Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases.

OBJECTIVES: To investigate whether administration of postoperative oral antimicrobial drugs has a beneficial effect on preventing surgical site infections (SSI) in clean orthopedic surgery involving stainless steel plating systems. STUDY DESIGN: Randomized prospective clinical study. ANIMALS: Dogs (n = 97). METHODS: One hundred consecutive cases (97 dogs) that had clean orthopedic surgery requiring stainless steel plate fixation were randomly assigned using a random number generator to either YES group (administration of postoperative oral antimicrobials) or NO group (no administration of postoperative oral antimicrobials). Dogs in YES group were administered oral cefalexin or potentiated amoxicillin for 7 days, whereas dogs in NO group were discharged without oral antibiotics. Minimum follow-up was 12 months. Multivariable logistic regression was used to determine risk factors for SSI. RESULTS: Overall postoperative infection rate was 12.9%. Infection occurred in 2 cases (4.3%) administered postoperative oral antimicrobials and in 10 cases (21.3%) not administered postoperative antimicrobials. Total anesthetic time and use of oral antimicrobials were the only significant factors associated with SSI. Use of postoperative antimicrobials was associated with a significant reduction in the risk of infection by ~84% and risk of infection was increased by ~2% for each minute increase in anesthesia time. CONCLUSIONS: Administration of oral postoperative antimicrobials had a protective effect against development of SSI in clean orthopedic implant surgery.

Hybrid cemented/cementless total hip replacement in dogs: seventy-eight consecutive joint replacements.

OBJECTIVE: To evaluate the use of hybrid total hip replacement (THR), using a cementless acetabular component and a cemented femoral component. STUDY DESIGN: Prospective case series. SAMPLE POPULATION: Client-owned dogs (n = 71). MATERIALS AND METHODS: Consecutive clinical cases that had hybrid THR were studied. Radiographic features, pain scores, and lameness scores were recorded pre- and postoperatively. Longer term outcome was assessed by owner questionnaire. RESULTS: Hybrid THRs (n = 78) were performed in 71 dogs. Four cases (5%) had major postoperative complications; 3 were resolved after revision surgery, and 1 owner requested an explantation. No other major complications were identified on follow-up radiographs (67 THR) at 12 weeks. On clinical follow up (77 THR) at 4 weeks, lameness had improved in 68, was unchanged in 8, and was worse in 1. Pain had decreased in 72, was unchanged in 4, and was worse in 1. At 12 weeks (69 THR) compared with preoperative status, lameness had improved in 67 and was unchanged in 2. Pain had improved in 68 and was unchanged in 1. Longer term follow-up (mean, 16 months) was available for all hips. No further complications were reported. Owner satisfaction was good for 76 THRs and reasonable for 2. CONCLUSIONS: Hybrid THR can be performed successfully with a low complication rate and represents an alternative to either entirely cemented or cementless implantation.

Analysis of intensive outpatient neuro-rehabilitation outcomes using FIM+FAM(UK).

OBJECTIVE: To analyse the functional outcomes of adults following acquired brain injury attending an intensive outpatient neuro-rehabilitation programme relative to a comprehensive TBI day programme service in the United States. DESIGN: Retrospective audit of all admissions over a two-year period (2001-2003) to an outpatient neuro-rehabilitation service utilising an interdisciplinary team model. SETTING: Outpatient neuro-rehabilitation service. PARTICIPANTS: 89 patients in receipt of 2+ therapies attending for intensive day neuro-rehabilitation programme. MAIN OUTCOME MEASURES: Routine FIM+FAM(UK) scores were compiled on admission and discharge. The FIM+FAM(UK) is a widely employed outcome measure of activity and participation comprising 30 items across a range of domains including self care, domestic skills, mobility, communication, cognitive and social abilities. The scale is divided into two broad domains of functioning (motor and cognitive). DATA ANALYSIS: Descriptive analysis of demographic, patient diagnosis, referral patterns and time since injury to attendance was undertaken. Analysis of FIM+FAM(UK) admission and discharge scores was performed. RESULTS: Complete admission and discharge scores were available for 65 patients. Significant mean improvements in motor (12.0 point change), cognitive (7.3 point change) and composite FIM+FAM(UK) (19.3 point change) scores were observed indicating reduced functional dependence following an intensive period of outpatient neuro-rehabilitation. CONCLUSION: The FIM+FAM(UK) measure demonstrated sensitivity to change across functional domains relevant to goal directed intensive outpatient interdisciplinary neuro-rehabilitation.

