Factors influencing common diagnoses made during first-opinion small-animal consultations in the United Kingdom

It is currently unclear how frequently a diagnosis is made during small-animal consultations or how much of a role making a diagnosis plays in veterinary decision-making. Understanding more about the diagnostic process will help direct future research towards areas relevant to practicing veterinary surgeons. The aim of this study was to determine the frequency with which a diagnosis was made, classify the types of diagnosis made (and the factors influencing these) and determine which specific diagnoses were made for health problems discussed during small-animal consultations. Data were gathered during real-time direct observation of small-animal consultations in eight practices in the United Kingdom. Data collected included characteristics of the consultation (e.g. consultation type), patient (e.g. breed), and each problem discussed (e.g. new or pre-existing problem). Each problem discussed was classified into one of the following diagnosis types: definitive; working; presumed; open; previous. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3). Problems without a previous diagnosis, in cats and dogs only, were included in the model, which had a binary outcome variable of definitive diagnosis versus no definitive diagnosis. Data were recorded for 1901 animals presented, and data on diagnosis were gathered for 3192 health problems. Previous diagnoses were the most common diagnosis type (n = 1116/3192; 35.0%), followed by open (n = 868/3192; 27.2%) then definitive (n = 660/3192; 20.7%). The variables remaining in the final model were patient age, problem history, consultation type, who raised the problem, and body system affected. New problems, problems in younger animals, and problems raised by the veterinary surgeon were more likely to result in a definitive diagnosis than pre-existing problems, problems in older animals, and problems raised by the owner. The most common diagnoses made were overweight/obese and periodontal disease (both n = 210; 6.6%). Definitive diagnoses are rarely made during small-animal consultations, with much of the veterinary caseload involving management of ongoing problems or making decisions around new problems prior to a diagnosis being made. This needs to be taken into account when considering future research priorities, and it may be necessary to conduct research focused on the approach to common clinical presentations, rather than purely on the common diagnoses made. Examining how making a diagnosis affects the actions taken during the consultation may shed further light on the role of diagnosis in the clinical decision-making process

Common decisions made and actions taken during small-animal consultations at eight first-opinion practices in the United Kingdom

In order for veterinary surgeons to undertake an evidence-based approach to making decisions about theirpatients, it is important that new evidence is generated to support the clinical decision-making process.Many of the decisions are likely to be around the actions taken to treat or manage health problemsdiscussed during the consultation, and little is currently known about the factors which affect the typeof action taken. The aim of this study was to determine the decisions made and actions taken for healthproblems discussed during first-opinion small-animal consultations, as well as identifying factors whichmay affect the decision-making process.Data were gathered during direct observation of small-animal consultations conducted by 62 veterinarysurgeons in eight first-opinion practices in the United Kingdom. For each patient presented, data weregathered on all health problems discussed during the consultation. The decision made (whether an actionwas taken or not) and the action taken where applicable (e.g. therapeutic treatment with antibiotics) wasalso recorded. A three-level multivariable logistic-regression model was developed, with problem (Level1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3), and a binaryoutcome variable of action versus no action.At least one action was taken for 69% (n = 2203/3192) of all problems discussed. Therapeutic treatmentwas the most common action taken (n = 1286/3192 problems; 40.3%), followed by management advice(n = 1040/3192; 32.6%) and diagnostic work-up (n = 323/3192; 10.1%). The most common therapeutictreatment was antibiotics (n = 386/1286; 30%), while the most common management advice given wasdietary advice (n = 509/1040; 48.9%). The three explanatory variables remaining in the final model werewhether the problem was a presenting or non-presenting problem, the type of diagnosis made, andthe body system affected. Explanatory variables which did not remain in the final model were patientsignalment, problem history, consultation type, clinical examination type, and who raised the problem(veterinary surgeon or owner).For over two-thirds of problems discussed, an action was taken which suggests these problems maybe seen as important by the veterinary surgeon and/or pet owner. No action was taken for almost a thirdof cases which could represent ‘watchful waiting’, which has been highlighted as important in humanhealthcare. Future research should focus on the common actions taken, further exploring the complexdecision-making process, and examining the effect of the decisions made on long-term patient outcomes

What outcomes should be measured in feline chronic kidney disease treatment trials? Establishing a core outcome set for research

Chronic Kidney Disease (CKD) is an important cause of feline morbidity and mortality. There is currently no agreement on which outcomes are most important in CKD treatment trials to assist evidence-based decision making.Core Outcome Sets (COSs) originated in human healthcare and are an agreed set of outcomes to be measured and reported as a minimum in any trial conducted relating to a particular disease. To establish a COS for feline CKD, this study used a systematic review and two consensus methodologies (an electronic Delphi (eDelphi), and an in-person consensus meeting), with an international panel of key stakeholders.The systematic review identified 104 unique published parameters, which were rated by panellists in round 1 of the eDelphi. Panellists were also asked to suggest additional parameters. In round 2 these additional parameters were rated and any parameters not understood by >10 % of panellists in round 1 were redefined and re-rated. Parameters reaching consensus in rounds 1 and 2 were removed from round 3, when all remaining parameters were re-rated by panellists who could view their own previous rating alongside the median rating of the whole panel. To reach inclusion in the COS, parameters had to be rated 8 or 9 on a Likert scale of 1−9 (where 1 was not important and 9 was very important) by more than 80 % of panellists. In the consensus meeting, panellists discussed and re-rated borderline parameters and streamlined the final COS. Borderline parameters were those that had been closest to, but not achieved, the 80 % threshold for inclusion.The eDelphi panel (n = 73) rated 24/104 parameters highly enough for inclusion and proposed an additional 20 parameters, of which 3 reached the inclusion threshold. This totalled 27 parameters for inclusion. The consensus meeting panel (n = 16) rated an additional 6/20 borderline parameters highly enough for inclusion. During the streamlining process, 4 parameters were removed as one was considered not an outcome, and three were already addressed by other parameters. The remaining COS totalled 29 parameters. These were grouped into 9 core themes: clinical examination, quality of life, serum biochemistry, complete blood count, urinalysis, total amount of food eaten, CKD progression, survival time and cause of death.This is the first COS for feline medicine. In future treatment efficacy trials the COS will strengthen the evidence-base for this condition, by facilitating easier comparison of results between studies, and reduce research waste

