Development of video tutorials to help parents manage children with acute illnesses using a modified Delphi method.

AIM: Children often fall sick, which causes concern among parents. Online health information can be confusing and difficult to understand. We aimed to produce simple, informative video tutorials on the symptoms ill children present. METHODS: We used a modified Delphi method to produce video tutorials on the symptoms of fever, vomiting and diarrhoea, abdominal pain, breathing difficulties, sore throat, red eyes, earache and rash. We identified the most common symptoms in acutely ill children. During the first consensus round, experts rated statements on out-of-hospital management from existing health information. Video tutorials were produced from statements rated to be included. The second consensus round involved video showings and editing. Two videos were evaluated in focus groups by parents. RESULTS: During the first round, experts rated a median of 79 (40-154) statements for each symptom. Panels consisted of a median of seven (6-11) experts, primarily. Panels reached a consensus on inclusion, neutrality or exclusion in 83% of statements. The second round led to adjustments to the videos and final approval by experts. Most parents evaluated the videos as 'informative, easy to understand and calming'. CONCLUSION: We produced video tutorials on the common symptoms ill children present using a modified Delphi method. Feedback from parents in focus groups was positive.

Combined aerobic and resistance training improves physical capacity in women treated for gynecological cancer.

PURPOSE: The purpose of this study was to evaluate the effects of 16 weeks combined aerobic and resistance training, twice a week, on the physical performance in women treated for gynecological cancer. METHODS: Sixty women (56.9 ± 13.3 years) who had completed curative treatment for gynecological cancer were divided into two groups: a physical training group (PT) (n = 29) or a control group (C) (n = 31). The PT group performed two sessions of combined aerobic and resistance training weekly for 16 weeks. Peak oxygen consumption (V̇O2peak) and one repetition maximum (1RM) of leg press, leg extension, and chest press were measured before group assignment, after 16 weeks and at the 1-year follow-up. RESULTS: A significant increase in V̇O2peak (ml min-1 kg-1) (29.7 ± 8.0 vs. 31.3 ± 8.3, p = .009), leg press (kg) (113.0 ± 27.3 vs. 116.7 ± 29.2, p = .047), leg extension (kg) (44.2 ± 10.1 vs. 48.0 ± 10.6, p < .001), and chest press (kg) (24.5 ± 7.5 vs. 26.9 ± 8.2, p = .001) was seen in the PT group from pre- to post-measurement. The PT group maintained the improved aerobic condition and muscle strength 1 year after the training intervention. In the C group, there were no significant differences between pre- and post-measurements, but a significant decrease (28.2 ± 7.5 vs. 27.0 ± 7.3, p = .040) in the V̇O2peak from post to 1-year follow-up measurements. CONCLUSIONS: Combined aerobic and resistance training twice a week in 16 weeks improves V̇O2peak and maximal strength in women treated for gynecological cancer. The training effects were sustained after 1 year in the PT group.

Are bi-axial proximal sesamoid bone fractures in the British Thoroughbred racehorse a bone fatigue related fracture? A histological study.

OBJECTIVES: To investigate whether microfractures and alterations in the trabecular bone area are associated with catastrophic bi-axial proximal sesamoid bone fractures (PSBF). METHODS: Proximal sesamoid bones (PSB) from 10 racehorses with PSBF and from 10 control racehorses without musculoskeletal injury were examined using the bulk basic fuchsin method. Bone histomorphometric and microfracture analysis was performed, and cases and controls compared using two-sample t-test, paired t-test, and Mann-Whitney U test. RESULTS: There was no significant difference in the microfracture density and the trabecular bone area between bones from case and control horses, and between fractured and non-fractured bones in case horses. CLINICAL RELEVANCE: Microfracture density was low in the areas of the PSB examined. Microfracture density was not significantly different between groups, indicating that propagation of micro-cracks is an unlikely predisposing pathologic alteration in PSBF in British racehorses. There was no significant difference in the bone surface area between groups, which one would expect if modelling, adaptation and an increase in bone density were associated with PSBF fracture in the case horses. Therefore, PSBF in the British racehorse does not appear to be associated with microfractures of the trabecular bone of the PSB. The PSB fractures might represent an acute monotonic fracture; however, the aetiology of the fractures remains unknown with additional research required.

Catastrophic biaxial proximal sesamoid bone fractures in UK Thoroughbred races (1999-2004): horse characteristics and racing history.

