Development of the Patient-Reported Indicator Surveys (PaRIS) conceptual framework to monitor and improve the performance of primary care for people living with chronic conditions.

BackgroundThe Organisation for Economic Co-operation and Development (OECD) Patient-Reported Indicator Surveys (PaRIS) initiative aims to support countries in improving care for people living with chronic conditions by collecting information on how people experience the quality and performance of primary and (generalist) ambulatory care services. This paper presents the development of the conceptual framework that underpins the rationale for and the instrumentation of the PaRIS survey. METHODS: The guidance of an international expert taskforce and the OECD Health Care Quality Indicators framework (2015) provided initial specifications for the framework. Relevant conceptual models and frameworks were then identified from searches in bibliographic databases (Medline, EMBASE and the Health Management Information Consortium). A draft framework was developed through narrative review. The final version was codeveloped following the participation of an international Patient advisory Panel, an international Technical Advisory Community and online international workshops with patient representatives. RESULTS: 85 conceptual models and frameworks were identified through searches. The final framework maps relationships between the following domains (and subdomains): patient-reported outcomes (symptoms, functioning, self-reported health status, health-related quality of life); patient-reported experiences of care (access, comprehensiveness, continuity, coordination, patient safety, person centeredness, self-management support, trust, overall perceived quality of care); health and care capabilities; health behaviours (physical activity, diet, tobacco and alcohol consumption), sociodemographic characteristics and self-reported chronic conditions; delivery system characteristics (clinic, main healthcare professional); health system, policy and context. DISCUSSION: The PaRIS conceptual framework has been developed through a systematic, accountable and inclusive process. It serves as the basis for the development of the indicators and survey instruments as well as for the generation of specific hypotheses to guide the analysis and interpretation of the findings.

Understanding factors impacting patient-reported outcome measures integration in routine clinical practice: an umbrella review.

PURPOSE: Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice. METHODS: An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework. RESULTS: 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, 'change champions' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators. CONCLUSIONS: The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.

Ultrasound is an accurate imaging modality for diagnosing hip luxation in dogs presenting with hind limb lameness.

OBJECTIVE: To determine the accuracy of ultrasound for diagnosing hip luxation in dogs presenting for hind limb lameness. METHODS: 24 client-owned dogs presenting with pelvic limb lameness and concern for hip luxation were enrolled in this prospective diagnostic accuracy study from April 1, 2021, to July 1, 2022. An experienced ultrasonographer and a novice ultrasonographer, both masked to the diagnoses, performed hip ultrasonography using a point-of-care ultrasound machine. The experienced evaluator also performed a more comprehensive ultrasonography with a high-end ultrasound machine to characterize concurrent pelvis and hip disease. Pelvic radiographs served as the criterion standard for the diagnosis of hip luxation. RESULTS: Ultrasonographic diagnosis of hip luxation demonstrated high accuracy, ranging from 84.2% to 100% for detecting the presence of luxation and 80.6% to 98.1% for diagnosing the direction of luxation for the novice and experienced evaluators, respectively, with substantial interevaluator agreement (κ = 0.722). Compared to radiographs, ultrasound accurately diagnosed the presence of osteoarthrosis with almost perfect agreement (κ = 0.913) and the presence of fractures of the femoral head/neck and the nonaxial portions of the pelvis with substantial intermodality agreement (κ = 0.775). In 36% of patients, ultrasound identified injury to soft tissue structures that contribute to hip stability, including the gluteal muscles, gemelli, and joint capsule. CONCLUSIONS: Ultrasound can be utilized to accurately diagnose the presence of hip luxation and document concurrent hip and pelvic disease. CLINICAL RELEVANCE: Applications include the use of ultrasonography as part of a routine point-of-care protocol to catalogue injuries in patients with acute trauma and in mobile practice or remote settings where radiography is not readily available.

International cross-cultural development and field testing of the primary care practice questionnaire for the PaRIS survey (PaRIS-PCPQ).

