Atypical hand, foot, and mouth disease associated with coxsackievirus A6 infection, Edinburgh, United Kingdom, January to February 2014.

In January to February 2014, 16 hand, foot and mouth disease (HFMD) cases were identified in Edinburgh, United Kingdom. All presented with atypical features, with most (n=13) resembling eczema herpeticum or chickenpox. Coxsackievirus A6 (CV-A6) was identified in all the typed cases (n=11). As atypical forms of HFMD associated with CV-A6 are likely to emerge throughout Europe, clinicians should be alert to unusual clinical presentations of HFMD and virologists aware of effective diagnostic testing and enterovirus typing methods.

Accidental asphyxia due to closing of a motor vehicle power window.

Injuries and deaths among children left unattended in motor vehicles are frequent and the rates are increasing. Injuries associated with motor vehicle power windows usually affect children, in particular children under 6 years of age. This case report is about a child who was asphyxiated because of a motor vehicle power window closing. She was rapidly resuscitated and recovered fully. A brief review of the literature, epidemiology, and preventive measures to avoid this type of injury is also presented.

The synchrony of prostaglandin-induced estrus in cows was reduced by pretreatment with hCG.

The induction of optimal synchrony of estrus in cows requires synchronization of luteolysis and of the waves of follicular growth (follicular waves). The aim of this study was to determine whether hormonal treatments aimed at synchronizing follicular waves improved the synchrony of prostaglandin (PG)-induced estrus. In Experiment 1, cows were treated on Day 5 of the estrous cycle with saline in Group 1 (n = 25; 16 ml, i.v., 12 h apart), with hCG in Group 2 (n = 27; 3000 IU, i.v.), or with hCG and bovine follicular fluid (bFF) in Group 3 (n = 21; 16 ml, i.v., 12 h apart). On Day 12, all cows were treated with prostaglandin (PG; 500 micrograms cloprostenol, i.m.). In Experiment 2, cows were treated on Day 5 of the estrous cycle with saline (3 ml, i.m.) in Group 1 (n = 22) or with hCG (3000 IU, i.v.) in Group 2 (n = 20) and Group 3 (n = 22). On Day 12, the cows were treated with PG (500 micrograms in Groups 1 and 2; 1000 micrograms in Group 3). Blood samples for progesterone (P4) determination were collected on Day 12 (Experiment 1) or on Days 12 and 14 (Experiment 2). Cows were fitted with heat mount detectors and observed twice a day for signs of estrus. Four cows in Experiment 1 (1 cow each from Groups 1 and 2; 2 cows from Group 3) had plasma P4 concentrations below 1 ng/ml on Day 12 and were excluded from the analyses. In Experiment 1, cows treated with hCG or hCG + bFF had a more variable (P = 0.0007, P = 0.0005) day of occurrence of and a longer interval to estrus (5.9 +/- 0.7 d, P = 0.003 and 6.2 +/- 0.8 d, P = 0.005) than saline-treated cows (3.4 +/- 0.4 d). The plasma P4 concentrations on Day 12 were higher (P < 0.0001) in hCG- and in hCG + bFF-treated cows than in saline-treated cows (9.4 +/- 0.75 and 8.5 +/- 0.75 vs 4.1 +/- 0.27 ng/ml), but there was no correlation (P > 0.05) between plasma P4 concentrations and the interval to estrus. In Experiment 2, cows treated with hCG/500PG and hCG/1000PG had a more variable (P = 0.0007, P = 0.002) day of occurrence of and a longer interval to estrus (4.2 +/- 0.4 d, P = 0.04; 4.1 +/- 0.4 d, P = 0.03) than saline/500PG-treated cows (3.2 +/- 0.1 d). The concentrations of plasma P4 on Days 12 and 14 of both hCG/500PG- and hCG/1000PG-treated cows were higher (P < 0.05) than in saline/500PG-treated cows (7.3 +/- 0.64, 0.7 +/- 0.08 and 7.7 +/- 0.49, 0.7 +/- 0.06 vs 5.3 +/- 0.37, 0.5 +/- 0.03 ng/ml). The concentrations of plasma P4 on Days 12 or 14 and the interval to estrus were not correlated (P > 0.05) in any treatment group. The concentrations of plasma P4 on Days 12 and 14 of hCG/500PG- or hCG/1000PG-treated cows were correlated (r = 0.65, P < 0.05; r = 0.50, P < 0.05). This study indicated that treatment of cows with hCG on Day 5 of the estrous cycle reduced the synchrony of PG-induced estrus and that this reduction was not due to the failure of luteal regression.