REASON FOR PERFORMING STUDY: Catastrophic biaxial proximal sesamoid bone fractures (PSBF) have not yet been described in detail in the UK racing population. OBJECTIVES: To determine the incidence and relative risk (RR) of PSBF in different types of racing in the UK; and to describe horse-level characteristics and racing histories of horses sustaining these injuries. METHODS: Distal limbs were collected from all racehorses suffering catastrophic fractures during racing at all 59 racecourses in the UK, in a prospective study from February 1999 to December 2004. Post mortem investigation identified the anatomical location and type of fracture. Horse, racing history, race and racecourse details were obtained. Characteristics of the horses that sustained PSBF were described. The incidence and RR of PSBF in the different types of racing in the UK were calculated. RESULTS: Thirty-one horses suffered PSBF during the study period. The incidence of PSBF in all types of race was 0.63 per 10,000 starts (31/494,744). The incidence was highest in flat races on all weather surfaces (1.63 per 10,000 starts: 12/73,467; RR = 4.4 when compared to turf flat racing). Affected horses had an average age of 5.6 years and had started a mean of 28 races at the time of fracture. CONCLUSION AND POTENTIAL RELEVANCE: There is a strong association between type of racing surface and PSBF. Horses competing in flat races on all weather surfaces have an increased risk of PSBF. These fractures appear to happen in experienced horses with several starts, with few fractures occurring within the first season of racing. Further research should focus on identification of underlying pathology of these fractures. Epidemiological studies aimed at the identification of risk factors for PSBF in the UK racing population would require a large number of cases acquired over many years given the relatively low incidence of PSBF.

Retrospective study of palmar/plantar annular ligament injury in 71 horses: 2001-2006.

REASON FOR PERFORMING STUDY: Constriction of the digital flexor tendon sheath (DFTS) and its contents by the palmar/plantar annular ligament (PAL) is well recognised. However, primary injury of the PAL has not been well documented. OBJECTIVES: To describe the clinical features of PAL injury, determine its prevalence with or without subcutaneous fibrosis and/or concurrent injury within the DFTS, and assess response to treatment. METHODS: Horses were selected for inclusion based upon clinical features consistent with PAL injury and the presence of a thickened PAL (> or =2 mm) verified ultrasonographically. A retrospective analysis of case records from 3 clinics was performed. Details of breed, age and use, and results of clinical and ultrasonographic assessments and response to treatment were recorded. Horses were treated conservatively or surgically by desmotomy of the PAL, with or without tenoscopic evaluation of the DFTS. A telephone questionnaire was performed to assess response to treatment. RESULTS: Seventy-one horses were included in the study and middle aged or older general purpose riding horses predominated. PAL desmopathy occurred more frequently in hind- than in forelimbs. The method of treatment, thickness of the PAL or presence of subcutaneous fibrosis did not significantly affect prognosis; however, <50% of horses were able to return to athletic function. There was a trend for horses with PAL desmopathy alone to have the best outcome. Bilateral thickening of the PAL or concurrent fore- and hindlimb injuries had a negative effect on prognosis, as did the simultaneous presence of subcutaneous fibrosis and lesions within the DFTS. CONCLUSIONS AND CLINICAL RELEVANCE: PAL injury is characterised by a convex contour of the palmar/plantar aspect of the fetlock, associated with thickening of the ligament with or without subcutaneous fibrosis. Bilateral PAL thickening is common in older horses, ponies and cobs; however, bilateral PAL enlargement is often present with only unilateral lameness. Treatment methods used in this study did not appear to influence outcome significantly.

Evaluation of the subjective and objective effect of maximal electrical stimulation in patients complaining of urge incontinence.

BACKGROUND: Favorable results have been reported following Maximal Electrical Stimulation (MES) of patients with urgency and urge incontinence. However, patient groups have often been mixed and outcome measures poorly defined. We therefore wanted to treat a homogeneous patient population with MES and evaluate the effect by defined subjective and objective outcome measures. METHODS: Eighteen female patients complaining of urge incontinence had MES performed. Before and 3 months after MES, the patients performed a 24 hour micturition chart and pad test. They indicated on a visual analogue scale their subjective degree of urgency and leakage and had an ambulatory urodynamic monitoring performed. Nine months after MES the patients were asked whether their urge incontinence was less, equal or more troublesome than before MES. RESULTS: After MES the patients indicated significantly less urgency and leakage. A significant difference was not found in any of the objective outcome measures after MES. Six out of 18 patients (33%) found their urge incontinence less troublesome 9 months after MES, while 12 (66%) found it unchanged or more troublesome than before. CONCLUSIONS: Significantly subjective effect was found following MES. However, none of the objective outcome measures were significantly improved. We were disappointed by the results and have stopped using the method.

