Body condition scoring facilitates healthcare monitoring in Hermann's Tortoises (Testudo hermanni ssp.).

Clinical assessment of body condition is crucial in captive and free-ranging reptiles, since a large percentage of diseases result from inadequate nutrition. However, preventive health care is restricted by the lack of a practical method for the assessment in tortoises. Pre-existing evaluation systems based on weight and shell measurements are laborious and ignore the clinical presentation of the animal. The present study aimed to facilitate the assessment by establishing a body condition score. A total of 373 Hermann's Tortoises (Testudo hermanni) (n = 281 tortoises kept as pets in Germany and n = 92 tortoises originating from a free-ranging population (68) or a rearing station (24) in France) were examined and data (weight (g), carapace length (cm), width (cm), height (cm)) were recorded in a standard protocol between October 2020 and October 2021. A modified version of a body condition score for Mojave Desert Tortoises (Gopherus agassizii) (1 = cachectic, 3 = ideal, 5 = obese) was utilized and tested against pre-existing shell measurement systems (Jackson's ratio, body condition index, volume condition index, circumferential product). German captive tortoises were significantly heavier and larger than French specimens. In the Spearman's correlation matrix, the body condition score showed a statistically significant correlation with all measurement methods in the total population of captive tortoises (Testudo hermanni boettgeri), with a medium correlation strength, and a lack of correlation in free-ranging tortoises (Testudo hermanni hermanni). However, individual animal data suggested misleading results of mathematical equations in terms of body condition. Clinical evaluation of tortoises, including a body condition score, should be considered essential to provide good healthcare and should be an integral part of general examination.

[General practice care for patients with chronic non-cancer pain: A rapid review as part of the RELIEF project]. / Hausärztliche Versorgung von Patient:innen mit chronischen nicht-tumorbedingten Schmerzen: ein Rapid Review im Rahmen des RELIEF-Projekts.

INTRODUCTION: Approximately one fifth of the German population suffers from chronic pain, which is often associated with limitations in coping with everyday life, social isolation and psychological comorbidities such as anxiety and depression. The importance of a treatment approach that considers biological, psychological, and social factors (bio-psycho-social model) as well as non-drug interventions is emphasized in current guidelines, but presents challenges for primary care practices. To support the implementation of evidence-based best practice recommendations, the RELIEF project (Resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices) aims to develop a case management program for the primary care of patients with chronic non-tumor pain. METHODS: Prior to intervention development, a rapid review was conducted to identify best practice recommendations for the care of patients with chronic non-tumor pain, barriers and strategies to their implementation, and gaps in care in current guidelines and literature. Selective searches of guidelines, PubMed, the Cochrane Library, bibliographies of relevant publications, and the gray literature focused on assessment and monitoring, education, promotion of self-care, and rational pharmacotherapy. RESULTS: Numerous recommendations on assessment and monitoring were identified, but only a few studies examined their feasibility in primary care practices. Guidelines contained few specific recommendations on content and format of patient education on chronic pain. Recommendations for non-drug self-care measures were mainly related to physical activity, relaxation techniques, behavioral therapy techniques and external applications. Especially for the area of physical activity, numerous barriers but also strategies for a successful implementation could be identified. DISCUSSION: In a potential primary care model for patients with chronic non-tumor pain, pain assessment should aim to identify patients who need support in implementing medication and non-medication interventions in the primary care setting and/or could benefit from specialized care. To implement recommendations for pain education, primary care physicians need educational materials in a variety of formats and levels of detail that ideally could be processed by patients at home and then get addressed in practices using simple key questions. Non-drug measures should be an explicit part of the treatment plan. CONCLUSION: Many of the identified recommendations for the treatment of patients with chronic non-tumor pain can also be considered relevant for the primary care setting. Specific guidelines and concepts for primary care physicians that include setting-specific characteristics at the physician, patient, and system levels would be desirable for a successful implementation of these recommendations.

A questionnaire-based investigation of the swimming puppy syndrome: 115 dogs.

