Securing access to personnel and materials in transboundary animal disease responses

A lack of human and material resources can limit effective responses to animal disease emergencies. Drawing upon examples from Australia and New Zealand, this paper proposes a framework for identifying human and material resources and securing the necessary personnel and materials before or during an animal disease emergency. This staged process involves: a) assessing the nature of the risks to be managed, b) identifying the types of resources required, c) assessing available resources and identifying gaps and d) developing arrangements to ensure availability of resources. It discusses the advantages and disadvantages of different strategies to secure access to human and material resources, including whole-of-government arrangements to access other government resources, national and international reserve models for responders, just-in-time employment and purchase of materials, and purchase of stockpiles.

Clinical efficacy and tolerance of an extract of green-lipped mussel (Perna canaliculus) in dogs presumptively diagnosed with degenerative joint disease

AIM

To evaluate the efficacy and tolerance of an extract of green-lipped mussel (GLME) in the management of mild-to-moderate degenerative joint disease (DJD) in dogs.

METHODS

Eighty-one dogs presumptively diagnosed with DJD were treated orally daily with either GLME or a placebo for 56 days, in a double-blind, placebo-controlled study. In an uncontrolled open-label extension to the study, all dogs were treated with GLME for an additional 56 days (from Days 57-112). Clinical signs were subjectively scored by the owners, and findings of detailed musculoskeletal examinations were scored by one veterinarian. Efficacy was assessed from a qualitative comparison of the proportion of dogs with improved clinical signs, and a quantitative comparison of the scores of the musculoskeletal examinations, between groups. Haematological and biochemical analyses and reports by owners of possible adverse drug reactions were used to screen for evidence of toxicity.

RESULTS

There was close agreement between assessments by the veterinarian and owners. The clinical signs of DJD in both GLME-treated and placebo groups improved significantly over baseline by Day 28; this improvement continued over the entire course of the study. There were no significant differences between groups on Day 28. On Day 56, a higher proportion of dogs in the GLME-treated group had improved clinical signs (p=0.018), and GLME-treated dogs had marginally better (p=0.053) musculoskeletal scores than dogs in the placebo group. The differences between the groups were no longer apparent by Day 112, by which time the former placebo group had been receiving GLME for 56 days in the open-label phase of the study. The proportion of dogs in the former placebo group that had improved by Day 112 (29/32; 91%) was significantly greater (p=0.012) than the proportion improved at Day 56 (15/37; 41%). No signs of toxicity were apparent.

CONCLUSIONS AND CLINICAL RELEVANCE

GLME had a beneficial effect on the clinical signs of dogs presumptively diagnosed with mild-to-moderate DJD. Long-term therapy may be required before improvement is apparent.

Consequences of disease: testing the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH) model

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) model proposes that there are three consequences of disease, impairment (I), disability (D) and handicap (H) and that they are sequentially related. This paper examines first, whether I, D and H can be measured independently and second, whether there is support for the sequential or causal relationship between the three constructs. Cross-sectional data from a representative sample of 101 disabled adults and longitudinal data from 108 myocardial infarction (MI) and 68 Stroke patients were used. Standard measures of I were used for each clinical condition. Measures of D and H were derived from the British version of the Sickness Impact Profile (SIP) and additional measures of D were available for the Stroke group. Judges classified SIP items according to ICIDH definitions of D and H. Correlation, Confirmatory Factor Analyses and Path Analyses were used to examine the main hypotheses. Valid measures of D and H were derived and there was evidence of separation of the three constructs for the Stroke patients but not for the other groups. For both Stroke and MI, I was not predictive of D and H. For Stroke, the best path model included a path from D to H, but not from H to D and this was found for self-report and performance measures of D. Using these measures, the ICIDH model was supported in that D predicted H for stroke, but there was no support for a path between I and D or between I and H. Further it was not always possible to distinguish the three constructs. Possible limitations in the measures and in the ICIDH model as a testable scientific model are discussed.

Problems with the sickness impact profile: a theoretically based analysis and a proposal for a new method of implementation and scoring

The Sickness Impact Profile (SIP) is one of the most widely used health status measures, but there are problems with the measure that lead to inconsistent and illogical scores. There are many desirable features to the SIP development methodology in that it is based on a good range of items and the item weightings are valuable. The current method of scoring the SIP is the use of a summated total and was selected based on limited empirical evidence. However, in this paper we argue that there are problems with the SIP because the current empirically derived method of scoring is incompatible with both the underlying theoretical scaling framework (Thurstone scaling) and the nature of the items in the SIP. In addition, the items do not have properties consistent with the scaling methodology. We suggest that it is crucial to take both a theoretical and empirical approach to selecting a scoring method. To examine problems associated with the SIP we explored the underlying scaling methodology and identified the types of items in the SIP. A new method of scoring is proposed that is consistent with the items and scaling in the SIP, namely using the maximum individual weighting from the items that were checked as a category score. This new method of scoring resolves many of the previously observed problems in the SIP. The new method of scoring also presented the opportunity for a new implementation of the SIP that reduces the number of items that most respondents, especially those with severe limitations, would be asked. Without taking a theoretical approach to scoring we suggest that subsequent, empirically based, scale amendments are unlikely to solve the problems. It is proposed that this new method of scoring justifies a thorough empirical investigation.

