Caring for a sick or injured child during the COVID-19 pandemic lockdown in 2020 in the UK: An online survey of parents' experiences.

BACKGROUND: During the COVID-19 pandemic, the first UK lockdown (March to May 2020) witnessed a dramatic reduction in children presenting to primary/emergency care, creating concern that fear of the virus was resulting in children presenting late. METHODS: An online survey was co-developed with UK parents to understand the impact of the lockdown on parents' help-seeking for, and care of, their sick/injured child(ren). The survey was advertised through social media and snowballing to parents whose children had been ill/injured during the lockdown. Analysis used descriptive statistics, SPSSv25 and thematic analysis. RESULTS: The survey was fully completed by 198 UK parents. The majority asked for help (144/198): from their family doctor (78), national helplines (48) or an Emergency Department (23). Most reported that their decision-making had not changed, although how they sought help had changed. A few parents reported that the severity and duration of illness had increased because of uncertainty about and/or difficulty accessing services. Parents did not always report seeking help for symptoms rated red or amber by the Royal College of Paediatrics and Child Health. Parents reported accessing information through the internet or using information that they already had. PARENT CONTRIBUTION: This was a collaboration with parents from survey development to dissemination, with two parents being integral members of our research team. CONCLUSIONS: Our questionnaire was completed by parents who were not deterred from seeking help for their sick or injured children. Even for these parents, the lockdown changes to services created uncertainty about, and barriers to, accessing medical help for their children.

When All Else Fails: Alternative Methods of Euthanasia.

Barbiturate overdose as a method of euthanasia is becoming unacceptable. This has made alternative methods of euthanasia very important. Gunshot or captive bolt euthanasia is among methods that are acceptable, but they may not be esthetically acceptable. This has led to the use of other methods of euthanasia. Inducing anesthesia prior to euthanasia offers an easier method of control. Adjunctive techniques using intravenous potassium or magnesium salts administered intravenously and intracardiac administration of potassium chloride or intrathecal lidocaine offer alternatives that work well and are more environmentally safer than barbiturates. Pithing and exsanguination are also environmentally safer but may not be as esthetically acceptable as the other methods.

Enrichment for Carneaux pigeons used in behavioral learning research.

In studies of behavior and learning, common enrichment items and techniques may be prohibited because they interfere with the study. This column describes a new enrichment strategy that can be given to pigeons being used in behavioral learning research. The enrichment device encourages foraging in singly housed Carneaux pigeons.

Intravenous continuous infusion of lidocaine for treatment of equine ileus.

OBJECTIVE: To determine if intravenous lidocaine is useful and safe as a treatment for equine ileus. STUDY DESIGN: Prospective double-blinded placebo-controlled trial. STUDY POPULATION: Horses (n = 32) with a diagnosis of postoperative ileus (POI) or enteritis and that had refluxed >20 L or had been refluxing for >24 hours. METHODS: Refluxing horses were administered lidocaine (1.3 mg/kg intravenously [IV] as a bolus followed by a 0.05 mg/kg/min infusion) or saline (0.9% NaCl) solution placebo for 24 hours. Variables evaluated included volume and duration of reflux, time to 1st fecal passage, signs of pain, analgesic use, heart rate and arrhythmias, respiratory rate, temperature, days of hospitalization, outcome (survival to discharge), and complications. RESULTS: Of the lidocaine-treated horses, 65% (11/17) stopped refluxing within 30 hours (mean+/-SD, 15.2+/-2.4 hours) whereas 27% (4/15) of the saline-treated horses stopped within 30 hours. Fecal passage was significantly correlated with response to treatment; horses that responded to lidocaine passed feces within 16 hours of starting the infusion. Compared with placebo treatment, lidocaine treatment resulted in shorter hospitalization time for survivors, equivalent survival to discharge, no clinically significant changes in physical or laboratory variables, and no difference in the rate of incisional infections, jugular thrombosis, laminitis, or diarrhea. Muscle fasciculations occurred in 3 lidocaine-treated horses (18%). CONCLUSION: IV lidocaine significantly improved the clinical course in refluxing horses with minimal side effects. CLINICAL RELEVANCE: At the infusion rate studied, IV lidocaine is safe and should be considered for the treatment of equine ileus.

