OP0212-HPR PATIENT ASSESSMENT CHRONIC ILLNESS CARE (PACIC) AND ITS ASSOCIATIONS WITH QUALITY OF LIFE AMONG SWISS PATIENTS WITH SYSTEMIC SCLEROSIS – A MIXED METHODS STUDY

Background

Variable disease presentation and symptom burden in patients living with systemic sclerosis (SSc) require a chronic care approach including competent, coordinated, multidisciplinary collaboration as well as self-management support targeting individual patient needs. The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management.1 Little is known about how CCM elements are implemented in SSc care or how patients’ care experiences relate to health-related quality of life (HRQoL).

Objectives

First, to describe current SSc care in Switzerland according to the CCM from the patient perspective and examine relationships with HRQoL. Second, to explain these results by patients’ illness and care experiences.

Methods

We employed an explanatory sequential mixed methods design (Figure 1). First, we conducted a cross-sectional quantitative survey (n=101 Swiss patients) using the Patient Assessment of Chronic Illness Care (PACIC-20)2 and Systemic Sclerosis Quality of Life (SScQoL)3 questionnaires. Because PACIC has not been used in the context of SSc, we used the Mokken model to test the construct validity of the PACIC scale and its subscales. After excluding five problematic items, H coefficients were ‘strong’ for the subscales and the global scale (0.52) suggesting a robust unidimensional scale.

Figure 1.

Schematic of the explanatory, sequential mixed methods design

Next, we used data from individual patient interviews (n=4) and one patient focus group (n=4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions.

Results

The mean overall PACIC-15 score was 3.0 / 5.0 (95% CI: 2.8–3.2, n= 100), indicating care was ‘never’ to ‘generally not’ aligned with the CCM. Lowest subscale scores related to ‘goal setting/tailoring’ (mean = 2.5, 95% CI: 2.2–2.7) and ‘problem solving/contextual counselling’ (mean = 2.9, 95% CI: 2.7–3.2) (Table 1). No significant associations were identified between the mean PACIC-15 and SScQoL scores.

Table 1.

Summary of scores (n=101) for the 15-item PACIC scale (adapted version of the original 20-item scale)

PACIC mean scores (95% CI)PACIC 15-item mean score3.0 (2.8–3.2)1: Patient activation(mean of items 1–3)3.4 (3.1–3.6)2: Delivery system design/ Decision Support(items 4–6)3.2 (3.0–3.4)3: Goal setting/ Tailoring(items 7–9)2.5 (2.2–2.7)4: Problem solving/ Contextual Counselling(items 12–15)2.9 (2.7–3.2)5: Follow-up/ Coordination(items 19–20)3.3 (3.0–3.5)

Note: CI=Confidence interval; PACIC=Patient Assessment of Chronic Illness Care

Interviews revealed patients frequently encounter major shortcomings in care including experiencing organized care with limited participation, not knowing which strategies are effective or harmful and feeling left alone with disease and psychosocial consequences. Patients often responded to challenges by dealing with the illness in tailored measure, taking over complex coordination of care and relying on an accessible and trustworthy team.

Conclusion

The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling –aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.

References

[1]Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998;1(1):2-4.

[2]Glasgow RE, Wagner EH, Schaefer J, et al. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care 2005;43(5):436-44.

[3]Ndosi M, Alcacer-Pitarch B, Allanore Y, et al. Common measure of quality of life for people with systemic sclerosis across seven European countries: a cross-sectional study. Ann Rheum Dis 2018;77(7):1032-38.

Acknowledgements

We wish to thank the participating patients, the Swiss Scleroderma patient association, and the focus group participants for their generosity and collaboration.

Disclosure of Interests

Agnes Kocher Consultant of: Pfizer, Grant/research support from: Boehringer Ingelheim, Swiss Nursing Science Foundation, Swiss League Against Rheumatism, University of Basel, Michael Simon: None declared, Andrew A. Dwyer Grant/research support from: Boston College, U.S. National Institutes of Health (U.S.A.), Catherine Blatter: None declared, Jasmina Bogdanovic: None declared, Patrizia Künzler-Heule: None declared, Peter Villiger: None declared, Diana Dan: None declared, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim, Ulrich Walker: None declared, Dunja Nicca: None declared

Anticoagulation and outcomes after surgical aortic valve replacement with a biological prosthesis

Background

No strong recommendation exists regarding the use of short-term anticoagulation after surgical aortic valve replacement (SAVR) with a biological prosthesis.

