Treatment of otitis externa

BackgroundOtitis externa is a commonly diagnosed disorder in dogs and can carry a high welfare impact on affected animals. This study aimed to report the prevalence and explore the role of breed and aural conformation as predisposing factors for canine otitis externa in the UK. The study used a cohort design of dogs under UK primary veterinary care at clinics participating in the VetCompass Programme during 2016. Risk factor analysis used multivariable logistic regression modelling.ResultsThe study included a random sample of 22,333 dogs from an overall population of 905,554 dogs under veterinary care in 2016. The one-year period prevalence of otitis externa was 7.30% (95% confidence interval [CI]: 6.97 to 7.65). Breed and ear carriage were the highest ranked risk factors. Compared with crossbred dogs, sixteen breed types showed increased odds, including: Basset Hound (odds ratio [OR] 5.87), Chinese Shar Pei (OR 3.44), Labradoodle (OR 2.95), Beagle (OR 2.54) and Golden Retriever (OR 2.23). Four breeds showed protection (i.e. reduced odds) of otitis externa: Chihuahua (OR 0.20), Border Collie (OR 0.34), Yorkshire Terrier (OR 0.49) and Jack Russell Terrier (OR 0.52). Designer breed types overall had 1.63 times the odds (95% CI 1.31 to 2.03) compared with crossbred dogs. Compared with breeds with erect ear carriage, breeds with pendulous ear carriage had 1.76 times the odds (95% CI 1.48 to 2.10) and breeds with V-shaped drop ear carriage had 1.84 times the odds (95% CI 1.53 to 2.21) of otitis externa.ConclusionsBreed itself and breed-associated ear carriage conformation are important predisposing factors for canine otitis externa. Greater awareness of these associations for both predisposed and protected breeds could support veterinary practitioners to promote cautious and low-harm approaches in their clinical advice on preventive care for otitis externa, especially in predisposed breeds.

Otitis externa is a ubiquitous inflammatory disease; although it arises most commonly from an infection, there is no consensus in the UK for the reporting of ear swab culture results. This study aims to review current microbiology laboratory reporting of ear swab specimens to primary care and reach an evidence-based consensus for a reporting policy. Fifty consecutive ear swab reports were reviewed from each of 12 laboratories in the South West region to determine and discuss reporting practice. The Health Protection Agency (HPA) GP Microbiology Laboratory Use Group reviewed the underlying evidence and worked towards a consensus of expert microbiology opinion for laboratory reporting of ear swab results using a modified version of the Delphi technique. A total of 487 reports from primary care were reviewed (54% female; 46% male). Cultures most commonly yielded Pseudomonas species (36%), Staphylococcus species (21%), Streptococcus species (15%) and fungi (11%). Five reporting policies were agreed: Policy 1: Common pathogens such as group A β-haemolytic streptococci, Streptococcus pneumoniae, Staphylococcus aureus – Always reported by name with antibiotic susceptibilities. Policy 2: Pseudomonas species – Always reported, but antibiotic susceptibilities only reported in severe disease. Policy 3: Aspergillus, Candida, coliforms and Proteus species, as well as non-group A streptococci and anaerobes – Only reported if moderate numbers of colonies and it is the predominant organism present; if appropriate report antibiotic susceptibilities. Policy 4: Coagulase-negative staphylococci, diphtheroids and enterococci – Not reported by name; generic terms used and antibiotic susceptibilities not reported. Policy 5: When antibiotic susceptibilities reported these must include susceptibility to a topical antibiotic. It is suggested that laboratories should consider adopting this evidence-based reporting consensus for ear swab culture results from primary care patients with otitis externa.

Otitis externa is a common presenting complaint in practice. Ear infections by Pseudomonas aeruginosa are particularly problematic due to the organism's high level of resistance and ability to damage the tympanum. Treatment should be based on susceptibility testing although minimum inhibitory concentrations (MICs) are not available for all treatment options. Silver sulfadiazine has been used in cases of recurrent P.aeruginosa otitis, although a MIC for silver sulfadiazine as a single agent has not been established. To describe susceptibility patterns of P.aeruginosa isolated from canine otitis externa and determine the MIC for silver sulfadiazine and other topical antimicrobials. Thirty-six P.aeruginosa isolates were collected from client-owned dogs, suffering from otitis externa. Susceptibility patterns were established using disc diffusion susceptibility testing against 17 antimicrobial agents. For determination of the MIC, selected strains were tested against increasing concentrations of marbofloxacin, enrofloxacin, gentamicin, polymyxin B and silver sulfadiazine using broth microdilution. For nine of 17 antimicrobial agents, complete resistance was seen in all isolates tested via disk diffusion susceptibility testing. Approximately 94% and 96% of isolates were susceptible to gentamicin and imipenem, respectively. These findings were consistent with broth dilution, where all strains were susceptible to gentamicin. Resistance was higher against polymyxin B and the fluoroquinolones. Silver sulfadiazine was effective invitro with a MIC ranging from 1 to 64μg/mL. As the MIC of silver sulfadiazine was lower than the concentration in a 1% preparation, such a product potentially represents a treatment option for dogs with P.aeruginosa otitis.

