Who is prescribing psychotropic medications in a public developmental-behavioural clinical service and how often?

AIM

Psychotropic prescribing by paediatricians is increasingly common, and there is considerable variation in care provided. The aims of this study were to examine current rates of psychotropic prescribing in the developmental-behavioural outpatient clinics at the Royal Children's Hospital's Centre for Community Child Health, and to compare rates between paediatric consultants and advanced trainees.

METHODS

Data were extracted for appointment encounters from electronic medical records across 12 months in 2017. Patient demographics, provider and medication order data were analysed using Excel and STATA to calculate logistic regression, standard deviation, percentages and means.

RESULTS

From 5069 encounters, there were 847 (16.7%) that included psychotropic prescribing. Advanced trainees prescribed psychotropic medications in only 4.4% of their encounters compared with consultants who prescribed these medications in 23% of encounters (P < 0.001). Stimulants were the most commonly prescribed psychotropic medication (62%), either alone (86.3%) or in combination (13.7%).

CONCLUSIONS

Psychotropic prescribing rates were lower than expected. Advanced trainees may need more experience in psychotropic prescribing.

Increased frequency of CD45 negative T cells (T zone cells) in older Golden retriever dogs

T zone lymphoma (TZL) is characterized by the clonal expansion of T cells lacking expression of the pan-leukocyte antigen CD45 (TZ cells). A strong breed predisposition is observed in Golden retrievers. This study aimed to confirm aberrant CD45 mRNA expression and determine if Golden retrievers without clinical lymphoma have an increased frequency of circulating TZ cells. Gene expression analysis on confirmed TZL cases showed a significant decrease in CD45 expression compared to normal dogs. Peripheral blood samples from senior dogs, 242 Golden retrievers and 42 non-Golden retrievers, without evidence of lymphoproliferative disease were assessed for the presence of TZ cells by flow cytometry. Thirty-one percent of Golden retrievers had TZ cells compared to 14% of non-Golden retrievers. Thirty-four percent of Golden retrievers with TZ cells had a clonal T cell receptor gamma (TRG) gene rearrangement. Interestingly, 20% of Golden retrievers without TZ cells also had a clonal TRG rearrangement. Golden retrievers may have an increased risk of TZL due to an increased frequency of TZ cells.

Nutrient load generated by storm event runoff from a golf course watershed

Turf, including home lawns, roadsides, golf courses, parks, etc., is often the most intensively managed land use in the urban landscape. Substantial inputs of fertilizers and water to maintain turf systems have led to a perception that turf systems are a major contributor to nonpoint source water pollution. The primary objective of this study was to quantify nutrient (NO(3)-N, NH(4)-N, and PO(4)-P) transport in storm-generated surface runoff from a golf course. Storm event samples were collected for 5 yr (1 Apr. 1998-31 Mar. 2003) from the Morris Williams Municipal Golf Course in Austin, TX. Inflow and outflow samples were collected from a stream that transected the golf course. One hundred fifteen runoff-producing precipitation events were measured. Median NO(3)-N and PO(4)-P concentrations at the outflow location were significantly (p < 0.05) greater than like concentrations measured at the inflow location; however, median outflow NH(4)-N concentration was significantly less than the median inflow concentration. Storm water runoff transported 1.2 kg NO(3)-N ha(-1) yr(-1), 0.23 kg NH(4)-N ha(-1) yr(-1), and 0.51 kg PO(4)-P ha(-1) yr(-1) from the course. These amounts represent approximately 3.3% of applied N and 6.2% of applied P over the contributing area for the same period. NO(3)-N transport in storm water runoff from this course does not pose a substantial environmental risk; however, the median PO(4)-P concentration exiting the course exceeded the USEPA recommendation of 0.1 mg L(-1) for streams not discharging into lakes. The PO(4)-P load measured in this study was comparable to soluble P rates measured from agricultural lands. The findings of this study emphasize the need to balance golf course fertility management with environmental risks, especially with respect to phosphorus.

Diet and lifestyle variables as risk factors for chronic renal failure in pet cats

A case-control study examining diet and lifestyle variables to generate hypotheses of potential risk factors for chronic renal failure in pet cats was conducted in five private practices in Texas, USA and at the Texas A&M University Veterinary Medical Teaching Hospital. A telephone questionnaire was used to gather information from owners of 38 cats newly diagnosed with CRF between December 1994 and 1995 and from owners of 56 control cats. Factor analysis was used to determine whether composite variables should be constructed to summarize the nutritional predictors adequately. The composite variables and other lifestyle variables were analyzed with logistic-regression. Three final exploratory models were developed: ad libitum feeding with fiber; ad libitum with Factor-2 (a composite variable composed of fiber, magnesium, protein, sodium and ash); and fiber alone. Ad libitum feeding and increased ash intake were associated with increased odds of CRF; increased dietary fiber, magnesium, protein and sodium were associated with decreased odds of CRF.

Treatment of opportunistic mycobacterial infections with enrofloxacin in cats

Marked improvement was observed in the condition of 6 cats with opportunistic mycobacterial infections during treatment with enrofloxacin, a fluoroquinolone antibiotic. Complete remission was achieved in 3 cats after 3 to 7 weeks of treatment. The other 3 cats were euthanatized after 1 to 2 weeks of treatment for reasons not related to the treatment. Lesions did not recur within the follow-up period, which ranged from 9 to 16 months. Treatment of opportunistic mycobacterial infection in cats is complicated because many mycobacteria are resistant to antituberculosis drugs, which also can be toxic to cats, and because results of susceptibility testing with other antimicrobials do not always correlate with clinical response. Often, neither satisfactory nor long-term response is observed in cats treated surgically or with the antibiotics currently recommended. These findings suggested that enrofloxacin is effective in the treatment of infections caused by Mycobacterium smegmatis and M fortuitum var fortuitum in cats.

History of veterinary public health in Australasia

The geographic isolation of Australasia has played a significant role in preventing the introduction of exotic diseases or in limiting the spread of many diseases which entered after settlement. Some infections such as psoroptic mange, tuberculosis and brucellosis became widely dispersed and some were ultimately to require novel methods to curtail them, e.g. greater use of rail and road transportation to convey stock, improved methods to locate and muster livestock in bush terrain (helicopters), improved diagnostic tests and the introduction of effective methods for tracing diseases found at abattoirs to the farms of origin. From the 1860s to the 1880s, there were such high mortalities from anthrax in Australia that a business syndicate associated with the Pasteur Institute established a laboratory in Sydney to produce anthrax vaccine from 1890 to 1898. The two-dose vaccine developed by Pasteur was unable to compete with a single dose spore vaccine later pioneered locally by Gunn and McGarvie-Smith. The most important achievements in veterinary public health in Australasia have been the successful eradication of brucellosis, the virtual eradication of hydatid disease in New Zealand and Tasmania, the substantial progress made in the eradication of tuberculosis from all but small regions of Australasia, and the development of a commercial vaccine to prevent Q fever in humans.

A clinical trial of a topical preparation of miconazole, polymyxin and prednisolone in the treatment of otitis externa in dogs

A topical preparation containing miconazole, polymyxin and prednisolone was shown to be more effective in the treatment of otitis externa in 167 dogs than 2 other ear preparations containing antibiotics, an antimycotic and a corticosteroid. With miconazole, polymyxin and prednisolone, the recurrence rate was 26.7% compared with 72.6% and 54.3% when the other products were used. The mean duration of treatment required to achieve resolution of clinical signs was 9.6 days, compared with 12.2 days and 13.0 days and no cases failed to respond to treatment, compared with 17.7% and 14.3%. Malassezia canis alone (71%) or in association with bacteria (18%) was recovered from 44 of 49 ears cultured.

The ecology of Rhodococcus equi and physicochemical influences on growth

Growth of Rhodococcus equi was studied in vitro. Optimal growth occurred under aerobic conditions between pH 7.0 and 8.5, at 30 degrees C. R. equi survived better in a neutral soil (pH 7.3) than it did in two acid soils (pH less than 5.5). It grew substantially better in soils enriched with faeces than in soils alone. Simple organic acids in horse dung, especially acetate and propionate, appear to be important in supporting growth of R. equi in the environment. The ecology of R. equi can be best explained by an environmental cycle allowing its proliferation in dung, influenced by management, grazing behaviour and prevailing climatic conditions. Preventive measures should be aimed at reducing or avoiding focal areas of faecal contamination in the environment.

Ecology of Rhodococcus equi

A selective broth enrichment technique was used to study the distribution of Rhodococcus equi in soil and grazing animals. Rhodococcus equi was isolated from 54% of soils examined and from the gut contents, rectal faeces and dung of all grazing herbivorous species examined. Rhodococcus equi was not isolated from the faeces or dung of penned animals which did not have access to grazing. The isolation rate from dung was much higher than from other samples and this was found to be due to the ability of R. equi to multiply more readily in dung. Delayed hypersensitivity tests were carried out on horses, sheep and cattle, but only horses reacted significantly. The physiological characteristics of R. equi and the nature of its distribution in the environment suggested that R. equi is a soil organism.

Evaluation and use of a micro-broth dilution procedure for testing sensitivity of fermentative avian mycoplasmas to antibiotics

A micro-broth dilution procedure is described for testing the sensitivity of glucose-fermenting avian mycoplasmas to antibiotics. A systematic evaluation was made of potential sources of variation that could affect the reliability of this procedure. Strain WVU 1853 of Mycoplasma synoviae (MS) was used as a standard culture and was tested against the antibiotics erythromycin, spiramycin, streptomycin, tetracycline, tiamulin, and tylosin. Inoculum density, duration of incubation before the test was read, and initial pH of the medium significantly affected test results. Type of serum and concentration of pig serum in the medium had little effect, provided the test was read when the phenol red indicator in the medium of a culture control (without antibiotic) had changed from deep red (pH 7.8) to orange-yellow (pH 7). The presence of bacterial inhibitors in the medium, the solvents used to dissolve some antibiotics, the use of thawed or actively growing cultures, and the number of passages of the culture before testing did not appear to be significant causes of test variation. By controlling important sources of variation, a standardized test was developed that gave reproducible results. The standardized test was used to determine the sensitivity to antibiotics of 49 strains of M. gallisepticum (MG), eight strains of MS, five strains of M. pullorum, seven strains of M. gallinaceum, and one strain of M. columborale. Minimum inhibitory concentrations of the macrolide antibiotics were lower for the majority of MG strains than for the other Mycoplasma species tested. However, some strains of MG showed acquired resistance to the macrolide antibiotics. These strains also showed increased resistance to lincomycin and tiamulin.

Comparison of three techniques for isolation of Rhodococcus (Corynebacterium) equi from contaminated sources

Inoculation of a liquid medium comprised of Trypticase soy broth (BBL Microbiology Systems), cycloheximide, nalidixic acid, penicillin, and potassium tellurite and subcultured onto M3 medium plus potassium tellurite was highly successful for the isolation of Rhodococcus (Corynebacterium) equi from soil.