Welsh hospital admissions due to dog bites and strikes (2014-2022).

OBJECTIVE: To describe the incidence and victim demographics of Welsh hospital admissions due to dog bites and strikes from 2014 to 2022. STUDY DESIGN: Descriptive analysis of Welsh hospital admissions data. METHODS: Residents of Wales admitted to a Welsh National Health Service (NHS) hospital for a dog bite or strike, were identified using ICD-10 codes. The annual incidence of dog bite and strike admissions between 2014 and 2022 was calculated and stratified by child-adult status, sex, and Local Health Boards. Trends over time were analysed using the Chi-square test for trends. RESULTS: Hospital admissions due to dog bites and strikes have significantly increased from 16.3 per 100,000 to 23.7 per 100,000 population in 2022. This was driven by an increase in non-geriatric adults and an increase in three Local Health Boards. The Swansea Bay area has the highest incidence in Wales (56.1 admissions per 100,000). CONCLUSIONS: Wales has a higher incidence of dog bites and strikes than England or the Republic of Ireland. Work in the communities where incidence is exceptionally high is needed to understand the reasons behind having the highest incidence of dog bites in the British Isles and to establish the most efficacious methods for bite prevention.

Dog-related deaths registered in England and Wales from 2001 to 2021.

OBJECTIVE: This study aimed to describe the incidence and demographics of fatal dog bites or strikes, as defined in English and Welsh mortality data (2001-2021). STUDY DESIGN: A descriptive analysis of the Office for National Statistics registered deaths data set. METHODS: Individuals whose cause of death was defined as 'bitten or struck by a dog' were identified. The average annual number of dog-related deaths and trends in incidence were calculated. Age and sex demographics of victims were described. RESULTS: In total, there were 69 registered deaths, a mean of 3.3 (95% confidence interval 0.3-6.3) dog-related deaths per year, and a mean annual incidence of 0.59 (95% confidence interval 0.06-1.11) deaths per 10 million population. There was no year-on-year change in incidence. Of victims, 59% were male, 10% were <5 years, and 30% were ≥75 years. CONCLUSIONS: Dog-related deaths are rare in England and Wales and have not increased between 2001 and 2021. Further contextual information about the incidents is needed to be able to develop public health strategies and interventions.

A pilot study of Australian pet owners who engage in social media and their use, experience and views of online pet health information.

OBJECTIVE: The aim of this study was to gain a better understanding of Australian pet owners' use of the internet for pet health; how trustworthy they rate various pet health information sources and the use of online information in subsequent veterinary consultations. METHOD: An anonymous questionnaire was developed, consisting of 30 questions, and distributed between March 2018 and May 2018 using convenience sampling through social media venues including Facebook and Twitter. All respondents were over the age of 18, lived in Australia and owned a pet animal. RESULTS: A total of 228 responses were received. The most common sources of pet health information were veterinarians (88.2%) and internet websites (81.1%). Most respondents reported using the internet 'many times per day' at either home or work. The majority of respondents used the internet to seek pet health information either 'not weekly but at least once a month' or 'less than once a month'. Nearly half of the respondents stated that they only 'sometimes' discuss their online findings with their veterinarian. Approximately one half of respondents agreed with the statement that online pet health information had affected their decision about whether to take their pet to the veterinarian. CONCLUSION: This study assesses how pet owners use the internet for pet health information and the role veterinarians can play in helping to facilitate these searches with tools such as information prescriptions. Further large-scale research is needed to help further understand this increasingly important aspect of pet health.

Pilot study of Australian veterinarians and their perceptions and experiences related to online pet health information.

OBJECTIVE: Investigate Australian veterinarians' perceptions of clients' use of the internet to find pet health information. METHODS: An anonymous online survey was distributed using social media, e-newsletters and veterinary magazines. RESULTS: A total of 85 complete responses were obtained from Australian veterinarians. Most (80%) reported believing that > 80% of their clients have access to the internet at home or work, but 68% thought that the majority of their clients do not understand what they read online. Attitudes regarding the impact of online pet health information on the veterinarian-client relationship were mixed (56% reported negative impact and 33% a positive impact), as well as for clients' use of the internet for information on companion animal health (47% reported negative impact and 38% a positive impact). When asked how often they suggest specific websites to their clients ('information prescriptions'), the majority of veterinarians reported that this is done infrequently. CONCLUSION: This pilot study highlighted the perception of Australian veterinarians of their clients' use of the internet to find pet health information. It also highlighted the need for a large-scale, detailed survey of Australian veterinarians and their views in relation to pet owners and their use of online information. This should include evaluation of information prescriptions and their potential benefits for clients and patients.

Reliability and validity of the English and Malay versions of the Driving and Riding Questionnaire: a pilot study amongst older car drivers and motorcycle riders.

