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PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261139
Author(s):  
Annabel J. Craven ◽  
Camilla Pegram ◽  
Rowena M. A. Packer ◽  
Susan Jarvis ◽  
Paul D. McGreevy ◽  
...  

Undesirable behaviours (UBs) in dogs are common and important issues with serious potential welfare consequences for both the dogs and their owners. This study aimed to investigate the usage of drug therapy for UBs in dogs and assess demographic risk factors for drug-prescribed UBs within the dog population under primary-care veterinary care in the UK in 2013. Dogs receiving drug therapy for UB were identified through the retrospective analysis of anonymised electronic patient records in VetCompass™. Risk factor analysis used multivariable logistic regression modelling. The study population comprised 103,597 dogs under veterinary care in the UK during 2013. There were 413 drug-prescribed UBs recorded among 404 dogs. The prevalence of dogs with at least one UB event treated with a drug in 2013 was 0.4%. Multivariable modelling identified 3 breeds with increased odds of drug-prescribed UB compared with crossbred dogs: Toy Poodle (OR 2.75), Tibetan Terrier (OR 2.68) and Shih-tzu (OR 1.95). Increasing age was associated with increased odds of drug-prescribed UB, with dogs ≥ 12 years showing 3.1 times the odds compared with dogs < 3 years. Neutered males (OR 1.82) and entire males (OR 1.50) had increased odds compared with entire females. The relatively low prevalence of dogs with at least one UB event that was treated with a drug in 2013 could suggest that opportunities for useful psychopharmaceutical intervention in UBs may be being missed in first opinion veterinary practice. While bodyweight was not a significant factor, the 3 individual breeds at higher odds of an UB treated with a behaviour modifying drug all have a relatively low average bodyweight. The current results also support previous research of a male predisposition to UBs and it is possible that this higher risk resulted in the increased likelihood of being prescribed a behaviour modifying drug, regardless of neuter status.


Author(s):  
Alexander Seifert ◽  
Neil Charness

AbstractDigital (consumer) services, such as ticket machines, self-checkout, and online reservations, have become increasingly important in modern society. Studies on adoption of these services and openness to using future public digital services (e.g., online voting, online taxes, electronic patient records) have mostly focused on younger adults or nonrepresentative samples among older adults. Therefore, two important questions remain that can best be addressed with representative sampling: To what extent do older adults use or are willing to use current and future digital services in their everyday lives? How do older adults evaluate the ease of use of these services?. The study included data on use of current and future digital services among a large Swiss sample of 1149 people age 65 years and older (mean age: 74.1 years, SD: 6.69). Descriptive and multivariate analyses showed that (a) established services such as cash machines were used more often than new services, such as self-checkout apps or machines. (b) Perceived ease of use is related to age, socioeconomic status, health, and interest in technology. (c) Only 8.9% had an overall positive attitude toward these digital services, and this attitude was predicted by age, gender, socioeconomic status, and interest in technology. (d) Participants were more often open to filing taxes online than voting online, and openness was predicted by age, income, and interest in technology. Today, mainly older adults with a high interest in technology use digital services. Nevertheless, potential for greater use is evident.


Author(s):  
Ole Kristian Alhaug ◽  
Simran Kaur ◽  
Filip Dolatowski ◽  
Milada Cvancarova Småstuen ◽  
Tore K. Solberg ◽  
...  

