Background Emergency laparotomies in donkeys are infrequently performed and there is limited literature on the subject. Objectives To determine findings and associated outcomes of exploratory laparotomies in donkeys. Study design Descriptive retrospective study. Methods Donkeys undergoing emergency exploratory laparotomy for investigation and treatment of colic at seven UK referral hospitals between 2005-2017 were included. Data were retrieved from available hospital records. Descriptive statistics and inferential statistical analysis of outcomes of interest was performed in three steps. Results Thirty-three cases fulfilled the inclusion criteria. Clinical signs on presentation were available for 32 donkeys, of which 53.1% (17/32) presented for investigation of colic while in 46.9% (15/32) the presenting complaint was non-specific. Primary lesion location included small intestine (42.4%, 14/33), large colon (39.3%, 13/33), caecum (6.1%, 2/33), stomach (6.1%, 2/33) and 6.1% (2/33) had multiple abnormal findings without a clear primary lesion. Overall survival to discharge was 54.5% (18/33). Five donkeys (15.2%, 5/33) were euthanased at surgery and of those recovering from general anaesthesia a further 35.7% (10/28) were euthanased or died prior to discharge. Six donkeys (21.4%, 6/28) required a second laparotomy of which 4 (66.7%, 4/6) survived. Post-operative complications occurred in 82.1% (23/28) of cases and included hyperlipaemia (42.9%, 12/28), incisional complications (21.4%, 6/28), ileus (21.4%, 6/28) and persistent colic (17.9%, 5/28). When adjusted for other complications, donkeys with primary gastric lesions were less likely to have presented with severe colic compared with those with primary small intestinal lesions (OR: 0.07, 95% CI 0.01-0.95, p = 0.05). Only age was positively associated with death prior to discharge (OR: 1.18, 95% CI 1.03-1.36, p = 0.02). Main limitations Small sample size and retrospective design. Conclusion Donkeys with abdominal lesions may present with a range of signs often not including colic. Surgical findings were diverse and survival to discharge appears to be lower than in horses.

Current consensus defines mild-moderate equine asthma (mEA; previously inflammatory airway disease) by a hierarchy of indicators of lung pathology: cough, poor performance, increased tracheobronchial mucus, inflammatory bronchoalveolar lavage (BAL) cytology and pulmonary dysfunction. Exclusion criteria include fever, systemic disease, or increased resting respiratory effort. The aim of this review was to inform future research by identifying gaps, strengths and weaknesses in the current body of evidence supporting this consensus-proposed definition. Objectives were to critique evidence supporting the inclusion of each diagnostic indicator in the case definition, by summarising and evaluating evidence for its association with higher-level indicators of lung inflammation. Searches of three databases identified 2275 articles relating to mEA or its diagnostic indicators, from which 298 full-text articles were screened and 45 reviewed in full. Studies (n = 44) had been performed worldwide in clinics, hospitals, racetracks, yards or research herds, in 6092 horses. Studies were predominantly opportunistic observational (n = 13/44: 29.5%) or cross-sectional (n = 11/44; 25%). The median number of horses per study was 74. Where breed and use were reported most were Thoroughbreds (58.2%; 2730/4688) and racehorses (72.8%; n = 3960/5439). Domains rated as high risk of bias in almost 50% of articles were 'study power' and 'masking'. Heterogeneity in clinical and laboratory measures precluded meta-analysis. Evidence was more consistent for certain pairwise relationships (e.g., between cough and tracheobronchial mucus) than others (e.g., BAL cytology and lung function). Findings highlight the need for increased standardisation of diagnostic methods and reporting to facilitate future systematic review and meta-analysis.

The global problem of unowned domestic cats, driven by their phenomenal reproductive success, carries significant economic, animal welfare and biodiversity costs. Desexing owned cats prior to puberty prevents unwanted litters that contribute to unowned cat populations. The prevalence and predictors of desexing, and the age at which surgery was carried out were investigated using anonymized electronic patient records in the VetCompass Australia database of cats presented to veterinary practices. Of 52,941 cats born between 2010 and 2017, 83.6% were desexed. Among 7463 desexed females, 21.5% had been desexed by 4 months of age, 59.8% by 6 months and 85.4% by 1 year. Sex, breed, location and socioeconomic indices significantly influenced desexing status and age at surgery. Cats born between 2010 and 2017 had greater odds of being desexed than cats born between 1995and 2009 at each age cut-off (≤ 4 months [OR 1.76, CI 95 1.58–1.97], ≤ 6 months [OR 1.50, CI 95 1.38–1.62] and ≤ 1 year [OR 2.33, CI 95 2.11–2.57] p < 0.001). Most cats presented to veterinarians in Australia are desexed. Compared with cats born before 2010, cats born later are significantly younger at desexing but, even so, many cats would have reached sexual maturity before surgery. These findings will inform the design of front-line strategies promoting prepubertal desexing and they demonstrate, for the first time, a shift towards desexing younger cats.

