Words will never hurt me? Preferred terms for describing obesity and binge eating.

OBJECTIVE: This study evaluated individuals' language preferences for discussing obesity and binge eating. METHOD: Participants (N = 817; 68.3% female) were an online community sample. They rated the desirability of terms related to obesity and binge eating, and also completed psychometrically established eating-disorder measures. In addition to examining participants' preferences, analyses explored whether preferences differed by socio-demographic variables, weight status and binge-eating status. RESULTS: Preferred obesity-related terms were weight and BMI, although women rated undesirable obesity-related terms even lower than did men. Participants with obesity and binge eating rated weight, BMI, unhealthy BMI and large size as less desirable than participants with obesity but not binge eating. Binge-related terms were generally ranked neutrally; preferred descriptions were kept eating even though not physically hungry and loss of control. CONCLUSIONS: Preferred terms were generally consistent across sex, weight status and binge-eating status. Using terms ranked more preferably and avoiding terms ranked more undesirably may enhance clinical interactions, particularly when discussing obesity with women and individuals reporting binge eating, as these groups had stronger aversion to some non-preferred terms. Findings that the selected binge-related descriptions were rated neutrally on average provide support for their use by clinicians.

Partnered pharmacist charting on admission in the General Medical and Emergency Short-stay Unit - a cluster-randomised controlled trial in patients with complex medication regimens.

WHAT IS KNOWN AND OBJECTIVE: Patients admitted to general medical units and emergency short-stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors. METHODS: We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short-stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients' medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process. RESULTS: Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0-35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3-1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2-1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4-3·1). WHAT IS NEW AND CONCLUSION: Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short-stay patients with complex medication regimens or polypharmacy.

Glycopeptide-induced vasculitis--cross-reactivity between vancomycin and teicoplanin.

Teicoplanin has been suggested for use in patients suffering complications from vancomycin. We describe two patients who developed a vasculitic rash whilst on vancomycin with recrudescence of the rash with subsequent teicoplanin therapy.

Colonic anastomosis in the presence of fecal peritonitis using a disposable skin stapler.

The purpose of this study was to determine if the method of intestinal anastomosis used by British military surgeons for the management of small bowel injuries could be used to manage colonic trauma when fecal peritonitis may be present. Anastomoses were performed using skin staples in lieu of sutures in pig colons in the presence of fecal contamination and early peritonitis. The times taken to complete the anastomoses were recorded. Animals were euthanatized at 2, 5, and 14 days following surgery. Healing was assessed clinically, at postmortem, and by histological examination. In addition, the anastomoses were tested for integrity by intraluminal distension with water, and for healing strength by tensiometry. The mean +/- SD time taken to perform the anastomoses (n = 18) was 10.8 +/- 2.8 min. There were no clinical or postmortem findings suggestive of anastomotic leakage. Only one anastomosis leaked at an intraluminal pressure of less than 100 cm H2O. Testing of ultimate tensile strength of the colon adjacent to the anastomosis showed that the anastomotic line was significantly weaker than the proximal (p < .05 analysis of variance, ANOVA) and distal colon (p < .001) at 5 days and that the colon proximal to the anastomosis was weaker than the colon distally at all time points; this was statistically significant (p < .01, ANOVA) at 5 days. These results suggest that a primary colonic skin-stapled anastomosis in the presence of fecal peritonitis is quick to perform and has a low risk of failure.

Recent experience with arterial embolism of the limbs in a vascular unit.

A 5 1/2-year experience of 147 patients with arterial embolism of the limbs is reported. The mean age was 66.9 years, range 24-90 years and the male to female ratio was 1.07 to 1. Two distinct types of embolic episode with very different clinical consequences were recognised. Type I (64%) in which large emboli occluded the proximal arteries of the lower limb. They were usually treated by embolectomy and were followed by death or permanent disability in 63% of patients. Type II (36%) in which small emboli occluded the arterial supply of the upper limb or the arteries of the distal lower limb. Embolectomy was performed in only 60% of cases. Death was unusual and disability occurred largely as a consequence of non-surgical management. After occlusion of the aorta, iliac or femoral arteries embolectomy is necessary to save both life and limb while after embolism of the arm or distal lower limb it is essential for the preservation of function.

Incentivising appropriate care: the case of immunizations.

