Several experiments were conducted to evaluate the protein quality of various raw and rendered animal by-product meals commonly used in companion animal diets. Six freeze-dried raw animal meals (beef lungs, pork lungs, sheep lungs, pork livers, oceanfish, chicken necks) and 3 rendered animal meals (lamb meal, regular ash poultry by-product meal, and low ash poultry by-product meal) were fed in chick assays to determine Lys and TSAA bioavailability, protein efficiency ratio (PER), and net protein ratio (NPR). Each experimental diet was offered to 4 replicates of 5 chicks per pen in all growth assays. Furthermore, each animal by-product meal was fed to mature White Leghorn roosters for determination of true AA digestibility. All freeze-dried, raw animal meals were offered to 5 replicate roosters, and all rendered animal meals were offered to 4 replicate roosters. Most raw animal meals exhibited moderate to high protein quality. Lysine bio-availabilities ranged from 86 to 107% and 70 to 99% for raw and rendered animal meals, respectively. Bio-availability of TSAA ranged from 64 to 99% and 61 to 78% for raw and rendered animal meals, respectively. The PER values ranged from 2.83 to 4.03 and 2.01 to 3.34 for raw and rendered animal meals, respectively. The NPR values ranged from 3.83 to 4.8 and 3.05 to 4.12 for raw and rendered animal meals, respectively. Despite a numeric increase in NPR vs. PER values, the overall ranking of animal meals remained similar. Lamb meal had the poorest PER and NPR values, and pork lungs had the greatest values. Total essential AA digestibility and total AA digestibility ranged from 93.6 to 96.7 and 90.3 to 95.5%, respectively, for raw animal meals and 84.0 to 87.7 and 79.2 to 84.8%, respectively, for rendered animal meals. Rendered animal meals generally had lower protein quality than raw animal meals, with lamb meal consistently having the poorest protein quality and pork livers having the greatest protein quality.

This article discusses a project conducted in Worcestershire nursing homes to review current practices in the management of skin tears and the subsequent development and implementation of guidelines resulting in a standardised client care package. An initial audit in five care homes was followed by an in-depth audit in 52 homes over a 12-week period. This led to the development of resources and the 'STAR box' to assist with implementation of timely and appropriate care delivery.

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A survey of ward nurses in medical, surgical, orthopaedic and rehabilitation specialties in relation to their care of wounds and their choice and use of wound dressings was carried out in May and August 2009 at St Mary's Hospital. Isle of Wight, UK. The objectives were to find out the distribution of wound types, and their characteristics, that were treated by ward nurses in the hospital, and to assess clinical practice in the use of wound dressings, before and after a bespoke programme of education and training. A visual framework to aid the ward nurses in the choice of dressings and frequency of change was introduced after the May 2009 survey. Following the nurses' education and training programme a repeat survey, using the same methodology, was conducted in August 2009. In the initial survey, 172 wounds were included (mean number of wounds per patient 1.64) and in the repeat one, 159 (mean number of wounds per patient 1.54). In both phases of the survey, the most common wound type was pressure ulcers, followed by surgical wounds; over 60% of the wounds were pressure ulcers, of which around half were category 1, and one-third were category 2. No category 4 ulcers were recorded. About one-third of the wounds had a duration of more than 21 days. On average, wound dressings were left in place for between two and three days, with 35% of dressings being changed on a daily basis. The mean cost of dressings per wound per week was observed to be lower in the repeat survey than in the initial one (£9.02 and £11.23 respectively). The number of undesirable reasons for changing the dressing was lower in the second phase than the first. The methodology of the surveys provided meaningful and valuable results over a short timescale, and increased understanding of wound types, their characteristics, and clinical practice. The surveys showed that data that can be collected in a short period using a simple tool can yield complex and revealing data trends. They also showed that an education programme followed by a re-survey can improve practice and reduce the costs of wound care.

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ResultsSeventy-five patients with poor-prognosis disease, according to International Germ Cell Cancer Collaborative Group classification, received GAMEC as initial therapy. With a median follow-up of 63 months, the median progression-free survival (PFS) was >14 months. The 2-year PFS rate was 61.5% (95% confidence interval [CI] 49.1-71.6), and the 3year overall survival (OS) rate was 71.9%. Seventy-six patients received GAMEC as second-line therapy (following failure of bleomycin, etoposide and cisplatin or etoposide cisplatin). The median PFS was 7.5 months (95% CI 5.2-not evaluable), the 2-year PFS rate was 43.5% (95% CI 32.1-54.4) and the 3year OS rate was 53.7% (95% CI 41.6-64.3). In the third-line setting (n = 11), the 2-year PFS was 18.2% (95% CI 2.8-44.2). Overall, the treatment-related death rate declined from 10.5% in the first 15 years to 2.6% in the last 5 years. ConclusionGAMEC was an effective regimen in untreated poorprognosis disease and on relapse following conventional cisplatin and etoposide-based chemotherapy. Risk categorization based on LDH/age is more sensitive than that based on the updated IPFSG criteria. It is possible to identify patients who are particularly likely to benefit from this treatment, which has the important advantages of short duration and absence of bleomycin, particularly in patients with central nervous system and mediastinal disease. Lowdose induction treatment is associated with safer delivery of treatment without compromising survival.

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