Evaluation of a biocide footbath solution in the occurrence and healing of digital dermatitis lesions in dairy cows: A clinical trial.

The objective of this study was to evaluate the effect of the implementation of different footbathing practices using a new biocide solution (Pink-Step™, Qalian, France) in the healing and the occurrence of bovine digital dermatitis (bDD) lesions. The investigation was conducted through a controlled within cow clinical trial in which the hind feet of cows from each farm were allocated either to the control group or to a moderate (MR) or (IR) intensive footbath-regimen groups. The trial involved 1036 cows (2072 feet) from 10 dairy farms located in western France where bDD was endemic. Split-footbaths were placed at the exit of the milking parlor of each farm, allowing the biocide to be administered to one side of the cows while using the other empty side as a negative control. The administration frequency for MR was of 2 days/week/1st-month, then 2 days/2 weeks/2nd-month, and then 2 days/month, and for IR was of 2 days/week/1st-2nd months, and then 2 days/2 weeks. Footbaths were administered during 140 days (approx.), and feet were evaluated for the at least once a month in the milking parlor. Nested survival models were used to estimate the relative impact of the footbath regimens and other concomitant risk factors on the time that bDD lesions occurred or healed. No effect of Pink-Step™ was evidenced on the bDD occurrence during the trial. The risk for bDD occurrence was increased by poor feet cleanliness at both the cow (HR 1.69, CI 1.21-2.39) and farm level (HR 2.06, CI 1.44-2.94). Otherwise, the use of Pink-Step™ in an IR was effective in improving the healing of bDD lesions (HR 1.79, CI 1.12-2.88). The time to healing was also improved in inactive lesions (HR 2.19, CI 1.42-3.37). Conversely, the time to healing was delayed in feet receiving hoof-trimming (HR 0.41, CI 0.26-0.62), in cows with a contralateral bDD lesion (HR 0.32, CI 0.22-0.46) or in late lactation (HR 0.61, CI 0.43-0.85), and finally in farms with more than 100 cows (HR 0.48, CI 0.34-0.67). These findings reinforce the crucial role of hygiene in bDD dynamics and highlight the importance of implementing multiple control measures simultaneously, such as hygiene improvements in the barn, early detection and treatment of bDD lesions and the correct usage of individual and collective treatments. The implementation of Pink-Step™ represents a promising strategy for reducing the persistence of bDD lesions in affected herds.

Current recommendations for footbath solutions renewal rates in dairy cattle: the need for adaptation?

Footbaths represent a potentially useful strategy for the prevention of claw infectious diseases by treating a large number of animals concomitantly. Nevertheless, under field conditions, footbath solutions are exposed to increasing number of animal passages and therefore, to different volume losses and concentrations of manure contamination which could alter their presumed bactericidal activity. Across increasing number of cow passages, the organic matter (OM) concentration, the microbial load (ML) and the residual volumes were assessed in six commercial farms. The results indicate that the OM concentration and ML increased linearly with the number of passages of animals, and with the number of defecations in the footbath. The OM concentrations and the ML were not impacted by the farm's feet hygiene status (clean, fair and dirty), suggesting that probably the increasing number of cow passages and defecations influenced more the contamination of footbaths than the hygiene of the feet. In all the farms the volumes decreased drastically after 200 cow passages (50%). The OM concentrations after 150 and 200 cow passages did not exceed the regulatory concentrations in which disinfectant products should demonstrate to still be effective (20 g/l), and coincide with the often advised renewal rates. The findings of this study suggested that beyond the footbath contamination by OM, the renewal rates must be mainly adapted according to the remaining volume to guarantee that the entire foot is covered and therefore assure the topical action of the solution. This study highlights the importance of footbath designs for the successful implementation of these strategies in practice.

The nature of advanced practice nursing.

In attempting to define "advanced practice," we argue that nursing as such is teleological or goal-directed with those goals being defined by the patient or client in interaction with the nurse. In helping the patient meet identified goals, the nurse requires 2 kinds of knowledge-general and particular. General includes theory (know what/why), pattern recognition (know what), and practical knowledge (know how). Particular (know who) is personal knowledge about the patient. The advanced practice nurse, by virtue of graduate education, is able to move beyond the familiar and experientially learned. He or she makes a deliberate attempt to situate self in a dialectic between general and particular knowledge in such a way that the interplay opens possibilities. Knowing when a particular action would be most helpful is defined as practical wisdom. We argue that a highly developed sense of practical wisdom is the hallmark of advanced practice.

Doctors' and nurses' perceptions of ethical problems in end-of-life decisions.

