Dog-assisted interventions in care homes: A qualitative exploration of the nature,meaning and impact of interactions for older people

Dog-assisted interventions (DAI) have been shown to have a wide-range of potential benefits for older adults living in care homes. Yet, there is a lack of published qualitative research which explores the experiences of care home residents, staff and dog-owner volunteers involved in DAI to fully understand its meaning, impact and value. This study aimed to explore the impact of a DAI on the social and emotional wellbeing of older residents living in care homes. The research employed a qualitative study design comprising overt, naturalistic researcher observation of weekly DAI sessions with 54 older adult residents across four participating care homes in the South East region of England over 3 months in 2018. Data were also collected through focus groups with 12 care home staff and 7 dog-owner volunteers. The data from the observations and focus groups was individually coded followed by thematic analysis across the three data sources. Findings demonstrated there were clear benefits for older people who engaged with DAI, as well as for dog-owners and to some extent for care home staff members. Benefits included sensory, emotional stimulation and opportunities for social interaction, reminiscence on early life experiences and these were supported by the development of some new social relationships. While there were some environmental challenges to implementing DAI, the findings confirm its value for care home residents, with minimal drawbacks from an organizational standpoint. As a low cost intervention, adoption of DAI in care home settings appeared to strengthen relationships between residents and staff and enable wider relationships with an external community resource.     

Menstrual pain and risk of epithelial ovarian cancer: Results from the Ovarian Cancer Association Consortium

Menstrual pain, a common gynecological condition, has been associated with increased risk of ovarian cancer in some, but not all studies. Furthermore, potential variations in the association between menstrual pain and ovarian cancer by histologic subtype have not been adequately evaluated due to lack of power. We assessed menstrual pain using either direct questions about having experienced menstrual pain, or indirect questions about menstrual pain as indication for use of hormones or medications. We used multivariate logistic regression to calculate the odds ratio (OR) for the association between severe menstrual pain and ovarian cancer, adjusting for potential confounders and multinomial logistic regression to calculate ORs for specific histologic subtypes. We observed no association between ovarian cancer and menstrual pain assessed by indirect questions. Among studies using direct question, severe pain was associated with a small but significant increase in overall risk of ovarian cancer (OR = 1.07, 95% CI: 1.01–1.13), after adjusting for endometriosis and other potential confounders. The association appeared to be more relevant for clear cell (OR = 1.48, 95% CI: 1.10–1.99) and serous borderline (OR = 1.31, 95% CI: 1.05–1.63) subtypes. In this large international pooled analysis of case‐control studies, we observed a small increase in risk of ovarian cancer for women reporting severe menstrual pain. While we observed an increased ovarian cancer risk with severe menstrual pain, the possibility of recall bias and undiagnosed endometriosis cannot be excluded. Future validation in prospective studies with detailed information on endometriosis is needed.     

Bacteriological safety and cost-effectiveness of a nonrefluxing valve in the irrigation system during outpatient flexible cystoscopy

OBJECTIVE: To critically evaluate the infection rate associated with the use of a nonrefluxing irrigation system for outpatient flexible cystoscopy, by comparing it with conventional irrigation systems, and to determine the costs and benefits of this system of irrigation delivery. PATIENTS AND METHODS: All patients undergoing flexible cystoscopy on scheduled outpatient lists were considered for inclusion in the study; 143 patients of 220 undergoing cystoscopy fulfilled the study criteria. The study group of patients underwent cystoscopy with a new single-use nonrefluxing valve inserted into the same irrigation delivery system that was used for the whole endoscopy session, and the control group had the complete irrigation system changed after each endoscopic examination. Midstream urine samples were taken for analysis before cystoscopy and again 3-4 days later. Infection was defined as a pure growth of >/= 105 organisms/mL, with associated pyuria defined as >/= 10 pus cells per high power microscopic field. RESULTS: Complete data were available on 133 patients, with a further nine being excluded from the statistical analysis because they had a pre-existing urinary tract infection, leaving 64 patients in the study and 69 in the control groups. The overall infection rate for flexible cystoscopy was 3.2%, with no significant difference between the study and control groups. Cost savings of > 35% can be expected using the nonrefluxing valve method of irrigation delivery. CONCLUSION: The nonrefluxing valve caused no detectable increase in patient morbidity from bacterial infection when compared with conventional irrigation systems for flexible cystoscopy, and can save considerable costs.     

