Clinical bleeding diathesis, laboratory haemostatic aberrations and survival in dogs infected with Angiostrongylus vasorum: 180 cases (2005-2019).

OBJECTIVES: Bleeding diathesis is a complication in dogs infected with Angiostrongylus vasorum. This retrospective study investigated clinical and laboratory haemostatic differences in A. vasorum-positive dogs with and without signs of bleeding and impact of bleeding on survival. MATERIALS AND METHODS: Demographics, type of clinical bleeding, haematocrit and a range of haemostatic tests, including thromboelastography and derived velocity curves were retrospectively registered from A. vasorum-positive dogs. All parameters were compared between dogs with and without signs of bleeding using univariable analyses. Binomial and multinomial regression models were applied to examine specific indicators in the bleeding dogs. P-values were false discovery rate adjusted, and adjusted P<0.05 was considered significant. RESULTS: One hundred and eighty dogs entered the study, including 65 dogs (36.1%) presenting with bleeding diathesis. Different types of cutaneous and mucosal bleeding were the most common clinical findings. Twenty dogs presented with neurological signs associated with intracranial and intra-spinal bleeding. One hundred and thirty-seven dogs had haematological and/or haemostatic laboratory analyses performed. Haematocrit, platelet count, thromboelastographic angle, maximum amplitude, global clot strength, maximum rate of thrombin generation and total thrombin generation were decreased, while prothrombin time was prolonged in bleeding dogs. Survival rate of bleeding dogs was lower at hospital discharge (76.9%) and 1 month after diagnosis (66.0%) than in dogs without signs of bleeding (94.8% and 90.1% at discharge and at 1 month, respectively). CLINICAL SIGNIFICANCE: Several haemostatic aberrations were detected in A. vasorum-positive dogs with bleeding diathesis. Bleeding was identified as an important negative prognostic indicator in A. vasorum-positive dogs.

[The channels for important new knowledge to medical doctors. The case of Helicobacter pylori and stomach and duodenal ulcers.].

UNLABELLED: A retrospective survey of the flow of information to medical doctors as regards the relationship between Helicobacter pylori and stomach and duodenal ulcer and other gastrointestinal diseases. This is the Icelandic part of a joint study in five Nordic countries. OBJECTIVE: The objective of the research was to assess the effectiveness of different sources of information, to measure the length of time it takes for the information to spread and influence medical practice. MATERIAL AND METHODS: The information was collected with the help of questionnaires that were sent to 159 general practitioners (GP) and 110 physicians in three medical specialities. Among the questions asked were when and how the information had reached the respondents and when and how it had influenced their medical practices. RESULTS: The knowledge about Helicobacter pylori had generally reached medical doctors six to eight years after it first appeared in the medical journals and had three years later led to changes in the routine examinations and treatment. The specialists got the news one to three years earlier than the GPs and also started to prescribe antibiotics one to three years earlier. The most frequently cited source of information was international medical journals, then scientific conferences, colleagues and The Icelandic Medical Journal. The most important source was considered to be international medical journals, then scientific conferences and colleagues. A certain difference was found between GPs and the specialist doctors. More GPs said they had got information from the pharmaceutical industry or through The Icelandic Medical Journal and relied on clinical diagnosis. More specialist doctors considered the most important source of new knowledge to be the colleagues, they also said they used endoscopy and took tissue samples more often and more often considered it correct to do so. CONCLUSIONS: Only a decade after the first reports on Helicobacter pylori appeared in medical journals most Icelandic doctors had got the knowledge and were prescribing appropriate treatment, the specialist doctors in the lead. International medical journals spread the news most effectively but The Icelandic Medical Journal played only a minor role. The question is if the process could have been accelerated any further by some more hitting Icelandic news and by more definite initiative in framing guidelines.

Diffusion of knowledge of Helicobacter pylori and its practical application by Nordic clinicians.

BACKGROUND: The knowledge uptake by physicians in five Nordic countries about Helicobacter pylori and gastrointestinal disease was studied. METHODS: Questionnaires were sent to 1832 general practitioners (GP) and gastroenterologists (GE), and central persons were interviewed in Norway, Sweden, Denmark, Finland, and Iceland. RESULTS: Half the GEs had heard of H. pylori by 1987 and had begun eradication treatment before 1991, and half the GPs had by 1989 and 1992, respectively. By 1996 this applied to more than 90% of both groups. The most important information sources were national journals for GPs and international journals and conferences for GEs. More than 80% of respondents considered H. pylori causative for peptic ulcer, less than 50% for stomach cancer, and 10% for non-ulcer dyspepsia. Variations between countries were mostly small. CONCLUSIONS: GPs and GEs in the Nordic countries have knowledge of H. pylori, and there is broad agreement on diagnosis and treatment, although some differences exist.

[Gaining new knowledge in clinical practice]. / Opptak av ny kunnskap i klinisk praksis.

A study of the diffusion of knowledge about Helicobacter pylori and gastrointestinal disease among Norwegian clinicians is reported. A questionnaire about when and how research results on Helicobacter pylori and gastrointestinal disease were taken up by doctors in their practice was sent to 200 general practitioners and 200 medical and surgical gastroenterologists. This Norwegian study is part of a comparative study of the uptake process in the five Scandinavian countries which is planned to be published in an international journal. The specialists both heard of research results and started using new treatments earlier than the general practitioners. The main sources of information for the general practitioners were the national medical journal and courses or conferences, whilst the specialists obtained their information mainly from international journals and courses or conferences. The general practitioners were more likely to treat Helicobacter pylori positive dyspepsia and to use serology as a diagnostic tool, whilst the specialists were more likely to use breath tests and had a greater belief in the role of Helicobacter pylori as a cause of gastric cancer. The great majority of both groups knew of Helicobacter pylori as a cause of peptic ulcer disease, used antibiotics in its treatment, and preferred (referral to) endoscopic biopsy as the main diagnostic tool.

[Knowledge about Helicobacter pylori and antibiotic treatment of peptic ulcer. A model study of information dissemination and implementation of the new knowledge in clinical practice]. / Viden om Helicobacter pylori og antibiotikabehandling af ulcussygdom. Et modelstudie over informationsspredning og implementering af ny viden i klinisk adfaerd.

Dissemination of information concerning new knowledge on peptic ulcer disease caused by Helicobacter pylori and treatment with antibiotics was surveyed. In 1996 a questionnaire was mailed to 200 gastroenterologists and 200 general practitioners. Physicians enumerate national medical journals as the most frequent source of information about the relationship between Helicobacter pylori and gastrointestinal ulcer. Six years after the first publication in international journals, 44% of the doctors had noticed this relation. Nearly all physicians had introduced antibiotics in treatment af peptic ulcer disease ten to twelve years after first announcement. The gastroenterologists preferred international medical journals whereas general practitioners stated national medical journals were the most important sources of new knowledge. General practitioners lacked knowledge of published guidelines for treatment of peptic ulcer disease.