Burnout and stress-related factors among junior staff of three dental hospital specialties.

OBJECTIVE: To determine whether occupational stress, health status, job satisfaction and burnout differed between the three major hospital dental specialties, and to compare this data with previous studies. DESIGN: A cross-sectional survey. SETTING: The regional dental teaching hospital and outlying hospital units in Merseyside in 1993. SUBJECTS AND METHODS: All 52 junior hospital dentists in the Merseyside area were invited to complete a self-report questionnaire to be returned by post. Up to three reminders were sent. 42 staff replied (81% response rate). MAIN OUTCOME MEASURES: Occupational Stress Indicator, Maslach Burnout Inventory. RESULTS: The profile of stressors was comparable to a previously reported sample of hospital dentists. Job satisfaction varied significantly across specialties (P < 0.015) whereas personal achievement was reported to be strong regardless of the nature of work. Self-reported health (physical and mental) was similar across specialties. 10% of respondents were suffering burnout. Depersonalisation (a result of extended and demanding contacts with patients) was significantly (P < 0.05) greater in restorative and oral surgery specialties in comparison with orthodontists. CONCLUSIONS: Although short-term stressors among hospital dental staff were not different between occupational groups, some important longer term effects were identified.

Ireland, the UK and Europe: a review of undergraduate medical education in palliative care.

Palliative Care is an important and emerging medical speciality, formally recognised by the Irish Medical Council in June 1995. Three years previously, in 1992, the Association of Palliative Medicine for Great Britain and Ireland published an official curriculum for undergraduate medical education in palliative care. The European Association of Palliative Care held a workshop the following year and reported that, with the exception of the UK, education for medical students is incomplete. This review examines the evidence that European undergraduate medical education in palliative care is underdeveloped. Key elements of effective undergraduate teaching programmes in this discipline are identified. Finally, it is noted that little has been written about undergraduate palliative care education in Irish medical schools; the situation in this country is thus unknown. A study to determine current education in palliative care in Irish medical schools is required.

Rapid testing for respiratory syncytial virus in a paediatric emergency department: benefits for infection control and bed management.

Respiratory syncytial virus (RSV) is responsible for annual winter outbreaks of respiratory tract infection among children in temperate climates, placing severe pressure on hospital beds. Cohorting of affected infants has been demonstrated to be an effective strategy in reducing nosocomial transmission of RSV, and may keep cubicles free for other patients who require them. Testing of symptomatic children for RSV is standard practice, but unfortunately traditional laboratory testing is not rapid enough to aid decision-making processes. Rapid point-of-care testing (POCT) in the emergency department has been suggested as an alternative. We performed a prospective study to quantify the amount of cubicle time saved by using POCT results to allow a targeted cohorting strategy. Over the four-month study period, the POCT allowed 183 children to be admitted directly to a designated cohort area, thus saving 568.5 cubicle-days for other patients. This is equivalent to five cubicles being left free for each day of the study period. This is the first time the benefits of using POCT have been quantified in this way. POCT for RSV is a safe, cost-effective and efficient way to improve bed management.

An evaluation of the 'short form' course experience questionnaire with medical students.

In this study we have validated the Course Evaluation Questionnaire (CEQ) as an instrument for use with undergraduate medical students. We have demonstrated satisfactory construct validity and reliability for the inventory. The CEQ is an appropriate instrument for course evaluation in medical education.

Curriculum change: the importance of team role.

This paper describes a study examining aspects of team role in the management of curriculum change. The Belbin Team Role Self-Perception Inventory was completed by 25 members (83%) of a faculty curriculum development team. Overall the group showed a preference for the implementer and shaper roles, whilst the completer-finisher role was relatively weakly represented, ranking fifth out of eight possible roles. Older and more senior team members favoured the co-ordinator role, whilst younger and more junior members favoured the team-worker and completer-finisher roles. Some implications of these findings are discussed in the light of the current trend for widespread change in undergraduate medical curricula and the challenges faced by medical schools in a resource constrained environment.

