Ancillary Treatments Research Articles

Diagnosis, treatment and outcomes for koala chlamydiosis at a rehabilitation facility (1995–2005)

To document the application of diagnostics and treatments at one rehabilitation facility over 10 years and their effects on recovery and post-release survival of 88 koalas treated for chlamydiosis, and to highlight associated wildlife care issues with potential significance to animal welfare and disease ecology. Using a retrospective analysis of medical records, we identified risk factors for successful release using a logistic regression model and descriptive statistics. We examined the clinical presentation, signalment, diagnostics, treatments, outcomes and whether released koalas were re-presented by the end of 2008 indicating post-release survival. Records of 88 koalas were included. Treatments and diagnostics were directed at the anatomical site displaying clinical signs. Younger age and use of ancillary treatments were associated with successful release. The type, route and duration of the treatments used were not those theorised to result in microbial cure. Despite this, approximately 50% of koalas were released and many survived in the wild for extended periods. Wildlife rehabilitators' records can guide research priorities and the development of care facilities and policies. This study identified the need for more accessible chlamydial diagnostic tests and veterinary support of carers, and the need for a more rigorous assessment of novel therapies. Current treatment regimens appear to be moderately successful in terms of clinical improvement, but it is unclear which aspects are responsible for the success or whether microbial cure is achieved. The long-term effect of released koalas on wild populations requires further study to assess its contribution to the conservation of koala populations.

Overview of respiratory syncytial virus disease in young children

Correspondence: J Michael Hoopes MedImmune, LLC, 1 MedImmune Way, Gaithersburg, MD 20878, USA Tel +1 301 398 5520 Fax +1 301 398 8520 Email hoopesm@medimmune.com Abstract: Respiratory tract illnesses associated with respiratory syncytial virus (RSV) were first reported more than 160 years ago and gained acceptance as a major respiratory pathogen in the late 1950s. Annual epidemics show a seasonal pattern typically beginning in the late fall and ending in early spring, averaging 5 months in length, and varying in time of onset, offset, and duration depending on geographic location. Manifestations of RSV illness primarily involve the upper respiratory tract but can spread to the lower airways and lead to bronchiolitis and/or pneumonia. Initial infection occurs in approximately two-thirds of children during the first year of life; nearly all children are infected at least once by 2 years of age. Reinfection is common throughout life, but initial illness during infancy generally presents with the most severe symptoms. Medical risk conditions that consistently predispose young children to serious lower respiratory tract infection (LRTI) include congenital heart disease, chronic lung disease, and premature birth. Serious LRTI due to RSV is the leading cause of hospitalization in infants and young children worldwide and annual mean hospital expenses have been estimated to exceed 1 billion dollars in the United States. Young children incur more inpatient and outpatient visits for RSV LRTI than for influenza. RSV has a greater impact than influenza on hospitalization in infants with respect to length of stay, severity/course of disease, and resultant needs for ancillary treatments. Unlike many other childhood illnesses, a vaccine is not currently available for preventing RSV disease.

Applied kinesiology: Distinctions in its definition and interpretation

Modification of the motor system in assessing and treating as well as understanding one of the causes of musculoskeletal dysfunctions is a topic of growing importance in healthcare. Applied kinesiology (AK) addresses this interest in that it is a system which attempts to evaluate numerous aspects of health (structural, chemical, and mental) by the manual testing of muscles combined with other standard methods of diagnosis. It leads to a variety of conservative, non-invasive treatments which involve joint manipulations or mobilizations, myofascial therapies, cranial techniques, meridian and acupuncture skills, clinical nutrition and dietary management, counseling skills, evaluating environmental irritants, and various reflex techniques. The effectiveness of these ancillary treatments is believed to be consistent with the expanded construct validity of the manual muscle test (MMT), as described, although this assertion has primarily been tested in outcome studies.AK and its adjunctive procedures (challenge and therapy localization) are highlighted in this review providing details of its implementation as prescribed by an International College of Applied Kinesiology's Board of Examiners, cited for its scholarly and scientific activities. Because these procedures are believed to identify specific articular, soft tissue, biochemical, or emotional issues underlying muscle function, the applicability of this diagnostic method for all clinicians treating muscle imbalance disorders is described. As of yet, MMT efficacy in therapy localization and challenge techniques has not been established in published, peer-reviewed research.A variety of challenges likewise remain for professional AK to establish itself as an emerging science, with numerous gaps in the literature and testable hypotheses enumerated. Of particular concern are a multiplicity of derivatives of AK that have been described in the literature, which should be greeted with caution in light of the fact that they lack one or more of the essential attributes of AK as described in this report. The validity of these studies which have been critical of applied kinesiology appears in many instances to be no greater than several of the randomized controlled trials, cohort studies, case control studies, and case studies found in this communication to support various aspects of applied kinesiology.

