Owner Perceptions of Long-Term Systemic Use of Subcutaneous Administration of Polysulfated Glycosaminoglycan

2021 ◽  
Author(s):  
Gabriella Varcoe ◽  
Julia Tomlinson ◽  
Jane Manfredi
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Gastrointestinal Symptoms ◽  
Subcutaneous Administration ◽  
Degenerative Joint Disease ◽  
Severe Adverse Event ◽  
Joint Disease ◽  
Disease Modifying ◽  
Rehabilitation Clinic

ABSTRACT Polysulfated glycosaminoglycan (PSGAG) is a slow-acting disease-modifying agent used to treat degenerative joint disease. Although labeled for intramuscular use, it is commonly given by owners via a subcutaneous (SC) route. There is little information on adverse events related to SC administration or what other therapies are used concurrently with PSGAG. We hypothesized that SC PSGAG is perceived by owners as having minimal adverse events and that it would most often be given with other therapies. Owners (n = 378) were surveyed about their perceptions regarding SC PSGAG prescribed to dogs at one veterinary rehabilitation clinic. Complete surveys were provided for 69 dogs (two owners had multiple dogs). Overall, 13/69 (18.8%) dogs had an adverse event reported during the use of PSGAG. Most events were considered minor (stomach upset, loose stool, pain at injection site, fear) and did not lead to discontinuation of PSGAG. One dog experienced a moderate adverse event (persistent gastrointestinal symptoms) and one a severe adverse event (thrombocytopenia, bruising), which resolved after discontinuing PSGAG. PSGAG is most commonly administered along with other medications and rehabilitation therapies. The present study demonstrates that SC administration of PSGAG is well tolerated in most of the dogs, with primarily mild, self-resolving adverse events.

Owner Perceptions of Long-Term Systemic Use of Subcutaneous Administration of Polysulfated Glycosaminoglycan

2021 ◽  
Vol 57 (5) ◽  
pp. 205-211
Author(s):  
Gabriella Varcoe ◽  
Julia Tomlinson ◽  
Jane Manfredi
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Gastrointestinal Symptoms ◽  
Subcutaneous Administration ◽  
Degenerative Joint Disease ◽  
Severe Adverse Event ◽  
Joint Disease ◽  
Disease Modifying ◽  
Rehabilitation Clinic

ABSTRACT Polysulfated glycosaminoglycan (PSGAG) is a slow-acting disease-modifying agent used to treat degenerative joint disease. Although labeled for intramuscular use, it is commonly given by owners via a subcutaneous (SC) route. There is little information on adverse events related to SC administration or what other therapies are used concurrently with PSGAG. We hypothesized that SC PSGAG is perceived by owners as having minimal adverse events and that it would most often be given with other therapies. Owners (n = 378) were surveyed about their perceptions regarding SC PSGAG prescribed to dogs at one veterinary rehabilitation clinic. Complete surveys were provided for 69 dogs (two owners had multiple dogs). Overall, 13/69 (18.8%) dogs had an adverse event reported during the use of PSGAG. Most events were considered minor (stomach upset, loose stool, pain at injection site, fear) and did not lead to discontinuation of PSGAG. One dog experienced a moderate adverse event (persistent gastrointestinal symptoms) and one a severe adverse event (thrombocytopenia, bruising), which resolved after discontinuing PSGAG. PSGAG is most commonly administered along with other medications and rehabilitation therapies. The present study demonstrates that SC administration of PSGAG is well tolerated in most of the dogs, with primarily mild, self-resolving adverse events.

scholarly journals Considering additive effects of polypharmacy

2020 ◽  
Author(s):  
Monika Lexow ◽  
Kathrin Wernecke ◽  
Gordian L. Schmid ◽  
Ralf Sultzer ◽  
Thilo Bertsche ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Additive Effects ◽  
Product Characteristics ◽  
Cross Sectional ◽  
Term Care ◽  
Event Identification ◽  
Summary Of Product Characteristics ◽  
Naranjo Algorithm

