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2.
BMC Public Health ; 24(1): 1272, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724984

RESUMO

BACKGROUND: Zoonotic infections are a recognised risk for the veterinary community. Veterinary students are at risk, due to the range of activities they participate with on training coupled with their inexperience; yet the prevalence and severity of infections in veterinary students has been little studied. In this study, a survey explored zoonotic infections in UK and Irish veterinary students. METHODS: A survey containing both open and closed questions, was distributed to undergraduate veterinary students at all veterinary schools in the UK and Republic of Ireland. Descriptive statistics, and univariable logistic regression were used to explore quantitative data; thematic analysis was used to explore qualitative data. RESULTS: There were 467 responses, 31.5% (95% CI 27.3-35.9, n = 147) of those students reported having contracted at least one zoonotic infection during their studies. The most prevalent self-reported infections were cryptosporidiosis (15.2% of all respondents), dermatophytosis (5.6%), and other gastrointestinal infections assumed to be of zoonotic origin (4.5%). 7% of respondents reported having acquired a zoonosis within the last 12 months, 91% of these infections were acquired during farm placements. Thematic analysis (n = 34) showed that infection was an accepted risk, particularly on farm, and students were often reluctant to take time off their studies or placements as a result of infection. Reporting was very low, meaning universities would not have accurate figures on infection risk or particularly risky placement providers. CONCLUSIONS: Based on these survey results, veterinary students appear to be at increased risk of contracting zoonotic diseases, particularly on farm placements. Attitude and behaviour change at multiple levels is required to reduce the risk of infection to students and normalise reporting of illness.


Assuntos
Zoonoses , Humanos , Irlanda/epidemiologia , Estudos Transversais , Reino Unido/epidemiologia , Masculino , Feminino , Animais , Zoonoses/epidemiologia , Adulto , Adulto Jovem , Estudantes/estatística & dados numéricos , Estudantes/psicologia , Inquéritos e Questionários , Prevalência , Adolescente
3.
BMJ Open ; 13(10): e071852, 2023 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-37802621

RESUMO

OBJECTIVE: To evaluate the impact of mobile vaccination units on COVID-19 vaccine uptake of the first dose, the percentage of vaccinated people among the total eligible population. We further investigate whether such an effect differed by deprivation, ethnicity and age. DESIGN: Synthetic control analysis. SETTING: The population registered with general practices (GPs) in nine local authority areas in Cheshire and Merseyside in Northwest England, UK. INTERVENTION: Mobile vaccination units that visited 37 sites on 54 occasions between 12 April 2021 and 28 June 2021. We defined intervention neighbourhoods as having their population weighted centroid located within 1 km of mobile vaccination sites (338 006 individuals). A weighted combination of neighbourhoods that had not received the intervention (1 495 582 individuals) was used to construct a synthetic control group. OUTCOME: The weekly number of first-dose vaccines received among people aged 18 years and over as a proportion of the population. RESULTS: The introduction of a mobile vaccination unit into a neighbourhood increased the number of first vaccinations conducted in the neighbourhood by 25% (95% CI 21% to 28%) within 3 weeks after the first visit to a neighbourhood, compared with the synthetic control group. Interaction analyses showed smaller or no effect among older age groups, Asian and black ethnic groups, and the most socioeconomically deprived populations. CONCLUSIONS: Mobile vaccination units are effective interventions for increasing vaccination uptake, at least in the short term. While mobile units can be geographically targeted to reduce inequalities, we found evidence that they may increase inequalities in vaccine uptake within targeted areas, as the intervention was less effective among groups that tended to have lower vaccination uptake. Mobile vaccination units should be used in combination with activities to maximise outreach with black and Asian communities and socioeconomically disadvantaged groups.


Assuntos
COVID-19 , Vacinas , Humanos , Adolescente , Adulto , Idoso , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação , Inglaterra
4.
World J Urol ; 41(8): 2265-2271, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37395756

