GP coding behaviour for non-specific clinical presentations: a pilot study

Background: Clinical coding is an integral part of primary care. Disease incidence studies based on primary care electronic health records (EHRs) rely on the accuracy of these codes. Current code validation methods are not appropriate for non-specific conditions and provide limited information about GPs' decision-making behaviour around coding. Qualitative methods could offer insight into decision-making behaviour around coding of patients with non-specific conditions. Aim: To investigate the decision-making behaviour of GPs when applying Read codes to non-specific clinical presentations, using Lyme disease as a case example. Design & setting: A pilot study was undertaken, involving masked semi-structured interviews of eight GPs in the North West of England. Method: Semi-structured interviews were carried out based on 11 clinical cases representative of Lyme disease presentations. Discrete answers were described descriptively. Interview transcripts were analysed using a thematic approach. Results: Themes underpinning GPs’ coding behaviour included: GP personal and professional experience; clinical evidence; diagnostic uncertainty; professional integrity and defensive practice; and patient-sourced health information and beliefs. GPs placed Lyme disease on their differential diagnosis list for five cases; in only two cases would GPs select a Lyme disease related Read code. Conclusion: GPs were reluctant to code with specific diagnostic Read codes when they were presented with patients with vague or unfamiliar symptomology. This masked questionnaire methodology offers a new approach to validate incidence figures, based on Read codes of non-specific conditions. The reluctance to code poses many problems for primary care EH

Backyard poultry cases in UK small animal practices: Demographics, health conditions and pharmaceutical prescriptions

Background: Backyard poultry ownership is of keen interest in the United Kingdom. However, despite this, little is known about veterinary care engagement and outcomes of visits in this group of species. Methods: This study described and characterised veterinary practice‐visiting backyard poultry, utilising electronic health record data supplied by veterinary practices voluntarily participating in the Small Animal Veterinary Surveillance Network between 1st April 2014 and 31st March 2019. Results: In total, 4424 recorded poultry consultations originating from 197 veterinary practices (352 sites) were summarised. Chicken consultation (n = 3740) peak incidence was in early summer (April‐June), relative to all recorded species. More chickens resided in rural (incident rate ratio = 2.5, confidence interval [CI] 2.3–2.6, p <0.001) or less deprived areas. Non‐specific clinical signs were commonly recorded (17.6% of chicken consultations, CI 15.9–19.2), as were those indicative of advanced disease. This latter finding was reflected in prescribed management strategies, with euthanasia comprising 29.8% (CI 27.0–32.6) of consultations. Antimicrobials were commonly prescribed (33.0% of consultations, CI 29.8–36.2), 43.8% of which included antimicrobials considered ‘highest priority critically important’ by the World Health Organisation. Conclusion: Our findings indicate a need to tailor antimicrobial prescription guidance to the backyard poultry setting. In addition, late presentation of disease, vague clinical descriptions in clinical narratives and high euthanasia rates show that disease identification, management and knowledge of poultry health and welfare among owners and veterinary surgeons can be improved

An irradiated brown-dwarf companion to an accreting white dwarf

Interacting compact binary systems provide a natural laboratory in which to study irradiated substellar objects. As the mass-losing secondary (donor) in these systems makes a transition from the stellar to the substellar regime, it is also irradiated by the primary (compact accretor)1, 2. The internal and external energy fluxes are both expected to be comparable in these objects, providing access to an unexplored irradiation regime. The atmospheric properties of donors are largely unknown3, but could be modified by the irradiation. To constrain models of donor atmospheres, it is necessary to obtain accurate observational estimates of their physical properties (masses, radii, temperatures and albedos). Here we report the spectroscopic detection and characterization of an irradiated substellar donor in an accreting white-dwarf binary system. Our near-infrared observations allow us to determine a model-independent mass estimate for the donor of 0.055 ± 0.008 solar masses and an average spectral type of L1 ± 1, supporting both theoretical predictions and model-dependent observational constraints that suggest that the donor is a brown dwarf. Our time-resolved data also allow us to estimate the average irradiation-induced temperature difference between the dayside and nightside of the substellar donor (57 kelvin) and the maximum difference between the hottest and coolest parts of its surface (200 kelvin). The observations are well described by a simple geometric reprocessing model with a bolometric (Bond) albedo of less than 0.54 at the 2σ confidence level, consistent with high reprocessing efficiency, but poor lateral heat redistribution in the atmosphere of the brown-dwarf donor4, 5. These results add to our knowledge of binary evolution, in that the donor has survived the transition from the stellar to the substellar regime, and of substellar atmospheres, in that we have been able to test a regime in which the irradiation and the internal energy of a brown dwarf are comparable