A comprehensive appraisal of meta-analyses focusing on nonsurgical treatments aimed at decreasing perioperative mortality or major cardiac complications

Millions of patients worldwide who undergo surgical procedures face significant morbidity and mortality risks. Several systematic reviews have been performed on ancillary treatments aimed at improving surgical outcomes, but their features and scholarly impact are unclear. We describe characteristics of meta-analyses on ancillary treatments aimed at improving surgical outcomes and explore factors associated with scholarly citations. Systematic reviews published up to 2008 were searched without language restrictions in MEDLINE/PubMed. Reviews focusing on nonsurgical treatments aimed at decreasing mortality or major cardiac complications were included. Associations between content, quality, and bibliometric details and scholarly citations in several indexes were systematically appraised. From 2,239 citations, 84 systematic reviews were identified. Patients most commonly underwent cardiovascular surgery (40.2%), and were tested for cardiovascular drugs (25.8%), with placebo acting as control (38.1%). Internal validity appeared largely robust, as most (50.5%) reviews were at low risk of bias. Normalized yearly citations for the included reviews ranged between 5.6 in Google Scholar and 4.3 in Web of Science. Multivariable analysis showed that citations were significantly and positively associated with number of authors, North American corresponding author, number of studies included, number of patients included, noncardiothoracic surgical scope, explicit funding, and lack of competing interests (all p < 0.05). Systematic reviews currently represent a key element in defining state of the art ancillary treatments of patients undergoing surgery. However, the citation success of available meta-analyses is not significantly associated with prognostically relevant findings or quality features.

134 COST-EFFECTIVENESS OF SHOCK WAVE FREQUENCIES OF 60 VERSUS 120 SHOCKS PER MINUTE FOR TREATMENT OF UPPER URETERAL STONES: ECONOMIC ANALYSIS OF A RANDOMIZED, DOUBLE-BLIND TRIAL

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2012134 COST-EFFECTIVENESS OF SHOCK WAVE FREQUENCIES OF 60 VERSUS 120 SHOCKS PER MINUTE FOR TREATMENT OF UPPER URETERAL STONES: ECONOMIC ANALYSIS OF A RANDOMIZED, DOUBLE-BLIND TRIAL Zachary Klinghoffer, Vincent Tu, and Kenneth Pace Zachary KlinghofferZachary Klinghoffer Hamilton, Canada More articles by this author , Vincent TuVincent Tu Hamilton, Canada More articles by this author , and Kenneth PaceKenneth Pace Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.183AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Increasing evidence suggests that lower shockwave frequencies may improve stone fragmentation rates at the expense of longer operative times. The purpose of our study was to compare the cost-effectiveness of shockwave frequencies of 60 and 120 shocks per minute for primary treatment of upper ureteral stones. METHODS A decision analysis model was developed to estimate the costs and stone-free rates associated with treatment at shockwave frequencies of 60 and 120 shocks per minute. Stone-free rates and probabilities of requiring ancillary procedures, including shockwave lithotripsy re-treatment, ureteroscopy with laser lithotripsy and percutaneous nephrolithotomy, following primary treatment were derived from our previously published randomized, double-blind trial. Costs of shockwave lithotripsy at 60 and 120 shocks per minute were obtained from our institutional data. Costs of ancillary procedures were obtained from the Ontario Case Costing Initiative. Univariate and probabilistic sensitivity analyses were performed to determine which parameters affected the outcome of our model. RESULTS Primary treatment of upper ureteral stones with shockwave lithotripsy at 60 shocks per minute was the more cost-effective treatment strategy, rendering one patient stone-free for $1,925 Canadian dollars (CAD). Shockwave lithotripsy at 120 shocks per minute rendered one patient stone-free for $2,178 CAD. Univariate sensitivity analysis demonstrated our model to be robust to changes to key parameters. Probabilistic sensitivity analysis reinforced shockwave lithotripsy at 60 shocks per minute as the more cost-effective treatment strategy compared to 120 shocks per minute across all willingness-to-pay thresholds. CONCLUSIONS Primary treatment of upper ureteral stones with shockwave lithotripsy at 60 shocks per minute is more cost-effective than treatment at 120 shocks per minute. Our study demonstrates that although the cost of initial treatment at 60 shocks per minute exceeds that of treatment at 120 shocks per minute due to increased operative times, treatment at 60 shocks per minute is more cost-effective due to the decreased need for ancillary treatments. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e55 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Klinghoffer Hamilton, Canada More articles by this author Vincent Tu Hamilton, Canada More articles by this author Kenneth Pace Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Calf health from birth to weaning. II. Management of diarrhoea in pre-weaned calves.

