CM Research has announced the results of a survey conducted this month in which veterinary surgeons named Osurnia as the best new product of 2015.

290 companion animal veterinary surgeons took part in the survey, which is designed to provide veterinary surgeons with their peers’ unbiased judgement on which new veterinary products, services or devices have made the biggest impact on the industry.

The questions were unprompted to ensure that the respondents were not influenced by pre-set survey options. CM Research points to the fact that many of the products that featured in its rankings were launched before 2015, including 2nd and 3rd placed Apoquel and Bravecto, as evidence of this freedom.

The full list of products named more than once in this year's survey was:

Animalcare is offering veterinary practices free pots of Procanicare, its GI support product for dogs.

Procanicare contains three canine-specific strains of Lactobacillus bacteria, which the company says are proven to improve stool consistency, accelerate recovery following acute episodes of diarrhoea and improve well-being.¹

The company also points to a number of studies which it says are evidence of the importance of supporting puppies' intestinal microbiomes.

'New puppy diarrhoea' is, it says, typically due to exposure to factors that are known to risk microbiome disturbance, such as diet change and going to a new home, at a time when the microbial population is at its more sensitive.²

Animalcare says other studies show that microbiome disturbances in early life can have a significant impact on health in adulthood.^2,3

James Beaumont, Marketing Manager at Animalcare said: “We often hear from breeders, new puppy owners and vets that puppies which have had Procanicare seem brighter, have firmer stools and less flatulence. With the evidence mounting that the adult intestinal microbiome is shaped in early life and knowing the important and varied role that it has in wider health throughout life, we want to help vets proactively support the GI health of their youngest patients by providing Procanicare for them to trial, with no risk.”

References

1. Gomez-Gallego.C .et al (2016) A canine-specific probiotic product in treating acute or intermittent diarrhea in dogs: A double-blind placebo-controlled efficacy study. Vet Microbial. 197:122-128.
2. Gensollen, T., et al. (2016) How colonization by microbiota in early life shapes the immune system. Science 352 (6285), 539-544.
3. Rodríguez, J.M., et al. (2015) The composition of the gut microbiota throughout life, with an emphasis on early life. Microbial Ecology in Health & Disease, 26:26050

The Royal Veterinary College is calling for dogs diagnosed with osteoarthritis to take part in a revolutionary study in which their movement will be monitored by a state-of-the-art recorder.

The recorder (pictured right), which is attached to the dog's collar, uses miniaturised sensors based on those found in smart phones. It can distinguish between different activities independent of the dog's location, allowing constant recording of movement in the dog's home environment, to complement the traditional clinical assessments carried out as part of the trial.

The study is being carried out to assess the efficacy of the joint mobility supplement Yumove in reducing the clinical signs of osteoarthritis. This will be the first time that the real effect of a joint supplement has been measured.

Dr. John Howie, co-founder of Lintbells, the company that makes Yumove, said:  "This is the first time the real effect of a joint supplement has been measured and it will be a very fast trial. Yumove is a supplement that has been specifically formulated to include glucosamine, chondroitin and Omega 3 from green-lipped mussel, which all work together to increase joint mobility and provide an anti-inflammatory effect."

The research is being led by Dr Matthew Pead the RVC's Academic Director of Professional Assessment and Development. He said: "The results of this study will have important clinical implications for the understanding and treatment of canine OA, with the ultimate aim of advancing the treatment of this difficult and degenerative disease for the benefit of many thousands of dogs."

Any veterinary surgeon with a patient in their practice that might benefit from this study is invited to refer them. Further details are available the Clinical Investigation Centre at the Royal Veterinary College - email cic@rvc.ac.uk or phone 01707 666605.

CVS has completed the conversion of a 66-year-old pub in Gorleston, Norfolk, into a state-of-the-art veterinary hospital. 

The Veterinary Hospital and Surgery acquired the Magdalen Arms in late 2014 and started work on the conversion of the listed building in March 2015, with particular care needed to preserve original features including its Dutch gables and the falcon logo of local brewery Lacon’s, which is incorporated into the brick work.

The new hospital was officially opened at the end of February, with the Mayor of Great Yarmouth, Malcolm Bird, and local 2012 Paralympic gold medallist Jessica-Jane Applegate unveiling the plaque. More than 1,000 local people came to have a look round, many bringing their canine friends.

