Weekly Proactive Telephone Breastfeeding Standard Care by Lactation Consultants in the First Month Postpartum Prolongs Breastfeeding for Up to 6 Months.

Many mothers, especially those with co-morbidities, do not achieve exclusive breastfeeding (EBF) for the first 6 months, with the loss of multiple health benefits including enhanced infant nutrition. We wished to evaluate whether proactive lactation consultant telephone advice in the first month postpartum improved breastfeeding rates for up to 6 months. A prospective cohort observational study was performed. Mother groupings included the following: Control (CG, n = 379)-standard postnatal care; Exposure (EG, n = 386)-standard postnatal care delivered by lactation consultant telephone contact for the first 3 weeks postpartum and then follow-up calls at 1, 3 and 6 months postpartum to ascertain breastfeeding status. Sore nipples (24%) and fussy/unsettled behaviour (14-19%) were common EG concerns. EG EBF rates were higher at 1 month (65% vs. 53%; p < 0.001), 3 months (57% vs. 49%; p = 0.041) and 6 months (45 vs. 33%; p < 0.001). EG EBF rates across the 6 months were higher for infants admitted to the NNU (52.9% vs. 37.5%, p = 0.003), obese mothers (58.3% vs. 37.2%, p < 0.001), mothers with depression (60.8% vs. 43.4%, p = 0.036) and all birth modes. Proactive early lactation advice significantly prolongs EBF and consequently enhances infant nutrition overall, including for mothers at risk of early breastfeeding cessation.

UK-based multicentre cross-sectional study assessing advice requests veterinary dermatologists received from general practitioners.

BACKGROUND: There is little currently little information available regarding the nature of the advice requests veterinary dermatologists receive from general practitioners. Collation of such data could direct continuing veterinary development in the future. METHODS: Dermatologists completed hand-written recording sheets during or after enquiries. Information recorded included the route of enquiry, nature of advice, material provided, practice type and location, animal signalment, presenting signs, diagnosis/differential diagnosis, treatment and referral recommendations, time taken and if charges were made. RESULTS: Twelve dermatology services recorded 768 advice requests over a 6-month period. Most requests were submitted via email and related to canine dermatology (81%). An average of 9.5 minutes was spent replying to requests. Charges were made in 2% of cases. Advice regarding otitis was most commonly sought, followed by pruritus, alopecia and crusting. The most frequently discussed diagnoses included allergy, otitis, pyoderma, demodicosis, dermatophytosis and neoplasia. Antibiotics, anti-pruritics and topical otic medications were the most commonly discussed therapeutics. LIMITATIONS: This is an initial study and therefore there are limitations involving the depth of the data. Additional studies should be completed which identify why advice is sought, decision-making regarding referral, and if advice should be charged similarly to other disciplines. CONCLUSIONS: These findings highlight that veterinarians mostly frequently seek advice on management of common dermatological problems, including allergy, otitis and pyoderma.

Using social network analysis as a tool in action research.

The following paper presents case examples of one research team's use of social network analysis (SNA) with three different collaboratives in South Florida: (a) a Collective Impact initiative seeking to end youth homelessness, (b) a university collaborative of campus organizations working towards Black students' concerns, and (c) a movement network of local social justice organizations. The research team used SNA to assess the level of connectivity of three different community coalitions. While research questions were slightly different for each collaborative, each project asked about the frequency of communication between organizations to determine connectivity. Results vary between case examples. Both the Youth Homeless Collaboration and the Black Student Association used Gephi to analyze results, while The Community Partnership used R to measure network centrality. The paper concludes with a general discussion of challenges related to using SNA as an action research tool, as well as the role of power in organizational networks.

Alcohol and cocaine use prior to suspected suicide: Insights from toxicology.

INTRODUCTION: This study investigates whether there is a relationship between alcohol and cocaine use in deaths where suicide by self-injury is the suspected cause of death. METHODS: Adults referred by coroners to the Imperial College London Toxicology Unit for toxicological analysis between 2012 and 2016 were reviewed for inclusion criteria. Those who died by self-injury reasoned to be deliberate were included in the analysis. Femoral blood alcohol concentration (BAC) and presence of cocaine or benzoylecognine (a metabolite of cocaine) in blood and/or urine were tabulated and odds ratios calculated. RESULTS: A total of 1722 decedents met inclusion criteria. BAC was ≥50 mg/dL in 29% of decedents. Cocaine was detected in 8.4% of cases. The likelihood of testing positive for cocaine increased with BAC and was most frequent between 100 and 199 mg/dL, consistent with moderate to severe intoxication (odds ratio 5.88, 95% confidence interval 3.80, 9.09; P ≤ 0.001) compared to those with BAC <10 mg/dL. DISCUSSION AND CONCLUSIONS: This study demonstrates a correlation between increasing BAC and likelihood of cocaine use prior to suspected suicide, up to a level consistent with severe intoxication. Cocaine use was found in a high proportion of cases relative to the general population reporting regular use. This pattern of drug and alcohol use has previously been given little attention in suicide prevention strategies and clinical prioritisation.