Calfhood diseases have a major impact on the economic viability of cattle operations. The second of this three part review series considers the management of diarrhoeic diseases in pre-weaned calves. In neonatal calf diarrhoea, oral rehydration therapy is the single most important therapeutic measure to be carried out by the farmer and is usually successful if instigated immediately after diarrhoea has developed. Continued feeding of milk or milk replacer to diarrhoeic calves is important, to prevent malnourishment and weight loss in affected calves. Indiscriminative antibiotic treatment of uncomplicated diarrhoea is discouraged, whereas systemically ill calves can benefit from systemic antibiotic treatment for the prevention of septicaemia or concurrent diseases. Ancillary treatments and specific preventive measures are discussed. Eimeriosis has a high economic impact on the farming industries due to direct cost of treatment and calf losses, but especially due to decreased performance of clinically as well as sub-clinically affected animals. Emphasis lies on prophylactic or metaphylactic treatment, since the degree of damage to the intestinal mucosa once diarrhoea has developed, makes therapeutic intervention unrewarding.

Predictors of Abstinence: National Institute of Drug Abuse Multisite Buprenorphine/Naloxone Treatment Trial in Opioid-Dependent Youth

To examine predictors of opioid abstinence in buprenorphine/naloxone (Bup/Nal)-assisted psychosocial treatment for opioid-dependent youth. Secondary analyses were performed of data from 152 youth (15-21 years old) randomly assigned to 12 weeks of extended Bup/Nal therapy or up to 2 weeks of Bup/Nal detoxification with weekly individual and group drug counseling. Logistic regression models were constructed to identify baseline and during-treatment predictors of opioid-positive urine (OPU) at week 12. Predictors were selected based on significance or trend toward significance (i.e., p < .1), and backward stepwise selection was used, controlling for treatment group, to produce final independent predictors at p ≤ .05. Youth presenting to treatment with previous 30-day injection drug use and more active medical/psychiatric problems were less likely to have a week-12 OPU. Those with early treatment opioid abstinence (i.e., weeks 1 and 2) and those who received additional nonstudy treatments during the study were less likely to have a week-12 OPU and those not completing 12 weeks of treatment were more likely to have an OPU. Youth with advanced illness (i.e., reporting injection drug use and additional health problems) and those receiving ancillary treatments to augment study treatment were more likely to have lower opioid use. Treatment success in the first 2 weeks and completion of 12 weeks of treatment were associated with lower rates of OPU. These findings suggest that youth with advanced illness respond well to Bup/Nal treatment and identify options for tailoring treatment for opioid-dependent youth presenting at community-based settings. Buprenorphine/Naloxone-Facilitated Rehabilitation for Opioid Dependent Adolescents; http://www.clinicaltrials.gov; NCT00078130.

Secondary Prevention of HIV in the United States: Past, Current, and Future Perspectives

To provide a synopsis of past, current, and potential next-generation approaches to prevention for positives (PfP) interventions in the United States. For a variety of reasons, PfP interventions, with the goals of limiting HIV transmission from people living with HIV/AIDS (PLWHA) to others and protecting the health of PLWHA, did not appear with any frequency in the United States until about 2000. Even today, the number and breadth of evidence-based PfP interventions is very limited. Nevertheless, meta-analytic evidence demonstrates that such interventions can be effective, perhaps even more so than interventions targeting HIV-uninfected individuals. We review early and more recent PfP interventions and suggest that next-generation PfP interventions must involve behavioral and biologic components and target any element that affects HIV risk behavior and/or infectivity. Next-generation PfP interventions should include increased HIV testing to identify additional PLWHA, components to initiate and maintain HIV care, to initiate antiretroviral therapy and promote adherence, and to reduce sexual and injection drug use risk behavior, as well as ancillary treatments and referrals to services. Comprehensive next-generation PfP interventions, including all of these elements and effective linkages among them, are discussed.

