Sensory innervation of the dorsal longitudinal ligament and the meninges in the lumbar spine of the dog.

Although intervertebral disc herniation is a well-known disease in dogs, pain management for this condition has remained a challenge. The goal of the present study is to address the lack of information regarding the innervation of anatomical structures within the canine vertebral canal. Immunolabeling was performed with antibodies against protein gene product 9.5, Tuj-1 (neuron-specific class III ß-tubulin), calcitonin gene-related peptide, and neuropeptide Y in combination with the lectin from Lycopersicon esculentum as a marker for blood vessels. Staining was indicative of both sensory and sympathetic fibers. Innervation density was the highest in lateral areas, intermediate in dorsal areas, and the lowest in ventral areas. In the dorsal longitudinal ligament (DLL), the highest innervation density was observed in the lateral regions. Innervation was lower at mid-vertebral levels than at intervertebral levels. The presence of sensory and sympathetic fibers in the canine dura and DLL suggests that pain may originate from both these structures. Due to these regional differences in sensory innervation patterns, trauma to intervertebral DLL and lateral dura is expected to be particularly painful. The results ought to provide a better basis for the assessment of medicinal and surgical procedures.

PML-nuclear bodies decrease with age and their stress response is impaired in aged individuals.

BACKGROUND: Promyelocytic leukemia nuclear bodies (PML-NBs) have been depicted as structures which are involved in processing cell damages and DNA double-strand break repairs. The study was designed to evaluate differences in patients' PML-NBs response to stress factors like a cancerous disease and ionizing radiation exposure dependent on age. METHODS: In order to clarify the role of PML-NBs in the aging process, we examined peripheral blood monocytes of 134 cancer patients and 41 healthy individuals between 22 and 92 years of age, both before and after in vitro irradiation. Additionally, we analyzed the samples of the cancer patients after in vivo irradiation. Cells were immunostained and about 1600 cells per individual were analyzed for the presence of PML- and γH2AX foci. RESULTS: The number of existing PML-NBs per nucleus declined with age, while the number of γH2AX foci increased with age. There was a non-significant trend that in vivo irradiation increased the number of PML-NBs in cells of young study participants, while in older individuals PML-NBs tended to decrease. It can be assumed that PML-NBs decrease in number during the process of aging. CONCLUSION: The findings suggest that there is a dysfunctional PML-NBs stress response in aged cells.

Intradermal lidocaine or bacteriostatic normal saline to decrease pain before intravenous catheter insertion: a meta-analysis.

PURPOSE: Anesthetics used to decrease pain during peripheral intravenous catheter insertion have been studied with equivocal results. This meta-analysis determined if lidocaine or bacteriostatic normal saline (BaNS) is more effective in reducing pain associated with peripheral intravenous catheter cannulation in adults. METHODS: PubMed, EMBASE, CINAHL, ProQuest Dissertation and Theses, and Web of Science databases were queried. Thirteen randomized controlled trials were analyzed. RESULTS: Mean sample was 119.9 (±82.0); combined N was 1,559. Mean effect size was z = 0.46 (confidence interval = 0.24-0.68) indicating lidocaine was more effective than BaNS in providing pain relief (P < .001). CONCLUSION: Cost-benefit issues and lidocaine drug shortages must be considered when making definitive practice recommendations.

Accuracy of the Surprise Question on an Inpatient Oncology Service: A Multidisciplinary Perspective.

The surprise question (SQ), "Would you be surprised if your patient died within a year?", has been studied in the cancer population as a prognostic prompt. Studies have almost exclusively directed the SQ to physicians, whereas perspectives of nurses remain underevaluated. We asked the SQ for patients admitted to an inpatient medical oncology service to medical oncology, palliative care, and hospital medicine teams and bedside nurses. We performed a 1-year retrospective chart review to identify how concordant various provider types were in their prognostic estimations and identified the missed opportunity rate (MOR) defined as the number of patients who died within a particular time frame but who the providers had predicted would be alive and may not have had a palliative approach. Oncologists had higher MORs for the 6-month and 1-year SQ when compared with hospital medicine providers. Bedside nurses were least concordant in their estimations of prognosis and had higher MORs for all time frames of the SQ. Missed opportunities might have significant implications for the end-of-life care for cancer patients, and continued research is needed to understand what influences provider prognostication and how this impacts palliative care utilization for patients with life-limiting disease.

Sexual Health: Exploring Patient Needs and Healthcare Provider Comfort and Knowledge.