Swimming Puppy Syndrome (SPS) is a benign reversible condition of unknown etiology in multiple dog breeds. Affected dogs show laterally abducted limbs and are unable to stand and walk on their own. The current knowledge of this condition derives from few case reports or small case series. Therefore, the aim of this study was to collect data on the clinical course from a large cohort of dogs with SPS with an online questionnaire supported by video footage. Potential risk factors were compared between 110 litters with SPS and 103 unaffected litters. SPS was reported in 115 dogs from 48 different breeds comprising a wide range of small, middle, and large breeds. Litters with SPS were significantly smaller than unaffected litters. Cesarean sections were reported more frequently in affected litters, but the overall rate of reported birth complications did not differ significantly from unaffected litters. Most puppies were able to stand and walk at a median age of 4.5 weeks (up to 12 weeks) and clinical signs resolved at a median age of six weeks (up to 12 weeks). Puppies from large breeds showed faster recovery than puppies from medium and small breeds. Occasionally, residual deficits were reported and only three dogs failed to recover. A clustering of SPS occurred in closely related litters in four kennels of four different dog breeds (Greater Swiss Mountain Dog, Golden Retriever, Miniature Bull Terrier, Norwich Terrier). The study shows the benign clinical course of SPS in a large cohort of puppies from multiple dog breeds. Potential risk factors including reports on birth complications, size and muscle mass compared to littermates and diet of the dam during pregnany were evaluated and no influence on the occurrence of SPS was identified.

Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infections in German Primary Care: Results of the Regional Intervention Study CHANGE-3 and the Nested cRCT.

Within primary care, acute respiratory tract infections (ARTIs) are the most common reason for prescribing antibiotics. The aim of the CHANGE-3 study was to investigate how antibiotic prescribing for non-complicated ARTIs can be reduced to a reasonable level. The trial was conducted as a prospective study consisting of a regional public awareness intervention in two regions of Germany and a nested cluster randomised controlled trial (cRCT) of a complex implementation strategy. The study involved 114 primary care practices and comprised an intervention period of six winter months for the nested cRCT and two times six winter months for the regional intervention. The primary outcome was the percentage of antibiotic prescribing for ARTIs between baseline and the two following winter seasons. The regression analysis confirmed a general trend toward the restrained use of antibiotics in German primary care. This trend was found in both groups of the cRCT without significant differences between groups. At the same time, antibiotic prescribing was higher in routine care (with the public campaign only) than in both groups of the cRCT. With regard to secondary outcomes, in the nested cRCT, the prescribing of quinolones was reduced, and the proportion of guideline-recommended antibiotics increased.

Fall-risk-increasing drugs in older patients: the role of guidelines and GP-centred health care in Germany.

BACKGROUND: fall-risk-increasing drugs (FRIDs) are a ubiquitous issue, especially for older patients. As part of a German guideline for pharmacotherapy, from 2019, a new quality indicator for this patient group was developed to measure the percentage of patients receiving FRIDs. METHODS: patients, aged at least 65 years in 2020, insured by the Allgemeine OrtsKrankenkasse statutory health insurance (Allgemeine Ortskrankenkasse, Baden-Wuerttemberg, Germany) with a particular general practitioner (GP) were observed from 1 January to 31 December 2020 cross-sectionally. The intervention group received GP-centred health care. Within GP-centred health care, GPs have the role of gatekeepers for patients within the health system and are-in contrast to regular care GPs in addition to other commitments-obliged to regularly attend training sessions on appropriate pharmacotherapy. The control group received regular GP care. For both groups, we measured the percentage of patients receiving FRIDs as well as the occurrence of (fall-related) fractures as the main outcomes. To test our hypotheses, we performed multivariable regression modelling. RESULTS: a total of 634,317 patients were eligible for analysis. Within the intervention group (n = 422,364), we could observe a significantly reduced odds ratio (OR) for obtaining a FRID (OR = 0.842, confidence interval [CI]: [0.826, 0.859], P < 0.0001) in comparison to the control group (n = 211,953). Moreover, we could observe a significantly reduced chance for (fall-related) fractures in the intervention group (OR: 0.932, CI: [0.889, 0.975], P = 0.0071). CONCLUSIONS: the findings point in the direction that the health care providers' awareness of the potential danger of FRIDs for older patients is higher in the GP-centred care group.

