Compliance of referral and hospital documentation with National Institute of Health and Care Excellence guidelines for the extraction of third molars: a comparative analysis of two NHS Trusts.

To find out whether documentation for the extraction of wisdom teeth complies with National Institute of Health and Care Excellence (NICE) guidelines, we reviewed the referral letters and hospital notes of patients treated at the maxillofacial unit of two NHS Trusts (A: 314 records and B: 280) over 12 months (1 September 2012 to 31 August 2013). Compliance was assessed as unsatisfactory ("indication for extraction not mentioned", "incorrect indication", "indication unclear") or satisfactory ("correct indication implied", "correct indication explicit"). The grade of the clinician who examined the patient was also recorded. A total of 194/314 (62%) referral letters in Trust A and 126/280 (45%) in Trust B were unsatisfactory (p<0.001). Hospital notes were unsatisfactory in 168/323 (52%) and 87/297 (29%) of cases, respectively (p<0.001). In Trust A, middle grades saw 23% (75/323) of the patients, as compared with 53% (157/297) in Trust B. In both, junior staff produced the highest percentage of satisfactory documentation, but in Trust A they were also responsible for most of the unsatisfactory examples. However, senior house officers saw 60% (195/323) of the patients in Trust A, and only 28% (83/297) in Trust B. Consultants were responsible for significantly more unsatisfactory documentation (p<0.001). One referral letter (0.2%) and seven hospital records (1%) explicitly and accurately complied with the guidelines. We conclude that compliance of documentation with the current NICE guidelines is poor and inconsistent.

Cellulose crystallites.

This article discusses advances in understanding the structural and physicochemical characteristics of suspensions of cellulose crystallites prepared by acid hydrolysis of natural cellulose fibres. Consideration of recent developments in visualization of crystallite ultrastructure may provide clues to suspension behavior. In addition, novel applications in a diverse range of fields are presented, from iridescent pigments to biomolecular NMR studies.

Comparison of a new foam mattress with the standard hospital mattress.

This study evaluates pressure ulcer incidence rates and comfort perceptions in 100 subjects admitted to a district general hospital. Subjects were divided into two groups, Group A using the standard hospital mattress (Transfoam), which had been in use in the hospital for three years, and Group B using the study mattress (Transfoamwave), which was new at the beginning of the trial. Due to the low observed incidence of pressure ulcers, it has not been possible to determine whether there is a difference in the clinical performance of the mattresses. Both appear to provide similar levels of comfort. Seat cushions were provided for each trial subject but staff failed to make good use of them, which suggests that more education is required in this area.

A randomised controlled trial of two pressure-reducing surfaces.

This randomised controlled trial of two dry-flotation pressure-reducing surfaces evaluates pressure sore incidence, patient comfort and the appropriate use of equipment in 100 orthopaedic patients. The trial involved five full Roho mattresses, five Sofflex mattresses and 10 Roho Quatro cushions to be used to complement the beds. Given the low rate of pressure sore incidence in this high-risk group it is not possible to determine whether there is any difference in effectiveness between the two mattresses. Both appear to provide similar levels of comfort, with the majority of patients finding them either comfortable or very comfortable. The initial setting of the equipment was, however, unsatisfactory.

A study of the performance of a pressure reducing foam mattress after three years of use.

This paper details the follow up clinical evaluation of a pressure reducing foam mattress (PRFM) three years after a randomised controlled trial. The PRFMs involved in the 1993 randomised controlled trial were used constantly for three years and recalled in 1996. In the original trial the control group had consisted of 18 standard NHS mattresses. In 1996 none of these mattresses were still in use which made it impossible to replicate the 1993 randomised controlled trial. Instead a clinical evaluation using the 1993 methods was carried out using the PRFMs only. Recruitment to the evaluation proved difficult because changes in clinical practice between the two studies had resulted in shorter lengths of stay in hospital for the target population. Comparison of the two outcome measures namely pressure sore incidence and the subjects' perception of comfort showed no statistically significant change between 1993 and 1996. With the exception of two damaged mattress covers all of the original foam components and covers remained in working order in 1996. During the time between the two studies, a pressure sore prevention programme was implemented within the research area. This programme has resulted in a year by year drop in the Directorate incidence rate. It is therefore not possible to attribute the low pressure sore incidence rate to the PRFMs alone. The results obtained suggest that the PRFMs appear to be providing a similar level of performance after three years of use.

A physiologically based pharmacokinetic model for methyl mercury in the pregnant rat and fetus.