Background Arthroscopy has been advocated as the treatment of choice for dorsal osteochondral chip fracture of the metacarpo/metatarsophalangeal (MCP/MTP) joint. However, there is no published research on racing performance outcomes of horses with this pathology managed nonsurgically. Objectives To compare racing career outcomes of Thoroughbred racehorses with nonsurgically (non-SX) or surgically (SX) managed MCP/MTP dorsal osteochondral chip fracture alongside a cohort of horses with no dorsal osteochondral chip fracture (unexposed). Study design Retrospective cohort study conducted between 2006 and 2014. Methods Radiographs of Thoroughbred racehorses were reviewed to identify MCP/MTP dorsal osteochondral chip fractures. Unexposed horses under the care of the same practice were recruited randomly from training records. Racing outcomes were analysed using survival analysis and logistic, linear and negative binomial regression techniques. Results Dorsal osteochondral chip fractures were identified in 98 (70 non-SX, 28 SX) horses and compared with 648 unexposed horses. There was no significant difference among non-SX, SX, and unexposed horses in respect of total career starts, or likelihood of ever winning, placing, or earning money in a race (P > .05). SX horses had a significantly higher rate of wins/start than non-SX horses (rate ratio 1.6, CI 1.1-2.4, P = .02) and unexposed horses (rate ratio 1.9, CI 1.3-2.8, P = .001). Total career earnings for the SX horses were 4.1 times that of the unexposed horses (95% CI 1.2-14.5, P = .03), although total career earnings did not differ significantly between non-SX and unexposed horses (P = .8). Main limitations Retrospective observational study where management technique was not randomised or blinded. Small number of surgically managed horses and potential selection bias for surgical management. Conclusions Nonsurgical management of this injury appears to be a valid management choice given that it was not associated with significant effects on racing career performance relative to a large unexposed cohort in this study population.

BACKGROUND Exercise-associated cardiac rhythm disturbances are common but there is a lack of evidence-based criteria on which to distinguish clinically relevant rhythm disturbances from those that are not. OBJECTIVES To describe and characterise rhythm disturbances during clinical exercise testing; to explore potential risk factors for these rhythm disturbances and to determine whether they influenced future racing. STUDY DESIGN Retrospective cohort using a convenience sample. METHODS Medical records were reviewed from two clinical services to identify horses with poor performance and/or respiratory noise with both exercise endoscopy and electrocardiography results. Respiratory and ECG findings recorded by the attending clinicians were described, and for polymorphic ventricular rhythms (n = 12), a consensus team agreed the final rhythm characterisation. Several statistical models analysing risk factors were built and racing records were reviewed to compare horses with and without rhythm disturbance. RESULTS Of 245 racehorses, 87 (35.5%) had no ectopic/re-entrant rhythms, 110 (44.9%) had isolated premature depolarisations during sinus rhythm and 48 (19.6%) horses had complex tachydysrrythmias. Rhythm disturbances were detected during warm-up in 20 horses (8.2%); during gallop in 61 horses (24.9%) and during recovery in 124 horses (50.6%). Most complex rhythm events occurred during recovery but there was one horse with a single couplet during gallop and another with a triplet during gallop. In 15 horses (one with frequent isolated premature depolarisations and 14 complex rhythms) were considered by clinicians to be potentially contributing to poor performance.Treadmill exercise tests, the presence of exercise-associated upper respiratory tract obstructions and National Hunt racehorses were associated with rhythm disturbances. The proportion of horses racing again after diagnosis (82%) was similar in all groups and univariable analysis revealed no significant associations between subsequent racing and the presence of any ectopic/re-entrant rhythm, or the various sub-groups based on phase of exercise in which this was detected. MAIN LIMITATIONS Reliance on retrospective data collection from medical records with no control group. Exercise ECGs were collected using only 1 or 2 leads. Variables examined as risk factors could be considered to be inter-related and our sub-groups were small. CONCLUSIONS This study confirms a high prevalence of cardiac rhythm disturbances, including complex ectopic/re-entrant rhythms, in poorly performing racehorses. Detection of rhythm disturbances may vary with exercise test conditions and exercise-associated upper respiratory tract obstructions increases the risk of rhythm disturbances.

