Involving Patients in Their Care

There has been growing interest internationally in how health services might more actively involve—and support the involvement of—patients in deciding about their treatments and in the delivery of their own care. Patient involvement can take diverse forms, and can be valued for a range of reasons. There has been a strong tendency for policies and service development initiatives to emphasize the need for health professionals to communicate to inform patients’ choice-making and to encourage patients to make particular practical contributions to their care. Recent studies of patients’ experiences, however, particularly in the context of breast cancer, have highlighted the additional significance of the relational aspects of involvement and the social factors (including those operating within healthcare settings) that influence patients’ potential to contribute. Further research and debate is needed to illuminate the ethical as well as the practical aspects of involving patients in their care.     

An Epizootiological Report of the Re‐emergence and Spread of a Lineage of Virulent Newcastle Disease Virus into Eastern Europe

A number of contemporary outbreaks of Newcastle disease (ND) in Israel, Turkey, Georgia and Bulgaria have all been caused by a very similar viruses related to lineage 5a (genotype VIIa). Comparison with published ND virus (NDV) sequences suggests that this virus strain originated in South‐East Asia and on introduction has circulated widely in backyard poultry in the Middle East and into Eastern Europe. An intracerebral pathogenicity index of 1.9 was obtained for a representative isolate from Bulgaria. In addition, the International Reference Laboratory for ND has characterized a molecular epidemiologically linked virus that has been reported to have caused disease in well‐vaccinated broiler chickens in Pakistan. In the 1990s, another strain from the 5a lineage NDV was introduced into Europe and spread across the continent causing numerous outbreaks up to 1999. Despite improved controls, including good diagnostic tests and widespread vaccination, in commercial poultry, the novel circulating NDV strains described here have been established widely in the region and represent an increased risk for similar disease outbreak events to reoccur within the EU.     

Stress injury of the rib in a swimmer

Rib stress injuries are uncommonly reported but have been documented among athletes, most notably rowers. There have only been two prior case reports of rib stress injuries in swimmers, both of which were young females. Magnetic resonance (MR) imaging was either not obtained or the imaging characteristics were incompletely described. We present a case of an isolated third rib stress injury in a collegiate male swimmer diagnosed via MR imaging. We briefly discuss the possible etiologies for rib stress injuries, their MR appearance, as well as their treatment.