GPs' opinions of discharge summaries generated by advanced nurse practitioners in emergency care settings.

AIM: Clinical handover at the point of discharge is critically important. It generally occurs through a written document, usually in the form of a discharge summary. Hospital discharge summaries contribute to continuity of care for patients who leave hospital and who may require care in the community provided by their GP. They must be accurate, valid, reliable, timely, legible and complete. The aim of this study was to investigate GPs' perceptions of the content of discharge summaries generated by emergency advanced nurse practitioners (EANPs). METHOD: A cross-sectional descriptive survey design was used and a questionnaire was distributed to 120 GPs. Raw statistical data were analysed using SPSS v22 while the qualitative data from the open-ended questions were manually analysed. FINDINGS: Most GPs were satisfied with the EANPs' discharge summary letters. However, this study supports previous papers that identified deficits in communication between secondary care and GPs. CONCLUSION: There is a need to refine discharge summaries to create an enhanced structured discharge summary template that can be used by all disciplines.

Managing acute shoulder injuries in the emergency department.

Patients with shoulder injuries commonly present to emergency departments (EDs) and minor injury units and it is vital that they receive the same high standard of care regardless of where they receive it or who delivers it. The author, therefore, developed an algorithm to help standardise diagnosis and management of shoulder injuries. This article describes acute shoulder injuries often seen in EDs and advanced health assessments of these injuries, including specific tests, and uses a case study to illustrate how the algorithm helped diagnose and manage care of a patient with a dislocated shoulder.

Diagnosing Achilles tendon injuries in the emergency department.

Achilles tendon (AT) injury is an overuse injury often seen in professional and recreational athletes. It tends to affect men, particularly those in their thirties and forties, more than women, and is typically seen in people who are intermittently active. To ensure AT ruptures are identified and treated effectively, early intervention in emergency departments (EDs) is crucial. This article discusses how advanced nurse practitioners can use their comprehensive problem-solving, clinical decision-making and clinical judgement skills to manage patients who present with suspected AT injury. It also describes the anatomy of tendon rupture, the aetiology and mechanism of injuries, and the importance of assessment and diagnostic tools, therapeutic techniques and management strategies. Finally, it considers the psychological effect this injury can have on patients, while in the ED and after discharge. A case study is included as an example of ED management.

Dealing with the effects of domestic violence.

Domestic violence has a lasting and damaging effect on the lives of thousands of women, men and children in Ireland and the UK. Yet, healthcare services are il equipped to deal with the victims of physical, sexual, and psychological abuse, many of whom present to emergency departments because they need help and support. As this article discusses, healthcare staff have a responsibility of care for such people. They must be able to recognise and respond to the signs of domestic abuse, and refer people who experience it to the appropriate organisations.

Pneumonia from Angiostrongylus vasorum infection in a red panda (Ailurus fulgens fulgens).

A 9-year-old, male, captive red panda (Ailurus fulgens fulgens) in an urban zoo in the United Kingdom presented with respiratory distress and weight loss. The animal was euthanatized, and a postmortem examination was performed. The lungs were diffusely consolidated with extensive mineralization. Microscopically, there was extensive obliteration of normal pulmonary architecture by sheets and coalescing nodules of partially mineralized fibrous tissue and granulomatous inflammation centered on large numbers of nematode larvae and eggs. First stage nematode larvae were isolated from lung tissue and were characterized as Angiostrongylus vasorum on the basis of their morphology and sequencing of the 18S ribosomal RNA gene and the entire second internal transcribed spacer. Although A. vasorum has previously been reported in red pandas in a zoological collection in Denmark, this study is the first reported case in the United Kingdom and occurs against a background of geographical spread and increased incidence of disease in domestic and wild canids. Angiostrongylus vasorum should be considered a differential diagnosis for respiratory disease in the red panda and taken into account when planning parasite and pest control programs for zoological collections.

Redescription and first molecular characterization of the little known feline neurotropic nematode Gurltia paralysans (Nematoda: Metastrongyloidea).

Gurltia paralysans is a poorly documented metastrongyloid nematode of cats, which mainly parasitizes the veins in the spinal cord subarachnoid space and parenchyma. Parasitic paraparesis caused by G. paralysans is a lesser-known spinal cord disease affecting domestic and wild felids of South America. Regions where feline gurltiosis is endemic include the southern parts of Chile and Argentina. Intra vitam diagnosis of feline gurltiosis remains challenging and is based primarily on neurological signs and the exclusion of other ethiologies for feline myelopathies. In view of the lack of information in the literature for this neglected feline neurological parasitosis, we have undertaken a detailed redescription and molecular characterization to expand on the previously available details in the original descriptions by Wolffhügel in 1993. The specimens used in this study were collected from spinal cord lesions of gurltiosis-affected domestic cats. Female and male specimens were morphologically and morphometrically examined using light and scanning electron microscopy. Molecular characterization was performed by sequencing a partial region of the nuclear ribosomal DNA and cytochrome oxidase gene of this parasite, and phylogenetic trees were constructed from the 28S D2-D3 and ITS2 regions using the Maximum Likelihood method. Sequence matching and phylogenetic analysis with these new sequences were consistent with the morphological classification of G. paralysans being within the Metastrongyloidea superfamily, but no consistent relation to a specific metastrongyloid family. The newly developed G. paralysans-specific PCR described here not only provides a useful diagnostic tool for feline gurltiosis in domestic cats living in endemic areas, but could also be used in large-scale epidemiological surveys on the intermediate mollusk host and the final host. By combining the morphology, molecular, and phylogenetic data we have reliably identified G. paralysans and confirmed its taxonomic status within the Metastrongyloidea.

'A torn shoulder': an emergency department case study.

BACKGROUND: Rupture of the biceps is not a very common presentation to the emergency departments; as a result, it is poorly documented, especially in nursing literature. It is important that these patients are appropriately managed by registered advanced nurse practitioners. As the diagnosis of rupture is usually made on clinical grounds with imaging assisting in the diagnosis, left untreated these injuries can lead to considerable functional deficits. METHODS: The following paper is a case study based on a patient who presented to the emergency department with a proximal biceps rupture following trauma. The paper focuses on the clinical assessment and management of patients who present to the emergency department with these injuries. RESULTS: This case study increases awareness of bicep ruptures and its management in the ED. Discussion points include the neurovascular assessment of these patients, the appropriateness of diagnostic imaging, and in-depth clinical examination techniques. CONCLUSION: Rupture of the biceps tendon is often a result of a sudden forceful extension of the elbow against a previously contracted biceps and flexed elbow. The patient often describes a popping noise and presents with a 'popeye' deformity over their biceps. It is important to be vigilant with these injuries as early recognition will optimise the patients' outcomes.

Biogeography of Parasitic Nematode Communities in the Galápagos Giant Tortoise: Implications for Conservation Management.

The Galápagos giant tortoise is an icon of the unique, endemic biodiversity of Galápagos, but little is known of its parasitic fauna. We assessed the diversity of parasitic nematode communities and their spatial distributions within four wild tortoise populations comprising three species across three Galápagos islands, and consider their implication for Galápagos tortoise conservation programmes. Coprological examinations revealed nematode eggs to be common, with more than 80% of tortoises infected within each wild population. Faecal samples from tortoises within captive breeding centres on Santa Cruz, Isabela and San Cristobal islands also were examined. Five different nematode egg types were identified: oxyuroid, ascarid, trichurid and two types of strongyle. Sequencing of the 18S small-subunit ribosomal RNA gene from adult nematodes passed with faeces identified novel sequences indicative of rhabditid and ascaridid species. In the wild, the composition of nematode communities varied according to tortoise species, which co-varied with island, but nematode diversity and abundance were reduced or altered in captive-reared animals. Evolutionary and ecological factors are likely responsible for the variation in nematode distributions in the wild. This possible species/island-parasite co-evolution has not been considered previously for Galápagos tortoises. We recommend that conservation efforts, such as the current Galápagos tortoise captive breeding/rearing and release programme, be managed with respect to parasite biogeography and host-parasite co-evolutionary processes in addition to the biogeography of the host.

