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Aims: Since 2020 there has been an increase in the number of polyps removed from patients scoped for the Bowel Cancer Screening Programme (BCSP) of England. General cellular pathology workload also continues to increase disproportionately ahead of consultant pathologist numbers in the United Kingdom. The Optical Diagnosis initiative for BCSP patients has not yet, and may not be, implemented at every hospital in England. The following study therefore aimed to determine whether only a certain number of removed polyps need to be histologically assessed to consistently guide a BCSP patient's post‐polypectomy management, and whether all remaining smaller polyps beyond that number could then be discarded. Methods: This retrospective study considered all BCSP specimens/cases submitted to the Cellular Pathology department of a large English teaching hospital from 2016 to 2024. Only cases with six or more resected polyps, for which the endoscopic report stated individual sizes, were included in the final study cohort. Results: Of the 8066 BCSP cases submitted to the aforementioned department, there were six or more polyps for 345 cases. Analysis of the final study cohort of 135 cases showed that assessment of the seven largest polyps measured endoscopically was sufficient to correctly guide follow‐up management of the BCSP patient as per the 2020 British Society of Gastroenterology post‐polypectomy guidelines. Conclusions: When colonoscopy of a BCSP patient leads to removal of multiple polyps, only the seven largest polyps need to be assessed histologically and the remaining smaller polyps could be discarded with no impact to the patient's BCSP‐related management. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusion To explore how women appreciated the risks discussed within the consent process for planned caesarean section (CS).Exploratory qualitative interview study.NHS Teaching Hospital in Central London.Women over the age of 18, English speaking, scheduled for a planned CS.Semi‐structured interviews were conducted before and after a woman's CS. Eighteen women were recruited and interviewed prior to undergoing CS and 12 of these were interviewed following CS. Interviews were audio‐recorded, transcribed and thematically analysed.Themes generated from analysis of interviews exploring the experiences of women consenting to CS and specifically their awareness of postpartum haemorrhage (PPH), hysterectomy, organ damage and risk of placental abnormalities in future pregnancies.Two broad themes and four subthemes were identified (1) Untimely provision of risk information: (a) superficial risk discussions during the antenatal period and full risk disclosure on the day of surgery and (b) incompleteness absent or sparse risk disclosure prior to making the decision to undergo the CS, where women were unaware of specific risks and (2) Emotional overload: (a) fear of risks and (b) fear that a CS will be denied to them—women's cognitive response and notably their emotional response to their situation limited their understanding of risks disclosed.The consent process for planned CS was found to lack appropriate and full risk disclosure. Risk disclosure was ill‐timed or deficient in facilitating women's understanding of risks reflecting a consent process which does not meet legal and professional standards of informed consent. [ABSTRACT FROM AUTHOR]

Objectives Animals Studied Procedure Results Conclusion This study aimed to explore anatomical differences in the aqueous humor (AH) outflow pathway between male and female dogs using ultrasound biomicroscopy (UBM).Clinical data were collected from 30 eyes of 30 dogs (15 males: 10 right eyes, 5 left eyes; and 15 females: 7 right eyes, 8 left eyes) treated at the Veterinary Medical Teaching Hospital of Chungbuk National University, South Korea, between August 2018 and February 2024.The study conducted an in‐depth UBM examination, specifically observing peripheral anterior chamber depth (ACD), geometric iridocorneal angle (ICA), and angle‐opening distance (AOD) alongside measurements of ciliary cleft width (CCW), length (CCL), and area (CCA), and assessed the longitudinal fibers of ciliary muscle thickness (Lf‐CMT) and the longitudinal and radial fibers of ciliary muscle thickness (LRf‐CMT) for gender‐based differences.The study identified a significant sex difference in peripheral ACD, with females displaying shallower depths compared to males, potentially clarifying the higher incidence of glaucoma in female dogs. No significant gender differences were found in ICA, AOD, CC parameters, or ciliary muscle parameters measurements.This research uncovered that peripheral ACD is significantly shallower in females than in males, potentially indicating a risk factor that could contribute to the development of primary angle‐closure glaucoma. [ABSTRACT FROM AUTHOR]

Introduction: There are few accurate prognostic indications of the illness's development and severity for COVID‐19, despite certain biomarkers having been investigated. The unexpected nature of COVID‐19's course, which can quickly progress from asymptomatic to life‐threatening symptoms, lies at the heart of the disease's intricacy. Predicting SARS‐CoV‐2 pathogenicity through laboratory biomarkers and as such, identifying the patients' illness severity at the time of their initial admission would be crucial in improving patient care. In this study, we sought to evaluate the potential of hematological, biochemical, and inflammatory biomarkers in predicting the course of COVID‐19 at a tertiary hospital in western Kenya. Methods: This cross‐sectional study involved 48 COVID‐19 patients (16 asymptomatic; 16 moderate symptomatic; and 16 severe symptomatic) and 48 age‐sex‐matched COVID‐19‐negative clients attending the Moi Teaching and Referral Hospital, Kenya. Demographic information, self‐reported chronic illnesses, symptoms, and laboratory results were collected at recruitment. Results: Significantly, the severity of COVID‐19 was associated with; hemoglobin (p < 0.0001), white blood cells (p = 0.0022), hematocrit (p < 0.0001), blood urea nitrogen (p = 0.01), blood sodium (p = 0.0002), potassium (p = 0.0483), C‐reactive protein (p = 0.0002), and Lactate Dehydrogenase (p < 0.0001). Regression analysis of CRP revealed a strong positive correlation (p = 0.0006) whereas LDH revealed a weak positive correlation (p < 0.0001) with COVID‐19 disease severity. Discriminative accuracy was highest when asymptomatic was compared to severe COVID‐19 for CRP and LDH (AUC: 0.8867, 95% CI: 0.7532–1.000) and (AUC: 1.000, 95% CI: 1.000–1.000) respectively. Conclusion: The hematological indices, inflammatory and biochemical biomarkers studied have the potential to predict the course of COVID‐19. These parameters may be useful in helping design appropriate care for COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Objectives: To assess the accuracy and utility of transabdominal sonographic paraumbilical and suprapubic sliding signs in predicting intra‐abdominal adhesions in women undergoing repeat Cesarean section (CS), and to investigate the association of repeat CS with short‐term maternal and neonatal outcomes. Methods: This was a prospective observational study of pregnant women with a history of CS who were scheduled for third‐trimester elective or emergency CS at a tertiary referral and teaching hospital between July 2021 and June 2022. In order to evaluate the role of transabdominal sonographic paraumbilical and suprapubic sliding signs in the prediction of intra‐abdominal adhesions, participants underwent a high‐resolution transabdominal ultrasound scan prior to repeat CS. Free cephalad and caudad gliding of the uterus under the abdominal wall during deep inhalation and exhalation in each area was considered a positive sliding sign, suggesting a low risk of intra‐abdominal adhesions. The absence of such movement was considered a negative sliding sign, suggesting a high risk of intra‐abdominal adhesions. The presence or absence of intra‐abdominal adhesions was then confirmed during surgery by physicians who were blinded to the sonographic sliding‐sign findings. The type of adhesion, structures involved, method of adhesiolysis, incision‐to‐delivery time, 1‐min and 5‐min Apgar scores, maternal and neonatal injury and other short‐term complications were also reported. Results: Of 419 women with a history of at least one previous CS who underwent repeat CS, the preoperative sonographic paraumbilical and suprapubic sliding signs were negative in 173 (41.3%) and 178 (42.5%) women, respectively. On repeat CS, 224 (53.5%) women had intra‐abdominal adhesions, of which 165 (39.4%) had dense adhesions and 59 (14.1%) had only filmy adhesions. The sensitivity and specificity of a negative preoperative paraumbilical sliding sign in predicting the presence of dense intra‐abdominal adhesions in women undergoing repeat CS were 94.6% (95% CI, 92.4–96.7%) and 93.3% (95% CI, 90.9–95.7%), respectively. A negative suprapubic sliding sign also showed high sensitivity (95.2% (95% CI, 93.1–97.2%)) and specificity (91.7% (95% CI, 89.1–94.4%)). Additionally, a negative sliding sign at both locations in the same patient had robust sensitivity (90.2% (95% CI, 87.3–93.0%)) and specificity (96.3% (95% CI, 94.5–98.1%)). We found that the risk of dense intra‐abdominal adhesions increased with parity and the number of previous CS. Dense intra‐abdominal adhesions were associated with increased incision‐to‐delivery time, higher risk of maternal bladder injury, intraoperative bleeding and postpartum hemorrhage. Conclusions: Dense intra‐abdominal adhesions are common in women with a history of CS and are associated with delayed delivery of the neonate and increased risk of adverse maternal outcomes. The transabdominal sonographic paraumbilical and suprapubic sliding signs are robust methods for the accurate preoperative prediction of dense intra‐abdominal adhesions in patients with a history of CS. As the techniques are easy to learn and perform, the sliding sign should be used more widely for triaging patients at high risk of dense intra‐abdominal adhesions for appropriate preoperative planning. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether physical function and quality of life was influenced by discharge on the same‐day after a total laparoscopic hysterectomy. Design: Multicentre non‐inferiority randomised controlled trial. Setting: Five teaching hospitals and two university hospitals in the Netherlands. Population: Patients undergoing laparoscopic hysterectomy for benign or premalignant disease. Methods: Following informed consent, participants were allocated 1:1 either to same‐day discharge (SDD) or next‐day discharge (NDD). Main Outcome Measures: The primary outcome was physical function at 7 days after surgery measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function short Form 10A. Secondary outcomes were physical function and quality of life at 1 and 3 days and 6 weeks after surgery measured with PROMIS short Form 10A and the EuroQol questionnaire (EQ‐5D‐5L). Results: Two hundred and five patients were included of whom 105 were allocated to SDD and 100 to NDD. Physical function 7 days after surgery was 35.95 in the SDD group and 35.63 in the control group (mean difference 0.32; 95% CI [0.07–0.57]). As the upper limit of the 95% CI does not exceed the non‐inferiority margin of 4 points, non‐inferiority of SDD could be demonstrated. No difference in physical function nor quality of life on Days 1 and 3 and 6 weeks could be found. Conclusion: This research demonstrates same‐day discharge after laparoscopic hysterectomy is non‐inferior to next day discharge in physical function 7 days after surgery. [ABSTRACT FROM AUTHOR]

