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The focus of continuing professional development in general practice is shifting towards professional development and away from following personal areas of interest. Previous work has suggested that much CPD has not had an obvious impact in the three areas of professional development: the needs of individual doctors, patients and the needs of the NHS. We report on the results of a programme of study where developments in all three were perceived as being achieved. This outcome was realized by basing learning around real problems course members encountered in their daily work, using these real situations to identify theory, then reinforcing this learning through practical application. [ABSTRACT FROM AUTHOR]

Background: Only 27 cases of equine conjunctival haemangiosarcoma have been reported in the literature over the past 37 years. Out of these, 22% of cases were lost to follow-up, 52% were euthanized, and 26% survived. A scarcity of cases and information is available for this rarely seen conjunctival tumour., Aim: To describe the clinical features, management, and outcome of conjunctival hemangiosarcoma in seven horses in the UK., Methods: Optivet medical records were reviewed for equine cases seen or advised on with a histopathological diagnosis of conjunctival haemangiosarcoma between January 2013 and March 2023. Medical records were accessed for details of signalment, history, management, and follow-up. Histopathology was used to confirm the diagnosis of haemangiosarcoma and assess the surgical margins. Immunohistochemistry was performed in a minority of cases with poorly differentiated solid tumours to support vascular lineage., Results: Seven eyes from seven horses (five geldings and two mares) with a mean age of 16 years and median of 18 years (range 10-21 years) met the criteria. Serosanguinous discharge was seen in six eyes. All eyes were managed surgically; 4 by exenteration and 3 by conjunctivectomy/keratectomy. Adjunctive cryotherapy was performed in two eyes. Metastatic disease in the ipsilateral parotid salivary gland, confirmed with histopathology, was seen in one horse. Surgical margins were clear in all but one eye. Solar elastosis was noted in five eyes. All horses were healthy at the last follow-up (0.2-5 years, mean 2.9 years, and median 2 years)., Conclusion: Equine conjunctival haemangiosarcoma is rare. Serosanguinous ocular discharge is a common clinical sign. Early surgical excision is highly effective. Solar elastosis is a common histopathological feature, suggesting a role for UV-light in the pathogenesis.

Mycobacterium (M.) bovis can infect cats and is a demonstrated zoonosis. We describe an outbreak of M. bovis in pet cats across England and Scotland associated with feeding a commercial raw food diet. Forty-seven cats presented with (pyo)granulomatous lesions, lymphadenopathy, pulmonary and/or alimentary disease over a one-year period where M. bovis infection was suspected or definitively diagnosed, and the cats all consumed the same specific brand of commercial raw venison pet food. Infection with M. bovis genotype 10:a was confirmed by culture and DNA typing of isolates in a small number of cases (n = 5); PCR was used in combination with or as an alternative to culture (n = 12) and/or infection with a Mycobacterium tuberculosis complex group organism was strongly suggested by positive responses to an interferon-gamma release assay (IGRA; n = 34). Asymptomatic at-risk cats were screened by IGRA, identifying a further 83 infected cats. The five culture-positive cases were distributed across areas of England and Scotland at low risk of endemic bovine tuberculosis. Investigations revealed affected cats were mainly indoor-only, and had been fed the same commercial raw food as at least part of their diet. This diet was recalled by the manufacturer due to failure of statutory meat inspection of the component venison. As far as possible, other sources of infection were explored and excluded, including wildlife contact, access to raw milk and living with people with active M. bovis infection. Four owners and one veterinary surgeon were found to have high likelihood of latent tuberculosis infection. One owner required treatment. Although it was not possible to conclusively demonstrate a zoonotic origin for these infections, neither was it possible to eliminate the possibility. Our results provide compelling evidence that the commercial raw diet of these cats was the likely route of M. bovis infection in this outbreak of cases., (© 2020 The Authors. Transboundary and Emerging Diseases published by Wiley-VCH GmbH.)

The 2019 online pre-exposure prophylaxis (PrEP) user survey in the United Kingdom was conducted to assess HIV PrEP access, and user characteristics. One in five respondents continued experiencing difficulties accessing PrEP; users were almost exclusively gay or bisexual men at high risk of HIV. The majority obtained PrEP through health service clinics and rated PrEP positively. High STI rates were reported among users. Renal and sexual health checks are advised for those sourcing PrEP privately.

Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the UK has levelled-off. Data (2015-2016) from the national unlinked-anonymous monitoring survey of PWID, an annual survey that collects data from PWID across England, Wales and Northern Ireland, were used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year were used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc-negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions.