The School Function Assessment: identifying levels of participation and demonstrating progress for pupils with acquired brain injuries in a residential rehabilitation setting.

BACKGROUND: Delivering and monitoring residential rehabilitation services for pupils with acquired brain injuries (ABI) is challenging because of variability in aetiology, age and pre-morbid characteristics. Therapists and educators in this residential rehabilitation setting identified the need for a comprehensive tool which would capture the pupils' ability to participate in typical, everyday, school-based functional activities. This study aimed to explore the ability of the School Function Assessment (SFA) to identify levels of participation in school-based functional tasks and demonstrate progress for pupils with an ABI in a residential rehabilitation setting. METHODS: The SFA was conducted on admission and discharge for pupils with ABI receiving residential rehabilitation between January 2007 and October 2011. Data analysis used Kruskal-Wallis to determine between-group differences in age, time post injury and weeks in rehabilitation. Linear mixed effects modelling was used to establish differences between admission and discharge scores. Case vignettes demonstrated how the SFA was used with individual pupils. RESULTS: Seventy pupils were identified (31 traumatic brain injury; 29 non-traumatic and 10 anoxic) 42 boys and 28 girls whose age at injury was 4.5-17.2 years (median 12.8). The SFA demonstrated that 54/70 pupils had made progress with their ability to participate in school activities. Significant differences were found between admission and discharge SFA scores for participation, physical and cognitive assistance and adaptation and activity performance (P < 0.05). There was wide variability between individual profiles reflecting the heterogeneity of ABI. CONCLUSIONS: The SFA determined levels of participation in school-based functional tasks for these residential pupils with an ABI and demonstrated progress both at the group and individual level in this residential rehabilitation setting. It identified the amount of support a pupil would need when they return to their local school and their strengths and needs in relation to participation in physical and cognitive school-based functional activities.

A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic.

INTRODUCTION: A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. MATERIAL AND METHODS: We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. RESULTS: In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e. CONCLUSIONS: Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.

Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction.

BACKGROUND AND PURPOSE: Monoamine oxidase inhibitors (MAOI) are known to cause serotonin toxicity (ST) when administered with selective serotonin reuptake inhibitors (SSRI). Methylene blue (methylthionium chloride, MB), a redox dye in clinical use, has been reported to precipitate ST in patients using SSRI. MB was assessed for MAO inhibition and so for its potential to precipitate ST. EXPERIMENTAL APPROACH: Inhibition of purified human MAO was quantified using kinetic assays and visible spectral changes to study the interactions of MB with MAO A. KEY RESULTS: MB was a potent (tight binding) inhibitor for MAO A. It also inhibited MAO B but at much higher concentration. Interactions of MB with the active site of MAO A were confirmed by its action both as an oxidising substrate and as a one-electron reductant. CONCLUSIONS AND IMPLICATIONS: MB is a potent reversible inhibitor of MAO A with implications for gut uptake of amines when administered orally. At concentrations reported in the literature after intravenous administration, MAO B would be partially inhibited but MAO A would be completely inhibited. This inhibition of MAO A would be expected to lead to perturbations of 5-hydroxytryptamine metabolism and hence account for ST occurring when administered to patients on SSRI treatment.

The cytotoxic and cytostatic effects of the bitter melon (Momordica charantia) on human lymphocytes.

We have previously reported that a crude extract from the bitter melon (Momordica charantia) killed human leukemic lymphocytes in a dose-dependent manner while not affecting the viability of normal human lymphocyte cells at these same doses (Takemoto et al., 1980). We now report that the crude preparation has both cytostatic and cytotoxic activities which are heat stable and trypsin-sensitive. Time and dose-response curves suggest that the factors act quickly, perhaps by entry into the cell. The effects of the crude extract are complete after only 2 hr of exposure. These activities are not due to the presence of the lectins from bitter melon seeds, as these purified proteins had no activity against human lymphocytic cells.

Acceptability to patients of a honey dressing for non-healing venous leg ulcers.

OBJECTIVES: This four-centre feasibility study was undertaken to determine whether Medihoney, a proprietary blend of honeys, is an acceptable treatment for patients with leg ulcers in terms of pain relief, odour control and overall patient satisfaction. METHOD: Forty patients whose leg ulcers had not responded to 12 weeks of compression therapy were recruited. Medihoney dressings were applied on their ulcers for the 12-week study period. All other aspects of their care, including the use of compression bandaging, remained unchanged. Their leg ulcers were assessed every two weeks. This included the use of a patient questionnaire. RESULTS: Overall, ulcer pain and size decreased significantly and odorous wounds were deodorised promptly. This had a positive impact on patient satisfaction with the Medihoney treatment. CONCLUSION: The results support the previously reported positive effects of honey and revealed a high patient acceptance for this treatment. Following these results, comparative clinical trials, which should also consider pain, are now recommended.