At our quaternary teaching hospital in Queensland, Australia, there has been a rapid increase from 2019 to 2022 in the usage of fibrinogen concentrate (FC) in preference to cryoprecipitate for cardiac surgery. FC is indicated for patients having major trauma requiring haemostatic resuscitation, major intraoperative haemorrhage, or liver transplant patients with major intraoperative haemorrhage. These patients must exhibit severe hypofibrinogenaemia, which is assessed using assay cut‐offs of thromboelastogram (TEG) (citrated functional fibrinogen [CFF] ≤ 10 mm) or rotational thromboelastometry (ROTEM) (FIBTEM A5 ≤ 8 mm). FC usage over cryoprecipitate for cardiac surgery is an ongoing debate due to advantages such as dose predictability, rapid reconstitution, viral inactivation, and minimal transfusion‐related adverse events; however, it is expensive. The aim of this study was to capture prescribing patterns of FC and appropriateness against local guidelines. Retrospective data were analysed, and the practice was compared to hospital guidelines. Data from 52 patients over a 4‐year period (2019–2022) showed intraoperative haemorrhage was the leading indication for FC use (65%, n = 34), followed by liver transplantation (27%, n = 14), and major trauma (8%, n = 4). When breaking down the cause of intraoperative haemorrhage, cardiothoracic surgery, both elective (50%, n = 17) and emergency procedures (41%, n = 14), accounted for 91% of all operative bleeding requiring FC. There were 34 (65%) of 52 patients who received a differing dose of FC compared to what was recommended in the hospital guideline, with 50% (n = 17) receiving a higher than recommended dose and 50% (n = 17) receiving lower than recommended doses. This project was exempt due to the local policy requirements that constitute research by the Metro South Human Research Ethics Committee (Reference no: CM2305202303). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of standard care involved the use of existing non‐identifiable patient records. [ABSTRACT FROM AUTHOR]

Background Approach Evaluation Implications Short ‘programmes’ of professional development can have limited impact on clinical supervisors' practices. This paper reports on an innovative programme of professional development, implemented in a tertiary teaching hospital, that was designed to build clinical supervision capacity, improve the educational practice of frontline clinical supervisors and cultivate future educational leaders.The programme was a partnership venture between St. Vincent's Hospital Melbourne and the University of Melbourne. It has a three‐tiered tapered design: a foundational self‐paced online course; online, interprofessional learning communities; and a Graduate Certificate in Clinical Education. Participants progressed from one tier to the next, with the largest number of employees participating in the primary tier (N = 112).We adopted a utilisation‐focused approach to evaluation, collecting multiple data sets across the tiers. Participants reported greater consciousness of their teaching practices, made changes to their practice, and the interprofessional learning communities allowed better integration of practical knowledge with the formal knowledge from the foundational course. Systemic outcomes included the creation of informal educator networks and the diffusion of ideas and practices within the hospital.Managers and clinical education leaders at the hospital concluded that funding this programme of professional development provided significant benefits, with a high return on investment, which may be transferable to other health care settings that place value on clinical education. For the outcomes to be sustainable, an ongoing programme of professional development needs to be built into the institution's fabric so that the resultant supervisory practices become strongly embedded in the organisational culture. [ABSTRACT FROM AUTHOR]

Objective: To compare glucose measurements from capillary and venous blood samples using a point‐of‐care (POC) glucometer with a standard laboratory (colorimetric, glucose oxidase) assay (LABGLU) in a population of hospitalized, neonatal foals. Design: Multicenter, prospective, experimental study, conducted between March 2019 and June 2020. Setting: Four university teaching hospitals and 1 private referral hospital. Animals: Fifty‐four hospitalized neonatal (≤30 days of age) foals. Interventions: Simultaneous capillary (muzzle, POCMUZ) and venous (jugular, POCJUG) blood samples were obtained to determine POC glucose concentrations. Venous samples were also analyzed by LABGLU. Each foal was sampled at the time of enrollment or admission to the hospital and at 1 subsequent point during hospitalization. Indirect mean arterial pressure and hematocrit were concurrently recorded. Measurements and Main Results: Bland–Altman analysis showed a mean bias (95% limits of agreement) of −28.0 (−88.6 to 32.6) mg/dL for comparison of POCJUG with LABGLU, −8.2 (−94.3 to 78.0) mg/dL for POCMUZ and LABGLU, and 18.8 (−44.4 to 82.0) mg/dL for POCMUZ and POCJUG. A total of 63.5% of the POCJUG and 45.2% of the POCMUZ samples exceeded the reference value by ±15 mg/dL (for LABGLU samples <75 mg/dL) or ±15% (for LABGLU samples ≥75mg/dL). Concordance correlation coefficient (95% confidence interval [CI]) indicated a fair agreement between POCJUG and LABGLU (0.75, 95% CI: 0.66–0.82) and between POCMUZ and LABGLU (0.71, 95% CI: 0.58–0.80). Fifty percent (14/28) of hypoglycemic foals on the reference method were incorrectly classified as euglycemic by POCJUG, and 5 of 28 were incorrectly classified by POCMUZ. Conclusions: In the sampled population, the chosen POC glucometer lacked agreement with the standard laboratory measurement. Limits of agreement were wide for both POCJUG and POCMUZ. Inaccuracies in POC results could impact decision‐making in the clinical management of glycemic control in hospitalized neonatal foals and, importantly, increase the risk of hypoglycemic events being underdiagnosed in critical patients. [ABSTRACT FROM AUTHOR]

Objective: To quantify and characterize plasma cannabinoid concentrations in cases of suspected cannabis toxicity in dogs, identify potential correlations between clinical signs and plasma concentrations, and assess the specificity of cannabis toxicity diagnosis based on clinical signs alone. Design: Observational study. Setting: Veterinary teaching hospital. Animals: Thirty‐eight client‐owned animals. Interventions: Blood was collected from dogs presenting to the emergency room for suspected cannabinoid intoxication based on history or physical examination findings. Samples were analyzed using a validated liquid chromatography–tandem mass spectrometry method for the cannabinoids Δ9‐tetrahydrocannabinol (THC), cannabidiol (CBD), and their active metabolites. Measurements and Main Results: The most common abnormality observed was ataxia (35/38 dogs), with urinary incontinence, lethargy, and hyperesthesia also commonly noted. Cannabinoids were quantifiable in 37 of 38 plasma samples (97.4%), with THC the predominant cannabinoid (range: 1.99–2748 ng/mL). Lower concentrations of CBD (up to 115.3 ng/mL) and cannabinoid metabolites were detected. Of the clinical signs recorded, only abnormal reflexes were statistically correlated with the THC concentration at the time of sampling (P = 0.01). Conclusions: A diagnosis of suspected cannabinoid toxicity based on case history and clinical presentation was confirmed via quantifiable plasma concentrations in nearly all cases. Although the range of plasma cannabinoid concentrations was broad, the clinical signs observed were generally similar. Other than the presence of abnormal reflexes, clinical signs were not associated with plasma THC concentrations. Subsequent confirmation of cannabinoids in plasma indicates that cannabis toxicity in dogs can be diagnosed with high specificity by veterinarians based only on history and clinical abnormalities. [ABSTRACT FROM AUTHOR]

Background: The relationship between collapse and a diagnosis of hypoadrenocorticism is not well understood in dogs. Hypothesis: To assess the prevalence of episodes of collapse in dogs screened for hypoadrenocorticism, and to assess the prevalence of confirmed hypoadrenocorticism in dogs presenting with reported collapse. Animals: Seventy‐three client‐owned dogs with resting cortisol concentrations were measured and presented to a University teaching hospital for collapse. Methods: Retrospective review of medical records of dogs at a single center. Results: The prevalence of episodes of collapse in dogs that had a resting cortisol measurement was 73/856 (8.5%; 95% confidence interval [95% CI], 6.7%‐10.6%). Resting cortisol concentration was <2 μg/dL (<55 nmol/L) in 19 dogs. Cortisol concentration after ACTH stimulation was <2 μg/dL (<55 nmol/L) in 1 of the 73 dogs in this cohort, consistent with a diagnosis of hypoadrenocorticism, giving a prevalence estimate of hypoadrenocorticism of 1.3% (95% CI, 0.15%‐6.2%). In 8 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). The most common diagnosis was vasovagal syncope (10/73), followed by sick sinus syndrome and third‐degree atrioventricular block (2/73). The final diagnosis was unknown in 24/73 dogs. Conclusions and Clinical Importance: Hypoadrenocorticism was the final diagnosis in 1 of 73 dogs presented to a teaching hospital either in a collapsed state or with a previous history of episodes of collapse. No dog presenting as cardiovascularly stable for intermittent collapse was found to have hypoadrenocorticism. [ABSTRACT FROM AUTHOR]

