Anxiety, Disability, and Pain Predict Outcomes of Complex Regional Pain Syndrome: An 8-year Follow-up of a Prospective Cohort.

Factors contributing to the varied outcomes of complex regional pain syndrome (CRPS) are not well known. This study aimed to determine whether baseline psychological factors, pain, and disability influence long-term CRPS outcomes. We conducted an 8-year follow-up from a previous prospective study of CRPS outcomes. Sixty-six people diagnosed with acute CRPS were previously assessed at baseline, 6 months, and 12 months and in the current study, 45 were followed up after 8 years. At each timepoint, we measured signs and symptoms of CRPS, pain, disability, and psychological factors. Mixed-model repeated measures were used to identify baseline predictors of CRPS severity, pain, and disability at 8 years. Predictors of greater CRPS severity at 8 years were female sex, greater baseline disability, and greater baseline pain. Predictors of greater pain at 8 years were greater baseline anxiety and disability. The only predictor of greater disability at 8 years was greater baseline pain. Findings suggest CRPS is best understood from a biopsychosocial perspective, and baseline anxiety, pain, and disability may influence the trajectory of CRPS outcomes as far as 8 years later. These variables could be used to identify those at risk of poor outcomes or form targets for early interventions. PERSPECTIVE: This paper presents the findings of the first study to prospectively investigate predictors of CRPS outcomes over 8 years. Baseline anxiety, pain, and disability predicted greater CRPS severity, pain, and disability over 8 years. These factors could identify those at risk of poor outcomes or form targets for early interventions.

The perceptions of cancer health-care practitioners in New Zealand and the USA toward psychedelic-assisted therapy with cancer patients: A cross-sectional survey.

OBJECTIVES: A resurgence of research investigating the administration of psychedelic compounds alongside psychotherapy suggests that this treatment is a promising intervention for anxiety, depression, and existential distress in people with cancer. However, psychedelic treatment that induces a mind-altering experience potentially poses barriers to vulnerable cancer patients, and health-care practitioners may have concerns about referring their patients to trials investigating this approach. The aim of the current study was to investigate the perceptions of cancer health-care practitioners based in New Zealand and the USA related to psychedelic-assisted therapy. METHODS: This study utilized a cross-sectional survey of cancer health-care practitioners in New Zealand and the USA via convenience sampling to identify their perceptions about the concept of conducting psychedelic-assisted therapy with cancer patients. RESULTS: Participants perceived that (1) psychedelic-assisted therapy has the potential to provide benefit for cancer patients, (2) research in this area across a variety of domains is important, (3) work should consider spiritual and indigenous perspectives of health, and (4) there was willingness to refer patients to trials in this area, especially patients with advanced disease who were no longer going through curative treatment. Participants in the USA had greater awareness of psychedelics than the New Zealand sample; however, New Zealand participants more strongly believed that spiritual/indigenous factors should be considered in psychedelic-assisted therapy. SIGNIFICANCE OF RESULTS: Cancer health-care practitioners in our sample considered research investigating the potential for psychedelic-assisted therapies to be important and may be more open to studies that start in palliative and end-of-life contexts.

Digital competency of Psychologists in Aotearoa New Zealand: A cross-sectional survey.

Background: The increasing implementation of digital health into psychological practice is transforming mental health services. Limited clinical resources and the high demand for psychological services, alongside the restrictions imposed on services during the global COVID-19 pandemic, have been a catalyst for significant changes in the way psychologists work. Ensuring Psychologists have the skills and competence to use these tools in practice is essential to safe and ethical practice. Aim: This study aimed to explore the digital competence of psychologists working in Aotearoa New Zealand and their use of digital tools in the practice. Methods: A cross-sectional online survey was conducted with Aotearoa New Zealand Registered Psychologists (n = 195) between July and November 2021. Results: Participants reported varying degrees of competence across the digital tasks presented, with participants most commonly reporting moderate to high competence for engaging in remote supervision via digital means (86%) and obtaining client's informed consent for digital work (82%). In contrast, tasks that participants most reported not being moderately or highly competent in included working with interpreters remotely and evaluating the effectiveness and security of smartphone apps. Motivations to use digital technologies included meeting client preferences and needs, necessity for continuity of care, and the benefits of increased accessibility and reach. In contrast, the barriers to using digital technologies included client characteristics or preference, clinical factors, clinician preferences and skills, and workplace or technical issues or concerns. The majority (91.1%) were potentially interested in further training in this area. Conclusions: The current study offers insights into the digital competencies of a workforce that has required rapid incorporation of technologies into professional practice over recent years. This snapshot of the digital skills of psychologists demonstrates a large variation in digital competence. In the current context, developing digital competencies seems a fundamental requirement for psychologists to work in ways that appropriately and safely deliver client-centred care.