[Criteria for waiting list guarantee. An attempt at precision]. / Kriterier for å få ventelistegaranti. Forsøk på presisering.

A scoring form has been developed, based upon the system of priorities used in Norway when deciding among patients waiting for investigation and treatment in hospital. This scoring form was used to evaluate 40 different case histories in gynaecological, orthopaedic, urologic and oto-rhino-laryngological departments. There was much disagreement when evaluating the different case histories. Using this scoring form did not result in greater agreement among the physicians using it than among another group of physicians who evaluated the same case histories without using the form.

[The waiting list guarantee. Variations in frequency of receiving the waiting list guarantee]. / Ventelistegarantiordningen. Variasjon i andel som får ventelistegaranti.

From 1987, patients waiting for treatment in Norwegian hospitals are given different degrees of priority, from zero to five. As from 1990, patients in priority group two are placed on a special list, and a report is made if they have not been treated within six months. There is a considerable variation in the frequency with which the patients are given this treatment guarantee in the different Norwegians counties. In the case of gynaecological patients the frequency varies from one to 94%, of urological patients from 43 to 100%, of orthopaedic patients from 21 to 89% and of otorhinolaryngological patients from 21 to 89%. The same variations are also seen within a single region of the country, and between departments. The reason for this discrepancy may be varying composition of the population, different extents of day surgery or different economic strategic thinking. Probably the main reason is that the criteria for giving a waiting list guarantee are not accepted as operational. This leads to different medical judgments when evaluating the applications for treatment in hospital.

[Smoking habits of pregnant women in municipalities of Asker and Baerum]. / Røykevaner hos gravide i Asker og Baerum kommune.

Smoking in pregnancy is unequivocally harmful to both foetal and maternal health. Earlier investigations in Norway among pregnant women who smoke have demonstrated a prevalence of smoking of around 40% and that some women stop smoking as soon as the pregnancy is confirmed (around 20%). This investigation reports only 16% smokers among pregnant women registered at 18th week of pregnancy in the two municipalities of Asker and Baerum. Average daily consumption was 8.6 cigarettes, and 65% of the women stated that they smoked more than five cigarettes per day. 97% expressed a positive interest in quitting smoking, and 76% had tried to quit earlier. 77% had a partner who was a daily smoker. An assessment of level of education showed that 82% had completed 12 years of schooling and 23% reached a higher educational level. We conclude that the relatively low incidence of daily smoking among pregnant women in these two municipalities should inspire the initiation of active intervention programmes.

[The role of the male partner in contraception and the decision for abortion. A questionnaire study among women applying for abortion and their male partners]. / Mannlig partners rolle ved prevensjonssvikt og abortvalg. En spørreundersøkelse blant abortsøkende kvinner og deres mannlige partnere.

Over a period of 12 months, 96 women who sought legal abortion and 52 of their male partners answered a questionnaire about contraception and abortion. Almost none of them had wanted a pregnancy from the start. Nevertheless two thirds had not used any contraceptives, mainly because they thought the chance of pregnancy was very small. Many stated that they had intended to use a condom, yet they did not do so. The majority of the women told their male partner about the pregnancy as soon as they knew of it themselves. A quarter of the women and about half of the men stated that both partners agreed that she should choose abortion. Two fifths of the women and about half of the men said that the woman's decision weighed most heavily. Many of the women said that the attitude of the partner to the pregnancy was important for their choice. Half of the women, however said that they would have chosen an abortion independent of the attitude of their partner.

Urethral pressure variations in females with and without neurourological symptoms.

Simultaneous urethrocystometry was performed in 93 females without and 174 patients with neurourological symptoms. Both populations were divided into 3 age groups. The urethral pressure variation (delta MUP) was calculated as the difference between the highest (MUPH) and the lowest maximum urethral pressure (MUPL) observed during one minute. In all age groups, both the highest and the lowest maximum urethral pressure, were significantly higher in the normal females than in the patients during retrograde bladder filling. There was, however, no significant difference in the degree of the urethral pressure variation (delta MUP) between normal females and patients in the different age groups. Typical urethral pressure variation was also observed during physiological bladder filling. Thus, urethral pressure variation in itself is a physiological phenomenon. With less difference between the lowest maximum urethral pressure and the bladder pressure the possibility of leaking urine is increased. A urethral pressure decrease may therefore cause leakage in a patient, but not in a normal female. More than 50% of the normal females had a urethral pressure variation of more than 20 cm H2O. The previous definitions of urethral pressure variations (unstable urethral pressure, urethral instability) which describe the condition as pathologic when the pressure varies more than 10, 15 or 20 cm H2O can therefore not longer be considered useful.

