Information needs for general practitioners on type 2 diabetes in Western countries. A systematic review

BACKGROUND

Most people with type 2 diabetes receive treatment in primary care by general practitioners who are not specialised in diabetes. Thus, it is important to uncover the most essential information needs regarding type 2 diabetes in general practice.

AIM

To identify information needs related to type 2 diabetes for general practitioners.

DESIGN AND SETTING

A systematic review focused on literature relating to Western countries.

METHOD

We searched the databases MEDLINE, Embase, PsycInfo and CINAHL from inception to January 2024. Two researchers conducted the selection process, and citation searches were performed to identify any relevant articles missed by the database search. Quality appraisal was conducted with the Mixed Methods Appraisal Tool. Meaning units were coded individually, grouped into categories, and then studies were summarized within the context of these categories using narrative synthesis. An evidence map was created to highlight research gaps.

RESULTS

Thirty-nine included studies revealed eight main categories and 37 subcategories of information needs. Categories were organised into a comprehensive hierarchical model of information needs, suggesting that 'Knowledge of guidelines' and 'Reasons for referral' encompass more specific information needs. The evidence map shows geographical distribution of categories and knowledge gaps in qualitative research on management and risk factors.

CONCLUSION

This systematic review provides GPs, policy makers, and researchers with a hierarchical model of information and educational needs for GPs, and an evidence map showing gaps in the current literature. Information needs about clinical guidelines and reasons for referral to specialised care overlapped with needs for more specific information.

The impact of train-the-trainer programs on the continued professional development of nurses: a systematic review

BACKGROUND

Train-the-trainer (TTT) programs are widely applied to disseminate knowledge within healthcare systems, but evidence of the effectiveness of this educational model remains unclear. We systematically reviewed studies evaluating the impact of train-the-trainer models on the learning outcomes of nurses.

METHODS

The reporting of our systematic review followed PRISMA 2020 checklist. Records identified from MEDLINE, Embase, CINAHL, and ERIC were independently screened by two researchers and deemed eligible if studies evaluated learning outcomes of a train-the-trainer intervention for trainers or trainees targeting nurses. Study quality was assessed with Joanna Briggs Institute's critical appraisal tools and data of study characteristics extracted (objective, design, population, outcomes, results). Heterogeneity of outcomes ruled out meta-analysis; a narrative synthesis and vote counting based on direction of effects (p < 0.05) synthesized the results. All records were uploaded and organized in EPPI-Reviewer.

RESULTS

Of the 3800 identified records 11 studies were included. The included studies were published between 1998 and 2021 and mostly performed in the US or Northern Europe. Nine studies had quasi-experimental designs and two were randomized controlled trials. All evaluated effects on nurses of which two also included nurses' assistants. The direction of effects of the 13 outcomes (knowledge, n = 10; skills, n = 2; practice, n = 1) measured in the 11 included studies were all beneficial. The statistical analysis of the vote counting showed that train-the-trainer programs could significantly (p < 0.05) improve trainees' knowledge, but the number of outcomes measuring impact on skills or practice was insufficient for synthesis.

CONCLUSIONS

Train-the-trainer models can successfully disseminate knowledge to nurses within healthcare systems. Considering the nurse shortages faced by most Western healthcare systems, train-the-trainer models can be a timesaving and sustainable way of delivering education. However, new comparative studies that evaluate practice outcomes are needed to conclude whether TTT programs are more effective, affordable and timesaving alternatives to other training programs.

TRIAL REGISTRATION

The protocol was registered in Research Registry ( https://www.researchregistry.com , unique identifying number 941, 29 June 2020).

Psychosocial aspects and perspectives of adult-onset type 1 diabetes: A systematic scoping review

AIM

To map existing research on psychosocial aspects of adult-onset type 1 diabetes (T1D), including psychosocial health status, ways psychosocial aspects may affect management of T1D in everyday life, and interventions targeting management of adult-onset T1D.

METHODS

We conducted a systematic search in MEDLINE, EMBASE, CINAHL and PsycInfo. Search results were screened with predefined eligibility criteria, followed by data extraction of the included studies. Charted data were summarized in narrative and tabular form.