AIMS: To identify and compare doctors' and nurses' perceptions of ethical problems. Rationale. Ethical problems are a source of tension for health professionals. Misunderstandings or conflicts may result from differing perceptions of ethical problems. If true collaboration is to be achieved, it is important to understand the perspectives of others, particularly when difficult end-of-life decisions must be made. METHODS: In this qualitative study a total of seven doctors and 14 nurses working in acute care adult medical-surgical areas, including intensive care, were asked to describe ethical problems that they frequently encounter in practice. Interviews were taped and transcribed. Thematic analysis followed. RESULTS: All participants experienced ethical problems around decision making at the end of life. The core problem for both doctors and nurses was witnessing suffering, which engendered a moral obligation to reduce that suffering. Uncertainty about the best course of action for the patient and family was a source of moral distress. Competing values, hierarchical processes, scarce resources, and communication emerged as common themes. The key difference between the groups was that doctors are responsible for making decisions and nurses must live with these decisions. Each group, therefore, asked different questions when encountering and interpreting sources of moral distress. CONCLUSIONS: It was concluded that observed differences between doctors and nurses were a function of the professional role played by each rather than differences in ethical reasoning or moral motivation. Although this was a small qualitative study on one institution, and may not be generalizable, results suggest that doctors and nurses need to engage in moral discourse to understand and support the ethical burden carried by the other. Administrators should provide opportunities for discourse to help staff reduce moral distress and generate creative strategies for dealing with this.

Effects of conflict resolution training integrated into a kindergarten curriculum.

The effectiveness of a conflict resolution training program was examined in an American midwestern suburban elementary school. Participants were 80 kindergartners randomly assigned to an experimental or control condition in morning or afternoon time blocks. Children in the experimental condition received 9 hr of conflict resolution training integrated into a curriculum unit on friendship taught daily for 4 consecutive weeks. Children in the control condition were taught the identical friendship unit for the same period of time without conflict resolution training. Teachers rotated equally across conditions. Significant differences between trained and untrained children occurred in their knowledge and retention of the conflict resolution procedure, willingness and ability to use the procedure in conflict situations, and conceptual understanding of friendship.

Hemin-dependent growth and hemin binding of Bartonella henselae.

Bartonella henselae causes cat-scratch disease and bacillary angiomatosis peliosis. The bacteria reside in erythrocytes of asymptomatic cats, which represent the natural reservoir for this pathogen. B. henselae is usually grown on blood-enriched media. Growth experiments on Brucella medium without blood demonstrated that heme compounds are essential for the growth of B. henselae and can completely substitute the addition of blood components. The heme precursor protoporphyrin IX alone, or in combination with FeCl(2) or FeCl(3), as well as transferrin or lactoferrin did not support growth, indicating that B. henselae cannot synthesize heme itself. Hemin supported growth even when free iron was chelated, indicating that hemin is also used as an iron source. Binding assays showed that hemin starvation increased the binding capacity of B. henselae for hemin, providing evidence that the bacteria carry a specific hemin uptake system, which might be regulated by hemin.

Ethical issues in public health nursing.

This qualitative study was designed to explore ethical issues in public health nursing in the Canadian context, and to begin to identify strategies to support ethical practice. Twenty-two public health nurses, 11 in rural and 11 in urban settings, were asked to describe ethical problems they had experienced in the course of their work. These participants most often described situations that required a relational response rather than an active choice between options. Their goal was to optimize the good, while at the same time maintaining a supportive relationship. Analysis revealed five interrelated themes, each with several subthemes: relationships with health care professionals; systems issues; character of relationships; respect for persons; and putting self at risk. It was clear that all aspects of public health nursing have ethical components.

Development of an instrument to investigate parents' perceptions of research with newborn babies.

Neonatal intensive care nurses are often involved in research protocols as investigators, research assistants or staff nurses implementing the protocol and providing support and explanations to families. It is important, therefore, that nurses have information about parents' understanding of and attitudes towards the research process. The purpose of this study was to begin an exploration of parents' perceptions about research with newborn babies through the development and validation of a survey instrument. The questionnaire included: demographic questions; scaled items about research with newborn babies; scenarios describing research studies that varied in degree of risk and benefit to the newborn baby; questions about parents' willingness to enrol their newborn baby in the studies described; and questions regarding circumstances under which consent should be sought. Content and face validity were established by an expert panel and a pilot test conducted with a small group of health care professionals and lay persons. A convenience sample of 231 parents of newborn babies completed the final version of the questionnaire. Factor analysis revealed seven factors corresponding to issues identified in the literature, providing evidence of construct validity. Parents appeared to have no difficulty in completing the instrument and all questions were answered by the majority of participants. It was concluded that the questionnaire had adequate psychometric properties and that a mixed method approach can be fruitful in exploring sensitive issues.

