A Survey of Orthopaedic Conditions in Small Animal Veterinary Practice in Britain

A two-month survey of small animal orthopaedic conditions was conducted by members of British Veterinary Orthopaedic association. Clinicians from 42 clinics participated from a variety of practice including referral, primary care and teaching institutions. A total of 1627 cases were recorded. The case load was dominated by dogs with evidence that in UK cats are underrepresented in veterinary orthopaedic practice. Evidence of breed predisposition to orthopaedic disease in dogs was not detected. The importance of trauma in younger patients and degenerative diseases in older dogs was confirmed. A strong similarity between the case loads seen at primary care and referral practices was recorded. The results of this survey may be useful to those planning clinical orthopaedic teaching and research programmes.

Members of BVOA recorded and collated details of all orthopaedic cases seen during February and March 1994. The case load was dominated by dogs with evidence that cats are underrepresented in orthopaedic practice. There were striking similarities between the case loads of primary care and referral institutes. The findings of this survey may help those responsible for planning clinical orthopaedic teaching and research.

Text-Based Program Addressing the Mental Health of Soon-to-be and New Fathers (SMS4dads): Protocol for a Randomized Controlled Trial

Background

Recent estimates indicating that approximately 10% of fathers experience Paternal Perinatal Depression (PPND) and the increasing evidence of the impact of PPND on child development suggest that identifying and assisting distressed fathers is justified on public health grounds. However, addressing new fathers’ mental health needs requires overcoming men’s infrequent contact with perinatal health services and their reluctance to seek help. Text-based interventions delivering information and support have the potential to reach such groups in order to reduce the impact of paternal perinatal distress and to improve the wellbeing of their children. While programs utilising mobile phone technology have been developed for mothers, fathers have not been targeted. Since text messages can be delivered to individual mobile phones to be accessed at a time that is convenient, it may provide a novel channel for engaging with “hard-to-reach” fathers in a critical period of their parenting.

Objective

The study will test the efficacy of SMS4dads, a text messaging program designed specifically for fathers including embedded links to online information and regular invitations (Mood Tracker) to monitor their mood, in order to reduce self-reported depression, anxiety and stress over the perinatal period.

Methods

A total of 800 fathers-to-be or new fathers from within Australia will be recruited via the SMS4dads website and randomized to the intervention or control arm. The intervention arm will receive 14 texts per month addressing fathers’ physical and mental health, their relationship with their child, and coparenting with their partner. The control, SMS4health, delivers generic health promotion messages twice per month. Messages are timed according to the babies’ expected or actual date of birth and fathers can enroll from 16 weeks into the pregnancy until their infant is 12 weeks of age. Participants complete questionnaires assessing depression, anxiety, stress, and alcohol at baseline and 24 weeks postenrolment. Measures of coparenting and parenting confidence are also completed at baseline and 24 weeks for postbirth enrolments.

Results

Participant were recruited between October 2016 and September 2017. Follow-up data collection has commenced and will be completed in March 2018 with results expected in June 2018.

Conclusions

This study’s findings will assess the efficacy of a novel text-based program specifically targeting fathers in the perinatal period to improve their depression, anxiety and distress symptoms, coparenting quality, and parenting self-confidence.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000261415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370085 (Archived by WebCite at http://www.webcitation.org/6wav55wII).

Supporting men through their transition to fatherhood with messages delivered to their smartphones: a feasibility study of SMS4dads

Background

The transition to parenthood can be a challenging time, in which both mothers and fathers experience increased risk of distress and depression. Mothers are more likely than fathers to engage with services and have their mental health monitored and attended to during the perinatal period. The present study aimed to explore whether smartphone technology could be used to address fathers’ needs across their transition to fatherhood.

Methods

A corpus of messages, including linked information and mood tracking software, was designed to support and enhance paternal relationships with their babies, their partners and themselves across the perinatal period. Messages were sent to project participants (N = 520) from 12-weeks’ gestation to 24-weeks after birth.

Results

Of those fathers enrolled (N = 520), 21.5% scored >13 on K6 and completion rate (85%) was similar between these and other fathers. Most fathers (63.1%) clicked at least one link and responses were received for 20.5% of mood tracker questions. The probability of reporting worse mood scores decreased over time. Fathers completing post study surveys (N = 101) reported that messages helped them in their experience of becoming a new dad (92.8%), as well as helping them develop a strong relationship with their new child (54.9%), and in their relationship with their partner (79%).

Conclusions

The present study has demonstrated that it is both feasible and acceptable to support new fathers with SMS4dads, a relationship-focused messaging system designed to be delivered to smartphones across fathers’ transition to parenthood.

A two phased study on health care professionals' perceptions of single or multi-use of intermittent catheters

AIMS

This two phase study aimed to explore health care professionals' teaching and prescribing practice related to intermittent catheterisation and to identify their perceptions about the possible implementation of a mixed (single and multi-use) package for intermittent catheterization.