RESULTS

We included 10 reports describing nine studies from the 7302 identified in the search. All studies were conducted in Europe. Participant characteristics were missing in several studies. Five of the nine studies incorporated psychosocial aspects as the main aim of the study. Limited information on psychosocial aspects was available in the remaining studies. We identified three overarching themes related to psychosocial aspects: (1) the impact of the diagnosis on everyday life, (2) the influence of psychosocial health on metabolic levels and adaptation, and (3) provision of self-management support.

CONCLUSIONS

Research focussing on psychosocial aspects of the adult-onset population is scarce. Future research should involve participants across the adult life age span and from a wider geographical area. Sociodemographic information should be collected to explore different perspectives. Further exploration of suitable outcome measures considering adults' limited experience of living with the condition is needed. This would help to better understand how psychosocial aspects may affect management of T1D in everyday life and thus enable healthcare professionals to provide appropriate support to adults with new-onset T1D.

When People with Chronic Conditions Turn to Peers on Social Media to Obtain and Share Information: A Systematic Review of the Implications for Relationships with Healthcare Professionals (Preprint)

BACKGROUND

People living with chronic conditions such as diabetes turn to peers on social media to obtain and share information. Although social media use has grown dramatically in the past decade, little is known about its implications for the relationships between people with chronic conditions and health care professionals (HCPs).

OBJECTIVE

We aimed to systematically review the content and quality of studies examining what the retrieval and sharing of information by people with chronic conditions on social media implies for their relationships with HCPs.

METHODS

We conducted a search of studies in MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO). Eligible studies were primary studies; examined social media use; included adults with any type of diabetes, cardiovascular diseases that are closely linked with diabetes, obesity, hypertension, or dyslipidemia; and reported on the implications for people with chronic conditions-HCP relationships when people with chronic conditions access and share information on social media. We used the Mixed Methods Appraisal Tool version 2018 to assess the quality of the studies, and the included studies were narratively synthesized.

RESULTS

Of the 3111 screened studies, 17 (0.55%) were included. Most studies (13/17, 76%) were of low quality. The narrative synthesis identified implications for people with chronic conditions-HCP relationships when people with chronic conditions access and share information on social media, divided into 3 main categories with 7 subcategories. These categories of implications address how the peer interactions of people with chronic conditions on social media can influence their communication with HCPs, how people with chronic conditions discuss advice and medical information from HCPs on social media, and how relationships with HCPs are discussed by people with chronic conditions on social media. The implications are illustrated collectively in a conceptual model.

CONCLUSIONS

More evidence is needed to draw conclusions, but the findings indicate that the peer interactions of people with chronic conditions on social media are implicated in the ways in which people with chronic conditions equip themselves for clinical consultations, evaluate the information and advice provided by HCPs, and manage their relationships with HCPs. Future populations with chronic conditions will be raised in a digital world, and social media will likely remain a strategy for obtaining support and information. However, the generally low quality of the studies included in this review points to the relatively immature state of research exploring social media and its implications for people with chronic conditions-HCP relationships. Better study designs and methods for conducting research on social media are needed to generate robust evidence.

Exploring protective factors through positive psychology and salutogenesis in Danish families with type 2 diabetes

People with type 2 diabetes (T2D) live with several challenges, which may enhance the risk of poor mental and physical health. However, despite living with a chronic illness, some individuals manage to achieve a life with positivity and well-being. The objective of this study is to explore the potential of Positive Psychology and Salutogenesis when analyzing how families with one or more members with T2D experience having resources leading to thriving. Data consist of 18 semi-structured family interviews with 38 participants. Data were analyzed using systematic text condensation with the concepts of sense of coherence and upward/downward spirals as the analytical framework. The analysis revealed three overall findings: (i) T2D is perceived as manageable due to general optimism despite living with a chronic illness; (ii) establishing supportive social relations means having the opportunity to share the burden of diabetes; and (iii) achieving an open dialogue and communicating the difficulties of diabetes without straining surroundings with negative illness communication. The three overall findings may reinforce each other in an upward spiral and enhance the sense of coherence. These findings have implications for diabetes management research and our understanding of psychological health in chronic illness. The overall goal is to help people with diabetes create meaning with their illness and make use of their social environment through dialogue and communication in order to increase positivity, optimism and mental health.