SummaryBackgroundPrevious studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited.ObjectivesTo investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections.Study designRetrospective analysis of clinical records.MethodsMedical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow‐up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival.ResultsHorses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18–0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12–5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78–8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00–1.02, P = 0.04), post‐operative synoviocentesis (HR 3.18, 95% CI 1.36–7.43, P = 0.006) and post‐operative wound dehiscence (HR 2.5, 95% CI 1.08–5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11–0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross‐sectional area) (HR 7.92, 95% CI 3.31–19.92, P<0.001). At follow‐up (median 30 months, range 0.25–13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow‐up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb.Main limitationsRetrospective study and incomplete follow‐up.ConclusionEndoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.

Purpose To describe Australians' prescribed medicine use on a typical day (September 25, 2018). Methods We conducted a cross-sectional study using nationally representative dispensing claims data using the Australian Government Department of Human Services random 10% sample of all Australians eligible for prescription medicines subsidised through the Australian Pharmaceutical Benefits Scheme (PBS). Our main outcome measures were the number and proportion of people using at least one prescribed medicine and the specific medicine groups and classes on the day. We estimated the proportion of Australians using these medicines using the mid-year Australian population as the denominator. We quantified multiple medicine use by calculating the number and proportion of people experiencing polypharmacy (the use of 5 or more unique medicines) and hyper-polypharmacy (the use of 10 or more unique medicines). Results We found that 9.0 million Australians used at least one PBS medicine on September 25, 2018; equating to 27.5 million medicines in use across Australia. "Cardiovascular system", "nervous system" and "alimentary tract and metabolism" medicines comprised the top three medicine groups. Over 1.8 million people experienced polypharmacy on the day, accounting for 13.6 million dispensed medicines. 1 022 590 (45%) people aged >= 70 years old experienced polypharmacy and 188 930 (8%) experienced hyper-polypharmacy. Conclusions Rates of polypharmacy were high, particularly in the people most susceptible to polypharmacy-related harm. Strategies to optimise the risk-benefit ratio of medicines and to reduce polypharmacy through "choosing wisely" and "de-prescribing" in this age group are needed. Australia's national data provides a benchmark to inform global medicine utilisation practices.

Background Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements. Methods We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes. Results Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements. Conclusion Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).

[1] Sebaldt RJ, Sheller JR, Oates JA, et al. Inhibition of eicosanoid biosynthesis by glucocorticoids in humans. PNAS. 1990;87:6974–6978. [2] Arnold DH. Acute asthma exacerbations, viral respiratory infections, and corticosteroid treatment. Lancet Respir Med. 2016;4:930–932. [3] Camargo CA, Jr., Smithline HA, Malice MP, et al. A randomized controlled trial of intravenous montelukast in acute asthma. Am J Respir Crit Care Med. 2003;167:528–533. [4] Knorr B, Holland S, Rogers JD, et al. Montelukast adult (10-mg film-coated tablet) and pediatric (5-mg chewable tablet) dose selections. J Allergy Clin Immunol. 2000;106:S171–S178. [5] Arnold DH, Bowman N, Reiss TF, et al. Adverse events are rare after single-dose montelukast exposures in children. Clin Toxicol (Philadelphia, Pa). 2018;56:25–29.

AimsTo examine prescribed psychotropic medicine use on a given day in Australia (25 September 2018; World Pharmacists Day), with a focus on psychotropic polypharmacy.MethodsWe used a 10% sample of individual‐level nationwide dispensing claims to examine psychotropic medicine use on a given day. We estimated the prevalence of psychotropic medicine use in all ages stratified by age and sex. We also calculated the observed vs expected (had medicines been randomly combined) prevalence of psychotropic combinations used. We focused on combinations of clinical significance as well combinations of psychotropics with medicines prescribed to manage cardiovascular risk and disease.ResultsSerotonin reuptake inhibitors, serotonin–noradrenalin reuptake inhibitors/noradrenaline reuptake inhibitors, tricyclic antidepressants and gabapentinoids dominated psychotropic use. The use of any psychotropic as a proportion of people in the Australian population increased with age, peaking at the 85–89 year age group and declining thereafter. Combinations of medicines from the same subclass generally occurred at lower than expected frequencies. However, combinations including atypical antipsychotics occurred more frequently than expected; e.g. 7.4× with anticonvulsants and 2.2× with other atypical antipsychotics. This was also the case for combinations of sedatives, e.g. anxiolytic with hypnotic benzodiazepines (3.8×). Lipid‐lowering drugs and antidiabetic medicines were combined with psychotropics at frequencies close to those expected had they been randomly combined.ConclusionPsychotropic use in older adults and certain psychotropic combinations that are not well supported with evidence remain prevalent and greater consideration of the drivers of this potentially inappropriate prescribing is required.