INTRODUCTION

Single-use intermittent catheters are the norm in the UK although multi-use is common in some other countries. A recent Cochrane review found no difference in complications, including urinary tract infection rates, between those using single or multi-use catheters. A flexible option of both multi-use and single use intermittent catheters could provide users with more flexible choices in self-care. However, understanding health care professionals' perspectives is one of the keys to developing a multi-use intervention.

DESIGN

A qualitative research framework using in-depth interviews to inform an on line survey.

METHOD

In-depth interviews were conducted with health care professionals based in the UK who prescribe catheters, teach intermittent catheterisation or manage an intermittent catheterisation service. The interviewees were selected to represent a range of clinical areas, experience and professions - continence advisors, urology, multiple sclerosis (MS) and spinal cord injury specialist nurses, and General Practitioners. Following framework analysis the themes and factors identified were used to develop an on-line survey which was disseminated through health care professional networks whose members saw patients who use intermittent catheters.

RESULTS

Nineteen health care professionals participated in the telephone interviews; 206 completed the survey. A wide range of professionals in terms of experience and specialty afforded rich information regarding the contextual issues around the teaching and prescribing of intermittent catheters. The primary finding was that health care professionals were concerned about 'minimising health risk' and maximising 'normalcy' for those using intermittent self-catheterisation. Health care professionals who worked in the acute setting or had no experience of re-use were most resistant to the re-use of catheters. Professionals requested evidence that a multi-use package would not increase the risk of developing a urinary tract infection or increase the burden of use to a patient before a mixed package would be considered.

CONCLUSIONS

For multi-use to be acceptable, evidence based guidelines must be available for healthcare professionals and cleaning methods must be acceptable and safe for intermittent catheter users. Further evidence may be required to establish that a mixed catheter package is equivalent to single use only, particularly for outcomes such as urinary tract infection, urethral injury and quality of life.

RELEVANCE TO CLINICAL PRACTICE

This paper highlights that if multi-use catheters are to be successfully introduced into clinical practice, the ease of use, safety and effectiveness of the cleaning technique will need to be convincingly demonstrated by a range of well-defined users.

Parent, partner, co-parent or partnership? The need for clarity as family systems thinking takes hold in the quest to motivate behavioural change

Research is increasingly pointing to the importance of extending the focus of childhood obesity intervention to include fathers, fathering figures, and other members of a child's primary parenting network. Advances in communication technology are now making it possible to achieve this aim, within current resources, using modalities such text messaging, web-based resources and apps that extend intervention to parents not in attendance at face to face interactions. However, published research is often unclear as to which parent/s they targeted or engaged with, whether interventions planned to influence behaviours and capabilities across family systems, and how this can be achieved. As childhood obesity research employing information technology to engage with family systems takes hold it is becoming important for researchers clearly describe who they engage with, what they hope to achieve with them, and the pathways of influence that they aim to activate. This paper integrates extant knowledge on family systems thinking, parenting efficacy, co-parenting, and family intervention with the way parents are represented and reported in childhood obesity research. The paper concludes with recommendations on terminology that can be used to describe parents and parenting figures in future studies.

Antibiotic Stewardship for Non-Infectious Disease Physicians: Focusing on When to Withhold, Modify and Discontinue Antibiotics

The multiple drug resistant organism (MDRO) and Clostridium difficile infection (CDI) epidemics are progressing relentlessly. Antibiotic stewardship (ABS) has evolved to confront these scourges. The Joint Commission has formulated a standard for its implementation and this should promote its use where others have failed. However, precisely how to intervene needs definition. Healthcare workers need practicable guidelines. The article discusses clinical scenarios where antibiotics should be withheld (Table 1), how they should be modified (Table 2) and when they should be discontinued (Table 3), three focal points of ABS.

Patient and provider perspectives on home telecare: Preliminary results from a randomized controlled trial

A randomized controlled trial of home telecare for the management of acute exacerbations of chronic obstructive pulmonary disease has been undertaken in the north-west of England. A videophone was used that communicates via the ordinary telephone network. The intervention period for each participant was two weeks. Participants in the telecare arm of the trial were asked to complete logbooks to record their experiences of each telecare encounter. A simple, self-completed, 10–item questionnaire was used that consisted of a Likert scale, ranging from 1 (totally disagree) to 5 (totally agree). Fourteen nurses completed 150 logbooks and 22 patients completed 145 logbooks. These results demonstrate significant differences in perception between patients and their health-care providers with regard to telecare encounters across all the domains addressed. Participating patients consistently demonstrated more positive views of the telecare encounters than their health-care providers.