RESUMO

PURPOSE: Our objective is to evaluate the clinically significant prostate cancer detection rate of overlapping and perilesional systematic biopsy cores and its impact on grade group (GG) concordance at prostatectomy. MATERIALS AND METHODS: Biopsy maps of those undergoing MRI-targeted (TB) and systematic biopsy (SB) were reviewed to reclassify systematic cores. Perilesional (PL) cores were defined as adjacent cores within 10 mm of the target lesion ("penumbra") whilst overlap (OL) cores were defined as cores within the ROI itself ("umbra"). All other cores were designated as distant cores (DC). The incremental csPCa detection rate (GG ≥ 2) and the rate of GG upgrading on prostatectomy as OL, PL and DC sequentially added to TB were determined. RESULTS: Out of the 398 patients included, the median number of OL and PL cores was 5 (IQR 4-7) and 5 (IQR 3-6) respectively. OL cores detected more csPCa than PL cores (31 vs 16%, p < 0.001). OL and PL cores improved the csPCa detection rate of TB from 34 to 39% (p < 0.001) and 37% (p = 0.001) respectively. TB+OL+PL had greater csPCa detection compared to just TB+OL (41 vs 39%, p = 0.016) and TB+PL (41 vs 37%, p < 0.001). Of the 104 patients who underwent prostatectomy, GG upgrading rate for TB+OL+PL was lower compared to TB (21 vs 36%, p < 0.001) and was not significantly different compared to TB+OL+PL+DC (21 vs 19%, p = 0.500). CONCLUSION: A biopsy strategy incorporating both intensive sampling of the umbra and penumbra improved csPCa detection and reduced risk of GG upgrading at prostatectomy.


Assuntos
Neoplasias da Próstata , Umbridae , Masculino , Animais , Humanos , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Prostatectomia , Biópsia , Imageamento por Ressonância Magnética , Gradação de Tumores , Biópsia Guiada por Imagem
5.
Vet Rec ; 193(7): e3171, 2023 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-37310022

RESUMO

BACKGROUND: Animal-related injuries pose a significant risk to the veterinary profession. This study aimed to describe the incidence, demographics, context and consequences of animal-related injuries at UK veterinary schools. METHODS: A multicentre audit of accident records (2009-2018) across five UK veterinary schools was performed. Injury rates were stratified by school, demographics and species. The context and cause of the injury were described. Multivariable logistic models explored factors associated with medical treatment, hospital visits and time off work. RESULTS: An annual rate of 2.60 (95% confidence interval 2.48-2.72) injuries per 100 graduating students was calculated, varying between veterinary schools. Injuries were more frequently recorded in staff than students, and there were significant differences between staff and students in the activities performed preceding injury. Cats and dogs were associated with the highest number of reported injuries. However, injuries associated with cattle and horses were the most severe, with significantly higher hospital attendances and more time off work taken. LIMITATIONS: Data were based on reported injuries and likely underestimate the true injury rate. The population at risk was hard to quantify as population size and exposure were variable. CONCLUSION: Further research is recommended to explore the clinical and workplace management, including recording culture, of animal-related injuries among veterinary professionals.


Assuntos
Traumatismos em Atletas , Doenças do Gato , Doenças dos Bovinos , Doenças do Cão , Doenças dos Cavalos , Humanos , Gatos , Animais , Cães , Cavalos , Bovinos , Faculdades de Medicina Veterinária , Estudantes , Reino Unido/epidemiologia , Traumatismos em Atletas/veterinária
6.
Prostate ; 83(8): 781-791, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36895163

RESUMO

INTRODUCTION: We report herein the impact of focal therapy (FT) on multi-domain functional outcomes in a Phase II prospective clinical trial (NCT04138914) in focal cryotherapy for clinically significant prostate cancer (csPCa). METHODS: The primary outcome was the detection of a ≥5 point deterioration in any of the four main expanded prostate index composite (EPIC) functional domains. Pretreatment multiparametric magnetic resonance imaging (mpMRI) and transperineal targeted and systematic saturation biopsy were used to select patients with prostate-specific antigen (PSA)≤20 ng/mL, Gleason grade group (GG) ≤4, mpMRI lesion volume ≤ 3 mL (for a single lesion) or ≤1.5 mL (where two lesions were present). Focal cryotherapy was performed with a minimum 5 mm margin around each target lesion. EPIC scores were obtained at baseline and posttreatment at 1, 3, 6, and 12 months. Mandatory repeat mpMRI and prostate biopsy were performed at 12 months to determine the infield and outfield recurrence. RESULTS: Twenty-eight patients were recruited. The mean age was 68 years, with PSA of 7.3 ng/mL and PSA density of 0.19 ng/mL2 . No Clavien-Dindo ≥3 complications occurred. Transient worsening of EPIC urinary (mean diff 16.0, p < 0.001, 95% confidence interval [CI]: 8.8-23.6) and sexual function scores (mean diff 11.0, p:0.005, 95% CI: 4.0-17.7) were observed at 1-month posttreatment, with recovery by Month 3. A subgroup who had ablation extending to the neurovascular bundle had a trend to delayed recovery of sexual function to Month 6. At 12-month repeat mpMRI and biopsy, 22 patients (78.6%) had no detectable csPCa. Of the six patients (21.4%) who had csPCa recurrences, four were GG2, one GG3, and one GG4. Four patients underwent repeat FT, one underwent radical prostatectomy, while the remaining one patient with low-volume GG2 cancer opted for active surveillance. CONCLUSION: FT using cryotherapy was associated with a transient deterioration of urinary and sexual function with resolution at 3 months posttreatment and with reasonable early efficacy in well-selected csPCa patients.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Masculino , Humanos , Idoso , Estudos Prospectivos , Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/patologia , Biópsia , Crioterapia/métodos
7.
Vaccine ; 41(7): 1290-1294, 2023 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-36669970