Construct validation of the hospital anxiety and depression scale with clinical populations

OBJECTIVE

the hospital anxiety and depression scale (HADS) attempts to measure anxiety and depression without confounding by somatic symptoms of physical disorder, and is widely used for this purpose. This paper addresses three questions about the validity of the HADS concerning its independence of physical symptoms, the extent to which its items robustly measure the identified constructs with varying clinical populations and situations, and its capacity to differentiate anxiety and depression.

METHODS

data from patients with breast disease, myocardial infarction (MI), and stroke were examined using factor analytic and psychometric analyses.

RESULTS

using exploratory factor analysis in patients with breast disease, 13 of the 14 HADS items fell on a psychological factor and loadings on the psychological factor were higher than loadings on the somatic factor for all items. The HADS showed high levels of internal consistency and there was little evidence that removing items would improve it. Confirmatory factor analyses (CFA) in MI and stroke groups confirmed the separation of anxiety and depression. Analyses indicated items, which were performing poorly for these clinical groups.

CONCLUSIONS

there was support for the validity of the HADS for all three questions. However, there were some evidences of individual items performing poorly. Given the ease of administration and the acceptability of this measure to ill or weak respondents, the HADS continues to perform satisfactorily.

Use of single-frequency bioimpedance at 50 kHz to estimate total body water in patients with multiple organ failure and fluid overload

OBJECTIVE

To investigate the relationship between single-frequency bioimpedance at 50 kHz (both total body impedance and segmental impedance) and total body water, measured using tritiated water in the presence of the severe fluid retention seen in multiple organ failure.

DESIGN

Prospective, controlled study.

SETTING

General intensive care unit.

SUBJECTS

Twenty patients with multiple organ failure and 30 normal volunteers, of whom a subgroup of ten had total body water measured.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Total body water and total and segmental bioimpedance values at 50 kHz were measured using tritiated water and a Holtain body composition analyzer in 20 patients with multiple organ failure and in ten normal volunteers. An additional 20 normal volunteers also had segmental and total body impedance measured. There was no difference in the linear regression lines constructed for the patients and the volunteers, but the SEM in the patients (7.6 L) was four times that seen in the normal subjects (1.9 L). In a further seven patients, the impedance technique overestimated the change in total body water, deduced from acute changes in weight, by between 0% and 46% (median, 12%). In the patients, who were supine, the knee-ankle segment contributed significantly more to total body impedance than it did in the normal volunteers (42.5% vs. 34.4%; p < .001), who were upright and mobile immediately before the measurement.

CONCLUSIONS

Although single-frequency bioimpedance does give an indication of total body water and change in total body water, it is neither precise nor accurate enough to be the sole guide to fluid therapy. The proportion of total impedance contributed by the knee-ankle segment, which contains relatively little water, was significantly greater in the patients than in the controls, probably reflecting better drainage of fluid from the lower limb in the supine position.

Impact on patients and partners of inpatient and extended cardiac counseling and rehabilitation: a controlled trial

OBJECTIVES

This study evaluated the effectiveness of cardiac counseling and rehabilitation programs led by a nurse counselor, compared with normal care on outcomes for myocardial infarction (MI) patients and their partners.

METHODS

A randomized controlled trial with follow-up to 1 year was conducted with 100 patients recruited within 72 hours of a first MI and their partners: a Control group received normal care; an Inpatient group received cardiac rehabilitation from a nurse counselor while in hospital; and an Extended group received the same cardiac rehabilitation as the Inpatient group, but with additional sessions continuing up to 6 weeks after discharge from hospital. The scales for main outcome measures were 1) knowledge of heart disease and treatment (correct, misconceptions, and uncertainty); 2) mood (Hospital Anxiety and Depression Scale); 3) satisfaction; 4) disability (Functional Limitations Profile).

RESULTS

Inpatient cardiac counseling and rehabilitation resulted in more knowledge, less anxiety, less depression, and greater satisfaction with care in both patients and partners and in less disability in patients, with effects enduring to 1 year. There was some evidence of additional benefit from the Extended program. Both nurse counselors achieved benefits on all outcome variables.

CONCLUSIONS

This Inpatient cardiac counseling and rehabilitation program resulted in significant and enduring benefits of clinical value. It is likely that it would be acceptable to most post-MI patients, many of whom are not offered or are unable to accept outpatient cardiac rehabilitation.

