An Atypical Course of Cardiomyopathy Syndrome (CMS) in Farmed Atlantic Salmon (Salmo salar) Fed a Clinical Nutrition Diet

Cardiomyopathy syndrome (CMS) poses a significant threat to farmed Atlantic salmon (Salmo salar), leading to high mortality rates during the seawater phase. Given that controlled experimental challenge trials with PMCV do not reproduce the mortality observed in severe field outbreaks of CMS, field trials on natural CMS outbreaks are warranted. This field study explored the impact of a clinical nutrition intervention, specifically a diet enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on a severe CMS outbreak in a commercial sea farm. CMS was diagnosed in a single sea cage with high mortality rates. Histopathological analysis, RT-qPCR in situ hybridization for virus detection, and fatty acid composition analysis were used to monitor the impact of disease and the inclusion of EPA and DHA in heart tissue. Following the implementation of clinical nutrition, a decline in mortality rates, regression of CMS-associated changes, and a significant reduction in piscine myocarditis virus (PMCV) RNA load were observed within the salmon population. Fatty acid composition analysis of heart samples demonstrated increased levels of EPA and DHA, reinforcing the association between dietary factors, viral load dynamics, and overall fish health. Although further validation is needed in future studies, as field trials may not be sufficient to establish causation, our results indicate that optimizing the EPA + DHA levels may prove beneficial in severe CMS outbreaks.

Should more attention be paid to polio sequela cases in China?

Since "Global Polio Eradication Initiative" was launched by World Health Assembly in 1988, the incidence rate of polio has been reduced by more than 99%, and the whole world has entered a post polio era nowadays. China has been a polio free status recognized by World Health Organization for 22 years and most people believe that no more public health concerns need to be given. How is the population of polio survivors in China? What strategies of health economics and actions of public health for those with polio are ethically appropriate? This article, first of all, deeply summarizes and analyzes the history, current situation and unmet needs of population with polio sequelae and post-polio syndrome in China, and then, puts forward important issues faced by polio survivors who natural infected and who due to vaccine associated paralytic polio and vaccine derived poliovirus. The management of polio survivor is not only a medical and rehabilitation problem involving accessibility, accommodations, but also a public health issue, and most importantly, an ethical concern. Furthermore, from the perspective of ethics such as Justice and Cooperation, the author demonstrates the rationality and necessity of continuing to pay more attention to polio sequela cases at this stage in China. Finally, many valuable suggestions and practical recommendations are given.

In-depth health surveillance and clinical nutrition in farmed Atlantic salmon: a strategic attempt to detect and mitigate an HSMI outbreak

Fish health personnel have limited tools in combatting viral diseases such as heart and skeletal muscle inflammation (HSMI) in open net-pen farmed Atlantic salmon. In this study, we aimed to predict HSMI by intensified health monitoring and apply clinical nutrition to mitigate the condition. We followed a commercial cohort (G1) of Atlantic salmon that was PRV-1 naïve when transferred to a sea cage at a location where HSMI outbreaks commonly occur. The fish in the other cages (G2-G6) at the location had a different origin than G1 and were PRV-1 positive prior to sea transfer. By continuous analysis of production data and sequentially (approximately every fourth week) performing autopsy, RT-qPCR (for PRV-1 and selected immune genes), blood and histological analysis of 10 fish from G1 and G2, we identified the time of PRV-1 infection in G1 and predicted the onset of HSMI prior to any clinical signs of disease. Identical sequences across partial genomes of PRV-1 isolates from G1 and G2 suggest the likely transfer from infected cages to G1. The isolates were grouped into a genogroup known to be of high virulence. A commercial health diet was applied during the HSMI outbreak, and the fish had low mortality and an unaffected appetite. In conclusion, we show that fish health and welfare can benefit from in-depth health monitoring. We also discuss the potential health value of clinical nutrition as a mean to mitigate HSMI.