Scintigraphic, radiographic, and thermographic appearance of the metacarpal and metatarsal regions of adult healthy horses treated with nonfocused extracorporeal shock wave therapy--a pilot study.

Nonfocused extracorporeal shock wave therapy (ESWT) treatment protocol is commonly used in veterinary practice. This study investigated the effects of four nonfocused ESWT treatments, given 2 weeks apart, on bone radiopharmaceutical uptake and radiographic and thermographic appearance in the metacarpal and metatarsal regions in six adult untrained horses. There were no measurable treatment effects determined by thermography (daily), scintigraphy (at 2-week intervals), and radiography (before study initiation and at study completion) between treated and control limbs. It was concluded that no gross evidence of bone remodeling is detectable by conventional clinical assessment when nonfocused ESWT is applied to healthy equine metacarpal or metatarsal bone.

Estimating research productivity and quality in assistive technology: a bibliometric analysis spanning four decades.

OBJECTIVE: Conduct a quantitative assessment of the number of papers contained in MEDLINE related to selected types of assistive technology (AT), and to identify journals publishing significant numbers of papers related to AT, and evaluate them with quantitative productivity and quality measures. DESIGN: Consecutive sample of all papers in MEDLINE identified by standard medical subject headings for selected types of AT from 1963-2003. MAIN OUTCOME MEASURES: Number of journals carrying AT papers, papers per journal (both total number and those specific to AT), journal impact factor, circulation, and number of AT citations per year over time for each area of AT. RESULTS: We present search terms, estimates of the numbers of AT citations in MEDLINE, the journals most likely to contain articles related to AT, journal impact factors, and journal circulations (when available). We also present the number of citations in various areas of AT over time from 1963-2003. Suggestions are presented for possible future modifications of the MEDLINE controlled vocabulary, based on terminology used in existing AT classifications schemes, such as ISO 9999. CONCLUSION: Research papers in the areas of AT examined showed publication across a wide variety of journals. There are a number of journals publishing articles in AT that have impact factors above the median. Some areas of AT have shown an increase in publications per year over time, while others have shown a more constant level of productivity.

Mental health issues among female clients of domestic violence programs in North Carolina.

OBJECTIVE: This study estimated the prevalence of mental health problems among clients of domestic violence programs in North Carolina, determined whether domestic violence program staff members routinely screen clients for mental health problems, described how domestic violence programs respond to clients who have mental health problems, and ascertained whether domestic violence program staff members and volunteers have been trained in mental health-related issues. METHODS: A survey was mailed to all known domestic violence programs in North Carolina. RESULTS: A total of 71 of the 84 known programs responded to the survey (85 percent response rate). A majority of programs estimated that at least 25 percent of their clients had mental health problems (61 percent) and stated that they routinely asked their clients about mental health issues (72 percent). More than half the programs (54 percent) reported that less than 25 percent of their staff members and volunteers had formal training on mental health issues. An even smaller percentage of programs (23 percent) reported that they had a memorandum of agreement with a local mental health center. CONCLUSIONS: The substantial percentage of domestic violence clients with concurrent mental health needs and the limited mental health services that are currently available have important implications for domestic violence and mental health service delivery.

A systematic review of telemonitoring for the management of heart failure.