A 12 years‐old, male indigenous dog was presented to Shahedul Alam Qaderi Teaching Veterinary Hospital (SAQTVH) in Chattogram, Bangladesh with a large tumour on its right front leg. The histopathological findings of the tumour were highly suggestive of an alveolar rhabdomyosarcoma (ARMS). The tumour was surgically removed from the dog. While there had been no recurrence for 5 months, the patient died 5 months post‐operatively. The cause of the death and presence of metastasis could not be confirmed as follow‐up investigations were declined by the owner. A histopathological study showed poorly differentiated neoplastic mononuclear cells forming nests in an alveolar pattern. Despite that the limited resources prevented myogenin staining for diagnostic confirmation, the well‐contained, defined appearance of the tumour supports the diagnosis of ARMS. This report highlights the challenges in diagnosing and treating ARMS in indigenous dogs and emphasizes the need for further research and diagnostic markers to improve detection and management. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Multiple trigger tools have been developed to identify medication‐related hospital (re)admissions (MRRs); however, the accuracy of these tools in real‐world clinical practice is uncertain. The objective of this study was to compare the accuracy of four different trigger tools (OPERAM, STOPP/START criteria, ADR‐tool, and QUADRAT) to identify MRRs compared with clinical adjudication.We conducted a secondary analysis of patients readmitted within 30 days to seven departments of a teaching hospital. In the primary study, which involved a retrospective chart review of 1111 readmissions, MRRs and their potential preventability were clinically adjudicated by physicians and pharmacists. In the current study, four trigger tools were applied by a different physician and pharmacist panel. Patients of all ages were included. Trigger tools included both explicit items specifying the event and the associated medication and implicit items requiring clinical knowledge. The accuracy of each trigger tool was assessed by calculating the proportion of clinically adjudicated MRRs each tool identified overall as well as according to explicit and implicit triggers separately. The accuracy of each tool to identify potentially preventable MRRs was also calculated.Of 1111 readmissions, 181 were adjudicated as medication‐related (mean age 69 years, 56% male); 72 (40%) MRRs were potentially preventable. The original OPERAM tool identified 166 (92%) MRRs (62% through explicit triggers). The STOPP/START criteria identified 23 (13%, 7% through explicit triggers), the ADR tool identified 51 (28%, all explicit triggers), and the QUADRAT tool identified 76 (42%; all explicit triggers) MRRs. Of the 72 potentially preventable MRRs, OPERAM identified 59 (82%), STOPP/START identified 18 (25%), ADR identified 20 (28%), and QUADRAT identified 21 (29%).The original OPERAM tool identified the highest proportion of (preventable) MRRs. However, this tool includes many implicit triggers requiring expert clinical knowledge. Future studies should assess the practicality of implementing this tool in daily practice. [ABSTRACT FROM AUTHOR]

Objective: To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. Methods: A retrospective cross‐sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. Results: The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1–89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: −12.6% [−17.5 to −7.5], P < 0.001 vs AAPC for vacuum: −6.2% [−14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). Conclusion: IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate. Synopsis: The present study corroborates global reports of declining IVD rates and increasing CS rates. There is need to increase IVD use to potentially reduce CS rate. [ABSTRACT FROM AUTHOR]

Objective: To compare the ability of bioreactance noninvasive cardiac output (BR‐NICO) with thermodilution cardiac output (TDCO) for the measurement of cardiac output (CO) in healthy adult horses receiving 2 different IV volume replacement solutions. Design: Prospective randomized crossover study from September to November 2021. Setting: University teaching hospital. Animals: Six university‐owned adult horses. Interventions: Horses were randomly assigned to receive 7.2% hypertonic saline solution (HSS) or 6% hydroxyethyl starch (130/0.4) solution (HETA). BR‐NICO and TDCO were measured simultaneously at baseline, 10, 20, 30, 40, 50, 60, 90, and 120 minutes before fluid administration and again at the same times after starting a bolus infusion of IV volume replacers. All solutions were administered within 10 minutes. Measurements and Main Results: BR‐NICO and TDCO were strongly correlated (Pearson r2 = 0.93; P < 0.01). Regression analysis showed the relationship between TDCO and BR‐NICO was BR‐NICO = 0.48 × TDCO + 0.6. For the corrected BR‐NICO values, the Bland–Altman agreement mean bias and lower/upper limits of agreement were −0.62 and −5.3 to 3.9 L/min, respectively. Lin's concordance (95% confidence interval) between methods was 0.894 (0.825–1.097). Compared with baseline, HSS increased the CO at 10 and 20 minutes (TDCO and BR‐NICO). Compared with baseline, HETA decreased the CO at 10 and 20 minutes (TDCO and BR‐NICO) and increased the CO at 90 (TDCO only) and 120 minutes (TDCO and BR‐NICO). Conclusions: BR‐NICO strongly agreed with TDCO in the measurement of CO in healthy unsedated adult horses. HSS administration significantly increased CO in the first 30 minutes, while HETA initially decreased CO at 10 minutes but increased CO to above baseline values by 90 minutes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the utility of the neutrophil‐to‐lymphocyte ratio (NLR) as a prognostic marker in cats with blunt trauma. Design: Retrospective study from January 2018 to December 2021. Setting: University teaching hospital. Animals: Medical records of 177 cats admitted with blunt trauma were evaluated. History, clinical findings, blood cell count‐based ratios, thoracic radiographs on presentation, and outcome were reviewed. The Animal Trauma Triage (ATT) score was assessed in each cat and classified as mild (1–3), moderate (4–7), and severe trauma (≥8). Forty‐eight healthy blood donor cats served as the control population. NLR, neutrophil counts, and lymphocyte counts were compared between cats with blunt trauma and controls, and among trauma patients. Interventions: None Measurements and Main Results: NLR, neutrophil counts, and lymphocyte counts significantly differ in cats with blunt trauma compared to controls (p < 0.001), and NLR was higher in patients with thoracic trauma (p = 0.044). Nonsurvivors had lower lymphocyte counts (p = 0.041), although those values do not appear to be clinically relevant. A significant increase in NLR was observed with increasing severity of trauma (p < 0.001). The NLR was not associated with the length of hospitalization, intensive care assistance, or mortality. Conclusion: NLR is a widely available diagnostic tool, which can be used in addition to ATT to assess trauma severity, although in our study it was not predictive of the outcome. [ABSTRACT FROM AUTHOR]

Background and Aims: COVID‐19 patients might be admitted to the hospital based on their clinical manifestations or to the intensive care unit (ICU) due to the severity of their symptoms or critical situation. Our main objective was to investigate clinical and demographic factors influencing COVID‐19 patients' admission to the ICU and length of stay (LOS) using extracted data from the hospital information systems in Iran. Methods: The data of hospitalized patients with confirmed COVID‐19 were retrieved from the health information system of Imam Khomeini Hospital Complex, Tehran, Iran between March 2020 and February 2022. The primary outcome was the ICU admission, and the secondary outcome was the LOS. The correlation analysis between laboratory findings and demographic data with ICU admission and LOS was done using SPSS 21.0, and p < 0.05 was considered significant. Results: Of all the 4156 patients, 2391 (57.5%) were male and the mean age was 58.69 ± 8.19 years. Of these, 9.5% of patients were admitted to ICU at any time point during their hospital stay. Age and laboratory variables such as neutrophil‐to‐lymphocyte ratio (NLR), ALT (U/L), albumin (g/dL), plasma glucose (mg/dL), ferritin levels (ng/mL), and phosphorous levels (mg/dL) shown the significant relationship with ICU admission. Also, being a smoker and having hypoxemia had a significant relationship with longer stays in the hospital. In this study, we validated a cut‐off value of 4.819 for NLR, calculated at hospitalization, as a useful predictor of disease progression and occurrence of serious clinical outcomes, such as ICU admission. Conclusion: The study examined various clinical factors associated with ICU admission in COVID‐19 patients. The findings suggest that certain factors can increase the risk of ICU admission and influence the length of hospital stay which should be focused in future studies. [ABSTRACT FROM AUTHOR]

Trauma is a serious public health problem, and abdominal injuries are among the leading causes of hospitalization after trauma. Therefore, this study aimed to determine the outcome of abdominal trauma and its predictors in patients who underwent laparotomy at Asella Referral and Teaching Hospital (ARTH), South Central Ethiopia. We conducted a retrospective institutional based cross‐sectional study of patients who underwent laparotomy for abdominal trauma at ARTH from October 1, 2015, to September 30, 2020. Bivariate and multivariate logistic regressions were used to determine associations between independent factors and mortality due to abdominal trauma, and a P value of <0.05 indicated statistical significance. Out of 139 patients, 110 (79.1%) were males and 88 (63.3%) aged <30 years old, with a mean age of 29 ± 15.73 years. The most common mechanism of injury was penetrating trauma, which accounted for 94 (67.6%) patients. The mortality rate was 21 (15.1%). Factors such as blunt mechanism of injury (95% CI: AOR: 3.36, 1.24–9.09), SBP < 90 mmHg at presentation (95% CI: AOR = 9.37, 3.28–26.80), time >6 hours from trauma to admission (95% CI: AOR: 5.44, 1.78–16.63), unstable intraoperative patient condition (95% CI: AOR = 8.82, 3.05–25.52), and patients who need blood transfusion (95% CI: AOR: 6.63, 1.92–22.91) were significantly associated with mortality. The mortality rate of abdominal trauma patients who underwent laparotomy was high. Therefore, healthcare providers should provide priority for traumatic patients as prolonged waiting time to get healthcare results in poor outcomes for the patients. [ABSTRACT FROM AUTHOR]

