Sustainability and economic investments in animal health systems

The paper outlines a framework for shaping and prioritising improvements to investments in animal health systems in order to improve their sustainability. The framework includes financial inputs that can be separated between core investments and day-to-day expenditures. The latter financial inputs should differentiate between avoiding losses in production and reducing wider societal impacts such as negative implications for trade and the environment. Overall the framework provides information on the financial costs of the animal health system and the animal health outcomes that, if collected over time, will allow the efficiency of resource use across the system to be measured. It discusses an application of the framework using existing data, which highlighted problems with measuring and costing veterinary inputs, and with quantifying the range of outputs and the impact of veterinary activities. The paper recommends that the framework proposed is reviewed and compared with work that has been carried out on the human health accounting systems. A true application of the framework will require data sets that can differentiate between public-sector, private-sector and non-governmental organisation investments and the cost of day-to-day animal health goods and services paid by animal owners. Data sets are also needed on animal health outcomes in order to compare investments with animal health outcomes and thereby: demonstrate the success of previous investments, identify weaknesses in the investment profile and ensure that future investments sustain an animal health system, which functions well.

A mixed method evaluation of adult tier 2 lifestyle weight management service provision across a county in Northern England

Adult obesity in the UK remains a public health priority. Current guidance recommends local areas provide multicomponent interventions to treat adults with overweight and obesity; however, there is currently a dearth of published evidence on the evaluation of these programmes. This study reports on a mixed method evaluation of seven tier 2 weight management programmes funded by a local authority in the North of England through their public health grant (a lifestyle multicomponent weight management programme for the treatment of adults with overweight and obesity, but not severe obesity, or obesity with severe co-morbidities). Data collected from over 2000 participants demonstrated that the proportion of participants achieving 5% initial body weight loss was comparable to that reported in recent UK weight management trials. Two services exceeded national criteria of 30% of participants achieving 5% initial body weight loss at 12 weeks, although long term data was limited. Greater weight loss was also observed in participants aged 35-44 and those without co-morbidities. This study provides important learning points for improvements in real world weight management services, these include: standardised data collection and management tools; staff training and communication requirements; the importance of programmes that are joined up to wider support services; and the importance of providing ongoing peer and provider support, continuous monitoring and feedback, and physical activities tailored to user needs.

Radiation Therapy as an Alternative Treatment for Desmoid Fibromatosis

AIM

To determine the outcome after radiation therapy for desmoid fibromatosis.

MATERIALS AND METHODS

A retrospective review of 50 patients treated between 1988 and 2016 in a specialised bone and soft tissue tumour clinic.

RESULTS

The median age at the time of radiation therapy was 36.8 years (range 15.1-69.0) and the median follow-up time was 51 months. Forty-three patients underwent radiation therapy as the definitive treatment with a median dose of 56 Gy (range 30-58.8 Gy). The median dose for the seven patients treated with postoperative radiation therapy was 50.4 Gy (range 48-56 Gy). Eleven patients (22%) developed progressive disease after radiation therapy at a median time of 41 months (range 12-113 months). The recurrences were within the radiation therapy field in four patients and outside the field in seven patients. One patient developed a radiation-induced malignancy 20 years after treatment.

CONCLUSIONS

Radiation therapy is an alternative treatment in the management of desmoid fibromatosis. It should be considered in patients for whom surgical resection is not feasible, or as adjuvant therapy after surgery with involved margins where any further recurrences would cause significant morbidity.

Non-Invasive Estimation of Cardiac Index in Healthy Volunteers

The primary objective was to non-invasively measure the cardiac index (CI) and associated haemodynamic parameters of healthy volunteers and their changes with age. This was a single centre, prospective, observational study of healthy volunteers aged between 20 and 59 years, using the ClearSight™ (Edwards Life Sciences, Irvine, CA, USA) device. We recorded 514 observations in 97 participants. The mean CI was 3.5 l/min/m2 (95% confidence interval [95% CI] 3.4 to 3.7 l/min/m2). The mean stroke volume index (SVI) was 47 ml/m2 (95% CI 45 to 49 ml/m2) and the mean systemic vascular resistance index was 2,242 dyne·s/cm5/m2 (95% CI 2,124 to 2,365 dyne·s/cm5/m2). There was an inverse linear relationship between increasing age and CI (P <0.0001), which decreased by 0.044 l/min/m2 (95% CI −0.032 to −0.056 l/min/m2) per year. This change was mostly due to a decrease in SVI of 0.45 ml/m2 (95% CI 0.32 to 0.57 ml/m2) per year (P <0.0001). The mean CI of young healthy humans is approximately 3.5 l/min/m2 and declines by approximately 40 ml/min/m2 per year, mostly due to a decline in stroke volume (SV). These findings have significant implications regarding the clinical interpretation of haemodynamic parameters and the application of these results to individual patients.

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

AIM

This systematic review investigates associations between maternal pre-pregnancy/early-pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women.

METHODS

Twelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base.

RESULTS

Twenty-two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross-sectional studies. Results suggested that in South Asian women, maternal pre-pregnancy/early-pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre-anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post-natal weight retention and post-natal impaired glucose tolerance. The evidence suggested a combined effect of pre-pregnancy/early-pregnancy anthropometrics and gestational anthropometric change on both GDM and post-natal weight retention.

CONCLUSION

The increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.