Searching PubMed to Retrieve Publications on the COVID-19 Pandemic: Comparative Analysis of Search Strings

Background

Since it was declared a pandemic on March 11, 2020, COVID-19 has dominated headlines around the world and researchers have generated thousands of scientific articles about the disease. The fast speed of publication has challenged researchers and other stakeholders to keep up with the volume of published articles. To search the literature effectively, researchers use databases such as PubMed.

Objective

The aim of this study is to evaluate the performance of different searches for COVID-19 records in PubMed and to assess the complexity of searches required.

Methods

We tested PubMed searches for COVID-19 to identify which search string performed best according to standard metrics (sensitivity, precision, and F-score). We evaluated the performance of 8 different searches in PubMed during the first 10 weeks of the COVID-19 pandemic to investigate how complex a search string is needed. We also tested omitting hyphens and space characters as well as applying quotation marks.

Results

The two most comprehensive search strings combining several free-text and indexed search terms performed best in terms of sensitivity (98.4%/98.7%) and F-score (96.5%/95.7%), but the single-term search COVID-19 performed best in terms of precision (95.3%) and well in terms of sensitivity (94.4%) and F-score (94.8%). The term Wuhan virus performed the worst: 7.7% for sensitivity, 78.1% for precision, and 14.0% for F-score. We found that deleting a hyphen or space character could omit a substantial number of records, especially when searching with SARS-CoV-2 as a single term.

Conclusions

Comprehensive search strings combining free-text and indexed search terms performed better than single-term searches in PubMed, but not by a large margin compared to the single term COVID-19. For everyday searches, certain single-term searches that are entered correctly are probably sufficient, whereas more comprehensive searches should be used for systematic reviews. Still, we suggest additional measures that the US National Library of Medicine could take to support all PubMed users in searching the COVID-19 literature.

Barriers to intra-familial prevention of type 2 diabetes: A qualitative study on horizons of significance and social imaginaries

Objectives

In families living with type 2 diabetes, relatives have a significantly heightened risk of developing the disease. In many families, both the person with type 2 diabetes and his/her relatives lack detailed knowledge about this risk. One obstacle to constructive intra-familial prevention and risk reduction is the lack of perceived familial disease relevance. The objective of the present study is to explore barriers to prevention in families with at least one adult with type 2 diabetes.

Methods

Data were gathered during eight problem assessment and ideation workshops with families. The data were analyzed using radical hermeneutics and interpreted using Taylor’s concepts of social imaginaries and horizons of significance.

Results

The analysis revealed three main barriers: (1) Sole responsibilities and the absence of collective practices, (2) intra-familial differences in perceptions of risks and future health, and (3) lack of perceived disease significance and the ensuing lack of mutual care. The participating families all experienced one or more of the three identified primary barriers.

Discussion

The study has produced important knowledge about barriers to familial prevention of type 2 diabetes. The findings confirm that familial prevention is indeed a complex matter that calls for the use of complexity-oriented approaches in health care practice.

Implementing a research-based innovation to generate intra-familial involvement in type 2 diabetes self-management for use in diverse municipal settings: a qualitative study of barriers and facilitators

BACKGROUND

Involving family members in disease management is vital to people with type 2 diabetes. New innovations that support family members' involvement can help both the person with type 2 diabetes and the relatives to create the supportive environment they need. The objective of the present study is to examine what facilitates and obstructs implementation of an innovation that supports intra-familial involvement in life with type 2 diabetes.

METHODS

Of the 48 healthcare professionals trained in facilitating the innovation in municipal patient education courses, single, semi-structured interviews were conducted with 13 of them. The interviews were focused specifically on the implementation process. All interviews were transcribed verbatim and analyzed using radical hermeneutics.

RESULTS

The analysis revealed three distinct themes affecting implementation of the innovation. 1) Focusing on creating family involvement in patient education for people with type 2 diabetes was relevant and important to the healthcare professionals. 2) The dynamics of group-based patient education sessions changed when family members were involved, which affects healthcare professionals' group facilitation methods. 3) Implementing new methods in patient education requires great commitment and support from the organization and management.