Crop sequences, nitrogen fertilizer and grazing intensity in relation to wheat yields in rainfed systems

SUMMARYThe Mediterranean region is experiencing unrelenting land-use pressure, largely driven by population growth. Long-term cropping system trials can guide crop and soil management options that are biophysically and economically sustainable. Thus, an extensive cereal-based rotation trial (1983–98) was established in northern Syria, to assess various two-course rotations with durum wheat (Triticum turgidumDesf.). The alternative rotations were: continuous wheat, fallow, chickpea (Cicer arietinum), lentil (Lens culinaris), medic (Medicagospp.), vetch (Vicia sativa) and watermelon (Citrullus vulgaris) as a summer crop. Ancillary treatments were: nitrogen (N) fertilizer application to the cereal phase (0, 30, 60 and 90 kg N/ha) and variable stubble grazing management (zero or stubble retention, moderate and heavy grazing). Both phases of the rotation trial occurred each year. The soil is a fine clay, thermic Calcixerollic Xerochrept. Seasonal rainfall was the dominant factor in influencing overall yields. Rotations significantly influenced yields, being highest for fallow (2·43 t/ha), followed by watermelon (similar to fallow), vetch, lentil, medic and chickpea, and least for continuous wheat (1·08 t/ha). Overall, yields increased consistently with added N, but responses varied with the rotation. The various stubble grazing regimes had little or no effect on either grain or straw yields. While the trial confirmed the value of fallow and the drawbacks of continuous cereal cropping, it also showed that replacing either practice with chickpea or lentil, or vetch for animal feed, was potentially a viable option. Given favourable economics, legume-based rotations for food and forage could contribute to sustainable cropping throughout the Mediterranean region.

A Survey of Snakebite Management Knowledge Amongst Select Physicians in Hong Kong and the Implications for Snakebite Training

The objective of the study was to assess the level of knowledge regarding snakebite management in doctors likely to treat such bites in the Special Administrative Region of Hong Kong in the People's Republic of China. Key concerns were doctor confidence, consistency of approach, use of anti-snake venom (ASV), and ancillary treatments. Hong Kong hospitals are equipped according to developed country standards, and knowledge therefore becomes the key factor in successful management. A predesigned questionnaire consisting of 29 multiple-choice questions was submitted to physicians likely to treat snakebite victims at all Hong Kong hospitals receiving such patients. The key finding identified that only 29% of responding doctors were confident about treating snakebites. In the case of ASV selection between the 2 products available that deal with different species, 66% of doctors either were unsure of which to use or believed the 2 ASVs to be the same. The use of inappropriate clinical endpoints for ASV therapy suggests it is being used unnecessarily. There is clear room for improvement in the knowledge base and confidence level of physicians treating snakebites in Hong Kong. Key components of management, such as ASV choice, indications, dosing, and clinical endpoints for administration, were sources of confusion to the participants in this study. The results demonstrate the need for a locally developed and widely distributed snakebite management protocol.

Favorable Outcome of Juvenile Dermatomyositis Treated without Systemic Corticosteroids

To describe the course of patients with juvenile dermatomyositis (JDM) treated effectively without systemic corticosteroids. A retrospective study of 38 patients with JDM treated at a tertiary care children's hospital identified 8 patients who had never received corticosteroids. Disease presentation and course, pharmacologic, and ancillary treatments were recorded. Patients in the no corticosteroid group were followed for a median of 2.8 years (range, 2.1 to 9.5 years). Treatment was primarily with intravenous immunoglobulin (IVIG) (75%) and methotrexate (50%), with favorable response in all. No serious treatment complications were observed; headaches were reported by 3 patients receiving IVIG. Two patients had a myositis flare after discontinuing all medications for more than 1 year; complete resolution of symptoms was observed after either 1 or 2 further doses of IVIG. Two patients had calcinosis (at 1 and 9 years of disease); however, no patient had joint contractures, muscle atrophy, lipodystrophy, or functional limitations. Systemic corticosteroids can be avoided in a select group of patients with JDM. Alternative agents such as methotrexate and IVIG may be prescribed to effectively treat JDM and prevent complications.

