Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach.

BACKGROUND AND OBJECTIVES: The suprascapular nerve (SSN) block is frequently performed for different shoulder pain conditions and for perioperative and postoperative pain control after shoulder surgery. Blind and image-guided techniques have been described, all of which target the nerve within the supraspinous fossa or at the suprascapular notch. This classic target point is not always ideal when ultrasound (US) is used because it is located deep under the muscles, and hence the nerve is not always visible. Blocking the nerve in the supraclavicular region, where it passes underneath the omohyoid muscle, could be an attractive alternative. METHODS: In the first step, 60 volunteers were scanned with US, both in the supraclavicular and the classic target area. The visibility of the SSN in both regions was compared. In the second step, 20 needles were placed into or immediately next to the SSN in the supraclavicular region of 10 cadavers. The accuracy of needle placement was determined by injection of dye and following dissection. RESULTS: In the supraclavicular region of volunteers, the nerve was identified in 81% of examinations (95% confidence interval [CI], 74%-88%) and located at a median depth of 8 mm (interquartile range, 6-9 mm). Near the suprascapular notch (supraspinous fossa), the nerve was unambiguously identified in 36% of examinations (95% CI, 28%-44%) (P < 0.001) and located at a median depth of 35 mm (interquartile range, 31-38 mm; P < 0.001). In the cadaver investigation, the rate of correct needle placement of the supraclavicular approach was 95% (95% CI, 86%-100%). CONCLUSIONS: Visualization of the SSN with US is better in the supraclavicular region as compared with the supraspinous fossa. The anatomic dissections confirmed that our novel supraclavicular SSN block technique is accurate.

Use-dependent block of the voltage-gated Na+ channel by tetrodotoxin and saxitoxin: Effect of pore mutations that change ionic selectivity.

Voltage-gated Na(+) channels (NaV channels) are specifically blocked by guanidinium toxins such as tetrodotoxin (TTX) and saxitoxin (STX) with nanomolar to micromolar affinity depending on key amino acid substitutions in the outer vestibule of the channel that vary with NaV gene isoforms. All NaV channels that have been studied exhibit a use-dependent enhancement of TTX/STX affinity when the channel is stimulated with brief repetitive voltage depolarizations from a hyperpolarized starting voltage. Two models have been proposed to explain the mechanism of TTX/STX use dependence: a conformational mechanism and a trapped ion mechanism. In this study, we used selectivity filter mutations (K1237R, K1237A, and K1237H) of the rat muscle NaV1.4 channel that are known to alter ionic selectivity and Ca(2+) permeability to test the trapped ion mechanism, which attributes use-dependent enhancement of toxin affinity to electrostatic repulsion between the bound toxin and Ca(2+) or Na(+) ions trapped inside the channel vestibule in the closed state. Our results indicate that TTX/STX use dependence is not relieved by mutations that enhance Ca(2+) permeability, suggesting that ion-toxin repulsion is not the primary factor that determines use dependence. Evidence now favors the idea that TTX/STX use dependence arises from conformational coupling of the voltage sensor domain or domains with residues in the toxin-binding site that are also involved in slow inactivation.

Functional assessment of chest wall integrity after methylmethacrylate reconstruction.

BACKGROUND: All patients with extensive resection of the anterolateral chest wall and the sternum followed by reconstruction with methylmethacrylate substitutes were assessed prospectively 6 months after the operation to delineate chest wall integrity with pulmonary function and cine-magnetic resonance imaging. METHODS: Twenty-six patients underwent chest wall reconstruction by use of methylmethacrylate between 1994 and 1998 due to primary tumors in 35%, metastases in 27%, T3 lung cancer in 19%, and debridement for radionecrosis and osteomyelitis in 19% of patients. Three to eight ribs were resected and additional sternum resection was performed in 39% of patients. RESULTS: There was no 30-day mortality. All patients were extubated after the operation without need for reintubation. Prosthesis dislocation occurred in 1 patient and infection in 2 patients during follow-up. Nineteen patients (73%) suffered no restrictions of daily activities. Clinical examination revealed normal shoulder girdle function in 77% of patients. There was no significant difference between preoperative and postoperative FEV1 (forced expiratory volume in 1 second) measurements in patients with lobectomy or wedge resections. Cinemagnetic resonance imaging revealed concordant chest wall movements during respiration in 92% of patients without paradoxical movements or implant dislocations being observed. CONCLUSIONS: Large defects of the anterolateral chest wall and sternum can be reconstructed efficiently with methylmethacrylate substitutes with minimal morbidity and excellent cosmetic and functional outcome.

An Integrated Work Force Planning Strategy For The Health Services 2009 - 2012

Workforce planning identifies the composition of the workforce required to deliver health service goals. It encompasses a range of human resource activities aimed at the short, medium and long-term. Workforce planning that is integrated with service and financial planning offers the best opportunity for linking human resource decisions to the strategic goals for the health services. Systems and structures are required to support and develop workforce planning activities

Equality Bill: Making it work Policy proposals for specific duties: Policy Statement

The new single Equality Duty represents a next step in equality legislation. The existing public sector equality duties for race, disability and gender were pioneering pieces of legislation which placed the public sector at the forefront of tackling discrimination and inequality.Many have seen the benefits the existing duties have delivered, but now is the time to go further. the aim of this bill is to extend the benefits of the equality duties to the other protected characteristics of age, sexual orientation, gender reassignment, and religion or belief.The Equality Duty will require public bodies to think about how they can eliminate discrimination, advance equality of opportunity and foster good relations for all the protected groups.