Purpose

Our aim was to analyze outcomes of patients receiving warfarin versus low-molecular weight heparin (LMWH) after isolated SAVR.

Methods

We retrospectively analyzed all adult patients who underwent surgery between 2009 and 2017 at our department (n=598). Exclusion criteria included pre-operative anticoagulation, atrial fibrillation, dialysis, previous aortic valve replacement, or active endocarditis. Patients who were discharged alive were stratified according to the type of anticoagulation (warfarin, n=332, 55.5%; LMWH, n=266, 44.5%). Long-term survival during the follow-up period was analyzed (median follow-up, 5.6 years).

Results

Patients who received warfarin had significantly lower logistic EuroSCORE and were younger (Table 1). Warfarin was more frequently utilized between 2009 and 2014, whereas LMWH was more commonly used between 2015 and 2017. Kaplan-Meier curves in Figure 1 show that patients who received warfarin had significantly superior long-term survival (log-rank test: p=0.002). Multivariable Cox proportional hazards regression analysis confirmed that the use of warfarin was associated with significantly lower risk of long-term mortality when compared with LMWH (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.34–0.74, p=0.001). Covariables in this model included logistic EuroSCORE, era, and duration of cardiopulmonary bypass.

Conclusions

The present analysis suggests that the use of warfarin is associated with significantly superior survival after SAVR with a biological prosthesis. Our findings require validation in a prospective randomized controlled trial.

Figure 1. Kaplan-Meier survival curves

Funding Acknowledgement

Type of funding source: None

SAT0652-HPR CHRONIC DISEASE MANAGEMENT AND HEALTH TECHNOLOGY READINESS OF PATIENTS WITH SYSTEMIC SCLEROSIS IN SWITZERLAND – A CROSS-SECTIONAL STUDY

Background:

People living with systemic sclerosis (SSc) often lack access to coordinated, specialized care and self-management support from qualified healthcare professionals. Such gaps lead to significant unmet health needs and inability to get preventive services. The Chronic Care Model (CCM) has been used to guide disease management across a wide range of chronic conditions. The CCM often uses e-health technologies to address self-management problems, connect patients with clinicians and reduce patient travel requirements.

Objectives:

To evaluate current SSc care practice patterns and elicit patient health technology readiness to define relevant aspects and resources needed to improve SSc chronic disease management.

Methods:

We employed a cross-sectional survey using the 20-item Patient Assessment of Chronic Illness Care (PACIC) instrument to assess how aspects of SSc care align with key components of the CCM.1Six items drawn from the ‘5A’ (ask, advise, agree, assist, and arrange) model of behavioural counselling were included (all 26 items scored on 5-point scale, 1=never to 5=always). Acceptance of health technology was evaluated by adapting and combining questionnaires from Vanhoof2and Halwas3. German and French speaking SSc patients (>18 years) were recruited from university/cantonal hospitals and the Swiss scleroderma patients’ association. Participants completed anonymous paper/online questionnaires. Data were analysed descriptively.

Results:

Of 101 SSc patients, most were female (76%), spoke German (78%) and had a median age of 60 years (IQR: 50-68). Median disease duration was 8 years (IQR: 5-15), spanning a range of severity (31% limited SSc, 36% diffuse SSc, 3% overlap syndrome). One-quarter (25%) did not know their disease subset.

The mean overall PACIC score was relatively low (2.91±0.95) indicating that care was ‘never’ to ‘generally not’ aligned with the CCM. Lowest mean subscale scores related to Follow-up/ Coordination (2.64±1.02), Goal setting (2.68±1.07) and Problem-solving/Contextual Counselling (2.94±1.22). The single items ‘Given a copy of my treatment plan’ (1.99±1.38) and ‘Encouraged to attend programs in the community’ (1.89±1.16) were given the lowest ratings. The ‘5A’ summary score was 2.84±0.97.

