THE USE OF INTRADERMAL SKIN TESTING AND HYPOSENSITIZATION INJECTIONS TO CONTROL SEASONAL DERMATITIS IN GREATER ONE-HORNED RHINOCEROSES (RHINOCEROS UNICORNIS).

Allergic dermatitis was diagnosed in a 25-yr-old female greater one-horned rhinoceros (Rhinoceros unicornis) and her 6-yr-old female offspring by skin biopsy, intradermal skin testing (IDST), and allergen-specific serum IgE testing. Dam and offspring presented with seasonal, erosive, and ulcerative dermatitis affecting the face, legs, and trunk starting at 6 and 2 yr of age, respectively. IDST was performed at the caudal pinnal base using 61 regionally specific allergens. Specific serum allergen responses were detected using Heska's Equine ALLERCEPT® Allergen Panel. Histopathology of the lesions was consistent with an allergic etiology. Injectable allergen-specific immunotherapy was initiated in both animals and within 6 to 18 mon after commencing hyposensitization clinical improvement was noted. This report documents a repeatable methodology for IDST and serological allergen testing for use in rhinoceroses. The hyposensitization protocol detailed here can help guide future treatment protocols.

The management of behavioural and psychological symptoms of dementia in residential homes: does Tai Chi have any role for people with dementia?

Dementia is a common illness that is increasing in frequency and set to challenge the resources and expertise of health and social care services over the coming years. Increasingly, there has been interest in the management of behavioural and psychological symptoms of dementia (BPSD), as they are both common and associated with a range of negative outcomes. BPSD are associated with the admission of people with dementia to care homes. Limited resources and lack of knowledge in permanent care settings often lead to BPSD being managed with antipsychotic medications, which are associated with significant morbidity and mortality. There is evidence for the benefits of exercise within care home settings, although only a few studies include those with cognitive impairment. Tai Chi is a mind-body exercise combining relaxed physical movement and meditation, and has been suggested to have many health benefits. This article discusses the rationale and available options for treating BPSD and the current practice and reviews the literature regarding the benefits of exercise and, in particular, Tai Chi in the management of BPSD.

Recovering from mental health problems: perceived positive and negative effects of medication on reconnecting with life.

BACKGROUND: At present there is no coherent theory of mental health recovery capable of guiding clinical practice. MATERIALS: On the basis of 32 interviews with those recovering in Ireland, a grounded theory study generated a theory of recovery as reconnecting with life. This paper reports extended findings on the perceived roles of medication in recovery. RESULTS: Medication combined with other strategies was viewed as both a facilitator and a barrier of reconnecting with life. Reduction and change of medication were reported as facilitating reconnection. CONCLUSIONS: Use of medication may need to be constantly revised to match self-perceived progress of reconnecting with life.

Recovering from recurrent mental health problems: giving up and fighting to get better.

The purpose of this paper is to present selected findings of a grounded theory study that aims to explore individual processes and desired outcomes of recovery from recurrent health problems in order to build up a theoretical framework of recovery in an Irish context. Volunteers included mental health service users or participants of peer support groups who have experienced recurrent mental health problems for two or more years, consider themselves in improvement, and are willing to participate in individual interviews. The current paper is based on the analysis of 15 audiorecorded and transcribed interviews. We identified two open codes of 'giving up' and 'fighting to get better'. Giving up was associated with accepting a passive identity of a patient with a chronic mental illness and a lack of intrinsic motivation to get better. Fighting had both positive (fighting for) and negative (fighting against) dimensions, as well as internal and external ones. The fight for recovery entailed substantial and sometimes risky effort. Starting such a fight required strong, self-sustained motivation. Service providers might need to discuss internal and external motivators of fighting for recovery with service users, with a view to including such motivators in the care plans.

Reducing the revolving door phenomenon.

OBJECTIVES: De-institutionalisation and the expansion of community services have resulted in a reduction in the number of inpatient admissions in Ireland having fallen by 31% between 1986 and 2006. However, despite this, readmissions continue to account for over 70% of all admissions. The policy document A Vision for Change identified many shortcomings in the current model of provision of mental health services, making recommendations for the future development of community-based services with emphasis on outreach components such as homecare, crisis intervention and assertive outreach approaches. These recommendations are reviewed in relation to readmissions and the impact they may have on reducing the revolving door phenomenon. METHOD: Three main intervention programmes essential to the delivery of an effective community-based service outlined and recommended by A Vision for Change, along with other pertinent factors, are discussed in relation to how they might reduce readmissions in Ireland. A series of Pearson correlations between Irish inpatient admissions rates and rates of outpatient attendances and provision of community mental health services are carried out and examined to explain possible relationships between increasing/decreasing admission rates and provision/attendances at community services. International literature is reviewed to determine the effectiveness of these intervention programmes in reducing admissions and readmissions and their relevance to the Irish situation is discussed. CONCLUSIONS: Whilst A Vision for Change goes a long way towards advocating a more person-centred, recovery oriented and integrated model of service delivery, it is apparent from the consistently high proportion of readmissions in Ireland that there are still many shortcomings in service provision. The availability of specialised community-based programmes of care is as yet relatively uncommon in Ireland and uneven in geographical distribution. A considerable improvement in their provision, quantitatively and qualitatively, is required to impact on the revolving door phenomenon. In addition a re-configuration of existing catchment populations is required if they are to be successfully introduced and expanded.