Seroprevalence of antibodies to Bartonella henselae in patients with cat scratch disease and in healthy controls: evaluation and comparison of two commercial serological tests.

Serologic testing for the presence of antibodies to Bartonella henselae is a widely accepted diagnostic procedure for laboratory confirmation of the diagnosis of cat scratch disease (CSD). In this study a commercially available indirect immunofluorescence assay (IFA) based on B. henselae-infected human larynx carcinoma cells (test A) was evaluated. Sera from 42 patients with CSD (20 confirmed by PCR) and 270 sera from healthy controls (consisting of 63 cat owners, 65 individuals whose last close contact with cats was >6 months previously, and 142 persons who had never been exposed to cats) were investigated for antibodies to B. henselae. All patients with CSD had titers of immunoglobulin G (IgG) to B. henselae of 128 or higher (test A; sensitivity, 100%). Of the 270 controls 189 (70%) were seronegative (titer, <64), 38 (14.1%) had titers of 64, 30 (11.1%) had titers of 128, 9 (3.3%) had titers of 256, and 4 (1.5%) had high titers, 512 (test A; specificity, 70%). Of the cat owners and individuals who had never had close contact with cats, 71.4 and 71.12%, respectively, were seronegative, and titers of 64, 128, 256, and 512 were found in 14.3 and 16.2%, 1.6 and 10.5%, 9.5 and 0.7%, and 3.2 and 1.4%, respectively. The sera from the patients and from the first 100 healthy adults without a history of close contact with cats were additionally tested with a second commercially available IFA, based on Vero cells infected with B. henselae and Bartonella quintana (test B). The sensitivity and specificity of test B were 93 and 73%, respectively. For patients with CSD the cross-reactivity between B. henselae and B. quintana in this test was 95%. Both systems are highly sensitive but less specific for detection of IgG antibodies to B. henselae in samples from patients with clinically apparent CSD. For detection of IgM antibodies, test A seems to be more sensitive (88%) and more specific (95%) than test B (sensitivity and specificity of 64 and 86%, respectively). The data show that the seroprevalence of antibodies to B. henselae in German individuals is high (30%). Low antibody levels are not sufficient evidence of active or prior infection.

Cardiovascular risk screening for women.

Cardiovascular disease is the leading cause of death of both men and women in Canada and the United States. The medical and societal emphasis on the occurrence of cardiovascular disease in men has resulted in an inclination to minimize its existence and severity in women. The purpose of this article is to assist clinical nurse specialists in cardiovascular risk-screening of women by providing a review of cardiovascular risk factors specific to women. Current knowledge about lipids, hypertension, diabetes, smoking, menopause, obesity, sedentary lifestyle, stress, and multiple roles are discussed. The clinical presentation for women and the clinical implications are presented. Lastly, implications for future research are described.

Augmentation mammoplasty: a complex choice.

Augmentation mammoplasty is a surgical procedure with known risks and complications. Despite this, millions of women have opted to undergo the procedure. With the recent publicity surrounding this procedure, and the current concern about long-term side effects, the rationale behind women's choice has been questioned. Often, health care professionals are less than empathetic when a women complains about experiencing complications. This attitude seems to "blame the victim." We examine the complex psychological and sociological factors behind a woman's decision to have her breasts enlarged artificially. It is our hope that the information presented herein will contribute to a better understanding and more compassionate care of women who have breast augmentation surgery.

Are outbreaks and sporadic respiratory infections by Mycoplasma pneumoniae due to two distinct subtypes?

Thirty-seven clinical isolates of Mycoplasma pneumoniae, cultured from patients' respiratory material between 1986 and 1994, were typed by immunological methods and by polymerase chain reaction (PCR). For immunological typing two monoclonal antibodies (mAb) were used that recognized the P1 adhesion of Mycoplasma pneumoniae strain FH but differed in their ability to inhibit the adherence of Mycoplasma pneumoniae to erythrocytes. The mAb P1.58, which was not able to inhibit adherence, showed reactions with all patients' isolates in immunoblots, whereas the adherence-inhibiting mAb P1.62 reacted with only seven patients' isolates. Due to variations within the P1-adhesin genome of Mycoplasma pneumoniae group 1 (Mycoplasma pneumoniae type strain M129) and group 2 (Mycoplasma pneumoniae type strain FH), two primer sets were designed. According to the size of the PCR-amplification products, all clinical isolates that showed no mAb P1.62 reactivity belonged to Mycoplasma pneumoniae group 1, whereas mAb P1.62-positive-reacting mycoplasma isolates were characterized as group 2 strains. During an outbreak of Mycoplasma pneumoniae diseases in 1992, all 19 clinical isolates showed no cross-reactivity in immunoblots with the mAb P1.62 and were typed by PCR as Mycoplasma pneumoniae group 1 strains. Furthermore, 206 Mycoplasma pneumoniae complement fixation test-positive patient sera (titer > 1:40) from the study period were tested for adherence-inhibiting antibodies towards both type strains. Thirty-two sera showed adherence-inhibiting antibodies towards group 1 and 22 towards group 2 mycoplasmas. In only seven sera were adherence-inhibiting antibodies directed to both Mycoplasma pneumoniae groups. The serological data of the outbreak in 1992 revealed that patients with Mycoplasma pneumoniae group 1 infections developed adherence-inhibiting antibodies more frequently than did patients infected with group 2, which might have implications for the pathogenesis of Mycoplasma pneumoniae diseases and subsequent infections.