OBJECTIVES: This study aimed to examine the reliability and validity of the English and Malay versions of the Driving and Riding Questionnaire. STUDY DESIGN: An observational study with a mix-method approach by utilising both questionnaire and short debriefing interviews. METHODS: Forward and backward translations of the original questionnaire were performed. The translated questionnaire was assessed for clarity by a multidisciplinary research team, translators, and several Malay native speakers. A total of 24 subjects participated in the pilot study. Reliability (Cronbach's alpha) and validity (content validity) of the original and translated questionnaires were examined. RESULTS: The English and Malay versions of the Driving and Riding Questionnaire were found to be reliable tools in measuring driving behaviours amongst older drivers and riders, with Cronbach's alpha of 0.9158 and 0.8919, respectively. For content validity, the questionnaires were critically reviewed in terms of relevance, clarity, simplicity, and ambiguity. The feedback obtained from participants addressed various aspects of the questionnaire related to the improvement of wordings used and inclusion of visual guide to enhance the understanding of the items in the questionnaire. This feedback was incorporated into the final versions of the English and Malay questionnaires. CONCLUSION: The findings of this study demonstrated both the English and Malay versions of the Driving and Riding Questionnaire to be valid and reliable.

Validity and Reliability of Malay Version of the Job Content Questionnaire among Public Hospital Female Nurses in Malaysia.

BACKGROUND: The Job Content Questionnaire (M-JCQ) is an established self-reported instrument used across the world to measure the work dimensions based on the Karasek's demand-control-support model. OBJECTIVE: To evaluate the psychometrics properties of the Malay version of M-JCQ among nurses in Malaysia. METHODS: This cross-sectional study was carried out on nurses working in 4 public hospitals in Klang Valley area, Malaysia. M-JCQ was used to assess the perceived psychosocial stressors and physical demands of nurses at their workplaces. Construct validity of the questionnaire was examined using exploratory factor analysis (EFA). Cronbach's α values were used to estimate the reliability (internal consistency) of the M-JCQ. RESULTS: EFA showed that 34 selected items were loaded in 4 factors. Except for psychological job demand (Cronbach's α 0.51), the remaining 3 α values for 3 subscales (job control, social support, and physical demand) were greater than 0.70, indicating acceptable internal consistency. However, an item was excluded due to poor item-total correlation (r<0.3). The final M-JCQ was consisted of 33 items. CONCLUSION: The M-JCQ is a reliable and valid instrument to measure psychosocial and physical stressors in the workplace of public hospital nurses in Malaysia.

Serine-arginine protein kinase 1 (SRPK1) inhibition as a potential novel targeted therapeutic strategy in prostate cancer.

Angiogenesis is required for tumour growth and is induced principally by vascular endothelial growth factor A (VEGF-A). VEGF-A pre-mRNA is alternatively spliced at the terminal exon to produce two families of isoforms, pro- and anti-angiogenic, only the former of which is upregulated in prostate cancer (PCa). In renal epithelial cells and colon cancer cells, the choice of VEGF splice isoforms is controlled by the splicing factor SRSF1, phosphorylated by serine-arginine protein kinase 1 (SRPK1). Immunohistochemistry staining of human samples revealed a significant increase in SRPK1 expression both in prostate intra-epithelial neoplasia lesions as well as malignant adenocarcinoma compared with benign prostate tissue. We therefore tested the hypothesis that the selective upregulation of pro-angiogenic VEGF in PCa may be under the control of SRPK1 activity. A switch in the expression of VEGF165 towards the anti-angiogenic splice isoform, VEGF165b, was seen in PC-3 cells with SRPK1 knockdown (KD). PC-3 SRPK1-KD cells resulted in tumours that grew more slowly in xenografts, with decreased microvessel density. No effect was seen as a result of SRPK1-KD on growth, proliferation, migration and invasion capabilities of PC-3 cells in vitro. Small-molecule inhibitors of SRPK1 switched splicing towards the anti-angiogenic isoform VEGF165b in PC-3 cells and decreased tumour growth when administered intraperitoneally in an orthotopic mouse model of PCa. Our study suggests that modulation of SRPK1 and subsequent inhibition of tumour angiogenesis by regulation of VEGF splicing can alter prostate tumour growth and supports further studies for the use of SRPK1 inhibition as a potential anti-angiogenic therapy in PCa.

Pathological analysis of lymph nodes in anterior prostatic fat excised at robot-assisted radical prostatectomy.

AIMS: To assess the lymph node content of anterior prostatic fat (APF) sent routinely at robot-assisted laparoscopic radical prostatectomy (RALP) and the incidence of positive nodes in the extended pelvic lymph node dissection. METHODS: Between September 2008 and April 2012, APF excised from 282 patients who underwent RALP was sent for pathological analysis. This tissue was completely embedded and lymph nodes counted. RESULTS: In total, 49/282 (17%) patients had lymph nodes in the APF, median lymph node yield in this tissue was 1 (range 1­5). In four patients, the lymph nodes contained metastatic deposits. These patients did not have positive nodes elsewhere in the extended lymph node dissection. CONCLUSIONS: APF contains lymph nodes in 1 in 6 patients and infrequently these may be malignant. APF should always be removed at radical prostatectomy. APF should be routinely sent for pathological analysis.

What is the point of tips?

AIMS: To look at the incidence of tip margin involvement in skin excisions for basal cell carcinomas (BCCs) and to examine if any factors might be used to predict margin involvement. METHODS AND RESULTS: All reports of BCCs by a single dermatopathologist were reviewed and 793 excisions were included from 642 patients. Whether there was BCC in the tip and whether this tip was involved were recorded together with macroscopic and microscopic factors based on the Royal College of Pathologists' (RCPath) dataset. Statistical analysis was carried out to determine associations between these factors and tip involvement. In 43 (5%) specimens the tip margin was involved and in 35 (4%) cases the peripheral lateral margin was involved. Risk factors for tip margin involvement were a lesion that was non-discernible macroscopically and most importantly, involvement of a peripheral lateral margin. CONCLUSIONS: The incidence of tip margin involvement is small and it appears unnecessary to embed the tips unless the lesion is non-discernible macroscopically or if the peripheral lateral margin is involved.

Discharge of patients to long-term care from a large acute hospital over a 12-year period.

BACKGROUND: Several factors may be important in determining the discharge of patients to long-term care from the acute hospital. AIMS: We aimed to look at factors associated with discharge to long-term care from St. James's Hospital, Dublin between 1997 and 2008. METHODS: Data obtained from a long-term care database within the geriatric service were analysed. This service is responsible for assessing and listing all patients for long-term care within the hospital. RESULTS: 3,107 patients were listed and 2,520 discharged to long-term care during the period. Mean age was 81.7±7.3 years and 64.1% were female. The number listed increased since 1997, but there was no change in age or gender. Median time to discharge was 52 days, but varied by year and was longer for public versus private facilities (mean difference=18 days, P=0.006). Mortality of those awaiting long-term care was 17.0%, but varied significantly by year and ranged form 9.3-29.0%. Mortality was higher in males, in those of older age and during the winter months. CONCLUSIONS: Variation in the time to discharge appears to be associated with changes in the provision of publicly funded private nursing home beds.

Dog owners' perceptions of breed-specific dangerous dog legislation in the UK.

The aim of this study was to identify both the level and source of knowledge that dog owners in the UK have of the Dangerous Dogs Act 1991. In order to acquire such information a questionnaire was designed and distributed using two main methods over a period of five months. Questionnaires were distributed via three pet-related online forums and by hand at two locations within five predefined areas in England. In total, 459 responses were received. Of these, 21.4 per cent were unable to name a single type of banned dog and 81.9 per cent of respondents agreed that information on dog legislation was not publicised enough. The knowledge of banned breeds among the dog owners surveyed was low and respondents expressed a desire to see the law relating to dangerous dogs in the UK either changed or improved.

Clinicopathological and molecular study of penile melanoma.

AIMS: To examine the clinicopathological features of a series of penile melanomas and screen for mutations in the BRAF and KIT genes, which are seen in melanomas from other sites. METHODS AND RESULTS: 12 patients with penile melanoma were identified over a 10-year period in two supra-regional networks in the UK. The 2- and 5-year survival was 61% and 20%, respectively. Half the patients had lymph node involvement at presentation; this was a poor prognostic indicator. KIT exons 11, 13, 17 and 18, and BRAF codons 600 and 601 were analysed for mutations by Sanger sequencing and pyrosequencing, respectively. None of the tumours showed either KIT mutations or the BRAF V600E mutation. CONCLUSION: Penile melanomas are extremely rare and have a similar prognosis to melanomas elsewhere, but they often present late, leading to a poor outcome. The mutations seen in melanomas from other sites appear to be rarely present in these tumours.

Early psychosis treatment in an integrated model within an adult mental health service.

OBJECTIVE: To compare the treatment of patients with early psychosis, 2 years after the introduction of an integrated model of enhanced management within a public adult mental health service, with an historic cohort from the same service. METHOD: Variables examined in the 2001 cohort were compared with 2008 patients. Computer database review and a file audit were conducted for all patients with early psychosis across the first 2 years of the program. RESULTS: Compared to the historic cohort, patients in the current cohort were 24% less likely to have been admitted (P=0.004). There were statistically significant reductions in involuntary status and use of a locked unit. Rates of police involvement in admission and use of seclusion were also reduced, though this trend was not significant. Average length of stay was reduced. Median duration of untreated psychosis was 3 months in both 2001 and 2008 cohorts. CONCLUSIONS: The introduction of an integrated model of management within an area mental health service for patients with early psychosis contributed to significant reductions in admissions, involuntary status and use of a locked ward. The data suggests that enhanced treatment of early psychosis patients can be offered within generic services.

