Presence of Systemic Inflammatory Response Syndrome Predicts a Poor Clinical Outcome in Dogs with a Primary Hepatitis

<div><p>Primary hepatopathies are a common cause of morbidity and mortality in dogs. The underlying aetiology of most cases of canine hepatitis is unknown. Consequently, treatments are typically palliative and it is difficult to provide accurate prognostic information to owners. In human hepatology there is accumulating data which indicates that the presence of systemic inflammatory response syndrome (SIRS) is a common and debilitating event in patients with liver diseases. For example, the presence of SIRS has been linked to the development of complications such as hepatic encephalopathy (HE) and is associated with a poor clinical outcome in humans with liver diseases. In contrast, the relationship between SIRS and clinical outcome in dogs with a primary hepatitis is unknown. Seventy dogs with histologically confirmed primary hepatitis were enrolled into the study. Additional clinical and clinicopathological information including respiratory rate, heart rate, temperature, white blood cell count, sodium, potassium, sex, presence of ascites, HE score, alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin and red blood cell concentration were available in all cases. The median survival of dogs with a SIRS score of 0 or 1 (SIRS low) was 231 days compared to a median survival of 7 days for dogs with a SIRS score of 2, 3 or 4 (SIRS high) (p<0.001). A Cox proportional hazard model, which included all other co-variables, revealed that a SIRS high score was an independent predictor of a poor clinical outcome. The effect of modulating inflammation on treatment outcomes in dogs with a primary hepatitis is deserving of further study.</p></div

Clinical decision-making of cardiologists regarding admission and treatment of patients with suspected unstable angina or non-ST-elevation myocardial infarction: protocol of a clinical vignette study.

Cardiologists face the difficult task of rapidly distinguishing cardiac-related chest pain from other conditions, and to thoroughly consider whether invasive diagnostic procedures or treatments are indicated. The use of cardiac risk-scoring instruments has been recommended in international cardiac guidelines. However, it is unknown to what degree cardiac risk scores and other clinical information influence cardiologists' decision-making. This paper describes the development of a binary choice experiment using realistic descriptions of clinical cases. The study aims to determine the importance cardiologists put on different types of clinical information, including cardiac risk scores, when deciding on the management of patients with suspected unstable angina or non-ST-elevation myocardial infarction. METHODS AND ANALYSIS: Cardiologists were asked, in a nationwide survey, to weigh different clinical factors in decision-making regarding patient admission and treatment using realistic descriptions of patients in which specific characteristics are varied in a systematic way (eg, web-based clinical vignettes). These vignettes represent patients with suspected unstable angina or non-ST-elevation myocardial infarction. Associations between several clinical characteristics, with cardiologists' management decisions, will be analysed using generalised linear mixed models. ETHICS AND DISSEMINATION: The study has received ethics approval and informed consent will be obtained from all participating cardiologists. The results of the study will provide insight into the relative importance of cardiac risk scores and other clinical information in cardiac decision-making. Further, the results indicate cardiologists' adherence to the European Society of Cardiology guideline recommendations. In addition, the detailed description of the method of vignette development applied in this study could assist other researchers or clinicians in creating future choice experiments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

Clinical decision-making of cardiologists regarding admission and treatment of patients with suspected unstable angina or non-ST-elevation myocardial infarction: protocol of a clinical vignette study.

Cardiologists face the difficult task of rapidly distinguishing cardiac-related chest pain from other conditions, and to thoroughly consider whether invasive diagnostic procedures or treatments are indicated. The use of cardiac risk-scoring instruments has been recommended in international cardiac guidelines. However, it is unknown to what degree cardiac risk scores and other clinical information influence cardiologists' decision-making. This paper describes the development of a binary choice experiment using realistic descriptions of clinical cases. The study aims to determine the importance cardiologists put on different types of clinical information, including cardiac risk scores, when deciding on the management of patients with suspected unstable angina or non-ST-elevation myocardial infarction. METHODS AND ANALYSIS: Cardiologists were asked, in a nationwide survey, to weigh different clinical factors in decision-making regarding patient admission and treatment using realistic descriptions of patients in which specific characteristics are varied in a systematic way (eg, web-based clinical vignettes). These vignettes represent patients with suspected unstable angina or non-ST-elevation myocardial infarction. Associations between several clinical characteristics, with cardiologists' management decisions, will be analysed using generalised linear mixed models. ETHICS AND DISSEMINATION: The study has received ethics approval and informed consent will be obtained from all participating cardiologists. The results of the study will provide insight into the relative importance of cardiac risk scores and other clinical information in cardiac decision-making. Further, the results indicate cardiologists' adherence to the European Society of Cardiology guideline recommendations. In addition, the detailed description of the method of vignette development applied in this study could assist other researchers or clinicians in creating future choice experiments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions