Intra-articular treatment with triamcinolone compared with triamcinolone with hyaluronate: A randomised open-label multicentre clinical trial in 80 lame horses.

REASONS FOR PERFORMING STUDY: Intra-articular (IA) injection of corticosteroids with or without hyaluronate (HA) has been used for decades in equine practice for treatment of noninfectious synovitis and osteoarthritis. However, to date, no large-scale randomised equine field trials have been reported that address the supposed superior clinical efficacy of the combination of corticosteroid + HA compared with IA injection of corticosteroid alone. OBJECTIVES: To compare the clinical efficacy of IA triamcinolone acetonide (TA, 12 mg) compared with IA TA (12 mg) + high molecular weight HA (20 mg) in horses with clinical joint disease. STUDY DESIGN: Prospective, randomised, parallel, open label, multicentre clinical trial. METHODS: Eighty client-owned horses from 13 clinics were included. Lameness and effusion scores were assessed at baseline and 3 weeks after IA treatment. A standardised telephone questionnaire was completed between the owner and consulting veterinarian at 3 months. The primary outcome parameter was clinical success rate, defined as ≥2 grades lameness reduction (on a 0-5 scale) at 3 weeks. Chi-square statistics and binary logistic regression were used to analyse data on an intention-to-treat basis for the 3 week outcome. RESULTS: The success rate of IA TA 3 weeks after treatment was 87.8%, while that of TA+HA was 64.1% (P = 0.01). Age >13 years was associated with a reduced success rate for the combination treatment (P = 0.004) at 3 weeks. At 3 months, half the horses in each group had returned to their previous level of performance. CONCLUSIONS: The combination of TA with HA was associated with a lower short-term clinical success rate and a similar medium-term outcome compared with IA TA, with only half of the horses performing at their previous level of exercise after 3 months regardless of treatment group allocation.

Determinants of quality of life in first-episode psychosis.

OBJECTIVE: To assess patient and/or illness characteristics associated with aspects of quality of life (QOL) in first-episode psychosis (FEP). METHOD: Patient characteristics, symptom ratings and Wisconsin QOL scale (client version) were assessed. Data were analysed with correlation coefficients and a hierarchical regression analysis. RESULTS: Patients presented with varying levels of QOL on different domains. The level of 'general satisfaction' was related to age of onset and social premorbid adjustment; 'weighted index of QOL' to social premorbid adjustment and inversely to educational premorbid adjustment; 'social relations' inversely to duration of untreated psychosis (DUP), length of prodrome and negative symptoms; 'psychological well-being' inversely to depression and educational premorbid adjustment; 'activities of daily living' to social premorbid adjustment and inversely to negative symptoms; and 'outlook on symptoms' to level of depression. CONCLUSION: Domains of self-rated QOL in FEP patients are differentially associated with malleable and non-malleable aspects of patient and illness characteristics.

Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale.

An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.

Student civility in nursing programs: a national survey.

A survey of 611 nursing programs was performed to determine the extent to which certain problematic student behaviors existed in schools of nursing, and how they were being addressed. Participants were also asked about specific behaviors of current students compared with those of 5 years ago. Of the 611 surveys sent to program directors, 2 were undeliverable and 409 responded for a response rate of 67 per cent. The majority of respondents (48.8 per cent) were from associate degree programs, followed by baccalaureate degree (43.9 per cent), and diploma programs (7 per cent). Three disruptive behaviors were identified by all respondents: inattentiveness in class, attendance problems, and lateness. Objectionable physical contact between students and instructors were identified by 24.8 per cent, and verbal abuse toward instructors in the clinical setting by 42.8 per cent. Demographic variables examined in terms of their relationship to the behaviors included type of program, nursing program size, size of the parent institution, geographic region, location of program, and sponsorship of program. Administrators in different types of educational programs and from various geographic locations reported problematic student behaviors with high frequency. Identifying strategies for handling disruptive behaviors and assistance in implementing them is recommended along with a national forum to discuss the issue.

Genetics and nursing: the interface in education, research, and practice.