Evaluation of Retreatment and Case Fatality Rates for Calves Treated with Antimicrobials and Ancillary Flunixin Meglumine for BRD Complex

Calves in a feed yard setting are commonly treated for respiratory disease (BRD). Often there are ancillary drugs used in addition to a primary antimicrobial. One of the ancillary treatments used is flunixin meglumine. Flunixin meglumine is labeled as a non-steroidal anti-inflammatory drug with antipyretic activity. Calves treated with flunixin meglumine show decreased body temperature in 24 hours. There is little data showing the effects of ancillary use on retreatment and case fatality rates. The objective of this trial was to evaluate repull rates and case fatality rates on BRD complex treated with or without ancillary flunixin meglumine.

The treatment of diarrhoea in the adult horse

SummaryThe priority in treating the equine patient with acute diarrhoea is to stabilise the haemodynamic aberrations secondary to the fluid and electrolyte losses. Once this has been initiated and the patient is stabilised ancillary treatments may be beneficial. Besides the well established effects of NSAIDs and polymixin B on systemic inflammation, recent studies suggest that the use of DTOS to bind bacterial toxins and Saccharomyces boulardii to reduce the severity and duration of diarrhoea may be beneficial. The justification for using probiotic products is scant. There is no evidence to suggest that systemic use of antimicrobials benefits equine patients with colitis, with the exception of metronidazole in cases of clostridial diarrhoea. In light of their potentially detrimental effects, their use can, in the opinion of the authors, not be advocated. Better understanding of the pathways of systemic inflammation and more selective anti‐inflammatory drugs may be of great benefit in the future.

Nutrient Dynamics in a Long‐Term Cereal‐Based Rotation Trial in a Mediterranean Environment: Nitrogen Forms

Mediterranean agriculture is mainly rainfed, with drought being the main crop production constraint, and is based on cereals, wheat (Triticum spp), and barley (Hordeum vulgare). Fallow was a traditional practice to conserve soil moisture, but because of land‐use pressure it is giving way to cereal monoculture, which is unsustainable. The substudy reported here was part of a long‐term rotation trial that sought to examine alternative crop rotation options, that is, durum wheat (T. durum var durum) in rotation with fallow, summercrop (melon, Citrullus vulgaris), wheat (continuous cropping), chickpea (Cicer arietinum), lentil (Lens culinaris), vetch (Vicia sativa), and medic (Medicago spp). Ancillary treatments involved nitrogen (N) applied to the cereal phase and variable stubble grazing intensity (stubble retention, medium grazing, and heavy grazing or complete stubble removal). This substudy, conducted in the final 3 years of the 14‐year trial, involved sampling soil and plants within the cropped rotation plots and sampling soil within bare microplots in selected larger rotation plots. We measured N forms in soil samples at different depths and throughout the seasons. Despite variation within and between seasons, the rotation effect of enhanced N was significant and consistent, being highest for vetch and medic, intermediate for chickpea and lentil, and least for continuous cereal, summer crop, and fallow. Therefore, legume‐based cereal rotations can enhance soil N and thus save on N fertilizer. In bare microplots, total N decreased, labile N was inconsistent, mineral N increased, and biomass N increased and remained stable during the cropping season and then sharply declined. The nutrient dynamic data complemented the crop yield, water‐use efficiency, and soil aggregation data from the trial to support the argument for using legumes in cereal rotations in place of fallow and continuous cereal cropping.

Current guidelines and their recommendations for prolactin monitoring in psychosis

Guidelines on the use of second-generation antipsychotics and physical health monitoring have begun to include information on hyperprolactinemia, and generally recommend that patients should be queried about possible symptoms related to elevated prolactin: menstrual abnormalities, galactorrhea and sexual dysfunction. However, with only two exceptions, none of the guidelines suggest performing baseline plasma prolactin levels. Although several of the guidelines mention the potential for hyperprolactinemia to be associated with osteopenia and osteoporosis, there is no guidance how to monitor for this. Product labeling for the different antipsychotics inform the clinician about potential risks but are not helpful with precise monitoring recommendations. The internal medicine literature contains important information regarding the pulsatile secretion of prolactin, differential diagnosis of hyperprolactinemia, and plasma levels of prolactin usually associated with certain symptoms that would be useful for the prescriber of antipsychotics to be aware of. The prudent clinician should consider obtaining a baseline plasma prolactin level and at least one follow-up measurement when starting any patient on a new antipsychotic. This will help guide clinical decisions about antipsychotic dosage, switching antipsychotic medications, or considering ancillary treatments to protect bone mass. These decisions would be within the context of considering other adverse events as well as the overall effectiveness of the antipsychotic medication being used.

