Bowel management post major joint arthroplasty: a randomised controlled trial to test two pre-admission bowel regimens

Background: The length of stay for patients undergoing joint arthroplasty has reduced but there is a paucity of knowledge relating to bowel management within this enhanced recovery framework. Aim: The study\u27s primary aim was to determine which of two dosage regimens of macrogol (Movicol®) commenced pre-operatively is most effective in facilitating a return to normal bowel function. Procedure: Ninety-one eligible patients were randomised to one of three groups: 1) commence macrogol one sachet in the morning for two days prior to surgery; 2) commence macrogol one sachet, morning and evening of the day prior to surgery; or 3) control group. Results: Seventy-seven percent of patients in group one, and 83% of group two had returned to normal bowel function by one-week post discharge compared to 70% of control patients (p = .470). Participants in group one required less aperients in the week following discharge compared with the other two groups although the result was not statistically significant (p = .060). Conclusion: Despite not reaching statistical significance, the results are considered clinically significant. The authors recommend patients commence macrogol one sachet in the morning for the two days prior to admission for major joint arthroplasty and the Murdoch Bowel Protocol® continue to be followed for inpatients

General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required

Comparing attentional bias to smoking cues in current smokers, former smokers, and non-smokers using a dot-probe task

Much evidence documents that individuals with emotional and drug-use disorders demonstrate biased attention toward stimuli associated with their disorder. This bias appears to diminish following successful treatment. Two studies examined whether current cigarette smokers show biased attention toward smoking-related images compared with non-smokers (Studies 1 and 2) and whether this bias is less pronounced in former smokers (Study 2). Attentional bias toward cigarette-related photographs was examined using the dot-probe task. Pairs of images (one smoking-related) appeared side by side for 500 ms on a computer screen prior to the presentation of a probe (an asterisk) replacing one of the photographs. Subjects struck a key as quickly as possible to indicate the probe location. Attentional bias was defined as faster reaction times when the probe replaced the smoking-related image. In both studies, current smokers displayed significantly greater attentional bias toward cigarette stimuli than did non-smokers. Former smokers in Study 2 displayed an intermediate level of bias, but did not differ significantly in bias score from either of the other groups. These results support further use of the dot-probe task as a measure of attentional bias in non-abstinent smokers and in individuals undergoing smoking cessation treatment

General practice physicians\u27 and nurses\u27 self- reported multidisciplinary end-of-life care: A systematic review

Background: General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide end-of-life care (EoLC) as the population ages. To enhance primary palliative care (PC), the care they provide needs to be understood to inform best practice models of care. Objective: To provide a comprehensive description of the self-reported role and performance of GPs and GPNs in (1) specific medical/nursing roles, (2) communication, (3) care co-ordination, (4) access and out-of-hours care, and (5) multidisciplinary care. Method: Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 29 reviewed papers reported the GPs’ and GPNs’ role in EoLC or PC practice. GPs report a central role in symptom management, treatment withdrawal, non-malignant disease management and terminal sedation. Information provision included breaking bad news, prognosis and place of death. Psychosocial concerns were often addressed. Quality of communication depended on GP–patient relationships and GP skills. Challenges were unrealistic patient and family expectations, family conflict and lack of advance care planning. GPs often delayed endof-life discussions until 3 months before death. Home visits were common, but less so for urban, female and part-time GPs. GPs co-ordinated care with secondary care, but in some cases parallel care occurred. Trust in, and availability of, the GP was critical for shared care. There was minimal reference to GPNs’ roles. Conclusions: GPs play a critical role in palliative care. More work is required on the role of GPNs, case finding and models to promote shared care, home visits and out-of-hours services

Fault kinematics in northern Central America and coupling along the subduction interface of the Cocos Plate, from GPS data in Chiapas (Mexico), Guatemala and El Salvador