Genetics is affecting all of health care, including nursing. The way in which nurses think about planning health care must be seen now through a "genetic eye" or lens, and nurses must learn to "think genetically." While efforts to integrate genetics into nursing began in earnest in the early 1980s, this effort did not accelerate until the mid-1990s. Before nursing can fully incorporate genetic knowledge into education and practice in a meaningful way, the ways in which genetics will influence health care must be understood. The basic knowledge, skills, and attitudes needed by health professionals are discussed as well as their integration into education and practice. Opportunities for nursing research in genetics are presented as are possible directions. Recommendations for facilitating the integration of genetics into nursing education, practice, and research are also presented.

Genetics in nursing education.

The discoveries stimulated by the human genome project have changed the way health and disease are thought about. In practice, health care professionals are responsible for the application of this knowledge. Guiding principles regarding genetics and health care lead to the knowledge nurses need, roles for nurses in relation to genetics, what knowledge is needed in nursing curricula, how to include the relevant information, and suggested approaches for inclusion despite barriers.

Disclosing the diagnosis of pediatric HIV infection: mothers' views.

ISSUES AND PURPOSE: The stigma of HIV infection creates barriers to disclosure. The purpose of this study was to identify to whom biological and foster mothers disclose the diagnosis of HIV infection, discuss their rationale, and describe the recipient's reactions. DESIGN AND METHODS: A descriptive, qualitative study included biological (n = 9) and foster (n = 11) mothers of children with HIV infection. RESULTS: Three themes emerged from the data: Telling for support, determining who should know, and telling children. These themes were present for both biological and foster mothers. PRACTICE IMPLICATIONS: It is important for nurses to realize that parental disclosure of the diagnosis of HIV infection is a long-term, age-appropriate process that will take place over many discussions and time, and should have the support of the interdisciplinary team. Additional psychological support also should be available.

Topical capsaicin in the management of HIV-associated peripheral neuropathy.

Distal symmetrical peripheral neuropathy (DSPN) is a particularly distressing pain syndrome associated with human immunodeficiency virus (HIV) disease. Capsaicin has been found to be effective in relieving pain associated with other neuropathic pain syndromes, and is mentioned as a possible topical adjuvant analgesic for the relief of DSPN. This multicenter, controlled, randomized, double-masked clinical trial studied patients with HIV-associated DSPN and compared measures of pain intensity, pain relief, sensory perception, quality of life, mood, and function for patients who received topical capsaicin to the corresponding measures for patients who received the vehicle only. Twenty-six subjects were enrolled in the study. At the end of 1 week, subjects receiving capsaicin tended to report higher current pain scores than did subjects receiving the vehicle (Mann-Whitney test; P = 0.042). The dropout rate was higher for the capsaicin group (67%) than for the vehicle group (18%) (chi 2 test of association; P = 0.014). There were no other statistically significant differences between the capsaicin and vehicle groups with respect to current pain, worst pain, pain relief, sensory perception, quality of life, mood, or function at study entry or at any time during the 4-week trial. These results suggest capsaicin is ineffective in relieving pain associated with HIV-associated DSPN.

Genetic testing, screening, and counseling issues in cardiovascular disease.

Genetic risk assessment for cardiovascular disease is less advanced and less widely performed to date than it is for cancer. Yet it is no less important. Alert clinicians should "think genetically" and follow up appropriately when confronted with a client having a family history of heart disease, early heart disease themselves, a known genetic disorder in which cardiac problems may be a component, or signs and symptoms indicative of a familial component to the heart problem observed. It is important for the clinician to know how, when, and to whom referral for further genetic evaluation and counseling should be made. Genetic testing and screening in children or adolescents for conditions such as hypertrophic cardiomyopathy (HCM), familial hypercholesterolemia (FH), and long QT (LQT) syndrome, when indicated, can help to save lives through preventive treatment and therapeutic interventions. Preparticipation sports physicals are one means of providing such screening and are important to conduct properly under guidelines recommended by the American Heart Association. Genetic testing for relatives of persons already identified to have heritable cardiac conditions is becoming more and more integral to mainstream primary health care but engender controversy when testing of children is involved. Clinicians must know how to interpret the results of such tests. Appropriate genetic counseling must accompany risk assessment, genetic testing, and screening for cardiovascular disease.

Closure of a septal perforation by means of an obturator.

The surgical closure of a naso-septal perforation is accompanied by many problems which can interfere with the good result. The authors describe a technique by which a naso-septal perforation can be closed by placing an obturator without performing any surgery.