Cardiac Rehabilitation Survey: Maintenance of Lifestyle Changes and Perception of Program Value

Graduates from a Phase II cardiac rehabilitation program were surveyed about their maintenance of healthy lifestyle changes from 1 to 4 years after completing the program. Patients were queried about their continued performance of routine aerobic exercise; use of safe exercise principles; adherence to a low-fat, low-cholesterol diet; and surveillance of lipid levels. Results showed that 74% of patient graduates reported exercising aerobically three to four times weekly, and 50% used their pulse rate to guide exercise intensity. The patients were also asked their opinions about the value of the cardiac rehabilitation program; 91% of patients reported an improvement in their quality of life, and 97% felt the program was a good use of insurance dollars. The findings of this study have implications for program evaluation and modification.     

Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors

OBJECTIVE: To evaluate the effectiveness of injury prevention training. DESIGN: Cluster randomised controlled trial. SETTING: Primary care facilities in the East Midlands area of the United Kingdom. SUBJECTS: Midwives and health visitors. INTERVENTION: Evidence based training session on the risks associated with baby walkers. MAIN OUTCOME MEASURES: The primary outcome measures were knowledge of baby walker use and walker related injury, attitudes towards walkers and towards walker education, and practices relating to walker health education. RESULTS: Trained midwives and health visitors had greater knowledge of the risks associated with baby walkers than untrained midwives and health visitors (difference between the means 0.22; 95% confidence interval (CI) 0.12 to 0.33). Trained health visitors had more negative attitudes to baby walkers (difference between the means 0.35; 95% CI 0.10 to 0.59) and more positive attitudes towards baby walker health education (difference between the means 0.31; 95% CI 0.00 to 0.62) than untrained health visitors. Midwives who had been trained were more likely to discuss baby walkers in the antenatal period than those who were not trained (odds ratio 9.92; 95% CI 2.02 to 48.83). CONCLUSIONS: Injury prevention training was associated with increased knowledge, more negative attitudes towards walkers, and more positive attitudes towards walker education. Trained midwives were more likely to give advice antenatally. Training did not impact on other practices. Larger trials are required to assess the impact of training on parental safety behaviours, the adoption of safety practices, and injury reduction.     

Necrotizing fascitis induced by mosquito bite

Necrotizing fascitis usually occurs after a perforating trauma or sometimes surgery. It is an acute necrotizing process which involves the fascia of the skin. Within one or two days of the causative event the patient experiences pain, oedema and a dusky bluish-red discolouration of the skin with or without bullae formation. These areas become gangrenous usually by the fifth day. Often any specific organisms are not grown on culture, but the common ones that are include beta-haemolytic streptococci, coliforms, enterococci, pseudomonas. Treatment comprises early detection, surgical debridement, intravenous antibiotics and supportive care. We report a case of grossly neglected necrotizing fascitis caused by mosquito bites. Our treatment consisted of intravenous antibiotics, thorough debridement, regular dressings and a split-thickness skin graft. These measures collectively preserved an otherwise hopelessly mutilated upper limb.     

Babywalkers: prevalence of use and relationship with other safety practices

Setting—36 primary care practices across Nottingham, UK.     

Morphine and corticotrophin-releasing factor potentiate maternal acceptance in multiparous ewes after vaginocervical stimulation

The effects of intracerebroventricular infusions of morphine, oxytocin, and corticotrophin-releasing factor (CRF) on maternal behaviour alone, or in conjunction with vaginocervical stimulation were determined in both nulliparous and multiparous ovariectomized ewes, primed with oestrogen for 3 days proir to testing. Both plasma and cerebrospinal fluid levels of oxytocin were measured under similar conditions, following CRF and morphine treatments. In nulliparous ewes, i.c.v. oxytocin and morphine reduced rejection behaviours, but neither these treatments nor vaginocervical stimulation promoted proceptive acceptance behaviour. Ewes that were maternally experienced showed increases in acceptance and a reduction of rejection behaviours following vaginocervical stimulation or i.c.v. oxytocin. Morphine and CRF potentiated the effects of vaginocervical stimulation on these behaviours. No treatment influenced oxytocin release per se, but i.c.v. morphine increased both peripheral and central release of oxytocin in response to vaginocervical stimulation. The results show that maternal experience is essential for oxytocin to promote proceptive behaviours and that morphine and CRF potentiate the effects of vaginocervical stimulation on acceptance behaviour. Since morphine also potentiated the release of oxytocin in response to vaginocervical stimulation it is difficult to separate the relative contribution of direct versus indirect effects of opiates in potentiating maternal bonding.     

Randomized controlled trial of teaching practice nurses to carry out structured assessments of patients receiving depot antipsychotic injections.

BACKGROUND: A third of patients with schizophrenia are out of contact with secondary services. Many of these patients receive maintenance medication as depot antipsychotics from practice nurses, most of whom have negligible training in mental health. AIM: To examine the impact of a structured assessment on the process of care and clinical status of schizophrenia patients by practice nurses who received a one-day training course. METHOD: All identified patients were randomly allocated to structured assessments and outcome, measured by the number of assessments and the changes in care recorded in primary care notes. A comprehensive assessment of clinical and social functioning and level of unmet need in intervention and control patients was carried out after one year by an independent researcher. RESULTS: A high rate of consultation and clinical need in this patient group was demonstrated. Practice nurses were more diligent in carrying out assessments than general practitioners (GPs), but there was no impact on treatment patterns or clinical outcome. CONCLUSIONS: Structured assessments by practice nurses are feasible with this patient group, but training, targeted at both nurses and GPs, is needed if this intervention is to translate into health gain.