An evaluation of the psychometric properties of the Indicator of Relative Need (IoRN) instrument

BACKGROUND: The Indicator of Relative Need (IoRN) instrument is designed for both health and social care services to measure function and dependency in older people. To date, the tool has not undergone assessment of validity. We report two studies aimed to evaluate psychometric properties of the IoRN. METHODS: The first study recruited patients receiving social care at discharge from hospital, those rehabilitating in intermediate care, and those in a rehabilitation at home service. Participants were assessed using the IoRN by a single researcher and by the clinical team at baseline and 8 weeks. Comparator instruments (Barthel ADL, Nottingham Extended ADL and Townsend Disability Scale) were also administered. Overall change in ability was assessed with a 7 point Likert scale at 8 weeks. The second study analysed linked routinely collected, health and social care data (including IoRN scores) to assess the relationship between IoRN category and death, hospitalisation and care home admission as a test of external validity. RESULTS: Ninety participants were included in the first study, mean age 77.9 (SD 12.0). Cronbach’s alpha for IoRN subscales was high (0.87 to 0.93); subscales showed moderate correlation with comparator tools (r = 0.43 to 0.63). Cohen’s weighted kappa showed moderate agreement between researcher and clinician IoRN category (0.49 to 0.53). Two-way intraclass correlation coefficients for IoRN subscales in participants reporting no change in ability were high (0.88 to 0.98) suggesting good stability; responsiveness coefficients in participants reporting overall change were equal to or better than comparator tools. 1712 patients were included in the second study, mean age 81.0 years (SD 7.7). Adjusted hazard ratios for death, care home admission and hospitalisation in the most dependent category compared to the least dependent IoRN category were 5.9 (95 % CI 2.0–17.0); 7.2 (95 % CI 4.4–12.0); 1.1 (95 % CI 0.5–2.6) respectively. The mean number of allocated hours of care 6 months after assessment was higher in the most dependent group compared to the least dependent group (5.6 vs 1.4 h, p = 0.005). CONCLUSIONS: Findings from these analyses support the use of the IoRN across a range of clinical environments although some limitations are highlighted

Resolution of sustained ventricular tachycardia in a horse presenting with colic with magnesium sulfate

Case reports demonstrating a return to sinus rhythm from sustained ventricular tachycardia (VT) are limited. VT is uncommon in horses but can be life threatening and has been reported in horses with primary gastrointestinal disease. Treatment is recommended if there is poor perfusion, if heart rate exceeds 100 beats/min, if multiform/polymorphic complexes or torsades des pointes is present. Lidocaine or magnesium sulfate is the first‐line medication. In this case, a 19‐year‐old Warmblood gelding with a history of exploratory laparotomy presented with an irregularly irregular cardiac rhythm and heart rate of 80 beats/min. ECG demonstrated VT with a heart rate of 75 beats/min. As the horse was already receiving a lidocaine bolus, the VT was treated with multiple boluses of intravenous magnesium sulfate over a period of several hours. This converted the VT to normal sinus rhythm (NSR) with heart rate of 44 beats/min and the horse remained in NSR until discharge 8 days later

Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study

Objective To examine recent trends and social inequalities in age specific coronary heart disease mortality

Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

IntroductionEquine glandular gastric disease (EGGD) is a common condition causing signs of gastric pain although lesions are highly variable in their appearance. The only definitive method to diagnose EGGD ante-mortem is gastroscopy. The current recommended method for describing these lesions is the European College of Equine Internal Medicine (ECEIM) guidelines; however, repeatability between users is variable. This study aimed to validate the reliability of lesion descriptions using ECEIM consensus guidelines, using four blinded equine internal medicine diplomates.MethodsNinety-two horses with EGGD with pre- and post-treatment gastroscopy images were identified using the electronic record at a UK equine hospital between 2012 and 2019. Eight horses were excluded due to non-diagnostic images. Four blinded observers used the recommended grading system to describe images and outcomes. Intraclass correlation coefficients and Krippendorff's alpha were used to determine reliability and agreement, respectively.ResultsIntraclass correlation coefficient for severity was 0.782 (95% confidence interval [CI] 0.722–0.832), for distribution was 0.671 (95% CI 0.540–0.763), for the descriptor raised was 0.635 (95% CI 0.479–0.741), fibrinosuppurative was 0.745 (95% CI 0.651–0.812), haemorrhagic was 0.648 (95% CI 0.513–0.744), hyperaemic was 0.389 (95% CI 0.232–0.522) and for outcome was 0.677 (95% CI 0.559–0.770). Krippendorff's alpha for severity was 0.466 (95% CI 0.466–0.418), for distribution was 0.304 (95% CI 0.234–0.374), for the descriptor raised was 0.268 (95% CI 0.207–0.329), fibrinosuppurative was 0.406 (95% CI 0.347–0.463), haemorrhagic was 0.287 (95% CI 0.229–0.344), hyperaemic was 0.112 (95% CI 0.034–0.188) and for outcome was 0.315 (95% CI 0.218–0.408).There was moderate reliability determined between observers using intra-class correlation coefficients and unacceptable agreement determined between observers using Krippendorff's alpha.DiscussionThese results suggest that the current grading system is not comparable between observers, indicating the need to review the grading system or define more robust criteria