Jean Fletcher illustrates nurse triage in primary care through a consultation for ear problems

Foreign body in the ear is commonly encountered in children by primary care givers, emergency department Physicians, Pediatricians and Otolaryngologists worldwide. We reviewed cases of aural foreign bodies in children seen in our centre over a five-year period with the aim of auditing our current practice and suggesting possible improvements suited for developing countries. Grains and seeds (27.9%), beads (19.7%), cotton wool (13.6%), paper (8.8%) and eraser (8.2%) formed the bulk of the aural foreign bodies. About 96% was removed without general anesthesia by using Jobson Horne's probe or aural dressing forceps (73.8%) under direct vision; or by syringing (22.1%). Some 4% had to be removed in the operating theatre under general anesthesia. The complications observed include bruise or laceration and bleeding from the external auditory canal (16.3%), otitis externa (6.5%) and traumatic perforation of the tympanic membrane (1.7%). Despite a high proportion of cases managed in the office setting, complication rates were within acceptable levels. There is need to develop practical criteria that will be beneficial to primary health care givers to determine which patients could be managed in the primary care setting with acceptable outcome.

BackgroundLabrador retrievers are reportedly predisposed to many disorders but accurate prevalence information relating to the general population are lacking. This study aimed to describe demography, mortality and commonly recorded diseases in Labrador retrievers under UK veterinary care.MethodsThe VetCompass™ programme collects electronic patient record data on dogs attending UK primary-care veterinary practices. Demographic analysis covered all33,320 Labrador retrievers in the VetCompass™ database under veterinary care during 2013 while disorder and mortality data were extracted from a random sample of 2074 (6.2%) of these dogs.ResultsOf the Labrador retrievers with information available, 15,427 (46.4%) were female and 15,252 (53.6%) were male. Females were more likely to be neutered than males (59.7% versus 54.8%, P < 0.001). The overall mean adult bodyweight was 33.0 kg (SD 6.1). Adult males were heavier (35.2 kg, SD 5.9 kg) than adult females (30.4 kg, SD 5.2 kg) (P < 0.001). The median longevity of Labrador retrievers overall was 12.0 years (IQR 9.9–13.8, range 0.0–16.0). The most common recorded colours were black (44.6%), yellow (27.8%) and liver/chocolate (reported from hereon as chocolate) (23.8%). The median longevity of non-chocolate coloured dogs (n = 139, 12.1 years, IQR 10.2–13.9, range 0.0–16.0) was longer than for chocolate coloured animals (n = 34, 10.7 years, IQR 9.0–12.4, range 3.8–15.5) (P = 0.028).Of a random sample of 2074 (6.2%) Labrador retrievers under care in 2013 that had full disorder data extracted, 1277 (61.6%) had at least one disorder recorded. The total number of dogs who died at any date during the study was 176. The most prevalent disorders recorded were otitis externa (n = 215, prevalence 10.4%, 95% CI: 9.1–11.8), overweight/obesity (183, 8.8%, 95% CI: 7.6–10.1) and degenerative joint disease (115, 5.5%, 95% CI: 4.6–6.6). Overweight/obesity was not statistically significantly associated with neutering in females (8.3% of entire versus 12.5% of neutered, P = 0.065) but was associated with neutering in males (4.1% of entire versus 11.4% of neutered, P < 0.001). The prevalence of otitis externa in black dogs was 12.8%, in yellow dogs it was 17.0% but, in chocolate dogs, it rose to 23.4% (P < 0.001). Similarly, the prevalence of pyo-traumatic dermatitis in black dogs was 1.1%, in yellow dogs it was 1.6% but in chocolate dogs it rose to 4.0% (P = 0.011).ConclusionsThe current study assists prioritisation of health issues within Labrador retrievers. The most common disorders were overweight/obesity, otitis externa and degenerative joint disease. Males were significantly heavier females. These results can alert prospective owners to potential health issues and inform breed-specific wellness checks.

