Attitudes of farm consultants in the South Island of New Zealand towards the role of veterinarians in farm businesses.

AIMS: To assess the attitude of dairy farm consultants to the role of veterinarians on dairy farms and whether they viewed veterinary advice as impartial, free from commercial bias and central to farm productivity and profitability. METHODS: A telephone survey was commissioned in September 2014 of 36 full-time farm consultants in the Canterbury and Otago region of New Zealand using a pre-prepared questionnaire to explore their attitudes towards the veterinary profession. Of those approached, 25 completed the survey. RESULTS: The consultants surveyed agreed or strongly agreed (21/23) that they were the custodians of animal health expenditure on farms, which was seen as an expense to be controlled (19/25 agreed or strongly agreed). This view was held more strongly (9/9 agreed or strongly agreed) by consultants with >5 years' professional experience, compared to 10/16 consultants with ≤5 years' experience. Most consultants (24/25) disagreed that they did not respect veterinary advice, but agreed (24/25) that veterinarians almost always had a vested interest in the advice that they gave. The role of veterinarians was seen by respondents to be mainly treatment of sick animals (22/25) and provision of animal health products (24/25), but not in maximising farm profitability (selected by 8/25 respondents). Consultants viewed their own roles as providing advice on the influence of animal health on farm profitability (21/25), nutrition (22/25) and reproduction (20/25). Most respondents (21/25) stated that reducing disease and animal health issues was important, but they (21/25) also identified a reduction in farm animal health expenditure as a measure of success. Only 7/25 consultants felt that they should work in partnership with veterinarians. CONCLUSIONS: This was a small scale study from one region of New Zealand but it indicates that consultants are ambivalent about the role and value of working more closely with veterinarians, and about the benefit that veterinary intervention may bring to a farm's profitability. CLINICAL RELEVANCE: More successful veterinary involvement on dairy farms will follow from a better understanding of how other rural professionals are involved in the farm's management and in meeting the individual farmer's goals and motivations.

An active video game intervention does not improve physical activity and sedentary time of children at-risk for developmental coordination disorder: a crossover randomized trial.

BACKGROUND: Children with developmental coordination disorder (DCD) are highly inactive and sedentary. The purpose of this study was to assess the impact of a home-based active video game intervention on objectively measured physical activity and sedentary behaviour in children at risk for DCD. METHODS: In a crossover randomized clinical trial, 21 children (mean age 11.0, SD 1.0; n = 11 girls) in Perth, Western Australia participated in two 16-week periods: no active video games (AVGs) control period and AVGs intervention period. Two active input consoles were provided to participants along with a selection of non-violent AVGs for participants to play at home. Participants wore accelerometers at baseline and following each period to determine minutes of sedentary, light, moderate and vigorous times in addition to self-reported types of activities in a diary. Linear mixed models, adjusted for the order of periods, compared physical activity and sedentary time during the last week of each period. RESULTS: There were no significant differences between the intervention and control periods in time spent in sedentary (decrease of -1.0 min/day during the intervention period, 95%CI -12.1, 10.1), light (increase of 2.2 min/day, 95%CI -8.8, 13.2), moderate (decrease of 0.7 min/day, 95%CI -4.6, 3.3) or vigorous (decrease of -0.6 min/day, 95%CI -1.6, 0.4). CONCLUSIONS: Among children at risk for DCD, participating in this AVG intervention did not improve objectively measured physical activity and sedentary time.

MRI development and validation of two new predictive methods of glenohumeral joint centre location identification and comparison with established techniques.

Identification of the centre of the glenohumeral joint (GHJ) is essential for three-dimensional (3D) upper limb motion analysis. A number of convenient, yet un-validated methods are routinely used to estimate the GHJ location in preference to the International Society of Biomechanics (ISB) recommended methods. The current study developed a new regression model, and simple 3D offset method for GHJ location estimation, employing easy to administer measures, and compared the estimates with the known GHJ location measured with magnetic resonance imaging (MRI). The accuracy and reliability of the new regression and simple 3D offset techniques were compared with six established predictive methods. Twenty subjects wore a 3D motion analysis marker set that was also visible in MRI. Immediately following imaging, they underwent 3D motion analysis acquisition. The GHJ and anatomical landmark positions of 15 participants were used to determine the new regression and simple 3D generic offset methods. These were compared for accuracy with six established methods using 10 subject's data. A cross validation on 5 participants not used for regression model development was also performed. Finally, 10 participants underwent a further two MRI's and subsequent 3D motion analysis analyses for inter-tester and intra-tester reliability quantification. When compared with any of the other established methods, our newly developed regression model found an average GHJ location closer to the actual MRI location, having an GHJ location error of 13+/-2 mm, and had significantly lower inter-tester reliability error, 6+/-4 mm (p<0.01).

Vetted access to day case hand surgery.

