Reducing occupational distress in veterinary medicine personnel with acceptance and commitment training: a pilot study.

AIMS: To determine whether an educational programme targeting the reaction of veterinary personnel to difficult client interactions reduced burden transfer, stress and burnout in veterinary staff. METHODS: Employees of three small-animal veterinary hospitals in the south-western United States of America were recruited and randomised to intervention (educational programme; n = 16) or control (no intervention; n = 18) groups. Participants of this randomised, parallel arms trial completed pre-programme assessment including the Burden Transfer Inventory (BTI), Perceived Stress Scale, and Copenhagen Burnout Inventory. Assessment was followed by two, group-format educational sessions, based on acceptance and commitment training, tailored to reducing reactivity to difficult veterinary client interactions (intervention group only). After training was completed, both groups were assessed using the same measures and the intervention participants provided use and acceptability ratings. RESULTS: Intervention participants rated the programme as useful and appropriate, and reported that programme techniques were used a median of 43 (min 9, max 68) times during the 2 weeks prior to retesting. Relative to pre-programme scores, median post-programme scores for reaction (subscore of BTI) to difficult client interactions decreased in the intervention group (33 vs. 54; p = 0.047), but not in the control group (51 vs. 59; p = 0.210). Changes in median scores for stress and burnout from pre- to post-programme were non-significant for both groups. CONCLUSIONS: This pilot and feasibility trial showed high rates of acceptability and use by participants, as well as promising reductions in burden transfer. A larger scale clinical trial with follow-up at extended time points is needed to more fully examine the efficacy of this novel programme. CLINICAL RELEVANCE: Preliminary findings suggest this programme may be a useful approach to reducing occupational distress for individuals working in veterinary practice.

Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada.

BACKGROUND: Elders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently complex care needs. While many medications could be problematic, this project targets medications that should be deprescribed for most elders and for which guidelines and evidence-based deprescribing tools are available. These are termed potentially inappropriate prescriptions (PIPs) and are as follows: proton pump inhibitors, benzodiazepines, antipsychotics, and sulfonylureas. Implementation strategies for deprescribing PIPs in complex older patient populations are needed. METHODS: This will be a pragmatic cluster randomized controlled trial in community-based primary care practices across Canada. Eligible practices provide comprehensive primary care and have at least one physician that consents to participate. Community-dwelling patients aged 65 years and older with ten or more unique medication prescriptions in the past year will be included. The objective is to assess whether the intervention reduces targeted PIPs for these patients compared with usual care. The intervention, Structured Process Informed by Data, Evidence and Research (SPIDER), is a collaboration between quality improvement (QI) and research programs. Primary care teams will form interprofessional Learning Collaboratives and work with QI coaches to review electronic medical record data provided by their regional Practice Based Research Networks (PBRNs), identify areas of improvement, and develop and implement changes. The study will be tested for feasibility in three PBRNs (Toronto, Montreal, and Edmonton) using prospective single-arm mixed methods. Findings will then guide a pragmatic cluster randomized controlled trial in five PBRNs (Calgary, Winnipeg, Ottawa, Montreal, and Halifax). Seven practices per PBRN will be recruited for each arm. The analysis will be by intention to treat. Ten percent of patients who have at least one PIP at baseline will be randomly selected to participate in the assessment of patient experience and self-reported outcomes. Qualitative methods will be used to explore patient and physician experience and evaluate SPIDER's processes. CONCLUSION: We are testing SPIDER in a primary care population with complex care needs. This could provide a widely applicable model for care improvement. TRIAL REGISTRATION: Clinicaltrials.gov NCT03689049 ; registered September 28, 2018.

The role of body image psychological flexibility on the treatment of eating disorders in a residential facility.

OBJECTIVE: The purpose of this study was to test whether pre-treatment levels of psychological flexibility would longitudinally predict quality of life and eating disorder risk in patients at a residential treatment facility for eating disorders. METHOD: Data on body image psychological flexibility, quality of life, and eating disorder risk were collected from 63 adolescent and 50 adult, female, residential patients (N=113) diagnosed with an eating disorder. These same measures were again collected at post-treatment. Sequential multiple regression analyses were performed to test whether pre-treatment levels of psychological flexibility longitudinally predicted quality of life and eating disorder risk after controlling for age and baseline effects. RESULTS: Pre-treatment psychological flexibility significantly predicted post-treatment quality of life with approximately 19% of the variation being attributable to age and pre-treatment psychological flexibility. Pre-treatment psychological flexibility also significantly predicted post-treatment eating disorder risk with nearly 30% of the variation attributed to age and pre-treatment psychological flexibility. DISCUSSION: This study suggests that levels of psychological flexibility upon entering treatment for an eating disorder longitudinally predict eating disorder outcome and quality of life.

