Corrective shoeing as the only treatment of a congenital flexural deformity of the distal interphalangeal joint in the hind limb of a Spanish filly

En el presente artículo se describe el caso de una potra PRE, de 18 meses de edad, con una deformación flexural congénita de la articulación interfalangiana distal del miembro pelviano derecho, que respondió a una serie de herrados correctivos. Existen diversas opciones terapéuticas en una deformación flexural en la articulación interfalangiana distal en potros: tratamiento conservador (modificación de la dieta, ejercicio controlado, oxitetraciclina y control del dolor), quirúrgico (desmotomía del ligamento accesorio del tendón del flexor digital profundo y tenotomía del flexor digital profundo) y herrado terapéutico. En este caso, debido a la larga duración del proceso y a la negativa del propietario a someter a la potra a cirugía, se optó por un tratamiento ortopédico podológico. En el primer herrado, se aplicó una herradura de tamaño superior al casco, con extensión craneal, sin recortar los talones. Además, se hicieron claveras alternativas en las cuartas partes y talones. En el segundo herrado, 45 días después, se colocó una herradura sin compensar en las lumbres, del mismo tamaño que la utilizada en el primer herrado. Debido al crecimiento del casco, se recortaron los talones. En el tercer herrado, 45 días tras el segundo, las lumbres habían crecido, ocupando la extensión craneal de la herradura. Se mantuvieron las claveras alternativas para evitar clavar en hombros, favoreciendo así la expansión del casco en esta zona. Además, para mejorar la sujeción al caso se usó una herradura con pestañas en los hombros. Tras la serie de tres herrados, se apreció una notable mejoría clínica en esta potra. En conclusión, la deformación flexural congénita de la articulación interfalangiana distal puede responder a una serie de herrados correctores en algunos casos, sin necesidad de tratamientos adicionales.In the present article, we describe a congenital flexural limb deformity affecting the distal interphalangeal joint of the right hind limb in an 18-months old Spanish filly which positively responded to serial corrective shoeing procedures. There are different therapeutic options for the treatment of flexural limb deformity in the distal interphalangeal joint in horses: conservative treatment (changes in diet, controlled exercise intensity, oxytetracycline and medical pain management), surgical (inferior check ligament desmotomy and deep digital flexor tenotomy) and therapeutic shoeing. In the case presented here, because of the long duration of the process and because the owner refused the surgical option, we selected the orthopedic shoeing. In the first shoeing, we used a shoe bigger than the hoof, with cranial toe extensions. Additionally, we use alternative nail holes in quarters and heels. In the second shoeing, carried out 45 days after the first shoeing, we used a non-compensated shoe of the same size those used in the first shoeing. Furthermore, and because of the growth of the hoof, the heels were lowered. In the third shoeing, performed 45 days after the second, we observed that the toe grew up in the cranial toe extensions. We kept the alternative nail holes in order to avoid the holes in the toes promoting the growth of the hoof in the toes. Moreover, and in order to hold better the shoe, we applied with clicks in the toes. After 3 shoeing procedures, the filly underwent a marked improvement. It is concluded that a congenital flexural deformity affecting the distal interphalangeal joint might favorably respond in some cases to a series of corrective shoeing procedures without the necessity of additional treatments

Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time

This is the final version. Available from BMJ Publishing Group via the DOI in this record.OBJECTIVE: Investigators within many disciplines are using measures of well-being, but it is not always clear what they are measuring, or which instruments may best meet their objectives. The aims of this review were to: systematically identify well-being instruments, explore the variety of well-being dimensions within instruments and describe how the production of instruments has developed over time. DESIGN: Systematic searches, thematic analysis and narrative synthesis were undertaken. DATA SOURCES: MEDLINE, EMBASE, EconLit, PsycINFO, Cochrane Library and CINAHL from 1993 to 2014 complemented by web searches and expert consultations through 2015. ELIGIBILITY CRITERIA: Instruments were selected for review if they were designed for adults (≥18 years old), generic (ie, non-disease or context specific) and available in an English version. RESULTS: A total of 99 measures of well-being were included, and 196 dimensions of well-being were identified within them. Dimensions clustered around 6 key thematic domains: mental well-being, social well-being, physical well-being, spiritual well-being, activities and functioning, and personal circumstances. Authors were rarely explicit about how existing theories had influenced the design of their tools; however, the 2 most referenced theories were Diener's model of subjective well-being and the WHO definition of health. The period between 1990 and 1999 produced the greatest number of newly developed well-being instruments (n=27). An illustration of the dimensions identified and the instruments that measure them is provided within a thematic framework of well-being. CONCLUSIONS: This review provides researchers with an organised toolkit of instruments, dimensions and an accompanying glossary. The striking variability between instruments supports the need to pay close attention to what is being assessed under the umbrella of 'well-being' measurement.This research was supported by a University of Exeter Medical School PhD Studentship

