associated with potentially fatal dermatitis with secondary systemic disease in small mammals, felids and procyonids among others, as well as an occasional zoonosis. We describe clinical spectra in non-chiropteran hosts, review risk factors and summarize ecological and epidemiological studies. The genus is disproportionately represented on rodents. Disease in felids and procyonids ranges from very mild to death. Knowledge of the geographical distribution of the mites is highly inadequate, with focal hot spots known for Notoedres cati in domestic cats and bobcats. Predisposing genetic and immunological factors are not known, except that co-infection with other parasites and anticoagulant rodenticide toxicoses may contribute to severe disease. Treatment of individual animals is typically successful with macrocytic lactones such as selamectin, but herd or wildlife population treatment has not been undertaken. Transmission requires close contact and typically is within a host species. Notoedric mange can kill half all individuals in a population and regulate host population below non-diseased density for decades, consistent with frequency-dependent transmission or spillover from other hosts. Epidemics are increasingly identified in various hosts, suggesting global change in suitable environmental conditions or increased reporting bias.
Many people experience an ongoing relationship with a deceased loved one. This is called a “continued bond.” However, little is known about the adolescent experience with continued bonds once a parent has died. This study describes three ways that adolescents continue their relationship with a parent after that parent's death.
Individual semistructured interviews were conducted with nine adolescent children of deceased hospice patients from a large hospice in northeastern Ohio as part of a larger grounded-theory study. The interviews were audiotaped, transcribed verbatim, and analyzed using a conventional content analysis approach.
Adolescents continued their bonds with deceased parents in one of three ways: experiencing encounters with the deceased parent, listening to the inner guide of the parent, and keeping mementos to remind them of the parent.
Significance of results:
The ways that the adolescents continued their bond with a deceased parent assisted them in creating meaning out of their loss and adjusting to life without that parent. Our results can be used by health professionals and parents to help adolescents after a parent has died.
Background: There are no disease modifying agents for the treatment of Alzheimer’s disease (AD). Pathologically, AD is associated with the misfolding of two peptides: beta-amyloid (plaques) and tau (tangles). Methods: Using large-scale computer simulations, we modelled the misfolding of both beta-amyloid and tau, identifying a common conformational motif (CCM; i.e. an abnormal peptide shape), present in both beta-amyloid and tau, that promotes their misfolding. We screened a library of 11.8 million compounds against this in silico model of protein misfolding, identifying three novel molecular classes of putative therapeutics as anti-protein misfolding agents. We synthesized approximately 400 new chemical entity drug-like molecules in each of these three classes (i.e. 1200 potential drug candidates). These were comprehensively screened in a battery of five in vitro protein oligomerization assays. Selected compounds were next evaluated in the APP/PS1 doubly transgenic mouse model of AD. Results: Two new classes of molecules were identified with the ability to block the oligomerization of both beta-amyloid and tau. These compounds are drug-like with good pharmacokinetic properties and are brain-penetrant. They exhibit excellent efficacy in transgenic mouse models. Conclusion: Computer aided drug design has enabled the discovery of novel drug-like molecules able to inhibit both tau and beta-amyloid misfolding.
A survey questionnaire was sent to cotton consultants of Arkansas and Mississippi through direct mail and Louisiana and Tennessee consultants through on-farm visits in fall of 2011. The survey was returned by a total of 22 Arkansas, 17 Louisiana, 10 Mississippi, and 11 Tennessee cotton consultants, representing 26, 53, 13, and 38% of total cotton planted in these states in 2011, respectively. Collectively, the area planted to glyphosate-resistant (Roundup Ready®, RR) cotton was 97%, glyphosate plus glufosinate-resistant (Widestrike® Flex, WRF) cotton was 30%, and glufosinate-resistant (Liberty Link, LL) cotton was 2.6% of the total cotton surveyed in 2011. Seventy percent of area in all states is still under continuous RR/WRF cotton. Average cost of herbicides in RR systems was $114 ha−1 and in LL systems was $137 ha−1. Across the states, cotton planted under no-tillage, conservation tillage, and conventional tillage was 31, 36, and 33%, respectively, of total scouted cotton. Area under conventional tillage increased and conservation tillage decreased in Arkansas compared with a previous survey conducted in 2006. Palmer amaranth, morningglories, and horseweed in the order of listing were the most problematic weeds of cotton across Arkansas, Mississippi, and Tennessee. In Louisiana, however, morningglories were the most problematic weed followed by Palmer amaranth and common waterhemp. Glyphosate-resistant (GR) Palmer amaranth infested only 13% of scouted cotton area in Louisiana compared with 75% in the remaining three states, and consequently, hand-weeding to control GR Palmer amaranth is practiced on only 2.5% of total scouted area of Louisiana and 49% of the scouted area of the remaining three states. Hand-weeding added an additional $12 to 371 ha−1 to weed-management costs. One-half (50%) of the cotton consultants emphasized the need for more research on residual herbicides that can control GR Palmer amaranth effectively.