Hospital Admission and Discharge: Lessons Learned from a Large Programme in Southwest Germany.

Introduction: In the context of a GP-based care programme, we implemented an admission, discharge and follow-up programme. Description: The VESPEERA programme consists of three sets of components: pre-admission interventions, in-hospital interventions and post-discharge interventions. It was aimed at all patients with a hospital stay participating in the GP-based care programme and was implemented in 7 hospitals and 72 general practices in southwest Germany using a range of strategies. Its' effectiveness was evaluated using readmissions within 90 days after discharge as primary outcome. Questionnaires with staff were used to explore the implementation process. Discussion: A statistically significant effect was not found, but the effect size was similar to other interventions. Intervention fidelity was low and contextual factors affecting the implementation, amongst others, were available resources, external requirements such as legal regulations and networking between care providers. Lessons learned were derived that can aid to inform future political or scientific initiatives. Conclusion: Structured information transfer at hospital admission and discharge makes sense but the added value in the context of a GP-based programme seems modest. Primary care teams should be involved in pre- and post-hospital care.

[Acute respiratory tract infections and antibiotic prescriptions: What are patients' expectations?] / Akute Atemwegsinfekte und Antibiotikaverordnungen: Welche Erwartungen haben Patient*innen?

INTRODUCTION: The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. METHODS: 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive. RESULTS: 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a diagnosis of influenza from their GP. With specific diagnoses differentiated from uncomplicated respiratory tract infection, an increase in both the number of antibiotics hoped for and the number of antibiotics prescribed was observed. DISCUSSION: Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs.

[Diagnosis of kidney diseases in European tortoises (Testudo spp.)]. / Diagnostik von Nierenerkrankungen bei Europäischen Landschildkröten (Testudo spp.).

The diagnosis of kidney diseases in tortoises is only possible to a very limited extent on the basis of the general examination due to the development of unspecific disease symptoms. Extensive additional examinations are required to confirm the diagnosis. In addition to blood and urine tests, imaging techniques such as X-ray, computed tomography and MRI are suitable for visualizing the skeletal and organ systems, while additional samples can be taken during an endoscopic examination. There are clear species-specific differences with regard to the reference values of the laboratory parameters, which are in part significantly influenced by environmental influences, the seasons or even gender. It can also be seen that kidney diseases in tortoises kept in captivity are usually very advanced at the time of diagnosis, since these animals, like reptiles in general, show a pronounced lack of symptoms. Annual checks by a veterinarian specialized in reptiles can help to detect diseases at an early stage.

Implementation fidelity in a multifaceted program to foster rational antibiotics use in primary care: an observational study.

BACKGROUND: The ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program. METHODS: This observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants' views on five domains of the implementation were also measured. Binary logistic and multiple linear regression analyses were used to explore which views on the implementation were associated with participants' adherence to quality circles and use of additional bonus compensation. RESULTS: The analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n = 158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants' views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants' views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance. CONCLUSION: This study showed an overall high fidelity to the implementation program. Participants' views on the implementation were associated with degree of intervention fidelity. TRIAL REGISTRATION: ISRCTN, ISRCTN58150046.

Task sharing in an interprofessional medication management program - a survey of general practitioners and community pharmacists.