Self-reported vaccination-related behavior patterns among healthcare workers and the association with self-directed learning frequency: A nationwide cross-sectional survey

Background

Healthcare workers play an essential role in improving the public's vaccination uptake, but the full picture of such workers' engagement in vaccination-related behaviors has not been appropriately identified. According to the Integrated Theory of Health Behavior Change, self-directed learning may be a promising intervention for fostering engagement in vaccination-related behaviors, but the association between self-directed learning and such behaviors remains unclear. This study aimed to determine Chinese healthcare workers' level of engagement in behaviors for combatting vaccine-preventable diseases and assess the association between frequency of performing vaccine-focused SDL and engagement in vaccination-related behaviors.

Materials and methods

An online cross-sectional survey was conducted from January 27 to February 21, 2022, using the survey platform "wjx." Respondents were restricted to healthcare workers aged 18-65 years. A Sankey diagram and bar plots were constructed to determine patterns of engagement in a vaccination-related-behavior chain. Unconditional binary logistic regression models were fitted to determine the association between frequency of performing vaccine-focused self-directed learning and engagement in vaccination-related behaviors.

Results

Of the 2,248 survey respondents, data for 2,065 were analyzed. Participants who had received influenza or pneumococcal vaccination, routinely recommended vaccination to patients, tracked patients' vaccination status, and recommended efficiently accounted for 43.2%, 50.8%, 40.3%, and 36.4% of the total participants, respectively. When only considering those who routinely made such recommendations, the proportion of those who performed tracking and efficient recommendation was 28.8% and 26.2%, respectively. When compared to performing self-directed learning "never to less than once/six months," performing self-directed learning "more than once/week" was positively associated with being vaccinated (OR, 95% CI: 2.30, 1.74-3.03), routinely recommending vaccination (OR, 95% CI: 4.46, 3.30-6.04), and tracking the status of patients so recommended (OR, 95% CI: 6.18, 4.35-8.76).

Conclusions

Chinese healthcare workers' pattern of engagement in vaccination-related behaviors must be improved. Higher frequencies of engagement in self-directed learning are associated with more active engagement in vaccination-related behaviors, meaning raising such frequencies could be a promising intervention for fostering behavior changes in this regard and ultimately increasing vaccination coverage.

Clinical Decision Support May Link Multiple Domains to Improve Patient Care: Viewpoint

Integrating clinical decision support (CDS) across the continuum of population-, encounter-, and precision-level care domains may improve hospital and clinic workflow efficiency. Due to the diversity and volume of electronic health record data, complexity of medical and operational knowledge, and specifics of target user workflows, the development and implementation of comprehensive CDS is challenging. Additionally, many providers have an incomplete understanding of the full capabilities of current CDS to potentially improve the quality and efficiency of care delivery. These varied requirements necessitate a multidisciplinary team approach to CDS development for successful integration. Here, we present a practical overview of current and evolving applications of CDS approaches in a large academic setting and discuss the successes and challenges. We demonstrate that implementing CDS tools in the context of linked population-, encounter-, and precision-level care provides an opportunity to integrate complex algorithms at each level into a unified mechanism to improve patient management.

Living With COVID-19: A Systemic and Multi-Criteria Approach to Enact Evidence-Based Health Policy

The lifting of COVID-19 (coronavirus disease 2019) lockdown requires, in the short and medium terms, a holistic and evidence-based approach to population health management based on combining risk factors and bio-economic outcomes, including actors' behaviors. This dynamic and global approach to health control is necessary to deal with the new paradigm of living with an infectious disease, which disrupts our individual freedom and behaviors. The challenge for policymakers consists of defining methods of lockdown-lifting and follow-up (middle-term rules) that best meet the needs for resumption of economic activity, societal wellbeing, and containment of the outbreak. There is no simple and ready-to-use way to do this since it means considering several competing objectives at the same time and continuously adapting the strategy and rules, ideally at local scale. We propose a framework for creating a precision evidence-based health policy that simultaneously considers public health, economic, and societal dimensions while accounting for constraints and uncertainty. It is based on the four following principles: integrating multiple and heterogeneous information, accepting navigation with uncertainty, adjusting the strategy dynamically with feedback mechanisms, and managing clusters through a multi-scalar conception. The evidence-based policy intervention for COVID-19 obtained includes scientific background via epidemiological modeling and bio-economic modeling. A set of quantitative and qualitative indicators are used as feedback to precisely monitor the societal-economic-epidemiological dynamics, allowing tightening or loosening of measures before epidemic damage (re-)occurs. Altogether, this allows an evidence-based policy that steers the strategy with precision and avoids any political shock.