In fall 2011, cotton and soybean consultants from Arkansas, Louisiana, Mississippi, and Tennessee were surveyed through direct mail and on-farm visits, and rice consultants from Arkansas and Mississippi were surveyed through direct mail to assess the importance and level of implementation of herbicide resistance best management practices (HR-BMPs) for herbicide-resistant weeds. Proper herbicide timing, clean start with no weeds at planting, application of multiple effective herbicide modes of action, use of full labeled herbicide rates, and prevention of crop weed seed production with importance rating of ≥ 4.6 out of 5.0 were perceived as the most important HR-BMPs in all crops. Purchase of certified rice seed was on 90% of scouted hectares. In contrast, least important HR-BMPs as perceived by consultants with importance ratings of ≤ 4.0 in cotton, ≤ 3.7 in rice, and ≤ 3.8 in soybean were cultural practices such as manual removal of weeds; tillage including disking, cultivation, or deep tillage; narrow (≤ 50 cm)-row crops, cover crops, and altered planting dates. Narrow crop rows and cover crops in cotton; altered planting dates in cotton and soybean; and cleaning of farm equipment and manual weeding in rice and soybean is currently employed on ≤ 20% of scouted hectares. Extra costs, time constraints, adverse weather conditions, lack of labor and equipment, profitability, herbicide-related concerns, and complacency were perceived as key obstacles for adoption of most HR-BMPs. With limited adoption of most cultural practices that reduce risks of herbicide-resistant weeds, there are opportunities to educate growers concerning the proactive need and long-term benefits of adopting HR-BMPs to ensure sustainable weed management and profitable crop production.
Soybean consultants from Arkansas, Louisiana, Mississippi, and Tennessee were surveyed by direct mail and by on-farm visits in fall 2011 to assess weed management practices and the prevalence of weed species in midsouth U.S. soybean. These consultants represented 15, 21, 5, and 10% of total soybean planted in Arkansas, Louisiana, Mississippi, and Tennessee, respectively, in 2011. Collectively, 93% of the total scouted area in these four states was planted with glyphosate-resistant (RR) soybean. The adoption of glufosinate-resistant (LL) soybean was greatest in Arkansas (12%), followed by Tennessee (4%), Mississippi (2%), and Louisiana (< 1%). Only 17% of the RR soybean was treated solely with glyphosate, compared with 35% of LL soybean treated solely with glufosinate. Across four states, average cost of herbicides in RR and LL soybean systems was US$78 and US$91 ha−1, respectively. Collectively across states, total scouted area under conventional tillage was 42%, stale seedbed was 37%, and no-tillage was 21%. Palmer amaranth and morningglories were the most problematic weeds in all four states. Additionally, barnyardgrass and horseweed were the third most problematic weeds of Arkansas and Tennessee, respectively, and Italian ryegrass was the third most problematic weed in Louisiana and Mississippi. Glyphosate-resistant Palmer amaranth infested fewer fields in Louisiana (16% of fields) than it did in the remaining three states (54% collectively). Average Palmer amaranth hand-weeding costs in the midsouth was US$59 ha−1. Three-fourths of the midsouth consultants stipulated the need for continued research and education focused on management of glyphosate-resistant and glyphosate-tolerant weed species.
Parasites typically have low reproductive fitness on paratenic hosts. Such hosts offer other significant inclusive fitness benefits to parasites, however, such as increased mobility and migration potential. The parasite fauna of the guppy (Poecilia reticulata) is dominated by the directly transmitted ectoparasites Gyrodactylus bullatarudis and Gyrodactylus turnbulli. In the wild, close predatory and competitive interactions occur between the guppy and the killifish Rivulus hartii. Previous observations suggest that these fish can share gyrodactylids, so we tested experimentally whether these parasites can use R. hartii as an alternative host. In aquaria, G. bullatarudis was the only species able to transmit from prey to predator. Both parasite species transferred equally well to prey when the predator was experimentally infected. However, in semi-natural conditions, G. bullatarudis transmitted more successfully to the prey fish. Importantly, G. bullatarudis also survived significantly longer on R. hartii out of water. As R. hartii can migrate overland between isolated guppy populations, G. bullatarudis may have an enhanced ability to disperse and colonize new host populations, consistent with its wider distribution in the wild. To our knowledge, this is the first empirical study demonstrating a predator acting as a paratenic host for the parasites of its prey.
To report two cases of laryngeal plasmablastic lymphoma, a rare and relatively recently described form of non-Hodgkin's lymphoma. It has not previously been described in the larynx, nor associated with upper airway obstruction.
We describe the clinicopathological features of two such cases in human immunodeficiency virus positive patients, and we discuss their unusual presentations and diagnostic features.
When evaluating a laryngeal tumour, plasmablastic lymphoma and other non-Hodgkin's lymphomata should be considered as differential diagnoses, particularly in the setting of a high prevalence of human immunodeficiency virus infection. Biopsy with detailed histopathological and immunohistochemical evaluation is recommended to ensure correct diagnosis and optimal management.
Cyathostomins are the most prevalent equine intestinal parasites and resistance has been reported in these nematodes against all 3 licensed anthelmintic classes. Strategies need to be developed that are less dependent upon drugs and more reliant on management-based control. To develop these we need to understand natural transmission patterns better. Here, we analysed longitudinal fecal egg count (FEC) data from 5 pony populations used for conservation purposes. We tested how egg excretion varied amongst populations and individuals, and how this was affected by age and climate. There was evidence for consistency in FECs over time at the individual level; this was generally weak and accounted for <10% of the total variance. Animals <5 years old had higher FECs and there was profound seasonal variation in FECs, with highest levels recorded in spring/summer. Effects of monthly temperature and rainfall explained most, but not all, of the observed seasonal variation and associations between climate measures and FECs were stronger in younger versus adult animals. One population was occasionally treated with anthelmintics and analysis of this population suggested that treatment substantially altered the seasonal dynamics. This paper highlights the variability in strongyle egg excretion amongst individuals and the factors involved in this variation.