Human Healthcare Providers Research Articles

Comparison of Conventional Anesthesia Nurse Education and an Artificial Intelligence Chatbot (ChatGPT) Intervention on Preoperative Anxiety: A Randomized Controlled Trial

PurposeThis study aimed to evaluate the effects of an artificial intelligence (AI) chatbot (ChatGPT-3.5, OpenAI, USA) on preoperative anxiety reduction and patient satisfaction in adult patients undergoing surgery under general anesthesia. DesignThe study used a single-blind, randomized controlled trial design. MethodsIn this study, 100 adult patients were enrolled and divided into 2 groups: 50 in the control group, in which patients received standard preoperative information from anesthesia nurses, and 50 in the intervention group, in which patients interacted with ChatGPT. The primary outcome, preoperative anxiety reduction, was measured using the Japanese State-Trait Anxiety Inventory (STAI) self-report questionnaire. The secondary endpoints included participant satisfaction (Q1), comprehension of the treatment process (Q2), and the perception of AI chatbot’s responses as more relevant than those of the nurses (Q3). FindingsOf the 85 participants who completed the study, the STAI scores in the control group remained stable, whereas those in the intervention group decreased. The mixed-effects model showed significant effects of time and group–time interaction on the STAI scores; however, no main group effect was observed. The secondary endpoints revealed mixed results; some patients found that the chatbot’s responses were more relevant, whereas others were dissatisfied or experienced difficulties. ConclusionsThe ChatGPT intervention significantly reduced preoperative anxiety compared with the control group; however, no overall difference in the STAI scores was observed. The mixed secondary endpoint results highlight the need for refining chatbot algorithms and knowledge bases to improve performance and satisfaction. AI chatbots should complement, rather than replace, human healthcare providers. Seamless integration and effective communication among AI chatbots, patients, and healthcare providers are essential for optimizing patient outcomes.

Generative AI as Virtual Healthcare Assistant for Enhancing Patient Care Quality

This study investigates the potential of Chat Generative Pre-Trained Transformer (ChatGPT) as a virtual healthcare assistant to enhance the quality of patient care. Inadequate patient care within healthcare systems is a key issue that has resulted in lower satisfaction and medical errors. Virtual healthcare assistants, exemplified by ChatGPT, have emerged as a promising solution to mitigate these challenges. A comprehensive literature review compares the benefits and drawbacks of using virtual healthcare assistants with those of human healthcare providers to assess their effectiveness in enhancing patient care. The article discusses the ChatGPT development process, including the data sources used, training and validation, and the integration of this technology into healthcare systems. The results of testing ChatGPT in patient care, including patient feedback, are provided. The study interprets these findings and indicates that ChatGPT can significantly enhance patient care. The implications of implementing virtual healthcare assistants in the healthcare sector are also explored, along with potential future research areas for enhancing ChatGPT. This study provides important new insights into how virtual healthcare assistants might enhance patient care and offers recommendations for healthcare organizations and legislators on leveraging ChatGPT. It shows that the astonishing development in patient care, known as ChatGPT, has the potential to revolutionize the healthcare industry.

Artificial intelligence (AI) or augmented intelligence? How big data and AI are transforming healthcare: Challenges and opportunities.

The sanctity of the doctor-patient relationship is deeply embedded in tradition - the Hippocratic oath, medical ethics, professional codes of conduct, and legislation - all of which are being disrupted by big data and 'artificial' intelligence (AI). The transition from paper-based records to electronic health records, wearables, mobile health applications and mobile phone data has created new opportunities to scale up data collection. Databases of unimaginable magnitude can be harnessed to develop algorithms for AI and to refine machine learning. Complex neural networks now lie at the core of ubiquitous AI systems in healthcare. A transformed healthcare environment enhanced by innovation, robotics, digital technology, and improved diagnostics and therapeutics is plagued by ethical, legal and social challenges. Global guidelines are emerging to ensure governance in AI, but many low- and middle-income countries have yet to develop context- specific frameworks. Legislation must be developed to frame liability and account for negligence due to robotics in the same way human healthcare providers are held accountable. The digital divide between high- and low-income settings is significant and has the potential to exacerbate health inequities globally.

Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression

ABSTRACT Introduction Postpartum depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. Areas covered WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive-Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device’s design principles, enabling technology, risk handling, and efficacy data in PPD. Expert opinion WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based-care.