The Effectiveness of Fluorescent Light Energy as Adjunct Therapy in Canine Deep Pyoderma: A Randomized Clinical Trial.

A single centre, single-blinded, prospective, randomized, controlled clinical study was conducted to evaluate the effectiveness of twice weekly fluorescent light energy therapy (Phovia™) as adjunct to systemic antibiotics in the management of deep pyoderma in dogs. Dogs with clinical lesions consistent with deep pyoderma, positive bacterial culture, and showing neutrophil engulfing bacteria at cytology were included in the study. Assessments were undertaken weekly for 8 weeks and every 2 weeks thereafter until 12 weeks after enrolment. At each visit, lesions were scored and cytology was conducted to determine a neutrophil engulfing bacteria score. All dogs (Groups A and B) were treated with systemic antibiotic twice daily, and Group B received additionally Phovia twice weekly. Median treatment duration was 11.7 weeks for Group A and 5.7 weeks for Group B. After 8 weeks of treatment, the percentage of dogs that achieved clinical resolution was 35.0% and 88.0% for Groups A and B, respectively. Lesion scores showed highly statistically significant difference in favour of Group B from week 3 to 8, and neutrophil engulfing bacteria scores showed statistical difference from week 2 onwards in favour of Group B. These results indicate that Phovia, when used as an adjunct to systemic antibiotics, can accelerate time to clinical resolution in cases of canine deep pyoderma.

Management of canine perianal fistula with fluorescence light energy: preliminary findings.

BACKGROUND: Canine perianal fistula (CPF) is a severe, painful, debilitating skin condition affecting the perianal skin. It often interferes with the quality of life of both dog and owner. Conventional medical treatment involves the use of immunosuppressive therapy; however, the successful resolution of lesions can be limited by poor owner compliance, adverse drug effects and dependence on costly therapies. HYPOTHESIS/OBJECTIVES: The present study aimed to assess the potential benefits of fluorescent light energy (FLE) on cases of CPF. ANIMALS: Four dogs with active perianal fistulas METHODS AND MATERIALS: FLE was applied as sole management therapy once a week with two consecutive applications in the same session for each dog until clinical signs had significantly improved, with weekly assessments for a six week period. Dogs were assessed by measuring the size of lesions at the start of the study and then weekly for six weeks, using planimetry software. Owners recorded vocalization and straining frequency scores during their pet's defaecation, and perianal licking frequency on a 0-5 point scale to assess the response to therapy. RESULTS: All dogs improved with FLE, achieving a significant reduction in vocalization, straining and licking after two weeks (P = 0.002). After five weeks of FLE therapy, lesional areas had significantly decreased (P = 0.04). Only one dog required more than seven applications. No adverse events were reported. CONCLUSION AND CLINICAL IMPORTANCE: FLE may be a promising alternative therapy for CPF.

Fluorescence biomodulation in the management of canine interdigital pyoderma cases: a prospective, single-blinded, randomized and controlled clinical study.

BACKGROUND: Interdigital pyoderma is a common multifactorial, inflammatory disease of the canine interdigital skin. Lesions commonly become infected secondarily. In addition to management of the underlying cause, management of the chronic inflammatory changes in the interdigital skin created by secondary infection and by the release of keratin into deep tissues is required. Fluorescence biomodulation appears to modulate the inflammatory process in dermatological disorders and has shown promise in preliminary studies evaluating its use in superficial and deep pyoderma in dogs. HYPOTHESIS/OBJECTIVES: To evaluate the effect of a fluorescence biomodulation (FB) system used in conjunction with systemic antibiotic on clinical manifestations of canine interdigital pyoderma (CIP), compared to dogs treated with antibiotic alone. ANIMALS: Thirty-six dogs diagnosed with CIP. METHODS AND MATERIALS: Dogs were randomly allocated to treatment groups of either antibiotic alone (Group A) or antibiotic plus twice-weekly FB application (Group B). Dogs were scored over a 12 week period on the basis of two measured parameters: a global lesion score composed of four different lesions types and neutrophil engulfing bacterial scores. RESULTS: A statistically significant decrease was seen by Week 3 in both measured parameters for Group B compared to Group A. The mean time-to-resolution of lesions was 4.3 weeks in Group B and 10.4 weeks in Group A. CONCLUSION AND CLINICAL IMPORTANCE: The FB system shows promise as an adjunct therapy to systemic antibiotic use in the management of CIP.