Summary Background Potential additive effects of polypharmacy are rarely considered in adverse events of geriatric patients living in long-term care facilities. Our aim, therefore, was to identify adverse events in this setting and to assess plausible concomitant drug causes. Methods A cross-sectional observational study was performed in three facilities as follows: (i) adverse event identification: we structurally identified adverse events using nurses’ interviews and chart review. (ii) Analysis of the concomitantly administered drugs per patient was performed in two ways: (ii.a) a review of summary of product characteristics for listed adverse drug reactions to identify possible causing drugs and (ii.b) a causality assessment according to Naranjo algorithm. Results (i) We found 424 adverse events with a median of 4 per patient (range 1–14) in 103 of the 104 enrolled patients (99%). (ii.a) We identified a median of 3 drugs (range 0–11) with actually occurring adverse events listed as an adverse drug reaction in the summary of product characteristics. (ii.b) Causality was classified in 198 (46.9%) of adverse events as “doubtful,” in 218 (51.2%) as “possible,” in 7 (1.7%) as “probable,” and in 1 (0.2%) adverse event as a “definitive” cause of the administered drugs. In 340 (80.2%) of all identified adverse events several drugs simultaneously reached the highest respective Naranjo score. Conclusion Patients in long-term facilities frequently suffer from many adverse events. Concomitantly administered drugs have to be frequently considered as plausible causes for adverse events. These additive effects of drugs should be more focused in patient care and research.

scholarly journals Intermediate to Long Term Clinical and Radiographic Outcomes of Triple Arthrodesis: A 422 Case Retrospective Review

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0025
Author(s):  
Jesse King ◽  
Karl Henrikson ◽  
Thomas Harper ◽  
Mike Anderson ◽  
Chris Stauch ◽  
...  
Keyword(s):  
Infection Rate ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Triple Arthrodesis ◽  
Non Union ◽  
Radiographic Outcomes ◽  
Diabetic Status ◽  
Radiographic Data

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: Triple arthrodesis is a commonly performed surgical treatment for hindfoot arthritis and deformity. No study has clearly delineated correlates of both clinical and radiographic outcomes in a sample size this large. The purpose of this study is to explore predictive and demographic outcome measures with long-term followup after triple arthrodesis. Methods: With IRB approval, an institutional radiology database was queried for patients undergoing triple arthrodesis between 2004 and 2016, by a single surgeon at a single institution. A total of 465 cases were identified. Pre- and post-operative clinical and radiographic data was collected retrospectively. Demographic and predictive data included: age, Body Mass Index (BMI), American Society of Anesthesiologists Score (ASA), Charleston Comorbidity Index (CCI), diabetic status, osteoporosis, hypothyroidism, and neuromuscular disease status. Clinical outcomes including infection rate, reoperation rate and clinical nonunion were recorded. Unintended return to the operating room defined clinical failure. Radiographic data including non-union rate, pre- and post- operative ankle degenerative joint disease was also recorded. Statistical analysis was then performed to evaluate the relationship between predictive measures and various outcomes including reoperation, infection, and non-union rates. 23 cases were lost to follow-up. Results: A total of 442 feet (397 patients) were analyzed. The average age was 54 years (14 to 85) with the majority of cases being female (60%). Average follow up was 593 days (40 to 4079). Overall failure rate was 13.7% with clinical nonunion rate of 4.5%. Infection rate was 5.9%. Mortality rate was 0% at 2 years post-operatively. Predictors of failure included: increased BMI, elevated ASA, history of diabetes, underlying neuromuscular disorder (Figure 1). We found no significant difference between pre and post-operative degenerative joint disease rates in the midfoot (9.4%, 12.5%) and ankle (11.7%,13.7%), respectively. Conclusion: Triple arthrodesis is a highly effective procedure for treating hindfoot arthritis. Certain predictive measures including BMI, ASA score, diabetic status and underlying neuromuscular disorders significantly correlate with radiographic union. Additionally, diabetic status significantly correlates with infection status postoperatively. An understanding of these predictive measures may help surgeons in their preoperative planning to improve their clinical and radiographic success rates.

scholarly journals The N-Acetyl Phenylalanine Glucosamine Derivative Attenuates the Inflammatory/Catabolic Environment in a Chondrocyte-Synoviocyte Co-Culture System

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Stefania Pagani ◽  
Manuela Minguzzi ◽  
Laura Sicuro ◽  
Francesca Veronesi ◽  
Spartaco Santi ◽  
...  
Keyword(s):  
Nuclear Translocation ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Primary Cells ◽  
Catabolic Enzymes ◽  
Disease Modifying Therapy ◽  
Gene And Protein Expression ◽  
Disease Modifying