Welsh hospital admissions due to dog bites and strikes (2014-2022)

Objective To describe the incidence and victim demographics of Welsh hospital admissions due to dog bites and strikes from 2014 to 2022. Study design Descriptive analysis of Welsh hospital admissions data. Methods Residents of Wales admitted to a Welsh National Health Service (NHS) hospital for a dog bite or strike, were identified using ICD-10 codes. The annual incidence of dog bite admissions between 2014 and 2022 was calculated and stratified by child–adult status, sex, and Local Health Boards. Trends over time were analysed using Chi-square test for trends. Results Hospital admissions due to dog bites and strikes have significantly increased from 16.3 per 100,000 to 23.7 per 100,000 population in 2022. This was driven by an increase in non-geriatric adults, and an increase in three Local Health Boards. The Swansea Bay area has the highest incidence in Wales (56.1 admissions per 100,000). Conclusions Wales has a higher incidence of dog bites than England or the Republic of Ireland. Work in the communities where incidence is exceptionally high is needed to understand the reasons behind having the highest incidence of dog bites in the British Isles and to establish the most efficacious methods for bite prevention

Zoonotic infections in UK and Irish veterinary students: a cross-sectional survey.

Zoonotic infections are a recognised risk for the veterinary community. Veterinary students are at risk, due to the range of activities they participate with on training coupled with their inexperience; yet the prevalence and severity of infections in veterinary students has been little studied. In this study, a survey explored zoonotic infections in UK and Irish veterinary students. A survey containing both open and closed questions, was distributed to undergraduate veterinary students at all veterinary schools in the UK and Republic of Ireland. Descriptive statistics, and univariable logistic regression were used to explore quantitative data; thematic analysis was used to explore qualitative data. There were 467 responses, 31.5% (95% CI 27.3-35.9, n = 147) of those students reported having contracted at least one zoonotic infection during their studies. The most prevalent self-reported infections were cryptosporidiosis (15.2% of all respondents), dermatophytosis (5.6%), and other gastrointestinal infections assumed to be of zoonotic origin (4.5%). 7% of respondents reported having acquired a zoonosis within the last 12 months, 91% of these infections were acquired during farm placements. Thematic analysis (n = 34) showed that infection was an accepted risk, particularly on farm, and students were often reluctant to take time off their studies or placements as a result of infection. Reporting was very low, meaning universities would not have accurate figures on infection risk or particularly risky placement providers. Based on these survey results, veterinary students appear to be at increased risk of contracting zoonotic diseases, particularly on farm placements. Attitude and behaviour change at multiple levels is required to reduce the risk of infection to students and normalise reporting of illness

Dog-related deaths registered in England and Wales from 2001 to 2021

Introduction: This study aimed to describe the incidence and demographics of fatal dog bites or strikes, as defined in English and Welsh mortality data (2001-2021). Methods: Data from the Office for National Statistics registered deaths dataset were used to identify individuals whose cause of death was defined as: bitten or struck by a dog. The average annual number of dog-related deaths and trends in incidence were calculated. Age and sex demographics of victims were described. Results: There were 3.3 (95%CI 0.3-6.3) dog-related deaths per year, a mean annual incidence of 0.59 (95%CI 0.06-1.11) deaths per 10 million population. There was no obvious trend in incidence. Of victims, 59% were male, 10% were &lt;5 years, and 30% were more than 75 years. Discussion: Dog-related deaths are rare in England and Wales and have not increased between 2001 and 2021. Further contextual information about the incidents is needed to be able to develop public health strategies and interventions.</jats:p