Computed tomography of a canine omental torsion secondary to a chronic abdominal gossypiboma and concurrent incidental broad ligament torsion.

A 5-year-old female spayed Dogue de Bordeaux was referred for concerns of an abdominal mass and peritoneal effusion. Abdominal radiographs identified a mid-ventral abdominal soft tissue opaque mass containing a radiopaque marker consistent with a gossypiboma. Contrast-enhanced abdominal CT identified two whirl signs associated with the abdominal gossypiboma. Exploratory laparotomy confirmed an omental torsion with encapsulated gossypiboma and concurrent incidental torsion of the remnant of the right broad ligament. Based on a literature review, omental torsions are an unreported complication of gossypibomas in canids.

The Impact of Web-Based Continuing Medical Education Using Patient Simulation on Real-World Treatment Selection in Type 2 Diabetes: Retrospective Case-Control Analysis.

BACKGROUND: Despite guidelines recommending the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in certain patients with type 2 diabetes (T2D), they are not being prescribed for many of these patients. Web-based continuing medical education (CME) patient simulations have been used to identify clinicians' practice gaps and improve clinical decision-making as measured within a simulation, but the impact of this format on real-world treatment has not been researched. OBJECTIVE: This study aimed to evaluate the effect of a simulation-based CME intervention on real-world use of GLP-1 RAs by endocrinologists and primary care physicians. METHODS: Two evaluation phases of the CME simulation were conducted: phase I, the CME simulation phase, was a paired, pre-post study of 435 physician learners in the United States; and phase II, the real-world phase, was a retrospective, matched case-control study of 157 of the 435 physicians who had claims data available for the study period. RESULTS: Phase I CME results showed a 29 percentage point increase in correct decisions from pre- to postfeedback (178/435, 40.9% to 304/435, 69.9%; P<.001) in selecting treatment that addresses both glycemic control and cardiovascular event protection. Phase II results showed that 39 of 157 (24.8%) physicians in the intervention group increased use of GLP-1 RAs, compared to 20 of 157 (12.7%) in the comparison group. Being in the intervention group predicted GLP-1 RA use after education (odds ratio 4.49; 95% CI 1.45-13.97; P=.001). CONCLUSIONS: A web-based CME simulation focused on secondary prevention of cardiovascular events in a patient with T2D was associated with increased use of evidence-based treatment selection in the real world.

What Is Your Diagnosis?

In collaboration with the American College of Veterinary Radiology.

Comparing the Rat Grimace Scale and a composite behaviour score in rats.

There is a growing interest in the use of voluntarily displayed ongoing behaviours in laboratory animals to assess the pain experience. In rats, two behavioural pain scales, the Rat Grimace Scale (RGS, a facial expression scale) and a composite behaviour score (CBS, a behavioural ethogram reliant on postural changes), are both promising pain assessment methods. Both scales have been used to assess pain in a laparotomy model, however, they have never been compared directly and the knowledge of how different analgesics may affect these two scales is limited. This study aimed to provide a comparison to discriminate the temporal and analgesic response in a laparotomy model. Female Wistar (n = 26) and Sprague Dawley rats (n = 26) were block randomized to receive saline, meloxicam (2 mg/kg) or buprenorphine (0.05 mg/kg) 30 minutes before laparotomy. Rats were video-recorded before surgery (BL) and at 30, 150, 270, and 390 minutes post-operatively. Videos were assessed according to both scales by a trained, blinded observer. Both CBS and RGS scores increased significantly at all post surgical timepoints in the saline group. Both buprenorphine and meloxicam reduced CBS scores to baseline levels following laparotomy; however, RGS scores were only reduced following buprenorphine. RGS scores in the meloxicam group remained similar to scores of the saline group. These findings suggest that the CBS and RGS differ in their sensitivity to discriminating analgesic effects.

Quality Improvement in Management of Acute Coronary Syndrome: Continuing Medical Education and Peer Coaching Improve Antiplatelet Medication Adherence and Reduce Hospital Readmissions.

BACKGROUND: Reducing hospital readmissions and improving patient adherence to antiplatelet medications after an acute coronary syndrome (ACS) event are important goals for improving patient health and decreasing healthcare costs. Nearly half of patients will have a secondary event within 1 year of the initial ACS event. Quality improvement (QI) initiatives that include continuing medical education and peer coaching may improve physician practice patterns and, therefore, patient outcomes. METHODS: This study evaluated the impact of a QI initiative on antiplatelet (P2Y12 inhibitor) medication adherence (measured via pharmacy fill rates postdischarge) and hospital readmissions. RESULTS: Notable physician performance and patient-level changes included significant increases in antiplatelet medication counseling at hospital discharge (30%-57%; P < 0.0001), in P2Y12 inhibitor prescribing at hospital discharge (76%-84%; P = 0.02), and in patient fill rates for branded P2Y12 inhibitors (72%-100%; P = 0.0001). There were numerical trends toward lower rates of ACS-related rehospitalizations at 60 days postdischarge (from 11% to 7%; P = 0.15) and of all-cause rehospitalizations at 60 days (from 20% to 14%; P = 0.10). CONCLUSION: Important in the rapidly evolving landscape of quality healthcare, QI involving continuing medical education and peer coaching demonstrably impacted physician performance and patient outcomes after an ACS event.