Caring for people with dementia in non-specialist settings.

This article provides a selective review and discussion of the literature focusing on educational issues for adult health nurses caring for people with dementia in general hospital settings. The term 'adult health nurses' refers to registered nurses (adult) and registered general nurses (RGNs).

Satisfied carers of persons with enduring mental illness: who and why?

BACKGROUND: This secondary mixed-methods analysis was based on the interview data collected for an exploratory study of the experiences and needs of carers of persons with enduring mental illness. The aims were to identify and describe socio-demographic and contextual factors associated with the satisfaction of carers with family support. METHOD: Content analysis and non-parametric tests were used for the exploration of qualitative and quantitative data collected from 38 carers. RESULTS: The majority of the satisfied carers were male and from a higher socio-economic group than other carers. The ill relatives of all satisfied participants resided outside their family homes. Carer satisfaction was associated with such categories as: a caring service; supportive and unintrusive family relationships; being accepted as partners; supportive community; and suitable family services. All the identified categories were interrelated. CONCLUSIONS: The identified categories and socio-demographic factors should be considered for inclusion in the planning and evaluation of family support services.

Examining the impact of a specialist care homes support team.

AIM: To examine the work and perceived impact of a dedicated specialist care homes support team. METHOD: A constructivist methodology was adopted. Data were collected in the form of semi-structured interviews and focus groups with staff, telephone interviews with managers, observation of meetings and teaching sessions, and analysis of documents. FINDINGS: This study was unable to demonstrate statistically the effectiveness of the care homes support team, but the narrative evidence demonstrates the impact the team had during the study. The perceived importance of sharing knowledge and experiences was mentioned repeatedly by participants. The study showed that the care homes support team had made an impact by: empowering participating care home staff; promoting more rapid access to services for care home residents; improved quality of life for residents; promoting changes in organisational and professional culture in the participating homes; and supporting staff in the systematic management of long-term conditions. CONCLUSION: Initiatives such as a dedicated specialist care homes support team demonstrate the potential for developing new ways of working to provide multiprofessional healthcare services to care homes. Such services could be cost effective, while helping older people to maintain their health, functional ability and quality of life.

Coping strategies and styles of family carers of persons with enduring mental illness: a mixed methods analysis.

A qualitative exploratory study investigated the experiences and needs of family carers of persons with enduring mental illness in Ireland. The current mixed-methods secondary study used content analysis and statistical procedures to identify and explore the coping strategies emerging from the original interviews. The majority of family carers reported use of active behavioural coping strategies, sometimes combined with active cognitive or avoidance strategies. The percentage of cares reporting use of active cognitive strategies was the lowest among those whose ill relative lived in their home, and the highest among those whose relative lived independently. Participants with identified active cognitive strategies often reported that their relative was employed or in training. Participants who reported use of avoidance strategies were significantly younger than participants who did not report use of such strategies. The lowest percentage of avoidance strategies was among participants whose ill relative lived independently, whereas the highest was among carers whose relative lived in their home. The findings of this study highlight the importance of a contextual approach to studying coping styles and processes. Further research questions and methodological implications are discussed.

First admissions to inpatient care in Ireland for schizophrenia 1971-2004: trends in gender and age.

First admissions for schizophrenia to inpatient psychiatric services in Ireland are declining. The reason for this decline has been debated and it has been proposed that it could be attributable to either a decline in incidence or to policy changes or to both. OBJECTIVES: This study examines the trends in first admission numbers for schizophrenia in Ireland and the influence of gender and marital status on age at first admission over the time period 1971-2004. METHOD: Data were derived from the National Psychiatric Inpatient Recording System (NPIRS) for the years 1971-2004 inclusive. All first admissions with a diagnosis of schizophrenia during these years were included in the analysis. RESULTS: The results showed a significant decline in the number of first admissions with the number of first admissions for males exceeding those for females. The average age of first admission was higher for females than males (p < 0.001). The average age of first admission showed a decline for males (p < 0.001), but not for females. Marital status was a stronger predictor of age of admission than gender (p < 0.001). Never married persons had a lower age of first admission than those married and the delaying effect of marriage on age at first admission was evident in males and females (p < 0.001). CONCLUSIONS: An examination of first admission hospital data confirm male disadvantage in schizophrenia. The study highlighted a number of areas for future research which include examining gender differences in more refined diagnostic sub groups of schizophrenia and the monitoring of first contacts with community-based mental health services.

Therapeutic touch and dementia care: an ongoing journey.

Touch is considered a core aspect of care provision and therapeutic relationships. Therapeutic touch allows nurses to facilitate healing and forge therapeutic relationships through touch or non-touch and maintain channels of communication often lost in dementia as the disease progresses. This article reports the findings of a research project to examine the effectiveness of therapeutic touch in dementia care.

