Common feline problem behaviors: Urine spraying

2019 ◽  
Vol 21 (3) ◽  
pp. 209-219 ◽  
Author(s):  
Debra F Horwitz
Keyword(s):  
Problem Behaviors ◽  
Treatment Options ◽  
Scent Marking ◽  
Standing Position ◽  
Evidence Base ◽  
Correct Identification ◽  
Medical Problems ◽  
Urine Marking ◽  
Resultant Increase ◽  
Relationship Of

Practical relevance: Urine spraying (synonymous terms include urine marking or scent marking) is commonly described as urine deposited on vertical surfaces while the cat is in a standing position. With the increasing trend of keeping cats indoors in some countries and the potential resultant increase in frustration-related behaviors, urine spraying may occur in the home. Although also a normal feline behavior, it is usually not deemed acceptable when the cat targets household possessions. Urine spraying is a common behavioral complaint that practitioners receive from cat owners and has the potential to disrupt the human–cat bond. In fact, feline elimination issues are a frequent reason cited by owners when they relinquish their cats to shelters and rescue organizations. Clinical challenges: While the location of the deposited urine should be diagnostic, this is not always the case. Urine marking can occur on horizontal surfaces, thus complicating the diagnosis. Urine spraying by intact males and females is used to signal availability for mating but the behaviour can also be exhibited by neutered animals. Multiple factors including medical problems can trigger the onset and maintenance of urine spraying, and correct identification of these is necessary for treatment to be most successful. Evidence base: This review draws on information from multiple studies that have been published on the normal aspects of urine spraying in cats, the frequency as reported by owners, the relationship of urine spraying to intercat aggression and various treatment options including behavior modification, pheromone therapy and use of psychoactive medication.

Establishing a Group Educational Session for Hyperacusis Patients

2019 ◽  
Vol 28 (2) ◽  
pp. 245-250
Author(s):  
Ann E. Perreau ◽  
Richard S. Tyler ◽  
Patricia C. Mancini ◽  
Shelley Witt ◽  
Mohamed Salah Elgandy
Keyword(s):  
Therapeutic Process ◽  
Treatment Options ◽  
Clinical Group ◽  
Education Session ◽  
Group Approach ◽  
Treatment Protocols ◽  
Educational Session ◽  
Evidence Based Treatment ◽  
Relationship Of ◽  
The Relationship

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197

Mass Gathering Events: Retrospective Analysis of Patient Presentations over Seven Years

2002 ◽  
Vol 17 (3) ◽  
pp. 147-150 ◽  
Author(s):  
Kathryn M. Zeitz ◽  
David P.A. Schneider ◽  
Dannielle Jarrett ◽  
Christopher J. Zeitz
Keyword(s):  
Formal Analysis ◽  
Presentation Rate ◽  
Evidence Base ◽  
First Aid ◽  
Event Analysis ◽  
Mass Gathering ◽  
Medical Problems ◽  
Maximum Daily Temperature ◽  
Day Of The Week ◽  
Crowd Size

AbstractIntroduction:St John Ambulance Operations Branch Volunteers have been providing first-aid services at the Royal Adelaide Show for 90 years. The project arose from a need to more accurately predict the workload for first-aid providers at mass gathering events. A formal analysis of workload patterns and the determinants of workload had not been performed.Hypothesis:Casualty presentation workload would be predicted by factors including day of the week, weather, and crowd size.Method:Collated and analyzed casualty reports over a seven-year period representing >7,000 patients who presented for first-aid assistance for that period (63 show days) were reviewed retrospectively.Results:Casualty presentations correlated significantly with crowd size, maximum daily temperature, humidity, and day of the week. Patient presentation rate had heterogeneous determinants. The most frequent presentation was minor medical problems with Wednesdays attracting higher casualty presentations and more major medical categories.Conclusion:Individual event analysis is a useful mechanism to assist in determining resource allocation at mass gathering events providing an evidence base upon which to make decisions about future needs. Subsequent analysis of other events will assist in supporting accurate predictor models.