Phylogeny for species of Haemonchus (Nematoda: Trichostrongyloidea): considerations of their evolutionary history and global biogeography among Camelidae and Pecora (Artiodactyla).

Phylogenetic analysis of 25 morphological characters among the 12 species of Haemonchus resulted in 1 most parsimonious tree (60 steps; consistency index = 0.67, retention index = 0.80). Monophyly for Haemonchus was diagnosed by 3 unequivocal synapomorphies, including the asymmetric origin of the dorsal ray, relative size of the ventral rays, and the presence of a barb on each spicule tip. Species of Haemonchus have complex histories with respect to host and geographic associations: (1) origins in Africa with basal diversification in antelopes (H. krugeri, H. lawrencei, H. dinniki, H. horaki), (2) independent events of colonization for those species in Caprini and Bovinae (H. contortus, H. placei, H. bedfordi, H. similis), (3) colonization and development of core host associations within Camelidae (H. longistipes) and among Antilopinae, Tragelaphini, and Giraffidae (H. mitchelli, H. okapiae, H. vegliai), and (4) geographically widespread species that are represented only by those that have been translocated with domestic stock. The North American fauna is characterized by 3 introduced and exotic species, H. placei, H. contortus, H. similis, which emphasizes the importance of continued documentation of faunal diversity in the context of predictive foundations derived from phylogenetic studies. Satellite associations for species of Haemonchus, particularly among Cervidae and Camelidae in the Neotropics and Cervidae, Antilocapridae, and possibly wild Caprinae in the Nearctic, have been a consequence of introductions and exchange of parasites at historical interfaces for managed and natural ecosystems. Such distributions are emblematic of the overriding significance of anthropogenic factors as determinants of the global distributions for pathogenic parasites in domestic and wild ruminants.

Ovejector structure in the Haemonchinae (Nematoda:Trichostrongyloidea) of ruminants.

The use of ovejector structure in the phylogeny of the Haemonchinae is hampered by differences among nematologists in the application of terminology and the recognition of homologous parts. Some workers recognize a sphincter with 2 parts, but others recognize only the proximal, rounded part of the sphincter and include the distal cylindrical part of the sphincter with the vestibule. The results of this study demonstrate that all sphincters of Haemonchinae of ruminants have 2 parts. To encourage the application of a uniform terminology to homologous parts of the ovejector, we propose the use of the terms "sphincter 1" for the rounded part and "sphincter 2" for the cylindrical part. It is hoped that clarification of the terminology for ovejectors of the Haemonchinae will provide a model useful for improving descriptions of ovejectors throughout the Trichostrongyloidea.

Redescriptions of Haemonchus mitchelli and Haemonchus okapiae (Nematoda: Trichostrongyloidea) and description of a unique synlophe for the haemonchinae.

In the course of a revision of Haemonchus Cobb, 1898 (Nematoda), commonly referred to as large stomach worms, significant new morphological information was discovered that allows the recognition of 2 species believed for more than 50 yr to be synonymous. Both species, Haemonchus mitchelli Le Roux, 1929, from the eland Taurotragus oryx and other African ruminants and H. okapiae van den Berghe, 1937, from the okapi Okapia johnstoni, have a synlophe of 42 ridges, but the synlophe of H. mitchelli is longer than that of H. okapiae. The distal tip of the left spicule of H. mitchelli bears a barb that is about twice as long as the short barb and half as long as the long barb on the right spicule. In contrast, the barb on the left spicule of H. okapiae is similar in size to the short barb and about 25% as long as the long barb of the right spicule. The dorsal ray of H. mitchelli is bifurcated distally for 25-39% (32%) of its length and its stem is expanded proximally, but the dorsal ray of H. okapiae is bifurcated 37-50% (42%) and its stem is of uniform thickness.

