The Impact of Two Recommended Withholding Periods for Omeprazole and the Use of a Nutraceutical Supplement on Recurrence of Equine Gastric Ulcer Syndrome in Thoroughbred Racehorses.

The impact of recommended withholding periods (RWPs) for omeprazole on the recurrence of Equine Gastric Ulcer Syndrome (EGUS) is unknown. The study was designed to compare the effect of two RWPs on EGUS recurrence post-omeprazole treatment and to determine if a nutraceutical supplement would reduce EGUS recurrence when administrated during an RWP. The study was a blinded, randomized clinical trial. Part 1: Horses were allocated to an RWP0 or RWP2 and crossed over after 4-weeks. Horses received oral omeprazole once daily, except during the RWPs at the end of the treatment periods. Part 2: Horses received omeprazole for 21 days prior to an RWP2 during which they received a nutraceutical supplement. Gastroscopy was performed on Day 0 and pre- and post- RWP. Part 1: More horses were affected by Equine Squamous Gastric Disease (ESGD) after the '2-clear-days' RWP than the 'not on race-day' RWP (p = 0.012). The prevalence of ESGD post-RWP for '2-clear-days' did not differ from day 0 (p = 0.478). Part 2: The prevalence of ESGD post-RWP was lower than on Day 0 (p = 0.046). A difference in recurrence of ESGD was present between the two common RWPs. The implications of this on the welfare of Thoroughbred racehorses warrant further discussion.

Community Outbreak of Pseudomonas aeruginosa Infections Associated with Contaminated Piercing Aftercare Solution, Australia, 2021.

In April 2021, the South Eastern Sydney Local Health District Public Health Unit (Sydney, New South Wales, Australia) was notified of 3 patients with Pseudomonas aeruginosa infections secondary to skin piercings performed at the same salon. Active case finding through laboratories, clinician alerts, and monitoring hospital visits for piercing-related infections identified additional cases across New South Wales, and consumers were alerted. We identified 13 confirmed and 40 probable case-patients and linked clinical isolates by genomic sequencing. Ten confirmed case-patients had used the same brand and batch of aftercare solution. We isolated P. aeruginosa from opened and unopened bottles of this solution batch that matched the outbreak strain identified by genomic sequencing. Piercing-related infections returned to baseline levels after this solution batch was recalled. Early outbreak detection and source attribution via genomic sequencing are crucial for controlling outbreaks linked to contaminated products. Manufacturing standards for nonsterile cosmetic products and guidance for piercing aftercare warrant review.

Evaluation of the effects of medium-term (57-day) omeprazole administration and of omeprazole discontinuation on serum gastrin and serum chromogranin A concentrations in the horse.

BACKGROUND: Rebound gastric hyperacidity (RGH) secondary to hypergastrinemia has been suggested to contribute to the rapid recurrence of equine squamous gastric disease (ESGD) in horses after discontinuation of omeprazole. HYPOTHESIS/OBJECTIVES: To evaluate changes in serum gastrin and chromogranin A (CgA) concentrations in response to medium-term (57-day) omeprazole treatment and after omeprazole discontinuation. ANIMALS: Fourteen mature Thoroughbred racehorses in simulated race training. METHODS: Horses received 2.28 g of oral omeprazole PO q24h for 57 days within a 61-day period, excluding a withholding period applied mid-protocol during which treatment was stopped as part of a concurrent study. Serum samples were collected on day 0 before omeprazole treatment, on day 1 of each week of the treatment period, and for an additional 5 weeks after discontinuation of treatment. Serum gastrin and CgA concentrations were analyzed using radioimmunoassay (RIA) and ELISA, respectively. RESULTS: Median serum gastrin concentrations increased 2.5-fold from baseline to day 7 (P < .001) but did not increase further during the omeprazole treatment period. Median serum gastrin concentrations returned to baseline within 2 to 4 days after administration of the last dose of omeprazole. No effect of treatment or discontinuation was seen in serum CgA concentrations. CONCLUSIONS AND CLINICAL IMPORTANCE: Serum gastrin concentrations increased in response to omeprazole treatment but returned to baseline within 2 to 4 days after the last dose of omeprazole. No effect of treatment or discontinuation was seen in serum CgA concentrations. Our results do not support the use of tapering protocols in horses.