Background: Our aim was to measure the effectiveness of oral isotretinoin with desloratadine compared with oral isotretinoin alone in treating moderate to severe acne at a tertiary care teaching hospital in North India. In this study, 90 patients with moderate to severe acne were enrolled to participate based on their fulfilling the inclusion criteria. Methods: A randomized, assessor‐blinded, parallel‐arm study was conducted. Randomization was done using computer‐generated tables to allocate treatments in a 1:1 ratio. A low‐dose oral isotretinoin at a dose of 0.3 mg/kg/day with tab desloratadine at 5 mg/day was applied to the study group and compared against the same patients going without the dosage when controls were conducted. Follow‐up was at 4, 8, and 12 weeks. Results: The primary outcome was an improved global acne grading system (GAGS) score and decreased acne lesion count. Secondary outcome: patient satisfaction with treatment. The 90 participants were randomized and 15 participants dropped out of the study, leaving 75 participants for intention to treat analysis (n = 41, n = 30). At week 12, the GAGS score and acne lesion count between the study and control groups were comparable (P > 0.05). Pruritus reported was 9.76% in the study versus 33.33% in the control group (P = 0.018). Also, 53.66% of participants reported "excellent" treatment satisfaction in the study group versus 36.67% in the control group. Conclusions: The addition of desloratadine to an isotretinoin regimen has a role in reducing disease and therapy‐related pruritus in acne and leads to improved patient satisfaction. [ABSTRACT FROM AUTHOR]

The article discusses the evaluation of participation and recruitment bias in a real-world data (RWD) study called REALYSA, which focuses on newly diagnosed lymphoma patients. The study found that 54% of patients were included in the program, and factors such as age, gender, lymphoma subtype, performance status, and comorbidities were analyzed. The findings provide insights into patient participation in RWD programs and contribute to the understanding of lymphoma treatment strategies. The study also found that certain factors, such as disease aggressiveness and management approach, influenced the inclusion rate in the program. However, the study had limitations and further research is needed to better understand selection bias in real-world lymphoma cohorts. [Extracted from the article]

Objectives: Arthroscopic treatment is indicated for external snapping hip (ESH) syndrome in patients refractory to conservative treatment, but snapping does not disappear completely in some case. No previous studies have described the clinical course of ESH syndrome in patients who presented with persistent snapping after an arthroscopic procedure. We demonstrated the clinical outcomes following an incomplete arthroscopic iliotibial band (ITB) release for ESH syndrome. Methods: This retrospective observational study was performed at two teaching hospitals between October 2015 and December 2021. We reviewed the data of 33 patients (34 hips) aged ≥18 years, diagnosed with ESH syndrome, who were treated with arthroscopic ITB release. Patients who presented with persistent snapping despite sufficient arthroscopic ITB release following systematic order were defined as having an incomplete release. We collected the data for recurrent symptomatic snapping hip as the primary outcome after a minimum 2‐year follow‐up. The visual analogue scale (VAS) and modified Harris hip (mHHS) scores were measured as secondary outcome. Results: "Incomplete release" was identified in three of the 34 hips (8.9%). Cases of recurrent symptomatic snapping or conversion to open surgery were not observed. The symptoms of residual snapping spontaneously disappeared in all cases following routine postoperative rehabilitation within a 3‐month follow‐up period. The VAS (4 ± 1) and mHHS (17 ± 6) scores of all the patients improved. Conclusion: When refractory ESH syndrome is identified during arthroscopic surgery, appropriate ITB release and removal of the major lesion causing snapping are expected to lead to resolution of residual symptoms without conversion to open surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine if Irish Wolfhounds (IWs), like other sighthounds, are hyperfibrinolytic compared with nonsighthound dogs using 2 native and tissue plasminogen activator (tPA)‐enhanced viscoelastic assays, one that is whole blood‐based (viscoelastic coagulation monitor [VCM]) and the other that is plasma‐based thromboelastography (TEG). Design: Cohort study. Setting: University teaching hospital. Animals: A convenience sample of 27 IWs recruited from the Irish Wolfhound Association of New England Specialty and the local community, and 27 healthy, age‐matched, large‐breed control dogs. Interventions: None. Measurements and Main Results: Blood samples including CBC, biochemistry, traditional coagulation, and viscoelastic testing were collected from IWs and control dogs. Twelve IWs had viscoelastic testing. IWs had lower fibrinogen concentrations (215.5 ± 57.8 vs 251.4 ± 64.5 mg/dL, P = 0.034) and formed weaker clots on both whole‐blood VCM and plasma TEG assays (maximum clot firmness [VCM‐MCF] = 39.4 [25.1–48.8] vs 48.5 [34.6–57.3], P = 0.0042; maximum amplitude [TEG‐MA] = 22.7 [14.7–33.6] vs 32.2 [26.9–42.0], P < 0.0001). IWs were hyperfibrinolytic compared with control dogs on VCM whole‐blood assays, with 25 U/mL tPA (lysis at 30 min [VCM‐LI30] = 68.1 [0–100] vs\ 99.9 [63.3–100], P = 0.0009; lysis at 45 min [VCM‐LI45] = 31.0 [0–100] vs 98.1 [38.4–100], P = 0.0002) but hypofibrinolytic compared with controls on TEG plasma assays with 50 U/mL tPA (lysis at 30 min [TEG‐LY30] = 45.7 [4.6–94.6] vs 93.7 [12.3–96.5], P = 0.0004; lysis at 60 min [TEG‐LY60] = 68.7 [29.7–96.8] vs 95.7 [34.4–97.6], P = 0.0003). Minimal fibrinolysis was measured on whole‐blood VCM or plasma TEG assays without the addition of tPA, and there were no differences between the 2 groups. Conclusions: Weaker clots were found in IWs than control dogs. With the addition of tPA, IWs had evidence of hyperfibrinolysis on whole‐blood VCM assays and hypofibrinolysis on plasma TEG assays compared with control dogs. Without the addition of tPA, however, both groups of dogs showed minimal fibrinolysis on viscoelastic testing. [ABSTRACT FROM AUTHOR]

Background: Obtaining accurate knowledge of the anatomical structure of the skull helps in ontogenetic studies and determining sexual polymorphisms. Objectives: This study uses anatomical dissection and radiography to develop a size standard for the skull of the Saanen goat; information that will be applied to clinical evaluation and decision‐making. Methods: A total of 14 adult Saanen goat skulls (7 male and 7 female goats) were taken from the slaughterhouse and transferred to the clinic of the Faculty of Veterinary Medical Teaching Hospital, Urmia University, Urmia, Iran. Radiographs of each skull were prepared in the dorsal–ventral, left and right lateral recumbency. These heads were then brought over to the anatomy department, where the chosen morphometric traits were assessed and their means recorded. Results: According to the findings of this study, the dorsal view of the skull revealed an incisive raphe and a widespread foramen of the nose. In the ventral view, the incisive bones were observed in the most cranial region of the skull. The base of the occipital bone was relatively large, and the jugular process was well‐developed. In the lateral view, the incisive bone was extended to the cranial and had a narrow process on the dorsal surface. Regarding infra‐orbital foramen, it was visible in the maxillary bone. Moreover, the lacrimal bone was perceived as a distinct bone. Conclusion: The precise standards acquired in this study can be utilized to interpret the findings and make clinical decisions about the normal and abnormal size of the bones that make up the skulls of the Saanen goats. [ABSTRACT FROM AUTHOR]

Society's growing attention to sustainability has also brought about major challenges for the healthcare sector. In particular, hospitals by virtue of their function are also called to incorporate social and environmental issues in the undertaking of their activities. In this scenario, hospitals must also provide a correct representation of these issues through an adequate sustainability disclosure. However, despite the relevance of the topic, it is still little explored in the academic field. This study aims to fill this important gap by investigating the determinants of online sustainability disclosure through a legitimacy theory perspective. The econometric analysis, conducted on a sample of the best hospitals in the world, highlights a low level of dissemination of sustainability information. Furthermore, it demonstrates a positive impact of the size, public status and teaching status of hospitals on the amount of sustainability information disclosed by these institutions through their website. [ABSTRACT FROM AUTHOR]

Background and Aim: Goiter is a major source of morbidity in the world, especially in the developing world, where dietary iodine deficiency, a known cause of this condition, is endemic. The diagnosis is mostly by ultrasonography (USG) scan, which can give anatomical, pathological, and functional information for the management of goiter. This study aimed to determine the commonest ultrasound findings of goiter in Ghana. Method: The records of all 213 patients with goiter diagnosed by USG scan over a 5‐year period were retrieved. Data collected were sociodemographics, ultrasound features, thyroid nodules diameter, and Thyroid Imaging Reporting and Data System (TI‐RADS) scores, which were analyzed using GNU PSPP, version 1.2.0‐3. χ2 and two‐tailed independent samples t‐test were also employed, with p ≤ 0.05. Results: A total of 213 patients with goiter diagnosed by USG scan were obtained over the study period. The mean age of the participants was 50.01 ± 17.27 years, with an age range of 16−92 years and females constituting the majority (82.16%). The commonest ultrasound features were well‐defined solid nodules. The lesion sites for most patients were the whole thyroid (28.17%), both lobes (24.41%), and the right lobe (20.19%). The mean difference in sizes of cysts and solid nodules among genders was 0.26 (CI: −0.14 to 0.67, p = 0.20) and 0.12 (CI: −0.43 to 0.66, p = 0.67), respectively. The TI‐RADS score featured TI‐RADS 4 (36.62%), TI‐RADS 1 (28.17%), TI‐RADS 3 (25.82%), TI‐RADS 5 (5.16%), and TI‐RADS 2 (4.23%). Solid nodules (49.32%, p = 0.001) and cysts (35.71%, p = 0.003) were more common within 41−60 years and less frequent in those <21 years. A p ≤ 0.05 was considered significant in this study. Conclusion: The predominant ultrasound features were well‐defined solid nodules, simple cysts, and solid nodules with cystic changes, mostly located in the entire thyroid gland and least located in the isthmus only. Cysts and solid nodules were mostly seen in the 41−60 years age group. Key points: What is known about this topic Well‐defined solid nodules, simple cysts, and solid nodules with cystic changes were some of the ultrasound features of an enlarged thyroid gland.Lesion sites of an enlarged thyroid gland included the isthmus, left, and right lobes. What this study adds Most patients presenting with enlarged thyroid glands had lesions in the entire thyroid.Thyroid Imaging Reporting and Data System (TI‐RADS 4) was the most predominant TI‐RADS score, and TI‐RADS 2 was the least.Few patients presented with lesions in the isthmus only, and the majority in the entire thyroid gland.Cysts and solid nodules were mostly seen in those 41−60 years and least in those <21 years. Clinical implications of this study Knowing the locations, types, and sizes of thyroid lesions will aid clinicians in planning appropriate management for the patient.Radiologists should adopt the TI‐RADS lexicon in their reporting of thyroid imaging to enable proper communication amongst themselves and with the clinicians once they are familiar with the TI‐RADS lexicon. [ABSTRACT FROM AUTHOR]

