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Background: Treatment of Vitis vinifera fruit (VVF) ingestion can be challenging due to no clear toxic dose, signalment factors and variable clinical signs. Current treatment guidance is generalised: decontamination, aggressive fluid therapy, monitoring and/or treatment of renal dysfunction. The objective of this study was to conduct a scoping review of scientific evidence regarding the ingestion of VVF in dogs. Three primary areas were reviewed: VVF types ingested, clinical signs reported and treatments given. The inclusion criterion was any paper presenting data on clinical signs or treatments of dogs that had ingested VVF (unprocessed VVF only). Methods: The following databases were searched: CAB Abstracts, Medline, Embase and Scopus. No limits were placed on language or date. The review followed the Joanna Briggs Institute scoping review methodology. Results: Twenty‐four papers were identified. A wide range of VVF types were ingested, but the toxic dose was difficult to ascertain. The most commonly reported signs were gastrointestinal, renal, neurological and haematological. Treatment commonly consisted of fluid therapy, diuretics and antiemetics. Limitations: This scoping review neither explored cases of processed VVF ingestion nor did it chart laboratory findings; therefore, potentially clinically significant findings in these areas may have been missed. Conclusions: VVF ingestion typically causes gastrointestinal/renal dysfunction, with no clear toxicity attributable to VVF type. Treatments varied according to the presence/absence of clinical signs, and the prognosis was varied. Further research on current treatment efficacy is warranted, permitting an evidence‐based, risk–benefit approach to be adopted by clinicians. [ABSTRACT FROM AUTHOR]

In the article the author comments on the paper "Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation" by Federico Lega and Stefano Calciolari. He categorizes the options for future healthcare delivery discussed in the paper, and mentions the growth of the medical tourism modality. The author recommends thoughtful decisions when thinking of integrating different levels of care in delivery systems.