Periodontal health, neutrophil activity and cardiovascular health in captive chimpanzees.

OBJECTIVE: To investigate the association of dental and cardiac disease in a cohort of captive chimpanzees DESIGN: 12 captive chimpanzees underwent periodontal and cardiac examinations under anaesthesia during a relocation to a new enclosure. Blood samples were taken for analysis of circulating markers of cardiac health, nutritional status and isolation of neutrophils for functional assays. They were then observed for three years for signs of heart disease. RESULTS: Although the chimpanzees displayed large quantities of supragingival plaque, they had low bleeding scores. Peripheral blood neutrophils responded to innate and adaptive immune stimuli. In the follow up period two animals died and post mortem confirmed heart disease. Levels of NT-proBNP were found to be high in chimpanzees that died from heart disease. CONCLUSIONS: Whilst there appeared to be a correlation between probing depth and age, there appeared to be no correlation between dental data and heart data in this cohort.

Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4.

OBJECT: Patients with traumatic brain injury (TBI) with low presenting Glasgow Coma Scale (GCS) scores have very high morbidity and mortality rates. Neurosurgeons may be faced with difficult decisions in managing the most severely injured (GCS scores of 3 or 4) patients. The situation may be considered hopeless, with little chance of a functional recovery. Long-term data are limited regarding the clinical outcome of children with severe head injury. The authors evaluate predictor variables and the clinical outcomes at discharge, 1 year, and long term (median 10.5 years) in a cohort of children with TBI presenting with postresuscitation GCS scores of 3 and 4. METHODS: A review of a prospectively collected trauma database was performed. Patients treated at Riley Hospital for Children (Indianapolis, Indiana) from 1988 to 2004 were reviewed. All children with initial GCS (modified for pediatric patients) scores of 3 or 4 were identified. Patients with a GCS score of 3 were compared with those with a GCS score of 4. The outcomes of all patients at the time of death or discharge and at 1-year and long-term follow-up were measured with a modified Glasgow Outcome Scale (GOS) that included a "normal" outcome. Long-term outcomes were evaluated by contacting surviving patients. Statistical "classification trees" were formed for survival and outcome, based on predictor variables. RESULTS: Sixty-seven patients with a GCS score of 3 or 4 were identified in a database of 1636 patients (4.1%). Three of the presenting factors differed between the GCS 3 patients (n = 44) and the GCS 4 patients (n = 23): presence of hypoxia, single seizure, and open basilar cisterns on CT scan. The clinical outcomes were statistically similar between the 2 groups. In total, 48 (71.6%) of 67 patients died, remained vegetative, or were severely disabled by 1 year. Eight patients (11.9%) were normal at 1 year. Ten of the 22 patients with long-term follow-up were either normal or had a GOS score of 5. Multiple clinical, historical, and radiological factors were analyzed for correlation with survival and clinical outcome. Classification trees were formed to stratify predictive factors. The pupillary response was the factor most predictive of both survival and outcome. Other factors that either positively or negatively correlated with survival included hypothermia, mechanism of injury (abuse), hypotension, major concurrent symptoms, and midline shift on CT scan. Other factors that either positively or negatively predicted long-term outcome included hypothermia, mechanism of injury, and the assessment of the fontanelle. CONCLUSIONS: In this cohort of 67 TBI patients with a presenting GCS score of 3 or 4, 56.6% died within 1 year. However, approximately 15% of patients had a good outcome at 10 or more years. Factors that correlated with survival and outcome included the pupillary response, hypothermia, and mechanism. The authors discuss factors that may help surgeons make critical decisions regarding their most serious pediatric trauma patients.

Developing a workbook to support healthcare assistants in delivering competent care.

Ensuring that healthcare assistants are competent to perform tasks delegated to them is essential. The Newcastle upon Tyne Hospitals NHS Foundation Trust has developed a workbook that addresses competencies in continence (catheter care), nutrition and pressure ulcer prevention. The workbook aims to accompany clinical-based learning and help HCAs progress through the NHS Knowledge and Skills Framework. This article outlines issues around competence, and the three clinical areas covered in the workbook.

The identification of osteoporosis in patients presenting with low-impact fracture: a pilot study of a method for identification of these patients.

OBJECTIVES: To assess the use of a portable ultrasound unit in screening for osteoporosis in older patients presenting to the Emergency Department (ED) with low-impact fractures. METHOD: All patients over 65 years with a possible low-impact fracture were to be identified and screened. Full ethical approval was obtained. An initial pilot study of "non-osteoporotic" ED staff was carried out before the full study was to occur. RESULTS: The pilot study showed portable ultrasound measuring proximal phalanx bone mineral density lacked both precision and accuracy. CONCLUSIONS: The aims of the study were worthwhile. However, the initial pilot study showed that the tools were inadequate for a full study. The full study was abandoned and new ways of identifying these patients are being looked at.

Body weight change and mortality in a cohort of elderly patients recently discharged from the hospital.

OBJECTIVES: To evaluate the prognostic significance of weight change in frail elderly patients. DESIGN: Prospective study. SETTING: The general medical or surgical wards of a university-affiliated Department of Veterans Affairs hospital. PARTICIPANTS: Six hundred sixty randomly selected subjects aged 65 or older. MEASUREMENTS: At admission and discharge, each subject completed a standardized diagnostic evaluation, including demographic variables, and basic medical, functional, and nutritional assessments. Weights were recorded from hospital or clinic visits in the year before admission, during the current hospitalization, and after discharge for a median of 5.6 years. Average yearly intraindividual weight change was calculated using least-squares regression. Associations between intraindividual weight change and mortality were identified using Cox proportional hazards regression. RESULTS: During the study, 314 subjects (48%) died. A U-shaped association between weight change and mortality was observed. Those who were relatively weight stable (+/-1 kg/y) had the lowest mortality (28%). Compared with this group, the adjusted relative risks (ARR) of death for those who lost 1 or more to less than 3 kg/y and 3 or more kg/y were 2.14 (95% confidence interval (CI)=1.52-3.00) and 3.59 (95% CI=2.58-4.99), respectively. The ARR associated with a weight gain of 1 or more to less than 3 kg/y and 3 or more kg/y was 1.38 (95% CI=0.91-2.10) and 3.73 (95% CI=2.34-5.94), respectively. The amount of bidirectional weight fluctuation (estimated using coefficient of variance) was not significantly associated with mortality. CONCLUSION: For reasons that are not clear, elderly patients who gain 3 or more kg/y after hospital discharge are at nearly the same risk of mortality as those who lose this amount of weight.

Where have all the bubbles gone? An ode to Hydrogen peroxide, the champagne of all wound cleaners.

Hydrogen peroxide solution can be very effective for cleaning grit filled wounds and grazes. Its use in Accident and Emergency (A&E) departments has gone out of vogue due to concerns about air emboli formation. This article discusses the truth behind these concerns and whether it is in fact safe to use hydrogen peroxide solution for wound cleaning in specific situations.