Using Baclofen to Explore GABA-B Receptor Function in Alcohol Dependence: Insights From Pharmacokinetic and Pharmacodynamic Measures.

Background: The role of GABA-B neurotransmission in addiction has recently received increased attention, with clinical trials indicating that baclofen, a GABA-B receptor agonist, may reduce alcohol consumption, craving and promote abstinence. However, the optimal dose to treat alcohol dependence is unclear with patients requesting and tolerating much higher doses of baclofen, compared with other clinical uses. We assessed the pharmacokinetics and pharmacodynamics (PK/PD) of baclofen to provide insight into GABA-B sensitivity in this patient group, relative to controls. Methods: Male healthy volunteers (controls, n = 12) and abstinent alcohol dependent individuals (AD, n = 8) received single oral doses of baclofen or placebo in a 3-way crossover design. Controls received placebo/10 mg/60 mg baclofen in a randomized, double-blind design, AD received placebo/60 mg/90 mg baclofen in a single-blind design. PK/PD measures were recorded at baseline and multiple time-points up to 6 h post-dosing, including plasma baclofen, plasma growth hormone (GH), Subjective High Assessment Scale (SHAS) and biphasic alcohol effects scale (BAES). Repeated measures ANOVA analysis explored "change from baseline" dose, time, group, and interaction effects, t-tests compared peak effects. Results: Dose-dependent effects of baclofen on PK and PD measures were observed in both control and AD groups. Whilst there were no significant group differences in any baclofen PK parameters (t 1/2, t max , C max , AUC), marked differences in PD effects were clearly evident. In controls, 60 mg baclofen significantly increased total SHAS and BAES scores, and significantly increased plasma GH levels compared with placebo, with peak effects at 60-120 min, in line with its PK profile. In AD, 60 mg baclofen had limited effects on these parameters; SHAS scores, BAES scores and plasma GH levels were significantly blunted compared with controls (significant group*time interactions P = 0.0014, 0.0015 and P < 0.0001, respectively). Conclusions: Our study shows blunted sensitivity to baclofen in AD relative to controls, with no difference in PK suggesting a lower GABA-B receptor sensitivity. This may explain why higher baclofen doses are requested and tolerated in the treatment of alcohol dependence. Our data has implications for choice of dose in future clinical trials in AD and possibly other substances of dependence.

Community Power Structure Analysis and the Ethical Considerations of "Studying Up".

This narrative outlines our challenges in studying power and power structures within an individual-level ethical framework. Taking a social ethics perspective, we share the story of our "sticky situation" (Campbell, ) that transpired during a multi-year community partnership. We were asked, by our community partners, to help collect interview data without informed consent. As a team of community-engaged university researchers, we were faced with a seemingly easy ethical situation (no consent, no research) that had unexpectedly complicated and long-lasting consequences. This experience revealed to us how community-engaged research and action, under a traditional ethics framework, can often work to protect those in positions of power and offer little to disrupt the status quo. Reflecting on the tension between individual and social ethics, we discuss the limitations of an individual-level framework, including the definitions for respect for persons, justice, and beneficence, on our ability as a field to understand, critique, and contribute to the dismantling of oppressive power structures.

Diagnosis and treatment of dermatophytosis in dogs and cats.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology.

BACKGROUND: Dermatophytosis is a superficial fungal skin disease of cats and dogs. The most common pathogens of small animals belong to the genera Microsporum and Trichophyton. It is an important skin disease because it is contagious, infectious and can be transmitted to people. OBJECTIVES: The objective of this document is to review the existing literature and provide consensus recommendations for veterinary clinicians and lay people on the diagnosis and treatment of dermatophytosis in cats and dogs. METHODS: The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. CONCLUSIONS: No one diagnostic test was identified as the gold standard. Successful treatment requires concurrent use of systemic oral antifungals and topical disinfection of the hair coat. Wood's lamp and direct examinations have good positive and negative predictability, systemic antifungal drugs have a wide margin of safety and physical cleaning is most important for decontamination of the exposed environments. Finally, serious complications of animal-human transmission are exceedingly rare.

