Cardiac biomarkers in hyperthyroid cats.

BACKGROUND: Hyperthyroidism has substantial effects on the circulatory system. The cardiac biomarkers NT-proBNP and troponin I (cTNI) have proven useful in identifying cats with myocardial disease but have not been extensively investigated in hyperthyroidism. HYPOTHESIS: Plasma NT-proBNP and cTNI concentrations are higher in cats with primary myocardial disease than in cats with hyperthyroidism and higher in cats with hyperthyroidism than in healthy control cats. ANIMALS: Twenty-three hyperthyroid cats, 17 cats with subclinical hypertrophic cardiomyopathy (HCM), and 19 euthyroid, normotensive healthy cats ≥8 years of age. Fourteen of the hyperthyroid cats were re-evaluated 3 months after administration of radioiodine ((131)I). METHODS: Complete history, physical examination, complete blood count, serum biochemistries, urinalysis, blood pressure measurement, serum T4 concentration, plasma concentrations of NT-proBNP and cTNI, and echocardiogram were obtained prospectively from each cat. RESULTS: Hyperthyroid cats and cats with HCM had plasma NT-proBNP and cTNI concentrations that were significantly higher than those of healthy cats, but there was no significant difference between hyperthyroid cats and cats with HCM with respect to the concentration of either biomarker. In hyperthyroid cats that were re-evaluated 3 months after (131) I treatment, plasma NT-proBNP and cTNI concentrations as well as ventricular wall thickness had decreased significantly. CONCLUSIONS AND CLINICAL IMPORTANCE: Although there may be a role for NT-proBNP in monitoring the cardiac response to treatment of hyperthyroidism, neither NT-proBNP nor cTNI distinguish hypertrophy associated with hyperthyroidism from primary HCM. Therefore, the thyroid status of older cats should be ascertained before interpreting NT-proBNP and cTNI concentrations.

Milk fat synthesis in dairy cows is progressively reduced by increasing supplemental amounts of trans-10, cis-12 conjugated linoleic acid (CLA).

Conjugated linoleic acid (CLA) supplements containing a variety of isomers reduce milk fat yield. We have recently identified trans-10, cis-12 CLA as the isomer responsible for inhibiting milk fat synthesis in dairy cows. Our objectives were to determine milk fat yield and fatty acid composition responses to different doses of trans-10, cis-12 CLA. Multiparous Holstein cows (n = 4) were used in a 4 x 4 Latin square design. Treatments consisted of a 5-d abomasal infusion of four doses of trans-10, cis-12 CLA, i.e., 0.0, 3.5, 7.0 and 14.0 g/d. Milk fat yield was decreased 25, 33, and 50%, and milk fat concentration was reduced 24, 37 and 46% when cows received 3.5, 7.0 and 14.0 g/d of trans-10, cis-12 CLA, respectively. Feed intake, milk yield, and milk protein content and yield were unaffected by treatment. Milk fatty acid composition revealed that de novo synthesized fatty acids (short and medium chain) were extensively reduced when cows received the two highest doses, but at the low dose (3.5 g/d), decreases in de novo synthesized fatty acids and preformed fatty acids were similar. Changes in milk fatty acid composition also demonstrated that (9)-desaturase activity was inhibited at the two high doses of trans-10, cis-12 CLA, but was unaffected by the low dose. Results indicate minimal quantities of trans-10, cis-12 CLA (0.016% of dietary dry matter) markedly inhibited milk fat synthesis (25% reduction) and that a curvilinear reduction in milk fat yield occurred with increasing quantities of trans-10, cis-12 CLA.

Work in progress. Integrating physicians' services in the home.

OBJECTIVE: While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved. DESIGN: A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont. SETTING: Home care in London, Ont. PARTICIPANTS: Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses. METHOD: In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques. MAIN FINDINGS: Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success. CONCLUSION: Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians.

Masking and unmasking the sexual abuse of children: perceptions of violence against children in "the Badlands" of Ontario, 1916-1930.

This article explores the legal and social understandings of incest in early-twentieth-century Canada, examining the way in which sexual abuse was identified in sensational court cases but ideologically masked in social consciousness. First, the legal treatment of incest is examined through court cases, with special focus on one case that animated a grand jury report on a rural area where incest and violence supposedly flourished. Second, the grand jury's legal, medical, and social assumptions about incest, reflecting eugenic priorities as well as class and gender prejudices, are surveyed. Third, the actual use of the grand jury report in subsequent cases is probed. The report became a generalized explanation for all kinds of familial violence placing blame for violence on poor, degenerate, and immoral parents but ignoring the structural problems of power and patriachy.

Albinism: an update and review of the literature.