Novel molecular diagnostic (PCR) diagnosis and outcome of intestinal Echinococcus multilocularis in a dog from western Canada.

To describe the novel PCR diagnosis and outcome of intestinal Echinococcus multilocularis in a dog. A 13-month-old female intact dog with naturally occurring intestinal E multilocularis. The 13-month-old dog initially presented with a reduced appetite and weight loss and then developed hematochezia. The clinical history included a lack of endoparasite preventive care (fecal testing, deworming), exposure to coyotes, fox, sheep, and rodents and the dog had intermittently been fed a raw food diet. Physical examination revealed a thin dog, with a 2/9 body condition score, that was otherwise clinically unremarkable. A fecal sample was submitted for screening for gastrointestinal parasites as part of an infectious disease assessment. The fecal PCR test reported detection of E multilocularis. This result was sequenced as the European haplotype E3/E4. Centrifugal flotation (same sample) did not detect taeniid eggs. The dog was treated with metronidazole, maropitant, and milbemycin oxime/praziquantel. Clinical improvement was noted within 48 hours. No DNA of E multilocularis was detected in a fecal sample collected approximately 10 days after treatment. The dog's owner was advised to provide monthly deworming (praziquantel) for all dogs on the property and to contact their human health-care provider due to potential zoonotic exposure risk. Increasing detection of E multilocularis is occurring in dogs in Canada and the US. Alveolar echinococcosis can cause severe disease in dogs and humans. Fecal PCR detection and surveillance may alert practitioners to canine intestinal cases and allow dogs to serve as sentinels for human exposure risk.

A review of adverse events in animals and children after secondary exposure to transdermal hormone-containing medicinal products.

Hormonal replacement therapy is widely used to treat conditions in humans, the most well-known indication being the relief of menopausal symptoms in women. Many of the hormone-containing products (HCP) are applied to the skin. This transdermal delivery poses a risk to animals and humans through secondary exposure, especially when product information is not strictly followed. The aim of this article is to raise awareness among veterinarians and human healthcare providers of this risk; based on evidence from spontaneous reporting of suspected adverse events (AEs) in animals and humans. Interventions are also explored to mitigate the risk of secondary exposure to transdermal HCP (THCP). The Swedish Medical Products Agency has received several, mainly serious, AE reports in animals and children following secondary exposure to THCPs. The AE reports were reviewed together with worldwide data from the EudraVigilance Veterinary database and human EudraVigilance Data Analysis System. The clinical signs reported in animals included persistent signs of oestrus, poor growth rate and birth defects. In humans, reported clinical signs included precocious puberty, unresolved virilisation, accelerated growth rate and female infertility. It is important that THCP are used according to manufacturer's instructions and users are made aware of risks and mitigating measures. This review of AEs in animals and children provides evidence to show that the use of THCP poses a risk for secondary exposure. Efficient communication strategies that stretch across veterinary and human medicinal disciplines are required to raise mutual awareness and minimise the risk of AEs in animals and humans.

Balint in the Animal World: Balint Groups for Veterinary Professionals.

Veterinary medical providers face many of the same stressors related to the therapeutic relationship that human medical providers face, and have reported high rates of emotional distress as an aspect of Veterinary practice. Balint Group work is relatively novel in Veterinary Medicine, and the Balint method has yet to be evaluated in the veterinary community. We hypothesized that applying the Balint method in veterinary medicine would be feasible and offer similar benefits to veterinary providers. The authors offered monthly in-person Balint groups, co-led by two American Balint Society trained leaders and evaluated feedback from Balint group attendees to determine the value and feasibility of adapting Balint groups from Human Medicine to veterinary professionals. Balint groups were offered to the veterinary community at a non-profit urban specialty and emergency hospital. During the pandemic, the group transitioned to an online format. All participants were sent an anonymous email survey to collect feedback about their experience. Monthly Balint Groups were offered to veterinary professionals, with traditional Balint structure and parameters and co-led by ABS trained leaders. Feedback was obtained, indicating that Balint Group discussions were helpful to Veterinarians. Balint Groups are a useful tool for veterinary professionals and are likely to provide similar benefits to those enjoyed by human healthcare providers.