Use of a hearing loss grading system and an owner-based hearing questionnaire to assess hearing loss in pet dogs with chronic otitis externa or otitis media.

BACKGROUND: Hearing loss is important when assessing the suitability of dogs with otitis externa/media for medical or surgical therapy. HYPOTHESIS/OBJECTIVES: To assess an owner-completed questionnaire as an indicator of hearing loss and a canine hearing loss scoring system in chronic canine otitis. ANIMALS: One hundred hospital population dogs referred for chronic otitis investigation. METHODS: Owners completed a questionnaire to assess their dog's response to common household noises. The presence of otitis externa or media was determined and brainstem auditory-evoked response measurements were performed on each dog. The minimal hearing threshold (MHT) in decibels normal hearing level (dB NHL) was recorded and categorized according to the human World Health Organization grading system into five grades from 0 to 4 with cut-off values of ≤25 dB NHL, 26-40 dB NHL, 41-60 dB NHL, 60-80 dB NHL and ≥81 dB NHL. RESULTS: The questionnaire correctly determined normal hearing in grade 0 cases, but did not reliably detect unilateral or grade 1 bilateral hearing loss. For dogs with bilateral hearing loss ≥ grade 2, questionnaire sensitivity was 83% [24 of 29, 95% confidence interval, (CI) 64-94%] and specificity was 94% (67 of 71, 95% CI 86-98%). Higher grades of hearing loss were significantly associated with the presence of otitis media (P < 0.01). CONCLUSIONS AND CLINICAL IMPORTANCE: The questionnaire may be a useful in-practice screening tool in chronic canine otitis for moderate to severe bilateral hearing deficits (MHT ≥41 dB NHL). The hearing loss grading system may help clinicians make therapeutic decisions. Chronic otitis media may be associated with higher grades of hearing loss.

Study to assess in vitro antimicrobial activity of nine ear cleaners against 50 Malassezia pachydermatis isolates.

BACKGROUND: Ear cleaning is an important part of the successful therapy of otitis externa. HYPOTHESIS/OBJECTIVES: To evaluate the in vitro activity of nine commercially available ear cleaners (Cerumaural(®), CleanAural Dog(®), Epi-Otic(®), MalAcetic Aural(®), Otoclean(®), Otodine(®), Sancerum(®), Surosolve(®) and TrizUltra™ + Keto) against 50 Malassezia pachydermatis isolates from clinical cases of canine otitis externa. To the authors' knowledge, this is the first study to analyse the in vitro susceptibility of a large number of M. pachydermatis isolates to a variety of ear cleaner products. ANIMALS: Forty-nine hospital population dogs diagnosed with otitis externa with Malassezia spp. present on cytological examination of ear swabs and culture. METHODS: The antimicrobial activity of nine ear cleaners was tested against 50 M. pachydermatis isolates from 49 clinical cases of canine otitis externa using an in vitro agar diffusion test. RESULTS: There were statistically significant differences in activity between ear cleaners, with five showing excellent in vitro anti-Malassezia activity (CleanAural Dog(®), Epi-Otic(®), MalAcetic Aural(®), Sancerum(®) and TrizUltra™ + Keto), two moderate activity (Otodine(®) and Surosolve(®)), one variable activity (Otoclean(®)) and one no activity (Cerumaural(®)). There was a significant overall difference in susceptibility between M. pachydermatis isolates tested (P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Ear cleaners with activity against Malassezia may help to reduce the unnecessary use of antibiotic-containing polypharmaceutical ear medications. This study shows that the use of a large number of isolates may provide a more accurate account of the in vitro activity of a product.

Development of acute Henoch-Schönlein purpura subsequent to endodontic treatment.

BACKGROUND: Henoch-Schönlein purpura (HSP) is an inflammatory disorder of unknown origin that is characterized by IgA-dominant immune complexes in smaller blood vessels. It results in a triad of symptoms, including a purpuric rash on the lower extremities, abdominal pain or renal involvement, and arthritis. Any of the triad may be absent, however, which often leads to confusion in diagnosing the condition. Cases of acute HSP developing subsequent to dental treatment have not been previously reported in the dental literature. CASE REPORT: This study reports the unusual case of a 14-year-old female who developed acute HSP following endodontic treatment. CONCLUSION: Treatment for this condition is supportive and children affected by this disorder need close follow-up of their renal status.