Population health and medicine: Policy and financial drivers

PURPOSE

The financial and policy levers of population health and potential opportunities for pharmacists are described.

SUMMARY

Three long-standing problems drive the focus on population health: (1) the United States suffers far worse population health outcomes compared with those of other developed nations that spend significantly less on healthcare, (2) the U.S. healthcare system's focus on "sick care" fails to address upstream prevention and population health improvement, and (3) financial incentives for healthcare delivery are poorly aligned with improvements in population health outcomes. The Patient Protection and Affordable Care Act of 2010 (ACA) was arguably the first major healthcare legislation since 1965 and had 3 main strategies for improving population health: expand health insurance coverage, control healthcare costs, and improve the healthcare delivery system. Federal and state legislation as well as Medicare and Medicaid financing strategies have designated mechanisms to reward advances in population outcomes since the passage of the ACA. States are responsible for many of the factors that affect population health, and a bipartisan effort that builds upon state and federal collaboration will likely be needed to implement the necessary health policy initiative. Population health issues affect productivity in the United States; conversely, improvements in population health may increase productivity, helping to offset the rising federal debt. Employers are in a position to improve population health and consequently help reduce the federal debt by addressing lifestyle, chronic disease, poverty, and inequality. National pharmacy organizations, regulatory bodies, and journal editors need to collectively agree to a threshold of quality and rigor for publication and endorsement.

CONCLUSION

Knowledge of the policy and financial drivers of population health may both support pharmacists' efforts to improve population outcomes and identify opportunities for professional advancement.

Interventions and observations associated with survival of orphaned shelter kittens undergoing treatment for diarrhea

OBJECTIVES

The objective of this study was to identify significant associations between treatment interventions and survival of orphaned shelter kittens with diarrhea.

METHODS

Orphaned kittens admitted to a large open-intake municipal animal shelter and entering a volunteer foster care provider network between April 2016 and July 2017 were studied. Individual orphaned kittens for which the care provider sought examination by shelter veterinarians because of clinical signs of diarrhea were included. Treatments administered were recorded and their association with kitten survival to adoption or transfer to a rescue partner was statistically examined.

RESULTS

A total of 1718 orphaned kittens were fostered, among which 220 kittens (12.8%) from 118 different litters were presented for evaluation of diarrhea. A total of 172 (78.2%) kittens underwent treatment for their diarrhea, among which 153 (89.0%) survived to adoption or transfer to a rescue partner and 19 (11.0%) died or were humanely euthanized. Kittens with diarrhea that were ⩾4 weeks of age were 24.8 times more likely to survive (95% confidence interval [CI] 6.8-89.8; P <0.0001). While controlling for age, kittens that received a vitamin and mineral supplement were 12.8 times more likely to survive (95% CI 3.1-52.5; P = 0.0004) than kittens with diarrhea that did not receive the supplement. Treatment with subcutaneous fluids, penicillin G, tube feeding, a probiotic containing Enterococcus faecium SF68, ponazuril or metronidazole did not statistically significantly increase the survival of kittens with diarrhea.

CONCLUSIONS AND RELEVANCE

Age ⩾4 weeks and treatment of diarrhea with a vitamin and mineral supplement favorably improves survival of orphaned kittens to adoption. Application of these findings are likely to improve the health and welfare of this population and contribute to a refinement in use of shelter resources.