Treatment of a wound infection in a patient with mantle cell lymphoma.

This case study examines the impact of a severe wound infection on a patient undergoing chemotherapy for the treatment of mantle cell lymphoma. The study illustrates how life threatening an infection can become in a patient whose body is compromised as a consequence of both disease and chemotherapy treatment. A number of specialist products were required in order to overcome the infection, debride and heal the wound. These included larval therapy, vacuum-assisted closure and Leptospermum honey. While this case study focuses on the successful outcome of one particular patient it aims to raise awareness of the role of specialist products, both old and new, in improving healing rates of complex wounds.

Alternating pressure systems: reducing user error.

Pressure sores remain a major clinical challenge for nearly every sector of health care. The Department of Health has recognised this and in the 1994/95 NHS Priorities and Planning Guidance encouraged healthcare providers to set annual targets for the reduction of the prevalence of sores by 5 per cent. It has been argued that this is not straightforward (NHS CRD 1995) especially as many areas do not monitor the problem and so do not know how effective they are at preventing sores. Reduction cannot be attempted unless an effective prevention plan is in place. The causes of pressure sores are multifactorial, so the prevention strategies must reflect this.

Methicillin resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) has had a major impact on health care causing much anxiety and distress to patients and staff, and resulting in huge financial costs. It has been widely publicised by the media which in some cases has added to people's alarm. The screening, treatment and resultant isolation affects all aspects of the patient's care and will also influence the management of any wounds. MRSA has been isolated in both acute and chronic wounds and so the management of these must be included in any infection control policy.

The use of honey in wound management.

Honey has been used as a wound treatment for more than 2,000 years. Greater scientific understanding of how it works, particularly as an antibacterial agent, has led practitioners to reconsider the therapeutic value of honey. Once honey is commercially available as a regulated product in the UK, practitioners will have access to an effective, alternative wound treatment. Specific, sterilised honeys intended for wound care will provide a safe natural product to manage colonised or infected wounds that would otherwise remain unresponsive to treatment.

Are referrals to occupational therapy for developmental coordination disorder appropriate?

AIMS: To assess children referred to the Occupational Therapy Service in Gwent with a presumptive diagnosis of developmental coordination disorder (DCD) in order to investigate the appropriateness of their referral. METHODS: Non-urgent referrals to the occupational therapy team for children with coordination difficulties in Gwent between June 2001 and February 2002 were studied. RESULTS: Eighty nine children, aged 5-10 years, were identified. Thirteen children who would not meet the DCD criteria were excluded. This left 76 children, 67 of whom were actually assessed. If the 15th centile for the Movement ABC is used, 26 children met and 41 failed one of the four criteria in DSM IV (38%). If the 5th centile is used, 21 children met and 46 failed one of the four criteria in the DSM (31%). Of the major groups of referrers, school nurses did the best with 48% success rate; better than the paediatricians with 32%. The worst success rate was in educational psychologists and teachers, with only 20% of cases referred actually having DCD. These differences did not quite reach statistical significance. CONCLUSIONS: Less than a third of referrals to occupational therapy for DCD actually have the diagnosis. This suggests that referrers need further training and guidance. This includes a knowledge and understanding of the DSM IV criteria and their interpretation. This would reduce the number of time consuming, unnecessary assessments being done. A triage procedure with a checklist would be a good way forward and we hope to devise one to assist referrers with this process.

Guanylate cyclase activity in human leukemic and normal lymphocytes. Enzyme inhibition and cytotoxicity of plant extracts.

Cyclic GMP is thought to be involved in lymphocytic cell proliferation and leukemogenesis. In general, the nucleotide is elevated in leukemic vs. normal lymphocytes and changes have been reported to occur during remission and relapse of this disease. Although the cA/cG ratios are higher for normal lymphocytes the basal guanylate cyclase (EC 4.6.1.2) activities do not correlate with altered cyclic GMP levels. The crude guanylate cyclases display classical Michaelis-Menten kinetics with Kms for Mn-GTP of 463 mumol/l and 20-90 mumol/l for normal and leukemic lymphocytes, respectively. An extract from the bitter melon (Momordica charantia) preferentially inhibits the soluble guanylate cyclase from leukemic lymphocytes. This inhibition correlates with its preferential cytotoxic effects for these same cells. Analyses of nine other cytotoxic plant extracts revealed that only an extract from the Lawson's cypress, Chamaecyparis lawsonianna, exhibits comparable cytotoxicity and guanylate cyclase inhibition levels.