Difference in incisional complications following exploratory celiotomies using antibacterial-coated suture material for subcutaneous closure: Prospective randomised study in 100 horses.

REASONS FOR PERFORMING STUDY: Incisional complications are a major post operative challenge following ventral midline exploratory celiotomy for abdominal pain in horses. They lead to discomfort, prolonged hospitalisation, longer recovery times and increased cost; therefore, investigation of preventative procedures are warranted. OBJECTIVES: To determine the clinical effect of antibacterial (triclosan) coated 2-0 polyglactin 910 suture material on the likelihood of incisional infections when used for closure of subcutaneous tissue following ventral midline celiotomies in horses. METHODS: One hundred horses undergoing exploratory celiotomy assigned at random to one of 2 groups. In the control group coated 2-0 polyglactin 910 (Vicryl) was used for apposition of the subcutaneous tissue in a simple continuous pattern and, in the study group, antibacterial (triclosan) coated 2-0 polyglactin 910 suture material (Vicryl Plus) was used. Post operatively an elastic adhesive abdominal bandage was applied, changed and the incision was inspected by a clinician blinded to the study protocol at 24-36 h and 6-9 days post operatively. Outcomes of interest were evidence of incisional pain, incisional oedema, sheath/udder oedema, incisional drainage, hernia formation and dehiscence. RESULTS: Antibacterial-coated suture material did not decrease the likelihood of incisional complications in 100 horses. CONCLUSIONS: A beneficial effect on ventral midline incisions in 100 horses was not evident by using antibacterial-coated suture material. POTENTIAL RELEVANCE: Lack of effectiveness of antibacterial-coated suture material in equine ventral midline closure after exploratory celiotomy and the observed potential adverse effects suggest that further clinical investigations are needed before using such material routinely on horses.

What did we learn about national organizational collaboration at the advisory committee level?

This article provides an overview of the typical roles and tasks of advisory groups in general, followed by a discussion of the roles and tasks the Interdisciplinary Generalist Curriculum (IGC) Project Advisory Committee was asked to assume and how these were fulfilled. It analyzes the lessons learned about advisory committees as a result of the IGC Project experience. Key elements of success in fulfilling advisory committee obligations include well-defined expectations, periodic evaluations, and clear communication between project leadership and the members of the advisory committee. In the spirit of lessons learned from the IGC Project, this critique identifies several philosophical and logistic issues that might be considered in the design and implementation of future projects, such as the need to choose committed, high-energy advisory committee members who are willing to perform many complex, time-consuming tasks.

Physicians in service to the underserved: an analysis of the practice locations of alumni of Western University of Health Sciences College of Osteopathic Medicine of the Pacific, 1982-1995.

PURPOSE: To determine how many osteopathic medical graduates (DOs) of the Western University of Health Sciences were practicing in underserved communities. METHOD: Practice address information was available for 765 of the 850 practicing DO alumni who had graduated from the University from 1982 through 1995. Alumni were categorized as practicing in underserved areas or not, following federally established guidelines; they were also categorized by gender, ethnicity, and medical specialty. RESULTS: Overall, 20.9% of these 765 alumni were practicing in underserved communities. The percentages of alumni practicing in underserved communities by gender, ethnicity, and specialty were: men, 20.9%; women, 21.0%; Caucasians, 20.5%; Asian Americans, 18.0%; African Americans, 25.0%; Hispanic Americans, 32.1%; Native Americans, 33.3%; primary care physicians, 20.9%; and non-primary care physicians, 20.9%. CONCLUSIONS: Approximately one in five practicing DO alumni of Western University was practicing in an underserved area. Examining these data by sex, ethnicity, and practice specialization suggested only weak associations between subgroup membership and practice in an underserved area.

A trek to the top: a review of acute mountain sickness.

Acute mountain sickness (AMS) affects, to varying degrees, all travelers to high altitudes (elevations greater than 5280 feet). In a small percentage of patients, AMS can lead to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE). Symptoms of AMS range from a combination of headache, insomnia, anorexia, nausea, and dizziness, to more serious manifestations, such as vomiting, dyspnea, muscle weakness, oliguria, peripheral edema, and retinal hemorrhage. Although the primary cause of these symptoms is related to the reduced oxygen content and humidity of the ambient air at high altitudes, the physiologic pathway relating hypoxemia to AMS and its sequelae remains unclear. Tips on self-diagnosis and symptom recognition are critical elements to be included in educating patients who are contemplating a trip to high altitudes. Preventive strategies include allowing 2 days of acclimatization before engaging in strenuous exercise at high altitudes, avoiding alcohol, and increasing fluid intake. Conditioning exercise for patients older than 35 years is also recommended before departure. A high-carbohydrate, low-fat, low-salt diet can also aid in preventing the onset of AMS. Acetazolamide (125 mg two or three times daily, or once at bedtime) has also been shown to reduce susceptibility to AMS and the incidence of HAPE and HACE. Although effective in treating cerebral symptoms of AMS, dexamethasone is not routinely recommended as a prophylactic agent for AMS.

Guidelines for designing resident rating forms.

A well-designed rating form provides one means to evaluate a resident's clinical performance. A clear perception of the program's goals is the foundation on which an original--or revised--design should rest. Suggestions for three different types of rating forms are presented here.