Abstract Purpose Data quality is essential for all types of research, including health registers. However, data quality is rarely reported. We aimed to assess the accuracy of data in a national spine register (NORspine) and its agreement with corresponding data in electronic patient records (EPR). Methods We compared data in NORspine registry against data in (EPR) for 474 patients operated for spinal stenosis in 2015 and 2016 at four public hospitals, using EPR as the gold standard. We assessed accuracy using the proportion correctly classified (PCC) and sensitivity. Agreement was quantified using Kappa statistics or interaclass correlation coefficient (ICC). Results The mean age (SD) was 66 (11) years, and 54% were females. Compared to EPR, surgeon-reported perioperative complications displayed weak agreement (kappa (95% CI) = 0.51 (0.33–0.69)), PCC of 96%, and a sensitivity (95% CI) of 40% (23–58%). ASA classification had a moderate agreement (kappa (95%CI) = 0.73 (0.66–0.80)). Comorbidities were underreported in NORspine. Perioperative details had strong to excellent agreements (kappa (95% CI) ranging from 0.76 ( 0.68–0.84) to 0.98 (0.95–1.00)), PCCs between 93% and 99% and sensitivities (95% CI) between 92% (0.84–1.00%) and 99% (0.98–1.00%). Patient-reported variables (height, weight, smoking) had excellent agreements (kappa (95% CI) between 0.93 (0.89–0.97) and 0.99 (0.98–0.99)). Conclusion Compared to electronic patient records, NORspine displayed weak agreement for perioperative complications, moderate agreement for ASA classification, strong agreement for perioperative details, and excellent agreement for height, weight, and smoking. NORspine underreported perioperative complications and comorbidities when compared to EPRs. Patient-recorded data were more accurate and should be preferred when available.


2022 ◽  
Author(s):  
Hanna Karhapää ◽  
Siru Mäkelä ◽  
Hanna Laurén ◽  
Marjut Jaakkola ◽  
Camilla Schalin-Jäntti ◽  
...  

Objective: Immune checkpoint inhibitors (ICI) can cause endocrine adverse events. However, endocrine AEs could be related to better treatment outcomes. Our aim was to investigate whether this holds true in a real-world setting of metastatic melanoma patients. Design: A retrospective single-institution study. Methods: We included 140 consecutive metastatic melanoma patients treated with ICI between January 2012 and May 2019. We assessed endocrine toxicity and best possible treatment outcomes from electronic patient records, including laboratory parameters, and radiological images. Results: Of the treated patients, 21 patients (15%) were treated with ipilimumab, 46 (33%) with nivolumab, 67 (48%) with pembrolizumab, and six (4%) with combination therapy (ipilimumab + nivolumab). Endocrine AEs appeared in 29% (41/140) patients. Three patients had two different endocrine AEs. Thyroid disorders were the most common: 26% (36/140), followed by hypophysitis: 4% (5/140). Three subjects (2%, 3/140) were diagnosed with autoimmune diabetes. Three patients had to terminate treatment due to endocrine toxicity. Radiological manifestations of endocrine AEs were found in 16 patients (39%, 16/41). Endocrine toxicity was associated with significantly better treatment outcomes. Median progression-free survival (8.1 months, range 5.1 – 11.1 months vs. 2.7 months, range 2.4 – 3.0 months, P < 0.001), and median overall survival (47.5 months, range 15.5 – 79.5 months vs. 23.7 months, range 15.3 – 32.1 months, P = 0.035) were longer for patients experiencing endocrine AEs. Conclusions: The higher number of endocrine AEs suggest regular laboratory monitoring aids in AE detection. Endocrine AEs in metastatic melanoma may correlate with better treatment outcomes.


2021 ◽  
Author(s):  
Alen Hascic ◽  
Aline Wolfensberger ◽  
Lauren Clack ◽  
Peter Werner Schreiber ◽  
Stefan P Kuster ◽  
...  

