Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): a study protocol for a randomised controlled trial of a Resource Kit.

Background: Improving care at home for people with dementia is a core policy goal in the dementia strategies of many European countries. A challenge to effective home support is the occurrence of crises in the care of people with dementia which arise from changes in their health and social circumstances. Improving the management of these crises may prevent hospital admissions and facilitate better and longer care at home.

Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study.

Background: Teams working in the community to manage crisis in dementia currently exist, but with widely varying models of practice, it is difficult to determine the effectiveness of such teams.

Objective: The aim of this study is to develop a "best practice model" for dementia services managing crisis, as well as a set of resources to help teams implement this model to measure and improve practice delivery. These will be the best practice tool and toolkit to be utilized by teams to improve the effectiveness of crisis teams working with older people with dementia and their caregivers.

How do small birds evolve in response to climate change? Data from the long-term record at La Brea tar pits.

Biology textbooks describe the small changes in the beaks of the Galápagos finches as exemplars of how birds evolve in response to environmental changes. However, recent studies of the abundant fossil birds at Rancho La Brea find no evidence of evolutionary responses to the dramatic climate changes of the glacial-interglacial cycle over the past 35 000 years: none of the large birds exhibit any change in body size or limb proportions, even during the last glacial maximum approximately 18 000-20 000 years ago, when the southern California chaparral was replaced by snowy coniferous forests. However, these are all large birds with large ranges and broad habitat preferences, capable of living in many different environments.

Did saber-tooth kittens grow up musclebound? A study of postnatal limb bone allometry in felids from the Pleistocene of Rancho La Brea.

Previous studies have demonstrated that the Pleistocene saber-toothed cat Smilodon fatalis had many forelimb adaptations for increased strength, presumably to grapple with and subdue prey. The Rancho La Brea tar pits yield large samples of juvenile limb bones forming a growth series that allow us to examine how Smilodon kittens grew up. Almost all available juvenile limb bones were measured, and reduced major axis fits were calculated to determine the allometric growth trends.

Which Are the Most Relevant Questions in the Assessment of Outcome after Distal Radial Fractures?

A study was designed to determine which wrist scoring system best correlates with patient satisfaction and which individual variables predict a satisfactory outcome. We looked at forty-five females and 5 males with wrist fractures at 12 weeks after injury and compared their level of satisfaction with various respected outcome measures. The mean age was 66 years.

Species longevity in North American fossil mammals.

Species longevity in the fossil record is related to many paleoecological variables and is important to macroevolutionary studies, yet there are very few reliable data on average species durations in Cenozoic fossil mammals. Many of the online databases (such as the Paleobiology Database) use only genera of North American Cenozoic mammals and there are severe problems because key groups (e.g.

The Bristol Radiology Report Assessment Tool (BRRAT): developing a workplace-based assessment tool for radiology reporting skills.

Aim: To review the development of a workplace-based assessment tool to assess the quality of written radiology reports and assess its reliability, feasibility, and validity.

Materials And Methods: A comprehensive literature review and rigorous Delphi study enabled the development of the Bristol Radiology Report Assessment Tool (BRRAT), which consists of 19 questions and a global assessment score. Three assessors applied the assessment tool to 240 radiology reports provided by 24 radiology trainees.

Recovery after hip fracture.

Objectives: The aim was to monitor the inhospital progress of 170 patients sustaining proximal femoral fractures. The extent of delay in discharge was recorded and what effect this prolonged hospitalisation had on nosocomial infection rates.

Setting: A regional trauma centre.

In vitro evaluation of the resistance to dislocation of a meniscal-bearing total knee prosthesis between 30 degrees and 90 degrees of knee flexion.

An increased incidence of dislocation is the most important potential disadvantage introduced by the use of meniscal-bearing prostheses. The aim of this in vitro study was to measure the resistance to dislocation of a meniscal-bearing total knee arthroplasty in various circumstances and to establish which anatomic structures contribute to bearing stability. The prosthesis was implanted into cadaver knee specimens mounted in a 6 df rig.

How long does hospital benefit patients with proximal femoral fracture?

No abstract.

Origins of spondyloarthropathy in Perissodactyla.

Objective: Spondyloarthropathy has clearly been documented as not limited in occurrence to humans. Transmammalian in nature, it is of interest to understand the antiquity, and perhaps the origins, of this disorder in animal groups sufficiently represented in the skeletal record.

Methods: Fossil and recent skeletons of perissodactylae from North America were systematically examined to determine the occurrence and population frequency of spondyloarthropathy.

Assessing outcome following calcaneal fracture: a rational scoring system.