Current methyl mercury (MeHg) guidelines for human exposure are not adequately protective against developmental effects in the children of women consuming MeHg-contaminated food. There is an urgent need to find ways to use human and/or animal studies of MeHg developmental toxicity to assess human health risk. To this end, a physiologically based pharmacokinetic model (PBPK) for methyl mercury in the pregnant rat and fetus has been developed. The cell membrane, blood-brain barrier, and the maternal/fetal placental membrane are the primary limitations to the distribution of MeHg in the pregnant rat and fetus. Individual fetal organs were modeled, including the fetal brain. Model results compare well with experimental data indicating that the model can be used to predict maternal or fetal organ MeHg concentrations for many dosing regimes. The model will allow the development of target organ (brain) dose-response relationships from studies of developmental toxicity in the rat which can be extrapolated to human physiology and used to develop exposure guidelines and standards that are protective against the MeHg exposure to the fetus.

Helicoidal self-ordering of cellulose microfibrils in aqueous suspension.

In many skeletal support systems of plants and animals, cellulose, chitin, and collagen occur in the form of microfibrils ordered in a chiral nematic fashion (helicoids). However, these structures remain poorly understood due to the many constituents present in biological tissues. Here we report an in vitro system that attracts by its simplicity. Only one chemical component, cellulose, is present in the form of fibrillar fragments dispersed in water. Above a critical concentration the colloidal dispersion separates spontaneously into a chiral nematic liquid crystalline phase. On drying this phase solidifies into regularly twisted fibrillar layers that mimic the structural organization of helicoids in nature.

Effects of zeranol-implantation periods on palatability of longissimus steaks from young bulls and steers.

Fifty-five fall-born, Simmental-crossbred, male calves were allotted at birth to one of five treatments: bulls castrated at 5 mo and implanted from birth to slaughter (ST); bulls implanted from birth to slaughter (BI-BS); bulls implanted from birth to weaning (BI-BW); bulls implanted from weaning to slaughter (BI-WS) and non-implanted control bulls (CB). Implanted calves received 36 mg of zeranol at approximately 100-d intervals. Calves were fed a high-concentrate diet from 8.1 mo of age to an average slaughter age of 17 mo. Longissimus steaks (LS) were evaluated for palatability traits by both a trained sensory panel (TSP) and a take-home consumer panel (CP). Conclusions from both panels were similar. The TSP found LS from ST to be juicier (P less than .05) than LS from all bull groups, and to be more tender (P less than .05) than LS from BI-BW and BI-WS. The CP found LS from ST to be juicier, more tender and more acceptable (P less than .05) than LS from BI-BW, BI-WS and CB. Steaks from BI-BS were more tender (P less than .05) than LS from BI-WS and CB. Steaks from BI-BS and BI-BW had lower (P less than .05) shear values than LS from CB, but LS from ST had lower (P less than .05) shear values than LS from all bull groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Implanting young bulls with zeranol from birth to four slaughter ages: III. Growth performance and endocrine aspects.

Seventy-two Simmental bull calves were assigned randomly either to a zeranol implanted (I) or nonimplanted (NI) control group. Within 3 d after birth, bulls assigned to the I treatment were implanted with 36 mg zeranol and reimplanted every 84 d until slaughter. Calves were weaned at 7.2 mo, preconditioned for 2 wk, and assigned within treatment to slaughter ages 12.0, 13.8, 15.7 and 17.4 mo. Blood samples were taken bimonthly from 8.3 to 16.6 mo of age. Weight gains, feed:gain ratios and slaughter and carcass weights were similar (P greater than .10) for I and NI bulls for the total feeding period. Weight gains for NI bulls were larger (P less than .05) from 7.7 to 9.5 mo and from 11.3 to 12.2 mo of age, whereas gains for I bulls were greater from 12.2 to 14.1 mo. Serum estradiol-17 beta (E2) and testosterone (T) concentrations were higher (P less than .05) for NI bulls at 8.3, 9.2, 10.2, 11.1, 12.1 and 13.0 mo. However, at 13.9 and 14.8 mo, E2 concentrations were higher (P less than .10) for I bulls. A similar, but nonsignificant (P greater than .10), trend was noted for T concentrations of I bulls at 13.9 and 14.8 mo. Rapid increases in E2 concentrations were observed from 8.3 to 9.2 mo in NI bulls, but from 12.1 to 13.9 mo in I bulls. Similarly, T concentrations increased rapidly from 8.3 to 10.2 mo in NI bulls, but from 12.1 to 14.8 mo in I bulls. Peak concentrations of T and E2 for NI bulls were observed near 11 and 13 mo, respectively, whereas peak T and E2 levels were delayed in I bulls until near 14 mo. Periods of greater weight gains for both NI and I bulls corresponded to rapidly increasing E2 and T concentrations. Serum thyroxine concentrations were lower (P less than .05) for I bulls at 13.9 mo but similar to NI bulls at all other ages. Serum insulin concentrations were higher (P less than .05) for I bulls than for NI bulls at 8.3, 10.2, 11.1 and 12.1 mo. Regardless of treatment, insulin concentrations increased with increasing age. Carcasses from I bulls were fatter (P less than .05) and tended (P = .09) to have smaller ribeye areas/100 kg carcass. Fat thicknesses for both treatments increased (P less than .05) from 13.8 to 15.7 mo. Skeletal maturity scores, 9-10-11th rib bone percentages and femur measurements indicated an increased skeletal maturation in I bulls.(ABSTRACT TRUNCATED AT 400 WORDS)