The impact of early life nutrition and housing on growth and reproduction in dairy cattle

Contentious issues in calf rearing include milk feeding practices and single versus group housing. The current study was performed on a high producing 170 Holstein cow dairy farm, to investigate the impact of nutrition and housing on growth and reproduction. Heifer calves (n = 100) were allocated in birth order to one of two commonly used management strategies. All calves received 3-4 litres of dam specific colostrum within 6 hours of birth. Group A calves were group housed from birth and fed milk replacer (MR) ad libitum via a computerised machine utilising a single teat, with weaning commencing at 63 days of age. Group R calves were initially housed in individual pens and received 2.5 litres of MR twice daily via a bucket until 21 days of age when they were group housed and fed 3 litres of MR twice daily via a group trough with weaning commencing at 56 days. From 12 weeks of age onwards, calves in both dietary groups were subject to common nutritional and husbandry protocols. All breeding of heifers was via artificial insemination with no hormonal intervention. Calves were weighed, body condition scored and morphometric measures recorded weekly up till 12 weeks of age then monthly until conception. Pre-weaning growth rates (kg/day) were significantly higher in Group A calves compared to Group R (0.89, 95% CI 0.86-0.93 vs 0.57, 95% CI 0.54-0.6 kg/day P < 0.001) with the most marked differences observed during the first three weeks of life (0.72, 95% CI 0.61-0.82 vs 0.17, 95% CI 0.08-0.26 P < 0.001). Whilst Group A calves gained body condition score (BCS) throughout the pre-weaning phase, Group R calves lost BCS during the first 4 weeks of life. Data suggested that Group R calves supported skeletal growth during this period by catabolising body tissue. Group A calves had a greater risk of disease than group R calves during the pre-weaning phase (diarrhoea: odds ratio 3.86, 95% CI 1.67-8.9; pneumonia: odds ratio 5.80, 95% CI 2.33-14.44) although no calves died during this period. Whilst pneumonia had a significant impact on growth during the study duration (P = 0.008), this was not the case for diarrhoea. Whilst univariate analysis failed to show any statistically significant group differences (P > 0.050) in any of the mean values of measured reproductive parameters, multivariable Cox regression suggested that there was a weak trend (P = 0.072) for Group A animals to achieve first service earlier than their Group R counterparts (62.6 weeks versus 65.3 weeks). Irrespective of dietary group, the hazard for achievement of all measured reproductive parameters, apart from time to puberty, was 20-40% less for heifers borne from multiparous dams compared to heifers from primiparous dams.

Abstract TP212: 24 S -Hydroxycholesterol as a Serum Biomarker for Acute Stroke

Introduction: Several serum based biomarkers for acute stroke have been identified, but the clinical values of these biomarkers have not been realized due to inadequate sensitivity and specificity in their measurements. 24 S -Hydroxycholesterol is a stable metabolite of cholesterol synthesized by neurons of the CNS, and released to the serum at a constant rate.

Hypothesis: We hypothesized that serum 24 S -Hydroxycholesterol would be an ideal biomarker for acute stroke.

Methods: Acute stroke patients presenting to ED were enrolled after informed consent. Serum samples were collected in ED and levels of 24 S -Hydroxycholesterol were determined by mass spectrometry. We enrolled 63 patients from October 2015 to October 2016. Of these 63 patients, 60 presented within 8 hours from onset of symptoms. Patients were categorized as no stroke, ischemic stroke, and intracerebral hemorrhage. We compared serum 24 S -Hydroxycholesterol levels in each group and the variation in 24 S -Hydroxycholesterol levels with regard to presenting NIHSS.

Result: Out of the 63 patients enrolled, 22 did not have a stroke, 36 had ischemic stroke, and 5 had intracerebral hemorrhage. The mean 24 S -Hydroxycholesterol levels were 54 ng/ml, 58 ng/ml and 75 ng/ml in the no stroke group, ischemic stroke group and intracerebral hemorrhage group, respectively. No correlation was observed between NIHSS and 24 S -Hydroxycholesterol levels. Difference in 24 S -Hydroxycholesterol levels between no stroke and intracerebral hemorrhage patients was statistically significant, but was limited by the small sample size (P = 0.047).

Conclusion: 24 S -Hydroxycholesterol may be a useful serum biomarker for intracerebral hemorrhage. Analyses in a larger population is needed to determine the practical importance of this biomarker.

Use of a depot steroid formulation with CHOP-based protocol in the treatment of mediastinal lymphoma in cats

The aims of this retrospective study were to evaluate the efficacy of different steroid formulations (depot vs oral) and if the continuous administration of steroids throughout and beyond a CHOP protocol might improve the survival time and rate of cats with mediastinal lymphoma. The medical records of client-owned cats diagnosed with mediastinal lymphoma were reviewed at two veterinary referral hospitals in Spain. Cases were recruited from 2008 to 2016. Those cats with mediastinal lymphoma treated with chemotherapy were used in the collection of data including surgical procedures, chemotherapy protocol, side effects, complete remission (CR), partial remission and survival time were calculated from time of diagnosis. The median survival time (MST) of group with depot steroid was 370.7 days and all cats are still alive. The MST of group with oral steroid was 267.9 days. The survival distributions were found to be significantly different. The use of depot injectable steroids with a CHOP-based protocol seems to result in a longer survival time in patients with mediastinal lymphoma when comparing the survival distribution for those receiving oral steroids with a CHOP-based protocol. Prospective studies with a higher number of cats are warranted to investigate the utility of injectable steroids depot with a CHOP-based protocol in the treatment of mediastinal lymphoma.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose

BACKGROUND

Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team.

METHODS

The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status.

RESULTS

The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE.

CONCLUSIONS

The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.