37 research outputs found
Vestibular disease in dogs under UK primary veterinary care: Epidemiology and clinical management
Background
Vestibular disease (VD), central or peripheral, can be a dramatic primary‐care presentation. Current literature describes mostly dogs examined in referral centers.
Hypothesis/Objectives
Describe the prevalence, presentation, clinical management, and outcomes of VD in dogs under primary veterinary care at UK practices participating in VetCompass.
Animals
Seven hundred and fifty‐nine vestibular cases identified out of 905 544 study dogs.
Methods
Retrospective cohort study. Potential VD cases clinically examined during 2016 were verified by reviewing clinical records for signalment, presenting clinical signs, treatments, and outcomes. Multivariable logistic regression was used to evaluate factors associated with VD.
Results
The overall prevalence of VD was 8 per 10 000 dogs (95% CI = 7‐9). Median age at first diagnosis was 12.68 years (interquartile range [IQR], 11.28‐14.64). Compared with crossbreeds, breeds with the highest odds of VD diagnosis included French Bulldogs (odds ratio [OR] = 9.25, 95% CI = 4.81‐17.76, P < .001), Bulldogs (OR = 6.53, 95% CI = 2.66‐16.15, P < .001), King Charles Spaniels (OR = 4.96, 95% CI = 2.52‐9.78, P < .001), Cavalier King Charles Spaniels (OR = 3.56, 95% CI = 2.50‐5.06, P < .001), and Springer Spaniels (OR = 3.37, 95% CI = 2.52‐4.52, P < .001). The most common presenting signs were head tilt (69.8%), nystagmus (68.1%), and ataxia (64.5%). The most frequently used treatments were antiemetics (43.2%), systemic glucocorticoids (33.1%), antimicrobials (25%), and propentofylline (23.25%). There were 3.6% of cases referred. Improvement was recorded in 41.8% cases after a median of 4 days (IQR, 2‐10.25).
Conclusions
Our study identifies strong breed predispositions for VD. The low referral rates suggest that primary‐care data sources offer more generalizable information for benchmarking to help clinicians review their own clinical activities
Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale
Absence of Seizures or Mirror Foci in Experimental Epilepsy After Excision of Alumina and Astrogliotic Scar
Thickness apropos stoichiometry in Pt-aluminide (PtAl) coating: Implications on the tensile properties of a directionally solidified Ni-base superalloy
Mirid (Hemiptera: Heteroptera) Specialists of Sticky Plants: Adaptations, Interactions, and Ecological Implications
Application of a novel molecular technique to characterise the effect of settling on microbial community composition of activated sludge
Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients
Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure
Background: Heart failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF. Objective: We aimed to explore and portray in detail, the perspectives of patients receiving, and pharmacists delivering an enhanced, pay for performance community pharmacy HF service. Setting: Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland. Methods Focus groups with pharmacists and semi-structured interviews with individual patients by telephone. Cross sectional thematic analysis of qualitative data used Normalization Process Theory to understand and describe patient's reports. Main outcome measure: Experiences of receiving and delivering an enhanced HF service. Results: Pharmacists voiced their confidence in delivering the service and highlighted valued aspects including the structured consultation and repeated contacts with patients enabling the opportunity to improve self care and medicines adherence. Discussing co-morbidities other than HF was difficult and persuading patients to modify behaviour was challenging. Patients were comfortable discussing symptoms and medicines with pharmacists; they identified pharmacists as fulfilling roles that were needed but not currently addressed. Patients reported the service helped them to enact HF medicines and HF self care management strategies. Conclusion: Both patients receiving and pharmacists delivering a cognitive HF service felt that it addressed a shortfall in current care. There may be a clearly defined role for pharmacists in supporting patients to address the burden of understanding and managing their condition and treatment, leading to better self management and medicines adherence. This study may inform the development of strategies or policies to improve the process of care for patients with HF and has implications for the development of other extended role services