Survey of ultrasound practice amongst podiatrists in the UK.

BACKGROUND: Ultrasound in podiatry practice encompasses musculoskeletal ultrasound imaging, vascular hand-held Doppler ultrasound and therapeutic ultrasound. Sonography practice is not regulated by the Health and Care Professions Council (HCPC), with no requirement to hold a formal qualification. The College of Podiatry does not currently define ultrasound training and competencies.This study aimed to determine the current use of ultrasound, training received and mentorship received and/or provided by podiatrists using ultrasound. METHODS: A quantitative study utilising a cross-sectional, on-line, single-event survey was undertaken within the UK. RESULTS: Completed surveys were received from 284 podiatrists; 173 (70%) use ultrasound as part of their general practice, 139 (49%) for musculoskeletal problems, 131 (46%) for vascular assessment and 39 (14%) to support their surgical practice. Almost a quarter (n = 62) worked for more than one organisation; 202 (71%) were employed by the NHS and/or private sector (n = 118, 41%).Nearly all (93%) respondents report using a hand-held vascular Doppler in their daily practice; 216 (82%) to support decisions regarding treatment options, 102 (39%) to provide diagnostic reports for other health professionals, and 34 (13%) to guide nerve blocks.Ultrasound imaging was used by 104 (37%) respondents primarily to aid clinical decision making (n = 81) and guide interventions (steroid injections n = 67; nerve blocks n = 39). Ninety-three percent stated they use ultrasound imaging to treat their own patients, while others scan at the request of other podiatrists (n = 28) or health professionals (n = 18). Few use ultrasound imaging for research (n = 7) or education (n = 2).Only 32 (11%) respondents (n = 20 private sector) use therapeutic ultrasound to treat patients presenting with musculoskeletal complaints, namely tendon pathologies.Few respondents (18%) had completed formal post-graduate CASE (Consortium for the Accreditation of Sonographic Education) accredited ultrasound courses.Forty (14%) respondents receive ultrasound mentorship; the majority from fellow podiatrists (n = 17) or medical colleagues (n = 15). Over half (n = 127) who do not have ultrasound mentorship indicated they would like a mentor predominantly for ultrasound imaging. Fifty-five (19%) report they currently provide ultrasound mentorship for others. CONCLUSIONS: Understanding the scope of ultrasound practice, the training undertaken and the requirements for mentorship will underpin the development of competencies and recommendations defined by the College of Podiatry to support professional development and ensure safe practice.

VKORC1 sequence variants associated with resistance to anticoagulant rodenticides in Irish populations of Rattus norvegicus and Mus musculus domesticus.

While resistance to anticoagulant rodenticides is known to occur in many European populations of Norway rat and house mouse, to-date no data is available on the occurrence in Ireland of such resistance. No genetic evidence for the occurrence of resistance was found in 65 Norway rat samples analysed, indicative of an absence, or low prevalence, of resistance in rats in at least the Eastern region of the island of Ireland. The presence of two of the most commonly found amino acid substitutions Leu128Ser and Tyr139Cys associated with house mouse resistance to anticoagulant rodenticides was confirmed. The occurrence of two such mutations is indicative of the occurrence of resistance to anticoagulant rodenticides in house mice in the Eastern region of the island of Ireland.

Influenza D Virus in Cattle, Ireland.

We detected influenza D virus in 18 nasal swab samples from cattle in Ireland that were clinically diagnosed with respiratory disease. Specimens were obtained from archived samples received for routine diagnosis during 2014-2016. Sequencing showed that viruses from Ireland clustered with virus sequences obtained in Europe within the D/swine/OK/1334/2011 clade.

A step forward in molecular diagnostics of lyssaviruses--results of a ring trial among European laboratories.

Rabies is a lethal and notifiable zoonotic disease for which diagnostics have to meet the highest standards. In recent years, an evolution was especially seen in molecular diagnostics with a wide variety of different detection methods published. Therefore, a first international ring trial specifically designed on the use of reverse transcription polymerase chain reaction (RT-PCR) for detection of lyssavirus genomic RNA was organized. The trial focussed on assessment and comparison of the performance of conventional and real-time assays. In total, 16 European laboratories participated. All participants were asked to investigate a panel of defined lyssavirus RNAs, consisting of Rabies virus (RABV) and European bat lyssavirus 1 and 2 (EBLV-1 and -2) RNA samples, with systems available in their laboratory. The ring trial allowed the important conclusion that conventional RT-PCR assays were really robust assays tested with a high concordance between different laboratories and assays. The real-time RT-PCR system by Wakeley et al. (2005) in combination with an intercalating dye, and the combined version by Hoffmann and co-workers (2010) showed good sensitivity for the detection of all RABV samples included in this test panel. Furthermore, all used EBLV-specific assays, real-time RT-PCRs as well as conventional RT-PCR systems, were shown to be suitable for a reliable detection of EBLVs. It has to be mentioned that differences were seen in the performance between both the individual RT-PCR systems and the laboratories. Laboratories which used more than one molecular assay for testing the sample panel always concluded a correct sample result. Due to the markedly high genetic diversity of lyssaviruses, the application of different assays in diagnostics is needed to achieve a maximum of diagnostic accuracy. To improve the knowledge about the diagnostic performance proficiency testing at an international level is recommended before using lyssavirus molecular diagnostics e.g. for confirmatory testing.

The university/community partnership: transdisciplinary course development.

This paper describes the process of expanding the knowledge base and clinical practice for students in professional preparation programs in social work, nursing and education. Through a partnership of university faculty and administrators of a private school for students with learning and behavior problems, a transdisciplinary course was designed to address the need for providing future professionals an opportunity to understand multiple perspectives in the design of clinical interventions.The process of defining the course content, identifying appropriate required reading, and building connections to field work was a collaborative effort and less problematic than the logistics of implementation. Negotiating the administrative barriers to interprofessional collaboration involving curriculum innovation was more challenging. Discussion also includes the need for a shared vision and responsibility for improving practice, the practical implications of university funding and the benefits and challenges of transforming current treatment paradigms into one focused on interprofessional care.

Dermojet delivery of bleomycin for the treatment of recalcitrant plantar warts.

BACKGROUND: Plantar warts may cause significant morbidity. Intralesional bleomycin is effective. When bleomycin is injected with a needle and syringe, it is difficult to prevent the bleomycin from infiltrating the dermis adjacent to the wart, producing unnecessary acute pain, persistent pain, and potential sloughing of normal adjacent skin. Efficacy of delivery by dermojet is not yet established. OBJECTIVES: To assess the response of recalcitrant plantar warts to bleomycin delivered by dermojet. METHODS: A total of 47 patients with 138 plantar warts present for more than 2 years and resistant to 10 cycles of cryosurgery, were recruited. Bleomycin (1 U/ml) was delivered intralesionally by dermojet at 5-week intervals for 25 weeks. RESULTS: Out of 138, 124 (89.9%) plantar warts showed complete or partial clearance after one to five sets of bleomycin injections. The recurrence rate was 6/138 (4.4%), and 8/138 (5.8%) warts failed to clear. The reduction in mean surface area of the plantar warts after each set of bleomycin injections compared to baseline surface area was statistically significant. Local side effects were similar to other methods of delivery. No systemic side effects were reported. CONCLUSIONS: This study assesses therapeutic efficacy of bleomycin delivered by dermojet in solely recalcitrant plantar warts. It provides preliminary evidence that this method of delivery may benefit a group of patients with particularly recalcitrant plantar warts and is safe and easy to use in routine dermatology practice.

Characterisation of an Irish caprine lentivirus strain--SRLV phylogeny revisited.

Small ruminant lentiviruses (SRLV), i.e. caprine arthritis-encephalitis virus (CAEV) (which infects goats) and maedi-visna virus (MVV) (which infects sheep) are two closely related lentiviruses but the relationship between goat and sheep lentiviruses has not been clearly established. To better understand their genetic relationship, we reinvestigated the phylogeny of SRLV using new sequences from an Irish and a Norwegian strain together with sequences available from databases. The phylogenetic analyses were carried out on the gag, pol and env fragments using four methods: neighbor-joining (NJ), Fitch and Margoliash (Fitch), Fitch and Wagner parsimony (Pars) and maximum likelihood (ML). The tree topologies were consistent whether derived from any of the four methods or any of the gene fragments, but the phylogenetic analyses in the pol and env regions were more informative than in the gag region. The Tamura-Nei model with variable rates across sites (described by a gamma distribution) provides a more accurate description of SRLV evolution than simple methods. The newly described Irish lentivirus strain, which was isolated from a goat, was closely related to the lentivirus that infects sheep: MVV. The novel Norwegian CAEV strain belonged to a cluster specific to the CAEV strains from Norway. Together, both data confirm the previously reported subdivision of the different SRLV strains into six clades. The caprine and ovine lentivirus sequences are interspersed in phylogenetic trees, supporting the existence of cross-species transmission. Nevertheless, the transmission of an ovine lentivirus to a goat could trigger the emergence of some goat-adapted phylums. Our new sequences confirm the complex situation in SRLV phylogeny but more sequences are needed to elucidate more precisely the relationship between SRLV.