Exploring the experiences of healthcare professionals in South Africa and Uganda around communicating with children about life-threatening conditions: a workshop-based qualitative study to inform the adaptation of communication frameworks for use in these settings.

OBJECTIVES: This study aimed to explore how published communication frameworks could be amended to ensure applicability and cultural appropriateness for professionals to support family-centred conversations by investigating' healthcare professionals' (1) experiences of providing support to families when a caregiver or a dependent child (<18 years old) has a life-threatening condition, (2) perceived challenges for caregivers and healthcare professionals in communicating with children about illness, (3) perceptions of how clinicians could be equipped to facilitate conversations between caregivers and children about an adult or the child's own life-threatening condition and (4) suggestions for amendments to previously published guidelines to ensure cultural relevance in South Africa and Uganda. DESIGN: A qualitative study involving two 2-day workshops with embedded focus group discussions, break out rooms and consensus discussions. SETTING: Health and social care and third sector organisations in South Africa and Uganda. PARTICIPANTS: Thirty-two professionals providing care to families affected by life-threatening conditions in South Africa or Uganda who were aged 18 years or older and able to converse in English. RESULTS: Participants identified obstacles to having conversations with caregivers about children and to telling children about serious illness during consultations. These included patients' beliefs about illness, medicine and death, language barriers between families and the healthcare team, and emotional and practical challenges for professionals in having these conversations. Culturally appropriate adaptations were made to previously published communication frameworks for professionals to support family-centred conversations. CONCLUSIONS: Culturally sensitive communication frameworks could help healthcare professionals to talk with families about what children need to know when they or a caregiver have a serious illness. More broadly, effective communication could be facilitated by promoting healthcare professionals' and communities' understanding of the benefits of telling children about illness within the family. Together these strategies may mitigate the psychological impact of global disease on children and their families.

Spatial partitioning by a subordinate carnivore is mediated by conspecific overlap.

There are several hypotheses that could explain territory size in mammals, including the resource dispersion hypothesis (RDH), the intruder pressure hypothesis (IPH), and the intraguild predation hypothesis (IGPH). In this study, we tested predictions of these three hypotheses regarding territories of 19 packs of endangered African wild dogs (Lycaon pictus) over 2 years in the Kruger National Park, South Africa. If territory size was supported by the RDH, then we would observe (1) wild dog territories would be larger when resource patches were more dispersed, (2) pack sizes would be larger when resource patches were rich, and (3) pack size would not affect territory size. If supported by the IPH, then we would observe (4) larger territories would experience less intrusions, and (5) there would be an increase in territory overlap in areas of low resource dispersion. Finally, if supported by the IGPH, we would observe (6) territories would be larger in areas of higher lion (Panthera leo) density, as evidence of a spatial avoidance strategy. We found that the IGPH was fully supported (6), the IPH half supported (5), and the RDH partially supported (1 and 3), where we found spatial partitioning of wild dogs with lions, potentially mediated by resources and territory overlap with conspecifics. Ultimately, our results show that subordinate carnivores must balance a trade-off between dominant interspecific competitors and conspecifics to successfully coexist in areas with dominant carnivores.

Maternal GIST in twin pregnancy: Case report of a rare and complex management challenge.

► Twin pregnancy ► GIST tumour ► Multidisciplinary team.

Community-based screening for Down's Syndrome in the first trimester using ultrasound and maternal serum biochemistry.

Two years of community-based first trimester screening (FTS) were audited. All women with singleton pregnancy in a defined health region who completed FTS (ultrasound and biochemistry) were included (n= 10,436) and outcomes obtained for 98.4%. All scans were performed or supervised by experienced sonologists with Fetal Medicine Foundation (FMF) accreditation. FMF software generated all risk assessments based on nuchal translucency (NT), maternal serum-free beta human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein A (PAPP-A). The detection rate for Trisomy 21 was 90.6% with a screen-positive rate of 3.9%. These findings indicate that where FTS is accessible within routine antenatal care, a detection rate of 90% and low screen-positive rate can be achieved using the FMF programme.

The use of a "liquid" electrode in hepatic electrolysis.

BACKGROUND: The use of direct current electrolysis as a local nonthermal ablative technique for colorectal liver metastases promises to be a simple, safe, and effective therapy. Under general anesthesia, electrolysis is presently limited to tumors smaller than 5 cm, due to the protracted nature of its administration. In an attempt to enhance the effect of electrolysis, a direct current was passed through a preinjected bolus of acetic acid. METHODS: The effect of a combination of electrolysis and an injection of acetic acid was tested in the liver of eight normal pigs. The volumes of necrosis caused were analyzed. RESULTS: Acetic acid independently produced a volume of necrosis but did not provide a volumetric or rate advantage when used in combination with a direct current. Statistically, the only main effect on the volume of necrosis was a result of electrolysis. CONCLUSION: The use of 50% acetic acid to augment the efficacy of direct current electrolysis cannot be recommended.

Electrolysis and other local ablative treatments for non-resectable colorectal liver metastases.

