Osteomyelitis Associated with \u3ci\u3eNocardiopsis composta\u3c/i\u3e in a Dog

Osteomyelitis can be caused by bacterial or fungal agents or may be idiopathic. Cocci, bacilli, and filamentous bacteria such as members of the Actinomycetes have all been determined to be causes of osteomyelitis. Differential diagnoses for Gram-positive filamentous rods in the family Actinomycetales causing osteomyelitis in the dog, include members of the more frequently encountered genera Nocardia and Actinomyces. Bacteria gain access to the bone via several routes but are most often associated with direct inoculation (such as percutaneous injuries, compound fractures, or secondary to foreign bodies such as surgical or other material including dirt and wood) and fracture instability. Less frequently, the route is hematogenous, as has been found with Propionibacterium acnes. Agents isolated from osteolytic lesions in dogs and cats have included Gram-positive Staphylococcus spp., Streptococcus spp., Gram-negative Escherichia coli, Proteus spp., Klebsiella spp., Pseudomonas spp., anaerobic Clostridium spp., Peptostreptococcus spp., Actinomyces spp., Bacterioides spp., Fusobacterium spp., and rarely Brucella canis, Nocardia spp., and Mycobacterium avium. Fungal causes include Coccidioides immitis, Blastomyces dermatitidis, Histoplasma capsulatum, Cryptococcus neoformans, and Aspergillus spp. Osteosarcoma with associated cellulitis is a reported noninfectious cause of osteomyelitis in dogs. Our report details the diagnosis, treatment, and resolution of osteomyelitis in a dog caused by a unique agent, Nocardiopsis composta

A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives

Objective to identify the extent to which Early Warning Systems (EWS) are used by midwives in the United Kingdom (UK), the maternity settings they are used in, physiological parameters used to ‘trigger’ referral, training provision, barriers to implementation and role in preventing maternal morbidity. Design cross-sectional survey of heads of midwifery services. An email questionnaire was sent in September 2012. Setting UK NHS secondary care organisations providing maternity care. Findings heads of midwifery from 107 (68%) of 157 NHS organisations responded, with 108 questionnaires returned as two organisations had recently merged. All organisations, apart from one which only had a free-standing midwifery unit, had introduced EWS. Nearly all respondents (99%) reported EWS were used by midwives antenatally, 76% in labour and 100% on the postnatal ward. All EWS charts included body temperature, heart rate, respiratory rate, systolic blood pressure and oxygen saturation although parameters for escalation varied widely. Barriers to use of EWS by midwives included overlap with the partogram in labour, and staff shortages and delays obtaining clinical review when referral was triggered. Two-thirds considered EWS prevented maternal morbidity although few could provide supporting evidence, for example, audit findings. Training for midwives in use of EWS was available in 83% of organisations. Conclusion most UK midwives are using EWS, with the highest use in obstetric units. The heterogeneity of EWS currently used potentially limits collation of evidence to inform appropriate system level responses. Research is needed to evaluate the role of EWS to prevent maternal morbidity during and after pregnancy in different maternity settings

Obesity and caries in four-to-six year old English children: a cross-sectional study.

BACKGROUND: Obesity and caries are common conditions in childhood and can have significant implications on children's wellbeing. Evidence into their association remains conflicting. Furthermore, studies examining the ssociation between obesity and caries commonly focus on individual-level determinants. The present study aimed to examine the association between obesity and caries in young English children and to determine the impact of deprivation and area-level characteristics on the distribution of the two conditions. METHODS: This was a cross-sectional study among children in Plymouth city aged four-to-six years. Anthropometric measurements included weight and height (converted to Body Mass Index centiles and z-scores), and waist circumference. Caries was assessed by using the sum of the number of teeth that were decayed, missing or filled. A questionnaire was used to obtain information on children's demographic characteristics, oral hygiene, and dietary habits. The impact of deprivation on anthropometric variables and caries was determined using Linear and Poisson regression models, respectively. Multiple logistic regression was used to assess the association between different anthropometric measures and caries. Logistic regression models were also used to examine the impact of several demographic characteristics and health behaviours on the presence of obesity and caries. RESULTS: The total sample included 347 children aged 5.10 ± 0.31 (mean ± SD). Deprivation had a significant impact on caries and BMI z-scores (p < 0.05). Neither BMI- nor waist circumference z-scores were shown to be significantly associated with dental caries. Among the neighbourhood characteristics examined, the percentage of people dependent on benefits was found to have a significant impact on caries rates (p < 0.05). Household's total annual income was inversely related to caries risk and parental educational level affected children's tooth brushing frequency. CONCLUSIONS: No associations between any measure of obesity and caries were found. However, deprivation affected both obesity and caries, thus highlighting the need to prioritise disadvantaged children in future prevention programmes

