Comparison of Fixed and Rising Displacement Rates of CO2 for Euthanasia of Aged Rats.

This study compared euthanasia induced by rising concentrations of CO2 in aged rats (n = 59) using different gas displacement rates. Rats were preimplanted with cardiovascular telemetry devices and had been previously used for short term safety pharmacology studies. Once fully recovered from previous studies, rats were euthanized using rising concentrations of CO2. Three groups were exposed to gas displacement at fixed flow rates of 30%, 40%, and 50%, and 3 groups were exposed to increased flow rates at predetermined, one-minute intervals (10 to 30%, 20 to 40%, and 30 to 50%). Comparisons were based on the time taken to reach 4 critical endpoints: dyspnea, ataxia, recumbency, and death. The preimplanted telemetry devices were used to record cardiovascular parameters. Video recordings of the euthanasias were performed to allow behavioral assessment by a blind observer. The histologic effects of the different concentrations were also evaluated. No significant differences were detected between the groups in behavioral scores or histopathology. Groups of rats exposed to higher levels of CO2 had a shorter time to loss of consciousness and death than did rats exposed to lower concentrations of CO2. No statistically significant differences were detected in the time by which rats showed visual signs of dyspnea. Slow CO2 displacement rates of CO2 may prolong the time necessary for euthanasia yet provide no appreciable improvement in welfare in aged rats and should therefore be avoided.

The Admiral Nurse Competency Framework: Encouraging Engagement and Putting It Into Practice.

BACKGROUND: Admiral Nurses undertake complex work with families living with dementia. Dementia UK commissioned The Association for Dementia Studies to refresh the Admiral Nurse Competency Framework and enable Admiral Nurses to articulate and critically reflect on their own practice progression. The Admiral Nurses were involved throughout the process to refresh the framework to ensure it was evidence based. METHOD: To encourage engagement with the framework, The Association for Dementia Studies worked with the Admiral Nurses during a roll-out phase. An exercise was developed to initiate critical reflective discussion. Critiquing a colleague's practice is a skill, provoking defensiveness if not facilitated thoughtfully. RESULTS: An exercise combining art cards with case study analysis worked well, promoting critical reflective dialogue between Admiral Nurses as peers. Engagement and feedback were positive, and the neutrality of the exercise provided a safe environment with the flexibility to allow in-depth and meaningful discussions. CONCLUSION: This technique could benefit work-based learning, facilitating creative critical reflection within practice. [J Contin Educ Nurs. 2019;50(5):205-210.].

Culturally Competent Health Care for Sex Workers: An Examination of Myths That Stigmatize Sex-Work and Hinder Access to Care.

Sex workers are individuals who offer sexual services in exchange for compensation (i.e., money, goods, or other services). Within the United States the full-service sex work (FSSW) industry generates 14 billion dollars annually there are estimated to be 1-2 million FSSWers, though experts believe this number to be an underestimate. Many FSSWers face the possibility of violence, legal involvement, and social stigmatization. As a result, this population experiences increased risk for mental health disorders. Given these risks and vulnerabilities, FSSWers stand to benefit from receiving mental health care however a constellation of individual, organizational, and systemic barriers limit care utilization. Destigmatization of FSSW and offering of culturally competent mental health care can help empower this traditionally marginalized population. The objective of the current review is to (1) educate clinicians on sex work and describe the unique struggles faced by FSSW and vulnerability factors clinicians must consider, (2) address 5 common myths about FSSW that perpetuate stigma, and (3) advance a research and culturally competent clinical training agenda that can optimize mental health care engagement and utilization within the sex work community.

Comparison of transdermal fentanyl and oral tramadol for lateral thoracotomy in dogs: cardiovascular and behavioural data.

OBJECTIVE: To compare the analgesic efficacy and suitability of an existing oral tramadol-based protocol with a transdermal fentanyl-based protocol following lateral thoracotomy in dogs. STUDY DESIGN: Prospective randomized clinical trial. ANIMALS: A group of 16 healthy laboratory beagle dogs. METHODS: Dogs were randomly allocated to one of two treatment groups: group F (intramuscular methadone 0.2 mg kg-1 and transdermal fentanyl 2.6 mg kg-1 both administered on discontinuation of anaesthesia, n = 8) or group T (intramuscular methadone 0.2 mg kg-1 on discontinuation of anaesthesia and again 4 hours later, followed by oral tramadol 12 mg kg-1 per 24 hours commencing 7 hours after discontinuation of anaesthesia, n = 8). Intercostal bupivacaine (0.5-1 mg kg-1) and subcutaneous carprofen (4 mg kg-1) were administered to all dogs at induction. Body weight (BW), presence of clinical signs, pain score, activity, heart rate (HR) and mean arterial pressure (MAP) were assessed for 72 hours postoperatively. RESULTS: No significant differences were observed in BW change, presence of clinical signs or gross locomotor activity between groups. Pain scores were low at all times for all dogs, and rescue analgesia was not required. Dogs in group T exhibited higher pedometric activity (p = 0.006), HR (p < 0.001) and MAP (p < 0.001) than those in group F, in particular on night 1 following surgery. Least squared mean (LSM) pedometric activity was 1.81 and 1.02 jerks minute-1, LSM HR was 111.13 and 78.64 beats minute-1 and LSM MAP was 111.62 and 105.24 mmHg, respectively, in groups T and F. CONCLUSIONS AND CLINICAL RELEVANCE: Both regimes appear to provide adequate analgesia following lateral thoracotomy in dogs. Ease of administration of transdermal fentanyl compared to oral tramadol is advantageous. Reduced activity observed with the fentanyl regime was not associated with any adverse effects and may be desirable following some invasive surgeries. However, while transdermal fentanyl remains currently unavailable in the European Union, the oral tramadol-based regime provides an acceptable alternative.