Investigations using logistic regression models on the effect of the LMA on morphine induced vomiting after tonsillectomy

The effect of intraoperative airway management on postoperative vomiting after tonsillectomy is unknown. Logistic regression was used in a retrospective study to investigate the effect of the laryngeal mask airway (LMA) on a morphine dose-vomiting response curve. Charts were reviewed in 351 children in whom the airway was managed with either a LMA (n=177) or a tracheal tube (n=174). A mean perioperative morphine dose of 0.10 mg.kg(-1) (SD 0.09) was used in 248 children and a further 103 children were given no opioid. One hundred and eighteen of these 248 children vomited (47.6%) compared to 14 of 103 children given no morphine (13.6%). The probability of vomiting was related to morphine dose using logistic regression with both a linear and an E(max) model. Both the calibration (Hosmer-Lemishow goodness of fit chi-squared test lambda(2), P=0.81) and discrimination (area under the receiver operating characteristic plot, AUC ROC=0.67) of the E(max) model were better than the linear model (lambda(2), P=0.49; AUC ROC=0.64). Pharmacodynamic parameter estimates for the Emax model were P(0) (the baseline probability of vomiting) 0.139, P(max) (the maximal probability of vomiting due to morphine) 0.96, ED(50) (morphine dose that induces an effect equivalent to 50% of the logit P(max)) 0.09 mg.kg-1. The probability of vomiting was 50% after morphine 0.125 mg.kg-1. The use of the LMA had no effect on this dose-response curve. A covariate analysis investigating propofol for induction or isoflurane for the intraoperative maintenance of anaesthesia, however, showed that both drugs shifted the curve to the right. The probability of vomiting was 50% after morphine 0.17 mg.kg(-1) and 0.21 mg.kg(-1) for the isoflurane and propofol use curves, respectively. The concomitant use of propofol and isoflurane, but not the use of the LMA, decreases the probability of vomiting due to morphine.     

CYTOGENETICS OF AN ATYPICAL SPITZ NEVUS METASTATIC TO A SINGLE LYMPH NODE

Clinicopathologic details of an atypical Spitz nevus are reported. A metastasis to a single ipsilateral lymph node is documented. Cytogenetic analysis of the metastatic lesion revealed a clonal chromosomal abnormality, add(6)(q12 13), previously noted in cases of malignant melanoma.     

Polycystic ovary syndrome and bulimia

One hundred fifty-three patients classified as suffering from polycystic ovarian syndrome (PCOS) and 109 patients who were suffering from a clear organic disorder or endocrinopathy received the bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behaviors. Patients with PCOS showed a significant increase in their mean BITE score for approximately a third had abnormal eating patterns, and 6% have scores suggestive of clinical bulimia compared with only 1% of women in the group with organic endocrinopathies. The work suggests that women with PCOS should be screened for abnormal eating behaviors and raises the possibility that treatment by psychological means should be considered when abnormal eating behaviors are present.     

Diminished degradation of yeast cytochrome c by interactions with its physiological partners.

The level and structure of yeast iso-1-cytochrome c and iso-2-cytochrome c, encoded by the nuclear genes CYC1 and CYC7, respectively, are normally not altered in rho- mutants, which completely lack the cytochromes a.a3 subunits and cytochrome b that are encoded by mitochondrial DNA. In contrast, iso-cytochromes c containing the amino acid change Thr-78-->Ile (T78I) were observed at the normal or near-normal wild-type level in rho+ strains but were completely absent in rho- mutants. We have demonstrated with the "global" suppressor mutation Asn-52-->Ile and by pulse-chase labeling that the T78I iso-1-cytochrome c undergoes rapid cellular degradation in rho- mutants. Furthermore, specific mutations revealed that the deficiency of T78I iso-1 cytochrome c can be caused by the lack of cytochrome a.a3 or cytochrome c1, but not by the lack of cytochrome b. Thus, this and certain other, but not all, labile forms of cytochrome c are protected from degradation by the interaction with its physiological partners.