Two new cestode species from the dwarf whipray, Himantura walga (Batoidea: Dasyatidae), from Borneo, with comments on site and mode of attachment.

Spiral intestines of 12 specimens of the dwarf whipray, Himantura walga, collected from Malaysian Borneo in 2002 and 2003, were examined for cestodes. These yielded a new species of Acanthobothrium (Tetraphyllidea) and a new species of Echinobothrium (Diphyllidea), both of which are described. Acanthobothrium marymichaelorum n. sp. is a category 1 species. It differs from all but 4 of its category 1 congeners in its possession of postovarian testes. It also differs from these 4 species in its possession of fewer testes, shorter length, fewer proglottids, and/or shorter posterior loculus. Echinobothrium minutamicum n. sp. differs from its congeners in its possession of outer hooks in the dorsal and ventral rostellar groups that are trifid; it is also the smallest member of its genus. The spiral intestine of H. walga consisted of 12 mucosal chambers. Most (89%) of the 35 specimens of E. minutamicum n. sp. for which chamber data were generated were found in chambers 2-4. In contrast, the 57 specimens of A. marymichaelorum n. sp. occurred throughout chambers 5-12, with 86% in chambers 6-10. The modes of attachment of both cestode species were similar, i.e., both embedded their scolex within the lumen of a mucosal crypt with the hooks and/or spines penetrating the lamina propria. Both also eroded the epithelial lining of the crypts and caused modest expansion of crypt diameter. Although the configuration of the mucosal surface may explain sites in which both species were able to attach, it does not explain their absence from other regions; histological sections and scanning electron microscopy showed the mucosal surface to be similar in configuration throughout the length of the spiral intestine. The cestode fauna of H. walga also included at least 1 species of rhinebothriine, 2 lecanicephalidean species, a trypanorhynch species, and 1-2 additional new species of Acanthobothrium. However, formal description of these species must await the collection of additional material, mature material, and/or the erection of the new genera. It is of note that the fauna of the dwarf whipray consists of a suite of unusually small taxa. Although the cestode genera reported here are generally consistent with those reported from other Himantura species, they are completely inconsistent with previous records from H. walga (as Trygon walga) in Sri Lanka. This suggests that either the original host identifications are suspect or that differences exist in the faunas of H. walga between these 2 localities.

Analyzing the influence of tic-related talk on vocal and motor tics in children with Tourette's syndrome.

This study examined the effect of tic-related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.

Habit reversal as a treatment for chronic skin picking in typically developing adult male siblings.

In this study, habit reversal was evaluated as a treatment for skin picking in typically developing adult male siblings using a nonconcurrent multiple baseline across participants design. Results showed socially valid decreases in reported picking as a result of treatment.

Evaluating the duration of the competing response in habit reversal: a parametric analysis.

The effectiveness of habit reversal was compared across three different competing response (CR) durations. Results showed that 1-min and 3-min CR durations were associated with short-term and long-term increases in nail length for people who bit their nails. A 5-s CR duration produced immediate increases in nail length that were not maintained. Social validity data were consistent with these findings.

Pancreatic tuberculosis.

Tuberculosis of the pancreas is a rare gastrointestinal tract entity. This unusual manifestation of tuberculosis should be included in the differential diagnosis of high-risk patients presenting with a pancreatic mass.

Efficient isolation of the rare diarrhoeic shellfish toxin, dinophysistoxin-2, from marine phytoplankton.

The rare diarrhoeic shellfish poisoning (DSP) toxin, dinophysistoxin-2 (DTX-2), which is an okadaic acid (OA) isomer, has been isolated from a marine phytoplankton biomass that consisted mainly of Dinophysis acuta. Using a large double plankton net (length 5.9 m), bulk phytoplankton samples were collected off the south-west coast of Ireland and extracted with methanol and chloroform. Liquid chromatography coupled with ionspray mass spectrometry and tandem mass spectrometry (LC-MS, LC-MS-MS) showed the sample contained DTX-2 and OA, at a concentration of 80 pg/cell and 60 pg/cell, respectively. Flash chromatography using silica, sephadex LH20 and C18-silica, followed by preparative reversed-phase LC, separated DTX-2 from OA. The efficiency of the separation procedures was substantially improved by the use of a bioscreen to detect DSP toxins in eluate fractions and the application of a new derivatisation procedure for the chromatographic elucidation of toxin profiles with fluorimetric detection (LC-FLD). Thus, 1/1000th aliquots of eluate fractions were assayed using protein phosphatase-2A for the presence of inhibitory compounds. Positive fractions were further analysed for DSP toxins by LC-FLD following derivatisation using the hydrazine reagent, luminarine-3. The identity and purity of the free isolated DTX-2 was confirmed using flow injection analysis (FIA) and liquid chromatography (FIA-MS, LC-MS and LC-MS-MS).