Availability of cancer decision-support tools: A cross-sectional survey of UK primary care

This is the author accepted manuscript. The final version is available from Royal College of General Practitioners via the DOI in this record.Background Decision-support tools quantify the risk of undiagnosed cancer in symptomatic patients, and may help general practitioners (GPs) when making referrals. Aims: To quantify the availability and use of cancer decision-support tools (QCancer® and Risk Assessment Tools). To explore the association between tool availability and two-week-wait referrals for suspected cancer. Design and setting: Cross-sectional postal survey in UK primary care. Methods: 4,600 GPs from a random sample of 975 UK general practices were invited to participate. Outcome measures included the proportions of UK general practices where: (1) cancer decision-support tools are available, and (2) at least one GP uses the tool. Weighted least-squares linear regression with robust errors tested the association between tool availability and number of two-week-wait referrals, adjusting for practice size, sex, age and index of multiple deprivation. Results: 476 GPs in 227 practices responded (response rates: practitioner, 10.3%; practice, 23.3%). Cancer decision-support tools were available in 83/227 (36.6%, 95% confidence interval 30.3% to 43.1%) practices. Tools were available and likely to be used in 38/227 (16.7%, 12.1% to 22.2%) practices. In sub-group analyses of 172 English practices, there was no difference in mean two-week-wait referral rate between practices with tools and those without (mean adjusted difference in referrals per 100,000: 3.1, -5.5 to +11.7). Conclusions: This is the first survey of cancer decision-support tool availability and use. It suggests that the tools are an underused resource in the UK. Given the cost of cancer investigation, a randomised controlled trial of such clinical decision-support aids would be appropriate.National Institute for Health Research (NIHR

Methods for modelling the cost-effectiveness of interventions for prostate cancer: a systematic review - Protocol

This is a protocol for a systematic review of methods for modelling the cost-effectiveness of interventions for prostate cancer. It will aim to identify and bring together all health economic modelling studies in prostate cancer, to inform the subsequent development of a whole disease model for prostate cancer. This protocol is being deposited prospectively. The following review activities have been completed at the time of depositing: Bibliographic database search strategies designed (MEDLINE, Embase, NHSEED, HTA) Bibliographic database searches conducted and results combined into an EndNote library prepared for screening Random sample of 100 citations selected for pilot screening No further review activities have been initiated or completed at time of depositing

Stated preferences for anti-malarial drug characteristics in Zomba, a malaria endemic area of Malawi

Published onlineJournal ArticlePublished open access article.BACKGROUND: The evidence on determinants of individuals' choices for anti-malarial drug treatments is scarce. This study sought to measure the strength of preference for adult antimalarial drug treatment attributes of heads of urban, rural and peri-urban households in a resource-limited malaria-endemic area of sub-Saharan Africa. METHODS: Discrete choice experiments were conducted with 508 heads of household interviewed face-to-face for a household population survey of health-seeking behavior in Zomba District, Malawi. The interviews were held in Chichewa and the choice experiment questions were presented with cartoon aids. The anti-malarial drug attributes included in the stated preference experiment were: speed of fever resolution, side effects (pruritus) risk, protection (duration of prophylactic effect), price, duration of treatment course and recommendation by a health professional. Sixteen treatment profiles from a fractional factorial design by orthogonal array were paired into choice scenarios, and scenarios were randomly assigned to participants so that each participant was presented with a series of eight pairwise choice scenarios. Respondents had the option to state indifference between the two profiles or decline to choose. Data were analysed in a mixed logit model, with normally distributed coefficients for all six attributes. RESULTS: The sex ratio was balanced in urban areas, whereas 63% of participants in rural areas were male. The proportion of individuals with no education was considerably higher in the rural group (25%) than in the urban (5%) and peri-urban (6%) groups. All attributes investigated had the expected influence, and traded-off in most respondents' choices. There were heterogeneous effects of price, pruritus risk, treatment recommendation by a professional, and duration of prophylaxis across respondents, only partly explained by their differences in education, household per capita expenditure, sex and age. Individuals' demand elasticity (simulated median, inter-quartile range) was highest (most responsive) to speed of symptom resolution (0.88, 0.80-0.89) and pruritus risk (0.25, 0.08-0.62). CONCLUSIONS: Most adult antimalarial users are willing to use treatments without recommendation from health professional, and may be influenced by price. Future studies should investigate the magnitude of differences in price and treatment attribute sensitivity between adult anti-malarial drug users in rural, peri-urban and urban areas in order to determine optimal price subsidies

Patient Choice for Older People in English NHS Primary Care: Theory and Practice

In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whethermaking individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people.This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care