The present paper is a review of the current ablative treatment options for the treatment of colorectal liver metastases. Cryotherapy, microwave coagulation therapy, radiofrequency ablation and laser-induced thermotherapy are discussed. Electrolysis, a novel non-thermal ablative treatment, is described. Potential benefits of electrolysis include the apparent ability to safely and effectively treat lesions abutting major hepatic structures and the lack of a systemic inflammatory reaction following electrolytic ablation. Further studies in animals and humans are needed to confirm this potential and to further refine the methods of electrolytic treatment of colorectal liver metastases.

Evaluation of samarium-153 and holmium-166-EDTMP in the normal baboon model.

Bone-seeking radiopharmaceuticals such as ethylenediaminetetramethylene phosphonate (EDTMP) complexes of samarium-153 and holmium-166 are receiving considerable attention for therapeutic treatment of bone metastases. In this study, using the baboon experimental model, multicompartmental analysis revealed that with regard to pharmacokinetics, biodistribution, and skeletal localisation, 166Ho-EDTMP was significantly inferior to 153Sm-EDTMP and 99mTc-MDP. A more suitable 166Ho-bone-seeking agent should thus be sought for closer similarity to 153Sm-EDTMP to exploit fully the therapeutic potential of its shorter half-life and more energetic beta radiation.

Gated blood pool SPECT and phase analysis to assess simulated Wolff-Parkinson-White syndrome in the baboon.

This study assesses the diagnostic potential of a tomographic technique with phase analysis to detect premature electroventricular contraction patterns simulated by pacing in the baboon. The data of gated SPECT were analysed by backprojection of the Fourier coefficients, followed by angulation and integration to thick slices of the entire ventricular mass yielding separate ventricular contraction patterns in three perpendicular views. Electrodes were implanted in each baboon: at the sinoatrial node; posterior, left ventricular; anterior left ventricular; on the left and the right lateral ventricular walls. The atrium was stimulated throughout at a fixed rate. Subsequent ventricular stimuli followed during the QRS complex, such to invoke the appearance of pre-excitation QRS morphology. The first points of activation (FPA) from this algorithm were correctly detected for the RV, for the anterior and posterior sites, although the latter two manifested first points in the RV. LV pacing manifested also as a FPA in the RV, but was followed by a true subsequent point in the LV.

Description of a mechanistic approach to pain management in advanced cancer. Preliminary report.

A mechanistic approach to advanced cancer pain management is proposed, based on the clinically perceived anatomical and pathophysiological mechanisms of pain generation. It is an extension of the World Health Organisation (WHO) analgesic ladder in which severity of pain is the principal determinant of analgesic choice. The mechanistic categories are: superficial somatic, deep somatic, visceral and neurogenic (mixed or pure, i.e., nociceptive component present or absent). Allocation of pain to the different categories is based on clinical history, physical findings and investigations to establish the site and extent of active primary or metastatic tumor deposits, and evidence of previous response to medication. Drug choice sequence is determined by the dominant pain mechanism judged to be present and not the severity of the pain. In order to describe this approach, mechanisms of pain, disease distribution and drug treatment have been analysed in the first 20 consecutive patients who consented to enter a longitudinal pain description and evaluation study on admission to an inpatient hospice unit. Despite a high exclusion rate from research standard monitoring due to severity of illness and related factors, the majority of eligible patients approached to enter the study did so, and the pain scoring was well tolerated. The implications of this for future research and clinical practice are discussed. In 6 patients only 1 pain mechanism was identified (visceral 4, deep somatic 2). Two mechanisms were present in 8 patients and 3 mechanisms in 6 patients. The deep somatic mechanism was identified in 15 patients, visceral mechanism in 13, neurogenic in 10 and superficial somatic in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

The baboon: an ideal model in biomedical research.

The baboon is a good animal model for research and investigations in physiology and pathophysiology, also using radiopharmaceutical techniques. It has several similarities to the human being, and all parameters in human physiology can be measured in the baboon model with the same or equal technical equipment. Fourier phase analysis in radionuclide ventriculography, hemodynamic reactions in a septic shock model, and investigations in conjunction with local anesthetics (eg, effects on cerebral blood flow) are typical types of research that have been or are currently being performed on the baboon. Institutes using the baboon model must be equipped with all instruments and operating facilities as would be needed for investigations in human beings. Ethical considerations must be regarded strictly and supervised by an ethics committee. Protocols must determine exactly why in vivo experimentation is preferred to in vitro tests. Anesthesia techniques in a baboon model allow study on the animal itself, eliminate pain (and stress) to the animal, and should not interfere with the aims of the investigation being performed.

A baboon model for in vivo assessment of mucociliary lung clearance.

A suitable baboon model (Papio ursinus) for assessing inhibitory effects on mucociliary lung clearance was required. Clearance of various dimensions of nebulized particles (99mTc-labelled) was monitored with the animals (n = 6) under either ketamine or pentobarbitone anaesthesia. The best prospect of substantial and reproducible clearance in spite of the inhibition by the anaesthesia were obtained with pentobarbitone, and using nebulized radiolabelled particles of diameter range between 10 and 45 microns, thus avoiding trapping in the non-ciliary alveoli.