The impact of intravenous medetomidine and vatinoxan on echocardiographic evaluation of dogs with stage B1 mitral valve disease.

INTRODUCTION/OBJECTIVE: The purpose of this study was to investigate the echocardiographic effects of intravenous medetomidine and vatinoxan in dogs with stage B1 mitral valve disease. We hypothesised medetomidine-vatinoxan would reduce the need for manual restraint during echocardiography without producing detrimental cardiovascular effects or echocardiographic changes. ANIMALS: Twelve client-owned dogs with stage B1 mitral valve disease. METHODS: A transthoracic echocardiographic examination was performed before and after sedation with intravenous medetomidine (10 µg/kg) and vatinoxan (200 µg/kg). Vital parameters were also recorded, and the level of sedation was assessed subjectively. The data were analysed with Student's t-tests with an alpha level of <0.05. RESULTS: End-systolic volume and left ventricular systolic diameter increased (from 0.89 ± 0.19 mL/kg to 1.13 ± 0.29 mL/kg and 0.96 ± 0.12 cm to 1.10 ± 0.10 cm, respectively) and ejection fraction (from 66.33 ± 4.0% to 56.23 ± 9.54%) and fractional shortening (from 36.13 ± 5.42% to 27.24 ± 5.6%) decreased significantly after sedation. End diastolic volume, left ventricular diastolic diameter, and left atrial size remained statistically unchanged, while aortic (from 1.34 ± 0.2 m/s to 0.99 ± 0.14 m/s) and pulmonic (from 0.94 ± 0.16 m/s to 0.66 ± 0.15 m/s) velocities decreased significantly. No dogs had a mean arterial pressure below 65 mmHg. Sedation enabled echocardiographic examination without manual restraint. No adverse effects were observed with the dose studied. CONCLUSIONS: Echocardiographic parameters were not completely comparable with the baseline values, which should be taken into consideration when evaluating dogs sedated with intravenous medetomidine-vatinoxan.

Social and healthcare students' competence in patient-oriented care enhanced during interprofessional practice: A scoping review.

AIM: This scoping review aimed to synthesise the findings of previous literature related to social and healthcare students' competence in patient-oriented care in interprofessional practice by attending multidisciplinary student teams. BACKGROUND: Learning about patient-oriented care requires the comprehensive consideration of patients' physical, emotional, social and economic aspects to offer the best need-based care. Multidisciplinary student teams in the clinical practice may support learning patient-oriented care; however, the current knowledge is fragmented. DESIGN: Scoping review METHODS: Data (N = 1548) were gathered from four databases, PubMed, MEDLINE, SocIndex and CINAHL, without start-date limitation until the end of December 2022. One article was found on the publisher's webpage recommendations. The selected studies (N = 15) answered the research questions and met the inclusion criteria. Quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) Quality Assessment Checklist. A thematic analysis process was used for data extraction and synthesis of results. RESULTS: Perspectives on patient-oriented care competencies were analysed for both students and patients cared for by a multidisciplinary student team. The themes described students' profound understanding of professional roles and responsibilities in patient-oriented care, collaborative patient-oriented care skills, improved interprofessional communication and reported patient experiences. CONCLUSIONS: Interprofessional practice versatility develops students' competence in patient-oriented care. Guaranteeing patient-oriented care requires a broad understanding of patients' comprehensive care needs, which can be addressed through multidisciplinary collaboration. Patients' experiences toward interprofessional student practice are mainly positive. Further research is needed to assess the impact of different interprofessional education methods on students' patient-oriented care competence using valid instruments and the long-term effects of students' competence in patient-oriented care.

Peripherally acting α-adrenoceptor antagonist MK-467 with intramuscular medetomidine and butorphanol in dogs: A prospective, randomised, clinical trial.

The aim of this study was to investigate the clinical usefulness of MK-467 (vatinoxan; L-659'066) in dogs sedated for diagnostic imaging with medetomidine-butorphanol. It was hypothesised that MK-467 would alleviate bradycardia, hasten drug absorption and thus intensify the early-stage sedation. In a prospective, randomised, blinded clinical trial, 56 client-owned dogs received one of two IM treatments: (1) 0.5mg/m2 medetomidine+0.1mg/kg butorphanol (MB, n=29); or (2) 0.5mg/m2 medetomidine+0.1mg/kg butorphanol+10mg/m2 MK-467 (MB-MK, n=27). Heart rates and visual sedation scores were recorded at intervals. Plasma drug concentrations were determined in venous samples obtained approximately 14min after injection. Additional sedation (50% of original dose of medetomidine IM) and/or IM atipamezole for reversal were given when needed. The area under the sedation score-time curve for visual analogue scale (AUCVAS30) was calculated for the first 30min after treatment using the trapezoidal method. Repeated ANOVA, Mann-Whitney U test and Fisher's exact test were used for parametric, non-parametric and dichotomous data. Heart rate was significantly higher from 10 to 40min with MB-MK than with MB. AUCVAS30 was significantly higher after MB-MK. More dogs treated with MB-MK required additional sedation after 30min, but fewer needed atipamezole for reversal compared with MB. Plasma concentrations of both medetomidine and butorphanol were higher after MB-MK. All procedures were successfully completed. MK-467 alleviated the bradycardia, intensified the early stage sedation and shortened its duration in healthy dogs that received IM medetomidine-butorphanol.

Laparoscopic vs robotic-assisted surgery for endometrial carcinoma in a centre with long laparoscopic experience.