This prospective study was undertaken in the day surgery unit of Monklands Hospital, Airdrie. The consultant hand surgeon screened all general practitioner referrals between September 1998 and July 2002, and suitable patients referred for minor hand procedures were listed directly on to the day-case waiting list without an initial review in outpatient department. The main end points in this study were accuracy of diagnosis, the appropriateness of surgical treatment plan, patient acceptability and the impact of direct listing on waiting times and attendance. There was agreement in clinical diagnosis in 92%, and the choice of treatment plan was judged to be appropriate in 96% cases. The overall patient acceptability was 90%. This one-visit system not only cuts down on the patients waiting time from initial referral up to surgery but also reduces the number of hospital visits for the patients.

Do check X-rays influence the management of patients who have undergone hip fracture fixation using image intensifier guidance?

OBJECTIVE: To determine if postoperative check X-rays influence the management of patients who have undergone hip fracture fixation using image intensifier guidance and the possible economic impact. A fractured neck of femur is the commonest fracture sustained in the UK amongst the elderly population, with internal fixation commonly carried out under image intensifier guidance, producing high quality intraoperative images. In the postoperative period, patients often receive a subsequent check X-ray, although recent evidence has suggested little additional information is gained. METHODS: We examined the X-rays of 100 patients who underwent internal fixation (using image intensifier guidance) for a fractured neck of femur. RESULTS: Twenty-four patients received a postoperative check X-ray, although none of these patients had their management altered by this subsequent X-ray. CONCLUSION: If these check X-rays are avoided, there is a potential saving of over 2000 sterling pound in our hospital and 38,800 sterling pound in Scotland per annum.

Metal-on-metal surface hip arthroplasty in patients with abnormal Coxanatomy: preliminary results.

The purpose of this study was to evaluate early to intermediate results of metal-on-metal (MoM) hip resurfacing arthroplasty in patients with abnormal hip anatomy. We evaluated nine MoM hip resurfacing arthroplasty in eight patients with abnormal coxanatomy performed at a district general hospital in the UK between March 1999 and November 2002. One patient had undergone bilateral sequential hip resurfacing procedure. These patients were defined to have abnormal coxanatomy by virtue of previous dysplastic disease of hip in three cases, previous Legg-Calve-Perthes disease, multiple epiphyseal dysplasia, T cell acute lymphoblastic leukaemia, trauma and sepsis in one case each. The mean follow-up was 40.8 months. The mean age at primary operation was 35 years (range: minimum 21 years; maximum 44 years). There were six male and two female patients. There were six right-sided and three left-sided procedures. All patients had satisfactory outcomes. There were no deep infections, dislocations, or femoral neck fractures. Although this is a short series, MoM resurfaced hips with appropriate case selection can yield satisfactory short-term to intermediate-term results in the young and active patients with abnormal hip anatomy.

An unfavourable outcome after periprosthetic fracture following metal-on-metal surface hip arthroplasty.

We report a case of a varus malunited periprosthetic femoral neck fracture following metal-on-metal hip resurfacing operation. Failure to closely observe and poor compliance in the young and active group of patients may contribute to such an unfavourable outcome.

Do creatine kinase (CK) levels influence the diagnosis or outcome in patients with compartment syndrome?

We report a retrospective study in patients with compartment syndrome with the aim to analyse: 1) whether the level of rise in CK levels is a useful marker to the presence of compartment syndrome and; 2) whether an early fasciotomy assists in lowering of the elevated CK levels. The results of our study suggest that although raised CK levels are not diagnostic, they are a useful adjunct in making a diagnosis, and hence CK estimation should be done in all patients with suspected compartment syndrome. Moreover, an early fasciotomy (< 12 hours) has a statistically significant influence in lowering elevated CK levels, confirming the view that the earlier the decompression, the lesser the muscle damage.

Acetabular augmentation using a second cup during revision hip arthroplasty: an unusual case report.

Acetabular wedge augmentation is a useful technique and is recommended in situations where cup revision is likely to be excessively difficult. Numerous augmentation designs that improve the stability of the hip are now available in the market. Occasionally, however, these devices are not readily available, particularly if problems such as instability and dislocation are not anticipated preoperatively. We report our experience in treating such a case, using an augment cut from a second cup with a follow-up for 30 months. Though there is no substitute for proper preoperative planning, awareness of this procedure is helpful as unexpected problems do arise in revision acetabular surgery.

Femoral neck fractures complicating metal-on-metal resurfaced hips: a report of 2 cases.

Metal-on-metal hip resurfacing arthroplasty is increasingly popular for younger patients with advanced hip disease. Intra-operative or immediate postoperative femoral neck fracture after metal-on-metal hip resurfacing is a well-described technical complication, ranging from 0% to 1.5%. We report 2 cases of late femoral neck fracture occurring 8 and 15 months following the index operation, with a review of the literature. We recommend that patient selection should be of prime importance before embarking on metal-on-metal surface hip replacement to avoid such complications.