Suitability of PSA-detected localised prostate cancers for focal therapy: experience from the ProtecT study.

BACKGROUND: Contemporary screening for prostate cancer frequently identifies small volume, low-grade lesions. Some clinicians have advocated focal prostatic ablation as an alternative to more aggressive interventions to manage these lesions. To identify which patients might benefit from focal ablative techniques, we analysed the surgical specimens of a large sample of population-detected men undergoing radical prostatectomy as part of a randomised clinical trial. METHODS: Surgical specimens from 525 men who underwent prostatectomy within the ProtecT study were analysed to determine tumour volume, location and grade. These findings were compared with information available in the biopsy specimen to examine whether focal therapy could be provided appropriately. RESULTS: Solitary cancers were found in prostatectomy specimens from 19% (100 out of 525) of men. In addition, 73 out of 425 (17%) men had multiple cancers with a solitary significant tumour focus. Thus, 173 out of 525 (33%) men had tumours potentially suitable for focal therapy. The majority of these were small, well-differentiated lesions that appeared to be pathologically insignificant (38-66%). Criteria used to select patients for focal prostatic ablation underestimated the cancer's significance in 26% (34 out of 130) of men and resulted in overtreatment in more than half. Only 18% (24 out of 130) of men presumed eligible for focal therapy, actually had significant solitary lesions. CONCLUSION: Focal therapy appears inappropriate for the majority of men presenting with prostate-specific antigen-detected localised prostate cancer. Unifocal prostate cancers suitable for focal ablation are difficult to identify pre-operatively using biopsy alone. Most lesions meeting criteria for focal ablation were either more aggressive than expected or posed little threat of progression.

Mentoring for NHS doctors: perceived benefits across the personal-professional interface.

OBJECTIVE: To investigate NHS doctors' perceived benefits of being involved in mentoring schemes and to explore the overlaps and relationships between areas of benefit. DESIGN: Extended qualitative analysis of a multi-site interview study following an interpretivist approach. SETTING: Six NHS mentoring schemes across England. MAIN OUTCOME MEASURES: Perceived benefits. RESULTS: While primary analysis resulted in lists of perceived benefits, the extended analysis revealed three overarching areas: professional practice, personal well-being and development. Benefits appear to go beyond a doctor's professional role to cross the personal-professional interface. Problem solving and change management seem to be key processes underpinning the raft of personal and professional benefits reported. A conceptual map was developed to depict these areas and relationships. In addition secondary analysis suggests that in benefitting one area mentoring may lead to consequential benefits in others. CONCLUSIONS: Prior research into mentoring has mainly taken place in a single health care sector. This multi-site study suggests that the perceived benefits of involvement in mentoring may cross the personal/professional interface and may override organizational differences. Furthermore the map developed highlights the complex relationships which exist between the three areas of professional practice, personal wellbeing and personal and professional development. Given the consistency of findings across several studies it seems probable that organizations would be strengthened by doctors who feel more satisfied and confident in their professional roles as a result of participation in mentoring. Mentoring may have the potential to take us beyond individual limits to greater benefits and the conceptual map may offer a starting point for the development of outcome criteria and evaluation tools for mentoring schemes.

Immunohistochemical staining for the differentiation of subungual keratoacanthoma from subungual squamous cell carcinoma.

BACKGROUND: Subungual keratotic tumours are rare. The clinical and histological distinctions between subungual keratoacanthomas (SUKAs) and subungual squamous cell carcinomas (SCCs) are important, but often difficult. Adequate methods of differentiation between the two are required, both for the purpose of management and for assessment of prognosis. AIM: To establish the value of immunohistochemical staining patterns of proliferating cells to distinguish between SUKAs and subungual SCCs. METHODS: In total, 20 keratotic tumours from 20 patients were examined with immunohistochemical staining techniques using bcl-2, Ki67 and p53. RESULTS: Of 20 patients, 4 had SUKAs, 5 had cutaneous KAs, 6 had subungual SCCs and 5 had cutaneous SCCs. Our results showed that a high index of staining of p53 favours the diagnosis of subungual SCC over SUKA. CONCLUSION: SUKAs do not express Ki67 strongly whereas some subungual SCCs do. Thus we conclude that immunohistochemistry for p53 and Ki67 may help distinguish between a subungual SCC and a SUKA.