CONCLUSION

Implementation of an innovation to involve families and close relatives in patient education in Danish municipalities is feasible, but highly dependent on the commitment of healthcare professionals and managers as well as their openness to new ways of facilitating group processes.

Reasons for Nonadherence to Statins - A Systematic Review of Reviews

PURPOSE

Lipid-lowering medications are often prescribed to decrease the risk of micro- and macro-cardiovascular complications related to dyslipidaemia. Despite widespread prescription of lipid-lowering drugs, including statins, adherence to therapy is a challenge worldwide. This systematic review of reviews aimed to conduct a critical appraisal and synthesis of review findings and to provide an overview of the factors that were found to affect adherence to lipid-lowering drugs, focusing on statins, in the reviews.

PATIENTS AND METHODS

A systematic review methodology was used. MEDLINE, Embase, and Epistemonikos databases were searched for relevant publications. AMSTAR 2 criteria were used to assess the quality of the selected publications.

RESULTS

From a total of 763 screened publications, 9 met all inclusion criteria and were included in this synthesis. Several factors were identified as being associated with adherence to lipid-lowering agents. Among them, high socio-economic and educational position, and middle age had a positive effect on adherence to lipid-lowering agents. Contrary, female sex, older and younger age, non-white race, low socio-economic position, high co-payments, being a new statin user, comorbidities, side effects, regimen complexity, type and intensity of statin dose, smoking, alcohol consumption, imperceptible benefits, and medical distrust contributed to non-adherence. The overall quality of the included reviews was considered critically low to moderate.

CONCLUSION

This review of reviews has evaluated the impact of factors on adherence statins. Further research related to modifiable predictors for non-adherence is warranted.

Targeting "hardly reached" people with chronic illness: a feasibility study of a person-centered self-management education approach

BACKGROUND

Self-management education is critical to the development of successful health behavior changes related to chronic illness. However, people in high-risk groups attend less frequently or benefit less from patient education programs than do people with more socioeconomic advantages.

AIM

The aim was to test the feasibility of a participatory person-centered education approach and tool-kit targeting self-management of chronic illness in hardly reached people.

METHODS

After participating in a training program, educators (n=77) tested the approach in practice. Data collection included online questionnaires for educators (n=65), observations of education sessions (n=7), and interviews with educators (n=11) and participants (n=22). Descriptive statistics were calculated. Transcripts of interviews and observations were analyzed using systematic text condensation. Feasibility was examined in terms of practicality, integration, suitability, and efficacy.

RESULTS

Educators had a positive response to the approach and found that the tools supported involving participants in education and support. Participant satisfaction varied, depending on the ability of educators to integrate the tools into programs in a meaningful way. The tools provided time for reflection in the education process that benefited participants and educators alike. Educators found it challenging to allow participants to help set the agenda and to exchange experiences without educator control. Barriers to use reported by educators included lack of time for both training and preparation.

LIMITATIONS

The testing included varied groups of participants, some groups included members of hardly reached populations and others did not. Also, some tools were only tried in practice by a few educators.

CONCLUSION

The approach was feasible in terms of practicality, integration, acceptability, and efficacy and perceived by educators as suitable for both hardly reached participants and those who are less disadvantaged. Implementation of the approach requires time for training and preparation.

Involvement of family members in life with type 2 diabetes: Six interconnected problem domains of significance for family health identity and healthcare authenticity

Objectives:

Family involvement plays a key role in diabetes management. Problems and challenges related to type 2-diabetes often affect the whole family, and relatives are at increased risk of developing diabetes themselves. We highlight these issues in our objectives: (1) to uncover specific family problems associated with mutual involvement in life with type 2-diabetes and (2) to analytically look at ways of approaching these problems in healthcare settings.

Methods:

Qualitative data were gathered in participatory problem assessment workshops. The data were analysed in three rounds using radical hermeneutics.

Results:

Problems were categorized in six domains: knowledge, communication, support, everyday life, roles and worries. The final cross-analysis focusing on the link between family identity and healthcare authenticity provided information on how the six domains can be approached in healthcare settings.

Conclusion:

The study generated important knowledge about problems associated with family involvement in life with type 2 diabetes and about how family involvement can be supported in healthcare practice.

