Status of transition care in inflammatory bowel disease in Spain. Different medical perspectives

Introduction: transition is important for a successful follow-up of adolescents with inflammatory bowel disease (IBD). The objectives of the study were to establish the situation of transition in Spain and to identify needs, requirements and barriers to transition from pediatric and adult gastroenterologist perspectives. Methods: a structured survey for self-completion using the REDCap platform was distributed via the Spanish Society for Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU). The questionnaire contained closed and ranked questions concerning transition, perceived needs, organizational, clinician and patient related barriers to transition. Results: one hundred and forty surveys were answered, 53% in pediatrics (PG) and 47% from adult gastroenterologists (AG) among 90 hospitals; 66% of them were reference centers. There was a higher response from pediatricians (18.2%) versus adult gastroenterologists (8.3%) (p = 0.03). A structured transition program is adequate in 42.2% centers. A well-structured transition was perceived as very important by 79.5% of PG and 63% of AG (p = 0.03). A higher proportion of both groups identified inadequacies in the preparation of adolescents for transfer (43% and 38%, p = ns). The main deficit areas were the lack of knowledge about disease and treatment as well as the lack of self-advocacy and care coordination. Lack of resources, time and critical mass of patients were the highest ranked barriers by both groups. AG and PG (54% and 55%) highlighted suboptimal training in adolescent medicine. Conclusions: in Spain, nearly half of the centers have developed a structured transition program. Lack of training, time and insufficient resources are the main barriers for a successful transition

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Status of transition care in inflammatory bowel disease in Spain. Different medical perspectives.

INTRODUCTION: transition is important for a successful follow-up of adolescents with inflammatory bowel disease (IBD). The objectives of the study were to establish the situation of transition in Spain and to identify needs, requirements and barriers to transition from pediatric and adult gastroenterologist perspectives. METHODS: a structured survey for self-completion using the REDCap platform was distributed via the Spanish Society for Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU). The questionnaire contained closed and ranked questions concerning transition, perceived needs, organizational, clinician and patient related barriers to transition. RESULTS: one hundred and forty surveys were answered, 53% in pediatrics (PG) and 47% from adult gastroenterologists (AG) among 90 hospitals; 66% of them were reference centers. There was a higher response from pediatricians (18.2%) versus adult gastroenterologists (8.3%) (p = 0.03). A structured transition program is adequate in 42.2% centers. A well-structured transition was perceived as very important by 79.5% of PG and 63% of AG (p = 0.03). A higher proportion of both groups identified inadequacies in the preparation of adolescents for transfer (43% and 38%, p = ns). The main deficit areas were the lack of knowledge about disease and treatment as well as the lack of self-advocacy and care coordination. Lack of resources, time and critical mass of patients were the highest ranked barriers by both groups. AG and PG (54% and 55%) highlighted suboptimal training in adolescent medicine. CONCLUSIONS: in Spain, nearly half of the centers have developed a structured transition program. Lack of training, time and insufficient resources are the main barriers for a successful transition.

Femoral head and neck excision in cats: medium- to long-term functional outcome in 18 cats.

OBJECTIVE: To assess the medium- to long-term functional outcome of cats after femoral head and neck excision (FHNE) using an owner-completed questionnaire. METHODS: Cats that had FHNE and were free of other orthopaedic or medical conditions that could affect their mobility, other than the studied coxofemoral joint(s), were included. A specific owner-completed questionnaire was used at a minimum of 4 months postoperatively. The questionnaire assessed the ability of the cats to perform normal feline activities, change of demeanour or behaviour, the necessity for long-term analgesia and the time taken to resume normal activities. RESULTS: Eighteen cats had undergone uni- or bilateral FHNE and met the inclusion criteria. All but one cat could perform normal feline activities without or with slight difficulty at follow-up. The aforementioned cat had notable, persistent difficulty in climbing. The majority of the cats took between 1 and 2 months to resume normal activity. No change in demeanour or behaviour was noted in any of the cats and none of the cats required long-term analgesia. CONCLUSIONS AND RELEVANCE: Based on the owner-completed questionnaire, cats have good-to-excellent medium- to long-term functional outcome after adequately performed FHNE.