Abstract Background Healthcare-associated infections remain a preventable cause of patient harm in healthcare. Full documentation of adherence to evidence-based best practices for each patient can support monitoring and promotion of infection prevention measures. Thus, we reviewed the extent, nature, and determinants of the documentation of infection prevention (IP) standards in patients with HAI. Methods We reviewed the electronic patient records (EMRs) of patients included in four annual point-prevalence studies 2013-2016 who developed a device- or procedure-related HAI (catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated infection (VAP), surgical site infection (SSI)). We examined the documentation quality of mandatory preventive measures published as institutional IP standards. Additionally, we undertook semi-structured interviews with healthcare providers and a two-step inductive (grounded theory) and deductive (Theory of Planned Behaviour) content analysis. Results Of overall 2972 surveyed patients, 249 patients developed 272 healthcare-associated infections (8.4%). Of these, 116 patients met the inclusion criteria, classified as patients with CAUTI, CLABSI, VAP, SSI in 21 (18%), 7 (6%), 10 (9%), 78 (67%) cases, respectively. We found a documentation of the IP measures in electronic medical records (EMR) in 432/1308 (33%) cases. Documentation of execution existed in the study patients’ EMR for CAUTI, CLABSI, VAP, SSI, and overall, in 27/104 (26%), 26/151 (17%), 46/122 (38%), 261/931 (28%), and 360/1308 (28%) cases, respectively, and documentation of non-execution in 2/104 (2%), 3/151 (2%), 0/122 (0%), 67/931 (7%), and 72/1308 (6%) cases, respectively. Healthcare provider attitude, subjective norm, and perceived behavioural control indicated reluctance to document IP standards. Conclusions EMRs rarely included conclusive data about IP standards adherence. Documentation had to be established indirectly through data captured for other reasons. It can be projected that a mandatory institutional documentation protocol and technically automated documentation would be necessary to alleviate this shortcoming in patient safety documentation.


2021 ◽  
Author(s):  
Shu Xin Teh ◽  
Andrew Bridgen ◽  
Shek Hong Ip

Abstract Background: Onychocryptosis is a common and debilitating condition that often require surgical management. Despite this minor procedure being the most common and effective method in managing this condition, as well as being one of the essential services provided by Health Care Professional Council (HCPC) registered podiatrists, there is limited evidence around the effectiveness of this procedure in the community setting. The aim of this study was to evaluate the effectiveness of a non-invasive minor procedure for the management of onychocryptosis. Methods: A retrospective study was undertaken within the community podiatry department. All patients who underwent minor procedure for the management of onychocryptosis between June 2018 and December 2019 were included in this study. The data were collected from the electronic patient records using a comprehensive data collection tool. Recurrence rate and infection rate were calculated to determine the effectiveness of the minor procedure. Results: 354 minor procedures were performed on 272 patients presenting with onychocryptosis. The recurrence rate of nail regrowth following intervention was 5.6% (N=20). Patients <40 years old were more likely to experience a recurrence of nail regrowth following an intervention (N=16). The postoperative infection rate was 8.8% (N=31). Patients who had a partial nail avulsion procedure were more likely to experience postoperative infection compared to total nail avulsion.Conclusions: Although the management of onychocryptosis with this minor procedure is effective within the community podiatry department, incorporation of evaluation of patient satisfaction following this procedure is suggested within the recommendations. The limitations of this study have been highlighted and a mixed method research project is recommended to explore this area of specialty to improve patient outcome.


2021 ◽  
Author(s):  
Vijay Shyam-Sundar ◽  
Dan F Stein ◽  
Martina Spazzapan ◽  
Andrew Sullivan ◽  
Cathy Qin ◽  
...  

Objective: We performed a single-centre retrospective observational study investigating the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term. Methods: All adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital (HUH) from 04.02.20 to 30.04.20 were eligible for inclusion. We retrospectively analysed demographic and biochemical data collected from the physical and electronic patient records according to the primary outcome of death at 28 days during hospital admission. Troponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5ng/l for females, >34 ng/l for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death. Results: Mean length of stay for all 402 hospitalised COVID-19 patients at HUH was 9.1 days (SD 12.0). Mean age was 65.3 years for men compared to 63.8 years for women. A chi-squared test showed that survival of COVID-19 patients was significantly higher in those with a negative troponin (p = 3.23 x10-10) compared to those with a positive troponin. In the multivariate logistical regression, lung disease, age, troponin positivity and CPAP were all significantly associated with death, with an AUC of 0.8872, sensitivity of 0.9004 and specificity of 0.6292 for the model. Within this model, troponin positivity was independently associated with short term mortality (OR 3.23, 95% CI 1.53-7.16, p=0.00278). Conclusions: We demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital.