Aim: To describe the epidemiology of veterinary pharmaceutical-related exposures based on telephone calls to Australia's largest poisons information centre. Methods: A retrospective analysis of exposures to pharmaceutical products intended for animal use, managed by the New South Wales Poison Information Centre (NSWPIC, Australia's largest poisons information centre) from 2014 to 2016 inclusive, was conducted. Case narratives were reviewed and coded for exposure-related circumstances and intended species. Descriptive statistics were generated and forest plots were produced to visualise the perceived severity of products. Results: From 2014 through 2016 NSWPIC received 2655 calls regarding exposure to veterinary pharmaceutical products: 11.72 human exposures to veterinary pharmaceuticals per 1000 PIC initial contact exposure calls (CI: 10.95-12.49) per year. The vast majority of exposures were with products intended for companion animals, particularly of the class "antiparasitic products, insecticides and repellents", with the most common individual specified product being pimobendan, a phosphodiesterase inhibitor used as a cardiac inotrope and vasodilator in dogs. Immunologicals presented the greatest perceived severity, with livestock vaccinations eliciting substantial proportions of symptomatic exposures and those receiving hospitalisation. Exploratory behaviour, such as accessing packaging, was a common source of exposure within toddlers and children in particular. Conclusions: This overview of all exposures to veterinary pharmaceutical products has identified high-risk groups to target interventions to reduce the incidence of future exposures. The pet-owning population and those personnel administering immunologicals to livestock represent a substantial cohort of individuals at risk of harm during, and in the immediate time following, administration of veterinary pharmaceutical products to animals. It is important to review risk management plans for veterinary pharmaceutical products to ensure product safety is as stringent as human equivalents. The legislative requirements concerning child-resistant packaging and the scheduling of livestock vaccines require reconsideration.

AimsWe aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs.MethodsThis descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug‐associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF.ResultsThere were 444 drug‐related deaths and 21,296 overdoses during the study period. FTI and CF were well correlated (Spearman's rho 0.64, P < .001). Of the classes of interest, opioids had the highest FTI (40.3 95% confidence interval [CI] 35.2–45.4 deaths per 100 years of use at the defined daily dose or deaths/DDD/100 years) and CF (12.4% 95%CI 11.0–13.9). Fentanyl, methadone and morphine had the highest relative fatal toxicity within this class. Tricyclic antidepressants had the highest relative fatal toxicity of all antidepressants (FTI 14.5 95%CI 9.7–19.3 deaths/DDD/100 years and CF 7.1% [95%CI 4.8–9.3]) and benzodiazepines appeared to be more associated with multiple agent deaths than single. Of the illicit drugs, heroin had the highest CF (26.4%, 95%CI 19.1–33.7).ConclusionKnowledge of relative lethal toxicity is useful to prescribers and medicines and public health policy makers in restricting access to more toxic drugs and may also assist coroners in determining cause of death.