Six existing clinical scoring systems for assessing outcome after calcaneal fracture are reviewed. All were applied to a diverse group of 75 patients who had sustained this injury. Stepwise multiple regression analysis was used to identify the most relevant variables within these systems.

Predicting the prognosis after proximal femoral fracture.

In 338 patients with proximal femoral fractures, age, sex, residence and mobility on admission were found to predict mortality, mobility and housing requirements after 1 year. Application of these data should permit better targeting of rehabilitation and earlier initiation of rehousing arrangements after proximal femoral fracture.

Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?

The benefits of parenteral non-steroidal analgesic drugs and low molecular weight heparin anticoagulants have been shown before, but there is concern that the use of these agents in combination may potentiate haemorrhagic side-effects because of simultaneous inhibition of the clotting cascade and platelet mechanisms of haemostasis. In a prospective controlled trial, 60 patients undergoing total hip replacement were randomised into two groups. Those in one group received intramuscular ketorolac and those in the other group opioid analgesia.

Factors affecting the outcome after proximal femoral fractures.

One hundred and forty-two consecutive patients with proximal femoral fractures were audited prospectively over a 1-year period. Mobility, age and sex were recorded along with timing of surgery, complications, 'will to live', length of admission, mortality, mobility and housing requirements on discharge. Operative procedures were performed mostly by intermediate surgical staff, on night-time emergency lists shared with other specialties.

Function ten years after Colles' fracture.

There are no data in the literature concerning the outcome of Colles' fracture beyond six years. One hundred consecutive patients with displaced Colles' fractures were reviewed ten years after the injury. Function, radiographic anatomy, osteoarthrosis, and reflex sympathetic dystrophy (algodystrophy) were all objectively assessed.

Length of hospital stay and outcome after femoral neck fracture: a prospective study comparing the performance of two hospitals.

Length of hospital stay and outcome after femoral neck fracture were compared in a prospective study between two adjacent hospitals. In matched populations, mean length of stay was 30.8 days at Hospital X and 15.

Radiological measurement of radial shortening in Colles' fracture.

100 consecutive patients with Colles' fracture were assessed functionally three months after the injury, and the result correlated with initial shortening of the radius. Three methods were used to measure radial shortening; only the one that measured the distance from distal radial to distal ulnar surfaces correlated with functional outcome. It is concluded that this is the most valid method of measurement and the deficiencies of the other methods are discussed.

Laboratory investigation in the diagnosis of pulmonary thromboembolism.

Laboratory findings were compared with lung scans in a prospective study of 260 patients undergoing ventilation-perfusion (V/Q) lung scanning for suspected pulmonary thromboembolism. The best discrimination between different lung scan results was obtained from the level of plasma cross-linked fibrin degradation products, every patient with a scan indicating a high probability of thromboembolism having detectable levels. An acute phase response was demonstrated in patients with pulmonary thromboembolism by a raised neutrophil count and elevated levels of plasma fibrinogen and serum C-reactive protein.

Single-Crystal 40Ar/39Ar Dating of the Eocene-Oligocene Transition in North America.

Explanations for the causes of climatic changes and associated faunal and floral extinctions at the close of the Eocene Epoch have long been controversial because of, in part, uncertainties in correlation and dating of global events. New single-crystal laser fusion (SCLF) (40)Ar/(39)Ar dates on tephra from key magnetostratigraphic and fossilbearing sections necessitate significant revision in North American late Paleogene chronology. The Chadronian-Orellan North American Land Mammal "Age" boundary, as a result, is shifted from 32.

A bacteriological study of the effect on the environment of using a one- or two-trolley system in theatre.

In a survey of 53 hospitals, 62% still had a transfer zone in theatre, involving the use of two trolleys. Reluctance to use one trolley without patient transfer was probably because of concerns about excessive bacterial contamination of the theatre. In an attempt to see if these concerns were justified, air in the operating theatre was sampled for bacterial content, as were the surfaces and wheels of trolleys and the floor in the theatre, anaesthetic room and at the 'red line' in the transfer zone.

Appendicectomy and carcinoma of the caecum.

A total of 519 patients presenting with carcinoma of the caecum in the Plymouth Health District between 1975 and 1987 were reviewed. The clinical course was determined in relation to patients with and without a history of previous appendicectomy. There was no difference in the incidence of previous appendicectomy between patients with carcinoma of the caecum and an age and sex matched control group.

Neurophysiological investigation of diabetic impotence. Are sacral response studies of value?

The role of electrophysiologically elicited sacral responses in the detection of the neurological component of diabetic impotence has been evaluated in a detailed study using properly defined diagnostic criteria. The results prove that these tests are not reliable indicators of neuropathy and their relevance in the routine investigation of diabetic impotence is of questionable value.