Effect of adding insulin degludec to treatment in patients with type 2 diabetes inadequately controlled with metformin and liraglutide: a double-blind randomized controlled trial (BEGIN: ADD TO GLP-1 Study)

AIM

To evaluate the efficacy and safety of adding insulin degludec (IDeg) to treatment in patients with type 2 diabetes receiving liraglutide and metformin and qualifying for treatment intensification because of inadequate glycaemic control.

METHODS

In this 26-week, double-blind trial, patients who still had inadequate glycaemic control after a 15-week run-in period with initiation and dose escalation of liraglutide to 1.8 mg in combination with metformin (≥1500 mg) were randomized to addition of once-daily IDeg ('IDeg add-on to liraglutide' arm; n = 174) or placebo ('placebo add-on to liraglutide' arm; n = 172), with dosing of both IDeg and placebo based on titration guidelines.

RESULTS

At 26 weeks, the mean change in glycated haemoglobin level was greater in the IDeg add-on to liraglutide arm (-1.04%) than in the placebo add-on to liraglutide arm (-0.16%; p < 0.0001). Similarly, the mean fasting plasma glucose reduction was greater, and self-measured plasma glucose values were lower at all eight time points, with IDeg add-on versus placebo add-on (both p < 0.0001). At 26 weeks, the IDeg dose was 51 U (0.54 U/kg). During the run-in period with liraglutide, body weight decreased by ∼3 kg in both groups. After 26 weeks, the mean change was +2.0 kg (IDeg add-on to liraglutide) and -1.3 kg (placebo add-on to liraglutide). Confirmed hypoglycaemia rates were low in both groups, although higher with IDeg than with placebo (0.57 vs. 0.12 episodes/patient-years of exposure; p = 0.0002). Nocturnal confirmed hypoglycaemia was infrequent in both groups, with no episodes of severe hypoglycaemia, and no marked differences in adverse events with either treatment approach.

CONCLUSION

The addition of liraglutide and IDeg to patients sub-optimally treated with metformin and liraglutide and requiring treatment intensification was found to be effective and well-tolerated.

Involuntary treatment of schizophrenia patients 2004-2010 in Denmark

OBJECTIVE

Treatment of schizophrenia is frequently complicated by patients' ambivalence and lack of insight into the disease, occasionally warranting involuntary treatment. This study aims to describe involuntary treatment in Danish schizophrenia patients.

METHOD

Patients diagnosed with a lifetime ICD-10 F20 schizophrenia diagnosis and alive in the period 2004-2010 were identified in the Danish Psychiatric Central Research Register, and data were linked to The Registry of Coercive Measures in Psychiatric Treatment.

RESULTS

Within the study period, a total of 18,599 admitted patients were identified, 3078 of which underwent involuntary treatment. The incidence rate for any involuntary treatment was 2.1 per in-patient year and 1.7 and 0.3 per in-patient year for rapid tranquilization and involuntary treatments, respectively. Somatic diseases comprised 34.5% of all involuntary treatments. Psychotropics comprised 56.9% with antipsychotics as the most common drug class (99.5%). Olanzapine was the most commonly used antipsychotic drug (33.2%). Treatment with depot injection and clozapine comprised only 13% and 4.8% of the antipsychotics used, respectively. Electroconvulsive therapy comprised 4.8% of all involuntary treatment.

CONCLUSION

Involuntary treatment involved a wide range of somatic treatment. Antipsychotic medicine was the most common psychotropic used. Involuntary treatment with depot antipsychotics and clozapine were rare.

Educator challenges using participatory methods in group-based patient education

Purpose

– The purpose of this paper is to explore educators’ experiences of putting a participatory and patient-centered education model, “The Health Education Juggler,” into practice after having attended a one-day seminar. The model consists of four educator roles in participatory group-based patient education in chronic illness: embracer (takes care of the group), facilitator (generates dialogue and participation), translator (communicates professional knowledge) and initiator (motivates action in patients).

Design/methodology/approach

– Qualitative analysis of observations of eight group-based patient education sessions and seven in-depth semi-structured interviews with 11 educators.