The benefits and acceptability of virtual reality interventions for women with metastatic breast cancer in their homes; a pilot randomised trial.

BACKGROUND: Women with metastatic breast cancer (MBC) report debilitating physical and psychological symptoms, including fatigue, anxiety, and pain, that greatly impact their quality of life. Immersive virtual reality (VR) has been proposed as an adjunctive pain therapy for patients with cancer, and evidence suggests it may also decrease symptoms of anxiety and depression. The purpose of this pilot study was to assess whether VR should be pursued as a feasible and acceptable adjunctive therapy to alleviate physical and psychological symptoms in women with MBC. METHODS: We conducted a pilot study testing the acceptability and efficacy of VR interventions with MBC patients to improve quality of life and to produce enduring decreases in fatigue, pain, depression, anxiety, and stress. Participants completed two different week-long VR experiences, reporting the prevalence of symptoms immediately before and after each study week, and 48 h later. Linear mixed models including fixed effects (VR intervention, counterbalancing order, and study week) and random effects (participant) were used to assess the effect of immersive VR on all outcome measures. RESULTS: Thirty-eight women with MBC completed the VR interventions and were included in analyses. Significant improvements post-intervention and/or 48 h later were demonstrated for quality of life, fatigue, pain, depression, anxiety, and stress. Across the entire study period, these differences met the criteria of a clinically important difference for quality of life, fatigue, depression, and stress. Participants reported feelings of relaxation and enjoyment and were highly likely to use the interventions gain. CONCLUSIONS: Our results demonstrate that VR experiences offer enduring benefits to the physical and psychological well-being of women with MBC. VR interventions are a feasible and acceptable intervention that can be conducted in a patient's own home. Such interventions are worthy of future investigation as a novel approach to improving quality of life in a patient population that have often been overlooked. TRIAL REGISTRATION: Prospectively registered on 25th October 2019 with Australian New Zealand Clinical Trials Registry (ref: ACTRN12619001480178 ).

Will I have sex to please you? Evaluating whether mindfulness buffers links between attachment and sexual motivations in daily life.

Insecurely attached individuals are more likely to report more maladaptive sexual motivations that predict worse personal and interpersonal outcomes. Given that mindfulness has been linked with improved relationship and sexual experiences, and that these effects may be moderated by attachment, the current study examined the possible buffering role of trait mindfulness on the links between attachment insecurity and daily sexual motives. Participants from New Zealand (N = 70) took part in a daily diary study that overcame limitations associated with previous cross-sectional research in the area (e.g., recall and aggregation biases). Online measures of trait mindfulness and attachment were completed, before participants reported their sexual motivations on each day they had sex for the next 14 days. Results provided some evidence that trait mindfulness has a therapeutic effect among more anxiously attached persons insofar as it reduced the degree to which attachment concerns manifested in maladaptive daily sexual motivations. In contrast, trait mindfulness did not buffer (and in some cases intensified) the links between attachment avoidance and maladaptive sexual motives. No significant interactions were detected between attachment insecurity and mindfulness in the prediction of adaptive daily sexual motivations. These findings suggest that mindfulness may differentially affect the manifestations of anxious and avoidant attachment. Practical and theoretical implications of the findings are discussed.

Cancer Healthcare Workers' Perceptions toward Psychedelic-Assisted Therapy: A Preliminary Investigation.