scholarly journals Treatment Options for Vestibular Migraine

US Neurology ◽  
2016 ◽  
Vol 12 (01) ◽  
pp. 39 ◽  
Author(s):  
Steffen Naegel ◽  
◽  
Manjit Matharu ◽  
Mark Obermann ◽  
◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
International Headache Society ◽  
Controlled Trial ◽  
Treatment Options ◽  
Evidence Base ◽  
Vestibular Migraine ◽  
Controlled Trials ◽  
Common Cause ◽  
Randomized Controlled ◽  
Trial Testing

Although vestibular migraine is a common cause of vertigo, affecting approximately 1% of the Western world’s population, it remains widely under-recognized and is under-diagnosed. Diagnostic criteria for vestibular migraine were recently published in collaboration with the International Headache Society and the Bárány-Society. Trials investigating the treatment of vestibular migraine are sparse but some are now underway. This review focuses on the treatments options available for vestibular migraine, based on the existing evidence base where available. Regarding acute treatments, there are two randomized controlled trials that provide evidence for the use of triptans (zolmitriptan and rizatriptan) for the management of vestibular migraine attacks. For prophylactic treatment, the evidence base is largely non-existent, since the only multicenter randomized placebo-controlled trial testing metoprolol versus placebo is still underway. Consequently, the treatment recommendations for the prophylactic treatment of vestibular migraine are mainly based on expert opinion and the treatments guidelines for migraine with and without aura.

scholarly journals Off-label prescribing of quetiapine in south locality crisis teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S87-S87
Author(s):  
Mamta Kumari ◽  
Arun Kumar Gupta ◽  
Peter Clarke
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Treatment Options ◽  
General Medical Council ◽  
Evidence Base ◽  
Medical Council ◽  
Team Members ◽  
Off Label ◽  
Psychotropic Medicines

AimsThe audit was carried out to determine the frequency of off label prescribing of quetiapine and compliance with standards within Trust Policy (UHM PGN 02 PPT PGN 08) – Physical Health Monitoring of Patients Prescribed Antipsychotics and other Psychotropic Medicines, NICE CG178, General Medical Council Ethical Standards and Royal College of Psychiatrists – College Report CR210.The main objectives of the audit were to determine if:Patients have been appropriately informed of off-label status and consent recorded.Alternative licensed treatment first used/ruled out.Appropriate communication on transfer of care.Appropriate physical health monitoring completed.BackgroundQuetiapine is associated with various physical side effects. Patients should be fully informed of the expected risks and benefits of treatment, and the limited evidence base for off-label prescribing.There are additional issues around the transfer of prescribing to primary care.MethodThe sample consisted of 50 consecutive patients selected from the crisis team caseload in the month of December 2018.Data reviewed in this audit were taken from six months period.Records audited were obtained from RiO (electronic records) and prescription charts.Data collection was started in January 2019 and completed in March 2019The audit tool was a dichotomous scale questionnaire based on NICE guidelines.Result4 patients from the sample (8%) were prescribed off-label quetiapine.100% had physical health monitoring completed as per Trust policy.100% off-label indication been clearly documented in notes.100% Consent to treatment was documented.100% had medication reviewed in the previous 6 months.75% had licensed medication used or ruled out before considering off-label quetiapine use25% risks/benefits of treatment were documented as part of a patient discussion.25% had documented evidence that alternative treatment options were discussed.25% had documented evidence of Community consultant/GP consent/agreement was obtained before transfer of prescribing75% had a documented plan for review of quetiapine for treatment efficacy and side effects50% had a documented plan in place for ongoing physical health monitoringConclusionSuggested a wider audit may be required with greater patient numbers and which specifically filters for patients prescribed quetiapine.Audit result has been shared with Crisis team members, Medicines Optimisation Committee and South Locality Quality Standards Committee in the trust.

scholarly journals Longitudinal child data: What can be gained by linking administrative data and cohort data?

