Electronic medical records from first opinion equine veterinary practice may represent a unique 2 resource for epidemiologic research. The appropriateness of this resource for risk factor analyses 3 was explored as part of an investigation into clinical and pharmacologic risk factors for laminitis. 4Amalgamated medical records from seven UK practices were subjected to text mining to identify 5 laminitis episodes, systemic or intra-synovial corticosteroid prescription, diseases known to affect 6 laminitis risk and clinical signs or syndromes likely to lead to corticosteroid use. Cox proportional 7 hazard models and Prentice, Williams, Peterson models for repeated events were used to estimate 8 associations with time to first, or subsequent laminitis episodes, respectively. Over seventy percent 9 of horses that were diagnosed with laminitis suffered at least one recurrence. Risk factors for first 10 and subsequent laminitis episodes were found to vary. Corticosteroid use (prednisolone only) was 11 only significantly associated with subsequent, and not initial laminitis episodes. Electronic medical 12 record use for such analyses is plausible and offers important advantages over more traditional data 13 sources. It does, however, pose challenges and limitations that must be taken into account, and 14 requires a conceptual change to disease diagnosis which should be considered carefully.
Clinical practice can differ between countries although the influence of individual practitioners and practice-specific policy on apparent intercountry differences requires further research. Despite several other NSAIDs being available and a substantial effort being made to evaluate their efficacy, the prescription of NSAIDs other than phenylbutazone and flunixin meglumine remains rather limited.
Acquisition and analysis of photographic images is an appropriate method for the objective measurement of foot conformation, both in clinical and, research settings.
This study highlights the administration of certain classes of antimicrobials in situations where their use is unlikely to be justified. If these findings reflect more general attitudes and behaviour then greater awareness of, and compliance with, recommendations for responsible antimicrobial use are required among equine practitioners. Bodyweight ought to be measured or estimated using validated objective techniques prior to systemic medications being administered.
The average age of the global human population is increasing, leading to increased interest in the effects of chronic disease and multimorbidity on health resources and patient welfare. It has been posited that the average age of the general veterinarian-attended horse population of the UK is also increasing, and therefore it could be assumed that chronic diseases and multimorbidity would pose an increasing risk here also. However, evidence for this trend in ageing is very limited, and the current prevalence of many chronic diseases, and of multimorbidity, is unknown. Using text mining of first-opinion electronic medical records from seven veterinary practices around the UK, Kaplan-Meier and Cox proportional hazard modelling, we were able to estimate the apparent prevalence among veterinarian-attended horses of nine chronic diseases, and to assess their relative effects on median life expectancy following diagnosis. With these methods we found evidence of increasing population age. Multimorbidity affected 1.2% of the study population, and had a significant effect upon survival times, with co-occurrence of two diseases, and three or more diseases, leading to 6.6 and 21.3 times the hazard ratio compared to no chronic disease, respectively. Laminitis was involved in 74% of cases of multimorbidity. The population of horses attended by UK veterinarians appears to be aging, and chronic diseases and their co-occurrence are common features, and as such warrant further investigation.
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