Surgical outcomes and costs of laparoscopic and robotic hysterectomy for the treatment of endometrial carcinoma were compared in a centre with lengthy experience with laparoscopic surgery. The robotic cohort (n = 67) had a longer operative time than the laparoscopic cohort (n = 150) (p < 0.0001). Lymph node yields were similar for both surgical modalities, but the median of estimated blood loss was lower in the robotic group (50 ml vs 100 ml; p < 0.0001). The proportion of patients with hospital stay > 2 days and rate of overall complications were similar in both groups. Operative costs were (Euros) €1,680 and €3,860 for the laparoscopic and robotic procedure, respectively. We conclude that robotic technology is feasible but does not provide short-term benefits for the treatment of endometrial carcinoma in a centre where laparoscopy has been established as the standardised minimally invasive surgical method.

Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study.

This 12-month retrospective questionnaire compared the occurrence of sports injuries in 149 cross country skiers, 154 swimmers, 143 long-distance runners and 128 soccer players aged 15-35 years. Soccer had significantly more injuries (5.1 injuries/1000 exposure hour) than other sports (2.1-2.8, P<0.001). More runners than soccer players reported overuse injuries (59% vs 42%, P=0.005), locating typically in the foot in runners, soccer players and skiers. Swimmers reported overuse injuries in the shoulder more commonly than skiers (40% vs 1%, P<0.001), who also intensively load shoulders. Acute injuries in skiers (80%) and in swimmers (58%), and overuse injuries in skiers (61%), occurred during exercise other than own event. In soccer and running the absence time from sport because of injuries was significantly longer than in skiing and swimming. No severe permanent disabilities occurred due to injury but seven women quit sports because of injury. In conclusion, type of loading is strictly associated with the anatomical location of an overuse injury as shown by the difference in shoulder injury incidence between swimmers and cross country skiers. In some sports, a significant proportion of acute injuries occur in other than the main event.

Economic burden and quality of life impairment increase with severity of PD.

PURPOSE: To define the interrelationship between cost-of-illness, quality of life (QoL) and Parkinson's disease (PD) severity in a common patient management setting in Finland.Scope. Two hundred and sixty consecutive outpatients with idiopathic PD participated. UPDRS, motor fluctuations, QoL, and the use of health care resources were measured. Direct and indirect costs were calculated. CONCLUSIONS: There is a strong relationship between QoL or cost-of-illness on the one hand, and severity of PD on the other. Treatment policies capable of reducing or delaying motor fluctuations would be expected to increase QoL and reduce some of the economic burden of PD.

Health and society in Finland: public health nurses' daily practice.

The role of public health nursing in Europe is changing as an ageing population and increasing social exclusion make new demands on health and social services. The purpose of this study was to describe how Finnish public health nurses (PHNs) practise in their daily work in order to meet the needs of this changing society. The knowledge base of the PHNs' work strongly emphasised experiential knowledge. However, on a theoretical level, medical knowledge dominated their work. The target of the PHNs' work was most frequently an individual, and perspectives of population or community were less common. The methods used in interactions with clients were participatory and empowered individuals to enhance their own health, and multiprofessional collaboration focused on joint decision-making and working towards the shared health goals of the client. However, PHNs need to employ a more reflective approach to their daily practice and take a more active role as an influential person in community and policy level.

Effects of 42 months of GH treatment on bone mineral density and bone turnover in GH-deficient adults.

OBJECTIVE: To study the effects of GH treatment for up to 42 months on bone mineral density (BMD) and bone turnover. DESIGN AND METHODS: BMD with dual energy X-ray absorptiometry, serum type I procollagen carboxy-terminal propeptide (PICP), serum type I collagen carboxy-terminal telopeptide (ICTP) and serum IGF-I were assessed in 71 adults with GH deficiency. There were 44 men and 27 women, aged 20 to 59 (median 43) years. Thirty-two patients completed 36 months and 20 patients 42 months of treatment. RESULTS: The BMD increased for up to 30-36 months and plateaued thereafter. In the whole study group, the maximum increase of BMD was 5.0% in the lumbar spine (P<0. 001), 5.9% (P<0.01) in the femoral neck, 4.9% (NS, P>0.05) in the Ward's triangle and 8.2% (P<0.001) in the trochanter area. The serum concentrations of PICP (202.6+/-11.5 vs 116.3+/-5.4 microg/l; mean+/-s.e.m.) and ICTP (10.5+/-0.6 vs 4.4+/-0.3 microg/l) doubled (P<0.001) during the first 6 months of GH treatment but returned to baseline by the end of the study (130.0+/-10.4 and 5.6+/-0.7 microg/l respectively), despite constantly elevated serum IGF-I levels (39. 6+/-4.1 nmol/l at 42 months vs 11.9+/-0.9 nmol/l at baseline; P<0.001). The responses to GH treatment of serum IGF-I, PICP, ICTP (P<0.001 for all; ANOVA) and of the BMD in the lumbar spine (P<0.05), in the femoral neck and the trochanter (P<0.001 for both) were more marked in men than in women. At the end of the study the BMD had increased at the four measurement sites by 5.7-10.6% (P<0.01-0.001) in patients with at least osteopenia at baseline and by 0.1-5.3% (NS P<0.05) in those with normal bone status (P<0.001 for differences between groups; ANOVA). Among patients who completed 36-42 months of treatment, the number of those with at least osteopenia was reduced to more than a half. The response of BMD to GH treatment was more marked in young than in old patients at three measurement sites (P<0. 05-<0.001; ANOVA). In the multiple regression analysis the gender and the pretreatment bone mass appeared to be independent predictors of three measurement sites, whereas the age independently determined only the vertebral BMD. CONCLUSIONS: GH treatment in GH-deficient adults increased BMD for up to 30-36 months, with a plateau thereafter. Concurrently with the plateau in BMD the bone turnover rate normalized. From the skeletal point of view GH-deficient patients exhibiting osteopenia or osteoporosis should be considered as candidates for GH supplementation of at least 3-4 years.