Fauna europaea: helminths (animal parasitic).

Fauna Europaea provides a public web-service with an index of scientific names (including important synonyms) of all living European land and freshwater animals, their geographical distribution at country level (up to the Urals, excluding the Caucasus region), and some additional information. The Fauna Europaea project covers about 230,000 taxonomic names, including 130,000 accepted species and 14,000 accepted subspecies, which is much more than the originally projected number of 100,000 species. This represents a huge effort by more than 400 contributing specialists throughout Europe and is a unique (standard) reference suitable for many users in science, government, industry, nature conservation and education. Helminths parasitic in animals represent a large assemblage of worms, representing three phyla, with more than 200 families and almost 4,000 species of parasites from all major vertebrate and many invertebrate groups. A general introduction is given for each of the major groups of parasitic worms, i.e. the Acanthocephala, Monogenea, Trematoda (Aspidogastrea and Digenea), Cestoda and Nematoda. Basic information for each group includes its size, host-range, distribution, morphological features, life-cycle, classification, identification and recent key-works. Tabulations include a complete list of families dealt with, the number of species in each and the name of the specialist responsible for data acquisition, a list of additional specialists who helped with particular groups, and a list of higher taxa dealt with down to the family level. A compilation of useful references is appended.

Cylicocyclus asini n. sp. (Nematoda: Cyathostominae) from donkeys Equus asinus in South Africa.

Cylicocyclus asini n. sp. is described from the ventral colons of seven domesticated donkeys Equus asinus in South Africa. The specimens are smaller than 11 members of the genus Cylicocyclus, which currently comprises 10 recognised species, one recognised subspecies and two species inquirendae, but is similar in size to the two smaller species, C. ashworthi and C. leptostomum. Additionally, the small size of its buccal capsule places it within the so-called small buccal capsule group, namely C. ashworthi, C. leptostomum, C. nassatus, C. radiatus and C. triramosus. The shape of the oesophagus at the oesophago-intestinal junction is elongate, similar to that of C. leptostomum. The female specimens have a tail length shorter than the vulva to anus distance, similar to three of the smaller Cylicocyclus species, namely C. leptostomum, C. radiatus and C. triramosus. The new species is distinguished from the smaller members of the genus by the presence of a 'club-foot' posterior in the female specimens, 40-46 elements in the external leaf-crown and a deep division of the dorsal ray which extends beyond the origin of the externodorsal ray. Similarly, the new species can be separated from the two other members in the genus with a 'club-foot' posterior in the females (C. auriculatus and C. gyalocephaloides) by its body length (6.6-8.47 mm) and the presence of a nipple-like dorsal gutter.

Paraorientatractis semiannulata n. g., n. sp. (Cosmocercoidea: Atractidae) from the large intestine of the side-necked turtle, Podocnemis unifilis Troschel, 1848 (Testudines: Pelomedusidae) in Brazil

Specimens collected from the large intestine of the side-necked turtle Podocnemis unifilis Troschel, 1848, in the region of Cumina and Trombetas rivers near Para, Brazil are assigned to a new genus and Paraorientatracti semiannulata. The new genus is separated from the nearest genus Orientatractis by the funnel-shaped mouth opening, the presence of 4 distinct lips, 4 papillae in the internal cycle, one on each lip margin, 2 lateral amphids with large amphidial pores and absence of submedian papillae. It is also separated from Orientatractis and Proatractis by the presence of striated lateral alae which curve dorsally extending from mid oesophagus to mid tail, the difference in size of the vulvar opening and the presence of large transverse ridges or semiannules on the dorsal surface. The new species can be separated from the species of the genera Orientatractis and Proatractis by the characters that distinguish the genera and the arrangement of the caudal papillae on the male. A host/parasite list for Podocnemis spp. is included.