Towards the end of life: An in-depth exploration of the role of Admiral Nursing in dementia care (Innovative practice).

There are approximately 150 Admiral Nurses in the UK who work alongside other health and social care professionals to support people with dementia and their family carers. However, the stigma of the disease and the lack of recognition that dementia is a life limiting illness have led to neglect in addressing the end of life challenges. The small in-depth study reported here aimed to add to an extremely limited formal evidence base for the effectiveness of this approach and to develop a greater understanding of the range of knowledge and skills required of them in ensuring they are better able to support families in the later stages of the illness. Findings focus on the experiences of family carers, the impact of performing the Admiral Nurse role and the use of qualitative measures in this setting.

How a link nurse ensured equal treatment for people of Asian origin with dementia.

A review of services for older people with dementia from black and minority ethnic (BME) communities in Wolverhampton found that these groups were under represented in mental health services. Problems included a lack of information about and awareness of services, confusion about the mental health condition and a reluctance to ask for help. The review also highlighted that the proportion of older people with dementia from BME groups is set to increase significantly. It made several wide ranging recommendations to improve access to and uptake of services for these groups, which led to the creation of an Asian link nurse role specifically for Punjabi speaking people of Asian origin. This practitioner is a qualified community psychiatric nurse, who speaks Punjabi, related languages and English, and understands the relevant cultural issues. This model has been used elsewhere and we believe it should be adopted more widely to ensure equal access to culturally appropriate services for older people from BME groups.

Decision-making by adolescents and parents of children with cancer regarding health research participation.

BACKGROUND: Low rates of participation of adolescents and young adults (AYAs) in clinical oncology trials may contribute to poorer outcomes. Factors that influence the decision of AYAs to participate in health research and whether these factors are different from those that affect the participation of parents of children with cancer. METHODS: This is a secondary analysis of data from validated questionnaires provided to adolescents (>12 years old) diagnosed with cancer and parents of children with cancer at 3 sites in Canada (Halifax, Vancouver, and Montreal) and 2 in the United States (Atlanta, GA, and Memphis, TN). Respondents reported their own research participation and cited factors that would influence their own decision to participate in, or to provide parental authorization for their child to participate in health research. RESULTS: Completed questionnaire rates for AYAs and parents were 86 (46.5%) of 185 and 409 (65.2%) of 627, respectively. AYAs (n = 86 [67%]) and parents (n = 409 [85%]) cited that they would participate in research because it would help others. AYAs perceived pressure by their family and friends (16%) and their physician (19%). Having too much to think about at the time of accrual was an impediment to both groups (36% AYAs and 47% parents). The main deterrent for AYAs was that research would take up too much time (45%). Nonwhite parents (7 of 56 [12.5%]) were more apt to decline than white parents (12 of 32 [3.7%]; P < .01). CONCLUSIONS: AYAs identified time commitment and having too much to think about as significant impediments to research participation. Addressing these barriers by minimizing time requirements and further supporting decision-making may improve informed consent and impact on enrollment in trials.

Evidence for the involvement of central 5-HT7 receptors in the micturition reflex in anaesthetized female rats.

(1) The effects of the selective 5-HT7 receptor antagonists SB-269970 (3-300 microg kg-1; n=5-6) and SB-656104 (30 microg kg-1; n=5) administered centrally (i.c.v.) were investigated on the 'micturition reflex' in the urethane anaesthetized female rat. (2) In cystometric recordings, SB-269970 caused significant increases in volume of 58+/-15 and 138+/-33% and pressure of 140+/-46 and 149+/-60% thresholds at 10 and 30 microg kg-1. These changes were associated with significant decreases in distension-induced bladder contraction of 62+/-14 and 60+/-11%, respectively. However, there was no change in residual volume. At the higher doses, SB-269970 blocked the micturition reflex. SB-656104 had similar effects to SB-269970 but in addition significantly increased the residual volume. (3) SB-269970 (10 microg kg-1; n=5) given i.v. had no effect on the micturition reflex. (4) SB-269970 (30 microg kg-1; n=4) given intrathecally (i.t.) had no effect on micturition reflex, although the selective 5-HT1A receptor antagonist WAY-100635 given i.t. after SB-269970 caused a significant increase in the volume threshold. (5) Using an isovolumetric method in which urethral changes were measured, SB-269970 (30 microg kg-1; n=4; i.c.v.) failed to have any effect on these urethral-evoked changes although they significantly reduced the amplitude of the bladder contraction. (6) These data demonstrate that 5-HT7 receptors located supraspinally in the rat are involved in the control of micturition.