Recent clinical trials suggest that psychedelic-assisted therapy is a promising intervention for reducing anxiety and depression and ameliorating existential despair in advanced cancer patients. However, little is known about perceptions toward this treatment from the key gatekeepers to this population. The current study aimed to understand the perceptions of cancer healthcare professionals about the potential use of psychedelic-assisted therapy in advanced cancer patients. Twelve cancer healthcare professionals including doctors, nurses, psychologists and social workers took part in a semi-structured interview which explored their awareness and perceptions toward psychedelic-assisted therapy with advanced cancer patients. Data were analysed using thematic analysis. Four inter-connected themes were identified. Two themes relate to the role and responsibility of being a cancer healthcare worker: (1) 'beneficence: a need to alleviate the suffering of cancer patients' and (2) 'non-maleficence: keeping vulnerable cancer patients safe', and two themes relate specifically to the potential for psychedelic-assisted therapy as (3) 'a transformative approach with the potential for real benefit' but that (4) 'new frontiers can be risky endeavours'. The findings from this study suggest intrigue and openness in cancer healthcare professionals to the idea of utilising psychedelic-assisted therapy with advanced cancer patients. Openness to the concept appeared to be driven by a lack of current effective treatment options and a desire to alleviate suffering. However, acceptance was tempered by concerns around safety and the importance of conducting rigorous, well-designed trials. The results from this study provide a useful basis for engaging with healthcare professionals about future research, trial design and potential clinical applications.

"I Don't Identify with It": A Qualitative Analysis of People's Experiences of Living with Complex Regional Pain Styndrome.

OBJECTIVE: Complex regional pain syndrome (CRPS) is a painful limb condition known to cause significant disability and distress. However, little previous research has explored CRPS from a patient perspective. The present qualitative study aimed to describe the experiences of people living with CRPS. SUBJECTS: Forty-eight people with CRPS participated in this research. METHODS: Participants completed a face-to-face or telephone interview about their perceptions and experiences of CRPS and completed three drawings to illustrate their experiences. Data were analyzed through reflexive thematic analysis, and images in drawings were grouped and coded by theme. RESULTS: Three overarching themes encapsulated the data, including that 1) people experience CRPS as a source of severe symptoms and emotional difficulties, 2) CRPS undermines personal and social identity, and 3) this results in psychological responses that protect against the emotional and social impact of severe symptoms. Psychological responses include: a) searching for an explanation, b) "nothing is my fault," emphasizing a lack of personal responsibility and personal control, and c) detaching the limb from the self. CONCLUSIONS: CRPS is experienced as highly threatening to physical ability, psychological state, and identity. In response to these threats, people may develop their own explanations for CRPS and may mentally detach themselves from responsibility, control, and the painful limb itself. Future research could explore the impact of these factors on psychological well-being and CRPS symptoms and outcomes.

Stigma in the face of cancer disfigurement: A systematic review and research agenda.

INTRODUCTION: An emerging body of work has reported on the psychological impact of disfigurement on cancer patients; however, the extent of research focusing on stigmatisation in this context is unclear. This review aimed to evaluate how stigma associated with disfigurement impacts on cancer patients. METHODS: A systematic review of literature was conducted using SCOPUS, Web of Science, MEDLINE and PubMed databases. Articles were included if they described a qualitative or quantitative study that investigated the impact of stigma and disfigurement on individuals with cancer and/or their families. Included studies were appraised for methodology and narratively synthesised. RESULTS: Of the 16 studies which met the inclusion criteria, ten were qualitative and six were quantitative. Publication dates ranged from 1994 to 2020. Results highlighted the varying impact of felt and enacted stigma in people with cancer disfigurement. While individuals cope with stigma in different ways and outcomes can sometimes be positive, most articles documented a negative impact to well-being including emotions such as disgust and shame. CONCLUSION: This review identified negative and (sometimes) positive consequences of disfigurement and stigma on cancer patients; however, the main finding is that relevant research is in its infancy. Several areas of future research are warranted.

The "Ick" Factor: An Unrecognized Affective Predictor of Physical Symptoms During Chemotherapy.

BACKGROUND: Patients undergoing chemotherapy experience a range of aversive symptoms. These symptoms vary across individuals and at least some of this variation can be predicted by psychological factors, such as distress. However, while psychological distress predicts some of the symptoms, it is limited in important ways. PURPOSE: To (a) assess the viability of disgust-a discrete emotion that specifically evolved for health-related reasons-as a predictor of chemotherapy-related symptoms (particularly, taste- and smell-related changes) and (b) compare the predictive utility of disgust sensitivity and propensity against the most commonly used affective predictor, that is, psychological distress. METHODS: Patients with cancer (N = 63) about to initiate chemotherapy were recruited in a prospective observational study. Psychosocial predictor variables were assessed at baseline, and outcomes (i.e., physical symptoms, body mass index [BMI], and food-based sensory-processing changes) were assessed at both baseline and 6 week follow-up. RESULTS: Psychological distress did not predict any of the outcomes. Both disgust sensitivity (ß = .53, p = .003) and propensity (ß = -.56, p = .002) predicted greater food-based sensory-processing changes, while disgust sensitivity marginally predicted greater chemotherapy-related physical symptoms (ß = .34, p = .060); neither of these two forms of disgust predicted BMI. CONCLUSIONS: The study provides first evidence showing (a) associations between trait disgust and food sensory-processing changes that arise during chemotherapy and (b) disgust as being a more useful predictor of food- and digestion-related symptoms than psychological distress. In doing so, it opens new doors for better care to be provided to patients undergoing chemotherapy.

When mental illness and cancer collide: An investigation of the predictors of outcomes for cancer patients with a history of mental health problems.

OBJECTIVE: People with a serious mental health condition are no more likely to receive a diagnosis of cancer than the general population but fare more poorly in terms of outcomes. The current study investigated whether a background of mental health problems (measured by contact with mental health services and psychotropic medication) predicted treatment outcomes over and above demographic and medical confounds for cancer patients at Counties Manukau Health. METHODS: The sample consisted of 1652 patients diagnosed with cancer in the period 1 January 2016 to 31 December 2016. The sample was split into three groups: non-mental health, moderate mental health, and serious mental health. RESULTS: Patients in the serious and moderate mental health groups were more likely to have physical comorbidities. Those in the serious mental health group were also marginally more likely to have advanced cancer at diagnosis. There were no differences between groups in terms of treatment delays, but patients in the serious mental health group were more likely to be hospitalised and die in the 12 months following diagnosis. Whilst differences in mortality may be explained by greater clinical complexity (being older, having other physical comorbidities) and later stage at presentation, mental health history was independently associated with hospitalisations. CONCLUSIONS: Cancer patients with a history of more serious mental health issues fare more poorly than those with moderate mental health issues or no such history. The clinical complexity of working with these patients, indexed by mental and physical comorbidities, may be a factor contributing to this disparity.

Fighting the flinch: Experimentally induced compassion makes a difference in health care providers.

OBJECTIVES: Although health care providers are required to sustain care in difficult circumstances, some patients challenge this principle. Evoking compassion seems likely to be helpful in such situations. This research aimed to evaluate whether inducing compassion in health care providers might mitigate disengagement with patients who have challenging presenting features such as those with disgusting symptoms and/or are to blame for their own health problems. DESIGN: An online experimental study with clinical health care providers. METHODS: Medical students (n = 219) and qualified health care professionals (n = 108) took part in an online experiment. Participants were randomized to view a slideshow of either neutral images (control) or compassion-inducing images (compassion condition) and were then presented with a series of patient vignettes where presenting problems systematically varied on patient responsibility and disgusting symptoms. Engagement was assessed by asking participants how caring they felt, how much they would want to help, how challenging it would be, and whether they would wear a mask. RESULTS: Participants reported less engagement with patients who were responsible for their illness and who presented with disgusting symptoms. Induced compassion offset disengagement and qualified health professionals were more caring and willing to help patients than medical students. The compassion induction eliminated some differences between experienced and trainee clinicians. CONCLUSIONS: This research demonstrates that disgust and patient responsibility impacts clinical engagement and that medical students are more impacted by such scenarios than qualified health providers. Inducing compassion may help to mitigate these differences, and further investigation into strategies that foster engagement with difficult patients is warranted. Statement of contribution What is already known on the subject? Health care providers are required to sustain care across all patients; however, some patients are more difficult to engage with than others. Clinical engagement appears to be impacted when patients present with disgusting symptoms and/or are to blame for their own health problems. What does this study add? This work reports on a vignette-based study that shows that disgusting symptoms and patient responsibility impact self-reported measures of clinical engagement in response to patient scenarios. Qualified health care providers are less likely to disengage in these situations than medical students. A very brief online induction of compassion has potential to mitigate differences between trained professionals and students.

