Arthroscopic-guided ulnar distraction for the correction of elbow incongruency in four dogs.

Four skeletally immature, small breed dogs (five elbows) with elbow incongruency were evaluated for forelimb lameness. Findings on clinical examination included pain, effusion and decreased range of motion of the affected elbow. Radiography, computed tomography and arthroscopy demonstrated elbow incongruency in all dogs. Fragmented medial coronoid process was diagnosed arthroscopically in three dogs (four elbows). Arthroscopic subtotal coronoidectomy was performed in all cases of fragmented medial coronoid process. Incongruency was corrected with acute ulnar lengthening under arthroscopic visualisation. The ulna was stabilised with a plate following correction. In two elbows an ostectomy of the anconeal process was performed to prevent impingement against the olecranon fossa. All dogs demonstrated improvement in lameness scores and client-scored visual analogue scale scores. Postoperative computed tomography showed significant improvement in elbow incongruency in all dogs. Arthroscopic-guided ulnar lengthening may be considered as a valid treatment in severe cases of elbow incongruency.

Hinged circular fixator construct for correction of congenital metatarsal deformity in a foal.

A five-week-old American Quarter Horse colt was presented for evaluation of a left hindlimb deformity and lameness. Radiographs of the left hindlimb revealed a varus deformity with recurvatum originating in the mid-diaphysis of the third metatarsal bone. Surgical correction was undertaken by performing an osteotomy through the centre of rotation of angulation located within the mid-diaphysis of the third metatarsal bone, and a four-ring hinged circular external fixator construct was applied. Distraction of the osteotomy site was performed over an 11 day period. Notable complications included failure of a fixation pin, infection of the surgical site, and temporary laxity of the supporting tendons and ligaments of the contralateral metatarsophalangeal joint. The fixator was maintained until there was sufficient bone formation to allow frame removal, 152 days after the initial surgery. Use of a hinged circular construct allowed for partial correction of the deformity with resultant lengthening and resolution of the lameness in this colt.

Retrospective comparison between minimally invasive plate osteosynthesis and open plating for tibial fractures in dogs.

OBJECTIVES: To compare fracture healing in diaphyseal tibial fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF). METHODS: Dogs in each group were matched for type of fracture, age and body weight. Stage of healing was measured blindly every four weeks postoperatively until complete healing. Outcome variables including fracture length, plate length, plate bridging ratio, plate working length, healing grading, and fracture reduction were compared between groups using the Mann-Whitney test. Significant difference was set at p <0.05. RESULTS: Based on the definition of clinical union, at 30 days five out of eight dogs managed with MIPO had healed, while two of the eight of dogs managed with ORIF had healed. We did not find any significant differences in the other outcome measures. No complications were reported in the MIPO group whereas one major complication was reported in the ORIF group. CLINICAL SIGNIFICANCE: All dogs treated by MIPO healed rapidly without any complications, nevertheless the difference in radiographic healing between the two groups was not significant.

Use of an interlocking nail-hybrid fixator construct for distal femoral deformity correction in three dogs.

Our purpose was to report the use of an interlocking nail-hybrid external fixator construct to correct distal femoral deformities in three dogs. Radiographs, computed tomography and a three-dimensional model were used to plan the surgical procedure. A femoral osteotomy or ostectomy was performed at the level of the centre of rotation of angulation in all three dogs. Angular and rotational deformities were corrected acutely. Distraction osteogenesis was performed to lengthen each femur postoperatively. All three dogs had additional anatomic abnormalities of the affected hindlimb complicating the correction of the distal femoral deformity. While the interlocking nail-hybrid fixator construct allowed for stable distraction of the femur, all three dogs developed complications during the postoperative convalescent period, and each had some degree of residual lameness. Lengthening the femur following acute deformity correction is problematic and additional experimental and clinical studies are warranted to decrease postoperative morbidity and improve functional results.

Latex allergy literature review: evidence for making military treatment facilities latex safe.