Factors affecting the adoption of telehealthcare in the United Kingdom: the policy context and the problem of evidence

The adoption of telehealthcare in the United Kingdom has been slow and fragmented. This paper presents a structural explanation for this by contrasting contending themes in recent UK health policy. It is argued that the conflict between trends towards modernizationand demands for evidence-based practicehave made it difficult for a major policy agency to emerge that can sponsor service development, and so proponents of telehealthcare have been forced to situate their work within the domain of R&D. This has led to a fragmented field of practice characterized by short-term and small-scale projects.

Evaluation of new technologies in health-care systems: what’s the context?

Evaluation is an essential component of the introduction of new technologies, treatment modalities and models of service delivery across the health-care sector. Such work attracts significant levels of public funding, but little attention has been paid to understanding evaluation as more than a set of applied methodological activities. This paper sets out an agenda for a more complex and richer understanding of evaluation as a set of professional and organizational dynamics.

Abstract PR12: Discovery and preclinical evaluation of cEt-modified KRAS antisense oligonucleotide inhibitors

KRAS is one of the most frequently mutated genes in cancer and its activation is thought to underlie the pathogenesis of up to 30% of all human tumors. However, to date KRAS has proven difficult to target with traditional pharmacologic approaches. Antisense technology is particularly attractive for such difficult drug targets as antisense oligonucleotide (ASO) inhibitors can be designed based on a targets RNA sequence alone.

cEt ASOs have been recently described and demonstrated to have significantly increased potency over previous generation ASO chemistries. Moreover, STAT3Rx/AZD9150, a cEt modified ASO targeting STAT3 mRNA was recently shown to produce robust STAT3 depletion in a broad range of xenograft models (AACR 2013) and importantly has also demonstrated promising single-agent antitumor activity in patients with advanced treatment-refractory cancers in phase I studies (ASCO 2013, EORTC 2014).

Here, we describe the preclinical evaluation of potent and selective cEt ASOs targeted to human or mouse KRAS mRNA. A human-specific KRAS cEt ASO which potently and selectively down-regulated KRAS demonstrated anti-proliferative effects and the expected down-stream pathway inhibition in a panel of KRAS mutant NSCLC, CRC and PDAC cells. The KRAS ASO was differentiated from MAPK pathway inhibitors selectively inhibiting the proliferation of KRAS mutant not KRAS wild type cells and not causing feedback reactivation of the MAPK or PI3K pathways. Systemic delivery of the KRAS ASO to mice bearing KRAS mutant NSCLC or CRC xenografts resulted in significant inhibition of KRAS tumour expression and antitumor activity. Importantly, the KRAS ASO also showed significant target knockdown and antitumor effects in KRAS mutant NSCLC patient-derived xenografts (PDX).

Finally, potent and selective murine-specific KRAS ASO produced robust target knockdown in a broad set of tissues without detectable tolerability signals associated with ASO-mediated systemic KRAS inhibition.

Taken together these data suggest that KRAS ASOs are an attractive therapeutic approach to target KRAS for the treatment of human cancers.

Citation Format: Alexey S. Revenko, Sarah J. Ross, Lyndsey L. Hanson, Rebecca Ellston, Chris May, Sanjay K. Pandey, Linda K. Buckett, Stephanie K. Klein, Mitchell Revill, Kevin Hudson, Brett P. Monia, David C. Blakey, Paul Lyne, Allan R. MacLeod. Discovery and preclinical evaluation of cEt-modified KRAS antisense oligonucleotide inhibitors. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr PR12.

The DEXMART hand: Mechatronic design and experimental evaluation of synergy-based control for human-like grasping

This paper summarizes recent activities carried out for the development of an innovative anthropomorphic robotic hand called the DEXMART Hand. The main goal of this research is to face the problems that affect current robotic hands by introducing suitable design solutions aimed at achieving simplification and cost reduction while possibly enhancing robustness and performance. While certain aspects of the DEXMART Hand development have been presented in previous papers, this paper is the first to give a comprehensive description of the final hand version and its use to replicate human-like grasping. In this paper, particular emphasis is placed on the kinematics of the fingers and of the thumb, the wrist architecture, the dimensioning of the actuation system, and the final implementation of the position, force and tactile sensors. The paper focuses also on how these solutions have been integrated into the mechanical structure of this innovative robotic hand to enable precise force and displacement control of the whole system.

Another important aspect is the lack of suitable control tools that severely limits the development of robotic hand applications. To address this issue, a new method for the observation of human hand behavior during interaction with common day-to-day objects by means of a 3D computer vision system is presented in this work together with a strategy for mapping human hand postures to the robotic hand. A simple control strategy based on postural synergies has been used to reduce the complexity of the grasp planning problem. As a preliminary evaluation of the DEXMART Hand’s capabilities, this approach has been adopted in this paper to simplify and speed up the transfer of human actions to the robotic hand, showing its effectiveness in reproducing human-like grasping.