Clinical Director Elissa Norman said: "In recent years we had outgrown our original surgery and it started to become difficult to offer the level of service we wanted to within the space we had.

"We knew that the Magdalen Arms, in addition to being a well-known local landmark, offered all the space we needed, a central location and plenty of parking.  The structure of the building made the conversion quite complex but the final result is beyond our expectations and we can’t wait to see the reaction of our clients when they bring their pets to us for the first time."

"We now have staff on site with patients 24 hours a day, 365 days of the year, plenty of parking and we can offer full access for disabled clients all of which were a priority for us.  The reception area is spacious and inviting, the consult rooms are well equipped and the new cat ward will create a less stressful environment for our feline patients.

"Watching this much-loved building take shape as a brand-new hospital with all the facilities we need for our patients, their owners and our staff has been special and I’m looking forward to helping it take on a different role within the community.  While the building work is now finished, we have lots of plans to develop the service we offer further over the next few months."

"We are grateful to the Mayor Malcolm Bird and to Jessica-Jane for helping us celebrate the opening of the hospital and it was great to welcome so many local people and show them around as they have been so supportive during the conversion.  It is clear that the building holds a strong place in many of their memories but that they are as excited as we are to see the amazing transformation that has taken place.  We look forward to serving them and caring for their pets in the years ahead."

ezyVet is sponsoring a free webinar to advise anyone who has ever considered opening their own veterinary practice about the main considerations, risks, and potential rewards of taking the plunge, at 8pm on Wednesday, 1st March 2023.

Speakers include Dr Ian Stroud, founder and veterinary director of Pet People, an independent small animal practice in Richmond, South West London, Jack Peploe, a veterinary IT expert and Certified Ethical Hacker, and Ciaran Milford, ezyVet’s EMEA sales manager, who has worked with every type of veterinary practice, from aspiring independents right through to established universities and corporate groups.

Lance Rice, creative director at ezyVet, who will moderate the webinar, said: “This webinar is for anyone who feels as though they’ve gone as far as they can in a senior vet or clinic director role, and thinks it might be time to follow their dream of opening their own practice.

“Our speakers are all vastly experienced and ideally positioned to explain what makes a successful launch, as well as the key mistakes and common traps that new owners fall into.

"Ian has a unique understanding of the challenges and opportunities involved with starting a veterinary practice.

"Jack is an expert in helping practices leverage technology to save time, whilst delivering exceptional patient care and bolstering their security posture.

"Ciaran is passionate about helping practices find the right solutions for their needs and business goals."

To register, visit: https://www.ezyvet.com/webinar/starting-a-vet-practice-uk

CVS reports that it is upskilling its nurses in diagnostic imaging techniques - so that they can take X-rays and perform CT scans, MRI and ultrasound.

To date most of these imaging procedures have been performed by vets within the group’s small animal first opinion veterinary practices.

The company says its Foundations in Diagnostic Imaging for Nurses training is designed to give its nurses more clinical stature in first opinion practice.

The programme will teach nurses the workings of an x-ray machine, common X-ray positions and contrast material.

It will also cover the principles of CT and MRI, showing how to set up and operate each piece of equipment, and how to support patients through these imaging procedures.

Finally, the course will provide the training nurses need to be able to perform ultrasounds within the current RCVS legal frameworks.

CVS says it believes this is a first in the veterinary profession

Tara Ryan, Chief Veterinary Nursing Officer at CVS said: “Imaging is a brand new area that we are starting to delegate to our nurses.

"Having heavily invested in our small animal first opinion practices over the last decade, we have a wide range of imaging equipment at many of our sites.

“Excitingly, this programme will open up the ability for nurses to start to contribute more information - to help vets identify and diagnose conditions and diseases in patients.

"It is another big step that we are taking to empower our brilliant nurses and to enable them to make a great clinical contribution towards the care of our patients – and to be the nurses they want to be.”

CVS is prioritising the consulting room and Schedule 3 delegated tasks as important areas for improving what it calls 'nurse optimisation'.

The company recognises that 'buy in' from veterinary surgeons is vital to the success of its efforts to optimise the role of its nurses, and the group has also published guidelines to provide clarity around effective delegation under Schedule 3. 

Zoetis has produced new guidance to help veterinary surgeons develop successful strategies for controlling worms in foals and youngstock.