Comparison of a Supraglottic Airway Device (v-gel®) with Blind Orotracheal Intubation in Rabbits.

INTRODUCTION: Achieving a secure airway in rabbits is generally considered more difficult than in cats or dogs. Their relatively large tongue, small oropharyngeal cavity and glottis limit direct visualization. A rabbit-specific supraglottic airway device (SGAD) may offer benefits over blind orotracheal intubation. ANIMALS AND METHODS: Fifteen adult New Zealand white rabbits were randomized to SGAD or orotracheal intubation (ETT). All animals were sedated with dexmedetomidine (0.1 mg kg-1 IM) and midazolam (0.5 mg kg-1 IM), followed by induction with alfaxalone (0.3 mg kg-1 IV). Two CT scans of the head and neck were performed, following sedation and SGAD/ETT placement. The following were recorded: time to successful device insertion, smallest cross-sectional airway area, airway sealing pressure, and histological score of tracheal tissue. Data were analyzed with a Mann-Whitney test. RESULTS: Two rabbits were excluded following failed ETT. Body masses were similar [ETT; n = 6, 2.6 (2.3-4.5) kg, SGAD; n = 7, 2.7 (2.4-5.0) kg]. SGAD placement was significantly faster [33 (14-38) s] than ETT [59 (29-171) s]. Cross-sectional area (CSA) was significantly reduced from baseline [12.2 (6.9-3.4) mm2] but similar between groups [SGAD; 2.7 (2.0-12.3) mm2, ETT; 3.8 (2.3-6.6) mm2]. In the SGAD group, the device tip migrated into the laryngeal vestibule in 6/7 rabbits, reducing the CSA. ETT airway seals were higher [15 (10-20) cmH2O], but not significant [SGAD; 5 (5-20) cmH2O, p = 0.06]. ETT resulted in significantly more mucosal damage [histological score 3.3 (1.0-5.0)], SGAD; 0.67 (0.33-3.67). CONCLUSION: The SGAD studied was faster to place and caused less damage than orotracheal intubation, but resulted in a similar CSA.

Determinants of adherence to diabetes treatment.

BACKGROUND: Understanding and improving medication adherence is crucial in diabetes management. Adherence to a diabetes regimen can improve glucose control and limit the development of complications. The aim of the present study was to evaluate the extent to which a variety of factors influence diabetes medication adherence. METHODS: A medication adherence survey was made available on WebMD, a medical information website for patients and/or consumers. Respondents were residents of the US, ≥18 years old, and diagnosed with either type 1 or type 2 diabetes mellitus (self-reported). RESULTS: Behavioral adherence (self-reported doses missed per week) correlated with perceived adherence (patients' self-report of their overall impression of medication adherence, ranked 0-5; P < 0.001). Adherent patients (very few [0%-10%] issues with adherence) were more likely to report having received information from their physician. Mostly adherent patients (few [11%-26%] issues with adherence) were less likely to obtain information from their physician, but reported more medication self-titration. Somewhat non-adherent patients (some [27%-46%] adherence issues) reported more "self-consciousness factors" and hypoglycemia. Non-adherent patients (many [47%-88%] adherence issues) were more likely to report worries about medication side effects. CONCLUSIONS: Receiving information from a healthcare provider is associated with greater diabetes medication adherence, suggesting the importance of clinicians making time to provide patient education.

Knowledge of PCSK9 and continued educational gaps: evaluating the impact of continuing medical education.

Reducing serum levels of low-density lipoprotein-cholesterol (LDL-C) is an important treatment objective in both the primary and secondary prevention settings. Although statin therapy remains the gold standard for reducing LDL-C, for a variety of reasons, many patients taking statins do not achieve adequate cholesterol lowering. This has created a need for new treatment approaches to manage dyslipidemia. One potential emerging treatment option to promote greater LDL-C reduction is the class of proprotein convertase subtilisin/kexin 9 (PCSK9) monoclonal antibodies, currently in phase 3 development. This study evaluated the impact of continuing medical education (CME) on increasing knowledge and awareness of the role of PCSK9 in lipid metabolism and analyzed persistent educational gaps to determine needs for future education. For cardiologists who participated in the CME activity, comparison of individually linked preassessment question responses to their respective postassessment question responses demonstrated improvement (n = 83; P < 0.05). Correct responses on postassessment questions ranged between 63% and 253% higher after CME, with an overall effect size of 0.72. Between 24% and 47% of learners showed improvement in understanding individual learning concepts. In the ever-evolving landscape of dyslipidemia management, CME demonstrably impacted knowledge of the PCSK9 monoclonal antibodies.