Effectiveness of neurodisability simulation training for NHS staff working in brain injury rehabilitation.

PURPOSE: Members of a regional inter-disciplinary neuro-rehabilitation service took part in simulation exercises aimed at providing insights into the lived experience of those with a neurodisability. The purpose of the study was to evaluate the impact of training on reflective clinical practice. METHOD: A sample of 78 professionals working within a U.K. regional neuro-rehabilitation service took part in neurodisability simulation exercises. Participants were drawn from all healthcare professions represented within the neuro-rehabilitation team. Quantitative and qualitative feedback was collected pre- and post-study and 3 months later. Length of working experience was examined as a possible mediating factor influencing attitudes towards and outcome of simulation training. RESULTS: Results suggest that participants found the simulation exercise experience insightful and increased their self-reported empathy and concern for those they care for. It also helped inform practical ways of working with patients. Length of staff experience was not found to be a significant factor in attitudes towards or outcome of the training. CONCLUSIONS: Simulation exercises, when organised with the aim of developing insight and empathy can result in positive outcomes for those who take part. Simulation exercises as an integrated learning tool for staff within healthcare settings should be provided.

Childhood trauma as a predictor of reoffending in a Northern Irish probation sample.

BACKGROUND: It is well-documented that there is a high prevalence rate of childhood trauma experiences among the prison population, and studies have found a link between childhood trauma and later acts of violence. OBJECTIVE: The aim of the current study was to investigate whether childhood trauma (i.e., physical, sexual, emotional abuse and physical neglect) among offenders who have served a life sentence in Northern Ireland was associated with general and violent reoffending patterns. The study also explored the relationship between childhood trauma resulting from the sectarian conflict "The Troubles" in the region and its impact on reoffending. METHOD: The casefiles of 100 offenders were coded for trauma experiences and official reoffending data was extracted. Logistic regression analysis was performed to explore the relationship between trauma and reoffending. RESULTS: The most common form of childhood trauma were emotional abuse and/or emotional neglect (n = 43), conflict-related trauma (n = 43) and physical abuse (n = 40). Only age (OR .91) and conflict-related trauma (OR 5.57) emerged as significant predictors (p < .05) of general reoffending at any time post release. Similarly, only age (OR .92) and conflict-related trauma (OR 4.57) emerged as significant predictors (p < .05) of violent reoffending. Although it did not reach significance (p =  .09), childhood physical abuse was related to an increase in the odds of violently reoffending, of a large magnitude (OR 4.09). CONCLUSIONS: Conflict-related trauma significantly predicted general and violent reoffending among offenders with previous violent convictions.

The trauma still goes on...: the multigenerational legacy of Northern Ireland's conflict.

Numerous studies have been conducted internationally on the subject of multigenerational trauma; however, little is currently known about its existence in the context of the Northern Ireland conflict. The present study explored the outcomes of and mechanisms through which the trauma of one generation impacts on subsequent generations in this context. Using an Interpretative Phenomenological Approach (IPA), this study examined the subjective experiences, beliefs and perceptions of four mothers from Northern Ireland, all of whom had endured trauma during their childhoods. Three main master themes emerged: 1. "Attempting to cope" addressed how the trauma was dealt with, and how these efforts can be the very mechanisms through which multigenerational trauma occurs. Examples include hiding the truth, seeing the truth as dangerous, and knowing and not knowing about the trauma; 2. "The trauma still goes on" highlighted the negative outcomes and consequences of the traumatic experiences within the family such as delayed impact, symptoms and anger; and 3. "Strength through adversity" included the more positive outcomes of their experiences, such as finding meaning through suffering and making efforts to stop the cycle. The results are discussed in terms of the existing theories on multigenerational trauma, and implications for practice are explored.

Social identification and post-traumatic stress symptoms in post-conflict Northern Ireland.

BACKGROUND: Understanding of the psychological impact of politically motivated violence is poor. AIMS: To examine the prevalence of post-traumatic symptoms subsequent to the 'troubles' in Northern Ireland. METHOD: A telephone survey of 3000 adults, representative of the population in Northern Ireland and the border counties of the Irish Republic, examined exposure to political violence, post-traumatic stress disorder (PTSD) and national identity. RESULTS: Ten per cent of respondents had symptoms suggestive of clinical PTSD. These people were most likely to come from low-income groups, rate national identity as relatively unimportant and have higher overall experience of the 'troubles'than other respondents. CONCLUSIONS: Direct experience of violence and poverty increase the risk of PTSD, whereas strong national identification appears to reduce this risk.