Longevity and Parasitism Capacity of Psyttalia concolor (Hymenoptera: Braconidae) Fed on Sugar Solutions and Insect Honeydew

Sugars are important food sources required by adult parasitoid species to enhance their survival, fecundity and fitness. The beneficial capacity of Psyttalia concolor Szépligeti, as a biological control agent of different fruit fly pest species, is expected to increase when different sugar food sources are supplied. The objective of this study was to test the effect of seven sugars (glucose, fructose, sucrose, trehalose, melibiose, melezitose and sorbitol) on the longevity and parasitism capacity of P. concolor. Moreover, we evaluated the effect of two types of honeydew excreted by hemipteran pests present in olive trees, Saissetia oleae Olivier (Coccidae) and Euphyllura olivina (Costa) (Psyllidae) on the longevity of the parasitoid. Our results show a positive effect of carbohydrate (single sugars and honeydew) consumption on parasitoid survival. Female longevity increased when fed on sorbitol and melibiose, while males benefited from feeding on glucose and fructose, suggesting that hexose-nectars would benefit males. Sucrose increased the percentage of non-emerged hosts and parasitism rate while melezitose significantly decreased these percentages, compared to the other sugars offered. P. concolor benefited more from feeding on honeydew than on sugars, and this food item can represent an important source of energy for the parasitoid. This result indicates the importance of specific nutrients for promoting the action of P. concolor against pestsinfo:eu-repo/semantics/publishedVersio

A methodology for transient state estimation based on numerical derivatives, optimal monitoring and filtered measurements

This paper proposes a methodology for transient state estimation in power systems. The proposed methodology is formulated using approximation methods for derivatives to relate the state variables to measurements. It does not require knowledge of the steady state to establish the pre-disturbance operation conditions. The method uses an optimal monitoring system based on topological analysis to obtain full observability. A saving index is introduced to analyze the effectiveness of the instrumentation used. The adverse effect of noisy measurements in the estimation process is mitigated using an Infinite Impulse Response (IIR) filter. A transient index is introduced to estimate the fault location. The transient state estimation is assessed using two test systems. The results are validated through direct comparison against those obtained by simulation using SimPowerSystems toolbox of Simulink®. With the proposed methodology, the transient state estimation can be obtained with an important saving in the implementation of the measuring system and with considerably less computational effort

What works in interventions targeting loneliness: a systematic review of intervention characteristics

This is the final version. Available on open access from BMC via the DOI in this recordData Availability: All included studies containing data have been cited in the manuscript. All data generated or analysed during this study are included in this published article, its supplementary information files, or are available from the corresponding author on reasonable request.BACKGROUND: Loneliness has been linked to negative health and economic outcomes across the life course. Health effects span both physical and mental health outcomes, including negative health behaviours, lower well-being, and increased mortality. Loneliness is however preventable with effective intervention. This systematic review aims to identify what has worked in interventions for loneliness to guide the development of future interventions. METHODS: Eight electronic databases (Medline, Embase, PsycINFO, Social Policy and Practice, Social Sciences Citation Index, Epistemonikos, CINAHL, Cochrane Library) were systematically searched from inception to February 2022 using terms for intervention and loneliness to identify relevant interventions in the general population. No restrictions on age, socio-economic status, or geographic location were imposed. Studies were to measure loneliness as the primary outcome through a validated scale or single-item question. Case studies were excluded. Additional studies were identified through citation chasing. Extracted data included study and intervention characteristics, and intervention effectiveness for cross-study comparison. Critical appraisal was conducted using the Joanna Briggs Institute and Critical Appraisal Skills Programme tools before the studies were summarised in a narrative synthesis. RESULTS: Searches identified 4,734 hits, from which 22 studies were included in this review. Of these studies, 14 were effective in reducing loneliness. Additionally, five studies presented unclear findings, and three concluded no decrease in loneliness. Interventions varied between group vs. individual format, online vs. in person delivery, and regarding both intervention duration and individual session length. Furthermore, this review highlighted five key areas when considering designing an intervention for loneliness: use of between session interaction, inclusion of clear learning mechanisms, role of active participation, number of opportunities for group or facilitator interaction, and variation in teaching and learning styles. CONCLUSIONS: Group sessions seem preferred to individual formats, and interaction through active participation and group or facilitator contact appear beneficial, however studies also recognised the importance of a person-tailored approach to delivery. Studies suggest there is no 'quick fix' to loneliness, but that learnt practices, behaviours, and community connection should be built into one's lifestyle to achieve sustained intervention effectiveness. Future interventions should consider longer follow-up periods, male and populations with lower educational levels

PRM14 European Assessment of the Validity of the QALY Outcome Measure: Results From the Experiment Conducted by the Echoutcome Project

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