Comparison of Radiography and Computed Tomography for Evaluation of Third Carpal Bone Fractures in Horses.

Radiographs underestimate the extent of bone injury in horses with third carpal bone (C3) fractures (Fx). We aimed to describe bone pathologies identified using computed tomography (CT) and compare the diagnostic value of digital radiography (DR) and CT in horses with C3 Fx. CT images of 15 racehorses with C3 Fx and 10 controls were reviewed (Part 1) then DR and CT images of 26 racehorses (24 Thoroughbred, 2 Standardbred) with C3 Fx (Part 2) were evaluated. Agreement on fracture geometry and concomitant bone lesions was tested between DR and CT using the kappa statistic (Part 2). For agreement analysis, 38 limbs were used (27 Fx carpi from 26 horses and 11 contralateral carpi). Intermodality agreement was good for recognition of displacement, fair for comminution, articular surface bone loss and osseous fragmentation, and poor-slight for recognition of whether the Fx was complete, additional fissures and lucencies. CT provides more detailed information than DR regarding bone pathology and fracture configuration in horses with C3 fracture. Correlation of CT findings with clinical information and outcome needs to be explored; however, the more accurate diagnosis possible with CT is likely valuable when deciding on the most appropriate management and for surgical planning.

Horse Grimace Scale Does Not Detect Pain in Horses with Equine Gastric Ulcer Syndrome.

Equine gastric ulcer syndrome (EGUS) is a highly prevalent and presumptively painful condition, although the amount of pain horses might experience is currently unknown. The aims of this study were to determine if the Horse Grimace Scale (HGS) could identify pain behaviours in horses with and without EGUS and if severity would be positively associated with the HGS score. Horse grimace scale scores were assessed blindly using facial photographs by seven observers and involved evaluation of 6 facial action units as 0 (not present), 1 (moderately present) and 2 (obviously present). Lameness examination, serum amyloid A (SAA) measurement and gastroscopy evaluation were performed on all horses. Horses (n = 61) were divided into two and three groups based on the presence (yes, no) and severity (none, mild, moderate-severe) of EGUS, respectively. Presence of lameness and elevated SAA (≥50 µg/mL) were used as exclusion criteria. Inter-observer reliability was analyzed by intra-class correlation coefficients (ICC). HGS scores between groups were compared using Welch's and Brown Forsythe tests (p < 0.05). Overall, HGS ICC was "excellent" (0.75). No significant differences (p = 0.566) were observed in HGS scores between horses with and without gastric lesions (mean, 95% CI; 3.36, 2.76-3.95 and 3, 1.79-4.20, respectively). HGS was not influenced by the presence or severity of EGUS in this current study. Further studies investigating the use of different pain scales in horses with EGUS are needed.

Legionella pneumophila serogroup 1 infection associated with the use of an apartment building spa pool.

Background: Legionnaires' disease is a notifiable condition in New South Wales (NSW), Australia; clinicians and laboratories are required to report the disease to NSW Health. We describe the investigation of a sporadic case associated with the use of a communal spa pool in the case's apartment building complex and the use of whole genome sequencing to examine relatedness between clinical and environmental Legionella pneumophila serogroup 1 (Lp1) strains. Methods: In February 2018, a confirmed case of Lp1 infection was notified in a man in his 60s hospitalised with pneumonia. We asked the clinical team to obtain sputum in the event we found a potential source. The case described the use of the communal spa pool in his apartment building on two occasions during the putative exposure period. Environmental Health Officers from the Public Health Unit inspected the spa pool and found that the free chlorine level was well below the recommended concentration; a water sample was submitted for microbial analysis. Results: Lp1 was grown from the case's sputum and microbial analysis of the spa water sample found Lp1 at a concentration of 20 CFU/mL. The human and environmental isolates were subjected to whole genome sequencing and found to be highly genomically related. There was no other plausible environmental source of legionella. Conclusions: Whole genome sequencing of the clinical and environmental Lp1 isolates implicated a contaminated spa pool as the source of the case's exposure. This strongly supports the application of whole genome sequencing to the investigation of single cases of legionellosis. Communal spa pools in apartment buildings are not regulated in most Australian jurisdictions but must be considered to pose a potential legionella risk if improperly maintained.

Immunohistochemical analysis of laryngeal muscle of horses clinically affected with recurrent laryngeal neuropathy.

BACKGROUND: As myosin heavy chain (MyHC) profile of muscle fibres is heavily influenced by neural input, changes in MyHC expression are expected in horses clinically affected with recurrent laryngeal neuropathy (RLN) yet, this has not been thoroughly investigated. OBJECTIVES: To describe the changes in MyHC and fibre diameter in left cricoarytenoideus dorsalis (L-CAD) muscle of horses with clinical signs of RLN. STUDY DESIGN: Observational cohort study. METHODS: Immunohistochemistry was used to assess the MyHC-based fibre-type proportion, size and grouping in the L-CAD of 10 Thoroughbred horses, five clinically affected with RLN and five unaffected controls based on resting endoscopic examination. The Mann-Whitney U test was used to compare the two groups. RESULTS: Compared to controls (of mean age 3.0 ± 1.7 years) which only expressed type I, IIA and IIX MyHC, the L-CAD of affected horses (of mean age 2.8 ± 0.8 years) had obvious fibre-type grouping, and despite apparent compensatory hypertrophy of a small number of fibres, a decrease in overall fibre diameter (median difference -35.2 µm, 95% CI -47.4 to -7.9, P = .02) and diameter of type IIA fibres (median difference -46.8 µm, 95% CI -52.1 to -5.0, P = .03) was observed. Anti-fast MyHC (MY32) cross-immunoreacted with embryonic-MyHC. Whereas MY32-positive fibres were identified as type IIX in controls, in affected horses these fibres were less than 50 µm diameter with internal nuclei and were MYH3-positive for embryonic myosin indicating depletion of type IIX fibres, yet active regeneration and fibre renewal. MAIN LIMITATIONS: Small sample size that did not include subclinical cases. Fibre size and appearance rather than staining colour were relied upon to differentiate embryonic from type IIX MyHC. CONCLUSIONS: Horses clinically affected with RLN have overall atrophy of fibres, loss of IIX fibres and expression of embryonic myosin indicating regenerative capacity. Despite hypertrophy of some remaining fibres, the overall decline in the bulk of fibres, including those most fatigue-resistant, may be the critical change that results in failure to maintain arytenoid abduction during exercise although direct comparison to subclinical cases is needed to confirm this.

Using a computerised database (REDCap) to monitor influenza vaccination coverage of healthcare workers and staff in South Eastern Sydney Local Health District.

Objective New South Wales (NSW) experienced a severe influenza season in 2017. In 2018, NSW Health implemented a campaign to improve healthcare worker (HCW) influenza vaccination coverage. The South Eastern Sydney Local Health District (LHD) trialled a centralised online database to monitor HCW uptake of the vaccination. This paper outlines how the monitoring system was chosen and developed, the process of implementation and the effectiveness of the system in this setting. Methods A literature review was conducted to identify an appropriate database. Stakeholder working groups took place across the LHD regarding implementation. An online vaccination consent form was developed and installed on the LHD network within 2 weeks. Administrative staff ensured timely entry of HCW data and vaccination status and analysis of uptake using Microsoft Excel. Results REDCap (Vanderbilt University, Nashville, TN, USA) was identified as the most appropriate web-based platform based on the ease of developing a secure and inexpensive data collection tool in a short time period. In all, 10064 employees were recorded in REDCap as having received the influenza vaccine. Customised REDCap reports allowed managers to follow up staff yet to receive their vaccination, which resulted in further vaccinations. Conclusions REDCap was successfully used as a data collection tool to track the influenza vaccination rates of staff. The data assisted the District Workforce Services in ensuring that facilities complied with NSW Health policy. This study highlights how REDCap may be used by similar organisations to monitor influenza vaccination of HCWs. What is known about the topic? There is increasing recognition of the need to ensure high-quality monitoring of HCW influenza vaccination rates, yet coverage is often difficult to measure accurately due to a lack of centralised reporting and monitoring systems. What does this paper add? This paper outlines how a computerised database (REDCap) was used by a NSW Health jurisdiction to monitor a vaccination program. REDCap is an inexpensive and easy to use system that allowed public health authorities rapid analysis of HCW vaccination coverage rates. What are the implications for practitioners? The findings add to the growing body of evidence demonstrating the utility of online systems for monitoring HCW influenza vaccinations. These results will be relevant to healthcare organisations and public health practitioners seeking quick and feasible research and data collection platforms.