BackgroundRottweilers are reportedly predisposed to many disorders but accurate prevalence information relating to the general population are lacking. This study aimed to describe demography, mortality and commonly recorded diseases in Rottweilers under UK veterinary care. Clinical health records within the VetCompass Programme were explored for disorders recorded during 2013.ResultsRottweilers comprised 5321 (1.17%) of 455,557 dogs attending 304 clinics. Annual proportional birth rates dropped from 1.75% in 2006 to 1.07% in 2013. Median adult bodyweight overall was 44.9 kg (IQR 39.55–51.00, range 20.00–88.80). Median male adult bodyweight (48.5 kg, interquartile range [IQR] 43.0–54.0, range 20.0–88.8) was heavier than female (41.5 kg, IQR 37.0–46.4, range 21.1–73.5) (P < 0.001). Median longevity overall was 9.0 years (IQR 7.2–10.5, range 0.0–17.0). Median female longevity (9.5 years, IQR 7.8–11.0) was greater than male (8.7 years, IQR 6.8–10.1) (P = 0.002). The most common causes of death were neoplasia (33.0%), inability to stand (16.0%) and mass-associated disorder (7.1%).At least one disorder was recorded for 60.31% of Rottweilers. The most prevalent specific disorders recorded were aggression (7.46%, 95% CI 6.40–8.64), overweight/obesity (7.06%, 95% CI: 6.02–8.21), otitis externa (6.14%, 95% CI: 5.18–7.23) and degenerative joint disease (4.69%, 95% CI: 3.84–5.66). Male Rottweilers had higher prevalence than females for aggression (9.36% versus 5.47%, P = 0.001) and pyotraumatic dermatitis (4.05% versus 1.76%, P = 0.001). Aggression was more prevalent in neutered than entire females (7.5% versus 3.1%, P = 0.003) but did not differ between neutered and entire males (9.6% versus 9.0%, P = 0.773). The most frequent disorder groups were musculoskeletal (12.01%, 95% CI: 10.69–13.45), dermatological (10.96%, 95% CI: 9.69–12.35), gastro-intestinal (195, 8.87%, 95% CI: 7.72–10.14), undesirable behaviour (7.96%, 95% CI: 6.87–9.18) and neoplasia (7.96%, 95% CI: 6.87–9.18).ConclusionsThe current study assists prioritisation of health issues within Rottweilers. Rottweilers are relatively short-lived and neoplasia is a common cause of death. The most common disorders were aggression, overweight/obesity, otitis externa and degenerative joint disease. Males were significantly heavier, shorter-lived and predisposed to aggression than females. These results can alert prospective owners to potential health issues and optimise sex selection decision-making.

Will the Australian Government's response to its 'National Ice Taskforce' deliver more treatment as promised?

A 26 year old otherwise well man with no medical history of note attended his general practice with a five day history of severe right ear pain and scanty ear...

Staphylococcus pseudintermedius (SP) is an important opportunistic pathogen, frequently associated with pyoderma and otitis in dogs. The emergence and rapid expansion of methicillin-resistant Staphylococcus pseudintermedius (MRSP) is problematic due to multidrug resistance and reduced treatment options. The aim of this study was to determine i) the prevalence of MRSP in dogs with pyoderma or otitis externa, ii) the antimicrobial resistance patterns of MRSP from South African isolates, and iii) the risk factors for MRSP-associated pyoderma or otitis externa in dogs in South Africa (RSA). Sixty-eight presumptive clinical SP isolates (collected from 65 dogs) from five geographically dispersed laboratories in RSA were collected over 2 years. Possible MRSP isolates were flagged when resistance to oxacillin was observed. Thereafter, all isolates were confirmed as SP by polymerase chain reaction (PCR) and further genotyped for the mecA gene. Fifty-seven of 68 isolates were confirmed to be SP (83.8%), while 49/57 (85.9%) carried mecA. Our findings showed that preliminary phenotypic methods supplemented by genotypic methods increased the accuracy of correctly identifying SP. All isolates were resistant to at least one antimicrobial drug. There was a high incidence of amoxicillin (70.1%) and enrofloxacin (65%) resistance. Important risk factors for mecA positive carriage were previous hospital admission, pruritus, and previous antibacterial failure. This study demonstrates a high prevalence of mecA positive carriage (85.9% of samples) in MRSP pyoderma and otitis in dogs in RSA. There is an urgent need for better laboratory diagnosis of MRSP and surveillance of dogs presenting with pyoderma and otitis in South Africa.