RESUMO

Uptake of COVID-19 vaccine first doses in UK care homes has been higher among residents compared to staff. We aimed to identify causes of lower COVID-19 vaccine uptake amongst care home staff within Liverpool. An anonymised online survey was distributed to all care home managers, between the 21st and the 29th January 2021. 53 % of 87 care homes responded. The overall COVID-19 vaccination rate was 52.6 % (n = 1119). Reasons, identified by care home managers for staff being unvaccinated included: concerns about lack of vaccine research (37.0 %), staff being off-site during vaccination sessions (36.5 %), pregnancy and fertility concerns (5.6 %), and allergic reactions concerns (3.2 %). Care home managers wanted to tackle vaccine hesitancy through conversations with health professionals, and provision of evidence dispelling vaccine misinformation. Vaccine hesitancy and logistical issues were the main causes for reduced vaccine uptake among care home staff. The former could be addressed by targeted training, and public health communication campaigns to build confidence and acceptance of COVID-19 vaccines.


Assuntos
Pesquisa Biomédica , COVID-19 , Feminino , Gravidez , Humanos , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Comunicação , Fertilidade , Vacinação
8.
Vet Rec ; 192(1): e2283, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36214777

RESUMO

BACKGROUND: This study aimed to investigate the perceived effect of the RCVS Certificate in Advanced Veterinary Practice (CertAVP) on its graduates, with respect to career advancement, professional practice and contentment with work in the veterinary industry. METHODS: A cross-sectional online survey of CertAVP graduates was performed, utilising descriptive analysis of Likert scales, logistic regression of demographic variable associations with key outcomes and free-text analysis. RESULTS: The majority (89%) of the 103 respondents felt that the CertAVP led to improvements in professional practice, 56% felt it had helped advance their career and 55% stated it had improved their contentment with work in the veterinary industry. The CertAVP was perceived to improve evidence-based practice, clinical governance, intellectual satisfaction and encourage lifelong learning, but was not perceived to improve work-life balance. LIMITATION: Due to potential response bias, this study may not represent the wider population. CONCLUSION: Despite respondents reporting career advancement, this was only reflected in mentorship and managing more complex cases; respondents neither felt that the CertAVP resulted in promotion, a pay rise or new leadership roles, nor did it afford greater flexibility in their working schedule.


Assuntos
Mobilidade Ocupacional , Certificação , Prática Profissional , Médicos Veterinários , Humanos , Certificação/estatística & dados numéricos , Estudos Transversais , Percepção , Inquéritos e Questionários , Médicos Veterinários/estatística & dados numéricos
9.
Sci Rep ; 12(1): 18256, 2022 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-36309570

RESUMO

Directing plant growth in weightlessness requires understanding the processes that establish plant orientation and how to manipulate them. Both gravi- and phototropism determine directional growth and previous experiments showed that high gradient magnetic fields (HGMF) can induce curvature in roots and shoots. Experiments with Brassica rapa verified that that gravitropism-like induction of curvature is possible in space and that the HGMF-responsive organelles are amyloplasts. We assessed the effect of space and HGMF based on 16 genes and compared their transcription with static growth and clinorotation. Amyloplasts size in root tips increased under weightlessness but decreased under clinorotation but not in response to magnetic fields. Amyloplast size changes were correlated with reduced amylase transcription in space samples and enhanced transcription after clinorotation. Mechanostimulation and weightlessness have opposite effects on the size of amyloplasts. The data show that plants perceive weightlessness, and that their metabolism adjusts to microgravity and mechanostimulation. Thus, clinorotation as surrogate for space research may lead to incorrect interpretations.