International audienceNew GPS measurements in Chiapas (Mexico), Guatemala and El Salvador are used to constrain the fault kinematics in the North America (NA), Caribbean (CA) and Cocos (CO) plates triple junction area. The regional GPS velocity field is first analysed in terms of strain partitioning across the major volcano-tectonic structures, using elastic half-space modelling, then inverted through a block model. We show the dominant role of the Motagua Fault with respect to the Polochic Fault in the accommodation of the present-day deformation associated with the NA and CA relative motion. The NA/CA motion decreases from 18-22 mm yr−1 in eastern Guatemala to 14-20 mm yr−1 in central Guatemala (assuming a uniform locking depth of 14-28 km), down to a few millimetres per year in western Guatemala. As a consequence, the western tip of the CA Plate deforms internally, with ≃9 mm yr−1 of east-west extension (≃5 mm yr−1 across the Guatemala city graben alone). Up to 15 mm yr−1 of dextral motion can be accommodated across the volcanic arc in El Salvador and southeastern Guatemala. The arc seems to mark the northern boundary of an independent forearc sliver (AR), pinned to the NA plate. The inversion of the velocity field shows that a four-block (NA, CA, CO and AR) model, that combines relative block rotations with elastic deformation at the block boundaries, can account for most of the GPS observations and constrain the overall kinematics of the active structures. This regional modelling also evidences lateral variations of coupling at the CO subduction interface, with a fairly high-coupling (≃0.6) offshore Chiapas and low-coupling (≃0.25) offshore Guatemala and El Salvador

Spitting Performance Parameters and Their Biomechanical Implications in the Spitting Spider, Scytodes thoracica

Spitting spiders Scytodes spp. subdue prey by entangling them at a distance with a mixture of silk, glue, and venom. Using high-speed videography and differential interference contrast microscopy, the performance parameters involved in spit ejection by Scytodes thoracica (Araneae, Scytodidae) were measured. These will ultimately need to be explained in biomechanical and fluid dynamic terms. It was found that the ejection of “spit” from the opening of the venom duct (near the proximal end of the fang) was orderly. It resulted in a pattern that scanned along a lateral-medial axis (due to fang oscillations) while traversing from ventral to dorsal (due to cheliceral elevation). Each lateral-to-medial sweep of a fang produced silk-borne beads of glue that were not present during each subsequent medial-to-lateral sweep. The ejection of “spit” was very rapid. A full scan (5–57 fang cycles, one upsweep of a chelicera) typically occupied less than 30 ms and involved fang oscillations at 278–1781 Hz. Ejection velocities were measured as high as 28.8 m/s. The “spit” was contractile. During the 0.2 s following ejection, silk shortened by 40–60% and the product of a full scan by both of the chelicerae could exert an aggregate contractile force of 0.1 – 0.3 mN. Based on these parameters, hypotheses are described concerning the biomechanical and fluid dynamic processes that could enable this kind of material ejection

Implicit Essentialism: Genetic Concepts Are Implicitly Associated with Fate Concepts

Genetic essentialism is the tendency for people to think in more essentialist ways upon encountering genetic concepts. The current studies assessed whether genetic essentialist biases would also be evident at the automatic level. In two studies, using different versions of the Implicit Association Test [1], we found that participants were faster to categorize when genes and fate were linked, compared to when these two concepts were kept separate and opposing. In addition to the wealth of past findings of genetic essentialism with explicit and deliberative measures, these biases appear to be also evident with implicit measure

Decision making as a predictor of first ecstasy use: a prospective study

Ecstasy (+/- 3,4-methylenedioxymethamphetamine) is a widely used recreational drug that may damage the serotonin system and may entail neuropsychological dysfunctions. Few studies investigated predictors for ecstasy use. Self-reported impulsivity does not predict the initiation of ecstasy use; the question is if neuropsychological indicators of impulsivity can predict first ecstasy use. This study tested the hypothesis that a neuropsychological indicator of impulsivity predicts initiation of ecstasy use. Decision-making strategy and decision-making reaction times were examined with the Iowa Gambling Task in 149 ecstasy-naive subjects. The performance of 59 subjects who initiated ecstasy use during a mean follow-up period of 18 months (range, 11-26) was compared with the performance of 90 subjects that remained ecstasy-naive. Significant differences in decision-making strategy between female future ecstasy users and female persistent ecstasy-naive subjects were found. In addition, the gap between decision-making reaction time after advantageous choices and reaction time after disadvantageous choices was smaller in future ecstasy users than in persistent ecstasy-naives. Decision-making strategy on a gambling task was predictive for future use of ecstasy in female subjects. Differences in decision-making time between future ecstasy users and persistent ecstasy-naives may point to lower punishment sensitivity or higher impulsivity in future ecstasy users. Because differences were small, the clinical relevance is questionabl