Sensitive determination of anatoxin-a, homoanatoxin-a and their degradation products by liquid chromatography with fluorimetric detection.

Cyanobacterial neurotoxins have been implicated in animal deaths resulting from drinking contaminated water. Anatoxin-a (AN) and homoanatoxin-a (HMAN) have previously been analysed using high-performance liquid chromatography (HPLC) with UV detection, but this procedure is insufficiently sensitive and is subject to interferences. A sensitive fluorimetric (FL) method for determining AN was recently developed using derivatisation with 4-fluoro-7-nitro-2,1,3-benzoxadiazole (NBD-F) and this has been applied to the simultaneous determination of AN, HMAN and their epoxy and dihydro degradation products. Microscale syntheses were used to prepare the dihydro and epoxy derivatives from AN and HMAN. These compounds were produced in high yields, as confirmed by electrospray MS and HPLC-FL of their benzoxadiazole derivatives. All six NBD derivatives were readily separated using isocratic reversed-phase HPLC. The recoveries of these compounds from spiked water samples, using weak cation-exchange (WCX) solid-phase extraction (SPE), were 83.2-84.9% at concentrations of 10 micrograms/l. The R.S.D. values were 1.7-3.9% (n = 8) and the limits of detection were better than 10 ng/l for all six compounds, illustrating the high sensitivity of the method. This methodology was successfully applied to the analysis toxin degradation products in natural samples. Dihydroanatoxin-a (0.8 mg/g) was isolated from a benthic Oscillatoria bloom from Caragh Lake, Ireland, and was found to contain two isomers but their ratio was different from that found in the synthetic material.

The role of birth injury and the consequences of inadequately treated hypogonadism in longstanding panhypopituitarism.

We describe a middle-aged profoundly hypogonadal man with panhypopituitarism since infancy who was treated only with glucocorticoid and thyroid replacement. A magnetic resonance imaging study (MRI) revealed absence of pituitary stalk and ectopic neurohypophysis consistent with traumatic transection, probably resulting from a traumatic birth. The hormonal consequences of this stalk lesion were recognized but inadequately treated for 45 years resulting in avoidable endocrine and psychosocial defects. Androgen replacement was started at age 45 with good initial results. The unique hormonal replacement issues at this age are discussed.

Temazepam and trimeprazine compared with placebo as premedication in children. An investigation extended into the first 2 weeks at home.

Temazepam, trimeprazine and placebo were compared as premedication in 85 children undergoing routine otolaryngological operations. Premedication with trimeprazine caused significantly more sedation than temazepam or placebo in patients on arrival in the anaesthetic room (P less than 0.02). Recovery time was significantly longer after trimeprazine than temazepam or placebo (P less than 0.012). Significantly more children (P less than 0.05) failed to recall a picture shown immediately before induction after trimeprazine and temazepam than with placebo. Fewer patients vomited after operation with trimeprazine than with temazepam or placebo (P less than 0.01). The majority of children exhibited some behavioural problem during the first 2 weeks at home, although this rarely lasted for more than a few days. More children exhibited apathetic/withdrawn behaviour after receiving placebo (P less than 0.05), although the significance of this should be interpreted with caution.

Conditions for tracheal intubation using atracurium compared with pancuronium.

Intubating conditions were compared using atracurium 0.6 and 0.8 mg kg-1 and pancuronium 0.08 and 0.1 mg kg-1 in 96 patients. They were randomly allocated and studied at 30, 45, 60 or 75 s after injection of the drug. Smooth intubation was not possible before 60 s with either drug and in 11 patients intubation could not be achieved at the chosen time. Atracurium 0.6 mg kg-1 and pancuronium 0.08 mg kg-1 gave comparable results. Atracurium 0.8 mg kg-1 gave intubating conditions comparable to those obtained with pancuronium 0.1 mg kg-1 at 45 and 75 s and slightly better conditions at 30 and 60 s.