Practitioner attitudes towards patients in forensic mental health settings.

Scotland has a national programme to improve mental health and well-being and addressing stigma among mental health practitioners is a priority. This study explores practitioner attitudes towards patients in medium and low secure forensic mental health settings through qualitative and quantitative approaches. Two questionnaires were used with nursing staff. A qualitative questionnaire asked participants to list examples of positive and negative practice and anti-discriminatory and discriminatory attitudes towards patients within forensic services. A quantitative questionnaire then asked participants to answer questions about a hypothetical man with schizophrenia called Harry. The overall balance of responses was more positive than negative in the qualitative results, particularly regarding patient rights, empowerment and control. However, there were a significant minority of negative attitudes in relation to recovery pessimism and desire for social distance. This was supported by the quantitative results where practitioners showed high stigma scores for avoidance and segregation. There were no significant differences in attitudes between medium and low secure settings. However overall, males reported more negative attitudes in relation to blame and avoidance and younger participants demonstrated more negative attitudes than older participants in relation to fear and danger. The implications for addressing stigma are discussed in relation to the wider national anti-stigma campaign and forensic services specifically.

Decontamination of laryngoscopes in The Netherlands.

In this study the decontamination procedures of laryngoscopes in Dutch hospitals are described, based on a structured telephone questionnaire. There were substantial differences between decontamination procedures in Dutch hospitals and the standards of the APIC (Association of Professionals in Infection Control and Epidemiology), CDC (Centers of Disease Control) and ASA (American Society of Anesthesiology) were met in full in 19.4% of the hospitals. The standards of manual decontamination, used in 78% of the 139 hospitals, were particularly disappointing; manual cleaning was considered inadequate in 22.9% of these hospitals and manual disinfection did not meet the standards of the APIC, CDC or ASA in any of these hospitals. Decontamination by instrument cleaning machines as a standard procedure was used in 30 (22%) hospitals. In three of these hospitals the blades were subsequently sterilized. We suggest adherence to the infection control guidelines of the CDC, APIC and ASA, until the safety of less conservative infection control practices are demonstrated.

Interferons regulate the phenotype of wild-type and mutant herpes simplex viruses in vivo.

Mechanisms responsible for neuroattenuation of herpes simplex virus (HSV) have been defined previously by studies of mutant viruses in cultured cells. The hypothesis that null mutations in host genes can override the attenuated phenotype of null mutations in certain viral genes was tested. Mutants such as those in infected cell protein (ICP) 0, thymidine kinase, ribonucleotide reductase, virion host shutoff, and ICP34.5 are reduced in their capacity to replicate in nondividing cells in culture and in vivo. The replication of these viruses was examined in eyes and trigeminal ganglia for 1-7 d after corneal inoculation in mice with null mutations (-/-) in interferon receptors (IFNR) for type I IFNs (IFN-alpha/betaR), type II IFN (IFN-gammaR), and both type I and type II IFNs (IFN-alpha/beta/gammaR). Viral titers in eyes and ganglia of IFN-gammaR-/- mice were not significantly different from congenic controls. However, in IFN-alpha/betaR-/- or IFN-alpha/beta/gammaR-/- mice, growth of all mutants, including those with significantly impaired growth in cell culture, was enhanced by up to 1,000-fold in eyes and trigeminal ganglia. Blepharitis and clinical signs of infection were evident in IFN-alpha/betaR-/- and IFN-alpha/beta/gammaR-/- but not control mice for all viruses. Also, IFNs were shown to significantly reduce productive infection of, and spread from intact, but not scarified, corneas. Particularly striking was restoration of near-normal trigeminal ganglion replication and neurovirulence of an ICP34.5 mutant in IFN-alpha/betaR-/- mice. These data show that IFNs play a major role in limiting mutant and wild-type HSV replication in the cornea and in the nervous system. In addition, the in vivo target of ICP34.5 may be host IFN responses. These experiments demonstrate an unsuspected role for host factors in defining the phenotypes of some HSV mutants in vivo. The phenotypes of mutant viruses therefore cannot be interpreted based solely upon studies in cell culture but must be considered carefully in the context of host factors that may define the in vivo phenotype.

Complete rupture of the Achilles tendon: two case presentations with six-year follow-up.

The authors present two cases involving complete rupture of the Achilles tendon. Pertinent anatomical considerations and probable pathogenesis are discussed. Surgical treatment produced excellent results.

Ergotaminism after a single dose of ergotamine tartrate.

A 32-year-old female developed classical signs and symptoms of ergotaminism after taking a single rectal suppository of ergotamine tartrate. Her symptoms gradually resolved with minimal therapy over the next week. Ergotaminism is the most frequent form of ergotism and should be considered in all patients with vascular insufficiency who are taking ergotamine-containing drugs.