Osteomyelitis Associated with \u3ci\u3eNocardiopsis composta\u3c/i\u3e in a Dog

Osteomyelitis can be caused by bacterial or fungal agents or may be idiopathic. Cocci, bacilli, and filamentous bacteria such as members of the Actinomycetes have all been determined to be causes of osteomyelitis. Differential diagnoses for Gram-positive filamentous rods in the family Actinomycetales causing osteomyelitis in the dog, include members of the more frequently encountered genera Nocardia and Actinomyces. Bacteria gain access to the bone via several routes but are most often associated with direct inoculation (such as percutaneous injuries, compound fractures, or secondary to foreign bodies such as surgical or other material including dirt and wood) and fracture instability. Less frequently, the route is hematogenous, as has been found with Propionibacterium acnes. Agents isolated from osteolytic lesions in dogs and cats have included Gram-positive Staphylococcus spp., Streptococcus spp., Gram-negative Escherichia coli, Proteus spp., Klebsiella spp., Pseudomonas spp., anaerobic Clostridium spp., Peptostreptococcus spp., Actinomyces spp., Bacterioides spp., Fusobacterium spp., and rarely Brucella canis, Nocardia spp., and Mycobacterium avium. Fungal causes include Coccidioides immitis, Blastomyces dermatitidis, Histoplasma capsulatum, Cryptococcus neoformans, and Aspergillus spp. Osteosarcoma with associated cellulitis is a reported noninfectious cause of osteomyelitis in dogs. Our report details the diagnosis, treatment, and resolution of osteomyelitis in a dog caused by a unique agent, Nocardiopsis composta

How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice

The accurate assessment and appropriate repair of birth related perineal trauma require high levels of skill and competency, with evidence based guideline recommendations available to inform UK midwifery practice. Implementation of guideline recommendations could reduce maternal morbidity associated with perineal trauma, which is commonly reported and persistent, with potential to deter women from a future vaginal birth. Despite evidence, limited attention is paid to this important aspect of midwifery practice. We wished to identify how midwives in the UK assessed and repaired perineal trauma and the extent to which practice reflected evidence based guidance. Findings would be used to inform the content of a large intervention study. A descriptive cross sectional study was completed. One thousand randomly selected midwives were accessed via the Royal College of Midwives (RCM) and sent a questionnaire. Study inclusion criteria included that the midwives were in clinical practice and undertook perineal assessment and management within their current role. Quantitative and qualitative data were collated. Associations between midwife characteristics and implementation of evidence based recommendations for perineal assessment and management were examined using chi-square tests of association. 405 midwives (40.5%) returned a questionnaire, 338 (83.5%) of whom met inclusion criteria. The majority worked in a consultant led unit (235, 69.5%) and over a third had been qualified for 20 years or longer (129, 38.2%). Compliance with evidence was poor. Few (6%) midwives used evidence based suturing methods to repair all layers of perineal trauma and only 58 (17.3%) performed rectal examination as part of routine perineal trauma assessment. Over half (192, 58.0%) did not suture all second degree tears. Feeling confident to assess perineal trauma all of the time was only reported by 116 (34.3%) midwives, with even fewer (73, 21.6%) feeling confident to perform perineal repair all of the time. Two thirds of midwives (63.5%) felt confident to perform an episiotomy. Midwives qualified for 20 years or longer and those on more senior clinical grades were most likely to implement evidence based recommendations and feel confident about perineal management. There are considerable gaps with implementation of evidence to support management of perineal trauma