BACKGROUND: Sexual health is an important quality-of-life issue for many cancer survivors; however, this issue remains inadequately discussed by healthcare providers (HCPs) and patients. OBJECTIVES: The purpose of this study is to explore whether clinical oncology HCPs have adequate knowledge and are comfortable addressing sexual health issues, and to explore and describe patients' attitudes, beliefs, and informational needs regarding sexual health. METHODS: A survey was completed by HCPs and three patient focus groups were conducted to learn more about sexual health. Survey data were analyzed using descriptive statistics, and qualitative responses were analyzed using content analysis. FINDINGS: The majority of survey respondents reported on the importance of discussing sexual concerns with patients, lacked sexual health training, and were uncomfortable discussing sexual health with patients. Focus group participants wanted access to timely information during treatment, online educational resources, and brochures and handouts; involvement of significant others; support from providers, peers, and survivors; and expert consultation.

Development of an intravenous skills module for graduate nurses.

Graduate nurses (GNs) are a major part of hospital recruitment. Forty-two percent of new hires are likely to be GNs. Many GNs feel ill prepared in intravenous (i.v.) catheter insertion and central line care. The purpose of this evidence-based practice project was to determine if an i.v. skills workshop would have a positive impact on GNs' comfort and skills. Casey-Fink Graduate Nurse Experience Survey data indicate that 29% of graduate nurse residents participating in the first cohort of this workshop list i.v. skills as most challenging. Postsurvey data showed that GN comfort level improved. Supporting the GN in this challenging transition by providing focused education and skills practice may alleviate this discomfort.

Distinct increased outliers among 136 rectal cancer patients assessed by γH2AX.

BACKGROUND: In recent years attention has focused on γH2AX as a very sensitive double strand break indicator. It has been suggested that γH2AX might be able to predict individual radiosensitivity. Our aim was to study the induction and repair of DNA double strand breaks labelled by γH2AX in a large cohort. METHODS: In a prospective study lymphocytes of 136 rectal cancer (RC) patients and 59 healthy individuals were ex vivo irradiated (IR) and initial DNA damage was compared to remaining DNA damage after 2 Gy and 24 hours repair time and preexisting DNA damage in unirradiated lymphocytes. Lymphocytes were immunostained with anti-γH2AX antibodies and microscopic images with an extended depth of field were acquired. γH2AX foci counting was performed using a semi-automatic image analysis software. RESULTS: Distinct increased values of preexisting and remaining γH2AX foci in the group of RC patients were found compared to the healthy individuals. Additionally there are clear differences within the groups and there are outliers in about 12% of the RC patients after ex vivo IR. CONCLUSIONS: The γH2AX assay has the capability to identify a group of outliers which are most probably patients with increased radiosensitivity having the highest risk of suffering radiotherapy-related late sequelae.

Slow release antibiotics for treatment of septic arthritis in large animals.

The search for an effective treatment for septic arthritis is ongoing. Current therapies are expensive since they require repeated joint lavage and long term antibiotic treatment. Local application of antimicrobial drugs is advantageous because high concentrations can be attained at the infection site, although repeated injections increase the risk of superinfection of the joint. Thus, slow release formulations, which have the advantage of local treatment yet single application of the drug, are appealing. Antibiotics used in slow release formulations are selected for tissue compatibility, an appropriate antibacterial spectrum, and stability both during the mixing procedure and within the carrier during the release period. Ideally the carriers should be bioresorbable. Promising reports on the clinical use of poly(methyl methacrylate) (PMMA) mixed with several different antibiotics, and of collagen sponges impregnated with gentamicin, should encourage the search for formulations optimally adapted to veterinary medical requirements.

The impact of dry versus moist heat on peripheral IV catheter insertion in a hematology-oncology outpatient population.

PURPOSE/OBJECTIVES: To determine whether dry versus moist heat application to the upper extremity improves IV insertion rates. DESIGN: Two-group, randomized, controlled clinical design. SETTING: An academic cancer infusion center in the western United States. SAMPLE: 136 hematologic outpatients with cancer or other malignancies. METHODS: Participants were randomly assigned to dry or moist heat with warmed towels wrapped around each patient's arm for seven minutes prior to IV insertion. Skin and room temperatures were monitored pre- and postwarming. Two experienced chemotherapy infusion nurses performed the venipunctures according to protocol. Outcomes were examined using variance analysis, with 34 patients for each combination of nurse and heat type. MAIN RESEARCH VARIABLES: Number of IV insertion attempts, time to achieve IV insertion postheating, patient anxiety levels pre- and postheating, and patient comfort. FINDINGS: Dry heat was 2.7 times more likely than moist heat to result in successful IV insertion on the first attempt, had significantly lower insertion times, and was more comfortable. Heat type had no effect on patient anxiety. CONCLUSIONS: Dry heat application decreases the likelihood of multiple IV insertion attempts and procedure time and is comfortable, safe, and economical to use in an outpatient oncology setting.