BACKGROUND: The PaRIS survey, an initiative of the Organisation for Economic Co-operation and Development (OECD), aims to assess health systems performance in delivering primary care by measuring the care experiences and outcomes of people over 45 who used primary care services in the past six months. In addition, linked data from primary care practices are collected to analyse how the organisation of primary care practices and their care processes impact care experiences and outcomes. This article describes the development and validation of the primary care practice questionnaire for the PaRIS survey, the PaRIS-PCPQ. METHOD: The PaRIS-PCPQ was developed based on domains of primary care practice and professional characteristics included in the PaRIS conceptual framework. Questionnaire development was conducted in four phases: (1) a multi-step consensus-based development of the source questionnaire, (2) translation of the English source questionnaire into 17 languages, (3) cross-national cognitive testing with primary care professionals in participating countries, and (4) cross-national field-testing. RESULTS: 70 items were selected from 7 existing questionnaires on primary care characteristics, of which 49 were included in a first draft. Feedback from stakeholders resulted in a modified 34-item version (practice profile, care coordination, chronic care management, patient follow-up, and respondent characteristics) designed to be completed online by medical or non-medical staff working in a primary care practice. Cognitive testing led to changes in the source questionnaire as well as to country specific localisations. The resulting 32-item questionnaire was piloted in an online survey and field test. Data from 540 primary care practices from 17 countries were collected and analysed. Final revision resulted in a 34-item questionnaire. CONCLUSIONS: The cross-national development of a primary care practice questionnaire is challenging due to the differences in care delivery systems. Rigorous translation and cognitive testing as well as stakeholder engagement helped to overcome most challenges. The PaRIS-PCPQ will be used to assess how key characteristics of primary care practices relate to the care experiences and outcomes of people living with chronic conditions. As such, policymakers and care providers will be informed about the performance of primary care from the patient's perspective.

Sex identification in juvenile and adult Indonesian blue-tongued skinks (Tiliqua gigas) through cystoscopy and accuracy of contrast radiography.

OBJECTIVE: To describe a nonsurgical endoscopic technique for sex identification in Indonesian blue-tongued skinks (Tiliqua gigas) and to assess accuracy of contrast radiography of the hemipenile/hemiclitoral pouches. ANIMALS: 42 clinically healthy Indonesian blue-tongued skinks between 6 months and 3 years old and weighing between 22 and 550 g. METHODS: Cystoscopy was performed under general anesthesia. Gonads were visualized through the transparency of the urinary bladder, and their gross morphology was described. Contrast was applied in the tail pouches before obtaining full-body radiographs. Two radiologists, blinded to the sex of the skink, evaluated the radiographs. RESULTS: Cystoscopy was achieved in all 42 skinks. Visualization of the gonads through the urinary bladder was possible in 41 (98%; 95% CI, 87% to 99%) of the skinks, with 18 of them identified as males and 23 identified as females. Median procedure time was 60 seconds (range, 25 to 180 seconds) and was not associated with procedure order (-0.69; 95% CI, -1.83 to 0.45) or with the weight (0.02 g; 95% CI, -0.07 to 1.0) or the identified sex (11.7; 95% CI, -15.07 to 38.45) of the skink. Radiographs had a sensitivity of 69.6% (95% CI, 47.1% to 86.8%) and a specificity of 75.0% (47.6% to 92.7%) to identify female skinks. All the skinks recovered uneventfully. CLINICAL RELEVANCE: Cystoscopic sex identification is feasible in Indonesian blue-tongued skinks of various age and size. Considering the difficulty in identifying their sex otherwise, this technique could provide a significant improvement in the veterinary care of this species. In this population, contrast radiographs showed limited accuracy for sex identification.

Three-dimensional electrical impedance tomography to study regional ventilation/perfusion ratios in anesthetized pigs.

This study aimed to develop a three-dimensional (3-D) method for assessing ventilation/perfusion (V/Q̇) ratios in a pig model of hemodynamic perturbations using electrical impedance tomography (EIT). To evaluate the physiological coherence of changes in EIT-derived V/Q̇ ratios, global EIT-derived V/Q̇ mismatches were compared with global gold standards. The study found regional heterogeneity in the distribution of V/Q̇ ratios in both the ventrodorsal and craniocaudal directions. Although global EIT-derived indices of V/Q̇ mismatch consistently underestimated both low and high V/Q̇ mismatch compared with global gold standards, the direction of the change was similar. We made the software available at no cost for other researchers to use. Future studies should compare regional V/Q̇ ratios determined by our method against other regional, high-resolution methods.NEW & NOTEWORTHY In this study, we introduce a novel 3-D method for assessing ventilation-perfusion (V/Q̇) ratios using electrical impedance tomography (EIT). Heterogeneity in V/Q̇ distribution showcases the significant potential for enhanced understanding of pulmonary conditions. This work signifies a substantial step forward in the application of EIT for monitoring and managing lung diseases.

Cricopharyngeal and thyropharyngeal myectomy for management of cricopharyngeal achalasia in a 6-month-old coton de Tulear dog.

A 6-week-old intact female coton de Tulear dog presented to a veterinary teaching hospital (VTH) internal medicine service for dysphagia that was persistent since birth. The patient was diagnosed with cricopharyngeal achalasia based on a fluoroscopic swallow study. To facilitate surgical intervention, a percutaneous endoscopic gastrostomy (PEG) tube was placed to bypass the upper esophageal sphincter and provide nutritional support until the dog was larger. At 6 mo of age, the dog underwent unilateral cricopharyngeal and thyropharyngeal myectomy. Marked improvement in dysphagia was noted immediately postoperatively. Improvement in dysphagia persisted in this dog, with continued marked improvement in clinical signs noted 1 y postoperatively. Key clinical message: Cricopharyngeal achalasia can be successfully managed with surgical intervention with a good long-term prognosis. Before surgical intervention, nutritional support is of critical importance. A combined procedure of cricopharyngeal and thyropharyngeal myectomy may be associated with outcomes superior to those of alternative procedures.

Myectomie cricopharyngée et thyropharyngée pour prise en charge de l'achalasie cricopharyngée chez un chien coton de Tuléar âgé de 6 mois. Une chienne coton de Tuléar femelle intacte âgée de 6 semaines a été présentée au service de médecine interne d'un CHU vétérinaire pour une dysphagie persistante depuis la naissance. Le patient a reçu un diagnostic d'achalasie cricopharyngée sur la base d'une étude fluoroscopique de la déglutition. Pour faciliter l'intervention chirurgicale, un tube de gastrostomie endoscopique percutanée (PEG) a été placé pour contourner le sphincter supérieur de l'oesophage et fournir un soutien nutritionnel jusqu'à ce que le chien soit plus gros. À l'âge de 6 mois, le chien a subi une myectomie cricopharyngée et thyropharyngée unilatérale. Une nette amélioration de la dysphagie a été notée immédiatement après l'opération. L'amélioration de la dysphagie a persisté chez ce chien, avec une amélioration continue et marquée des signes cliniques notée 1 an après l'opération.Message clinique clé :L'achalasie cricopharyngée peut être gérée avec succès par une intervention chirurgicale avec un bon pronostic à long terme. Avant l'intervention chirurgicale, le soutien nutritionnel est d'une importance cruciale. Une procédure combinée de myectomie cricopharyngée et thyropharyngée peut être associée à des résultats supérieurs à ceux des procédures alternatives.(Traduit par Dr Serge Messier).

Combining ultrasound radiomics, complete blood count, and serum biochemical biomarkers for diagnosing intestinal disorders in cats using machine learning.

This retrospective analytical observational cohort study aimed to model and predict the classification of feline intestinal diseases from segmentations of a transverse section from small intestine ultrasound (US) image, complete blood count (CBC), and serum biochemical profile data using a variety of machine-learning approaches. In 149 cats from three institutions, images were obtained from cats with biopsy-confirmed small cell epitheliotropic lymphoma (lymphoma), inflammatory bowel disease (IBD), no pathology ("healthy"), and other conditions (warrant a biopsy for further diagnosis). CBC, blood serum chemistry, small intestinal ultrasound, and small intestinal biopsy were obtained within a 2-week interval. CBC and serum biomarkers and radiomic features were combined for modeling. Four classification schemes were investigated: (1) normal versus abnormal; (2) warranting or not warranting a biopsy; (3) lymphoma, IBD, healthy, or other conditions; and (4) lymphoma, IBD, or other conditions. Two feature selection methods were used to identify the top 3, 5, 10, and 20 features, and six machine learning models were trained. The average (95% CI) performance of models for all combinations of features, numbers of features, and types of classifiers was 0.886 (0.871-0.912) for Model 1 (normal vs. abnormal), 0.751 (0.735-0.818) for Model 2 (biopsy vs. no biopsy), 0.504 (0.450-0.556) for Model 3 (lymphoma, IBD, healthy, or other), and 0.531 (0.426-0.589), for Model 4 (lymphoma, IBD, or other). Our findings suggest model accuracies above 0.85 can be achieved in Model 1 and 2, and that including CBC and biochemistry data with US radiomics data did not significantly improve accuracy in our models.

Canine intrahepatic portosystemic shunts: Interlobar and intralobar classifications.

This two-part study design showed that a canine congenital intrahepatic portosystemic shunt (IPSS) may be classified by its location within a liver fissure (interlobar) or lobe (intralobar). A prospective anatomic study reviewed normal canine liver morphology and showed the CT angiography (CTA) appearance of the normal canine ductus venosus (DV), which was confirmed via dissection and literature review to be between the papillary process and left-lateral liver lobe (in the fissure for ligamentum venosum). A retrospective multi-institutional case series documented the frequency of imaging findings in 56 dogs with a single IPSS that underwent portal CTA at Cornell University or the Schwarzman Animal Medical Center between June 2008 and August 2022. An interlobar IPSS was seen in 24 of 56 (43%) dogs, all arose from the left portal branch except one. These shunts were typically near the median plane, remained interlobar throughout the course, and were nearly always (96%) craniodorsal to the porta hepatis. Four types were distinguished: patent DV (11 dogs), left interlobar (11 dogs), right interlobar (1 dog), and ventral interlobar (1 dog). Only about half (46%) were in the fissure for ligamentum venosum and therefore classified as a patent DV. An intralobar IPSS was seen in 32 of 56 (57%) dogs, most (88%) originated from the right portal branch and were in the right-lateral liver lobe (21 dogs) or caudate process (7 dogs). During canine portal CTA, documenting the interlobar or intralobar location of an IPSS might increase the consistency and validity of IPSS description.

Idiopathic Left Ventricular Apical Aneurysm in a Sailor With Moderate Transient Chest Pain: A Unique Perspective on an Atypical Presentation in the Military Population.

Left ventricular (LV) apical aneurysm is a rare condition that carries a high risk of fatal cardiac rupture. Wall ruptures are an uncommon catastrophic complication after acute transmural myocardial infarction. Rarely is the rupture only contained by an adherent pericardium or hematoma creating a pseudoaneurysm. This clinical finding calls for emergent surgical intervention. If no ruptures are detectable and myocardium wall integrity is verified, the diagnosis of a true aneurysm can be made to be repaired via elective surgery. The etiological differential for a patient with an LV aneurysm in the setting of normal coronaries and in the absence of prior cardiac surgery remains broad, including traumatic, infectious, and infiltrative causes. In this case report, we demonstrate an atypical and rare presentation of an idiopathic LV apical aneurysm in a physically fit, active duty male in the U.S. Navy.

Metacarpophalangeal Joint Pathology and Bone Mineral Density Increase with Exercise but Not with Incidence of Proximal Sesamoid Bone Fracture in Thoroughbred Racehorses.

Proximal sesamoid bone (PSB) fracture is the leading cause of fatal musculoskeletal injury in Thoroughbred racehorses in Hong Kong and the US. Efforts are underway to investigate diagnostic modalities that could help identify racehorses at increased risk of fracture; however, features associated with PSB fracture risk are still poorly understood. The objectives of this study were to (1) investigate third metacarpal (MC3) and PSB density and mineral content using dual-energy X-ray absorptiometry (DXA), computed tomography (CT), Raman spectroscopy, and ash fraction measurements, and (2) investigate PSB quality and metacarpophalangeal joint (MCPJ) pathology using Raman spectroscopy and CT. Forelimbs were collected from 29 Thoroughbred racehorse cadavers (n = 14 PSB fracture, n = 15 control) for DXA and CT imaging, and PSBs were sectioned for Raman spectroscopy and ash fraction measurements. Bone mineral density (BMD) was greater in MC3 condyles and PSBs of horses with more high-speed furlongs. MCPJ pathology, including palmar osteochondral disease (POD), MC3 condylar sclerosis, and MC3 subchondral lysis were greater in horses with more high-speed furlongs. There were no differences in BMD or Raman parameters between fracture and control groups; however, Raman spectroscopy and ash fraction measurements revealed regional differences in PSB BMD and tissue composition. Many parameters, including MC3 and PSB bone mineral density, were strongly correlated with total high-speed furlongs.

Development of a minimally invasive endoscopic technique for excisional biopsy of the axillary lymph nodes in dogs.

OBJECTIVE: To develop and describe a minimally invasive technique for excisional biopsy of the axillary lymph nodes in dogs. STUDY DESIGN: Descriptive cadaver and clinical case series. ANIMALS: Four canine cadavers and three clinical patients. METHODS: A 3D computed tomographic reconstruction of the canine axilla was used to identify an optimal avenue of approach to the lymph nodes. This approach was refined using endoscopic techniques in four cadavers (six procedures) and potential surgical hazards, landmarks, and the surgical time required for excisional biopsy of the nodes was recorded. The procedure was then performed in three clinical cases. RESULTS: Axillary lymph node removal was achieved using an endoscopic technique with surgical times of 58 and 35 minutes in two of three clinical cases. The third case required conversion to an open approach after endoscopic identification of the node. No major complications were encountered. CONCLUSION: Excisional biopsy of the axillary lymph nodes can be performed successfully using a minimally invasive technique in the dog. Further investigation in clinical cases is needed to determine the risks and complications of this procedure. CLINICAL SIGNIFICANCE: Minimally invasive excisional biopsy of the axillary lymph nodes in dogs can be performed and may have a role in assisting with staging and local disease control in oncologic cases.

Intra- and interobserver assessments of intestinal wall thickness and segmentations from transverse sections of feline abdominal ultrasound images.

Measurements of intestinal wall thicknesses from ultrasound imaging (US) are routinely used to support diagnoses of intestinal disorders in cats, however published studies describing observer agreement are currently lacking. The aim of this retrospective, observer agreement study was to quantify inter- and intraobserver repeatability and agreement in the measurement of intestinal wall layer thicknesses and the segmentation of transverse sections of small intestines in US images of 20 cats. Intestinal wall layer thickness measurements of the mucosa, submucosa, muscularis, serosa layer, and total thickness of these layers were performed on five cats with small cell epitheliotropic lymphoma, five with inflammatory bowel disease, and 10 with other conditions. Thickness measurements and the segmentation encompassing the serosa layer were obtained from five observers four times non-sequentially. The average standard deviation in thickness measurements (95% confidence interval) in the mucosa, submucosa, muscularis, serosa, and total thickness were 0.35 (0.07-0.95), 0.24 (0.07-0.52), 0.22 (0.06-0.49), 0.20 (0.05-0.49), and 0.57 (0.11-1.60) mm, respectively. The average intraclass correlation coefficients, which estimates the degree of consistency in thickness measurements and segmentation areas for each observer, ranged from 0.355 to 0.870 and 0.850 to 0.993, respectively. The interclass correlation coefficient, which estimates the degree of consistency when measuring a thickness or segmentation area over all observers ranged from 0.115 to 0.753, and 0.811 to 0.902, respectively. The overall average Dice Coefficient, which estimates the extent of overlap of the segmentations for all observers was 0.957 (0.933 to 0.972). Our results suggest segmentations of small intestines have a higher interobserver agreement than measurements of intestinal wall thicknesses.

3D printed cannulas for use in laparoscopic surgery in feline patients: A cadaveric study and case series.

OBJECTIVE: To evaluate custom 3D printed laparoscopic cannulas (3DPC) in a feline cadaveric abdominal surgery model and report their use in two live feline subjects. STUDY DESIGN: Experimental cadaver study, live subject case series. ANIMALS: Ten feline cadavers; two feline subjects. METHODS: Custom 3DPCs were initially modeled in a PLA filament material and then created in an autoclavable dental resin for use in live patients. The surgery time, number of surgical collisions and cannula complications were recorded during cadaver procedures before and after use of 3DPCs. Cannula complications were recorded during live procedures and patients were followed to suture removal to record any incisional complications. RESULTS: There was a significant reduction in mean surgical time (125.6 vs. 95.2 min, p = 0.03), mean number of instrument collisions (6.8 vs. 2.6, p = 0.03), and mean number of cannula complications (10 vs. 2.2, p = 0.03) with the use of only 3DPCs during the procedure. During the live procedures the use of the 3DPCs was successful and no postoperative complications occurred at the incision sites. CONCLUSION: The use of customized 3DPCs may improve surgical dexterity and decrease complications in advanced procedures and was not associated with any clinical complications in two cats. The use of 3DPCs in veterinary medicine may allow for wider practice of laparoscopic techniques in small animals.

Laparoscopic vertical sleeve gastrectomy in felines: A cadaveric feasibility study and experimental case series in two cats.

OBJECTIVE: To evaluate the feasibility of laparoscopic vertical sleeve gastrectomy (LVSG) in feline cadavers using endoscopic stapling equipment and report clinical outcomes in two live feline subjects. STUDY DESIGN: Cadaveric study and experimental case series. ANIMALS: Ten feline cadavers; two feline subjects. METHODS: LVSG technique was refined on feline cadavers and included retraction of the liver, dissection of the stomach, assessment of proper location for gastrectomy via stapling, and leak testing. Appropriateness of gastrectomy, gastrectomy %, surgical times and complications were recorded. The procedure was performed on two live feline subjects, and they were followed for 4 months to report surgical complications. RESULTS: LVSG was completed in 9/10 cadavers and both live patients. Stenosis at the incisura was recorded in 2/9 cadavers. No obvious leaks were seen in the 8 cadavers that were tested or either live patient. The mean surgical time for all cadaver procedures and live patients was 110.4 and 115 minutes, respectively. Mean weight of resected cadaver stomach was 10 g and the mean % of the total stomach weight resected was 27.6%. No intra- or postoperative surgical complications occurred in the live subjects. CONCLUSION: LVSG technique appears feasible and safe for use in live patients. CLINICAL RELEVANCE: This LVSG technique may be safely used for partial gastric resection in cats. Further studies are necessary to determine if it is effective at reversing the effects of obesity and diabetes in this population.

Radiomics in veterinary medicine: Overview, methods, and applications.

Radiomics, or quantitative image analysis from radiographic image data, borrows the suffix from other emerging -omics fields of study, such as genomics, proteomics, and metabolomics. This report provides an overview of the general principles of how radiomic features are computed, describes major types of morphological, first order, and texture features, and the applications, challenges, and opportunities of radiomics as applied in veterinary medicine. Some advantages radiomics has over traditional semantic radiological features include standardized methodology in computing semantic features, the ability to compute features in multi-dimensional images, their newfound associations with genomic and pathological abnormalities, and the number of perceptible and imperceptible features available for regression or classification modeling. Some challenges in deploying radiomics in a clinical setting include sensitivity to image acquisition settings and image artifacts, pre- and post-image reconstruction and calculation settings, variability in feature estimates stemming from inter- and intra-observer contouring errors, and challenges with software and data harmonization and generalizability of findings given the challenges of small sample size and patient selection bias in veterinary medicine. Despite this, radiomics has enormous potential in patient-centric diagnostics, prognosis, and theragnostics. Fully leveraging the utility of radiomics in veterinary medicine will require inter-institutional collaborations, data harmonization, and data sharing strategies amongst institutions, transparent and robust model development, and multi-disciplinary efforts within and outside the veterinary medical imaging community.

Assessing the outcomes and experiences of care from the perspective of people living with chronic conditions, to support countries in developing people-centred policies and practices: study protocol of the International Survey of People Living with Chronic Conditions (PaRIS survey).

INTRODUCTION: In view of growing populations with chronic conditions, many countries are redesigning their health systems. However, little information is available about how health systems perform from the perspective of people living with chronic conditions. The Organisation for Economic Co-operation and Development (OECD) Member States therefore mandated the OECD to initiate the International Survey of People Living with Chronic Conditions (PaRIS survey), which aims to provide insight in outcomes and experiences of care as reported by people living with chronic conditions. The PaRIS-SUR consortium has been tasked by the OECD to support the development and implementation of the survey. METHODS AND ANALYSIS: As primary care services play a pivotal role in the management of chronic conditions, the PaRIS survey will be implemented in the primary care setting. Data will be collected with a survey among users of primary care services aged 45 years or older, of whom many have chronic conditions. An additional survey is conducted among their primary care providers. The nested study design will allow analysis of the patient-reported data in relation to characteristics of and care provided by primary care providers within and across countries. In 2022, the survey will be tested in a Field Trial in participating countries. Data for cross-country comparison will be collected by the Main Survey in 2023. ETHICS AND DISSEMINATION: Informed consent will be obtained from primary care providers and service users. National Project Managers search ethical approval of the survey in their country, if required. Reporting by the OECD will focus on questions for international comparison. A secured information technology platform will be developed for participants and stakeholders in countries to receive feedback and answer their own questions. Findings will also be disseminated through an international OECD flagship report, conferences, scientific papers and policy briefs, to inform strategies to improve care for people living with chronic conditions throughout the world.

Ultrasound is an accurate method compared to radiography for diagnosing the presence of acute hip luxation in cadaver dogs and can identify the direction of luxation with variable reliability.

Acute hip luxation is a common musculoskeletal injury in dogs, with radiographs being the preferred imaging modality for confirming the diagnosis. In large animal and human medicine, ultrasound is often utilized for this purpose. The objectives of this three-part study were to utilize a canine cadaver model to establish ultrasonographic features of hip luxation and evaluate the accuracy and reliability for diagnosing hip luxation with ultrasound. For the first prospective, exploratory study, a cadaver model was developed that allowed manual luxation and subsequent ultrasonography of the hip joint while in four directions of luxation. For the second prospective, anatomic study, a description of the ultrasonographic features for each direction of luxation was created. For the third prospective diagnostic accuracy, observer agreement study, 16 residency-trained and intern veterinarians without prior experience in this technique performed randomized, repeated ultrasound exams on cadaver hips assigned as normal or luxated (equally distributed between the 4 directions). A total of 1140 hip ultrasounds were performed with good accuracy (median, 90.8%; range, 61.4-100%), sensitivity (89.5%), and specificity (80.0%) for diagnosing the presence of hip luxation. Accuracy for identifying the correct quadrant of luxation was significantly lower (mean, 58.6%; range, 24.6-90.8%; P < 0.001). Intraobserver accuracy agreement varied widely from none to almost perfect agreement, and interobserver agreement ranged from slight to moderate agreement. The results of this study supported the use of ultrasound for diagnosing the presence of hip luxation but did not support replacing radiographs for diagnosing the direction of luxation.

Correlating Sensory Assessment of Smoke-Tainted Wines with Inter-Laboratory Study Consensus Values for Volatile Phenols.

Vineyard exposure to wildfire smoke can taint grapes and wine. To understand the impact of this taint, it is imperative that the analytical methods used are accurate and precise. This study compared the variance across nine commercial and research laboratories following quantitative analysis of the same set of smoke-tainted wines. In parallel, correlations between the interlaboratory consensus values for smoke-taint markers and sensory analyses of the same smoke-tainted wines were evaluated. For free guaiacol, the mean accuracy was 94 ± 11% in model wine, while the free cresols and 4-methylguaiacol showed a negative bias and/or decreased precision relative to guaiacol. Similar trends were observed in smoke-tainted wines, with the cresols and glycosidically bound markers demonstrating high variance. Collectively, the interlaboratory results show that data from a single laboratory can be used quantitatively to understand smoke-taint. Results from different laboratories, however, should not be directly compared due to the high variance between study participants. Correlations between consensus compositional data and sensory evaluations suggest the risk of perceivable smoke-taint can be predicted from free cresol concentrations, overcoming limitations associated with the occurrence of some volatile phenols, guaiacol in particular, as natural constituents of some grape cultivars and of the oak used for barrel maturation.