Drug–drug interactions are preventable causes of adverse events. Different factors have been recognized as important predictors of drug–drug interactions but few studies have addressed these predictors in patients admitted into medical wards of a tertiary hospital in Nigeria hence this study. This was a retrospective study conducted using case records of patients admitted into the medical wards between January 1 and December 31, 2020. Patients were selected using a systematic random sampling method. Socio‐demographic details including age, gender, number of comorbidities, and number of medications prescribed and diagnosis were collected on days 1, 3, and at discharge. Potential drug–drug interactions were checked using Lexi‐interact® software. Analysis was set at p < 0.05. A total of 430 case records were included in this study based on the inclusion criteria. Lexi‐interact recorded a prevalence of (217) 50.5% on day 1, (146) 34.0% on day 3, and (290) 67.4% at discharge. A significant association (p < 0.05) was found between the potential drug–drug interactions (DDI) and an increased number of medicines prescribed on all the days of admission. Also, patients without certain infectious or parasitic diseases have reduced odds of developing DDI. There is a need for continuous monitoring of medications from admission to discharge especially in the elderly, those on multiple medications, certain infectious or parasitic diseases, and comorbidities as these impact on DDIs. [ABSTRACT FROM AUTHOR]

Iron deficiency anaemia is still a global public health concern with the highest burden among children 6 to 23 months due to their rapid growth spurt exceeding breastmilk supply. Therefore, nutritional supply is a key source of iron to attain the required nutrients for better growth and development. This was a cross-sectional descriptive study done at Ishaka Adventist Hospital (IAH) and Kampala International University Teaching Hospital (KIUTH) from April to July 2022. Participants were consecutively enrolled in the study. Structured questionnaires, 24-hour dietary recall, and clinical assessment were used to obtain data. Data analysis was done using the statistical package for social scientists (SPSS) V22.0. Bivariable and multivariable analyses were done using logistic regression for associations with significance set at P value < 0.05. A total of 364 participants were enrolled, with the majority being males (198, 54.4%) and born at term (333, 91.5%). The modal age was 12-17 months [163(44.8%)] with a mean age of 14.1 months (SD 5.32). The overall prevalence of IDA was 151/364 (41.5%). The factors associated with IDA included male sex (aOR 1.61), current episode of diarrhoea (aOR 1.71), poor meal frequency (aOR 1.78), no vegetable consumption (aOR 2.47), and consuming fruits once (aOR 1.97) in 7 days preceding the study. The study finds a high prevalence of IDA among infants 6-23 months with at least four in 10 being affected. Screening for IDA should be recommended in male children with current diarrhoea, poor intake of fruits and vegetables, and poor meal frequency. The Mentzer index is an equally good alternative screening test for IDA. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. Methods: We conducted a facility‐based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. Results: Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow‐up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post‐procedure complications have been documented. Conclusion: Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same‐day implant localization and removal. Synopsis: Localization and removal of nonpalpable implants need careful evaluation. Specialized centers are essential to care for these patients and referral pathways should be arranged. [ABSTRACT FROM AUTHOR]

Introduction: Intravasation on hysterosalpingogram (HSG) is defined by the flow of injected contrast from the uterine cavity into adjacent myometrial vessels. Evidence suggests intravasation can result in consequences such as pulmonary and cerebral embolisms. However, adverse events are poorly reported across published studies. Reported intravasation ranges from 0.0% to 13%, with higher rates attributed to oil‐soluble contrast medium (OSCM) use. Recent reviews of OSCM's fertility‐enhancing benefits have prompted rapid clinical uptake by fertility specialists worldwide. This instigates increased concern for intravasation and its associated sequelae. We aim to assess the prevalence of intravasation in fluoroscopic HSGs and its reporting in Western Australia (WA). Methods: A two‐year retrospective analysis of all fluoroscopic HSGs in one public teaching hospital within WA was conducted. All HSGs were retrieved from the public radiology information system and a blinded method was utilised to verify the presence and grading of intravasation in captured HSG images. Grading of intravasation was attributed by anatomical spread: 1 to myometrium, 2 to parametrium and 3 to para‐iliac vessels. Results were subsequently compared with reported intravasation to assess for discrepancies. Results: Of 308 successful HSGs, an intravasation rate of 7.1% was identified. Of these cases, 45% were reported and 32% were graded. Majority (73%) of intravasation events were classified as grade 1, with 9.0% and 18% of cases classified as grade 2 and 3, respectively. Conclusion: Under‐reporting of intravasation emphasises a need for increased vigilance of radiologists. Standardised classification can provide interpretational consistency and should be considered to improve safety in future practice. [ABSTRACT FROM AUTHOR]

Objective: To compare plasma l‐lactate (LAC) values between samples collected from jugular and cephalic venipuncture in healthy horses and systemically ill horses. Design: Prospective, experimental study. Setting: Large animal university teaching hospital. Animals: Thirty healthy adult university‐owned horses and 43 client‐owned horses presenting to the large animal hospital for elective surgical procedures or for emergent medical evaluation of systemic illness. Interventions: Blood samples were collected from the jugular vein (JV) and cephalic vein (CV) and placed in EDTA blood tubes prior to any medical therapy. LAC values were obtained with a handheld lactate meter at the time of blood collection. Measurements and Main Results: LAC was higher in CV samples than JV samples in healthy horses (P < 0.001); however, all values were within the normal reference range. Similarly, LAC was higher in CV samples than JV samples in systemically ill horses (P < 0.001), but the median JV value was within normal reference range (1.9 mmol/L [17.1 mg/dL]), while the median CV value was outside the normal reference range (2.9 mmol/L [26.1 mg/dL]). Conclusions: The CV is an alternative venipuncture site for assessing plasma LAC if the JV is not accessible or to preserve the JV for subsequent catheterization. However, in ill horses, the CV value may be outside the reference range when the corresponding JV value would have been within the reference range. [ABSTRACT FROM AUTHOR]

Objective: To determine signalment, injury type, trauma severity score, and outcome of canine trauma patients undergoing surgical (emergency room [ER] or operating room [OR]) and nonsurgical treatment in addition to time to surgery, specialty services involved, and cost in the OR surgery population. Design: Retrospective evaluation of medical record and hospital trauma registry data on canine trauma cases. Setting: University teaching hospital. Animals: One thousand six hundred and thirty dogs presenting for traumatic injury between May 2017 and July 2020. Interventions: None. Measurements and Main Results: Demographics and outcome were compared for canine trauma patients undergoing OR surgery (12.8%, 208/1630), ER surgery (39.1%, 637/1630), or no surgical intervention (48.2%, 785/1630). Among the 2 surgical groups, 98.9% (836/845) survived to discharge compared with 92.2% (724/785) of the nonsurgical group (P < 0.0001). The OR surgical group had significantly higher median Animal Trauma Triage scores (2 vs 1, P < 0.0001) and median days in hospital (2 vs < 1, P < 0.0001) compared with the other groups. For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (45.2%, 94/208) and general surgery (26.9%, 56/208). Neurology and general surgery cases required the longest median length of stay in hospital, and ophthalmology and dentistry cases required the shortest. The median cost of visit was highest in neurology ($10,032) and lowest in ophthalmology ($2305) and dentistry ($2404). Conclusions: Surgical intervention in canine trauma patients appears to be associated with higher survival rates, and among the surgery groups, mortality was highest in the ER and general surgery groups. OR surgical intervention, in particular general surgery and neurology, was associated with increased length of hospitalization, increased cost, and higher Animal Trauma Triage scores. [ABSTRACT FROM AUTHOR]

Background: Fluoroscopic guidance has become the standard for a variety of medical procedures. Mastering these techniques requires practice, which may entail additional radiation for patients and providers. Despite their widespread use, the literature examining factors influencing radiation exposure in fluoroscopically guided pain procedures is scarce. Objective: To evaluate the influence of resident involvement on radiation exposure during fluoroscopy‐guided spinal interventions. Design: Single‐center, observational study. Setting: Outpatient physiatry clinic in a teaching hospital. Patients: All patients who received cervical or lumbar facet block(s) (FBs), transforaminal epidural steroid injection(s) (TFESIs) without digital subtraction, or a caudal epidural (CE) during the study period were included. Interventions: Resident involvement in the procedures: absent, observing, or participating. Main Outcome Measures: Machine‐indicated fluoroscopy time (seconds) and radiation dose (milligrays [mGy]). Results: Two hundred ninety six procedures were included: 188 FBs (58 cervical, 130 lumbar), 48 CEs, and 60 TFESIs. For lumbar FBs, fluoroscopy time and radiation dose increased significantly when residents performed them (meantime = 24.5 s, confidence interval [CI] = 20.4–28.7; meandose = 3.53 mGy, CI = 2.57–4.49) compared to when they observed (meantime = 9.9 s, CI = 8.1–11.7; meandose = 1.28 mGy, CI = 0.98–1.59) (mean difference: time = 14.63 s, CI = 9.31–19.94; dose = 2.25 mGy, CI = 1.17–3.33) and were absent during the procedure (meantime = 12.9 s, CI = 11.1–14.6; meandose = 1.65 mGy, CI = 1.40–1.89) (mean difference: time = 11.67 s, CI = 7.35–15.98; dose = 1.88 mGy, CI = 1.01–2.76). In the case of TFESIs, time, but not dose, increased significantly when residents observed (meantime = 39.1 s, CI = 30.7–47.6; meandose = 6.73 mGy, CI = 3.39–10.07) compared to when they were absent (meantime = 27.1 s, CI = 22.4–31.8; meandose = 4.41 mGy, CI = 3.06–5.76 (mean difference: time = 11.99 s, CI = 1.37–22.61; dose = 2.32 mGy, CI = −1.20–5.84). Finally, resident involvement did not significantly affect the outcomes for CEs (ptime =.032, pdose =.74) and cervical FBs (ptime =.64, pdose =.68). Conclusion: Resident participation affected lumbar FBs the most, with an increase in both fluoroscopy time and radiation dose. [ABSTRACT FROM AUTHOR]

Backgrounds: Acute surgical care nowadays usually involves access to urgent imaging. There is a paucity of data on how often the images or radiologist reports of these images are used by the surgical team. We aimed to identify the rates and timeliness of radiology images and report viewing for acute surgical admissions in an Australian tertiary university teaching hospital. Methods: We utilized a data set comprising radiological studies completed at our institute during a one‐month period. Investigations were classified by modality and whether images or reports were available 'in‐hours' or 'after‐hours'. The time taken from imaging to reports available for viewing by the surgical team was calculated using timestamps derived from electronic hospital systems. Spearman's rho test was used to assess correlation between the Study Ascribable Time and time to view an image or report. Results: Of 40 042 investigations, 1156 (3%) satisfied study criteria. Both images and reports were viewed in 82% (n = 950/1156) of cases. CT scans had the shortest median time for image (14 min, IQR 4–47 min) and report (25 min, IQR 8–68 min) viewing. CT (95%, n = 410/430) and MRI (95%, n = 38/40) scans had the highest proportion of both images and reports viewed, regardless of whether the scan was completed 'in‐hours' or 'after‐hours'. X‐ray reports were viewed least often (73%). Conclusion: This study demonstrates a high level of viewing of acute surgical radiological imaging and reports by surgical teams. The 'simpler' the study the less likely the radiology report will be viewed. [ABSTRACT FROM AUTHOR]

Background. Myomectomy can be associated with life-threatening conditions such as bleeding. Excessive bleeding usually necessitates blood transfusion. Interventions to reduce bleeding during myomectomy will help reduce the need for blood transfusion with its associated complications. Tranexamic acid has been used to reduce bleeding in other surgical procedures, and its usage during myomectomy merits evaluation. Objective. To assess the efficacy of tranexamic acid in reducing myomectomy-associated blood loss. Materials and Methods. This is a prospective double-blinded randomized trial conducted on women who had abdominal myomectomy. Patients were randomized into two groups. The study group received perioperative intravenous tranexamic acid (TXA) while the control group received a placebo. Intraoperative blood loss was calculated by measuring the volume in the suction apparatus and weighing the surgical swabs. In addition, blood collected postoperatively from the wound drains and drapes were measured. Haemoglobin concentrations were determined preoperatively and on second postoperative day for all cases. Any adverse effect was noted in both groups. The data was processed using Epi Info software (7.2.1, CDC, Atlanta, Georgia). The relationships between categorical data were analyzed using X 2 and Student's t -test to determine relationships between continuous variables, with a P value of 0.05 considered statistically significant, and correlation coefficients were calculated using Pearson's formula, and probability of 0.05 was set for statistical significance. Results. Symptomatic uterine myomas constituted 17.3% of all gynaecological admissions and 21.3% of gynaecological operations at Federal Teaching Hospital Abakaliki. The mean intraoperative blood loss among patients that had perioperative tranexamic acid infusion was 413.6 ± 165.6 ml, while that of patients with placebo infusion was 713.6 ± 236.3 ml. Perioperative tranexamic acid infusion therefore reduced mean intraoperative blood loss by 300 ml, and this was statistically significant (SMD = − 0.212 , 95% CI: −403.932 to −196.067, P < 0.0001). Perioperative tranexamic acid reduced mean total blood loss by a value of 532.3 ml, and this is statistically significant (SMD = 30.622 , 95% CI: 393.308 to 670.624, P < 0.0001). Tranexamic acid also improved postoperative haemoglobin concentration by 1.8 g/dl compared with placebo, and this is statistically significant (SMD = − 0.122 , 95% CI: 1.182 to 2.473, P < 0.0001). Tranexamic acid infusion decreased hospital stay by about 2 days, and this difference was statistically significant (SMD = − 3.929 , 95% CI: -3.018 to –0.983, P = 0.0003). There was no adverse drug reaction in the course of the study. Conclusion. The use of tranexamic acid during myomectomy reduced intraoperative and postoperative blood loss. It is also associated with decreased hospital stay. This trial is registered with NCT04560465. [ABSTRACT FROM AUTHOR]

Objective: To determine whether emergency staff and students can predict patient outcome within 24 hours of admission, comparing the accuracy of clinician prognostication with outcome prediction by Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scoring and identifying whether experience or mood would be associated with accuracy. Design: Prospective observational study between April 2020 and March 2021. Setting: University teaching hospital. Animals: One hundred and sixty‐one dogs admitted through an Emergency Service were assessed. Where data were available, an APPLEfast score was calculated per patient. An APPLEfast score of >25 was deemed a predictor for mortality. Interventions: None. Measurements and Main Results: Emergency staff and students were asked to complete surveys about dogs admitted to the emergency room. All clinicopathological data were available for review, and the animals were available for examination. Data collected included opinions on whether the patient would be discharged from hospital, a mood score, position, and experience in Emergency and Critical Care. One‐hundred and twenty‐five dogs (77.6%) were discharged; 36 dogs (22.4%) died or were euthanized. Two hundred and sixty‐six responses were obtained; 202 responses (75.9%) predicted the correct outcome. Students, interns, residents, faculty, and nurses predicted the correct outcome in 81.4%, 58.3%, 83.3%, 82.1%, and 65.5% of cases, respectively. Of 64 incorrect predictions, 43 (67.2%) predicted death in hospital. APPLEfast scores were obtained in 121 cases, predicting the correct outcome in 83 cases (68.6%). Of 38 cases in which APPLEfast was incorrect, 27 (71.1%) were dogs surviving to discharge. Mean APPLEfast score was 22.9 (± 6.2). There was no difference in outcome prediction accuracy between staff and APPLEfast scores (P = 0.13). Neither experience nor mood score was associated with outcome prediction ability (P = 0.55 and P = 0.74, respectively). Conclusions: Outcome prediction accuracy by staff is not significantly different to APPLEfast scoring where a cutoff of >25 is used to predict mortality. When predictions were incorrect, they often predicted nonsurvival. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aimed to characterize and evaluate the emergency approach, diagnosis, management, treatment, and follow‐up of nonspecific canine lameness cases. Design: Retrospective case series from September 25, 2013 to September 25, 2014. Setting: The study was conducted at an urban university teaching hospital. Animals: A consecutive sample of dogs presenting to the emergency service with nonspecific lameness in the designated timeframe was used to identify 134 cases. Owners were contacted to participate in the follow‐up survey; dogs that died prior to data collection were excluded from the survey. Medical records were reviewed for lameness localization, etiology of lameness, diagnostics obtained, medications prescribed, and owner recommendations. Interventions: Based on review of the medical records, the lameness localization, presumptive source of lameness (joint, soft tissue, neurological, or bone), diagnostics obtained, medications prescribed, and owner recommendations were recorded. Survey data included duration of lameness, perceived response to treatment, and activity level. Measurements and Main Results: Definitive diagnoses were not assigned in 88.8% of lameness cases. A presumptive diagnosis of soft tissue injury was assigned in 45.3% of cases. Single limb lameness was more prevalent than multiple limb lameness. Owners whose dogs were treated with medication were significantly more likely to report that the lameness resolved (P = 0.049). Dogs with injury localized to ≥1 of the joints were significantly less likely to have resolution of lameness (P = 0.037). Treatment recommendations were predominantly pain control and activity restriction. Conclusions: Nonspecific lameness represents approximately 4% of canine urban emergency cases. Highlighting the points of clinical care considerations in understanding the etiology of lameness in dogs represents an opportunity for improved patient care and growth in emergency referral and follow‐up. [ABSTRACT FROM AUTHOR]