According to the company, information on best worming strategies for foals and yearlings remains largely anecdotal, making it difficult to develop a clear plan for this age group. Zoetis veterinary surgeon Wendy Talbot has therefore reviewed the recent literature to develop an eight-point plan. 

Explaining the guidance, Wendy writes:

Foals and yearlings are usually more susceptible to worms than are adult horses because they have had little chance to develop any immunity. They are more vulnerable to related diseases and tend to have higher egg shedding, which increases the risk of infection. The main parasitic culprits in the UK for foals less than six months of age are large roundworms (ascarids). In older foals and weanlings, small and large strongyles, tapeworms (and pinworms) are the main considerations.¹ Yearlings may also have a second wave of large roundworm infection at 8-10 months of age.² Any control strategy will need to take into account the individual circumstances such as stocking density, pasture management and previous disease history.

Guidelines for parasite control in foals suggest a first treatment with fenbendazole at 2-3 months of age, targeting large roundworm, followed by another treatment at 5-6 months. Alternatively, pyrantel may be considered for these doses; however, there may be resistance in some areas and foals with large adult ascarid burdens may be at higher risk of intestinal rupture when this drug is used.⁴ At weaning (approximately six months of age), it is advisable to perform a faecal worm egg count (FWEC) to determine if treatment for strongyles is also required; the macrocyclic lactone anthelmintics (ivermectin or moxidectin) are expected to have the highest efficacy. At 9 and 12 months of age treatment for stronglyes and a larvicidal dose for encysted stages of small strongyles (moxidectin or a 5 day course of fenbendazole) are indicated.  A tapeworm treatment should be included with one of these doses.^2,3

For yearlings, two methods have recently been proposed for worm control: the first involves using faecal worm egg counts (FWECs) at more frequent intervals than for adults to guide dosing for strongyles in the grazing season.¹ The second suggests three baseline treatments targeting strongyles in spring, summer and late autumn, with FWECs in between to identify and treat any still shedding high numbers of eggs, up to a maximum of six treatments per year.² Macrocyclic lactones have the highest expected efficacy against small strongyles and should form the basis of treatments; however, pyrantel can be considered for some treatments where it has been shown to have continued efficacy. Both strategies include a larvcidal treatment for encysted small redworm combined with testing or treating for tapeworm in late autumn. The inclusion of one or two doses of a macrocyclic lactone each year (usually already used for small strongyle control) should be sufficient to prevent large strongyle related disease.³

The wide differences in the circumstances of foals and yearlings, together with geographical variations in resistance patterns and a lack of consensus on best practice in this group means it is not possible to define a single approach to a worming plan. An important point to note is that FWECs may give surprising results because higher counts are generally seen in youngstock.

Eight ways to keep clients' youngstock worms controlled:

1. Clean pasture is key to keeping foals and youngstock healthy. Regular removal of droppings is crucial to a successful worm control plan.
2. All foals are considered to be susceptible and at risk of acquiring ascarid infection. Some degree of anthelmintic intervention should be considered and in most circumstances administration at 2-3 months of age and again at 5-6 months of age is advisable.⁴
3. Older foals are primarily at risk of strongyle infection; macrocyclic lactone anthelmintics have the highest expected efficacy.
4. Worm egg counts are likely to be higher in yearlings compared to adults and interpretation of them requires good knowledge of all the circumstances including management, clinical history, previous worm control and test results. Cut-off values for treatment have been suggested to be between 100-500 epg.
5. Moxidectin for the treatment of encysted small redworm is advised for all youngsters (> 6 months of age) in late autumn.¹
6. Faecal worm egg counts are advisable in late winter/start of spring to identify high shedders. These should be treated as necessary with moxidectin particularly after a mild winter.¹
7. New arrivals should be dosed with moxidectin and then quarantined for three days.¹
8. A yearly faecal egg count reduction test is advised to check efficacy against strongyles and ascarids for all class of drugs used on the premises.¹

For further information on worming together with some equine specific CPD visit: https://blog.vetsupportplus.com/

1. Matthews www.vettimes.co.uk/article/helminth-control-programmes-for-equine-yearlings-at-pasture/
2. Nielsen (2017) Endoparasite Control. 9^th ECEIM congress proceedings, 63-64
3. AAEP (2016) Parasite Control Guidelines
4. Nielsen (2016) Evidence-based considerations for control of Parascaris spp. infections in horses. Equine vet. Educ.  28 (4) 224-231

Following a public consultation, the RCVS Council has voted to adopt all the proposals made by the RCVS Legislation Working Party concerning future veterinary legislation.