Empathic conversational agents for real-time monitoring and co-facilitation of patient-centered healthcare

Healthcare systems across the world are transitioning into patient-centered healthcare models to ensure improved health outcomes, increased operational efficiencies and respectful patient engagement. Digital health technologies are at the forefront of this transition in facilitating a role for the patient in the clinical dimensions of the healthcare trajectory, from diagnosis and interventions to treatment and recovery. Despite this prevalence in the clinical space, the non-clinical needs of patient mental health and wellbeing are frequently overlooked by contemporary patient-centered healthcare models. Conversational agents (or chatbots) are digital dialogue systems that are widespread and widely used in sequential information provision and information acquisition tasks. Given the intimate nature of this human-machine interaction, conversational agents can be effectively utilized to support and sustain patient mental health and wellbeing. In this paper, we propose an empathic conversational agent framework based on an ensemble of natural language processing techniques and artificial intelligence algorithms for real-time monitoring and co-facilitation of patient-centered healthcare for improved mental health and wellbeing outcomes. The technical contributions of this framework are; detection of patient emotions, prediction of patient emotion transitions, detection of group emotions, formulation of patient behavioral metrics, and resource recommendations based on patient concerns. The architectural contributions of the framework are intelligent communication channels that stream empathic conversational elements and resource recommendations for the multi-user conversations and co-facilitation updates for the human healthcare provider interface. The framework was empirically evaluated on a benchmark dataset and further validated based on a clinical protocol designed for its application in an online support group setting for cancer patients and caregivers in Canada. The results of these experiments confirm the effectiveness of this framework, its contributory role and practical value in realizing a patient-centered healthcare model for improved mental health and wellbeing outcomes.

Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal.

In both human and veterinary healthcare, gastrointestinal protectants (GIPs) are considered a staple of clinical practice in that they are prescribed by general practitioners (GPs) and specialists alike. Concerning GIP use, overprescription of proton pump inhibitors (PPIs) has become a growing concern among human healthcare providers. This trend has also been documented within veterinary practice, prompting the American College of Veterinary Internal Medicine (ACVIM) to publish a consensus statement in 2018 concerning evidence-based indications for GIP use. This observational cross-sectional study evaluated self-reported prescribing protocols among Portuguese GPs to determine whether there is adherence to the consensus guidelines. Respondents were Portuguese GPs recruited by social media posts in veterinarian online forums. Data were collected from 124 respondents concerning their GIPs of choice and their rationales for prescribing them. Data were mined for prescription patterns and protocols. Among GIPs, PPIs were prescribed more often. Rationales for use included gastrointestinal ulceration and erosion (GUE), prophylactic management of nonerosive gastritis, pancreatitis, reflux esophagitis, and steroid-induced ulceration. Once-daily administration of PPIs was the most frequent dosing regime among respondents. Ninety-six percent of PPI prescribers advocated that the drug be administered either shortly before or at mealtime. Forty-nine percent of respondents supported long-term use of PPIs. Fifty-nine percent of respondents acknowledged discontinuing PPIs abruptly. This study supports that Portuguese GPs commonly prescribe GIPs in accordance with ACVIM recommendations to medically manage GUE. However, misuse of GIPs does occur, and they have been prescribed where their therapeutic value is debatable. Educational strategies should target GPs in an effort to reduce GIP misuse.

Drug Misuse in the Veterinary Setting: an Under-recognized Avenue.

Prescription drug misuse is a public health concern. Governments are attempting to restrict the incidence of medication diversion by establishing laws to curb drug access from human healthcare providers. Veterinarians, who also prescribe controlled substances and see hundreds of millions of patients annually in the USA, are often overlooked as a source of prescription drug misuse. Evidence suggests that drug misuse occurs in the veterinary setting, and veterinarians acknowledge this as a common problem. Although analgesics are alleged to be the most common drug class diverted, a recent cross-sectional study suggests veterinarian opioid prescribing rate continues to increase. Prescription misuse in veterinarian settings is likely underestimated and needs to be better investigated. Human healthcare providers must familiarize themselves with this potential channel to prescription drugs and specifically question patients on veterinary drug misuse.