Role of topical antibiotics in hip surgery. A prospective randomised study.

BACKGROUND: The effectiveness of topical antibiotics has been shown well enough in vitro to justify strong consideration of their use in orthopaedic procedures. We carried out a randomised prospective trial to study the role of topical chloramphenicol ointment application on postoperative wounds following surgeries for hip fractures. METHODS: One hundred cases with fracture neck of femur were enrolled in the study. They were randomized into two treatment groups: one group had chloramphenicol ointment applied at the surgical site at the end of procedure and 3rd day postoperatively, while the control group did not. The wound was checked on the 3rd, 6th, 12th and 30th days postoperatively, by a tissue viability nurse on the guidelines issued by the Scottish Centre for Infection and Environmental Health (SCIEH). RESULTS: We had 12 cases with superficial infection of which 8 belonged to control group. The risk of developing wound infection, however, was not significant with and without the use of chloramphenicol ointment (relative risk 0.430, 95% confidence interval (CI) 0.120-1.544). Using multivariate analysis, no association was found between wound infection and age, gender, type of fracture or type of surgical procedure. Smoking was found to be the only factor significantly associated with infection, with the relative risk for current smokers compared with former/non-smokers being 7.29 (95% CI 1.62-32.67). CONCLUSION: Awareness is needed amongst the general public about the ill effects of smoking. There was reduction in the incidence of wound infection with the use of topical antibiotic ointment. However, this was not statistically significant to recommend its use in routine practice. A larger study should provide useful information on the role of topical antibiotic and its effect on postoperative wound infection.

Balloon flexor sheathplasty: one-stage grafting at 19 years.

The technique of dilatation of a flexor sheath to allow one-stage grafting was recently described and named balloon flexor sheathplasty [J. Hand Surg. 27B (2001) 487-488]. The scope of this procedure is not yet known and the application after significant delay has not been described. We report a case where balloon flexor sheathplasty allowed return of useful function after an interval of 19 years.

Flexor sheath dilatation with a Fogarty catheter.

The use of a Fogarty catheter to dilate a constricted flexor sheath is described. This relatively atraumatic method of dilating a constricted flexor sheath, may sometimes allow a one-stage rather than a two-stage tendon graft procedure.

Cement restriction technique in dynamic hip screw revisions.

When revising dynamic hip screw fixation to arthroplasty, the defect left by the lag screw in the proximal femur poses a problem for cement containment, with the potential for sub-optimal cementation. We recommend the use of a bioresorbable cement restrictor as a simple and effective means to overcome this problem.

Escape and aggregation responses of three echinoderms to conspecific stimuli.

In marine invertebrates, waterborne chemical stimuli mediate responses including prey detection and predator avoidance. Alarm and flight, in response to damaged conspecifics, have been reported in echinoderms, but the nature of the stimuli involved is not known. The responses of Asterias rubens Linnaeus, Psammechinus miliaris (Gmelin), and Echinus esculentus Linnaeus to conspecifics were tested in a choice chamber against a control of clean seawater (no stimulus). All three species showed statistically significant movement toward water conditioned by whole animals or homogenate of test epithelium. P. miliaris and E. esculentus displayed a statistically significant avoidance reaction, moving away from conspecific coelomic fluid, gut homogenate, and gonad homogenate. A. rubens was indifferent to conspecific coelomic fluid, pyloric cecum homogenate, and gonad homogenate but moved away from cardiac gut homogenate. P. miliaris was indifferent to gametes, but the other two species were significantly attracted to them. No species showed preference for one particular side of the chamber during trials to balance water flow. These echinoderms can distinguish between homogenates of conspecific tissues that might be exposed when a predator damages the test, and those that may emanate from the exterior surface during normal activities.

A single blind, prospective, randomized trial comparing n-butyl 2-cyanoacrylate tissue adhesive (Indermil) and sutures for skin closure in hand surgery.

Fifty patients underwent a variety of hand operations and were randomized for wound closure either with tissue adhesive (Indermil) or sutures. The two treatment groups had similar demographic characteristics and similar outcomes at the 2 and 6 week postoperative assessments which were performed by a designated tissue viability nurse blinded to the method of closure. Five minor wound dehiscences occurred: three in the adhesive group and two in the suture group. No infection occurred in either group. In conclusion, the study demonstrates tissue adhesive is as effective as suture in this type of hand surgery.

Spontaneous bifocal Clostridium septicum gas gangrene.

Clostridium septicum gas gangrene (myonecrosis) is an acutely painful and rapidly fatal infection occurring in the absence of trauma. Urgent surgery is essential both to control pain and to ensure survival. Most patients who develop this infection have an underlying malignancy and clinicians should be aware of this association. We present a case of bifocal myonecrosis which to our knowledge has not been reported previously.