The Legislative Reform Consultation took place between November 2020 and April 2021 and asked members of the veterinary profession and the public to give their responses to a package of proposals for future veterinary legislation designed to enhance the role of veterinary nurses, modernise RCVS registration, lead to a modern fitness to practise regime, and ensure the regulation of veterinary practices. 

The proposals represent the biggest legislative reform since the 1966 Veterinary Surgeons Act.

In total the consultation received 1,330 responses, of which 714 (54%) were from veterinary surgeons, 335 (25%) from veterinary nurses, 93 (7%) from veterinary paraprofessionals, 73 (5%) from student veterinary nurses, 58 (4%) from members of the public, 40 (3%) from veterinary and industry organisations, including representative bodies, and the remainder from veterinary students and veterinary practice managers.

An analysis of the consultation responses covering each of the five core areas and their individual recommendations can be found in the final report, which is available at www.rcvs.org.uk/legislativereform.

After considering this report, Council voted by a majority to accept the recommendations, meaning that they are now formally adopted as RCVS policy and will form the basis for discussions on the need for new legislation with the Department for Environment, Food & Rural Affairs (Defra).

Professor Stephen May has chaired the Legislation Working Party that developed the proposal since its inception in 2017 when he was RCVS President. He said: “We are very grateful to those individuals and organisations who took the time to complete this very important consultation on recommendations for the future legislative framework for the professions. We also appreciate the candour of those who were unsure about or opposed to the recommendations.

“When the Legislation Working Party met to consider the responses and the report, it decided that, while no substantive changes needed to be made to the principle-based recommendations, the points raised both against and in favour of individual recommendations gave us important material for additional consideration, and food for thought as to how any detailed proposals would be implemented once enabling legislation is in place.

“We look forward to submitting these recommendations to Defra formally, with a view to them becoming, in time, a bill put before Parliament to replace the Veterinary Surgeons Act 1966. In so doing, this would establish a modern, flexible and comprehensive piece of legislation that would make sure the regulatory structure for the veterinary professions is fit for purpose for decades to come.”

As well as the main report of the Legislative Reform Consultation, RCVS Council also considered a series of interim measures that would be in line with the overall aims of future legislative changes, but which could be implemented without primary legislation.

The proposed interim measures included:

• the establishment of smaller-scale (‘mini’) Preliminary Investigation Committees (PICs) to help streamline the concerns investigation process;
• the establishment of a Charter Case Protocol where certain cases that meet the threshold for a full disciplinary hearing, but which might be likely to attract a lesser sanction, may be concluded, without recourse to a full public Disciplinary Committee hearing, via a system of published warnings; and,
• changing the standard of proof in determining the facts of a case during a Disciplinary Committee hearing from the criminal standard (‘beyond all reasonable doubt’) to the civil standard (‘on the balance of probabilities’).

Council members voted on each of these interim measures on an individual basis – with the mini-PICs and the Charter Case Protocol being accepted by majority vote.

However, Council members voted against implementing the change to the standard of proof at this time, citing a number of concerns about the potential impact of it being implemented under the current concerns investigation and disciplinary procedures. Similar concerns had been put forward by many of those who responded to the consultation itself.

Eleanor Ferguson, RCVS Registrar, said: “The approved procedural changes will, I believe, lead to a significant improvement in the efficiency and effectiveness of our disciplinary processes. The Charter Case Protocol will mean that, in suitable cases where a finding of serious professional misconduct at a full disciplinary hearing would likely only lead to a reprimand or to no further action being taken, a more proportionate and less time-consuming and expensive means of resolving cases will be available. However, it will still reflect the seriousness of the matters and continue to protect the public interest, welfare and the reputation of the profession.

“Furthermore, by phasing out the Case Examiner Group stage and instead referring concerns to ‘mini’ PICs, which will decide if the threshold of serious professional misconduct has been met, it will make our concerns investigation processes clearer and more streamlined and therefore more efficient. We look forward to publishing further details on both of these changes in due course.