BACKGROUND: Pharmacist-led medication review and medication management programs (MMP) are well-known strategies to improve medication safety and effectiveness. If performed interprofessionally, outcomes might even improve. However, little is known about task sharing in interprofessional MMP, in which general practitioners (GPs) and community pharmacists (CPs) collaboratively perform medication reviews and continuously follow-up on patients with designated medical and pharmaceutical tasks, respectively. In 2016, ARMIN (Arzneimittelinitiative Sachsen-Thüringen) an interprofessional MMP was launched in two German federal states, Saxony and Thuringia. The aim of this study was to understand how GPs and CPs share tasks in MMP when reviewing the patients' medication. METHODS: This was a cross-sectional postal survey among GPs and CPs who participated in the MMP. Participants were asked who completed which MMP tasks, e.g., checking drug-drug interactions, dosing, and side effects. In total, 15 MMP tasks were surveyed using a 5-point Likert scale ranging from "I complete this task alone" to "GP/CP completes this task alone". The study was conducted between 11/2020 and 04/2021. Data was analyzed using descriptive statistics. RESULTS: In total, 114/165 (69.1%) GPs and 166/243 (68.3%) CPs returned a questionnaire. The majority of GPs and CPs reported (i) checking clinical parameters and medication overuse and underuse to be completed by GPs, (ii) checking storage conditions of drugs and initial compilation of the patient's medication including brown bag review being mostly performed by CPs, and (iii) checking side-effects, non-adherence, and continuous updating of the medication list were carried out jointly. The responses differed most for problems with self-medication and adding and removing over-the-counter medicines from the medication list. In addition, the responses revealed that some MMP tasks were not sufficiently performed by either GPs or CPs. CONCLUSIONS: Both GPs' and CPs' expertise are needed to perform MMP as comprehensively as possible. Future studies should explore how GPs and CPs can complement each other in MMP most efficiently.

[Acute respiratory tract infections and antibiotic prescriptions: What are patients' expectations?] / Akute Atemwegsinfekte und Antibiotika-Verordnungen: Welche Erwartungen haben Patient*innen?

INTRODUCTION: The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. METHODS: 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive. RESULTS: 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a diagnosis of influenza from their GP. With specific diagnoses differentiated from uncomplicated respiratory tract infection, an increase in both the number of antibiotics hoped for and the number of antibiotics prescribed was observed. DISCUSSION: Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs.

The Impact of Optical Impressions on Dog Feeding Practice.

According to the literature, as many as 60% of domestic dogs are overweight, whereby obesity is implicated in many serious diseases and hence a reduction of body weight results in a reduced risk of disease. Approximately 32% of reduction diets are unsuccessful in helping dogs to reach their ideal body weight. The likely reasons for this high drop-out rate include, among others, the fear of increased hunger-induced distress or a loss of affection on the part of the pet towards the owner. To alleviate these apprehensions, the use of optical effects that increase the perceived food intake could be useful. To investigate this, a mixed-methods study design was applied and 100 test persons-including dog owners and non-owners-were instructed to fill up 11 separate dog bowls with the same amount of dogfood. The bowls varied in 5 different variables (total height, upper diameter, angulation of sidewall, volume, and color). The influence of the shape and color of the dog bowls in relation to the filling quantity was evaluated. Overall, the body of the inner food bowl-especially its diameter and shape-showed a significant impact on the feeder as the wider the diameter, the more the dog bowl was filled. Moreover, the flatter the sidewall was angulated, the larger the fill-up quantity. Significantly, the volume on its own did not have a significant impact on the feeder. A difference of up to 37.6% in fill quantity resulted depending on the type of dog bowl used. Furthermore, the use of inner cones confused the test persons whereas different colors and the total height of the bowl showed no impact. Dog bowls with a small upper diameter and a steep sidewall-regardless of volume and color-were filled less by the test persons. This tendency could be useful for adapting the feeding of overweight dogs or those with an increased risk of obesity.

HIOPP-6 - a pilot study on the evaluation of an electronic tool to assess and reduce the complexity of drug treatment considering patients' views.

BACKGROUND: A complex drug treatment might pose a barrier to safe and reliable drug administration for patients. Therefore, a novel tool automatically analyzes structured medication data for factors possibly contributing to complexity and subsequently personalizes the results by evaluating the relevance of each identified factor for the patient by means of key questions. Hence, tailor-made optimization measures can be proposed. METHODS: In this controlled, prospective, exploratory trial the tool was evaluated with nine general practitioners (GP) in three study groups: In the two intervention groups the tool was applied in a version with (GI_with) and a version without (GI_without) integrated key questions for the personalization of the analysis, while the control group (GC) did not use any tools (routine care). Four to eight weeks after application of the tool, the benefits of the optimization measures to reduce or mitigate complexity of drug treatment were evaluated from the patient perspective. RESULTS: A total of 126 patients regularly using more than five drugs could be included for analysis. GP suggested 117 optimization measures in GI_with, 83 in GI_without, and 2 in GC. Patients in GI_with were more likely to rate an optimization measure as helpful than patients in GI_without (IRR: 3.5; 95% CI: 1.2-10.3). Thereby, the number of optimization measures recommended by the GP had no significant influence (P = 0.167). CONCLUSIONS: The study suggests that an automated analysis considering patient perspectives results in more helpful optimization measures than an automated analysis alone - a result which should be further assessed in confirmatory studies. TRIAL REGISTRATION: The trial was registered retrospectively at the German Clinical Trials register under DRKS-ID DRKS00025257 (17/05/2021).

