Recommendations for the practice of travel medicine

Travel Medicine has emerged as a distinct entity over the last two decades in response to a very substantial increase in international travel and is now forging its own identity, remit and objectives for care of the traveller. Crucial to the formation of any speciality is the definition of recommendations for its practice. This is particularly important and needed for travel medicine as it overlaps with and forms part of day-to-day work in a number of different medical specialities. This document defines a set of recommendations for the practice of travel medicine from the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow. Their objective is to help raise standards of practice and achieve greater uniformity in provision of services, better to protect those who travel. As travel medicine moves towards applying for speciality status, these standards will also contribute to that process.     

A guide to choosing a burn scar rating scale for clinical or research use

Introduction

A lack of high quality burn scar rating scales underpins the urgent need to introduce a guide for clinicians and researchers to choose the most appropriate scale for their requirements.

Methods

An updated electronic search of Medline, CINAHL, and EMBASE databases from 2010 to 2011 of a previous published systematic review were used to identify English articles related to burn scar rating scales. The clinimetric properties, content, purpose, characteristics of the subjects tested and feasibility of each scale were critically reviewed.

Results

An additional seven papers were identified by the updated search, bringing the total number of papers reviewed to 36. The majority (88%) covered items pertaining to the physical properties of the skin rated by an observer. All of the scales had been tested for the purpose of discriminating between patient groups; however, only preliminary evidence exists for the ability of the scales to measure change in scar properties over time. The majority of testing of scales occurred using Caucasian subjects, males, upper limb sites and adults.

Conclusions

This paper provides a guide to selecting the most appropriate burn scar rating scale for research and clinical practice by reviewing the content, purpose, test sample characteristics and feasibility of each scale.     

American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force Report on omalizumab-associated anaphylaxis

The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma and Immunology Executive Committees formed the Omalizumab Joint Task Force with the purpose of reviewing the Genentech Xolair (omalizumab) clinical trials and postmarketing surveillance data on anaphylaxis and anaphylactoid reactions. Using the definition of anaphylaxis proposed at a 2005 multidisciplinary symposia, the Omalizumab Joint Task Force concluded that 35 patients had 41 episodes of anaphylaxis associated with Xolair (omalizumab) administration between June 1, 2003, and December 31, 2005. With 39,510 patients receiving Xolair (omalizumab) during the same period of time, this would correspond to an anaphylaxis-reporting rate of 0.09% of patients. Of those 36 events for which the time of reaction was known, 22 (61%) reactions occurred in the first 2 hours after one of the first 3 doses. Five (14%) of the events after the fourth or later doses occurred within 30 minutes. Considering the timing of these 36 events, an observation period of 2 hours for the first 3 injections and 30 minutes for subsequent injections would have captured 75% of the anaphylactic reactions. The OJTF report provides recommendations for physicians who prescribe Xolair (omalizumab) on (1) the suggested wait periods after administration and (2) patient education regarding anaphylaxis.     

Patient education in Parkinson's disease: Formative evaluation of a standardized programme in seven European countries

OBJECTIVE: To evaluate a newly developed education programme for Parkinson's disease (PD) patients. METHODS: The programme consisted of eight sessions and aimed at improving knowledge and skills related to self-monitoring, health promotion, stress management, depression, anxiety, social competence, and social support, all with special reference to PD. The programme was formatively evaluated in seven European countries (Spain, Finland, Italy, The Netherlands, United Kingdom, Estonia, Germany) with 151 patients diagnosed with idiopathic PD. The evaluation included patients' ratings of the comprehensibility and feasibility of the programme as well as mood ratings before and after each session. Patients also completed questionnaires at the beginning and end of the programme to explore possible changes in disease-related psychosocial problems, quality of life, and depression. RESULTS: The programme was feasible to run, and patients were able to understand its elements. Patients reported mood elevations following individual sessions and reduced disease-related psychosocial problems after completing the programme. There were no substantial differences in results between cultures. CONCLUSION: Patient education appears to have potential as a useful and feasible intervention, complementing medical treatment in PD. PRACTICE IMPLICATIONS: The present programme will soon be available in seven European languages and can be tested in different health care systems.     

Use of the retained guidewire technique facilitates left ventricular epicardial capture during biventricular defibrillator implantation

We report a case of biventricular implantable cardioverter-defibrillator (ICD) insertion in which standard lead placement techniques could not achieve left ventricular capture. Protrusion of the guidewire beyond a venous stenosis provided adequate left ventricular capture.     

Thalamic and corticocortical connections of the second somatic sensory area of the mouse

Thalamic and corticocortical connections of the second somatic sensory area (SII) in the mouse cerebral cortex were investigated by means of the retrograde transport of horseradish peroxidase. Focal injections of the enzyme were made in physiologically determined locations within the parietal cortex. Results show that SII receives substantial inputs from topographically appropriate regions within the ipsilateral ventrobasal nucleus and from the ipsilateral posterior group. The limb representation, which was previously found to be responsive to auditory stimulation, received inputs also from the medial division of the medial geniculate body. The SII face representation, which is largely unresponsive to auditory stimuli, received little or no input from the medial geniculate body. SII injections yielded retrograde labeling in the topographically appropriate region in the first somatic sensory area (SI), and SI injections retrogradely labeled cells in SII in a pattern consistent with previous electrophysiological maps. Homotypical regions within SI and SII therefore appear to be reciprocally interconnected. SII also receives inputs from the ipsilateral motor cortex and from contralateral SI and SII. Finally, injections into the SI paw but not face regions yielded retrograde labeling in the thalamic ventrolateral nucleus. Thus, the distal limb representations in SI and SII each receive inputs from a third major relay nucleus (i.e., medial geniculate to SII, ventrolateral nucleus to SI) whereas the face representations do not. These results indicate a close functional interrelationship between homotypical areas in SI and SII, though the two areas differ in several important respects. It is proposed that SII in mice may complement the function of SI by helping to define the overall sensory context in which detailed tactile discriminations are made.