“Although Council members accepted that a change of the standard of proof would be an integral part of introducing a modern fitness to practise (FTP) regime as part of any future legislation, they had significant concerns about the ‘interim’ recommendation to introduce it under the current arrangements, in advance of implementing a full FTP model, and so a majority felt that they could not vote for it.”

To read the full report of the Legislative Reform Consultation, including analysis of the responses, please visit www.rcvs.org.uk/legislativereform.

The British Equine Veterinary Association is encouraging veterinary practices to recognise and reward their nurses.

The initiative comes after BEVA's new nurse committee ran a survey which found a poor understanding within the profession and amongst clients of what equine nurses can do.

Nurses said they believed they could be given more responsibility and do more within their roles and that there was a lack of opportunity for progression.

BEVA President David Rendle, who is championing this initiative, said: “RVNs are a significant an asset to any equine practice.

“They have invested a lot of time and effort to become highly skilled but in some instances their significant attributes are not being utilised to the full.

“Allowing RVNs to perform the clinical tasks that they are qualified to carry out under Schedule 3 of the Veterinary Surgeons Act 1966, will provide better job fulfilment and career development as well as free up veterinary surgeons to carry out other tasks, all increasing the efficiency of the veterinary team.

“I feel, and the RVN survey results would seem to confirm, that veterinary surgeons and practice managers do not appreciate how much veterinary nurses are allowed to do in equine practice.

"We all know veterinary nurses have the ability; look at what they do in small animal and human nursing, but we have felt unnecessarily constrained by Schedule 3 of the Veterinary Surgeons Act 1966 and the associated RCVS guidelines.

"If you actually look at Schedule 3 it is clear that we can and should be letting our qualified equine nurses do far more. 

“There are so many things in equine practice that nurses do better than vets.

"In addition to performing clinical tasks they can add wider value; they are generally (or are perceived by clients to be!) more patient, empathetic and caring so we should utilise these skills and get nurses to take on some of the roles that take more time and require longer client interactions – discussing parasite control programmes,  running weight loss clinics, reviewing healthcare plans, making follow-up phone calls and visits to name just a few.

"Nurses can take a lot of pressure off vets and can add a significant revenue stream for the practice.” 

On the 9th February, the BEVA will be hosting an online discussion forum for all members of the practice team to discuss the role of nurses and how their skills, experience and knowledge can be better-used. 

It's free for BEVA members: https://www.beva.org.uk/Home/Events/BEVA-Events/Event-Details.aspx?eventDateId=1716 

Marie Rippingale Chair of the BEVA Nurse Committee said: “Last year’s recruitment and retention survey revealed that 50% of nurse respondents were earning less than £25,000 per annum and 48% of nurses said they were likely to look for a new job in the next two years.

"When asked their top reasons for leaving, salary was the biggest reason, and common themes on what would help the retention of nurses included salary, work-life balance and career progression.

“The review of Schedule 3 is important so we can encourage delegation of tasks to RVNs.

"This will allow RVNs to demonstrate their value and worth, earning money for the practice and achieving job satisfaction at the same time. This will contribute positively towards the current retention crisis.”

To find out more about what equine veterinary nurses can do in practice visit https://www.beva.org.uk/nurses 

Photo:  Liphook Equine Hospital.

For the first time in over 60 years, the BSAVA has cancelled Congress due to the global spread of coronavirus.

The Association says it delayed this decision as late as possible, and whilst the most recent government advice does not prohibit large public gatherings, it recognises the importance of personal safety for Congress attendees and the need to support the profession in preserving business continuity, maintaining client services and protecting animal welfare.

Amanda Stranack, BSAVA CEO, said: "As the situation continues to escalate, the government have given a clear steer that they expect more stringent controls to come into force in the coming weeks. With Congress now only a few weeks away, we want to give all our attendees as much notice as possible, both to ensure peace of mind, and to give people adequate time and flexibility to change their plans.

"BSAVA recognises the pressures the current situation brings to bear on the veterinary community and in making this difficult decision, has the interests of the profession first and foremost in its mind.

"We would thank all those who have worked hard over the past two years to contribute to the development of Congress, a huge amount of effort goes into preparations from BSAVA volunteers, Congress participants and our staff."