In terms of technology readiness, 43% completed the survey online. Most participants owned a smartphone (81%), laptop (63%) and/or desktop computer (46%). The overwhelming majority of patients (91%) reported using the Internet in the last year – primarily for communication (e.g. emails, text messages). Participants indicated relatively little experience with e-health applications and participating in SSc online forums or self-help groups.

Conclusion:

To improve chronic disease management of SSc patients in Switzerland, current care practices warrant reengineering taking CCM components into account. Specific unmet needs relate to self-management support, help patients set individualized goals, and coordinate continuous care. Web-based technologies incorporating user-centred design principles may be a reasonable option for improving care.

References:

[1]Glasgow, RE, et al. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC).Med Care2005; 43(5): 436-44

[2]Vanhoof, JM, et al. Technology Experience of Solid Organ Transplant Patients and Their Overall Willingness to Use Interactive Health Technology. J Nurs Scholarsh2018; 50(2): 151-62

[3]Halwas, N, et al. eHealth literacy, Internet and eHealth service usage: a survey among cancer patients and their relatives. J Cancer Res Clin Oncol2017; 143(11): 2291-99

Disclosure of Interests:

Agnes Kocher Grant/research support from: Sandoz to support the development of an eLearning module for patients with rheumatic diseases., Michael Simon: None declared, Carlo Chizzolini Consultant of: Boehringer Ingelheim, Roche, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Andrew A. Dwyer: None declared, Peter Villiger Consultant of: MSD, Abbvie, Roche, Pfizer, Sanofi, Speakers bureau: Roche, MSD, Pfizer, Ulrich Walker Grant/research support from: Ulrich Walker has received an unrestricted research grant from Abbvie, Consultant of: Ulrich Walker has act as a consultant for Abbvie, Actelion, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, Sanofi, and ThermoFisher, Paid instructor for: Abbvie, Novartis, and Roche, Speakers bureau: Abbvie, Actelion, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, and ThermoFisher, Dunja Nicca: None declared

THU0623-HPR REVISION AND VALIDATION OF THE GERMAN VERSION OF THE SYSTEMIC SCLEROSIS QUALITY OF LIFE QUESTIONNAIRE (SSCQOL) WITH MOKKEN SCALE ANALYSIS

Background:

The Systemic Sclerosis Quality of Life Questionnaire (SScQoL) has been validated in six European languages.1Previous adaptation into German revealed issues with the dichotomous response structure in 10 items necessitating a review of the tool and further psychometric testing with patients in German speaking countries.

Objectives:

The aim of this study was to assess the German version of the SScQoL, extend the response structure and test its construct validity using Mokken scale analysis.

Methods:

This was a mixed methods study involving cognitive debriefing and survey methods. The expert committee extended the response structure of the 10 items from dichotomous to polytomous (4-point) responses: ‘always’, ‘usually’, ‘sometimes’ and ‘never’. In cognitive debriefing, a small convenience sample of patients with SSc completed the new version while ‘thinking aloud’ and commented on relevance of the items and the response structure.

Results:

In cognitive debriefing, six patients with SSc completed the new German SScQoL and reported problems with the remaining dichotomous items. These were subsequently converted into polytomous 4-point response structure by the expert committee.

Conclusion:

The German SScQoL has been revised into polytomous item structure and shown to be a valid and reliable measure of health-related quality of life in SSc. Further cross-cultural validity tests are required to assess its measurement equivalence with other SScQoL versions and thus enable multinational comparisons.

References:

[1]Ndosi M, Alcacer-Pitarch B, Allanore Y et al. Common measure of quality of life for people with systemic sclerosis across seven European countries: a cross-sectional study. Ann Rheum Dis, 2018; 77: 1032-1038

Table 1.