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Leanne Findlay ◽  
Elizabeth Beasley ◽  
Jungwee Park ◽  
Dafna Kohen ◽  
Yann Algan ◽  
...  
Keyword(s):  
Administrative Data ◽  
Well Being ◽  
Evidence Base ◽  
Kindergarten Children ◽  
Data Sets ◽  
Original Cohort ◽  
Financial Outcomes ◽  
Probabilistic Linkage ◽  
Statistics Canada ◽  
Relationship Of

IntroductionLinked administrative data sets are an emerging tool for studying the health and well-being of the population. Previous papers have described methods for linking Canadian data, although few have specifically focused on children, nor have they described linkage between tax outcomes and a cohort of children who are particularly at risk for poor financial outcomes. Objective and methodsThis paper describes a probabilistic linkage performed by Statistics Canada linking the Montreal Longitudinal Experimental Study (MLES) and the Quebec Longitudinal Study of Kindergarten Children (QLSKC) survey cohorts and administrative tax data from 1992 through 2012. ResultsThe number of valid cases in the original cohort file with valid tax records was approximately 84\%. Rates of false positives, false negatives, sensitivity, and specificity of the linkage were all acceptable. Using the linked file, the relationship of childhood behavioural indicators and adult income can be investigated in future studies. ConclusionsInnovative methods for creating longitudinal datasets on children will assist in examining long-term outcomes associated with early childhood risk and protective factors as well as an evidence base for interventions that promote child well-being and positive outcomes.

632 Family History of Children Diagnosed with Obstructive Sleep Apnea

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A248-A248
Author(s):  
Kristi Porterfield-Pruss ◽  
Denise Willis ◽  
Beverly Spray ◽  
Supriya Jambhekar
Keyword(s):  
Family History ◽  
Family Members ◽  
Biological Father ◽  
Medical Problems ◽  
Obstructive Sleep ◽  
Familial Association ◽  
History Of ◽  
The Mean ◽  
Relationship Of ◽  
The Relationship

Abstract Introduction Limited evidence suggests a familial association of OSA. It is not known how often children who require positive airway pressure (PAP) devices have a family member with OSA or that requires PAP. It is felt that PAP adherence in children is affected by PAP adherence in parents. We wanted to explore the relationship of OSA in children requiring PAP to OSA in immediate family members as well as the association of obesity and adherence between children and family members. Methods Caregivers of children who utilize PAP devices at home were invited to complete an electronic questionnaire regarding family history of OSA. Descriptive statistics were utilized to summarize results. Results The study was completed by 75 participants. The majority of children were male (64%, 48/75), black (47%, 35/75) and non-Hispanic (88%, 66/75). The mean age was 11.8 years (median 13) and mean BMI was 32.8 (median 29.8). The mean AHI on the diagnostic polysomnogram was 28.4 events per hour (median 15.3). Mean adherence to PAP > 4 hours per night was 56.5 (Median 68.2). Most, 87% (65/75), have other underlying medical problems. Twenty-four percent (18/75) have a biological father with OSA of whom 61% (11/18) are considered moderately/extremely obese. Of mothers, 13% (10/75) have OSA and 70% (7/10) are obese. Overall, 29% (22/75) had either a paternal (11%, 8/75) or maternal (19%, 14/75) grandfather with OSA of which 36% (8/22) are obese. For grandmothers, 31% (23/75) have OSA and 22% (5/23) are obese with more being paternal (19%, 14/75) compared to maternal (12%, 9/75). Of the 73 total family members reported to have OSA, 86% (63/73) use PAP and most (65%, 41/63) use it for > 4 hours every night. Few participants had siblings with OSA. Conclusion There were more fathers with OSA than mothers, but mothers were reported to be obese more often. Grandparents were reported to have OSA but were reported to be obese less often than parents. Maternal grandparents with OSA were reported to be obese more than paternal grandparents. The majority of family members with OSA who use CPAP report nightly use. Support (if any):

scholarly journals The Integrative Psychiatry Curriculum: Development of an Innovative Model

2019 ◽  
Vol 8 ◽  
pp. 216495611984711
Author(s):  
Noshene Ranjbar ◽  
Mari Ricker ◽  
Amelia Villagomez
Keyword(s):  
Online Courses ◽  
Training Programs ◽  
Treatment Options ◽  
Well Being ◽  
Evidence Base ◽  
Self Awareness ◽  
Group Setting ◽  
Whole Person ◽  
Treatment Plans ◽  
Integrative Psychiatry