Transcorneal aspiration for management of primary iris cysts in the standing horse

BackgroundEquine primary iris cysts are usually incidental findings but, if associated with clinical signs, may require intervention. The use of laser (Nd:Yag or diode) has been reported but requires specialised equipment. Transcorneal aspiration has not been previously evaluated in the standing horse.ObjectivesTo review outcomes of standing transcorneal aspiration of primary iris cysts (STAPIC) in horses.MethodsHorses were identified from electronic patient records from 2018 to 2024 across four collaborating centres. Clinical presentation and outcomes were identified and reported using descriptive statistics.ResultsEighteen horses were identified. Behavioural signs reported included ‘spooking’ and changes in rideability often associated with jumping. Single large unilateral cysts were present in 11 horses, bilateral cysts in three horses and multiple unilateral cysts in four horses. Following treatment, one horse developed uveitis and fibrin in the anterior chamber associated with needle contact with the iris stroma due to movement, and a second horse developed fibrin within the anterior chamber. Both conditions resolved with anti-inflammatory medication and administration of tissue plasminogen activator. No other adverse effects were reported. Follow-up was available from all horses (median: 6 months, interquartile range [IQR]: 4–11 months) with no recurrence, although one horse developed an iris cyst in the contralateral eye after 3 years. All owners reported improvement in clinical signs, with 61% reporting no further signs.ConclusionsSTAPIC is an effective and easily accessible alternative for treating iris cysts in horses rarely associated with complications

Collaborative conservation for snow leopards: lessons learned from successful community‐based interventions

Collaborative conservation interventions based on engagement with local communities are increasingly common, especially for large carnivores that negatively impact people's livelihoods and well-being. However, evaluating the effectiveness of large-scale community-based conservation interventions is rarely done, making it problematic to assess or justify their impact. In our study focused on snow leopards (Panthera uncia) in five countries, we show that bespoke and well-implemented community-based and conflict management intervention efforts can lead to more sustainable conservation outcomes. Collaborative interventions, spread over about 88,000 km2 of snow leopard habitat, reduced livestock depredation and disease and associated economic costs. Additionally, they generated conservation-linked livelihoods and enhanced community decision-making, leading to more positive behavioral intent toward snow leopards and improved communities’ cooperation, economic security, and confidence. Our results provide lessons learned and recommendations for practitioners and governments to alleviate conflicts and foster coexistence with snow leopards and large carnivores more broadly. These include prioritizing locally led tailored solutions based on the PARTNERS principles, recognizing local community rights in conservation decision-making, and recognizing the role of social norms in ensuring accountability

Temporal trends in hospitalisation for stroke recurrence following incident hospitalisation for stroke in Scotland

<p>Background: There are few studies that have investigated temporal trends in risk of recurrent stroke. The aim of this study was to examine temporal trends in hospitalisation for stroke recurrence following incident hospitalisation for stroke in Scotland during 1986 to 2001.</p> <p>Methods: Unadjusted survival analysis of time to first event, hospitalisation for recurrent stroke or death, was undertaken using the cumulative incidence method which takes into account competing risks. Regression on cumulative incidence functions was used to model the temporal trends of first recurrent stroke with adjustment for age, sex, socioeconomic status and comorbidity. Complete five year follow-up was obtained for all patients. Restricted cubic splines were used to determine the best fitting relationship between the survival events and study year.</p> <p>Results: There were 128,511 incident hospitalisations for stroke in Scotland between 1986 and 2001, 57,351 (45%) in men. A total of 13,835 (10.8%) patients had a recurrent hospitalisation for stroke within five years of their incident hospitalisation. Another 74,220 (57.8%) patients died within five years of their incident hospitalisation without first having a recurrent hospitalisation for stroke. Comparing incident stroke hospitalisations in 2001 with 1986, the adjusted risk of recurrent stroke hospitalisation decreased by 27%, HR = 0.73 95% CI (0.67 to 0.78), and the adjusted risk of death being the first event decreased by 28%, HR = 0.72 (0.70 to 0.75).</p> <p>Conclusions: Over the 15-year period approximately 1 in 10 patients with an incident hospitalisation for stroke in Scotland went on to have a hospitalisation for recurrent stroke within five years. Approximately 6 in 10 patients died within five years without first having a recurrent stroke hospitalisation. Using hospitalisation and death data from an entire country over a 20-year period we have been able to demonstrate not only an improvement in survival following an incident stroke, but also a reduction in the risk of a recurrent event.</p&gt