Warm Front, Better Health: Health Impact Evaluation of the Warm Front Scheme

About 4 million households in the UK cannot adequately heat their homes in winter due to low income and poor quality housing, the two main causes of fuel poverty. The primary impact of fuel poverty is cold homes in winter which can lead to various health problems and even death among the vulnerable young and the elderly population. The government launched the Warm Front scheme in 2000 to tackle fuel poverty among the vulnerable households in England by providing energy efficiency measures in the forms insulation and modern heating system(??). By 2004, about 770,000 households had benefited from the Warm Front scheme and a total of 2 million households are still expected to benefit by 2010. Since 2001, the Bartlett has been investigating with London School of Hygiene & Tropical Medicine and Sheffield Hallam University, the health and the environmental impact of the Warm Front scheme. This investigative study is the most detailed to date on fuel poor dwellings based on detailed surveys of household and dwelling data, fuel consumption record and monitored temperature and relative humidity from 3,100 dwellings before and after the energy efficiency measures. The Warm Front investigation was expected to continue until the end of 2007. The findings from the investigation indicated that the Warm Front scheme was likely to have benefits in terms of improved thermal comfort and well-being as a result of mean temperature rise of 1.6C in the living room and 2.8C in the bedroom. Warm Front also lead to a decrease in indoor relative humidity mainly from the increased temperature since there appeared to be little impact on vapour pressure from changes in air tightness. Pressure test results indicated that the effects of air tightness measures such as draught stripping and cavity wall insulation were offset by the installation of a central heating system, particularly when the pipe work feeding radiators was installed below timber floors.

Do brief alcohol motivational interventions work like we think they do?

BACKGROUND: Questions remain about how brief motivational interventions (BMIs) for unhealthy alcohol use work, and addressing these questions may be important for improving their efficacy. Therefore, we assessed the effects of various characteristics of BMIs on drinking outcomes across 3 randomized controlled trials (RCTs). METHODS: Audio recordings of 314 BMIs were coded. We used the global rating scales of the Motivational Interviewing Skills Code (MISC) 2.1: counselor's acceptance, empathy, and motivational interviewing (MI) spirit, and patient's self-exploration were rated. MI proficiency was defined as counselor's rating scale scores ≥5. We also used the structure, confrontation, and advice subscale scores of the Therapy Process Rating Scale and the Working Alliance Inventory. We examined these process characteristics in interventions across 1 U.S. RCT of middle-aged medical inpatients with unhealthy alcohol use (n = 124) and 2 Swiss RCTs of young men with binge drinking in a nonclinical setting: Swiss-one (n = 62) and Swiss-two (n = 128). We assessed the associations between these characteristics and drinks/d reported by participants 3 to 6 months after study entry. RESULTS: In all 3 RCTs, mean MISC counselor's rating scales scores were consistent with MI proficiency. In overdispersed Poisson regression models, most BMI characteristics were not significantly associated with drinks/d in follow-up. In the U.S. RCT, confrontation and self-exploration were associated with more drinking. Giving advice was significantly associated with less drinking in the Swiss-one RCT. Contrary to expectations, MI spirit was not consistently associated with drinking across studies. CONCLUSIONS: Across different populations and settings, intervention characteristics viewed as central to efficacious BMIs were neither robust nor consistent predictors of drinking outcome. Although there may be alternative reasons why the level of MI processes was not predictive of outcomes in these studies (limited variability in scores), efforts to understand what makes BMIs efficacious may require attention to factors beyond intervention process characteristics typically examined.

National Youth Work Development Plan 2003-2007

Irish society today is dramatically different from the one in which youth work services were first provided on a spontaneous and philanthropic basis more than one hundred years ago. At no time has the process of change been more striking than in the last ten to fifteen years. At least four major types of recent change, all clearly interrelated, can be identified: economic, political, technological and cultural. A further important aspect of cultural change in Ireland has been the continuing trend towards urbanisation, and the corresponding impact, largely negative, on rural communities. Particularly significant in the context of a Development Plan for Youth Work is the migration of young people away from rural areas to study or work, with most of them unlikely to return on a permanent basis. This, along with the rapid reduction in farm holdings and other changes in the countryside, has profound sociological and psychological repercussions for rural Ireland and indeed for Irish society as a whole. For young people living in rural areas the challenge is to provide youth work opportunities which are specially tailored to their needs and which take account of the ways in which their circumstances (e.g. regarding transport and access) are different from those of their urban peers

Information for parents on the work of NICORE

This leaflet describes the work of NICORE (Neonatal Intensive Care Outcomes Research and Evaluations), highlighting the importance of the data collected on each baby admitted to neonatal intensive care and how NICORE contributes to improved standards of care.

Preventing infection caused by Pseudomonas - work on water supplies

Information for parents on preventing infections caused by Pseudomonas

Health and wellbeing at work: a resource guide

This resource guide aims to support employers and employees to access information on improving health and wellbeing at work.Putting in place an effective workplace health programme that meets the needs of each business requires access to effective tools and information, which will help assess the needs of employees and assist with developing and implementing plans.This guide uses the World Health Organization (WHO) model as the basis for developing a workplace health programme. The WHO model involves eight stages and four aspects of the working environment.Included in the guide are information and contact details for organisations in Northern Ireland that can provide information and support to businesses on each of these aspects.The guide also includes case studies on local businesses that implemented a workplace health programme and a sample health and wellbeing action plan.�

Promoting positive mental health at work: a guide for employers

This booklet is one in a series aimed at promoting health in the workplace. It outlines to employers the importance of employees' mental health, good practice to support positive mental health at work, the legal requirements with regard to working environments and mental health, and key steps for action.