BACKGROUND: Telemonitoring allows a clinician to monitor, on a daily basis, physiological variables measured by patients at home. This provides a means to keep patients with heart failure under close supervision, which could reduce the rate of admission to hospital and accelerate discharge. OBJECTIVE: To review the literature on the application of telemedicine in the management of heart failure. METHODS: A literature search was conducted on studies involving telemonitoring and heart failure between 1966 and 2002 using Medline, Embase, Cochrane Library and Journal of Telemedicine and Telecare. RESULTS: Eighteen observational studies and six randomised controlled trials involving telemonitoring and heart failure were identified. Observational studies suggest that telemonitoring; used either alone or as part of a multidisciplinary care program, reduce hospital bed-days occupancy. Patient acceptance of and compliance with telemonitoring was high. Two randomised controlled trials suggest that telemonitoring of vital signs and symptoms facilitate early detection of deterioration and reduce readmission rates and length of hospital stay in patients with heart failure. One study also showed a reduction in readmission charges. One substantial randomised controlled study showed a significant reduction in mortality at 6 months by monitoring weight and symptoms in patients with heart failure; however, no difference was observed in readmission rates. Another randomised study comparing video-consultation performed as part of a home health care programme for patients with a variety of diagnoses, suggested a reduction in the costs of hospital care, which offset the cost of video-consultation. Patients with heart failure were not reported separately. One randomised study showed no difference in outcomes between the telemonitoring group and the standard care group. CONCLUSION: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention.

Helping women with disabilities and domestic violence: strategies, limitations, and challenges of domestic violence programs and services.

PURPOSE: To describe the types of services provided to women with disabilities at community-based domestic violence programs in the state of North Carolina, the challenges faced, and strategies used to provide the services. METHODS: We conducted a statewide cross-sectional survey of community domestic violence programs and had a response rate of 85%. RESULTS: Of the participating programs, 99% provided services to at least one woman with a physical or mental disability in the preceding 12 months; 85% offered shelter services to women with physical or mental disabilities. Most respondents (94%-99%) reported that their programs were either somewhat able or very able to provide effective services and care to women with disabilities. The respondents also described challenges to serving women with disabilities, including lack of funding, lack of training, and structural limitations of service facilities. Strategies used by the programs to overcome these challenges were networking and coordinating care with organizations that specifically serve disabled populations. CONCLUSIONS: Domestic violence programs in North Carolina provide services to women with disabilities but are faced with challenges stemming from limited funding, physical space, and training. Collaborations between domestic violence and disability service providers are necessary to improving the services and care delivered to women with disabilities who experience domestic violence.

Examination of the equine foot.

The examination of the foot must be based on observations of the hoof, followed by a careful determination of areas of pain. This must be followed by an assessment of the biomechanical forces on the hoof and limb. Finally, imaging gives insight into the nature of the injury and allows the examiner to prognosticate the outcome.

Severe carpometacarpal osteoarthritis in older Arabian horses.

OBJECTIVE: To report a severe form of carpometacarpal osteoarthritis (CMC-OA) affecting primarily older Arabian horses. STUDY DESIGN: Retrospective study. ANIMALS: Thirty-one horses with CMC-OA. METHODS: Carpal radiographs (405 sets) from 3 hospitals were evaluated to identify horses with marked osteoproliferative reaction across the medial aspect of the CMC joint. Owners were contacted to obtain detailed histories and status updates. Necropsy specimens of the CMC joint were evaluated at 2 hospitals to determine the prevalence of 2 variations in the articulation between the proximal second and third metacarpal bones. RESULTS: Thirty-one horses were identified as having marked osteoproliferative reaction at the CMC joint. Twenty-three (74%) were Arabian horses. Of the Arabian horses, the average age at admission was 14.4 years. Eight (34.8%) Arabian horses had a known history of trauma. Most were no longer rideable at presentation. Ten of the horses were subsequently euthanatized because of lameness. The dorsal and palmar articulations between the second and third metacarpal bones were examined in 177 horses. The palmar articulation was absent in 48% of Arabian horses and 12.5% of non-Arabian horses at 1 center, including 4 horses with CMC-OA. At the second center, the palmar articulation was present in 8 of 8 Arabian horses but was absent in 22 of 92 (24%) non-Arabian horses. CONCLUSIONS: An increased frequency of this crippling form of OA was observed in Arabian horses. It may reflect an increased prevalence, in some geographical regions, of an absent palmar articulation between the second and third metacarpal bones. CLINICAL RELEVANCE: Carpal trauma in some Arabian horses may result in unexpectedly severe carpometacarpal osteoarthritis.

Benefits are for basic needs, not takeaways.

I would like to reply to Fo Ettinger's article 'Ask and you might receive' (perspectives May 23).