BACKGROUND: Albinism can be a diagnostic challenge to the optometrist, with ocular albinism the entity most likely to be overlooked or misdiagnosed. Albinism should be suspect in a child with nystagmus. METHODS: Albinism is best diagnosed by electron microscopy of skin or hair bulbs. Measuring the flash visually evoked response (VER) is the best way to confirm the abnormal decussation of the optic nerve fibers. Transillumination of the iris can be performed to see if it lacks pigment on its posterior surface. Optometrists should also be alert for nystagmus, strabismus, lack of stereopsis, and poor fusional capacity. Most people with albinism have photophobia and reduced acuity, and many have defective hearing. RESULTS: This review describes the various kinds of albinism and summarizes associated ocular manifestations with pertinent forms of the disorder. CONCLUSIONS: Optometrists are responsible for detection of albinism and provision of optical aids and related advice to afflicted patients. These patients also need appropriate counselling and genetic studies of family members.

Iron chelators of the pyridoxal isonicotinoyl hydrazone class. Relationship of the lipophilicity of the apochelator to its ability to mobilize iron from reticulocytes in vitro: reappraisal of reported partition coefficients.

The partition coefficients P between n-octanol and water of pyridoxal isonicotinoyl hydrazone and 34 analogues have been determined experimentally; the values indicate that the partition coefficients calculated for these compounds, and previously reported (P. Ponka, D.R. Richardson, J.T. Edward, and F.L. Chubb. Can. J. Physiol. Pharmacol. 72: 659-666. 1994; D.R. Richardson, E.H. Tran, and P. Ponka. Blood, 86: 4294-4306. 1994), are too low by 2-3 orders of magnitude. The calculations, using Rekker's additive method, failed because the molecules have two or more hydrophilic sites close together. More recent additive schemes (CLOGP, KOWWIN, ACD/LogP) also failed. The only reliable method was the semi-empirical method of Hansch. This requires the experimental determination of the partition coefficient of at least one representative in each series of compounds of related structure. In the present paper, determination of log P of three representatives enabled us to calculate the partition coefficients of the other 32 compounds with acceptable accuracy. The new results show that apochelators have maximum activity in releasing 59Fe from reticulocytes when they have log P = 2.8 (P = 630), and not log P = 0 (P = 1), as reported by Ponka et al. (P. Ponka, D.R Richardson, J.T. Edward, and F.L Chubb. Can. J. Physiol. Pharmacol. 72: 659-666 1994).

Teaching child and adolescent psychiatry to family medicine trainees: a pilot experience.

OBJECTIVE: To develop learning objectives for teaching child psychiatry to family medicine trainees and to evaluate the best method of teaching these objectives. METHOD: For this descriptive study, knowledge, attitude, and skill objectives were presented to trainees at the start of a 6-month rotation, and an evaluation mechanism was developed based on the learning objectives. The method of instruction in each of the training locations was described independently by the child psychiatry consultant and attending family physician. The trainees' evaluations were presented according to training locations. RESULTS: Family medicine trainees perceived the teaching-consultation method, with live interviews, to be the most helpful and the didactic lecture format to be least helpful. CONCLUSION: The importance of teaching family medicine residents to recognize mental health problems in children and adolescents, preferably by using live interviews, and the implications for postresidency practice are emphasized.

Managing patient discharge to home: the challenges of achieving quality of care.

Discharging older patients from hospital to care at home presents considerable challenges for those concerned about the current mandate of quality management. A great many professionals with different priorities and organizational commitments are involved. The policies and procedures of at least two agencies, a hospital and a home care agency, play a role in shaping the whole process. The purpose of this study was to explore and describe factors other than medical condition and treatment which shaped the quality of the discharge experiences of older patients. Qualitative research methodology was used to document the discharge process from the perspective of 12 rural and nine urban patients, and a purposeful sample of 22 family caregivers and 117 professionals involved in their care. As well, 24 agency administrators with an overview of related policies and procedures provided data. Findings provide an in-depth description of the different implementation approaches and related quality issues in rural and urban settings. Quality management was undermined by role confusion, compromised and overly zealous pursuit of efficiency, fragmented work, variable physician practice style, and communication and coordination problems. Several readily implemented solutions to these problems are recommended. The implications of the more difficult leadership challenges related to achieving reasonable efficiency and maintaining a humane orientation in the complex care system are addressed.

Pilot study: effects of G-CSF on neutrophil ex-vivo function post bone marrow transplantation.