Implanting young bulls with zeranol from birth to four slaughter ages: I. Live measurements, behavior, masculinity and carcass characteristics.

Seventy-two Simmental bull calves were allotted randomly at birth to either a zeranol (Ralgro) implanted (I) treatment or a nonimplanted control (C) group. At birth, bulls assigned to the I treatment were implanted with 36 mg of zeranol and reimplanted at average intervals of 84 d until slaughter. Calves were weaned at 7.2 mo, preconditioned for 2 wk, and randomly assigned by treatment to slaughter ages of 12.0, 13.8, 15.7 and 17.4 mo and fed an 83% concentrate diet until slaughter. At 7.7 mo and all slaughter ages, live weights and hip heights were similar (P greater than .10), but I bulls had lower (P less than .05) masculinity scores than C bulls. Scrotal circumferences for I bulls were smaller (P less than .05) at 7.7, 12.0, 13.8 and 15.7 mo, but similar (P greater than .10) at 17.4 mo to C bulls. Behavioral observations of passive bunting, mounting attempts, facility rubbing and overall activity were less (P less than .05) for I bulls than C bulls from 12.0 to 13.8 mo but similar (P greater than .10) from 13.8 to 17.4 mo. Aggressive bunting was less (P less than .05) for I bulls during five of the seven observation times for the 12.0-to-13.8-mo period only. Slaughter and carcass weights and dressing percentages were similar (P greater than .10) for I and C bulls. Skeletal maturity and marbling scores, fat thicknesses, yield grades and 9-10-11th rib fat percentages were higher (P less than .05) and lean maturities, forehead hide weights, high dermis thicknesses, femur measurements and 9-10-11th rib bone weights and percentages were lower (P less than .05) for I than C bulls. Rib eye areas and carcass masculinity traits of jump muscle and crest of I bulls were less (P less than .05) at 13.8 mo but reached similar (P greater than .10) development to C bulls at 15.7 mo. Testicle weights of I bulls were lighter (P less than .05) at 12.0, 13.8 and 15.7 mo, but similar (P greater than .10) to C bulls at 17.4 mo. Growth traits (all weights plus hide and femur measurements) and maturation traits (skeletal and lean maturities, marbling scores, fat thicknesses and pizzle eye sizes) increased the most from 12.0 to 13.8 mo and 13.8 to 15.7 mo, respectively. We concluded that implanting young bulls with zeranol from birth to slaughter had minimal effects on live measurements, improved carcass desirability and delayed masculinity and behavioral development.

Ethylene oxide: evidence of human chromosomal effects.

Ethylene oxide is a known mutagen as indicated by short-term testing in vitro and in vivo. Occupational exposure can occur during ethylene oxide gas sterilization of materials for hospital and other use. To study the problem in a hospital sterilization facility where occupational exposure was suspected, epidemiologic, analytic and bioassay tools were employed. All persons whose work activities involved some aspect of the sterilization process were considered exposed to the gas. Within this group of symptomatic and asymptomatic individuals, chronic and incidental exposure was documented by clinical history. Sister chromatid exchanges were studied in lymphocytes cultured from exposed individuals as well as comparable controls. Four chronically exposed persons who reported upper respiratory and neurologic symptoms were studied in some detail. This group showed significantly increased sister chromatid exchange at three weeks and again at eight weeks after the last known exposure. Another group of eight persons with fewer complaints studied as late as the ninth week showed significantly increased exchanges. Incidental exposure may also increase sister chromatid exchange. The measured maximum concentration of ethylene oxide in the sterilizer room was 36 ppm (within standards set by the Occupational Safety and Health Administration).