Abstract Osteoarthritis (OA), the most prevalent degenerative joint disease, still lacks a true disease-modifying therapy. The involvement of the NF-κB pathway and its upstream activating kinases in OA pathogenesis has been recognized for many years. The ability of the N-acetyl phenylalanine glucosamine derivative (NAPA) to increase anabolism and reduce catabolism via inhibition of IKKα kinase has been previously observed in vitro and in vivo. The present study aims to confirm the chondroprotective effects of NAPA in an in vitro model of joint OA established with primary cells, respecting both the crosstalk between chondrocytes and synoviocytes and their phenotypes. This model satisfactorily reproduces some features of the previously investigated DMM model, such as the prominent induction of ADAMTS-5 upon inflammatory stimulation. Both gene and protein expression analysis indicated the ability of NAPA to counteract key cartilage catabolic enzymes (ADAMTS-5) and effectors (MCP-1). Molecular analysis showed the ability of NAPA to reduce IKKα nuclear translocation and H3Ser10 phosphorylation, thus inhibiting IKKα transactivation of NF-κB signalling, a pivotal step in the NF-κB-dependent gene expression of some of its targets. In conclusion, our data confirm that NAPA could truly act as a disease-modifying drug in OA.

Reporting adverse events at geriatric facilities

2014 ◽  
Vol 27 (2) ◽  
pp. 91-98 ◽  
Author(s):  
Tali Shmueli ◽  
Ronit Har Noy ◽  
Merav Ben Natan ◽  
Joshua Ben-Israel
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Event Management ◽  
Content Type ◽  
Adverse Event Management ◽  
Practical Nurses ◽  
Geriatric Center

Purpose – Adverse events and patient care-related adverse events are a challenging universal problem, among elder residents of geriatric facilities. The aim of this study was to examine which types of adverse events are characteristic of the geriatric center studied and which of the nursing staff reported this event. Design/methodology/approach – Data were retrieved from the computerized adverse event management system at a large geriatric center in central Israel, and all adverse events reported over the past three years were examined. Findings – The study findings indicate that the most common type of adverse event was falls. Older nurses with greater seniority in the facility show a higher tendency to report adverse events. In addition, registered nurses were found to report more often than practical nurses. Practical implications – This study highlights the important role that nurses can play in reporting and reducing adverse events. The role of the nurse is becoming increasingly complex, especially in geriatric facilities, which serve people with complex mental and physical states who are more susceptible to adverse events to begin with. Originality/value – Despite the large number of adverse events, few studies have been undertaken on adverse events in geriatrics in general, and in nursing homes and long-term facilities in particular. Answers to these questions will enable improvement in the quality of care provided and ensure a safe care environment for residents. Systematically examining types of adverse events and the characteristics of those who do and do not report them, can contribute to improvement of processes in the healthcare system in general, and in the facility in particular. Additionally, efficient investigation can improve the behavior of those who enable adverse events.

Clinical Evaluation and Long-Term Follow-Up of Dogs Having Coronoidectomy for Elbow Incongruity

2003 ◽  
Vol 39 (5) ◽  
pp. 473-478 ◽  
Author(s):  
Margaret Puccio ◽  
Dominic J. Marino ◽  
Joseph D. Stefanacci ◽  
Brian McKenna
Keyword(s):  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Disease Entity ◽  
Radiographic Findings ◽  
Clinical Presentations ◽  
Long Term Follow Up ◽  
The Mean ◽  
Joint Incongruity

A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.

Role of Arthroscopy in Ankle Degenerative Joint Disease: Long Term Retrospective Outcome (SS-48)

2013 ◽  
Vol 29 (6) ◽  
pp. e23-e24
Author(s):  
Francesco Allegra ◽  
Fabio Cerza ◽  
Emanuele Delianni ◽  
Stefano El Boustany ◽  
Roberto Zannoni
Keyword(s):  
Degenerative Joint Disease ◽  
Joint Disease

scholarly journals Safety and Tolerability, Dose-Escalating, Double-Blind Trial of Oral Mannitol in Parkinson's Disease

2022 ◽  
Vol 12 ◽  
Author(s):  
Eduard Linetsky ◽  
Suaad Abd Elhadi ◽  
Max Bauer ◽  
Akiva Gallant ◽  
Montaser Namnah ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Adverse Events ◽  
Gastrointestinal Symptoms ◽  
Secondary Outcome ◽  
Maximal Dose ◽  
Double Blind ◽  
Efficacy Measures ◽  
Dose Escalating