The effects of human recombinant granulocyte colony stimulating factor (G-CSF) on neutrophil recovery have been studied in patients undergoing bone marrow transplantation for haematological disease. Nine patients (five autografts and four allografts) were studied while receiving daily doses of G-CSF (range 2-20 micrograms/kg body weight) were compared to eight patients (four autografts and four allografts) who did not receive G-CSF as a control group. In both groups flow cytometry was used to determine neutrophil IgG Fc receptor (FcRII, FcRIII) expression. Phagocytosis and metabolic burst was assessed using IgG opsonized bacteria. The patients' neutrophils were studied prior to conditioning in autografts and donor cells were studied in allografts. Studies were repeated at neutrophil recovery (neutrophil count 1.0 x 10(9)/l) and ten days post recovery. At recovery FcRII expression was slightly increased in all groups, whereas the number of cells expressing FcRIII was reduced. This reduction was significant in the patients receiving rG-CSF at recovery and post recovery compared to the pretreatment levels. The ability to phagocytose bacteria in cells from patients receiving G-CSF was also reduced. The associated metabolic burst was significantly reduced in the autograft group but not the allograft group receiving rG-CSF. The reduced function and reduced expression of FCRIII suggests the presence of immature neutrophils in patients receiving rG-CSF post BMT.

Chart Audit of Mammography in a Family Practice: How to improve screening rates with a chart audit and outreach.

A chart audit was done of women in a family practice aged 50 to 69. Those who had not had a mammogram done opportunistically were then contacted by mail and by telephone. An original screening rate of 49.2% over 2 years rose to 69.7% after outreach. A Pap smear within 2 years and a history of breast lumps were associated with performance of mammography.

Hearing loss in elderly patients in a family practice.

OBJECTIVE: To investigate hearing loss in elderly patients. DESIGN: Cohort study. SETTING: Family practice. PATIENTS: All ambulatory patients 65 years of age or older who attended the practice from June to August 1989. OUTCOME MEASURES: The Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S) and the Welch-Allyn Audioscope. Patients who failed one or both of the screening tests were referred to a speech and hearing clinic for audiologic assessment and treatment recommendations. Those with hearing aids were excluded from the main study but were given the opportunity to have them assessed at the clinic. MAIN RESULTS: Of 157 eligible patients 42 were excluded: 16 refused to participate, 13 already had hearing aids, and 13 could not be contacted. Of the remaining 115, 34 failed one or both of the tests (14 failed the HHIE-S, 9 failed the audioscope test, and 11 failed both). Of the 34, 25 completed the audiologic assessment at the clinic. Fifteen were found to have severe hearing impairment; the recommendation was hearing aids for 12, further assessment for 2 and no treatment for 1. Of the remaining 10 patients it was thought that 6 would benefit from hearing aids. Ten of the 11 patients with hearing aids who agreed to undergo testing at the clinic were found to need an adjustment or replacement of their devices. CONCLUSIONS: Hearing loss is a significant problem in elderly patients in primary practice. Further study is required to determine which of the two screening tools is most effective. Most elderly patients with hearing aids may require modification or replacement of their devices.

Changes in rat luteal ultrastructure and P450scc mRNA and protein content after in vivo treatment with a gonadotropin-releasing hormone agonist.

Previous studies have demonstrated that plasma progesterone levels decrease in pregnant rats treated in vivo with a gonadotropin-releasing hormone agonist (GnRH-Ag), without changes in testosterone or estradiol levels in ovarian vein plasma. The objective of this study was to determine the loci of GnRH-Ag disruption of progesterone synthesis by examining luteal mitochondria, lipid droplets, cellular composition, and P450 side-chain cleavage (P450scc) enzyme and mRNA content in the pregnant rat. On Day 7 or 11 of pregnancy, osmotic minipumps containing GnRH-Ag were implanted into 5-7 rats. Sham operations were performed on 5-6 controls at each time period. Five micrograms per day of GnRH-Ag were released for about 24 h, after which corpora lutea and jugular vein plasma were collected. The corpora lutea were prepared for microscopy or analyzed for P450scc enzyme and mRNA content. Plasma progesterone levels were measured by RIA. In those rats treated with GnRH-Ag, progesterone levels had decreased, and within the luteal cells, there was an increase in the number of lipid droplets and a decrease in the number of tubular cristae within the mitochondria. Concomitantly, P450scc enzyme and mRNA content decreased on both Day 8 and Day 12 of pregnancy. Also, GnRH-Ag treatment decreased the ratio of large to small steroidogenic luteal cells on Day 8 of pregnancy, but did not alter cellular ratios on Day 12 of pregnancy. These observations suggest that treatment with GnRH-Ag inhibits progesterone synthesis by decreasing the amount of P450scc mRNA and enzyme content, which may alter the mitochondrial cristae structure on Day 8 and Day 12 of pregnancy. The reduction in tubular cristae and P450scc enzyme in the mitochondria may account for the increase in lipid droplets, as less cholesterol is converted to pregnenolone. An additional mechanism of inhibition may be the reduction in the number of large steroidogenic luteal cells, which appear to be the major source of progesterone in the rat corpus luteum on Day 8 of pregnancy.