Emotional predictors of bowel screening: the avoidance-promoting role of fear, embarrassment, and disgust.

BACKGROUND: Despite considerable efforts to address practical barriers, colorectal cancer screening numbers are often low. People do not always act rationally, and investigating emotions may offer insight into the avoidance of screening. The current work assessed whether fear, embarrassment, and disgust predicted colorectal cancer screening avoidance. METHODS: A community sample (N = 306) aged 45+ completed a questionnaire assessing colorectal cancer screening history and the extent that perceptions of cancer risk, colorectal cancer knowledge, doctor discussions, and a specifically developed scale, the Emotional Barriers to Bowel Screening (EBBS), were associated with previous screening behaviours and anticipated bowel health decision-making. RESULTS: Step-wise logistic regression models revealed that a decision to delay seeking healthcare in the hypothetical presence of bowel symptoms was less likely in people who had discussed risk with their doctor, whereas greater colorectal cancer knowledge and greater fear of a negative outcome predicted greater likelihood of delay. Having previously provided a faecal sample was predicted by discussions about risk with a doctor, older age, and greater embarrassment, whereas perceptions of lower risk predicted a lower likelihood. Likewise, greater insertion disgust predicted a lower likelihood of having had an invasive bowel screening test in the previous 5 years. CONCLUSIONS: Alongside medical and demographic factors, fear, embarrassment and disgust are worthy of consideration in colorectal cancer screening. Understanding how specific emotions impact screening decisions and behaviour is an important direction for future work and has potential to inform screening development and communications in bowel health.

Parasite stress and pathogen avoidance relate to distinct dimensions of political ideology across 30 nations.

People who are more avoidant of pathogens are more politically conservative, as are nations with greater parasite stress. In the current research, we test two prominent hypotheses that have been proposed as explanations for these relationships. The first, which is an intragroup account, holds that these relationships between pathogens and politics are based on motivations to adhere to local norms, which are sometimes shaped by cultural evolution to have pathogen-neutralizing properties. The second, which is an intergroup account, holds that these same relationships are based on motivations to avoid contact with outgroups, who might pose greater infectious disease threats than ingroup members. Results from a study surveying 11,501 participants across 30 nations are more consistent with the intragroup account than with the intergroup account. National parasite stress relates to traditionalism (an aspect of conservatism especially related to adherence to group norms) but not to social dominance orientation (SDO; an aspect of conservatism especially related to endorsements of intergroup barriers and negativity toward ethnic and racial outgroups). Further, individual differences in pathogen-avoidance motives (i.e., disgust sensitivity) relate more strongly to traditionalism than to SDO within the 30 nations.

The "ick" Factor Matters: Disgust Prospectively Predicts Avoidance in Chemotherapy Patients.

BACKGROUND: Chemotherapy can be physically and psychologically demanding. Avoidance and withdrawal are common among patients coping with these demands. PURPOSE: This report compares established emotional predictors of avoidance during chemotherapy (embarrassment; distress) with an emotion (disgust) that has been unstudied in this context. METHODS: This report outlines secondary analyses of an RCT where 68 cancer patients undergoing chemotherapy were randomized to mindfulness or relaxation interventions. Self-reported baseline disgust (DS-R), embarrassment (SES-SF), and distress (Distress Thermometer) were used to prospectively predict multiple classes of avoidance post-intervention and at 3 months follow-up. Measures assessed social avoidance, cognitive and emotional avoidance (IES Avoidance), as well as information seeking and treatment adherence (General Adherence Scale). RESULTS: Repeated-measures ANOVAs evaluated possible longitudinal changes in disgust and forward entry regression models contrasted the ability of the affective variables to predict avoidance. Although disgust did not change over time or vary between groups, greater disgust predicted greater social, cognitive, and emotional avoidance, as well as greater information seeking. Social avoidance was predicted by trait embarrassment and distress predicted non-adherence. CONCLUSIONS: This report represents the first investigation of disgust's ability to prospectively predict avoidance in people undergoing chemotherapy. Compared to embarrassment and distress, disgust was a more consistent predictor across avoidance domains and its predictive ability was evident across a longer period of time. Findings highlight disgust's role as an indicator of likely avoidance in this health context. Early identification of cancer patients at risk of deleterious avoidance may enable timely interventions and has important clinical implications (ACTRN12613000238774).

Does a brief state mindfulness induction moderate disgust-driven social avoidance and decision-making? An experimental investigation.

In this experimental study, we evaluated whether manipulated disgust and mindfulness predicted social avoidance in bowel health contexts. Community participants (n = 101) were randomised to conditions in which disgust and/or state mindfulness were experimentally induced. Tasks assessing social avoidance and perceptions of available social networks in the context of bowel/health problems were conducted. Manipulation checks confirmed the elicitation of disgust and state mindfulness in the applicable conditions. As expected, persons in the disgust condition were more likely to exhibit immediate social avoidance (rejecting a glass of water). State disgust predicted greater socially avoidant decision-making, less decisional conflict, and smaller social network maps. State mindfulness predicted fewer names on inner network circles and amplified the effect of disgust on creating smaller social network maps. This report furthers understanding of disgust and avoidance in bowel health contexts, and suggests the need for caution in mindfulness interventions that raise awareness of emotion without also providing skills in emotional regulation.

Trait and state disgust: an experimental investigation of disgust and avoidance in colorectal cancer decision scenarios.

OBJECTIVE: To evaluate whether trait and experimentally manipulated state disgust independently and/or interactively predict immediate and anticipated avoidance in decision scenarios related to colorectal cancer (CRC). METHOD: Eighty participants, aged 18 to 66 years, completed questionnaires assessing trait disgust prior to a laboratory session. Participants were gender block randomized to disgust or control conditions before completing tasks assessing immediate avoidance of a CRC disgust elicitor (stoma bag) and anticipated avoidance in hypothetical CRC scenarios. RESULTS: Manipulation checks confirmed the elicitation of disgust in the experimental condition. Persons in the experimental condition were more likely to exhibit immediate avoidance behaviors in response to a commonly used bowel disease device (stoma bag), and trait disgust predicted time to touch the device. Trait disgust also moderated the influence of state disgust on anticipated avoidance, namely delay in help seeking for bowel symptoms and predicted rating disgusting side effects as more deterring to adherence. CONCLUSIONS: The current report suggests the importance of examining disgust in CRC contexts and provides the first empirical demonstration that state and trait aspects of disgust may interactively operate to deter certain types of decisions. It thus furthers understanding of emotions and avoidance in a health context that has had surprisingly little focus to date.

Disgust and behavioral avoidance in colorectal cancer screening and treatment: a systematic review and research agenda.