Sue Paterson, BSAVA President, said: "It is with great regret that we have made the difficult decision to cancel Congress, which has taken place annually for more than 60 years. Congress is an incredibly important event in the veterinary calendar, and we were all looking forward to an inspiring agenda and saying a fond farewell to the city that has made Congress such a great success over so many years. The health and wellbeing of our attendees is of utmost importance to us, and whilst we are sorry to be making this decision, we are confident it is the right one."

BSAVA says it is aware of the impact that cancelling will have on many delegates' CPD hours, so it is now looking at other ways it can deliver Congress lectures and podcasts.

Sue added: "Whilst we won’t be able to deliver the full Congress programme, we will be working with our speakers to capture as many lectures as we can to make content available online."

The Royal Veterinary College has published a new study which concludes that owners of epileptic dogs value partnerships of care with their veterinary surgeon, and that owner satisfaction could be improved with more educational resources.

For the study, 21 owners were interviewed and transcripts thematically analysed.

Owners who reported positive experiences with their vets described the value of comprehensive initial explanations of their dog’s condition, seeing the same veterinary surgeon for each consult, and individual attributes of vets, including current knowledge on epilepsy management and good communication skills.

The authors say these factors are likely to contribute to improved two-way vet-owner communication, owner satisfaction and adherence to care instructions. 

The implications of a negative relationship were also highlighted by the study.

Owners’ dissatisfaction with perceived insufficient expertise from their general practice vet (resulting in referrals to specialists), and when referred, poor communication between referral specialists and their primary care vet.

Owners’ pre-existing views and values were identified as drivers of negative experiences including strong dog-owner bonds leading to extremely high expectations for veterinary care. 

Another factor was pre-existing distrust and perceived biases of the veterinary pharmaceutical industry.

Owners who had a more negative experience with veterinary surgeons were found to be more likely to perform their own personal research, putting them at higher risk of being influenced by the large amount  of misinformation online.

The authors say that vets often report that they find epilepsy challenging to manage, particularly as a high proportion of dogs do not respond sufficiently to available medications.

This study aimed to help provide a better understanding of owners’ wants and needs.

Dr Rowena Packer, Primary supervisor on this study and Lecturer in Companion Animal Behaviour and Welfare Science at the Royal Veterinary College, said: “Epilepsy is a challenging condition to manage for dog owners and veterinary surgeons alike.

"Owners’ emotions often run high due to the trauma of witnessing their beloved dog’s seizure, and the ongoing stresses of caregiving for their dog.

"In tandem, vets can feel frustrated at not always being able to reduce seizures as much as they’d hope.

"Combined, the capacity for disappointment and conflict is high.

“Forging strong, trusting partnerships of care between owners and vets is key to maintaining wellbeing for all three members of the ‘treatment triangle’ – affected dogs, owners and vets."

Amy Pergande, Royal Veterinary College Veterinary graduate who conducted this research as part of her Master of Research degree, said: “Improving availability of reliable information sources for epilepsy management could help veterinary teams to confidently prescribe ’information prescriptions’ that boost owner confidence and help them to feel empowered to contribute more actively in decision-making for their dog, in partnership with their vet.”

Dr Zoe Belshaw, EBVS Recognised Specialist in Small Animal Medicine, of EviVet Evidence-based Medicine Research Consultancy and co-author of the study, said: “Our research suggests owners really value vets taking the time, once the initial shock has receded, to share information, answer questions and signpost to external resources, including peer-to-peer support forums.

"Ensuring that owners feel confident and competent about caring for their dog with epilepsy is likely to benefit the dog, its owners and the veterinary team providing their ongoing care”.

MSD Animal Health has launched a new Chronogest CR pack for practices starting a dialogue with sheep producer clients about planned breeding for 2013 lamb sales, and is offering a free applicator with every four packs purchased.

The Chronogest CR intra-vaginal sponges, impregnated with 20mg of cronolone (flugestone acetate) synthetic hormone, are now available in foil wrapped packs of 25. The packs protect the sponges from light and moisture.

MSD is reminding practitioners that sponging programmes must be planned at least six weeks in advance of mating, with PMSG-Intervet injections essential at sponge removal.

The new packs of 25 will be available when existing 25, 50 and 100 pack sizes sell out.

Further information on planned breeding -  including newsletter copy and sheep producer advisory materials - is available from the MSD Animal Health veterinary support group (VSG) on 01908 685685 or via emailing vet-support.uk@merck.com