Flow cytometric analysis of the functional ability of neutrophils from patients with autoimmune neutropenia.

Flow cytometry has been used to evaluate the functional ability of neutrophils and the expression of IgG Fc receptors (FcRII and FcRIII) in autoimmune neutropenia. Quantification of the neutrophil oxidative burst was made by assaying the production of 2'7'-dichlorofluorescein (DCF) from non-fluorescent 2'7'-dichlorofluorescein trapped within the cell, by flow cytometric analysis of cellular fluorescence. In the present study the DCF assay was used to examine the response of neutrophils to stimulation by opsonized and non-opsonized Staphylococcus aureus. In addition, the rate of uptake of S. aureus labelled with the red nuclear dye propidium iodide was determined. The presence of surface-bound immunoglobulin, which may affect the phagocytic capacity of the neutrophil, was also measured. No correlation between the neutrophil count and level of membrane-bound IgG or the rate of bacterial uptake was found. The studies were performed on twenty patients with autoimmune neutropenia, twelve with other autoimmune disorders and fourteen normal controls. The rate of uptake of bacteria was considered in relation to the expression of FcRII and FcRIII. Good correlation was found with the level of expression of FcRII, the major receptor for neutrophil activation, and the rate of uptake of bacteria (r = 0.64).

Evaluating A Graduate Studies Program: A survey of former participants.

To evaluate the outcome of the program for graduate studies in family medicine at the University of Western Ontario, all 45 participants in the program were surveyed. Thirty-six percent of respondents held full-time academic appointments and 42% part-time academic positions. Eighty-four percent indicated a moderate to major effect on their career as a teacher; 67% indicated a moderate to major change in research skills; 42% indicated such a change in administrative skills. Ninety-one percent said they had achieved all or most of their objective in taking the program.

Influenza vaccination: a comparison of two outreach strategies.

Despite longstanding recommendations for annual influenza vaccination of all people age 65 and older, only 20% or less are regularly immunized. This paper compares two methods of immunization outreach to the elderly population. In 1985 and 1986 vaccine was offered to patients who attended one family practice for any reason during the months of October and November. In 1985 if patients had not received vaccine by October 31 an informational letter recommending immunization was also mailed. In 1986 nonimmunized patients were telephoned by the family practice nurse and informed of the rationale, availability, and advisability of receiving the vaccine. The immunization rate improved in patients attending the practice over the two study years. Additional outreach efforts showed a high degree of failure or refusal to receive immunization.

Factors determining patients' satisfaction in a family practice residency teaching center.

A primary function of family medicine teaching centers is to provide residents with ongoing experiences with patients and their families. A critical issue in maintaining a stable patient population for such teaching is patient satisfaction. In the study reported here, the authors examined the factors determining patients' satisfaction. A questionnaire was mailed to a representative sample of 10 percent of the patients in a family practice in a family medical center. Seventy-eight percent of the sample responded; these respondents were representative of the sample population. Four variables were identified as significant in determining the patients' satisfaction: whether the patients felt that the time spent with their identified family physician was adequate and that the physician's explanations regarding their health care and the teaching program were clear; whether the patients felt comfortable in expressing their concerns about the teaching program to the permanent staff members; whether the patients had a positive attitude regarding the teaching program; and whether the patients felt that their identified family physician was available to them.

Family physicians' perspective of patient care at the london regional cancer clinic.

This article describes a survey of the opinions of family physicians practising in the London, Ontario, area concerning the management of doctor/patient relationships and patient treatment in cases referred by family physicians to the London Regional Cancer Clinic. Findings clearly identified a need for better communication between Clinic staff and referring family physicians, greater continuity of care for patients at the clinic, continuing family physician support of patients during periods of hospitalization at the Clinic, and some administrative adjustments in Clinic routines that would reduce patient stress and discomfort and improve morale.

Acceptability of a faecal occult blood screening protocol for carcinoma of the colon in family practice.

Cancer of the colon is the second most common malignancy in North America and screening methods are needed for diagnosing the lesions at an early stage. Faecal occult blood screening is a method of secondary prevention which is particularly adaptable to the family practice setting. In order to test the feasibility of using this test in family practice, 16 family physicians participated in a trial screening programme using the Hemoccult II test. During the two-month trial 776 patients over 40 years of age were screened; 19 of the tests were positive but in two cases patients were thought to have failed to follow dietary and medical restrictions. Of the 17 patients with verified positive tests, further investigation showed five patients had neoplastic disease and three of these had malignant disease. The detection rate for cancer of the colon using the Hemoccult II test was therefore 3/776, equivalent to 3.9 per 1000 cases screened. By narrowing the age range for screening patients to between 45 and 75 years, the time involved to screen the population at risk could be decreased.