Chemical composition of snakes.

The present study was carried out to provide insight into the body composition of snakes, which is an important basis for determination of nutrient requirement and physiological processes. Carcasses of 86 captive snakes (31 pythons, 32 colubrids and 23 boas) were available for analysis. Skins and vertebrae bones of 11 snakes and livers of 64 snakes were analysed separately from the carcasses. Crude nutrients, major minerals and trace elements were investigated. The content of crude nutrients of the whole body was similar to those of mammals and birds. Relatively high contents of copper, zinc and especially of iron (up to 23,973 mg/kg dry matter) were found in the body, particularly in the liver. There was an increase of the iron content of the whole body over age.

Prevalence and patient-rated relevance of complexity factors in medication regimens of community-dwelling patients with polypharmacy.

PURPOSE: To describe the prevalence of complexity factors in the medication regimens of community-dwelling patients with more than five drugs and to evaluate the relevance of these factors for individual patients. METHODS: Data were derived from the HIOPP-6 trial, a controlled study conducted in 9 general practices which evaluated an electronic tool to detect and reduce complexity of drug treatment. The prevalence of complexity factors was based on the results of the automated analysis of 139 patients' medication data. The relevance assessment was based on the patients' rating of each factor in an interview (48 patients included for analysis). RESULTS: A median of 5 (range 0-21) complexity factors per medication regimen were detected and at least one factor was observed in 131 of 139 patients. Almost half of these patients found no complexity factor in their medication regimen relevant. CONCLUSION: In most medication regimens, complexity factors could be identified automatically, yet less than 15% of factors were indeed relevant for patients as judged by themselves. When assessing complexity of medication regimens, one should especially consider factors that are both particularly frequent and often challenging for patients, such as use of inhalers or tablet splitting. TRIAL REGISTRATION: The HIOPP-6 trial was registered retrospectively on May 17, 2021, in the German Clinical Trials register under DRKS-ID DRKS00025257.

Symmetrical Dimethylarginine as a Diagnostic Parameter in Hermann's Tortoises (Testudo hermanni).

Background: Despite improvements in habitational conditions, kidney disease is relatively common in tortoises. Objectives: Purpose of this study was the establishment of Symmetrical dimethylarginine (SDMA) reference values for clinically healthy Hermann's Tortoises. Animals: Clinically healthy Hermann's Tortoises (n = 131) were included in the period from October 2017 to September 2019. Methods: Creatinine and other biomarkers were tested at IDEXX Laboratories, Germany using residual blood samples from Hermann's tortoises. SDMA was measured with the IDEXX test and verified by liquid chromatography-mass spectrometry at IDEXX Laboratories, USA. Results: SDMA values ranged from 1 to 21 µg/dl (n = 131) for the IDEXX SDMA Test and SDMA values ranged from 1 to 17 µg/dl (n = 82) for LC-MS. For the comparison of the two measuring systems, the following results were obtained R 2 = 0.75 (p < 0.001). Conclusion and Clinical Importance: SDMA can be measured in Hermann's Tortoises and the reference values range in clinically healthy animals is comparable to that of dogs and cats.

Cross-sectoral Analysis of 1.4 Million AOK-insured Patients with Back Pain in Baden-Württemberg - What Influence does Outpatient Specialist Care Have? / Sektorenübergreifende Rückenschmerz-Versorgungsanalyse von 1,4 Mio. AOK-Versicherten in Baden-Württemberg ­ welchen Einfluss hat die ambulante fachärztliche Versorgung?