Background: Spinal cord compression (SCC) in metastatic prostate cancer (MPC) is a critical complication and multiple factors influence the optimal therapeutic strategy. We investigated the differences in practice patterns between teaching hospitals (TH) and non-teaching hospitals (NTH) across the United States. Method: Using the National Inpatient Sample Database (NIS), we performed a retrospective study on hospitalizations with MPC and SCC between 2016 and 2020 in US. We compared demographic factors, comorbidities, treatment modalities, duration of hospitalization, financial expenditures, and mortality between TH and NTH. We also examined the patients' characteristics and outcomes in TH and NTH based on their chosen therapeutic strategy. Results: We identified 11,380 admissions with metastatic prostate cancer and SCC; 9610 in TH and 1770 in NTH. The median cost of hospitalization was $21,922 in TH and $15,141 in NTH. Although the median age and Charlson comorbidity score did not differ between two groups, patients in TH were more likely to receive intervention (radiation or surgery) compared to NTH (Surgery: 28.2% in TH vs. 23.0% in NTH & Radiation: 12.1% in TH vs. 8.2% in NTH). Mortality was lower in TH than NTH (4.5% vs. 7.9%). In both TH and NTH, a higher proportion of patients with private insurance underwent surgery (TH: Surgery 25.1% vs. Radiation 18.8% & NTH: Surgery 27.0% vs. 6.9%). Black patients were more likely to receive radiation than surgery in TH (34.2% vs. 26.8%). Conclusion: This study showed a greater percentage of patients underwent surgical intervention at TH compared to NTH. Additionally, the type of insurance and racial background were associated with distinctive treatment approaches. [ABSTRACT FROM AUTHOR]

Trichomoniasis is caused by a flagellated protozoan parasite called Trichomonas vaginalis. It is one of the most common, curable nonsexually transmitted infections globally. In Ethiopia, complications associated with genital infection in pregnant women are a common problem. Despite the burden of the disease, epidemiological data related to this disease is currently rare in Africa, particularly in Ethiopia. Objective. This research is aimed at assessing the prevalence of Trichomonas vaginalis and associated factors among pregnant women attending antenatal care at Bule Hora University Teaching Hospital. Methods. An institutional-based cross-sectional study was conducted among 196 pregnant women attending ANC at Bule Hora University Teaching Hospital. Structured questionnaires were used to collect sociodemographic and associated factor data. The consecutive sampling technique was used to include study participants. The two vaginal swabs were collected by brushing the vagina with a sterile cotton swab and tested by using direct wet mount and the Giemsa staining. The data were analyzed using SPSS version 26 for logistic regression analysis. A p value < 0.05 with 95% CI was used to declare it statistically significant. Result. An overall prevalence of T. vaginalis among pregnant women was 7.7% (95% with confidence interval (CI), 0.043-0.123). The highest prevalence was observed among the 35–39-year-old age group with 18.2% and among widowed women with 25%. This study revealed that the number of sexual partners (AOR: 3.215, 95% CI: 1.062-9.731) was a significant associated factor of T. vaginalis.Conclusion. The prevalence of T. vaginalis was considerably high among pregnant women in this study. This finding emphasizes the need for routine screening and treatment of pregnant women in the first antenatal care and enhances the need for regular health education for pregnant women at antenatal clinics to make them aware of their health, and avoidance of the risk of trichomoniasis is advised. [ABSTRACT FROM AUTHOR]

Background. Enteric protozoa infections (EPIs) could worsen clinical outcomes in patients with diabetes mellitus and therefore requires prompt and accurate diagnosis and attention. This study aimed to determine the burden of EPIs and their associated factors among patients with and without diabetics at the Komfo Anokye Teaching Hospital (KATH) in Ghana. Again, the diagnostic performance of parasitological techniques routinely used for diagnosis was assessed. Methods. A total of 240 participants (made up of 140 patients with diabetes and 100 patients without diabetes) were recruited into the study by simple random sampling from November 2020 to May 2021. Stool samples of participants were collected, along with their demographic information, and examined using the saline direct wet mount (DWM), formol-ether concentration (FEC), and modified Ziehl–Neelsen staining (ZNS) techniques for the presence of enteric protozoans. Results. Enteric protozoa were found among 62/140 (44.3%) diabetic patients and 13/100 (13.0%) nondiabetic patients. The predominant protozoa identified were Cryptosporidium spp. (17.86%) among patients with diabetes and Blastocystis hominis (7.0%) among patients without diabetes. EPI was associated with diabetes mellitus status (AOR = 3.48, 95% CI, 1.55–7.79), having diabetes for more than five years (AOR = 3.83, 95% CI, 1.65–8.86) and having comorbidity (AOR = 2.93, 95% CI, 1.33–6.45). The FEC technique had the highest sensitivity (100.0%), specificity 94.3% (95% CI, 91.35–97.22), and accuracy 95.0% (95% CI, 88.54–98.13) when compared to other techniques for diagnosis. Conclusion. EPIs are a significant health problem among patients with diabetes at KATH, and therefore antiparasitic drugs should be included in their treatment protocols for better health outcomes. Again, the FEC technique has demonstrated better performance in detecting EPIs and is therefore recommended to achieve early and accurate diagnosis of EPIs. [ABSTRACT FROM AUTHOR]

This article explores the implementation of briefings and debriefings during ward rounds in teaching hospitals. It addresses concerns about the decline in bedside skills in medical training due to the shift towards conference room or hallway discussions. Briefings and debriefings, which involve planning before an activity and reflecting afterwards, have been found to enhance decision making, team communication, and reduce patient harm. The article offers practical guidance on how to incorporate briefings and debriefings during ward rounds, emphasizing the importance of shared mental models, trust, and effective communication. It highlights the benefits of these strategies in improving teamwork and learning, making rounds more efficient, and enhancing the education of trainees. [Extracted from the article]

Objective: To compare the Encounter Data System (EDS) and Medicare Provider Analysis and Review (MedPAR) completeness and medical coding of Medicare Advantage hospitalizations. Data Sources: FY 2016–FY 2019 data limited to hospitals paid under Medicare's Inpatient Prospective Payment System. Study Design: Secondary data analysis. Data Collection/Extraction Methods: Completeness of EDS and MedPAR data was estimated using the total number of unique hospitalizations in both data sources as denominator. Deriving this denominator involved matching cases in the EDS and MedPAR by MA enrollee, discharge date, and hospital. The higher the match rate, the more informative the comparison of EDS and MedPAR medical coding of the same hospitalization. EDS and MedPAR codes were assessed for similarity on six measures of Medicare Severity Diagnosis‐Related Group (MS‐DRG) assignment and identical diagnosis and procedure codes. Principal Findings: EDS hospitalizations' completeness increased steadily each year from 90% to 93%, driven by the 23 largest Medicare Advantage Organizations, which account for 83% of total cases. MedPAR completeness was relatively stable (89%) and benefited from 91% completeness among the largest hospitals, which are often teaching hospitals and account for 63% of MedPAR cases. By 2019, 97% of medical cases were assigned the same MS‐DRG, indicating the high consistency of the severity level coding, since 98% were assigned the same base MS‐DRGs, which include all severity levels for the same condition. Without chart reviews, medical cases with identical diagnosis codes increased from 87% to 92%. Conclusions: The EDS has a completeness advantage over MedPAR for studies of non‐teaching disproportionate share (DSH) hospitals and individual hospitals generally. MedPAR is only slightly less complete for hospitalizations of teaching DSH hospitals and large hospitals in general. A highly consistent EDS and MedPAR medical coding of matched cases is an important finding since the matched cases are 88% of EDS and 90% of MedPAR cases. [ABSTRACT FROM AUTHOR]

Global emergence of ciprofloxacin‐resistant ST198 Salmonella Kentucky poses an important public health threat. While conducting Salmonella surveillance among wildlife patients admitted to our veterinary medical teaching hospital in central New York, we isolated multidrug‐resistant (MDR) ST198 Salmonella Kentucky from an American black bear (Ursus americanus) in September 2020. The isolate was phenotypically resistant to numerous antimicrobial agents, including ceftriaxone and ciprofloxacin, and several antimicrobial resistance genes and mutational resistance determinants were detected. Between April and July 2021, the same strain of MDR ST198 Salmonella Kentucky was also isolated from seven other wildlife patients and multiple hospital environmental locations, suggesting nosocomial transmission. Ciprofloxacin resistance is conferred by triple point mutations in the quinolone resistance‐determining regions (QRDRs), a genotypic profile indicative of Clade ST198.2. To our knowledge, this is the first report of this ciprofloxacin‐resistant clade being identified in animals or animal products in the United States. Timely resolution of the outbreak was achieved following efforts to further enhance environmental disinfection protocols and biosecurity measures at the hospital, with no known cases or positive environmental samples after July 2021. [ABSTRACT FROM AUTHOR]

Aim: Phenobarbital, a long‐acting barbiturate, presents an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). Currently, existing research offers only modest guidance on the safety and effectiveness of phenobarbital in managing AWS in hospital settings. The study objective was to assess if a phenobarbital protocol for the treatment of AWS reduces respiratory complications when compared to a more traditionally used benzodiazepine protocol. Methods: A retrospective cohort study analyzing adults who received either phenobarbital or benzodiazepine‐based treatment for AWS over a 4‐year period, 2015–2019, in a community teaching hospital in a large academic medical system. Results: A total of 147 patient encounters were included (76 phenobarbital and 71 benzodiazepine). Phenobarbital was associated with a significantly decreased risk of respiratory complications, defined by the occurrence of intubation (15/76 phenobarbital [20%] vs. 36/71 benzodiazepine [51%]) and decreased incidence of the requirement of six or greater liters of oxygen when compared with benzodiazepines (10/76 [13%] vs. 28/71 [39%]). There was a significantly higher incidence of pneumonia in benzodiazepine patients (15/76 [20%] vs. 33/71 [47%]). Mode Richmond Agitation Sedation Scale (RASS) scores were more frequently at goal (0 to −1) between 9 and 48 h after the loading dose of study medication for phenobarbital patients. Median hospital and ICU length of stay were significantly shorter for phenobarbital patients when compared with benzodiazepine patients (5 vs. 10 days and 2 vs. 4 days, respectively). Conclusion: Parenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines. [ABSTRACT FROM AUTHOR]