Selective medicals at school entry.

This paper describes a selective procedure for use at school entry based on information from pre-school surveillance, parental questionnaires and class reviews. The pilot study in use over two years shows that the number of new conditions found at age 5 are relatively few in number and the extra time available can be used more appropriately for those with health problems affecting school progress. The job satisfaction for both nurses and doctors is increased and the parents are more fully involved with their child's health and progress. The introduction of a new computerised Child Health System and Parent Held Record will further enhance this system.

Stress in junior hospital medical and dental staff: a descriptive account of their concerns and needs.

Examines the issues of work-related stress in the healthcare professions, focusing on junior medical and dental staff. Identifies the stressors, and reports on an interview survey conducted as part of a larger study funded by the National Health Service Management Executive to identify the levels of stress. Concludes that outsourcing to an independent counselling service could prove to be an effective stress-management strategy.

Using the Delphi technique to identify the cancer education requirements of general practitioners.

UNLABELLED: Continuing education for the general practitioner (GP) is in need of revision. Much of today's continuing education is based upon a traditional didactic approach, which is believed to be inappropriate and inefficient for the learning needs of the increasingly stretched GP. OBJECTIVE: To investigate the educational needs of a group of GPs, using the response to cancer to construct an appropriate model for the provision of care in general practice. METHOD: The Delphi technique was adopted to reach "expert" consensus. PARTICIPANTS: 49 GPs currently practising within two health authorities within the north-west region of England. DESIGN: Three waves of data collection were employed, with the same sample and the inclusion of an additional reference group. RESULTS: Many issues relating to the difficulties experienced by GPs regarding care of cancer patients were identified, along with associated training needs. Successive rounds of this Delphi survey enabled consensus to be reached about the level of importance to be assigned to these issues. This technique avoided some of the problems associated with a conventional committee approach (e.g. time, expense and potential bias in decision-making process). CONCLUSIONS: First, the Delphi technique provided a relatively quick means of gaining a consensus on the complex task set for participants. Second, continuing training for GPs would benefit from the adoption of a problem-based learning approach rather than traditional didactic methods.

Ethylene regulation of wound-induced ribonuclease in turnip root tissue.

Exogenous ethylene enhances the synthesis of wound-induced ribonuclease (RNase) (EC2.7.7.16) in tissue discs of white turnip (Brassica rapa L. var. rapa (L.) Tell.). The half-maximal concentration is <0.01 µl/l ehtylene. Maximal response was obtained with either continuous ethylene treatment, or a 90-min pulse of ethylene followed by flushing with 1500 cm(3) of air/min at standard pressure or 500 cm(3)/min at hypobaric pressure for the remainder of the experiments. Addition of ethylene at 60-75 min after cutting had no effect on RNase activity. Also the effect of ethylene in enhancing RNase decreased about linearly when addition of ethylene was delayed for tissue discs. Since actinomycin-D inhibition of RNase synthesis, observed earlier, is also limited to the initial 45-60 min after cutting, these results are consistent with the view that ethylene is acting at transcription.

The orofacial cancer patient's support from the general practitioner, hospital teams, family, and friends.

BACKGROUND: After the diagnosis of cancer, about a third of patients have adjustment disorders. Of recently diagnosed patients, 5 to 15% experience serious psychological disturbances, but their distress is often undetected and untreated. Little attention has been directed to the patients' sources of support and their adequacy. METHODS: This study assessed a defined group (n = 49) of cancer patients' ratings of the support they received from general practitioners, hospital teams, family, and friends. Additional information was collected on the patients' interest in receiving further hospital services and their psychological morbidity (i.e., anxiety and depression). RESULTS: The results show wide variation in patients' perceptions of the helpfulness of the primary and secondary care teams, raising concern about the levels of help and support available to some cancer patients. CONCLUSIONS: Although this sample rated the help received from the hospital very highly, those patients who requested more information from the hospital sector showed little evidence of having had their general anxiety "buffered" by involvement of family members.