Clinically Prepared Veterinary Students: Enhancing Veterinary Student Hands-on Experiences and Supporting Hospital Caseload Using Shelter Medicine Program

Referral-level medicine is important in the veterinary curriculum, however veterinary students also need a solid base knowledge of clinically relevant, routine surgical and diagnostic skills to be clinically prepared after graduation. Exposure to a referral-only, or primarily referral caseload, does not always provide veterinary students with the routine hands-on experiences and competencies expected by the American Veterinary Medical Association Council on Education, the Royal College of Veterinary Surgeons, the Australian Veterinary Boards Council, or prospective employers. The aim of this descriptive study was to assess how a shelter medicine program can fill the companion animal caseload gap and create the necessary hands-on experiences considered essential in the veterinary curriculum. Pedagogical frameworks, course curriculum and design, student experiences, and student assessments were described for three core curricular areas (surgery, medical days, population medicine) of the Shelter Medicine Program at Mississippi State University. The shelter surgery experience provided a high-quality, high-volume spay/neuter environment where fourth-year students averaged 65 sterilization surgeries in two weeks and demonstrated a quantifiable decrease in surgical time. The shelter surgery experience added on average 9,000 small animal cases per year to the overall hospital caseload. Shelter medical days, where students provide veterinary care during on-site shelter visits, created opportunities for third-year students to directly interact with shelter animals by performing physical examinations and diagnostic testing, and to gain experience in developing treatment protocols and recommendations for commonly encountered problems. The shelter medical days experience averaged over 700 small animal cases per year and over 1,500 diagnostic procedures. Finally, students participated in 15 onsite shelter consultations where they obtained a working knowledge of biosecurity at a population level, including how to minimize the risk of infectious diseases spreading to healthy populations. Despite several challenges, results from this curricular program assessment support the aim that animal shelters and humane organizations offer opportunities that can be mutually beneficial for both animal organizations and veterinary students. The primary care caseload for the teaching institution was positively impacted, and students were better prepared to meet potential employers’ expectations and fulfill required core competencies in veterinary medical education.

Patients Are Our Teachers

In the patient-physician encounter, physicians hone their skills while alleviating the patient's suffering. Both benefit. Leaning on the work of Hippocrates, Darwin, and William Osler, the authors sketch out the case for honoring patients as indispensable teachers of the art and science of medicine. They argue that this tradition of Hippocratic medicine both anticipates modern precision medicine and reawakens a focus on public health medicine, each a benefit to the patients and communities served by physicians. A community that compromises the learning relationship of physician to patient and population undermines quality of care.

"Thank You for Giving Me a Voice!" A Longitudinal Evaluation of Patients' Experience of Partnering With Students in an Australian Medical School

BACKGROUND

We evaluated the patient-partner experience in a longitudinal program called Integrated Population Medicine in the Sydney Medical School to assess its acceptability. The program exposed senior medical students to the lived experience of chronic disease.

METHODS

We surveyed 267 people with chronic conditions recruited as patient-partners by the 2012 student cohort in a mixed-methods longitudinal cohort study. Surveys were administered 'over' 18 months: before, during, and after the program.

RESULTS

A total of 155 (58%) patient-partners completed the baseline survey; 52 patients returned all 3 surveys. Patient-partners remained very positive about the program across all surveys. More than 95% of respondents enjoyed interacting with the student, and most were very positive about their role in teaching the student. Three major themes emerged: willingness to help, a sense of gratitude and enjoyment, and a chance to teach and learn. Participants were willing to discuss their illness experiences and were keen to spend more time with students.

CONCLUSIONS

Patients are willing participants in longitudinal patient-partner programs. They perceive benefits for themselves and others, for the health system, and for students and would like to become more actively involved in medical education.

Integrating Population and Clinical Medicine: A New Third-Year Curriculum to Prepare Medical Students for the Care of Individuals, Panels, and Populations

Population and Clinical Medicine (PCM) I & II constitute two of the nine courses established for the Warren Alpert Medical School of Brown University's (AMS) innovative dual-degree Primary Care-Population Medicine (PC-PM) program. The courses will run consecutively during students' third year in the program, in conjunction with the Longitudinal Integrated Clerkship (LIC). Throughout the courses, students will examine the intersection between population and clinical medicine with a focus on vulnerable populations, the social and community context of care, quality improvement, and leadership. In addition to attending class sessions in which students will engage with leaders in relevant fields, students will also draw from patient and population-level experiences in the LIC to plan and implement two projects: a community-based intervention to address a particular health issue, and a quality improvement project to change a small aspect of care delivery at a clinical site. Finally, leadership skills development sessions will be incorporated, and leadership practice will occur during implementation of student projects.