London audit of drug-related overdose deaths: characteristics and typology, and implications for prevention and monitoring.

OBJECTIVES: To describe the circumstances and draft a typology of drug-related overdose deaths. SETTING: London, 2003. METHODS: An audit of 148 drug overdose deaths (involving heroin, methadone, dihydrocodeine, cocaine, amphetamine or MDMA) investigated by coroners during 2003. Information extracted on toxicology, pathology and circumstances were used to identify drug(s) implicated in the death. RESULTS: Poly- or multiple drug use was detected in the majority of deaths with at least 69 different combinations, including 66% for heroin and 42% for cocaine. Six categories of death were identified involving an opiate (100, 68%); cocaine (14, 9%); other controlled drug (five, 3%); mixed drug overdose (18, 12%); other prescribed drug (five, 3%); and other causes (seven, 5%). A witness was present and the death was not instantaneous in 92 (61%) cases, although evidence in the coronial file suggested that in the majority of cases the overdose went unnoticed until too late to intervene. In all, 15 (one in 10) of the deceased were released from prison within 3 months of death; and 37 (one in four) were reported as in receipt of a methadone prescription. CONCLUSIONS: Perhaps for the first time in the United Kingdom cocaine was detected in more drug overdose deaths than methadone. However, reducing heroin use is central to the prevention of drug-related deaths. We recommend that overdose prevention encompasses strategies to encourage a 'mutual duty of care' among problem drug users, and in the United Kingdom further investigation of the relationship of methadone treatment failures on overall trends in drug-related deaths is merited.

Local steroid injections for tennis elbow: does the pain get worse before it gets better?: Results from a randomized controlled trial.

OBJECTIVES: To compare the early effects of local corticosteroid injection, naproxen, and placebo as treatments for tennis elbow in primary care. Specifically, to find out whether the extra pain reduction experienced by patients who are given the steroid injection in the short-term would be realized within the first 5 days of treatment and to attempt to assess how much extra pain may be associated with the injection initially. METHODS: A randomized controlled trial carried out in 23 family practices in the United Kingdom. A total of 164 patients aged 18 to 70 years presenting with a new episode of tennis elbow were recruited and invited to keep a daily record of their pain intensity and medication use over the first 5 days of randomized treatment using a "diary." RESULTS: On day 1, pain scores were higher in the injection group compared with the naproxen group and placebo group, and the injection group was also taking more painkillers. By day 4, the converse was true, pain scores were significantly lower in the injection group than the other 2 groups, and patients given an injection were less likely to be taking painkillers than those in the placebo group. DISCUSSION: Steroid injection was associated with an increase in reported pain for the first 24 hours of treatment, but the therapeutic benefits compared with naproxen and placebo were evident 3 to 4 days after the start of treatment.

Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial.

OBJECTIVE: To determine the effect of artificial teats (bottle and dummy) and cups on breast feeding in preterm infants. DESIGN: Randomised controlled trial. SETTING: Two large tertiary hospitals, 54 peripheral hospitals. PARTICIPANTS: 319 preterm infants (born at 23-33 weeks' gestation) randomly assigned to one of four groups: cup/no dummy (n = 89), cup/dummy (n = 72), bottle/no dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who wanted to breastfeed were eligible to participate. INTERVENTIONS: Cup or bottle feeding occurred when the mother was unable to be present to breast feed. Infants randomised to the dummy groups received a dummy on entry into the trial. MAIN OUTCOME MEASURES: Full breast feeding (compared with partial and none) and any breast feeding (compared with none) on discharge home. SECONDARY OUTCOMES: prevalence of breast feeding at three and six months after discharge and length of hospital stay. RESULTS: 303 infants (and 278 mothers) were included in the intention to treat analysis. There were no significant differences for any of the study outcomes according to use of a dummy. Infants randomised to cup feeds were more likely to be fully breast fed on discharge home (odds ratio 1.73, 95% confidence interval 1.04 to 2.88, P = 0.03), but had a longer length of stay (hazard ratio 0.71, 0.55 to 0.92, P = 0.01). CONCLUSIONS: Dummies do not affect breast feeding in preterm infants. Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home, but has no effect on any breast feeding and increases the length of hospital stay.