Mokken scale analysis of the revised German SScQoL

Subscale (items)Scalability (H)Standard errorFunction (6)0.6640.048Emotional (13)0.6520.060Sleep (2)0.7980.061Social (6)0.6920.053Pain (2)0.9600.029Global scale (29)0.6230.062

Table legend: scalabilityH≥ 0.50 = strong, 0.49 to 0.40 = moderate, 0.39 to 0.30 = weak, while values of < 0.30 are not considered as unidimensional.

Disclosure of Interests:

Agnes Kocher Grant/research support from: Sandoz to support the development of an eLearning module for patients with rheumatic diseases., Mwidimi Ndosi Grant/research support from: Bristol Myers Squibb, Consultant of: Janssen, Pfizer, Kirsten Hoeper Consultant of: AbbVie, Celgene,, Speakers bureau: Abbvie, Chugai, Novartis, Lilly, Celgene, Sandoz Hexal, Michael Simon: None declared, Dunja Nicca: None declared

P1840Mid-term results of bioprosthetic aortic valve replacement with the Trifecta valve: A word of caution

Background

Structural valve deterioration (SVD) with associated bioprosthetic valve dysfunction remains an unsolved problem, exposing patients to the risk of aortic valve re-intervention after surgical aortic valve replacement (SAVR). Several strategies have been proposed to improve prosthesis design for optimal performance. The leaflets of the Trifecta valve are mounted on the outside of the prosthetic stent to achieve a larger orifice area. Although favourable early clinical outcomes have been reported, long-term durability still needs to be assessed.

Purpose

The aim of the current study was to assess the mid-term overall mortality and re-intervention rate in patients who received a Trifecta valve with a follow-up >5 years.

Methods

Patients who underwent SAVR at our centre between 2011 and 2012 were identified in the internal, prospective database. All patients with implantation of a Trifecta valve in aortic position were included. Primary endpoints were freedom from overall mortality and from re-operation at latest follow-up (FU). Additionally, assessment of echocardiographic parameters at baseline and follow-up was performed.

Results

Seventy-six patients (age 77.3±9.5 years, BMI 28.6±5.8, 68% male) were included in the study. EuroScore II was 7.2% (± 7.7) while mean STS-Mortality score was 2.4±1.1%. Of all procedures, 53% were isolated aortic valve replacements, whereas concomitant procedures were performed in 47% of cases (37% CABG, 12% mitral surgery, 8% tricuspid surgery). Baseline echocardiographic assessment showed a mean pressure gradient (MPG) of 51±21 mmHG, a peak pressure gradient (PPG) of 78±36 mmHG and a peak velocity (Vmax) of 4.2±1.1 m/s.

Thirty-day mortality was 7%. Freedom from overall mortality at 1 year and 5 years was 84% and 73%, respectively. Freedom from death and freedom from re-operation at latest FU (6.7±0.5 years) was 68% and 90%, respectively. In a composite endpoint analysis, freedom from death or re-intervention at latest follow up was 60%. A total of 7 patients underwent aortic valve re-interventions (re-replacements n=5, valve-in-valve n=2). Indications for re-interventions were SVD (n=5), NSVD (n=1, pannus ingrowth) and endocarditis (n=1). One case of re-stenosis occurred in a patient who was deemed not feasible for aortic valve re-intervention and died.

Kaplan Meier analysis

Conclusion(s)

To our knowledge, this patient cohort presents with the lowest rate of freedom from re-operation (90%, 6.7±0.5 years) after SAVR with the Trifecta valve. A relatively high number of SVD and NSVD has been observed, which might be attributable to the specific leaflet mounting or the deformable valve frame of the first generation. Current results call for further investigation with prospective echocardiographic follow-up in this patient group.

Acknowledgement/Funding

None

[Nursing role and TPE in patients with lymphoedema of the limbs]

Lymphoedema, primary and secondary after cancer treatment, is a chronic condition which has a significant impact on patients' quality of life. Therapeutic education plays an important role in the initial care and in the follow-up of these conditions.

Home parenteral nutrition is beneficial in systemic sclerosis patients with gastrointestinal dysfunction

OBJECTIVES

To assess 12-month changes in nutritional status and quality of life (QoL) in systemic sclerosis (SSc) patients requiring home parenteral nutrition (HPN).

METHOD

We conducted a retrospective, single-centre database analysis of SSc patients regarding a 12-month period of HPN at an interdisciplinary University Unit/team for nutrition and rheumatic diseases. Nutritional status was analysed by nutritional risk screening (NRS) and body mass index (BMI). QoL was evaluated using Short-Form Health Survey (SF-36) questionnaires.

RESULTS

Between 2008 and 2013, daily nocturnal HPN was initiated in five consecutive SSc patients (four females and one male, mean age 62.2 years) suffering severe malnutrition due to gastrointestinal tract (GIT) involvement. After 12 months of HPN, the mean NRS score decreased from 4.4 (range 4-5) to 1.4 (range 1-2), the mean BMI increased from 19.1 (range 17.4-20.3) to 21.0 kg/m² (range 18.3-23.4). QoL improved in all patients, reflected by the summary of physical components with 33.92 points before vs. 67.72 points after 12 months of HPN, and the summary of mental components with 49.66 points before vs. 89.27 points after 12 months of HPN. Two patients suffered one catheter-related infection each with subsequent surgical removal and reinsertion.

CONCLUSIONS

HPN is a feasible method for improving anthropometric parameters and QoL in SSc patients severely affected by GIT dysfunction. We recommend HPN in malnourished, catabolic SSc patients unable to otherwise maintain or improve their nutritional status.

A rare case of obstructive right atrial lipoma

Benign cardiac tumours are rare and cardiac lipomas account only for a small fraction among those. Most of these tumours differ in terms of clinical manifestation, diagnosis, morphology and size, and are therefore not diagnosed easily unless they become symptomatic. We report the case of a 71-year-old Caucasian woman with recurrent episodes of shortness of breath presenting with an acute exacerbation of dyspnoea and hypertensive crisis. Diagnosis of a right atrial lipoma with a coexisting patent foramen ovale was established on echocardiography and computed tomography, and the patient was evaluated for elective surgery. Comprising the entire free wall of the right atrium, the tumour was removed during open heart surgery on cardiopulmonary bypass. The right atrium and the orifices of both the superior and inferior vena cava were reconstructed with bovine pericardium. No evidence of tumour relapse was observed during successive follow-up visits.

Alemtuzumab in lung transplantation: an open-label, randomized, prospective single center study

Induction therapy with alemtuzumab followed by lower maintenance immunosuppression (IS) has been associated with reduced morbidity and mortality in abdominal and heart transplantation (TX). In the current study, alemtuzumab, in combination with reduced levels of maintenance IS, was compared to thymoglobulin in combination with standard IS. Sixty consecutive patients who underwent lung transplantation (LUTX) at a single center were prospectively randomized in two groups: group A received alemtuzumab in conjunction with reduced doses of tacrolimus, steroids and mycophenolate mofetil. Group B received thymoglobulin in association with standard dose IS. Patient and graft survival, freedom from acute cellular rejection (ACR), lymphocytic bronchiolitis, bronchiolitis obliterans syndrome, kidney function, infectious complications and posttransplant lymphoproliferative disorder were analyzed. Alemtuzumab induction therapy resulted in complete the absence of ACR episodes ≥ A2 within the first year post-TX. The difference to thymoglobulin was significant (alemtuzumab 0 vs. ATG 0.33; p = 0.019). All other factors studied did not show any differences between the two groups. Alemtuzumab induction therapy after LUTX in combination with reduced maintenance IS significantly reduces higher-grade rejection rates. This novel therapeutic agent had no impact on survival, infections rates, kidney function and incidence of malignancies.