Incentivising appropriate care is a two-way street. Patients need to take greater responsibility and provider payment systems need to reward the best quality care. Today we are seeing the reemergence of many vaccine-preventable diseases that we thought were eradicated long ago for all practical purposes. In the U.S., diphtheria, polio, measles, mumps, and rubella all are on an upsurge. In this era of stringent cost containment and "managed care," preventive childhood immunizations offer one of the highest financial returns on investment we can achieve. So why have our inner cities become worse than some third-world countries in terms of low immunization rates for preschool age children and high infant mortality? We argue that "it's the money."

The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill.

This paper discusses the history of assisted suicide/euthanasia and public attitudes in Canada; discusses depression in the terminally ill and the potential role of the psychologist in the assisted suicide/euthanasia process; and specifically addresses the importance of determining competence in terminally ill patients. One area in which the services of psychologists have not been used to their fullest potential is in the care of the terminally ill, particularly in helping them make end-of-life decisions. It is very important that individuals making end-of-life decisions be used to assessed for mental disorders in order to ensure that they are able to make competent decisions. If assisted suicide and euthanasia were to become legalized, psychologists should be involved in the assessment process in order to determine competency.

Combat casualties in the first decade of the 21st century--new and emerging weapon systems.

This paper reviews new and emerging weapons systems targeted directly or indirectly against personnel. It distinguishes emerging technologies that may form the basis of usable weapons in the next 10 years, from the speculations and aspirations of weapons designers, and identifies six groups of weapons systems which will present significant new or changing threats to UK forces. The article combines this information with knowledge of biophysical interactions and clinical effects, to identify possible consequences for the DMS in terms of types, patterns and numbers of casualties. Ballistic threats will continue to be the most common casualty-producing mechanism for servicemen in any environment.

The surgical management in war of penetrating wounds contaminated with chemical warfare agents.

Military surgeons in a future conflict may face the problem of wounds contaminated with chemical warfare (CW) agents. No useful guidelines for this eventuality exist-nor any assessment of the specific CW risk to such casualties or to the surgical teams operating on them. The principal hazard to surgeons is direct contact with contaminated clothing in the wound. Practices are recommended to reduce this threat significantly. Thorough wound excision augmented by lavage with a specific proprietary hypochlorite solution will provide effective wound decontamination without producing unacceptable tissue damage. The vapour hazard at surgery is very low-respirators are unnecessary but goggles or glasses should be worn to prevent conjunctival splashes of potentially contaminated body fluids.

Hyperbaric oxygen for a thalassaemic leg ulcer.

A thalassaemic ulcer in a male Greek Cypriot patient, resistant to standard medical treatment, was treated using hyperbaric oxygen in a recompression chamber. The patient breathed 100% oxygen by face mask whilst the chamber was compressed with air to a pressure of 2.5 atmospheres absolute. The ulcer became fully epithelialised within three weeks of starting treatment.

Intensity of imperative signal influences on redundancy deficit and latency in process schizophrenics.

The resilience of the redundancy deficit pattern of schizophrenic reaction time performance was explored by examining the resistance of redundancy deficit to an experimental manipulation of imperative signal intensity. Aversive levels of stimulation have been used to alter motivation and shown to normalize schizophrenic performance in other research. In this study, 20 schizophrenic patients were administered a reaction time task under conditions of usual motivation and, 1 day later, under conditions of aversive motivation induced by high decibel levels of stimulation. The redundancy deficit pattern was observed with usual motivation but not with so-called biological motivation. The results are discussed from the points of view of the utility of redundancy deficit as an index of vulnerability to schizophrenia, implications for attentional and motivational theories of schizophrenia, and finally, in terms of the more general role of aversive stimulation in schizophrenic deficit. The finding that redundancy deficit is ameliorated by aversive motivation is consistent with theories suggesting that schizophrenics respond primarily to negative motivation. Garmezy's suggestion that the common denominator of the multiplicity of schizophrenic deficits may lie in motivational factors, particularly the prepotent avoidance motive, is supported by these results.

Acute nerve injury as a complication of closed fractures or dislocations of the elbow.