Adolescent immunization: focus on implementation

On March 11-12, 1996, a workshop on how to implement new adolescent immunization (AI) recommendations was held in Atlanta, Ga. Sponsored by the Centers for Disease Control and Prevention, it was a collaborative effort of the National Immunization Program, the Division of Adolescent and School Health/National Center for Chronic Disease Prevention and Health Promotion, and the Hepatitis Branch/National Center for Infectious Diseases. The workshop brought together organizations and individuals interested in adolescent health and immunizations so they could address how new AI recommendations can be implemented most effectively. This article offers an overview of their discussions and suggestions, including issues of cooperation, education, legislation, and AI program development among health provider organizations, health department, schools, community groups and various other agencies relating to adolescent health services.

Bears, academia, and anaesthesia: a controlled study

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Why doctors and nurses must not kill patients

Euthanasia continues to be a subject of lively interest to many groups in society. It is often discussed in terms which appeal to those who believe there is no other way to relieve the sufferings of the dying, but which fail to explore its important ethical, professional and legal aspects. When these are examined, it is seen that the legalization of euthanasia would create major problems in medicine and nursing, chiefly centred on the likelihood of abuse and the difficulty or impossibility of its detection. It is now known from official sources that in Holland, the only place where euthanasia is widely practised though in defiance of the law, the authorities have no control over it, and it is indeed associated with many abuses, including the frequent killing of persons without their consent.

The effect of haematocrit on transthoracic electrical impedance and on the calculation of cardiac output by an impedance cardiograph

The Transthoracic electrical impedance (TEI) was measured using the Bomed NCCOM3 non-invasive cardiac output monitor in 27 patients with polycythemia rubra vera (PCRV) and in a control group of 27 patients with normal haematocrits. The mean haematocrit was 49.4% (SD 2.61) in the patients with PCRV and 42.1% (SD 2.95) in the control group, a difference that was significant (p less than 0.001). The mean TEI was also significantly higher in patients with PCRV than in the control group (p less than 0.05), the respective values being 31.25 (5.48) Ohms and 27.5 (3.31) Ohms. The mean values for cardiac output (CO) and cardiac index (CI) were similar in both groups.

Does geographical location influence inflow requirements of the Bain breathing system?

A review of publications from various countries, using the Bain system with a fresh gas flow of 70 ml kg-1 min-1 and controlled ventilation, show a range of mean PaCO2 values between 36 and 43 mmHg. It was suggested that these differences could be related to the geographic location of the patient population studied. Anaesthetists from seven institutions in West Germany, England, Sweden, the United States, Australia and Canada collaborated in a preliminary study designed to find out whether these differences could be reduplicated. In 142 patients under a standard anaesthesia with controlled ventilation, PaCO2 values were determined 30 min after the fresh gas flows had been set. For 70 ml kg-1 min-1 the mean PaCO2 values ranged from 33 to 40 mmHg; for 100 ml kg-1 min-1 from 28 to 35 mmHg. Compared to the mean PaCO2 values from Canada, the results from Australia and the USA were not different and all at the lower end of this range; Sweden, West Germany and England reported significantly higher PaCO2 values. In the absence of any other obvious explanation, we suggest that patients in England and Northern Europe could have a higher CO2 output under anaesthesia than North American or Australian patients.

Pigeon herpesvirus confirmed in South Africa

The history, geographical distribution, clinical signs, pathology and virology of pigeon herpesvirus infection and pigeon herpesvirus encephalomyelitis are briefly reviewed. A case of pigeon herpesvirus infection was diagnosed on clinical, macro- and histopathological appearance and confirmed by isolation of the virus in embryonated eggs, its growth in tissue culture, and by electron microscopy.

Immune response to the simultaneous vaccination of day-old chickens with live and inactivated oil-based Newcastle disease vaccines

THe immune response, as measured by the haemagglutination-inhibition test, to the simultaneous administration of live Hitchner B1 and 2 commercially available, inactivated, oil-based, emulsified, Newcastle disease vaccines at day-old is described. The response was monitored from day-old to 18 weeks, when the birds were challenged with a standardized virulent virus. It was found that the haemagglutination-inhibition titre fell below log2 5 when the chicks were 10 weeks of age. Challenge at 18 weeks yielded a mortality rate of 25% in the groups receiving both live Hitchner B1 and an oil-based vaccine in comparison with 94% in the group receiving Hitchner B1 alone. Simultaneous application of live and oil-based vaccines at day-old is conclusively insufficient to maintain adequate protection until 18 weeks and it is recommended that a booster vaccine be administered at 10 weeks.

Methods of conserving carbon dioxide in artificially ventilated patients: a clinical investigation

A technique is described for maintaining the PaCO2 within, or close to, the normal range in patients hyperventilated using the Mapleson D Circuit or the Circle system with the soda-lime excluded. Control is achieved by limiting the fresh gas inflow to 4-5 litres/minute.

Some adverse physiological effects of hypocarbia and methods of maintaining normocarbia during controlled ventilation--a review

Some of the adverse physiological effects of hypocarbia are described and the methods available to maintain the PaCO2 within or near the normal range during controlled ventilation are reviewed.