Latex allergy has become the epidemic of the 1990s for health care workers, as indicated by a remarkable increase in its prevalence. This literature review provides a brief background to the latex problem, strategies for prevention and management, a cost analysis of glove substitution in a clinical setting, and the implications for the military environment. Primary care providers must recognize the financial, medico-legal, occupational, and personal ramifications of latex allergy. Risk managers should realize that moving to a latex-free environment will reduce liability.

Successful interprofessional collaboration on the hospice team.

Despite the holistic approach inherent in the hospice philosophy, social work may be viewed in hospices as ancillary or secondary to medicine. Social work, in turn, may have a lack of training and sensitivity about other professions' expertise and values and as a result be unprepared to collaborate across the cultural boundary that exists between professions. Barriers to full use of all disciplines on the interdisciplinary team include lack of knowledge of the expertise of other professions, role blurring, conflicts arising from differences among professions in values and theoretical base, negative team norms, client stereotyping, and administrative issues. This article outlines the barriers and proposes solutions to address them.

The role of primary caregiver denial in inpatient placement during home hospice care.

This study conducted with a sample of 68 home hospice patients revealed that primary caregivers in denial of the patient's terminality were more likely to place hospice patients in inpatient treatment. Moreover, patients placed in inpatient settings were more likely to die there, rather than at home as planned. These findings suggest an impact of primary caregiver denial upon patient self-determination, and indicate the importance of addressing denial in counseling with primary caregivers of terminally ill patients.

Hospice access and use by African Americans: addressing cultural and institutional barriers through participatory action research.

This article describes a participatory action research project addressing the problem of African American access to and use of hospice. Qualitative interviews conducted with six African American pastors resulted in the identification of major themes used for development of a scale to measure barriers to hospice. A subsequent quantitative study documenting these barriers was conducted with 127 African American and European Americans. Results of both studies, which were used to further social action efforts in the community, indicated the cultural barriers of differences in values regarding medical care and differences in spiritual beliefs between African Americans and European Americans. Results also indicated institutional barriers, including lack of knowledge of services, economic factors, lack of trust by African Americans in the health care system, and lack of diversity among health care staff. Implications for social work practice and policy are discussed.

Psychosocial and spiritual care in hospice: differences between nursing, social work, and clergy.

A chart review of the most recent home visits from nursing, social work, and clergy to 37 home hospice patients indicated that all but two psychosocial and spiritual issues examined were addressed by hospice staff on home visits. Spirituality and, secondly, death anxiety were the most frequently discussed variables. Clergy addressed more spiritual issues than the other two professions, and social work addressed more psychosocial issues than the other two professions. These findings underscore the important roles that clergy and social work play on the hospice team, and imply that hospice should make a renewed commitment to psychosocial and spiritual care.

The peripheral giant cell granuloma.

A peripheral giant cell granuloma can be seen as a pedunculated or broad-based lesion. Such lesions occur after age 20 years, with 50 percent of patients 40 to 59 years old. Frequently, there is a history of trauma to the region.

Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery.

BACKGROUND: Once established in an institution, methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have proved difficult to eradicate, despite intensive infection control measures. This report describes the nosocomial infection with MRSA of 22 male infants in a neonatal nursery during a 7-month period and the infection control procedures that effectively brought this outbreak under control and eliminated recurrence for more than 3 1/2 years. METHODS: After a single index case of bullous impetigo caused by MRSA in a neonate discharged from the nursery 2 weeks previously, an additional 18 cases of MRSA skin infections were clustered in a 7-week period. Aggressive infection control measures were instituted, including changes in umbilical cord care, circumcision procedures, diapers, handwashing, gloves, gowns, linens, disinfection, placement in cohorts of neonates and staff, surveillance, and monitoring. RESULTS: These measures were not effective in slowing the outbreak. The single additional measure of changing handwashing and bathing soap to a preparation containing 0.3% triclosan (Bacti-Stat) was associated with the immediate termination of the acute phase of the MRSA outbreak. CONCLUSION: The nursery has remained free of MRSA for more than 3 1/2 years, attesting to the success of our program.