Twenty-one patients with acute injury of either the median, ulnar, radial, anterior interosseous or posterior interosseous nerves associated with 1540 closed fractures or dislocations of the elbow have been reviewed. The mean time of follow-up was three years and nine months. Nine patients, 6 of whom had ulnar nerve lesions, had persistent evidence of nerve damage. Five patients sustained median nerve lesions complicating supracondylar fractures of the humerus. One patient, in whom there was no evidence of nerve recovery at five months, made a full recovery following neurolysis. Of the 9 patients who sustained ulnar nerve lesions, 2 required neurolysis and anterior transposition of the nerve, at two months and five months respectively, to facilitate recovery. Except for one patient with persistent radial paraesthesiae, full spontaneous recovery occurred in 7 patients who had sustained either anterior interosseous, posterior interosseous or radial nerve lesions.

Prepreparatory interval effects on redundancy deficit reaction time patterns in schizophrenic and normal subjects using the embedded-set procedure.

The relative influence of genuine "redundancy deficit" and the artifactual effects of prepreparatory interval on measures of the redundancy deficit reaction time pattern (faster reaction time on trials with long preparatory intervals when the interval is of predictable vs. unpredictable length) was investigated in a study using the "embedded-set" procedure. Twenty normal and 20 schizophrenic subjects received two series of reaction time trials containing embedded sets (blocks) of four isotemporal 1-, 3-, and 7-second trials. The 7-second blocks (the blocks of interest for the calculation of redundancy deficit) were preceded by long prepreparatory intervals in one condition and by short intervals for the second. Each subject received both conditions, with the orders counterbalanced. The results indicated redundancy deficit for both schizophrenics and normals with short prepreparatory intervals, but in neither group with long prepreparatory intervals. This suggests that redundancy deficit in the embedded-set procedure (which is normally heavily biased with short prepreparatory intervals) may be more related to the enhancing effect of short prepreparatory intervals on the first (unpredictable) trial of the set than to impaired performance on the fourth (predictable) trial. The finding of similar effects in both schizophrenic and normal subjects raises questions about the specificity of redundancy deficit to schizophrenic reaction time performance. The results were discussed with reference to the original "long run" reaction time procedure for studying the same phenomenon, and theoretical issues related to the interpretation of results from the two procedures were considered.

Quantitative appraisal of Picolax (sodium picosulfate/magnesium citrate) in the preparation of the large bowel for elective surgery.

The authors have investigated the metabolic sequelae Picolax bowel preparation in a group receiving their preparation either 24 hours (n = 17) or 48 hours (n = 18) before elective colonic resection. No significant changes in any metabolic parameter were found in the 24-hour group. In the 48-hour group, there was a significant decrease in serum sodium (P less than 0.005), serum chloride (P less than 0.005), pH (P less than 0.005), HCO3 (P less than 0.005), and base excess (P less than 0.005). Only 16 of 35 cases (46 percent) had an acceptable bowel preparation: 11 of 17 (65 percent) in the 24-hour group and 5 of 18 (28 percent) in the 48-hour group. Marker studies did not correlate with the quality of bowel preparation. The risk of potentially explosive intraluminal gas was increased if the bowel preparation was poor: 12 of 19 patients (63 percent) with a poor bowel preparation compared with 3 of 16 patients (19 percent) of those with an acceptable preparation (P less than 0.005). Picolax is a poor mechanical bowel preparation and is associated with unacceptable physiologic disturbance if given two days before surgery.

Comparison of two closure techniques for the repair of experimental colonic perforations.

BACKGROUND: Primary repair of penetrating wounds of the colon is gaining increasing acceptance in surgical practice. This study compared two techniques for the repair of experimental colonic perforations in the presence of peritonitis. METHODS: Multiple colonic perforations were created in the colon of 24 pigs. Following a 6-h delay the perforations were closed either by local excision and suture or by skin staples applied to the seromuscular layers of the colon. The repairs were assessed biomechanically and histologically for up to 14 days after surgery. RESULTS: All animals had diffuse peritonitis at the time of colonic repair. Stapled repairs were completed significantly faster than sutured repairs (mean(s.d.) 4.8(1.6) versus 30.7(4.0) min, P < 0.001). Bio- mechanical evaluation of repairs revealed no significant differences between the two techniques. Histological examination of repairs closed by staples demonstrated more advanced healing compared with suture closure, on the basis of tissue apposition and inflammatory changes. CONCLUSION: Experimental colonic injuries may be treated successfully by primary repair in the presence of peritonitis. The use of skin staples for repair does not appear to prejudice colonic wound healing.