The Integrative Psychiatry Curriculum (IPC) was developed to train psychiatry residents and fellows to apply an Integrative Medicine (IM) approach for patients presenting with psychiatric disorders. Launched in 2015, IPC includes interactive online courses, in-person experiential sessions, and a clinical component with supervision. Twenty-one residents and fellows have completed the curriculum. The purpose of the IPC is 2-fold: to enhance patient wellness through training residents and fellows in evidence-based whole-person care and to improve physician well-being through enhanced stress management and self-awareness utilizing the practice of mind–body skills within a supportive small group setting. Course participants are trained in a broad range of prevention and treatment options and learn about their evidence base; they then practice incorporating IM into diagnosis and treatment plans through supervised clinical experience. This article describes the development of IPC and its elements. Efforts are underway to further develop and standardize the offerings and increase the portability of the course, making it easier for Psychiatry training programs with limited faculty expertise in IM to provide the curriculum for residents and fellows. To reach the goal of disseminating such a curriculum for integrative psychiatry, further funding and collaboration with multiple residency training programs is needed.

Functional abdominal pain: what clinicians need to know

2020 ◽  
Vol 105 (10) ◽  
pp. 938-944 ◽  
Author(s):  
Edward Thomas Andrews ◽  
R Mark Beattie ◽  
Mark P Tighe
Keyword(s):  
Abdominal Pain ◽  
Treatment Options ◽  
Underlying Mechanism ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Rational Approach ◽  
Recurrent Pain ◽  
Functional Abdominal Pain ◽  
Faecal Calprotectin ◽  
Family Acceptance

Abdominal pain in childhood is extremely common and presents frequently to both primary and secondary care, with many children having recurrent pain which impacts on daily functioning. Despite this most children have no discernible underlying pathology. We discuss the underlying mechanism for functional abdominal pain (visceral hypersensitivity), the evidence base linking parental anxiety and patient symptoms, and how parents can be supported in managing their children’s symptoms by addressing questions commonly asked by children and families. We look at the evidence for a one-stop rational approach to investigation including a coeliac screen, inflammatory markers and consideration of stool faecal calprotectin, in the absence of red flags. We evaluate commonly used treatments for functional abdominal pain, within a context of managing family expectations. Given the limitations in pharmacological treatment options, trials of probiotics, peppermint oil, mebeverine and (for short-term use only) hyoscine butylbromide may be appropriate. Psychological interventions including cognitive–behavioural therapy, distraction techniques and hypnotherapy have a better evidence base. There is also some evidence for other complementary therapies in children, including yoga and neurostimulation. Outcome is generally good providing there is child and family acceptance of the multiple factors implicated in the aetiology of the pain.

scholarly journals Treatment options in type-2 low asthma

2020 ◽  
pp. 2000528 ◽  
Author(s):  
Timothy SC Hinks ◽  
Stewart J Levine ◽  
Guy G Brusselle
Keyword(s):  
Severe Asthma ◽  
Bacterial Infections ◽  
Current Knowledge ◽  
Treatment Options ◽  
Occupational Exposures ◽  
Evidence Base ◽  
Type I ◽  
Eosinophilic Asthma ◽  
Ongoing Research

Monoclonal antibodies targeting IgE or the type-2 cytokines IL-4, IL-5 and IL-13 are proving highly effective in reducing exacerbations and symptoms in people with severe allergic and eosinophilic asthma respectively. However, these therapies are not appropriate for 30–50% of patients in severe asthma clinics who present with non-allergic, non-eosinophilic, “type-2 low” asthma. These patients constitute an important and common clinical asthma phenotype, driven by distinct, though poorly understood pathobiological mechanisms. In this review we describe the heterogeneity and clinical characteristics of type-2 low asthma and summarise current knowledge on the underlying pathobiological mechanisms, which includes neutrophilic airway inflammation often associated with smoking, obesity, occupational exposures and may be driven by persistent bacterial infections and by activation of a recently-described IL-6 pathway. We review the evidence base underlying existing treatment options for specific treatable traits which can be identified and addressed. We particularly focus on severe asthma as opposed to difficult-to-treat asthma, on emerging data on the identification of airway bacterial infection, on the increasing evidence base for the use of long-term low-dose macrolides, a critical appraisal of bronchial thermoplasty, and evidence for the use of biologics in type-2 low disease. Finally we review ongoing research into other pathways including TNF, IL-17, resolvins, apolipoproteins, type I interferons, IL-6 and mast cells. We suggest that type-2 low disease frequently presents opportunities for identification and treatment of tractable clinical problems and is currently a rapidly evolving field with potential for the development of novel targeted therapeutics.

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