Ripening of the cervix with prostaglandin E2-gel. A randomized study with a new ready-to-use compound of triacetin-prostaglandin-E2-gel.

A randomized study with a group of patients treated with a new ready-to-use triacetin-prostaglandin E2-gel compared to a non-treated group was conducted. The gel-treated group showed a distinct difference in cervical score after 12 h and ten patients were delivered during this period without further induction attempt compared to none in the control group. There was a significantly lower need for oxytocin stimulation in the treated group (P less than 0.0005), but there was no difference in the cesarean section rate or instrumental delivery rate. No side-effects were seen. This new gel seems effective and safe.

Comparison of the anaesthetic and haemodynamic effects of chlormethiazole and thiopentone.

Two groups of eight women (60-85 yr) undergoing gynaecological operations of 50 to 130 min duration were compared. Anaesthesia was induced with either thiopentone (mean 4.5 mg kg-1) or chlormethiazole (mean 6.0 mg kg-1) and maintained with nitrous oxide and pethidine in combination with the drug used for the induction. The hourly maintenance dose and the plasma concentration determined at equilibrium were greater for chlormethiazole (means 4.7 mg kg-1 h-1 and 27 mumol litre-1) compared with 1.3 mg kg-1 h-1 (P less than 0.01) and 16 mumol litre-1 respectively for thiopentone (P less than 0.02). Impedance cardiography showed that cardiac output was decreased by 30-40% in the thiopentone group (P less than 0.01), whereas no significant change was observed in the chlormethiazole group. Chlormethiazole anaesthesia was followed by a significant increase (P less than 0.02) in stroke volume. No correlations were found between the plasma concentrations and changes in the haemodynamic indices for either of the drugs.

Chlormethiazole (Heminevrin), pethidine and nitrous oxide as compared to halothane for general anesthesia.

The anaesthetic and postanaesthetic course in a group of gynaecological patients anaesthetized with chlormethiazole (Heminevrin) was investigated and the results compared to a similar group of patients anaesthetized with halothane. Both drugs were used as the main anaesthetic agent in the respective regimes, supplemented by nitrous oxide/oxygen and muscle relaxants. Because chlormethiazole is devoid of analgetic effects, the importance of using pethidine in combination with chlormethiazole is emphasized. An advantage of using chlormethiazole is that it can serve as both an induction and maintenance agent. The plasma concentrations of chlormethiazole were studied in seven patients. For induction, the mean concentration was 4.5 micrograms/ml. The mean concentration on waking at the termination of operation was 1.3 micrograms/ml. No serious side effects were encountered in either treatment. The results suggested that chlormethiazole in combination with an analgetic drug and nitrous oxide could be suitable in elderly patients, although occasionally less effective in the young.

Hepatitis following thiopentone. A case report.

A patient developed pyrexia and jaundice following repeated anaesthesia. The evidence suggests that thiopentone was the causative agent. This incident emphasizes the need for caution in associating jaundice and hepatitis with halothane in patients who have received thiopentone and halothane.

Cyclopropane and Caesarean section.

In a prospective study 589 patients were anaesthetized by the inhalation of cyclopropane 40% for 2--3 min. Relaxation was provided with suxamethonium and anaesthesia was maintained with cyclopropane 7.5%. The series was divided into four groups: patients in optimal condition (96 elective (group 1), 164 emergency (group 3)) and those not in optimal condition (75 elective (group 2), 254 emergency (group 4)). All infants from groups 1 and 3 had high Apgar scores, and all survived. Infants in groups 2 and 4 had lower Apgar scores, eight and 96 respectively were depressed, and 10 and 20 died because of obstetric and neonatal factors unrelated to the anaesthesia. Respiratory distress syndrome (RDS) developed in 44 infants. Among 29 infants in whom the birth weight was less than 2.5 kg the mortality was 31%, whereas no death occurred in mature infants. RDS was significantly more frequent after elective than after emergency surgery. Neonatal depression was independent of the length of the induction-delivery interval, which averaged 13.3 min. The frequency of awareness was 1.5%.