Understanding and Utilizing Medical Artificial Intelligence

Medical artificial intelligence is cost-effective, scalable, and often outperforms human providers. One important barrier to its adoption is the perception that algorithms are a “black box”—people do not subjectively understand how algorithms make medical decisions, and we find this impairs their utilization. We argue a second barrier is that people also overestimate their objective understanding of medical decisions made by human healthcare providers. In five pre-registered experiments with convenience and nationally representative samples (N = 2,699), we find that people exhibit such an illusory understanding of human medical decision making (Study 1). This leads people to claim greater understanding of decisions made by human than algorithmic healthcare providers (Studies 2A-B), which makes people more reluctant to utilize algorithmic providers (Studies 3A-B). Fortunately, we find that asking people to explain the mechanisms underlying medical decision making reduces this illusory gap in subjective understanding (Study 1). Moreover, we test brief interventions that, by increasing subjective understanding of algorithmic decision processes, increase willingness to utilize algorithmic healthcare providers without undermining utilization of human providers (Studies 3A-B). Corroborating these results, a study on Google testing ads for an algorithmic skin cancer detection app shows that interventions that increase subjective understanding of algorithmic decision processes lead to a higher ad click-through rate (Study 4). Our findings show how reluctance to utilize medical algorithms is driven both by the difficulty of understanding algorithms, and an illusory understanding of human decision making.

Voluntary Refusal of Foods and Fluids: A Comparative Survey Across Health Disciplines (P12-044-19)

ObjectivesTo compare differences in attitudes, beliefs and knowledge of Voluntary Refusal of Foods and Fluids among disciplines and health care providers. This project is of a comparative nature in keeping with One Health paradigms, and the first of its kind. MethodsA cross-sectional, incentivized, email survey of human health care providers, veterinary personnel, professional caregivers and lay persons. Questionnaire development through sequential focus groups of experts in palliative care was validated, piloted and revised accordingly. Data was acquired through Qualtrics, and analyzed with Nvivo and SPSS. Descriptives, correlations and regressions were employed, along with other non-parametric methods for analyses. The research was approved by IRB and Human Subjects Committees at the primary institution where the research was conducted. ResultsThe demographics significantly correlated with parameters of Voluntary Refusal of Foods and Fluids (VRFF) were religiosity, education and profession. Interestingly, geographic locale, method of Artificial Nutrition and Hydration (ANH), and “patient wishes” were not influential. There was a lack of uniformity in decision-making. Age was inversely related to institution of ANH in VRFF (P < 0.001). Veterinary personnel showed far greater fiscal conservancy for treatment of VRFF (P < 0.01), and were more willing to try ANH with poor prognoses (P < 0.05) versus human healthcare providers. Caregivers were far more likely to oppose intervention in patients with VRFF (P < .0.01). ConclusionsEtiology leading to VRFF was most important, as was experience with health care, death, ethics and technological advancement. Limitations include inability to show causality with cross sectional data. Further research on end of life decisions is required in light of the burgeoning geriatric population worldwide among both the human and companion animal populations. It is of great importance to conduct cross disciplinary research when an area of study is in its infancy, as is the case with VRFF. Funding SourcesThe project was funded through a foundation grant from Bridges to a Cure.

Resistance to Medical Artificial Intelligence

Abstract Artificial intelligence (AI) is revolutionizing healthcare, but little is known about consumer receptivity to AI in medicine. Consumers are reluctant to utilize healthcare provided by AI in real and hypothetical choices, separate and joint evaluations. Consumers are less likely to utilize healthcare (study 1), exhibit lower reservation prices for healthcare (study 2), are less sensitive to differences in provider performance (studies 3A–3C), and derive negative utility if a provider is automated rather than human (study 4). Uniqueness neglect, a concern that AI providers are less able than human providers to account for consumers’ unique characteristics and circumstances, drives consumer resistance to medical AI. Indeed, resistance to medical AI is stronger for consumers who perceive themselves to be more unique (study 5). Uniqueness neglect mediates resistance to medical AI (study 6), and is eliminated when AI provides care (a) that is framed as personalized (study 7), (b) to consumers other than the self (study 8), or (c) that only supports, rather than replaces, a decision made by a human healthcare provider (study 9). These findings make contributions to the psychology of automation and medical decision making, and suggest interventions to increase consumer acceptance of AI in medicine.

Network Diffusion and Technology Acceptance of A Nurse Chatbot for Chronic Disease Self-Management Support : A Theoretical Perspective.

