The effect of feeding a commercial feedstuff on gastric squamous gastric disease (ESGD) healing and prevention of recurrence.

Feedstuffs are often recommended to mitigate potential damage from acid associated with equine squamous gastric disease (ESGD). In acidic conditions, pectin alters its structure to one like mucus and binds the stomach mucosa, whilst alfalfa has a strong intrinsic acid buffering capacity. The study aimed to determine whether feeding a commercial beet pulp/alfalfa/oat fibre mix aids ESGD healing and/or prevention of recurrence. Ten adult horses with naturally occurring ESGD were included. All animals were treated with omeprazole as per the attending veterinarian's recommendation and randomly allocated to also be fed a commercial beet pulp/alfalfa/oat fibre mix (1Kg/horse divided into 2 meals/day; n=5) or no additional feed (n=5) for one month. Gastroscopy was then repeated to assess response to therapy. If the ESGD had healed, omeprazole therapy was discontinued, and the commercial feed given to all horses for a further month. Gastroscopy was repeated to determine ESGD recurrence. The mean (±SD) age of the horses was 11.6 (±3.8) years; 4 mares and 6 geldings; various breeds were represented; and the median (range) initial ESGD grade was 2 (2-4). ESGD had healed (grade 0/4) in all animals after one month. After a further month, ESGD had recurred in significantly (p=0.04) more animals that did not receive the commercial feed initially (3/5; 60%; mean [range] ESGD grade 3 [0,4]) compared to those that did (0/5; 0%; mean [range] ESGD grade 0 [0,0]). Thus, the commercial beet pulp/alfalfa/oat fibre mix aided prevention of ESGD recurrence when fed during the healing and prevention phases.

Litigation related to anaesthesia: analysis of claims against the NHS in England 2008-2018 and comparison against previous claim patterns.

We reviewed all 1230 claims against anaesthesia notified to NHS Resolution (formerly the NHS Litigation Authority, 1995-2017) in England between 2008 and 2018. Claims were categorised by incident type, severity (whether physical or psychological), and cost, and comparisons were made against a similar published analysis of data from 1995 to 2007. While the annual number of claims against anaesthesia increased by 62% from the earlier period, anaesthesia now accounts for smaller proportions of all claims submitted to NHS Resolution (1.5% vs. 2.5%) and of the total cost of all claims (0.7% vs. 2.4%). The absolute costs related to anaesthesia claims rose over 300%, totalling £145 million between 2008 and 2018, but the mean cost per closed claim (retail price index adjusted) fell by 6% to £74,883. The most common clinical categories were regional anaesthesia (24%), inadequate anaesthesia (20%) and drug administration (20%). Claims related to airway management, central venous catheterisation and cardiac arrest remained infrequent but severe and costly. The proportion of claims relating to regional anaesthesia and obstetric anaesthesia fell significantly, but claims relating to peripheral nerve blockade doubled. Our analysis includes categories relating to organisational and human factors which are present in a substantial proportion of claims; categories with the highest mean cost per claim included delayed care, planning, monitoring and consent. Overall, the specialty of anaesthesia is at low risk of litigation. Our analysis provides important insights into current and changing patterns in claim distributions that may help improve the quality of patient care and reduce future litigation. We recommend the establishment of a structure for national review and learning from all cases of litigation.

Effects on voluntary food intake of infusions of glucose and amino acids into the hepatic portal vein of chickens.

The hepatic portal veins of cockerels were catheterised to study the effects of 3-h infusions of nutrient solutions on voluntary food intake. An amino acid mixture, infused at rates up to 800 mg N/3 h, depressed intake of a standard diet in a significant linear manner (intakes with the highest dose and control: 1.6 g and 22.6 g/3 h respectively). Infusion of the highest dose into the jugular vein had a smaller and nonsignificant effect (17.2 and 25.3 g/3 h). The effects of combined infusion of amino acids and glucose into the portal vein on food intake were approximately additive.

Factors affecting food intake in the domestic chicken: the effect of infusions of nutritive and non-nutritive substances into the crop and duodenum.

1. Infusions of 10 g of diet mashed in 20 ml of water, increasing glucose loads and hypertonic solutions of glucose, sorbitol and KCl, were introduced into the crop of the adolescent cockerel (1.5 to 2.0 kg body weight and 12 to 20 weeks of age). All caused a significant reduction of food intake over the following 3-h period. 2. Duodenal infusions of hyperosmotic solutions of sorbitol and KCl at 3 osm significantly decreased food intake within an hour of infusion. Glucose infusion decreased intake only in birds starved for 3 h before the experiment. 3. The results are discussed in relation to the site of infusion and nutritive visceral mechanisms of food intake control. It is likely that there is a major osmotic control in the duodenum which may affect a secondary control system in the upper gastro-intestinal tract.

Evidence for hepatic glucostatic regulation of food intake in the domestic chicken and its interaction with gastro-intestinal control.

1. Male birds of a laying strain had permanent catheters introduced into the hepatic portal vein via the coccygeo-mesenteric vein. 2. Infusions of 5 ml of 40, 100 or 150 g glucose/l solution over 2 min caused a non-significant depression of food intake compared with a 9 g NaCl/l control solution. 3. Infusions of a range of isotonic glucose solution (0 to 60 g glucose/l, 30- mosm) at 1.4 ml/min over 3 h caused food intake depression within the 3-h period (P less than 0.01) proportional to the logarithm of the dose. 4. This effect was not observed when 60 g glucose/l was infused at the above rates into the jugular vein. 5. Starvation of the bird for 21 h accentuated the depressive effect of glucose load on food intake, especially when birds were not given food until after the 3-h infusion. 6. The infusion of solutions of sodium chloride (1.0 to 13.0 g/l, 33 to 433 mosmoles/kg) at 1.4 ml/min over 3 h stimulated food intake within the range of 3 to 7 g NaCl/l (100 to 233 mosm) but suppressed intake outside this range. This can be interpreted as a possible interaction with water intake control. 7. Infusion of 20 ml of glucose solution (0, 18 or 54 g/l) over 5 min into the crop and 0, 3.75 or 60 g glucose/l at 1.4 ml/min over 3 h into the hepatic portal vein, caused an additive, linear depression of food intake.