Hand ◽  
2021 ◽  
pp. 155894472110635
Author(s):  
Sidharth Sharma ◽  
Jason Ong ◽  
Amit Putti

Background: Proximal interphalangeal joint (PIPJ) osteoarthritis is a common condition that results in pain, stiffness, and loss of function in the affected hand. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. The wide-awake local anesthesia no tourniquet (WALANT) technique to perform surgery carries advantages such as lack of tourniquet discomfort, reduces the staffing and costs associated with anesthesia and sedation, and allows faster recovery. We aimed to determine whether the WALANT technique was safe and effective in the context of PIPJ arthroplasty. Methods: Patients were enrolled retrospectively from January 2015 to October 2020 by examining operating theater records and surgeon logbooks. Electronic patient records were examined to obtain patient data. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and Visual Analog Scale (VAS) for pain were sent by post to patients—with a separate DASH and VAS for each digit operated on. Results: Twenty-nine PIPJ arthroplasties were carried out using WALANT technique by 3 different surgeons all using the dorsal approach. All cases were successfully carried out as day-case procedures. There was a significant correlation with increasing VAS and increasing DASH score. Proximal interphalangeal joint arthroplasty improved range of motion from 28.9 ± 5.5° to 79.4 ± 13.3° ( P < .0001). Two cases developed complications related to surgery. Conclusions: Our study is the first to report the use of WALANT to perform PIPJ arthroplasty, and shows comparable results with traditional methods. Larger, multicenter prospective trials are required to determine the efficacy of this technique and to quantify its economical benefit.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049709
Author(s):  
Ina H Laursen ◽  
Karina Banasik ◽  
Amalie D Haue ◽  
Oscar Petersen ◽  
Peter C Holm ◽  
...  

PurposeThe aim of Copenhagen Hospital Biobank-Cardiovascular Disease Cohort (CHB-CVDC) is to establish a cohort that can accelerate our understanding of CVD initiation and progression by jointly studying genetics, diagnoses, treatments and risk factors.ParticipantsThe CHB-CVDC is a large genomic cohort of patients with CVD. CHB-CVDC currently includes 96 308 patients. The cohort is part of CHB initiated in 2009 in the Capital Region of Denmark. CHB is continuously growing with ~40 000 samples/year. Patients in CHB were included in CHB-CVDC if they were above 18 years of age and assigned at least one cardiovascular diagnosis. Additionally, up-to 110 000 blood donors can be analysed jointly with CHB-CVDC. Linkage with the Danish National Health Registries, Electronic Patient Records, and Clinical Quality Databases allow up-to 41 years of medical history. All individuals are genotyped using the Infinium Global Screening Array from Illumina and imputed using a reference panel consisting of whole-genome sequence data from 8429 Danes along with 7146 samples from North-Western Europe. Currently, 39 539 of the patients are deceased.Findings to dateHere, we demonstrate the utility of the cohort by showing concordant effects between known variants and selected CVDs, that is, >93% concordance for coronary artery disease, atrial fibrillation, heart failure and cholesterol measurements and 85% concordance for hypertension. Furthermore, we evaluated multiple study designs and the validity of using Danish blood donors as part of CHB-CVDC. Lastly, CHB-CVDC has already made major contributions to studies of sick sinus syndrome and the role of phytosterols in development of atherosclerosis.Future plansIn addition to genetics, electronic patient records, national socioeconomic and health registries extensively characterise each patient in CHB-CVDC and provides a promising framework for improved understanding of risk and protective variants. We aim to include other measurable biomarkers for example, proteins in CHB-CVDC making it a platform for multiomics cardiovascular studies.


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