Standing trans-nasal endoscopic guided CO2 laser fenestration of the palatine bone to access the sphenopalatine sinus in a horse.

OBJECTIVE: To describe a novel standing trans-nasal endoscopic guided CO2 laser fenestration approach to access the sphenopalatine sinus (SPS) in the horse. STUDY DESIGN: Case report. ANIMALS: Cadaver study and client-owned 20-year-old Warmblood gelding. METHODS: The rostral palatine bone within the nasopharynx was investigated as a possible site for fenestration to access the SPS in cadavers. The ability to fenestrate the SPS was tested in cadavers using a flexible endoscope and CO2 laser fiber inserted via biopsy channel. The fenestration procedure was then performed in a clinical case presented for unilateral epistaxis where a soft tissue attenuating mass in the right SPS was identified with standing computed tomography (CT). RESULTS: The cadaver study demonstrated the appropriate site within the nasopharynx midway between the vomer and dorsal conchal wall. The CO2 laser successfully ablated the mucosa and palatine bone to enable endoscopic access to the palatine portion of the SPS. The endoscopic procedure was performed as a two-step process via standing sedation due to mucosal bleeding obscuring visualization. Access to the SPS through fenestration allowed biopsy under direct endoscopic visualization with long-handled bronchoesophageal forceps inserted via the ipsilateral middle meatus. The mass within SPS was determined to be an undifferentiated carcinoma. Further treatment was declined and the horse euthanized 6 months following the procedure due to acute onset of neurologic symptoms. CONCLUSION: Endoscopically guided fenestration of the rostral palatine bone within the nasopharynx using CO2 laser in the standing horse provided good access and visualization of the palatine portion of the SPS.

Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial.

OBJECTIVE: To compare routine replacement of intravenous peripheral catheters with replacement only when clinically indicated. DESIGN: Randomised controlled trial. SETTING: Tertiary hospital in Australia. PARTICIPANTS: 755 medical and surgical patients: 379 allocated to catheter replacement only when clinically indicated and 376 allocated to routine care of catheter (control group). MAIN OUTCOME MEASURE: A composite measure of catheter failure resulting from phlebitis or infiltration. RESULTS: Catheters were removed because of phlebitis or infiltration from 123 of 376 (33%) patients in the control group compared with 143 of 379 (38%) patients in the intervention group; the difference was not significant (relative risk 1.15, 95% confidence interval 0.95 to 1.40). When the analysis was based on failure per 1000 device days (number of failures divided by number of days catheterised, divided by 1000), no difference could be detected between the groups (relative risk 0.98, 0.78 to 1.24). Infusion related costs were higher in the control group (mean $A41.02; pound19.71; euro24.80; $38.55) than intervention group ($A36.40). The rate of phlebitis in both groups was low (4% in intervention group, 3% in control group). CONCLUSION: Replacing peripheral intravenous catheters when clinically indicated has no effect on the incidence of failure, based on a composite measure of phlebitis or infiltration. Larger trials are needed to test this finding using phlebitis alone as a more clinically meaningful outcome. REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry ACTRN12605000147684.

Enhancing community-based disaster preparedness with information technology.

A critical component of community-based disaster preparedness (CBDP) is a local resource database of suppliers providing physical, information and human resources for use in disaster response. Maintenance of such a database can become a collaborative responsibility among community-based non-governmental organisations (NGOs) and public and private community organisations. In addition to mobilising resources, this process raises awareness within the community and aids in assessing local knowledge and resources. This paper presents the results of a pilot study on implementing a community-based resource database through collaboration with local American Red Cross chapters and public and private community organisations. The design of the resource database is described. The resource database is accessible via the internet and offline using laptops and handheld Personal Digital Assistants. The study concludes that CBDP is strengthened through a combination of appropriate information technology and collaborative relationships between NGOs and community-based organisations.