Assuntos
Voo Espacial , Ausência de Peso , Gravitropismo/fisiologia , Plastídeos/metabolismo , Raízes de Plantas/metabolismo , Plantas/metabolismo , Rotação , Amido/metabolismo , Campos Magnéticos
12.
Prostate Cancer Prostatic Dis ; 25(4): 720-726, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35027690

RESUMO

BACKGROUND: The optimal number of systematic biopsy cores in the era of multi-parametric MRI targeted biopsy remains unclear, especially on its impact of focal therapy planning. Our objective is to investigate the impact of reducing the number of systematic cores on prostate cancer detection in the era of MRI-US fusion targeted biopsy and as well as its relevance in template planning for focal therapy. MATERIALS AND METHODS: A retrospective analysis of 398 consecutive men who underwent both systematic saturation (~24 cores) and MRI-US fusion targeted biopsy was performed. Four reduced-core systematic biopsy strategies (two-thirds, half, one-third and one-quarter systematic cores) were modelled and the detection rates of clinically-significant prostate cancer (csPCa defined as grade group ≥2) were compared to that of a full systematic biopsy using McNemar's test. Focal therapy treatment plans were made based on positive cores on combined (targeted and systematic) biopsy and the various reduced-cores strategies to compare the proportion who had a change in treatment plan. RESULTS: csPCa was detected in 42% (168/398) of this patient cohort. Non-targeted systematic saturation biopsy had a 21% (83/398) csPCa detection rate. Our four strategies reduced the mean number of non-targeted systematic cores from 21.8 to 14.5, 10.9, 7.3 and 5.4 cores and their csPCa detection rates were significantly decreased to 16%, 13%, 9% and 8% respectively (all p < 0.05). Compared to the reduced-core strategies, a full systematic saturation biopsy resulted in change to the focal therapy treatment plan in 12% (2/3 cores), 19% (1/2 cores), 24% (1/3 cores) and 29% (1/4 cores) of the time (p = 0.0434). CONCLUSIONS: Reducing the number of systematic biopsies when performing an MRI-targeted biopsy leads to reduced detection of csPCa and alter the treatment plans for focal therapy, possibly limiting its oncological efficacy.


Assuntos
Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/terapia , Biópsia Guiada por Imagem/métodos , Estudos Retrospectivos , Próstata/patologia , Imageamento por Ressonância Magnética
14.
Prostate ; 82(3): 298-305, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34855228

RESUMO

OBJECTIVE: After radical prostatectomy (RP), one-third of patients will experience biochemical recurrence (BCR), which is associated with subsequent metastasis and cancer-specific mortality. We employed machine learning (ML) algorithms to predict BCR after RP, and compare them with traditional regression models and nomograms. METHODS: Utilizing a prospective Uro-oncology registry, 18 clinicopathological parameters of 1130 consecutive patients who underwent RP (2009-2018) were recorded, yielding over 20,000 data points for analysis. The data set was split into a 70:30 ratio for training and validation. Three ML models: Naïve Bayes (NB), random forest (RF), and support vector machine (SVM) were studied, and compared with traditional regression models and nomograms (Kattan, CAPSURE, John Hopkins [JHH]) to predict BCR at 1, 3, and 5 years. RESULTS: Over a median follow-up of 70.0 months, 176 (15.6%) developed BCR, at a median time of 16.0 months (interquartile range [IQR]: 11.0-26.0). Multivariate analyses demonstrated strongest association of BCR with prostate-specific antigen (PSA) (p: 0.015), positive surgical margins (p < 0.001), extraprostatic extension (p: 0.002), seminal vesicle invasion (p: 0.004), and grade group (p < 0.001). The 3 ML models demonstrated good prediction of BCR at 1, 3, and 5 years, with the area under curves (AUC) of NB at 0.894, 0.876, and 0.894, RF at 0.846, 0.875, and 0.888, and SVM at 0.835, 0.850, and 0.855, respectively. All models demonstrated (1) robust accuracy (>0.82), (2) good calibration with minimal overfitting, (3) longitudinal consistency across the three time points, and (4) inter-model validity. The ML models were comparable to traditional regression analyses (AUC: 0.797, 0.848, and 0.862) and outperformed the three nomograms: Kattan (AUC: 0.815, 0.798, and 0.799), JHH (AUC: 0.820, 0.757, and 0.750) and CAPSURE nomograms (AUC: 0.706, 0.720, and 0.749) (p < 0.001). CONCLUSION: Supervised ML algorithms can deliver accurate performances and outperform nomograms in predicting BCR after RP. This may facilitate tailored care provisions by identifying high-risk patients who will benefit from multimodal therapy.


Assuntos
Algoritmos , Inteligência Artificial , Simulação por Computador , Metástase Neoplásica/diagnóstico , Nomogramas , Prostatectomia , Neoplasias da Próstata , Aprendizado de Máquina Supervisionado , Biomarcadores/análise , Pesquisa Comparativa da Efetividade , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Recidiva , Análise de Regressão , Reprodutibilidade dos Testes , Medição de Risco/métodos , Medição de Risco/tendências
15.
Asian J Urol ; 8(4): 436-439, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34765452

RESUMO

Childhood priapism is a rare entity and there is currently no consensus regarding its contemporary management. The use of perioperative anticoagulation and open distal corpora-glandular shunt procedure in the management of childhood priapism has not been reported in the literature. We present a stuttering case of a 13-year-old boy who presented with idiopathic ischaemic priapism lasting 13 h in duration, which recurred despite corporal aspiration and alpha-adrenergic agonist injections, percutaneous distal shunt surgery, and revision of percutaneous distal shunt surgery. He was eventually successfully managed with perioperative subcutaneous enoxaparin, oral aspirin and clopidogrel in conjunction with an Al-Ghorab shunt, which led to sustained detumescence but with spontaneous morning erections. In paediatric patients with sustained childhood priaprism failing stepwise treatments, an Al-Ghorab shunt with perioperative anticoagulation is a viable option.

16.
BMC Health Serv Res ; 21(1): 1153, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34696803

RESUMO

INTRODUCTION: Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff's experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. METHODS: Semi-structured interviews and thematic analysis. RESULTS: We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. CONCLUSION: Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.


Assuntos
COVID-19 , Assistência de Longa Duração , Humanos , Casas de Saúde , Pesquisa Qualitativa , SARS-CoV-2
17.
Age Ageing ; 50(6): 1868-1875, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34272866

RESUMO

INTRODUCTION: Care homes have been severely affected by the SARS-CoV-2 pandemic. Rapid antigen testing could identify most SARS-CoV-2 infected staff and visitors before they enter homes. We explored implementation of staff and visitor testing protocols using lateral flow devices (LFDs). METHODS: An evaluation of a SARS-CoV-2 LFD-based testing protocol in 11 care homes in Liverpool, UK, including staff and visitor testing, plus a qualitative exploratory study in nine of these homes. The proportion of pilot homes with outbreaks, and outbreak size, were compared to non-pilot homes in Liverpool. Adherence to testing protocols was evaluated. Fifteen staff were interviewed, and transcript data were thematically coded using an iterative analysis to identify and categorize factors influencing testing implementation. RESULTS: In total, 1,638 LFD rapid tests were performed on 407 staff. Protocol adherence was poor with 8.6% of staff achieving >75% protocol adherence, and 25.3% achieving $\ge$50%. Six care homes had outbreaks during the study. Compared to non-pilot care homes, there was no evidence of significant difference in the proportion of homes with outbreaks, or the size of outbreaks. Qualitative data showed difficulty implementing testing strategies due to excessive work burden. Factors influencing adherence related to test integration and procedural factors, socio-economic factors, cognitive overload and the emotional value of testing. CONCLUSION: Implementation of staff and visitor care home LFD testing protocols was poorly adhered to and consequently did not reduce the number or scale of COVID-19 outbreaks. More focus is needed on the contextual and behavioural factors that influence protocol adherence.


Assuntos
COVID-19 , Teste para COVID-19 , Surtos de Doenças/prevenção & controle , Humanos , Pandemias , SARS-CoV-2
18.
Urol Oncol ; 39(12): 829.e9-829.e17, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34023195

RESUMO

BACKGROUND: The relevance of continuous testosterone (TT) monitoring in castration-resistant prostate cancer (CRPC) remains in question. OBJECTIVE: To determine if TT levels before and during novel anti-androgen therapies (NAAT), and the TT 'bounce' phenomenon may predict treatment response in CRPC. MATERIALS AND METHODS: From 2014 through 2018, we identified 92 CRPC patients treated with either Abiraterone or Enzalutamide from a prospectively maintained cancer registry. The TT levels measured before and during NAAT were correlated with the oncological outcomes, determined by PSA response (% change), PSA progression-free survival (PFS) and overall survival (OS). RESULTS AND LIMITATIONS: At CRPC, 58 (63.0%) and 34 (37.0%) patients opted for Abiraterone and Enzalutamide respectively. Median TT levels at CRPC status before and during NAAT were 10.37 ng/dl and 20.46 ng/dl respectively. PSA response was superior in patients with a higher TT before NAAT (P:0.048, median difference: 18.22%, 95% CI 0.70 - 40.37) and longer time to CRPC (P: 0.041, median difference: 15.31%, 95% CI 1.84 -34.84), with a trend towards lower TT during NAAT (P: 0.062). Over a follow up of 33.0 months, 65 patients (70.7%) developed PSA progression. PSA PFS was longer in patients with higher TT before NAAT (16.3 vs. 10.8 months; P: 0.023), lower TT during NAAT (17.0 vs. 9.1 months; P: 0.001), and longer time to CRPC (13.4 vs. 8.0 months; P: 0.032). Importantly, better OS was observed in lower TT during NAAT (45.0 vs. 33.0 months; P:0.029) and longer time to CRPC (43.0 vs. 31.0 months; P: 0.025). The TT 'bounce' phenomenon was observed in 28 patients (33.3%), and was associated with a poorer PSA response (P: 0.029, median difference: 18.90%, 95% CI 3.83 - 41.45), shorter PSA PFS (8.6 vs 15.2 months, P: 0.002) and shorter OS (29.0 vs. 45.0 months, P: 0.012). CONCLUSION: In CRPC patients, TT behaviors before and during NAAT, and the 'bounce' phenomenon continue to predict treatment response and could guide clinical decisions.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Testosterona/metabolismo , Idoso , Antagonistas de Androgênios/farmacologia , Humanos , Masculino , Intervalo Livre de Progressão , Neoplasias de Próstata Resistentes à Castração/mortalidade
19.
Vet Rec ; 188(7): e71, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33835557

RESUMO

BACKGROUND: Backyard poultry ownership is of keen interest in the United Kingdom. However, despite this, little is known about veterinary care engagement and outcomes of visits in this group of species. METHODS: This study described and characterised veterinary practice-visiting backyard poultry, utilising electronic health record data supplied by veterinary practices voluntarily participating in the Small Animal Veterinary Surveillance Network between 1st April 2014 and 31st March 2019. RESULTS: In total, 4424 recorded poultry consultations originating from 197 veterinary practices (352 sites) were summarised. Chicken consultation (n = 3740) peak incidence was in early summer (April-June), relative to all recorded species. More chickens resided in rural (incident rate ratio = 2.5, confidence interval [CI] 2.3-2.6, p <0.001) or less deprived areas. Non-specific clinical signs were commonly recorded (17.6% of chicken consultations, CI 15.9-19.2), as were those indicative of advanced disease. This latter finding was reflected in prescribed management strategies, with euthanasia comprising 29.8% (CI 27.0-32.6) of consultations. Antimicrobials were commonly prescribed (33.0% of consultations, CI 29.8-36.2), 43.8% of which included antimicrobials considered 'highest priority critically important' by the World Health Organisation. CONCLUSION: Our findings indicate a need to tailor antimicrobial prescription guidance to the backyard poultry setting. In addition, late presentation of disease, vague clinical descriptions in clinical narratives and high euthanasia rates show that disease identification, management and knowledge of poultry health and welfare among owners and veterinary surgeons can be improved.


Assuntos
Criação de Animais Domésticos , Doenças das Aves Domésticas/diagnóstico , Doenças das Aves Domésticas/tratamento farmacológico , Medicina Veterinária/estatística & dados numéricos , Animais , Anti-Infecciosos/uso terapêutico , Galinhas , Demografia , Eutanásia Animal/estatística & dados numéricos , Humanos , Propriedade , Prescrições/estatística & dados numéricos , Prescrições/veterinária , Reino Unido
20.
BMJ Paediatr Open ; 5(1): e001040, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33884313

RESUMO

Background: Responses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures. Methods: An audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ2 tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years' data. Results: Dog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7-12 year-olds, girls in 4-6 year-olds. Girls showed higher attendance rates in the summer, while boys' attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls. Conclusions: COVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via 'stay at home' orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.


Assuntos
COVID-19 , Animais , Criança , Controle de Doenças Transmissíveis , Cães , Serviço Hospitalar de Emergência , Hospitais Pediátricos , Humanos , Pandemias/prevenção & controle , Estudos Retrospectivos , SARS-CoV-2
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