Analgesic and motor-blocking action of epidurally administered levobupivacaine or bupivacaine in the conscious dog.

OBJECTIVE: To compare the analgesic and motor-blocking effects of epidurally administered levobupivacaine and bupivacaine in the conscious dog. STUDY DESIGN: Prospective, randomized, cross-over study. ANIMALS: Six adult female Beagle dogs. METHODS: Each animal received three doses of levobupivacaine or bupivacaine (0.5, 1.0 and 1.5 mg kg(-1); concentrations 0.25%, 0.50%, and 0.75%, respectively) in a total volume of 0.2 mL kg(-1) by means of a chronically implanted epidural catheter. Onset, duration (through pinch response in the sacral, lumbar and toe areas) and degree of analgesia and motor-blocking status was determined with a scoring system and at regular intervals over 8.5 hours before (baseline) and after drug administration. RESULTS: Epidurally administered levobupivacaine and bupivacaine had a similar dose-dependent analgesic action with no significant differences in onset (range: 5-8 minutes), duration (bupivacaine: 42 +/- 28, 135 +/- 68 and 265 +/- 68 minutes, and levobupivacaine: 28 +/- 33, 79 +/- 55 and 292 +/- 133 minutes; 0.25%, 0.50%, and 0.75%, respectively) or maximum degree of analgesia. However, levobupivacaine tended to produce a shorter duration of motor block than bupivacaine and the difference in the motor to nociceptive blockade times was significant at the highest dose. CONCLUSION: Epidural levobupivacaine produced an analgesic action similar to that of bupivacaine. CLINICAL RELEVANCE: Epidural levobupivacaine is suitable for clinical use in dogs, mostly at the highest dose if a high degree of analgesia is required.

Efficacy of tolfenamic acid and meloxicam in the control of postoperative pain following ovariohysterectomy in the cat.

OBJECTIVE: The hypothesis was that Visual Analog Scale (VAS) scores would be lower, and mechanical wound thresholds (MWT) higher, in cats receiving tolfenamic acid compared to those receiving placebo in the postoperative period following elective ovariohysterectomy. ANIMALS: Sixty-nine client-owned cats. METHODS: A prospective, randomized, blinded and placebo-controlled study was performed in cats which underwent ovariohysterectomy following preoperative tolfenamic acid, meloxicam, or placebo. A second dose of the same analgesic was administered 24 hours postoperatively. Assessments were made 1-hour before induction and 1, 2, 4, 6, 22, and 25 hours postoperatively. Pain was assessed by a blinded observer using Numerical Rating (NRS) and VAS scales. The MWT were measured using a force-measuring device. Group comparison was performed by using one-way ANOVA and chi-squared test for qualitative and quantitative data, respectively, and a mixed model for repeated measurements (p < 0.05). RESULTS: Sixty-five cats were included in the study. There were no differences between groups at baseline. There was a treatment effect on the NRS scores at 6, 22 and 25 hours. The meloxicam group was less painful than controls at 6 and 22 hours; both treatment groups were less painful than controls at 25 hours. There were no differences between groups in VAS for pain or sedation. The number of animals receiving rescue analgesia did not differ between groups. There was a treatment effect on MWT; thresholds in both treatment groups were significantly higher than that observed in controls at all time points. CONCLUSIONS: Preoperative tolfenamic acid or meloxicam reduced wound sensitivity following ovariohysterectomy in the cat. CLINICAL RELEVANCE: Tolfenamic acid and meloxicam administered preoperatively provided a similar analgesic effect in the postoperative period lasting 24 hours. Mechanical thresholds may be a better way of evaluating postoperative analgesia provided by nonsteroidal anti-inflammatory drugs in cats.