Telenursing is one type of telehealth service delivery proposed to resolve the predicted gap between healthcare workforce demand and supply globally. The aim of this article is to explore the 'Nurse Chatbot' for chronic care on the benefits of increasing patient/client access to healthcare information and maximizing the potential of artificial intelligence/AI to bridge the 'demand-supply gap' of human healthcare providers. Moreover,closing this gap through the establishment of a 'Nurse Chatbot' will be innovative, favorably scalable and customizable within a decentralized health network, and potentially sustainable in the new digital economy. Following are the assumptions : 1) "caring" communicated textually is highly 'transactive' in chronic disease selfmanagement support/CDSMS for goal agreements between agents and for overcoming the system noise in the form of cross-entropy, perplexity, and information wastage ; 2) 'Nurse Chatbot' is the interlocutor in nursing care and the nursing agency by superpositioning and entanglement ; and 3) possible effects of chatbot-user transactions are information flows, management of health, and patient satisfaction. This article also looks into 'Nurse Chatbot' development for CDSMS, simulation of its diffusion capacity egocentrically, technology acceptance model/TAM to inquire the engagement of users, and possible approaches to ethical and safety issues. J. Med. Invest. 66 : 24-30, February, 2019.

Owner-witnessed cardiopulmonary resuscitation in small animal emergency veterinary medicine.

OBJECTIVE To determine opinions of veterinary emergency health-care providers on the topic of owner-witnessed CPR in small animal emergency medicine and to identify reasons for opposition or support of owner-witnessed CPR. DESIGN Cross-sectional survey. SAMPLE 358 surveys completed by American College of Veterinary Emergency and Critical Care diplomates and residents as well as other emergency-care veterinarians and veterinary technicians between August 14, 2016, and September 14, 2016. PROCEDURES An internet-based survey was used to collect data on respondent demographics, CPR experience, and opinions about owner-witnessed CPR. Responses were collected, and the Fisher exact test or χ2 test was used to compare distributions of various opinions toward owner-witnessed CPR among certain respondent groups. RESULTS Owner presence during CPR was opposed by 277 of 356 (77.8%) respondents, with no substantial differences among demographic groups. Respondents with ≤ 10 years of experience were less willing to allow owner presence during CPR, compared with respondents with > 10 years of experience. Respondents who worked at practices that allowed owner presence during CPR were more likely to report emotional benefit for owners. CONCLUSIONS AND CLINICAL RELEVANCE Veterinary professionals surveyed had similar concerns about owner-witnessed CPR, as has been reported by human health-care providers about family-witnessed resuscitation. However, emotional benefits from family-witnessed resuscitation in human health care have been reported, and emotional impacts of owner-witnessed CPR could be an area of research in veterinary medicine. In addition, investigation is needed to obtain more information about pet owner wishes in regard to witnessing CPR performed on their pets.

Trauma Management of Military Working Dogs.

There are about 2,500 war and military service dogs in service, with about 700 serving at any given time overseas. Military Working Dogs (MWDs) are critical assets for military police, special operations units, and others operating in today's combat environment. The expectation, given the significant combat multiplier impact of these dogs and the intense bond between the handler and dog, is that injured working dogs will receive the same level of care as any injured U.S. military personnel. Veterinary care is available at multiple locations throughout theater, and the veterinary healthcare team is the MWD's primary provider. Yet, human healthcare providers (HCPs) may be the only medical personnel available to MWDs that are gravely ill or injured. As most HCPs are unfamiliar with medical care of dogs, the Joint Trauma System published a Clinical Practice Guideline (CPG), a set of detailed clinical guidelines for managing life-threatening problems of MWDs encountered in combat operations. The CPG is available at the JTS website. This article is covers the most common urgent MWD care challenges HCPs may face.

Survey of intestinal parasitism in dogs in the Phoenix metropolitan area.

