Care Pathways in Persistent Orofacial Pain: Qualitative Evidence from the DEEP Study.

Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.

Efficacy of oral famotidine and 2 omeprazole formulations for the control of intragastric pH in dogs.

BACKGROUND: Little is known about the efficacy of commonly used acid suppressants on intragastric pH in dogs. OBJECTIVE: To compare the effect of oral famotidine, 2 formulations of omeprazole, and placebo on intragastric pH in dogs with a catheter-free, continuous pH monitoring system. ANIMALS: Six healthy adult mixed-breed colony dogs. METHODS: Utilizing a randomized, 4-way cross over, open-label study, dogs were administered famotidine PO (1.0-1.3 mg/kg q12h), omeprazole tablet (1.5-2.6 mg/kg q24h), omeprazole reformulated paste (RP) (Gastrogard, 1.5-2.6 mg/kg q24h), and placebo for 7 days followed by a 10-day washout period. Radiotelemetric pH capsules were placed with gastroscopy assistance to continuously record intragastric pH for 4 days (days 4-7 of dosing). The percentage of time that intragastric pH was ≥3 and ≥4 was compared among treatment groups using repeated measures of analysis of variance. Tukey's Studentized range test was used to determine which groups were different with α= 0.05. RESULTS: Mean ± SD percent time intragastric pH was ≥3 and ≥4 was 22 ± 8% and 14 ± 6% for famotidine, 63 ± 14% and 52 ± 17% for omeprazole tablet, 54 ± 17% and 44 ± 18% for omeprazole RP, and 6 ± 6% and 5 ± 5% for placebo. Both omeprazole formulations significantly increased intragastric pH compared with famotidine and placebo, but omeprazole tablet and RP was not significantly different from each other. CONCLUSION: Oral omeprazole tablet and RP provide superior gastric acid suppression to famotidine, and should therefore be considered more effective for the treatment of acid related disorders in dogs.

Aspiration of barium-impregnated polyethylene spheres by a dog.

This case report describes an 11-year-old Belgian Malinois dog with acute onset of cough caused by aspiration of barium-impregnated polyethylene spheres (BIPS) and pneumonia following an episode of suspected gastric dilation. Although bronchoscopic retrieval of the BIPS was largely unsuccessful, the dog recovered uneventfully, with most of the BIPS being coughed out and swallowed over a 1-month period. Aspiration of BIPS should be considered a potential complication of their administration. Furthermore, endoscopic removal of aspirated BIPS is challenging and may not be indicated because of their inert nature and possible self-clearance.

Feline diarrhoea associated with Tritrichomonas cf. foetus and Giardia co-infection in an Australian cattery.

A 10-week-old female Ocicat was presented at a primary care feline veterinary practice for failure to thrive and diarrhoea. Numerous trophozoites, atypical for Giardia sp., were detected on a direct faecal examination, in addition to Giardia cysts. Although the failure to thrive and diarrhoea resolved following treatment for giardiasis, further diagnostic tests performed on faecal specimens from the kitten and 15 other Ocicats from the same cattery, including culture of trophozoites in In Pouch medium, PCR testing and molecular sequencing of PCR amplicons, confirmed infection with Tritrichomonas cf. foetus. This is the first report in Australia of feline trichomoniasis, which appears to be an emerging infectious disease of cats. Pertinent information regarding the clinical features, diagnosis, therapy, and potential source of feline trichomoniasis within Australia are discussed.

Hepatic cysts incarcerated in a peritoneopericardial diaphragmatic hernia.

Peritoneopericardial diaphragmatic hernia is a common incidental finding in cats and is rarely symptomatic. The case report described herein presented with dyspnoea secondary to incarceration of hepatic cysts within the pericardial space of a cat with a peritoneopericardial diaphragmatic hernia.

Hyponatremia and hyperkalemia associated with peritoneal effusion in four cats.

Four cats with considerable peritoneal effusion and corresponding hyponatremia and hyperkalemia were evaluated. The Na:K ratio in all cats was < 25, which is suggestive of adrenal insufficiency. An ACTH stimulation test was performed on 3 cats for evaluation of adrenal gland function. Serum cortisol and aldosterone concentrations did not support a diagnosis of adrenal gland insufficiency. In 1 cat, histologic evaluation of the adrenal glands at necropsy also failed to support a diagnosis of hypoadrenocorticism. On the basis of these findings, and because hyponatremia and hyperkalemia could not be readily explained by another cause, the electrolyte abnormalities were presumed to be secondary to peritoneal effusion.

Reproducibility of breath hydrogen concentration measurements in dogs after change of diet.

OBJECTIVE: To assess reproducibility of breath hydrogen (H2) concentration measurements in dogs on 3 consecutive days after introduction of a new diet. ANIMALS: 10 healthy colony-source dogs. Procedure Dogs were fed a commercial pet food for a minimum of 10 days before introduction of a high-carbohydrate commercial diet. Expired breath samples were collected at baseline and every 90 minutes for 18 hours on the first 3 days after introduction of the new diet. The area under the curve (AUC) for breath H2 concentration versus time on days 1, 2, and 3 were compared by use of repeated-measures ANOVA. RESULTS: The (AUC) did not differ significantly among test days 1, 2, and 3. CONCLUSIONS: Expired breath H2 concentration in dogs indicated good reproducibility during the first 3 days after introduction of a new diet. CLINICAL RELEVANCE: It is not necessary to provide a period for adaptation to a test diet prior to performing breath H2 tests in dogs.

Effect of five percent dehydration on breath hydrogen concentrations in dogs.

OBJECTIVE: To determine the effect of mild dehydration (5%) on expired breath H2 concentrations in dogs. ANIMALS: 10 healthy, colony-source dogs. PROCEDURE: Expired breath samples were collected at baseline, and every 90 minutes for 18 hours after ingestion of a test meal (commercial dog food and kibbled wheat) in fully hydrated dogs and in the same dogs when they had lost 5% of their body weight after food and water deprivation. The areas under the breath H2 concentration versus time curves (AUC) for the dehydrated and nondehydrated states were compared, using a two-stage, balanced, crossover, repeated measures technique. The number of breath samples considered to be contaminated by flatus were compared by use of a one-sided sign test. RESULTS: Expired breath H2 concentration of dogs during the dehydration test period was significantly (P < 0.02) greater than that during the nondehydration test period. In addition, flatulence was significantly (P < 0.033) more frequent in dogs during the dehydration period. CONCLUSIONS: Dehydrated dogs have greater expired breath H2 concentration and produce more flatus after ingestion of a carbohydrate-containing meal. Considered together, these findings suggest that dehydration results in an increase in the net amount of H2 produced in the gastrointestinal tract. CLINICAL RELEVANCE: Care should be taken to assess the hydration status, and to correct hydration deficits of dogs prior to breath H2 testing.