Findings

– Educators find it difficult to include disease-specific knowledge when working with a flexible patient-centered approach. They tend to stay in the role they find most comfortable during education sessions (most often that of embracer), rather than adopting new and more challenging roles in the teaching process. Educators theoretically understand the role of facilitator, but they do not know how to perform in this role in practice. The ability to juggle all educator roles depends on the ability to master each.

Practical implications

– The Health Education Juggler model shows promise in promoting participation and patient-centeredness and as a reflection tool for educators and an analytic tool for quality assessment of patient education. These findings support further development of model use.

Originality/value

– This model of educator roles in group-based patient education in chronic illness provides a new approach to patient education. It indicates the need for various professional competencies among educators to provide patient-centered education in a flexible way, with a strong focus on patient-identified problems and challenges, social learning processes and generation of internal motivation in patients.

Adsorption of methylamine on Ni 3 Al(111) and NiAl(110)--a high resolution photoelectron spectroscopy and density functional theory study

Methylamine adsorption on the ordered Ni(3)Al(111) and NiAl(110) surfaces has been investigated by high resolution photoelectron spectroscopy and density functional theory calculations. Methylamine adsorbs molecularly at both surfaces at low temperature (90 K). The experiments show that methylamine interacts with the surface aluminium atoms on both surfaces, resulting in a positive binding energy shift relative to the Al 2p bulk contributions. A shift towards lower binding energy is also observed on NiAl(110) attributed to first and second layer surface Al atoms not bonded to methylamine. According to total energy calculations methylamine binds through its N atom to Al on-top sites on NiAl(110) while the Ni on-top site is found to be slightly preferred over the Al on-top site on Ni(3)Al(111). Calculated adsorbate induced shifts are, however, in good agreement with the experimental values only when methylamine is situated in the Al on-top site on both surfaces. In both cases, a lone pair bonding mechanism is found.

Switching patients from olanzapine or risperidone to a combination treatment using perphenazine plus buspirone: evaluation of antipsychotic efficacy and side-effects, including extrapyramidal effects and weight loss

In this pilot study, we have investigated the effects of switching from olanzapine or risperidone treatment to low-dose perphenazine combined with buspirone in six schizophrenic patients who had experienced weight gain. We found no relapse as to psychotic symptoms measured by the CGI-S scale and no exacerbation of extrapyramidal side-effects as measured by the Simpson-Angus Scale. In addition, we observed a medium weight reduction of 10.5 kg (range 1-20 kg).

Distemper virus as a cause of central nervous disease and death in badgers (Meles meles ) in Denmark

During the summer of 2002 a distemper-like disease was observed in the free-ranging badger population in Denmark. It was characterised by grand seizures, abnormal behaviour and death; the badgers all had severe chronic pneumonia and some had non-suppurative encephalomyelitis. In this study, eight of the affected badgers were examined by gross pathological, histological, immunohistological, bacteriological, parasitological and virological methods, and were diagnosed with distemper; canine distemper virus was identified.

PASTEURELLA MULTOCIDA FROM OUTBREAKS OF AVIAN CHOLERA IN WILD AND CAPTIVE BIRDS IN DENMARK

An outbreak of avian cholera was observed among wild birds in a few localities in Denmark in 2001. The highest mortalities were among breeding eiders (Somateria mollissima) and gulls (Larus spp.). Pulsed-field gel electrophoresis (PFGE) was conducted using ApaI and SmaI as restriction enzymes and restriction enzyme analysis (REA) using HpaII. The Pasteurella multocida subsp. multocida strain isolated from birds in this outbreak was indistinguishable from a strain that caused outbreaks in 1996 and 2003. Most isolates from domestic poultry had other PFGE patterns but some were indistinguishable from the outbreak strain. Among 68 isolates from wild birds, only one PFGE and one REA pattern were demonstrated, whereas among 23 isolates from domestic poultry, 14 different SmaI, 12 different ApaI, and 10 different HpaII patterns were found. The results suggest that a P. multocida strain has survived during several years among wild birds in Denmark.

Verrucous endocarditis associated with Streptococcus bovis in mink (Mustela vison)

Between 1998 and 2001, mortalities due to verrucous endocarditis were experienced at several mink farms. Gram-positive cocci were isolated from the endocardium of all the animals examined but not always from other internal organs. Almost all the isolates were identified as Streptococcus bovis and only a few isolates belonged to other Streptococcus species. Typing by pulsed-field gel electrophoresis of a selection of isolates revealed several patterns and several different clones. Attempts to reproduce disease by the injection of cultures of a field isolate into healthy mink failed.