Mannitol, a natural alcoholic-sugar, was recently suggested as a potential disease-modifying agent in Parkinson's disease. In animal models of the disease, mannitol interferes with the formation of α-synuclein fibrils, inhibits the formation of α-synuclein oligomers and leads to phenotypic recovery of impaired motor functions. Parkinson's patients who consume mannitol report improvements of both motor and non-motor symptoms. Safety of long-term use of oral mannitol, tolerable dose and possible benefit, however, were never clinically studied. We studied the safety of oral mannitol in Parkinson's disease and assessed the maximal tolerable oral dose by conducting a phase IIa, randomized, double-blind, placebo-controlled, single-center, dose-escalating study (ClinicalTrials.gov Identifier: NCT03823638). The study lasted 36 weeks and included four dose escalations of oral mannitol or dextrose to a maximal dose of 18 g per day. The primary outcome was the safety of oral mannitol, as assessed by the number of adverse events and abnormal laboratory results. Clinical and biochemical efficacy measures were collected but were not statistically-powered. Fourteen patients receiving mannitol completed the trial (in addition to eight patients on placebo). Mannitol-related severe adverse events were not observed. Gastrointestinal symptoms limited dose escalation in 6/14 participants on mannitol. None of the clinical or biochemical efficacy secondary outcome measures significantly differed between groups. We concluded that long-term use of 18 g per day of oral mannitol is safe in Parkinson's disease patients but only two third of patients tolerate this maximal dose. These findings should be considered in the design of future efficacy trials.

Traumatic Coxofemoral Luxation in Dysplastic Dogs Managed with a Triple Pelvic Osteotomy: Results in four Dogs

1997 ◽  
Vol 10 (03) ◽  
pp. 136-140 ◽  
Author(s):  
D. D. Lewis ◽  
S. C. Kerwin ◽  
S. T. Murphy
Keyword(s):  
Femoral Head ◽  
Hip Dysplasia ◽  
External Rotation ◽  
Pelvic Osteotomy ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Contralateral Limb ◽  
Norberg Angle

SummaryTriple pelvic osteotomy (TPO) was used in the treatment for traumatic coxofemoral luxations in four adult, large breed dogs with hip dysplasia. Initial closed reductions failed in three and one dog had an initial closed reduction and subsequent open reduction of the coxofemoral luxation that failed. Hip dysplasia was thought to be a prominent factor contributing to the reluxation. TPO successfully maintained reduction of the coxofemoral luxation in all of the dogs. An increase in dorsal acetabular coverage of the femoral head following TPO was demonstrated by an increased Norberg angle. The improved congruency was thought to maintain reduction of the femoral head in the acetabulum and decrease stresses on the joint capsule, allowing healing to occur. Long-term (median: 343, mean ± SD: 406 ± 226 days follow-up) function of the affected limb was comparable to the contralateral limb. Three of the four dogs did not have radiographic progression of coxofemoral degenerative joint disease of the affected joint and differences in the progression of degenerative joint disease were not evident between the affected and the contralateral coxofemoral joint. A decrease in abduction and external rotation and an increase in internal rotation following TPO was noted in the affected coxofemoral joint. Our results establish the utility of this procedure in dysplastic dogs with traumatic coxofemoral luxations.Triple pelvic osteotomy used in the treatment for traumatic coxofemoral luxation in four adult, large breed dogs with hip dysplasia successfully maintained reduction and resulted in satisfactory limb function in all patients.

Incorporating a rehabilitation ethos into the management of canine osteoarthritis

2021 ◽  
Vol 26 (7) ◽  
pp. 139-146
Author(s):  
Hannah Capon
Keyword(s):  
Complex Disease ◽  
Evidence Base ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Mobility Function ◽  
High Incidence ◽  
Related Quality ◽  
Health Related

Osteoarthritis is a painful and debilitating degenerative condition with an extremely high incidence. Consequently, it is frequently encountered in first opinion practice and was recently cited as a primary cause of welfare compromise through extensive population studies carried out by Vet Compass, a division of the Royal Veterinary College. In the preceding article of this series (https://doi.org/10.12968/coan.2021.0014), the author provided a brief overview of the complexity of chronic pain associated with osteoarthritis and advocated for a polypharmacy approach guided by the clinical presentation. However, pain is only one clinical manifestation of degenerative joint disease. Osteoarthritis affects the whole joint and local support structures, as well as impacting the entire musculoskeletal system. Interventions targeting the multitude of consequences of this disease are likely to have greater impact on long-term analgesia, independent mobility, function, longevity and overall health-related quality of life. This article introduces the clinical reasoning and evidence base associated with an integrated multimodal approach to a multifaceted and complex disease.

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