Background: Equine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences. There is a paucity of data that accounts for the multifactorial nature of laminitis and considers time-varying covariates that may be associated with disease development; particularly those that are modifiable and present potential interventions. A previous case-control study identified a number of novel, modifiable factors associated with laminitis which warranted further investigation and corroboration. The aim of this study was to identify factors associated with equine laminitis in horses/ponies in Great Britain (GB) using a prospective, web-based cohort study design, with particular interest in evaluating modifiable factors previously identified in the case-control study. Results: Self-selected horse/pony owners in GB submitted initial baseline and follow-up health and management questionnaires for 1070 horses/ponies between August 2014 and December 2016. The enrolled horses/ponies contributed 1068 horse-years at risk with a median of 38 days between questionnaire submissions. Owners reported 123 owner-recognised and/or veterinary-diagnosed episodes of active laminitis using a previously-validated laminitis reporting form. Multivariable Cox regression modelling identified 16 risk/protective factors associated with laminitis development. In keeping with the previous case-control study, a prior history of laminitis (particularly non-veterinary-diagnosed episodes), soreness after shoeing/trimming and weight gain were associated with higher rates of laminitis. There is now strong evidence that these risk factors should be used to guide future recommendations in disease prevention. Factors with some prior evidence of association included breed, steroidal anti-inflammatory administration, transport and worming. The modifiable factors amongst these should be the focus of future laminitis studies. The remainder of the identified factors relating to health, turnout and grazing management and feeding are novel, and require further investigation to explore their relationship with laminitis and their applicability as potential interventions. Conclusions: This study has demonstrated a temporal relationship between a number of horse- and management-level factors and laminitis, identifying potential interventions and important risk groups for which these interventions would be of particular importance. These results serve as a sound evidence-base towards the development of strategic recommendations for the horse/pony-owning population to reduce the rate of laminitis in GB.

Euthanasia is a complex topic, with animal owners using multiple factors to shape their decision-making process. Previous epidemiological studies have described causes of equine mortality in specific populations, but there is limited evidence regarding factors contributing specifically to equine euthanasia in Great Britain (GB). This observational study used a prospective cohort design: the objectives were to describe owner-reported reasons for euthanasia, estimate the rate of euthanasia and identify associated factors in horses/ponies enrolled in a web-based epidemiological study of laminitis in GB. Self-selected horse/pony owners submitted regular management and health data over 29 months and reported dates and reasons for euthanasia during this period. The overall incidence of euthanasia was estimated and associated factors were identified using multivariable Cox regression modelling, adjusted for age, with variables retained in the final model if P ≤ 0.05. Data were available for 1070 horses/ponies contributing 1093 horse-years at risk (HYAR), with 80 owner-reported euthanasias. The incidence of euthanasia was 7.3 euthanasias per 100 HYAR (95 % confidence interval [CI] 5.9, 9.1). The most frequently reported health reasons contributing to euthanasia were laminitis-related consequences (25.0 % ; CI 16.8, 35.5 %), colic (21.3 % ; CI 13.7, 31.4 %), non-laminitic lameness (20.0 % ; CI 12.7, 30.1 %) and age-related deterioration, including owner-perceived compromised quality of life (20.0 % ; CI 12.7, 30.1 %). Health-related factors associated with significantly higher rates of euthanasia were colic (hazard ratio [HR] 26.4; CI 12.5, 55.8), pituitary pars intermedia dysfunction (HR 3.0; CI 1.7, 5.4) and lameness due to navicular syndrome (HR 5.9; CI 1.8, 20.0), soft tissue injury (HR 6.5; CI 2.7, 15.6) or laminitis (HR 2.7; CI 1.3, 5.7). Further factors included being pure bred (HR 1.7; CI 1.0, 2.8), female (HR 1.7; CI 1.0, 2.9), having poor owner-perceived hoof quality (HR 2.4; CI 1.1, 5.2), being entirely stabled (HR 5.0; HR 2.1, 12.0), being on loan or under temporary care of the study participant (HR 2.3; CI 1.2, 4.4) and participating in affiliated or professional competitions (HR 5.9; CI 2.4, 14.8). Euthanasia rates were significantly higher in the first two study years compared to the third (P < 0.001). Animals whose owners used the study's custom-designed weight tracker tool had significantly lower rates of euthanasia (HR 0.6; CI 0.3, 0.95). This study has identified a number of, arguably preventable, health-related factors associated with higher rates of euthanasia. Data on owners' decision-making process regarding euthanasia, including emotive and financial impacts, were not recorded but are important contributors to euthanasia that require better understanding.