The effect of serial administration of bicarbonate on plasma total CO2 concentrations in horses.

The administration of alkalinising agents including bicarbonate is of concern to racing authorities because resultant alkalosis may enhance performance and interfere with the detection of drugs in post-race urine. A threshold for total carbon dioxide (TCO2 ) of 36.0 mmol/L in plasma (with action limit of 37.0 mmol/L) has been set. Serial dosing of sodium bicarbonate has gained popularity in human athletes but has not been studied in horses previously. Sodium bicarbonate (200 g per horse) and 60 g of an electrolyte-vitamin complex was administered in 2-L water via nasogastric intubation to five Standardbred horses for three consecutive days (total dose bicarbonate 0.42 ± 0.02 g/kg). Serial blood samples were taken over Days 1-5, with the final day (5) intended to simulate a 'clear day', and TCO2 was analysed. Following the first bicarbonate administration, plasma TCO2 peaked at 6 h (34.8 ± 1.3 mmol/L), returning to baseline by 23 h. On Day 2, four out of the five horses showed a peak greater than 36.0 mmol/L (mean 37.0 ± 2.1 mmol/L). With daily repeated dosing, plasma TCO2 peaked progressively earlier, and by Day 3, the peak occurred at 2 h and concentrations declined more rapidly. On Days 4 and 5, TCO2 levels remained low (<32.1 mmol/L on Day 4 and between 27.0-31.2 mmol/L on Day 5). These studies demonstrate that serial dosing of a 'split dose' of sodium bicarbonate on three consecutive days does not result in the accumulation or carry-over of plasma TCO2 levels beyond the levels observed following a single dose.

Effects of a Brief Team Training Program on Surgical Teams' Nontechnical Skills: An Interrupted Time-Series Study.

BACKGROUND: Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. METHODS: Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program. RESULTS: We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist. CONCLUSIONS: Our results suggest associated improvements in teams' NOTSS after implementation of the team training program.

Changes in surgical team performance and safety climate attitudes following expansion of perioperative services: a repeated-measures study.

Objective The aim of the present study was to describe process changes in surgical team performance and team members' attitudes to safety culture following hospital relocation and expansion of perioperative services. Methods The study was a naturalistic study using structured observations and surveys to assess non-technical skills (NTS; i.e. communication, teamwork, situational awareness, decision making and leadership) in surgery. This interrupted time series design used mixed-linear regression models to examine the effect of phase (before and after hospital relocation) on surgical teams' NTS and their processes that may affect performance. Differences in self-reported teamwork and safety climate attitudes were also examined. Results In all, 186 procedures (100 before and 81 after hospital relocation) were observed across teams working in general, paediatric, orthopaedic and thoracic surgeries. Interobserver agreement ranged from 86% to 95%. An effect of phase was found, indicating that there were significant improvements after relocation in the use of NTS by the teams observed (P=0.020; 95% confidence interval 1.9-4.7). Conclusions The improvements seen in surgical teams' NTS performance and safety culture attitudes may be related to the move to a new state-of-the-art perioperative department. What is known about the topic? Patient safety in surgery relies on optimal team performance, underpinned by effective NTS. What does this paper add? The NTS of surgical teams may be improved through ergonomic innovations that promote teams' shared mental models. What are the implications for practitioners? Effective multidisciplinary teamwork relies on a combination of NTS and ergonomic factors, which inherently contribute to team performance and safety climate attitudes.

A Systematic Review of the Effect of Therapists' Internalized Models of Relationships on the Quality of the Therapeutic Relationship.

OBJECTIVE: Previous reviews have found equivocal evidence of an association between therapists' internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan's notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship. METHOD: Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping. RESULTS: Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client-rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists' manner and feelings toward their clients, was stronger. CONCLUSION: Evidence clearly shows that therapists' internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice.

Evaluation of a Brief Team Training Intervention in Surgery: A Mixed-Methods Study.