BACKGROUND: The emotion of disgust appears to promote psychological and behavioral avoidance, a dynamic that has significant implications in physical and psychological outcomes in colorectal cancer (CRC). Patients, caregivers, and health professionals alike are all potentially susceptible to responding with disgust and the associated avoidance. OBJECTIVE: This article aimed to review the early-stage literature related to disgust and CRC, consider the clinical implications, and suggest an appropriate research agenda. METHODS: Given limited research in this area, a systematic review of the literature was broadened to include disgust and all cancers. MEDLINE, Web of Science, SCOPUS, and ProQuest Dissertations and Theses databases were searched, with additional works sourced by reviewing citation lists and/or by contacting the lead authors. RESULTS: Nine studies were identified relating to disgust and cancer screening, and 6 related to disgust and cancer treatment. Two broad findings emerged: (1) disgust appears to be promoting aversion to (and avoidance of) CRC screening, and (2) several known elicitors of disgust are widely apparent in CRC contexts. CONCLUSIONS: Disgust likely represents a key emotional substrate for avoidance among CRC patients, caregivers, and health professionals. Further research is required to identify disgust's elicitors and effects in CRC contexts, informing interventions that target early identification of persons at risk of maladaptive outcomes. Exposure therapies and mindfulness training may be well suited to treating disgust-generated avoidance. IMPLICATIONS FOR PRACTICE: Disgust has significant implications in CRC contexts. Oncology nurses are uniquely positioned to guide clinical interventions and ultimately improve outcomes in this area.

Factors associated with methicillin-resistant versus methicillin-susceptible Staphylococcus pseudintermedius infection in dogs.

OBJECTIVE: To compare methicillin-resistant Staphylococcus pseudintermedius (MRSP) and methicillin-susceptible S pseudintermedius (MSSP) infections in dogs. DESIGN: Multicenter case-control study. ANIMALS: Dogs with MRSP infections were matched, by hospital, with 2 MSSP controls, with the infections occurring immediately before and after the case infection. PROCEDURES: Signalment, historical, clinical, treatment, and outcome data were documented. Conditional logistic regression was performed. A manual stepwise backward elimination procedure was used to build the multivariable model. RESULTS: 56 case and 112 control dogs were enrolled. Pyoderma was the most common infection type in both groups. In the final multivariable model, systemic administration of antimicrobials within 30 days prior to infection was significantly associated with an MRSP versus an MSSP infection (OR, 9.9; 95% confidence interval, 3.59 to 27.53). CONCLUSIONS AND CLINICAL RELEVANCE: The association of prior antimicrobial administration and MRSP infection indicated the potential impact of routine antimicrobial use in veterinary medicine on antimicrobial resistance and the need for prudent use of these important drugs. Mortality rate was not significantly different between MRSP and MSSP infections; the lack of a significant difference suggested that MRSP was inherently no more virulent than MSSP, provided the infection was properly diagnosed and appropriate treatment was started. Basic concepts such as prudent antimicrobial use and early diagnosis through timely submission of appropriate culture specimens therefore can be important measures to try to reduce the impact of this pathogen.

Effect of an anti-inflammatory dose of prednisone on thyroid hormone monitoring in hypothyroid dogs.

It is not uncommon for a hypothyroid dog to be receiving concurrent corticosteroids. As hypothyroid dogs receiving thyroid supplement need periodic monitoring, knowledge of whether prednisone alters thyroid hormone concentrations would be useful to determine whether testing can or should be done while the dog is receiving therapy and whether dose adjustments are appropriate. In this study, the effect of short-term anti-inflammatory prednisone was determined in dogs with naturally occurring hypothyroidism. Eight adult dogs were given prednisone (1.0 mg/kg, orally) daily for 7 days and then on alternate days for 14 days. Serum total thyroxine (T(4) ), free T(4) (fT(4) ), and thyroid-stimulating hormone (TSH) were measured on days 7, 21 and 28 and compared with baseline data. Total T(4) concentrations were significantly decreased after 7 days of anti-inflammatory prednisone, but were not significantly altered from baseline on days 21 or 28. Free T(4) and TSH concentrations were not significantly altered from baseline at any point during the study. Two dogs had decreased total T(4) concentrations on day 7, which may have resulted in an alteration in thyroid supplementation. Results showed that administration of prednisone at a dosage of 1 mg/kg, orally, once daily for 7 days decreased total T(4) , while fT(4) was unchanged, suggesting that fT(4) may be less affected by daily prednisone administration. Anti-inflammatory doses of prednisone administered every other day did not interfere with thyroid hormone monitoring.