Background and Aim: Hepatorenal syndrome (HRS) is a life‐threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States. Methods: Patients with HRS were identified from the national inpatient sample 2016–2019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non‐teaching hospitals (NTHs), teaching non‐transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching/transplant status and in‐hospital mortality and transplant‐free mortality was examined using multivariable linear and logistic regression analysis. Results: A total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non‐TTCs (aOR = 0.75, 95% CI: 0.68–0.83, P <0.001). Patients at TTCs had a lower transplant‐free mortality risk than those at NTHs (aOR = 0.75, 95% CI: 0.67–0.83, P < 0.001). There was no significant difference in all‐cause or transplant‐free mortality between TNTCs and NTHs. Conclusion: Patients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS. [ABSTRACT FROM AUTHOR]

A giant breed dog was presented to a university teaching hospital for restlessness and what its owners perceived to be vomiting. The patient was subsequently diagnosed with spontaneous pneumothorax secondary to a pulmonary mass and underwent median sternotomy for lung lobectomy. Post‐operatively, the patient developed iatrogenic pectus excavatum, which likely contributed to morbidity and prolonged hospitalisation. A Hoyer lift was employed to assist patient mobility and limit external sternal compression from prolonged recumbency. This case highlights the potential for iatrogenic pectus excavatum, which may affect recovery in giant breed dogs post‐median sternotomy. [ABSTRACT FROM AUTHOR]

Objective. Malaria during pregnancy is a priority area for malaria research and control as pregnant women represent a high risk group for severe malaria, and the presentation of malaria during pregnancy varies according to the level of transmission in the area; so the aim of this study is to determine the prevalence rates of malaria parasite among pregnant women attending to Saudi Kassala Teaching hospital in Kassala state, 2022. Methods. A cross-sectional study was carried out in Saudi Kassala Teaching hospital in Kassala State. This study involved one hundred and eighty-five blood samples collected from pregnant women who was then examined by using blood films and ICT for malaria, and the data were collected by a structured questionnaire and analyzed using SPSS version 21. Results. The prevalence of malaria among pregnant women was 2.2% (95% CI: 0.006–0.054). There was no significant difference among the different age groups with respect to the prevalence of malaria (P value = 0.483). The prevalence of malaria in rural residency was 2.2%, and this was significantly more common than the urban residency (P value = 0.021). When compared across the gestational trimesters, there was no significant difference between them (P value = 0.518). The number of gravidity is not related to malaria infection (P value = 0.737). The presence of symptom compliant of malaria during pregnancy does not suggest the presence of malaria (P value = 0.152). No difference was found between the different educational levels with respect to the prevalence of malaria (P value = 0.362). The result showed that there was 1 (0.5%) negative result in ICT which was positive in blood film for malaria (BFFM) and there were 3 (1.6%) positive malaria parasites by both methods in all 185 samples with statistically insignificant differences (P = 0.703). Conclusion. Plasmodium falciparum was only species detected in this study. Malaria among pregnant women was more prevalent in rural areas. However, other factors such as age, gestational age, gravidity, and educational level do not affect the prevalence of malaria in pregnant women. The presence of symptomatic compliant of malaria during pregnancy does not suggest the presence of malaria. The use of ICT or BFFM has similar diagnostic outcome for malaria in pregnancy. [ABSTRACT FROM AUTHOR]

Objectives. Drug utilization evaluation (DUE) studies aim to survey the appropriateness of drug use. DUE is an executive approach used to improve the use of medications as well as reduce the cost of treatment, ensure drug adequacy, and improve patient safety. The aim of this study was to evaluate the pattern of erythropoietin use, according to standard guidelines, in patients admitted to Namazi Hospital in Shiraz, Iran. Methods. In this descriptive, retrospective study, 230 patients were assessed. All patients who were hospitalized in different wards of Namazi Hospital, affiliated to Shiraz University of Medical Sciences, and received at least three doses of erythropoietin from September 2019 to March 2020 participated in this study. The following standard indicators of erythropoietin use were evaluated through reviewing medical charts of the cohort: drug dose, dosing intervals, route of administration, indication, monitoring of laboratory parameters, drug dose adjustment based on the response rate as well as target hemoglobin ≥12 g/dl, attention to major drug interactions, and administration of injectable or oral iron supplementation during treatment. Results. Most (65.2%) of the participants were male. The mean ± SD age of the patients was 47.55 ± 22.71 years. More than half (51.3%) of the included subjects were hospitalized in the nephrology ward. PDpoetin® and Cinnapoietin® were given to 52.6% and 47.4% of the study participants, respectively. Treatment of anemia due to chronic kidney disease was the most frequent indication of erythropoietin. The time interval of erythropoietin administration was three times a week for 68.3% of the patients. The most frequently administered weekly dose of erythropoietin was 12,000 units. The weekly dose, dose interval, and route of administration of erythropoietin were appropriate in 52.6%, 77.4%, and 100% of the patients, respectively. Dose adjustment based on the response rate, attention to major drug interactions as well as absolute-relative contraindications, and attention to the target hemoglobin ≥12 g/dl to decide whether or not to continue treatment were based on standard guideline in 98.1%, 98.7%, and 93% of the patients, respectively. The sum indexes of erythropoietin use were in line with standard guidelines in 75.84% of the cases. Conclusion. According to our results, in the setting of erythropoietin use in hospitals, physicians need more attention and education in areas such as selecting the proper dose of medication, correct indication of the drug, temporal arrangement of monitoring laboratory items, and the patient's need for iron supplements. [ABSTRACT FROM AUTHOR]

Objective: To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP‐Q stage ≥2 vaginal vault prolapse (VVP). Design: Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. Setting: Seven non‐university teaching hospitals and two university hospitals in the Netherlands. Population: Patients with symptomatic post‐hysterectomy vaginal vault prolapse, requiring surgical treatment. Methods: Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP‐Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. Main outcome measures: Primary outcome was disease‐specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri‐operative data, complications and sexual function. Results: A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease‐specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). Conclusions: LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow‐up period of 12 months. [ABSTRACT FROM AUTHOR]

Background: The prevalence, anatomical distribution, or nature of cutaneous, hair and oral mucosal abnormalities (CHMAs) in cattle is uncertain. Objectives: To determine how often dairy cattle admitted to a veterinary teaching hospital (VTH) had CHMAs (except for foot and ear canal) on physical examination and if there was an age‐related difference. Animals: Four hundred and thirty‐three cattle: cattle <3 months (n = 85), cattle 3 to 24 months (n = 73), and cattle >24 months (n = 275). Methods: In this descriptive, observational, prospective study, CHMAs of dairy cattle admitted to the VTH of the Université de Montréal were recorded over 1 year. Prevalences were calculated. Dermatological examinations were performed within 48 hours of admission, according to a glossary. Chi‐square tests were used to compare prevalence between age groups. Results: The 433 cattle were mostly females (97.5%) and of the Holstein breed (89.8%). The prevalence of cattle <3 months presenting with at least 1 identifiable CHMA was 65% (55/85). In cattle 3 to 24 months old, it was 90% (66/73), and in cattle >24 months, it was 99.3% (273/275). There were significant differences (P <.001) between the prevalence of CHMAs localized on the ischia, ilia, stifles, hocks, carpi, flank, lateral neck, dorsal cervical, and cornual regions in cattle >24 months vs <3 months. Conclusions and Clinical Importance.: CHMAs were highly prevalent and age‐specific. Calluses on the carpi and hocks of cattle >24 months were the most common CHMAs. [ABSTRACT FROM AUTHOR]

Background: Goats are increasingly popular as both production animals and pets. The frequency of and factors associated with periparturient reproductive complications in goats are largely unreported. Objectives: (1) To report the frequency of periparturient reproductive complications in does presented to university veterinary hospitals and (2) to identify factors associated with uterine tears in the study population. Animals: A total of 198 periparturient does presented to 9 university veterinary hospitals from October 2021 to June 2022. Methods: Multicenter, cross‐sectional study, with data collected from questionnaires completed by attending veterinarians. Logistic regression was used to identify factors associated with diagnosis of uterine tears. Results: Ninety‐three (47%) does had at least 1 periparturient reproductive complication. Periparturient complications included retained fetal membranes (n = 38, 26%), vaginal or perineal trauma (n = 33, 19%), uterine tears (n = 32, 18%), metritis (n = 22, 13%), uterine or vaginal hemorrhage (n = 8, 5%), Cesarean section complications (n = 8, 8%), and uterine prolapse (n = 1, 0.5%). A positive interaction effect was found between small breeds (Nigerian Dwarf and Pygmy) and manipulation on the farm by a layperson upon diagnosis of uterine tears (odd ratios [OR], 5.48; 95% confidence interval [CI], 1.41, 21.25; P =.01). Conclusions and Clinical Importance: Periparturient reproductive complications were common. Small breed combined with manipulation on the farm by layperson was associated with diagnosis of uterine tears. Clients should be educated that in the event of dystocia, small breed does are at greater risk of uterine tears and prompt veterinary intervention is critical. [ABSTRACT FROM AUTHOR]