The aim of this study was to evaluate a brief team training program in relation to teams' observed nontechnical skills (NTSs) in surgery, teams' perceptions of safety culture, and the training implementation. We used mixed methods to analyze structured observations of 179 surgeries, semistructured interviews with surgical team members from four selected surgical specialties, and a survey. There were significant (P < .001) improvements in surgical teams' observed NTSs and in the use of the World Health Organization's Surgical Safety Checklist after participation in the training program. Nonsignificant results included increased perceived safety climate and decreased perceived teamwork climate. From participant interviews, we identified that production pressure and time constraints were the biggest barriers to implementation and the greatest enabler was the organization's support for staff education initiatives. Most participants perceived the content of the program to be useful. These results highlight the complexities inherent in the development and evaluation of interdisciplinary patient safety interventions.

Correlates of non-technical skills in surgery: a prospective study.

BACKGROUND: Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. METHODS: We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. RESULTS: We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. CONCLUSIONS: Miscommunications and interruptions impact on team NTS performance.

The Gold in Garbage: Implementing a Waste Segregation and Recycling Initiative.

Generally, ORs produce approximately one-fifth to one-third of all waste in a hospital. Before our quality improvement project was performed in our tertiary care facility, all OR waste was disposed of as clinical waste. Disposal of clinical waste is more costly than disposal of general waste. Therefore, accurately segregating waste can have significant financial incentives. Our quality improvement project involved the implementation of processes that segregated general waste in the OR from clinical waste and translated to an almost 60% reduction of waste disposal costs for OR waste. Further, we implemented a recycling program that reclaimed a portion of the general waste. In total, our efforts reduced the amount of clinical waste produced by the OR by 82%, and the amount of total OR waste was reduced by more than 50%.

Hepatitis C enhanced surveillance: results from a southeastern Sydney pilot program.

AIM: Hepatitis C virus (HCV) is a potentially serious bloodborne virus, which persists in the majority of those infected. Long-term sequelae include liver cirrhosis, liver cancer and premature death. Early identification of newly acquired infection is important for protection of public health. Routine surveillance based on laboratory notification of HCV infection is not sufficient to differentiate between newly acquired and chronic infections. Enhanced surveillance systems have been trialled globally in a number of settings. This pilot program aimed to increase identification of newly acquired HCV cases in southeastern Sydney residents and to ascertain the likely mode of transmission. METHODS: All HCV notifications in southeastern Sydney residents with specimen dates from 1 July to 31 December 2012 were included in a pilot program. Demographic data, Australian Indigenous identification and previous laboratory results were collected from electronic medical records, where available. Enhanced surveillance forms were sent to referring doctors to seek information about clinical symptoms and previous hepatitis C pathology. Data were collated to assess, according to Australian national case definitions, whether cases were newly acquired or not, or were unable to be determined on the available information. RESULTS: There were 104 notifications of HCV infection during the surveillance period. Forms were sent to 100 requesting doctors, with 72 forms returned. Six newly acquired cases were identified, a rate of 8%, compared with 1-3% classified by routine surveillance. Twenty cases (28%) were not newly acquired and the status of 46 (64%) was unable to be determined. Of the six newly acquired cases, sexual transmission was deemed to be the likely route of exposure for four cases, and injecting drug use for the remaining two. CONCLUSIONS: Enhanced surveillance increased the rate of identification of newly acquired infections. However, the process was labour-intensive and the status of most cases was unable to be determined. Since identification of newly acquired cases has an important public health benefit in understanding factors in disease transmission, other approaches should be examined.

Exhausted but not cynical: burnout in therapists working within Improving Access to Psychological Therapy Services.

BACKGROUND: Burnout is common in mental health professionals and has serious personal and professional consequences. Levels and predictors of burnout for therapists within "Improving Access to Psychological Therapies" (IAPT) services are thus far unknown. AIMS: This study investigated levels and predictors of three burnout dimensions--Emotional Exhaustion (EE), Depersonalisation (DP) and Personal Accomplishment (PA)--in IAPT therapists. METHODS: Therapists from eight services completed a web-based survey measuring burnout levels and hypothesised burnout predictors. Reponses were matched to demographic information on clients with whom they had completed treatment in the last 2 months. RESULTS: 116 (n) therapists showed comparatively high levels of EE, and relatively low levels of DP and PA. These were predicted by some factors from the General Burnout Model and by Work Involvement styles. Stressful Involvement, in particular in-sessions feelings of anxiety predicted EE and DP, and Healing Involvement predicted Personal Accomplishment. The most important predictors of therapist burnout were service-related, particularly work demands and autonomy, and in-session feelings. CONCLUSIONS: Addressing these factors in IAPT services may prevent therapist burnout.