BACKGROUND:Arthroscopy is considered the treatment of choice for dorsal osteochondral chip fractures of the metacarpo/metatarsophalangeal (MCP/MTP) joints in the racehorse; however, there is no published research on non-surgical management of this injury. OBJECTIVES:To compare clinical features, intra-articular medication use and return to racing in Thoroughbred racehorses with non-surgically (non-SX) or surgically (SX) managed MCP/MTP dorsal chip fracture. STUDY DESIGN:Retrospective observational study conducted between 2006 and 2014. METHODS:Radiographs of Thoroughbred racehorses were reviewed to identify MCP/MTP dorsal osteochondral chip fractures. Clinical and intra-articular medication data were obtained from veterinary records, and return to racing data from a public online resource. RESULTS:A total of 98 MCP/MTP horses with dorsal chip fractures were identified (70 non-SX, 28 SX). Median age was 2 years (range 2-7 years). Osteochondral chip fractures predominantly involved the forelimbs (n = 92, 93.9%) and the majority were considered by the treating clinician to be clinically active (n = 85, 86.7%). Significantly more SX horses had a reported ongoing problem associated with the affected joint than non-SX horses (P = 0.002), however there was no significant difference between non-SX and SX horses in the number of intra-articular medications of affected joint per month of follow-up (P = 0.22). The proportion of horses racing post-diagnosis was not significantly different between non-SX (55/70; 78.6%, 95% CI 69.0, 88.2%) and SX horses (24/28; 85.7%, 95% CI 72.8, 98.73%) (P = 0.57). Median time to first start following diagnosis for non-SX (106 days, range 1-326) was significantly shorter than for SX horses (203 days, range 9-559) (P = 0.002). MAIN LIMITATIONS:Management technique was not randomised or blinded, with few surgically managed horses. CONCLUSIONS:The results contribute to the current evidence base used to guide management of osteochondral chip fractures of the MCP/MTP joints in the racehorse, and indicate that non-surgical management may be a valid treatment option for some injuries.

Objectives To assess the numbers of paracetamol overdose-related hospital admissions and deaths in Australia since 2007-08, and the overdose size of intentional paracetamol overdoses since 2004. Design, setting Retrospective analysis of data on paracetamol-related exposures, hospital admissions, and deaths from the Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD; 2007-08 to 2016-17), the New South Wales Poisons Information Centre (NSWPIC; 2004-2017), and the National Coronial Information System (NCIS; 2007-08 to 2016-17). Participants People who took overdoses of paracetamol in single ingredient preparations. Main outcome measures Annual numbers of reported paracetamol-related poisonings, hospital admissions, and deaths; number of tablets taken in overdoses. Results The NHMD included 95 668 admissions with paracetamol poisoning diagnoses (2007-08 to 2016-17); the annual number of cases increased by 44.3% during the study period (3.8% per year; 95% CI, 3.2-4.6%). Toxic liver disease was documented for 1816 of these patients; the annual number increased by 108% during the study period (7.7% per year; 95% CI, 6.0-9.5%). The NSWPIC database included 22 997 reports of intentional overdose with paracetamol (2004-2017); the annual number increased by 77.0% during the study period (3.3% per year; 95% CI, 2.5-4.2%). The median number of tablets taken increased from 15 (IQR, 10-24) in 2004 to 20 (IQR, 10-35) in 2017. Modified release paracetamol ingestion report numbers increased 38% between 2004 and 2017 (95% CI, 30-47%). 126 in-hospital deaths were recorded in the NHMD, and 205 deaths (in-hospital and out of hospital) in the NCIS, with no temporal trends. Conclusions The frequency of paracetamol overdose-related hospital admissions has increased in Australia since 2004, and the rise is associated with greater numbers of liver injury diagnoses. Overdose size and the proportion of overdoses involving modified release paracetamol have each also increased.

In Australia, compulsory microchipping legislation requires that animals are microchipped before sale or prior to 3 months in the Australian Capital Territory, New South Wales, Queensland and Victoria, and by 6 months in Western Australia and Tasmania. Describing the implementation of microchipping in animals allows the data guardians to identify individual animals presenting to differing veterinary practices over their lifetimes, and to evaluate compliance with legislation. VetCompass Australia (VCA) collates electronic patient records from primary care veterinary practices into a database for epidemiological studies. VCA is the largest companion animal clinical data repository of its kind in Australia, and is therefore the ideal resource to analyse microchip data as a permanent unique identifier of an animal. The current study examined the free-text ‘examination record’ field in the electronic patient records of 1000 randomly selected dogs and cats in the VCA database. This field may allow identification of the date of microchip implantation, enabling comparison with other date fields in the database, such as date of birth. The study revealed that the median age at implantation for dogs presented as individual patients, rather than among litters, was 74.4 days, significantly lower than for cats (127.0 days, p = 0.003). Further exploration into reasons for later microchipping in cats may be useful in aligning common practice with legislative requirements.