Serogroups and antimicrobial susceptibility among Escherichia coli isolated from farmed mink (Mustela vison Schreiber) in Denmark

Escherichia coli is commonly found in outbreaks of diarrhoea in mink during the production season although its role as a primary causal organism remains unclear. The present study was undertaken to determine the serogroups and antimicrobial susceptibility of E. coli isolates from healthy and diarrhoeic mink. Rectal swabs were taken from healthy and diseased animals, on six different farms, once at the onset of disease and again approximately 2 weeks later. The swabs were subjected to bacteriological investigation; a total of 210 E. coli were isolated, 98 from healthy animals and 112 from diseased. All isolates were serotyped and MICs were determined for nine antimicrobial compounds. Non-haemolytic isolates numbered 147, whereas 63 were haemolytic. Both haemolytic and non-haemolytic isolates were isolated from both healthy and diseased animals.A wide range of serogroups was detected, the most frequent being O2 (11.0%), O78 (11.0%), O153 (7.1%), O25 (5.7%), O6 (4.8%), and O15 (4.8%), but diarrhoea was not associated with specific serogroups. All isolates were sensitive to enrofloxacin, neomycin, gentamicin and colistin. In contrast, considerable variations in susceptibility were found among the six mink farms, for tetracycline (0-46.4%, average 21.9), ampicillin (2.9-50.0%, average 23.3), spectinomycin (8.0-35.7%, average 21.9), sulfamethoxazole (8.6-57.7%, average 30.0) and trimethoprim (0-35.7%, average 9.5). Resistance to tetracycline was statistically more prevalent among haemolytic than among non-haemolytic strains.In conclusion, serogrouping and haemolysin testing failed to identify any association with diarrhoeal disease and antimicrobial resistance was highly variable between different mink farms.

Mortality in farmed mink: systematic collection versus arbitrary submissions for diagnostic investigation

The distribution of diagnoses of mortality in mink submitted to the Danish Veterinary Laboratory (DVL) for diagnostic investigation in the calendar year 1997 was compared with the diagnoses of mortality in all dead mink collected at 4 selected farms (project farms) during the same period. A total of 1,015 submitted mink and 1,149 mink from the 4 project farms were subjected to post mortem investigation. The average size (breeding stock) of the project farms was larger than Danish farms on average. However, the distribution of colour types of the mink was comparable. The seasonal distribution of the material from project farms and that of the submissions were approximately the same. Differences in the distribution of diagnoses as well as recovered microorganisms were found, however, mainly related to the proportion of gastro-intestinal disorders and E. coli respectively. These proportions were negatively correlated. Overall the results showed that extrapolating diagnostic results of laboratory submissions to the population of farmed mink may be problematic, and more reliable methods for disease surveillance must be considered.

Testing blood plasma from cattle in leukosos-free herds for antibodies against bovine leukemia virus (BLV)

As a prelude to the introduction of serological methods in the Danish leukosis eradication programme, an examination for antibody to Bovine Leukemia Virus (BLV) was carried out in 215 randomly selected leukosis-free herds in three areas where 3 routine haematological screening tests had bee made over a period of 6 years. A gel diffusion test was applied to plasma samples. Of 3319 animals screened, none were found to have detectable levels of antibody to BLV in their plasma. This would seem to indicate that false positive reactions are not a serious problem in connection with this test, and also that herds classified as leukosis-free after a series of haematological herd tests carried out within a period of some years, are in fact free from infection with Bovine Leukemia Virus.

[Idiopathic autoimmune haemolytic anaemia in dogs (author's transl)]

Three cases of autoimmune hemolytic anemia in dogs are described. The description includes results of laboratory tests. All three cases were characterized by a short course of disease before the first "crisis". One of the dogs is still alive 2 years after the first crisis, having had one remission after 3 months. A second dog died five days after hospitalization (four days after initiation of medical treatment) whereas the third dog was killed one day after initiation of medical treatment because of rapidly developing weakness.