I. The Problem: Childhood Obesity—A Burgeoning Epidemic e490II. Childhood Obesity Research Summit.........e490III. Pathophysiology and Morbidity ofChildhood Obesity e490A. Pathophysiology of Obesity e490B. Medical Consequences of Childhood Obesity. . .e490C. Psychosocial and Societal Consequences ofChildhood Obesity e490IV. Current Healthcare Practices in ChildhoodObesity Prevention and Treatment e492A. Lifestyle Assessment: Diet and Physical Activity . . . .e492B. Clinical Assessment e493C. Psychosocial/Behavioral Assessment .......e493D. Implementing Effective Prevention andTreatment Options: Diet e494E. Implementing Effective Prevention and TreatmentOptions: Exercise and Sedentary Behaviors . . . .e495F. Implementing Effective Prevention TreatmentOptions: Family and Behavioral Approaches . . .e496G. Behavioral Management e497H. Medical and Pharmacological Management. . . .e497I. Surgical Management e498V. Barriers to Optimum Care e498A. Healthcare System Factors e4981. Preparedness of Providers e4982. Models of Coverage and Care e4993. Uninsurance and Underinsurance AmongChildren and Families e5004. Healthcare Providers and Settings asRole Models e500B. The Challenge of Behavior Change ........e5011. Motivational Interviewing for Pediatric Obesity. .e5012. Psychosocial Factors InfluencingBehavior Change e5023. Environmental Factors InfluencingBehavioral Change e503VI. Practice-Based Resources for Preventionand Management e503A. Models From Other Disciplines e5031. Adult Chronic Care Model e5032. Treatment of Heart Failure e5043. Treatment of Type 2 Diabetes Mellitus .....e5044. Treatment of Childhood Asthma.........e505B. Public Health Measures forChildhood Obesity e5061. Tobacco Control: Implications forChildhood Obesity e506C. Specific Research Issues e5061. Specifying Priorities in the Context of aComplex, Multifactorial Problem ........e5062. Taking a Developmental Approach .......e5073. Engaging Stakeholders e5074. Targeting the Appropriate Outcome .......e508VII. Research Challenges e509A. Research in the Busy Practice e509B. Bring Research Into Practices: Web-BasedAssessment for the PediatricObesity Clinic e509C. Research Agenda: NHLBI and thePediatric Heart Network e510D. Research Agenda: The Children’sOncology Group e510E. Research Agenda: CDC e511F. Research Agenda: Foundations e511VIII. Research and Policy: KnowledgeTranslation e512A. From Practice to Policy to Practice ........e512IX. Concluding Remarks e512Appendix A: Planning Committee e513Appendix B: Presenters e513

Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians

Otitis externa: what is the problem with getting it right? A mixed-methods study in primary and secondary care - ERRATUM.

The British Small Animal Veterinary Association (BSAVA) has announced the winners of its 2024 Clinical Abstracts Awards.The awards recognise the best short research presentations given during the BSAVA congress and are based on high-quality clinical research, undertaken in practice, industry and academia.The winners are: George Smith, Best Medicine Award for 'Predictors of clinically significant bleeding in dogs with severe thrombocytopenia'. Michelle Demkova, Best Student Award for 'Lifting the flap on otitis externa in dogs under primary veterinary care in the UK -the VetCompass view'. Kathryn Patel, Best Practitioner Award for 'Reflecting on first opinion clinical improvement project across 39 UK vet practices to support diagnosis and management of osteoarthritis'. Sebastian Wylie, Best Surgery Award for 'Complications and outcomes following surgical management of achilles tendon injury'. Clare Jones, Best Poster Award for 'Confidence with CPR within veterinary professionals.Would standardised CPR training help confidence within veterinary professionals?'

These Practice Guidelines for the Psychiatric Evaluation of Adults mark a transition in the American Psychiatric Association’s Practice Guidelines. Since the publication of the 2011 Institute of Medicine report Clinical Practice Guidelines We Can Trust, there has been an increasing focus on using clearly defined, transparent processes for rating the quality of evidence and the strength of the overall body of evidence in systematic reviews of the scientific literature. These guidelines were developed using a process intended to be consistent with the recommendations of the Institute of Medicine (2011), the Principles for theDevelopment of Specialty Society Clinical Guidelines of the Council of Medical Specialty Societies (2012), and the requirements of the Agency for Healthcare Research andQuality (AHRQ) for inclusion of a guideline in the National Guideline Clearinghouse. Parameters used for the guidelines’ systematic review are included with the full text of the guidelines; the development process is fully described in a document available on the APA website: http:// www.psychiatry.org/File%20Library/Practice/APA-GuidelineDevelopment-Process–updated-2011-.pdf. To supplement the expertise of members of the guideline work group, we used a “snowball” survey methodology to identify experts on psychiatric evaluation and solicit their input on aspects of the psychiatric evaluation that they saw as likely to improve specific patient outcomes (Yager 2014). Results of this expert survey are included with the full text of the practice guideline.