BACKGROUND: Back pain is one of the leading causes of disability globally and the most common musculoskeletal pain in Germany. The lifetime prevalence of back pain ranges from 74% to 85%, and the point prevalence ranges from 32% to 49%. One in five individuals with statutory health insurance visits a doctor at least once a year for back pain, and 1 in 20 individuals is on sick leave at least once a year. The question as to what extent can different outpatient care concepts substantially contribute to improving care and avoiding inpatient hospital treatment has repeatedly been the subject of controversial political discussions. This study aimed to present a description of the reality of care in Baden-Württemberg (BW), Germany, based on claims data. MATERIAL AND METHODS: Anonymised routine billing data of AOK Baden-Württemberg were analysed in compliance with data protection regulations. The billing data cover the outpatient and inpatient care sectors. All AOK patients in BW who received at least one ICD10 diagnosis from their physician in the first half of 2015 were considered for the analysis. Patients with at least one diagnosis of back pain were evaluated as patients with back pain, whereby the assignment to the diagnosis group of specific or non-specific back pain was made based on the code. RESULTS: In the first half of 2015, nearly 988 925 patients with back pain were registered in the 6696 primary care clinics in BW, approximately 302 524 patients in 1172 orthopaedic clinics and 17 043 patients in 89 neurosurgical clinics. Primary care clinics reported back pain diagnosis in 34.6%, orthopaedic clinics in 51.9% and neurosurgical clinics in 78.6% of cases. Primary care clinics diagnosed a specific cause in approximately one-third of patients with back pain, orthopaedic clinics in approximately 40% of their patients and neurosurgery clinics in one in two cases. Overall, approximately 1.2% of 1.3 million patients with back pain (January to December 2015 in BW) were hospitalised. Inpatient therapy consisted of surgical therapy and conservative therapy. Nucleotomy, decompression and spondylodesis were the three most common surgical procedures performed. Pain medication and remedy prescriptions decreased pain after spinal surgery. There are significant regional differences in referral and surgery rates. The mean inpatient referral rate was 535 of 100 000 AOK insurants, and the median was 536 of 100 000 AOK insurants. The mean surgery rate among all admitted patients with back pain was 49.9%, and the median was 49.8%. CONCLUSION: The vast majority of patients with back pain are treated as outpatients. Only approximately 1.2% of all patients with back pain were treated as inpatients in 2015. Of these, approximately half underwent surgery. Spinal surgeries led to a decrease in pain medication and remedy prescription postoperatively. The three most frequent surgical procedures were 'decompression', 'excision of disc tissue' and 'spondylodesis'. There were significant regional differences.

Computer-aided ration calculation (Diet Check Munich© ) versus blood profile in raw fed privately owned dogs.

Many dog owners create nutritionally imbalanced raw meat-based diets (RMBD) with information from the Internet and pseudo-scientific books, some even use pre-prepared frozen raw feed from online shops, local butchers or other providers. The risk of nutritional imbalances is therefore present. Blood profiles for dogs fed RMBD are promoted by laboratories as a simple tool for the owner to check the nutritional supply situation. Veterinarian nutrition specialists seem to be consulted less frequently and, in most cases, when blood analyses show deviations from reference ranges. The aim of the present study was to evaluate whether a RMBD blood profile reflects possible malnutrition according to a computer-aided ration check and to assess its clinical relevance. Using standardized questionnaires, the average daily rations of 104 dogs, 83 of which were fed raw diets versus 21 commercially fed dogs, were analysed using Diet Check Munich©, based on the National Research Council values. Afterwards, the SYNLAB.vet GmbH 'Barfer-Profil' test including calcium, phosphate, calcium/phosphate ratio, vitamin A, vitamin D, copper, zinc and iodine with additional parameters taurine, urea, uric acid and creatinine was carried out. No significant correlation between nutrient supply and associated blood parameters could be detected. Diet calculation revealed significantly more nutritional imbalances in the RMBD group than in the control group. Low plasma taurine could be detected only in the RMBD group. After participating, 30% of the dog owners (RMBD group) decided to adjust their dogs' diets at the nutrition consultation of the Clinic for Small Animal Internal Medicine of the LMU Munich. Based on these results, for most parameters a RMBD blood profile is not an appropriate tool to monitor a dog's nutrition and computer-aided ration calculation remains the gold standard for detecting nutritional imbalances.