Folliculogenesis, embryo parameters and post-transfer recipient pregnancy rate following equine follicle-stimulating hormone (eFSH) treatment in cycling donor mares.

BACKGROUND: Induction of multiple ovulations, or superovulation, may potentially increase the efficiency of equine embryo transfer programs. Our objective was to investigate the effects of equine follicle-stimulating hormone (eFSH) treatment on the success rate of embryo transfer programs in mares. METHODS: In the research facility of the University of Saskatchewan, Canada, we studied 12 donor mares and 37 recipient mares during the physiological breeding season. Donor mares were used in two consecutive oestrous cycles: the first served as the control cycle and in the second an eFSH regimen was applied (eFSH cycle). In the control cycle, mares were administered human chorionic gonadotropin (hCG) to induce ovulation when a follicle ≥35 mm in diameter was detected by transrectal ultrasonographic examination. In the second oestrous cycle, twice-daily eFSH treatment was initiated when a follicle ≥25 mm was detected and treatment ceased when a follicle ≥35 mm was present, at which time hCG was administered. All donor mares were artificially inseminated while in oestrus using fresh semen collected from a stallion of proven fertility. At 8 days post-ovulation, embryos were recovered transcervically and transferred individually to the uterus of a synchronised recipient mare. RESULTS: The eFSH treatment stimulated the ovary and resulted in greater numbers of ovulations and recovered embryos; however the recovered embryos tended to have a lower morphological grade than the control embryos, and the recipient pregnancy rate per transferred embryo was lower than anticipated. CONCLUSION: The numbers of recipient pregnancies and foals born that resulted from eFSH treatment were not different from the control.

Planning for chemical incidents by implementing a Delphi based consensus study.

This paper provides a practical approach to the difficulties surrounding planning for chemical incidents, based upon the results of a Delphi based consensus study. It is intended to offer advice, which can be implemented at regional and local prehospital and hospital level. The phases of the response that are covered include preparation, management of the incident, delivery of medical support during the incident, and recovery and support after the incident.

Delphi based consensus study into planning for chemical incidents.

OBJECTIVE: To achieve consensus in all phases of chemical incident planning and response. DESIGN: A three round Delphi study was conducted using a panel of 39 experts from specialties involved in the management of chemical incidents. Areas that did not reach consensus in the Delphi study were presented as synopsis statements for discussion in four syndicate groups at a conference hosted by the Department of Health Emergency Planning Co-ordination Unit. RESULTS: A total of 183 of 322 statements had reached consensus upon completion of the Delphi study. This represented 56.8% of the total number of statements. Of these, 148 reached consensus at >94% and 35 reached consensus at >89%. The results of the process are presented as a series of synopsis consensus statements that cover all phases of chemical incident planning and response. CONCLUSIONS: The use of a Delphi study and subsequent syndicate group discussions achieved consensus in aspects of all phases of chemical incident planning and response that can be translated into practical guidance for use at regional prehospital and hospital level. Additionally, areas of non-consensus have been identified where further work is required.

Rapid sequence induction in the emergency department: a strategy for failure.

BACKGROUND: Rapid sequence induction (RSI) is increasingly used by emergency physicians in the emergency department. A feared complication of the technique is the inability to intubate and subsequently ventilate the patient. Current drills based on anaesthetic practice may be unsuitable for use in the emergency department. OBJECTIVE: To construct a drill for failed adult intubation in the emergency department. METHODS: Literature review and consensus knowledge. RESULTS: A drill for failed adult intubation in the emergency department is given. SUMMARY: Failure to intubate following RSI in the emergency department is a feared complication. Practitioners must have a predetermined course of action to cope with this event. The guidelines presented here are tailored for use by the emergency physician.

What's the point of ST elevation?

OBJECTIVE: The magnitude of ST elevation is a key piece of information in the decision to thrombolyse in acute myocardial infarction. The ability of clinicians to reliably identify ST elevation has not been previously assessed. This study sought to determine the variability in assessment of ST elevation in a group of doctors who commonly prescribe thrombolysis. METHODS: The study was conducted in three large teaching hospitals in Manchester, England. A convenience sample of 63 SHOs and SpRs from emergency and general medicine were recruited. Each was shown three sample ECG complexes. They were asked to identify and quantify the degree of ST elevation. They then indicated the points on the ECG from which they measured ST elevation. RESULTS: ST elevation was not identified in 12% of cases. Doctors used a wide variety of points on the ST segment to assess elevation, this resulted in a wide variation in the observed magnitude of ST elevation. CONCLUSION: No guidance exists on where exactly ST elevation should be measured. This study shows a wide variation in practice. Protocol led thrombolysis decision pathways may be compromised by these findings.

Assessment of the pain of blood-sugar testing: a randomised controlled trial.

Lancet puncture to the side of the thumb resulted in less pain than lancet puncture to the finger or venepuncture at the elbow. Success rates were the same.

Delphi study into planning for care of children in major incidents.

This paper describes a Delphi study used to identify and improve areas of concern in the planning of care for children in major incidents. The Delphi was conducted over three rounds and used a multidisciplinary panel of 22 experts. Experts were selected to include major incident, immediate care, emergency medicine, and paediatric specialists. This paper presents a series of consensus statements that represent the Delphi group's opinion on the management of children in major incidents. The statements cover all phases of major incident planning and response. Paediatric services may play a vital role in the preparation and response to a major incident involving children. This paper represents a consensus view on how best to plan and respond to major incidents involving children. An accompanying paper describes the practical implementation of this guidance.

Planning for major incidents involving children by implementing a Delphi study.

This paper provides a practical approach to the difficult problem of planning for a major incident involving children. It offers guidance on how general principles resulting from an expert Delphi study can be implemented regionally and locally. All phases of the response are covered including preparation, management of the incident, delivery of medical support during the incident, and recovery and support. A check list for regional planners is provided. Supplementary equipment is discussed and action cards for key roles in the paediatric hospital response are shown. Particular emphasis is placed on management of the secondary-tertiary interface including the special roles of paediatric assessment teams and paediatric transfer teams. A paediatric primary triage algorithm is provided. The important role of local interpretation of guidance is emphasised.

The casualty profile from the Manchester bombing 1996: a proposal for the construction and dissemination of casualty profiles from major incidents.

OBJECTIVE: To produce a casualty profile for the Manchester bombing and to illustrate the potential uses of such templates in major incident planning. METHODS: A retrospective review of casualty notes from the Manchester bombing. RESULTS: A complete anonymous casualty profile for the Manchester bombing is given with AIS90 coded injuries. The majority (129, 62%) of casualties sustained minor injuries from flying glass. A significant number of casualties (36, 18%) presented with emotional distress or medical problems. A wide age range of casualties was involved. Few patients (19, 9%) required admission to hospital. There were no deaths and no casualties sustained major trauma. CONCLUSIONS: Casualty profiles may be useful in the planning and testing of health service major incident plans. Such information should be easily accessible to all emergency planners.

Reoperation after coronary bypass grafting.

Coronary artery bypass grafting is one of the most commonly performed surgical procedures in the western world, and myocardial revascularization during the first operation is well established. But patients are now surviving beyond the patency of their primary grafts. Repeat myocardial revascularization can be performed successfully in patients who have adequate ventricular function and graftable distal vessels.