OBJECTIVE To determine the prevalence of selected intestinal parasites in pet dogs and recently apprehended free-roaming (AFR) shelter dogs in the Phoenix metropolitan area and compare those prevalences between the 2 groups. DESIGN Cross-sectional study. SAMPLE Convenience samples of fecal specimens from owned pet dogs from the Phoenix metropolitan area (n = 175) and free-roaming dogs apprehended and admitted to Maricopa County Animal Care and Control and Arizona Humane Society facilities from November 2014 through March 2015 (188). PROCEDURES Fresh fecal specimens were collected from all dogs; for AFR shelter dogs, specimens were collected within 72 hours after facility admission. Standard centrifugal flotation tests and an ELISA were performed to detect 5 common intestinal parasites (roundworms, hookworms, whipworms, Giardia spp, and Cystoisospora spp). Group comparisons were performed by means of the χ2 test and Rogan-Gladen prevalence estimate. RESULTS At least 1 of the 5 evaluated parasites was detected in 85 (45.2%) fecal specimens from AFR shelter dogs and 24 (13.7%) specimens from owned pet dogs. This prevalence differed significantly between the groups. Notably, the prevalence of Giardia spp in AFR shelter dogs (n = 76 [40.4%]) was higher than previously reported in the United States. CONCLUSIONS AND CLINICAL RELEVANCE The prevalence of the evaluated intestinal parasites, particularly of Giardia spp, in AFR shelter dogs was higher than expected. This information is important for veterinarians, animal shelter personnel, pet owners, human health-care providers, and public health officials to consider when devising effective interventions and risk communication efforts against potential zoonotic threats, particularly those relevant to the Phoenix metropolitan area.

Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania.

BackgroundZoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.Methodology/ResultsWe conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.ConclusionsThis study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare provider education and improved clinical guidelines for syndrome-based disease management to provoke diagnostic consideration of locally relevant zoonoses in the absence of laboratory confirmation.

Practices and Perceptions of Animal Contact and Associated Health Outcomes in Pregnant Women and New Mothers.

Companion animals play an important role in our society. However, pregnant women and new mothers might have specific concerns about animal-associated health outcomes because of their altered immune function and posture as well as their newborn babies. The study was conducted to collect baseline data for developing an evidence-based intervention for pregnant women and new mothers to help them adopt certain behaviors to prevent adverse animal-associated health outcomes. A survey, using the Health Belief Model as the theoretical framework, was developed and administered to 326 women attending the Women, Infants, and Children programs in Illinois and Indiana in 2015. Prevalence of dog and cat ownership was estimated to be 39% (95% CI: 33–45%) and 26% (95% CI: 21–31%), respectively. Regardless of pet ownership, 74% of the respondents reported having some type of animal contact in the past month. Pregnancy or the birth of a child altered some animal contact practices among the study participants; particularly a discontinuation or decrease in cleaning cat litter boxes. Reports of diseases contracted from animals were low (4%) in this study. By contrast, animal-associated injuries were prevalent (42%), and the majority were caused by animals the respondents owned (56%). Overall, respondents indicated that they appreciated the benefits of a program addressing animal-associated health outcomes and did not indicate strong resistance to adopt certain behaviors. The majority recognized human health-care providers as a source of information about animal contact and associated health outcomes but less frequently identified veterinarians as a source for such information. In addition, although most of the respondents felt that health-care providers and veterinarians should initiate discussions about preventing animal-associated illness and injuries, only 41% among those who had visited doctors or prenatal care services reported that their health-care providers discussed these issues with them. The results indicate the importance of an intervention concerning animal contact and associated health outcomes for the target population and provide insights to the potential implications of program implementation.

Canine Tactical Field Care Part Three - Thoracic and Abdominal Trauma

Military and law enforcement agencies have seen a dramatic increase in the utilization of working canines both at home and in foreign deployments. Due to the fact that professional veterinary care is sometimes distant from internal disaster or foreign deployment sites, the military medic, police tactical medic, or other first-response medical care provider may be charged with providing emergency or even basic, non-emergency veterinary care to working canines. (Editor's Note: Military veterinary detachments are collocated next to the major human treatment facilities in a deployment environment. In a deployed environment veterinary care is located in areas where they are most needed or where most of the animals are located.) The medical principles involved in treating canines are essentially the same as those for treating humans, but the human healthcare provider needs basic information on canine anatomy and physiology and common emergency conditions in order to provide good basic veterinary care until a higher level of veterinary care can be obtained. This article represents the third in a series of articles designed to provide condensed, basic veterinary information on the medical care of working canines, to include military working dogs (MWDs), police canines, federal agency employed working canines, and search and rescue dogs, to those who are normally charged with tactical or first responder medical care of human patients. This article provides and overview of the diagnosis and treatment of common traumatic injuries to the thorax and abdomen.