Hematologic and plasma biochemical changes associated with fenbendazole administration in Hermann's tortoises (testudo hermanni).

Toxicosis associated with benzimidazole anthelmintics has been reported with increasing frequency in zoologic collections. Clinical signs, clinicopathologic abnormalities, and gross and histologic lesions are primarily the result of damage to the gastrointestinal and hematopoietic systems. Profound leukopenia, especially granulocytopenia, is the most common and severe clinicopathologic change associated with benzimidazole administration. Death usually occurs from overwhelming systemic bacterial and/or fungal infections secondary to severe immunosuppression. In this 125-day study, six male Hermann's tortoises (Testudo hermanni) were treated orally with two 5-day courses of fenbendazole 2 wk apart at a dosage of 50 mg/kg. Serial blood samples were used to assess hematologic and plasma biochemical changes before, during, and following the treatment period. Although the tortoises remained healthy, blood sampling indicated an extended heteropenia with transient hypoglycemia, hyperuricemia, hyperphosphatemia, and equivocal hyperproteinemia/hyperglobulinemia, which were considered to be in response to fenbendazole administration. Changes in several other clinicopathologic parameters appeared to correlate with fenbendazole administration. The hematologic and biochemical changes seen in the healthy animals in this study should be considered when treating compromised tortoises with fenbendazole. Hematologic and plasma biochemical status of tortoises/reptiles should be determined before treatment and monitored during the treatment period. The risk of mortality of an individual from nematode infection should be assessed relative to the potential for metabolic alteration and secondary septicemia following damage to hematopoietic and gastrointestinal systems by fenbendazole.

Preventing hip fracture in care homes 1: views of residents and staff.

Hip protectors have been shown to be effective in reducing the incidence of hip fracture among older people living in care homes (Parker et al, 2004). However, there are problems with compliance. This article reports findings from a survey of 138 staff from 23 care homes about experiences and perceptions of using hip protectors. The survey was complemented by qualitative case studies involving staff, to be linked to compliance with wearing hip protectors including comfort, acceptability to the resident and appearance. Few practical difficulties in using hip protectors were identified. Staff and residents' perceptions and experiences of using hip protectors vary and are likely to influence compliance.

The potential use of prehospital thrombolysis in a rural community.

BACKGROUND: It is recommended that eligible patients receive thrombolytic treatment within 90 min of alerting medical or ambulance services. The Donegal Area Rapid Treatment Study (DARTS) showed that pre-hospital thrombolysis reduces "call to needle" times for patients living remote from the hospital base [Donegal Area Rapid Treatment Study (DARTS): Final Report. North Western Health Board]. AIM: To review DARTS data to describe the potential impact of pre-hospital thrombolysis on a defined population. METHOD: Data from the DARTS project was reviewed to describe cases where thrombolysis was not administered, cases where thrombolysis was administered in hospital but not in the community, and to extrapolate these findings to other rural regions in the area to identify the potential for additional pre-hospital thrombolysis. RESULTS: Eighty-four patients from DARTS practices presented to the district hospital with AMI during the study period with 35% (29/84) receiving thrombolysis. Of the 29 who received thrombolysis, 87% (25) were referred from the general practitioner. Of these, 32% (8/25) were administered thrombolysis by the general practitioner. Of the general practitioner referrals that did not receive pre-hospital thrombolysis (n = 17), 65% (11/17) were not thrombolysed in the community for appropriate clinical reasons and 35% (6/17) could have been potentially eligible for pre-hospital thrombolysis. Inclusion of these patients suggests a potential pre-hospital thrombolysis rate in the region of 56%. For the rural Donegal areas this would result in a potential 17 cases per year being eligible for pre-hospital thrombolysis. CONCLUSIONS: Currently, 35% of the 240 AMIs that occur annually in the region receive thrombolysis. Broad implementation of DARTS in the region would provide pre-hospital thrombolysis to approximately an additional 25 patients each year, with a potential for further gains. For this to become a reality, support and encouragement must be provided to all rural general practitioners, the ambulance services, receiving hospitals and policy makers to implement a pre-hospital thrombolysis policy.

Preventing hip fractures in care homes 2: role of the specialist nurse.

This article is the second of a two-part series based upon a research project to evaluate the impact of a specialist nurse role in reducing the incidence of hip fracture within care homes. The first article (Vol 13 (21): 1242-48) described the background and methods of the study, and presented the findings relating to resident and staff experiences of using hip protectors as a preventive measure within the homes. This article focuses on staff experiences of hip fracture prevention strategies and implementing evidence-based practice in this area. Findings suggest that specialist nurses have the potential to encourage evidence-based practice within care homes, while also improving staff morale and job satisfaction.

Therapeutic touch in dementia care.

Touch, in its purest sense, is considered by many as a core aspect of care-giving and of the nurse-patient relationship. Touch is a fundamental element in nursing work and one of the most personally experienced of all communicative sensations. Some believe it to be the 'mother of the senses', symbolising caring and providing validation of existence as an individual ( Autton 1989 , Estabrooks and Morse 1992 , Weiss 1992).