Evidence for exercise-based interventions across 45 different long-term conditions: An overview of systematic reviews

Background Almost half of the global population face significant challenges from long-term conditions (LTCs) resulting in substantive health and socioeconomic burden. Exercise is a potentially key intervention in effective LTC management. Methods In this overview of systematic reviews (SRs), we searched six electronic databases from January 2000 to October 2023 for SRs assessing health outcomes (mortality, hospitalisation, exercise capacity, disability, frailty, health-related quality of life (HRQoL), and physical activity) related to exercise-based interventions in adults (aged >18 years) diagnosed with one of 45 LTCs. Methodological quality was assessed using AMSTAR-2. International Prospective Resister of Systematic Reviews (PROSPERO) ID: CRD42022319214. Findings Forty-two SRs plus three supplementary RCTs were included, providing 990 RCTs in 936,825 people across 39 LTCs. No evidence was identified for six LTCs. Predominant outcome domains were HRQoL (82% of SRs/RCTs) and exercise capacity (66%); whereas disability, mortality, physical activity, and hospitalisation were less frequently reported (≤25%). Evidence supporting exercise-based interventions was identified in 25 LTCs, was unclear for 13 LTCs, and for one LTC suggested no effect. No SRs considered multimorbidity in the delivery of exercise. Methodological quality varied: critically-low (33%), low (26%), moderate (26%), and high (12%). Interpretation Exercise-based interventions improve HRQoL and exercise capacity across numerous LTCs. Key evidence gaps included limited mortality and hospitalisation data and consideration of multimorbidity impact on exercise-based interventions. Funding This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)—NIHR202020)

Sample-to-sample torque fluctuations in a system of coaxial randomly charged surfaces

Polarizable randomly charged dielectric objects have been recently shown to exhibit long-range lateral and normal interaction forces even when they are effectively net neutral. These forces stem from an interplay between the quenched statistics of random charges and the induced dielectric image charges. This type of interaction has recently been evoked to interpret measurements of Casimir forces in vacuo, where a precise analysis of such disorder-induced effects appears to be necessary. Here we consider the torque acting on a randomly charged dielectric surface (or a sphere) mounted on a central axle next to another randomly charged surface and show that although the resultant mean torque is zero, its sample-to-sample fluctuation exhibits a long-range behavior with the separation distance between the juxtaposed surfaces and that, in particular, its root-mean-square value scales with the total area of the surfaces. Therefore, the disorder-induced torque between two randomly charged surfaces is expected to be much more pronounced than the disorder-induced lateral force and may provide an effective way to determine possible disorder effects in experiments, in a manner that is independent of the usual normal force measurement.Comment: 7 pages, 3 fig

Observation of a new chi_b state in radiative transitions to Upsilon(1S) and Upsilon(2S) at ATLAS

The chi_b(nP) quarkonium states are produced in proton-proton collisions at the Large Hadron Collider (LHC) at sqrt(s) = 7 TeV and recorded by the ATLAS detector. Using a data sample corresponding to an integrated luminosity of 4.4 fb^-1, these states are reconstructed through their radiative decays to Upsilon(1S,2S) with Upsilon->mu+mu-. In addition to the mass peaks corresponding to the decay modes chi_b(1P,2P)->Upsilon(1S)gamma, a new structure centered at a mass of 10.530+/-0.005 (stat.)+/-0.009 (syst.) GeV is also observed, in both the Upsilon(1S)gamma and Upsilon(2S)gamma decay modes. This is interpreted as the chi_b(3P) system.Comment: 5 pages plus author list (18 pages total), 2 figures, 1 table, corrected author list, matches final version in Physical Review Letter

Search for displaced vertices arising from decays of new heavy particles in 7 TeV pp collisions at ATLAS

We present the results of a search for new, heavy particles that decay at a significant distance from their production point into a final state containing charged hadrons in association with a high-momentum muon. The search is conducted in a pp-collision data sample with a center-of-mass energy of 7 TeV and an integrated luminosity of 33 pb^-1 collected in 2010 by the ATLAS detector operating at the Large Hadron Collider. Production of such particles is expected in various scenarios of physics beyond the standard model. We observe no signal and place limits on the production cross-section of supersymmetric particles in an R-parity-violating scenario as a function of the neutralino lifetime. Limits are presented for different squark and neutralino masses, enabling extension of the limits to a variety of other models.Comment: 8 pages plus author list (20 pages total), 8 figures, 1 table, final version to appear in Physics Letters