Effects of Dietary Additives and Early Feeding on Performance, Gut Development and Immune Status of Broiler Chickens Challenged with Clostridium perfringens

The effects of dietary additives and holding time on resistance and resilience of broiler chickens to Clostridium perfringens challenge were investigated by offering four dietary treatments. These were a negative control (basal), a positive control (Zn-bacitracin) and two dietary additives, mannanoligosaccharides (MOS), and acidifier. Two holding times included (a) immediate access to feed and water post hatch (FED) and (b) access to both feed and water 48 h post hatch (HELD). Chicks fed Zn-bacitracin had no intestinal lesions attributed to necrotic enteritis (NE), whereas chicks fed both MOS or acidifier showed signs of NE related lesions. All dietary treatments were effective in reducing the numbers of C. perfringens in the ileum post challenge. The FED chicks had heavier body weight and numerically lower mortality. The FED chicks also showed stronger immune responses to NE challenge, showing enhanced (p<0.05) proliferation of T-cells. Early feeding of the MOS supplemented diet increased (p<0.05) IL-6 production. The relative bursa weight of the FED chicks was heavier at d 21 (p<0.05). All the additives increased the relative spleen weight of the HELD chicks at d 14 (p<0.05). The FED chicks had increased villus height and reduced crypt depth, and hence an increased villus/crypt ratio, especially in the jejunum at d 14 (p<0.05). The same was true for the HELD chicks given dietary additives (p<0.05). It may be concluded that the chicks with early access to dietary additives showed enhanced immune response and gut development, under C. perfringens challenge. The findings of this study shed light on managerial and nutritional strategies that could be used to prevent NE in the broiler industry without the use of in-feed antibiotics.

Assessing most practical and effective protocols to sanitize hands of poultry catching crew members

Catching crew members can heavily contaminate their hands with organic material. They can act as mechanical vector and spread diseases between farms. Hand hygiene is an important issue for the industry as a whole and for human health by reducing contamination risks. Many studies, in human medicine, tend to make hand rub a standard for hand hygiene. However, few studies have tested the effectiveness of hand hygiene products on visibly contaminated hands. The objective of this study was to evaluate the effectiveness of practical hand sanitization protocols: water and soap, degreasing cream and hand wipes, all combined with alcohol-based hand gel. The use of alcohol-based gel alone was also evaluated. For the reduction of coliforms after washing, there was no statistically significant difference between protocols when the initial level of bacterial contamination was low to moderate. When hands were highly contaminated, the alcohol-based gel alone was less effective than the degreasing cream combined with the alcohol-based gel (p=0.002). As for the reduction in total aerobic bacteria counts, there was no difference between protocols when the initial level of bacterial contamination was low. The water, soap and alcohol-based gel protocol was more effective than the scrubbing wipes and alcohol-based gel protocol when hands were moderately (p=0.002) and highly contaminated (p=0.001). All protocols were effective in neutralizing Salmonella on hands. Reducing the level of bacterial contamination on hands before using an alcohol-based gel seems important to ensure effective hand sanitation for highly and moderately contaminated hands. This can be done by using a degreasing cream or water and soap. Based on the survey, catching crew members preferred using warm water and soap compared to a degreasing cream.

Characterisation and response of intestinal microflora and mucins to manno-oligosaccharide and antibiotic supplementation in broiler chickens

1. An experiment was conducted to characterise and evaluate, in comparison to zinc bacitracin (ZnB), the response of intestinal microflora and mucins to manno-oligosacchares (MOS, Bio-MOS(R), Alltech Biotechnology, Nicholasville, Kentucky, USA). 2. Supplementation of MOS and ZnB selectively increased the intensity of sulphomucins. As revealed by the plate culture method, MOS accelerated the maturation of gut microflora by promoting the growth of lactobacilli in the ileal mucosa and vice versa on ileal and caecal clostridia. Unlike MOS, ZnB suppressed the growth of intestinal bacteria, especially those of lactobacilli and clostridia. Use of T-RFLP further revealed that MOS increased the diversity of lactobacilli in the ileum and ileal mucosa but the opposite was observed for ZnB. It also appears that MOS and ZnB possessed a common property in differentially favouring the growth of certain Lactobacillus species. There was also evidence to show that both MOS and ZnB also increased the homogeneity of the gut microflora, possibly through the regulation of the overall gut bacterial communities. 3. Improvement in intestinal microbial homogeneity and mucin synthesis, coupled with the differential selections for certain specific beneficial bacterial species, may ultimately be proven to be the target mechanisms in the search for more effective alternatives to antibiotics.