Measuring nurses' moral reasoning.

The purpose of this exploratory study was to examine the possibility of designing a satisfactory method, using written responses to hypothetical scenarios, for evaluating the quality of moral reasoning in student nurses. Scenarios were developed from interviews with practising nurses. Nurses and student nurses provided written responses to the scenarios, and nursing faculty members from six institutions sorted the responses according to their perceptions of quality (i.e. 'best', 'next best', 'worst' etc.). There was very little agreement among faculty members on the quality of the responses. Consequently, it was impossible to develop a 'best' response on which the faculty members could agree. Analysis revealed a framework used by the participants for ethical decision-making. The results of this study have important implications for the way in which we think about the teaching and the evaluation of nursing ethics.

Molecular mimicry by Mycoplasma pneumoniae to evade the induction of adherence inhibiting antibodies.

Specific regions of adherence binding sites and epitopes of the P1 adhesin of Mycoplasma pneumoniae were synthesised as octapeptides and used as targets in a modified enzyme-linked immunosorbent assay. Acute phase and convalescent sera from 10 patients with M. pneumoniae infection were tested for antibody reactivity to these octapeptides. In convalescent sera, antibody activities were directed against octapeptides of the epitope regions, whereas no antibody activity was found in acute or convalescent sera to octapeptides of adherence-mediating binding sites could be explained partially from the results of cross-reactivity experiments with adherence-inhibiting anti-P1 adhesin monoclonal antibodies (MAbs). Two of these MAbs showed cross-reactions with intracellular antigens of eukaryotic cell lines in immunofluorescence microscopy experiments. The cross-reacting antigens were isolated and characterised as glyceraldehyde-3-phosphate dehydrogenase and 2-phospho-D-glycerate hydrolyase. Antigenic mimicry of eukaryotic structures by functional sites of the P1 adhesin of M. pneumoniae may influence the pathogenesis of M. pneumoniae infection.

Breast augmentation surgery: a women's health issue.

Surgery to increase breast size is a common procedure. In this paper we examine the reasons why women choose to undergo the procedure, the history of breast enhancement, current surgical approaches, possible complications and their treatment. Driving forces behind the choice to have augmentation surgery appear to be related to feelings of low self-esteem and self-confidence. Although there is a large literature related to breast augmentation, little of it is research-based. The research that there is focuses on complications and their treatment, with an emphasis on capsular contracture. Few of the studies are long-term, although complications have been noted as long as 25 years after initial implantation. There is a need for research into the experience of women undergoing augmentation mammaplasty but, perhaps more importantly, there is also a need to examine ways in which women can be helped to accept themselves as they are.

Follow-up of day-surgery cataract patients.

1. Cataract patients received widely differing amounts of information about their surgery and their pre- and postoperative courses. Although most received some information, no patient received what could be considered complete information. 2. Most patients would have liked more specific information about what they could expect and what they could do to take care of themselves after surgery. Some patients were surprised that they could not see perfectly after surgery. Such feelings led to uncertainty and concern about the success of the procedure. 3. The cataract patients had a relatively uneventful postoperative course, complaining little about nausea, vomiting, fatigue, and difficulty moving and sleeping. Although pain generally was rated as low, 15% of patients complained of severe pain on the 1st postoperative day.

Incomplete neural deficits in thoracolumbar and lumbar spine fractures. Reliability of Frankel and Sunnybrook scales.

Because neural status is used both as a treatment determiner and outcome measure, a universal, reliable scale is required. Experienced personnel, provided with concise definitions, demonstrated high inter-rater reliability of Frankel and Sunnybrook scales (Pearson correlation coefficients 0.71-0.91), with 94-100% intra-rater agreement. Both scales correspond to total sensory and motor function but are insensitive to walking and bladder function. Frankel's wide clinical use, reliability, and simplicity identify it to be the preferred measurement system until a better alternative is developed. Discussion of neural status must include description of bladder and walking function.