Direct observation and adherence to tuberculosis treatment in Chongqing, China: a descriptive study

China has an estimated 5 million people with tuberculosis (TB). Official policy is that treatment of all patients is directly observed by health workers; completion rates are reported to be in excess of 90%, and drugs should be supplied for free. However, some research suggests there is a gap between the official policies and practice. Survey of TB patients in four counties of one municipality; record assessment at one TB centre; patient and village doctor in-depth interviews. Sixteen per cent (64/401) reported being directly observed every time they took treatment; less than 5% of TB patients (17/401) were observed by health staff. Overall, 12.5% (50/401) reported they had not taken any TB drugs in the previous week, but this varied between the four counties (range 6.2 to 21.7%). We used survival analysis with medical records at one centre: 74.1% of new patients collected their drugs for their sixth month of treatment, and 50.3% attended the final visit at 6 months. Qualitative research indicated direct observation is neither well understood nor thought to be necessary, and that patients reported being charged expensive fees for ancillary treatments, such as liver protection drugs. In China, direct observation is not well implemented and may not be a feasible policy option. Official completion rates are higher than we found in this study. The concept of free treatment has become blurred, with charges for additional tests and drugs, especially liver protection drugs. The government is already actively tackling these issues, and involvement of managers and others in this process will be helpful.

Rainfed wheat-based rotations under Mediterranean conditions: Crop sequences, nitrogen fertilization, and stubble grazing in relation to grain and straw quality

Crop rotations have evolved as a strategy to obtain harvestable yields in stressed environments due to improved water-use efficiency, nitrogen (N) fixation, and breaking diseases cycles. While fallowing or growing legume crops in the alternate year have shown to consistently increase yields in semi-arid environments such as in the Mediterranean area, little emphasis has been given to cereal quality in rotation trials, especially with respect to N, and thus improved animal and human nutrition. This paper reports the effect of those treatments on cereal quality parameters, especially N, and thus protein, in wheat grain and straw in a long-term (14 years) rainfed cropping systems trial in the medium rainfall zone (300–400 mm year −1) in northern Syria that examined seven alternative-year options with durum wheat ( Triticum turgidum var durum), i.e., vetch ( Vicia sativa), medic ( Medicago spp.), chickpea ( Cicer arietinum), lentil ( Lens culinaris), fallow, watermelon ( Citrullus vulgaris) as a summer crop in the fallow year, and continuous wheat. Two ancillary treatments involved N fertilization (0, 30, 60, 90 kg N ha −1) in the cereal phase, and stubble grazing management (moderate and heavy grazing, and no grazing or stubble retention). Both the rotation and N treatments had a significant influence on all parameters (test weight, grain and straw N percentage, and total N uptake). By comparison, grazing management had little influence on quality parameters except test weight; however, the residue × N interaction was significant. Rotations such as those with medic and vetch enriched the N in grain and straw. These rotations thus improved the nutritional value in terms of protein of the grain, an important consideration as per capita consumption of bread is high in the Middle East and other sources of protein are limited. Similarly, as grazed or fed straw is dominant in the diet of sheep, the enhanced nutrition is of significance. While fallow produced the highest yields, and is a hedge against the effects of drought, it produces grain and straw of low nutritional value with respect to protein, as a result of dilution of available soil N in the increased biomass. Though less obvious than yield, crop quality parameters should be considered in any cropping system involving rotations, especially those involving legumes.

Equine idiopathic cheek teeth fractures: Part 3: A hospital‐based survey of 68 referred horses (1999–2005)

There is limited information available on the more serious sequellae of idiopathic cheek teeth (CT) fractures. To obtain information on clinical and ancillary diagnostic findings in referred horses with idiopathic CT fractures. Details of all horses suffering from idiopathic CT fractures referred to the Equine Hospital at the University of Edinburgh 1999-2005 were examined, and information concerning fracture patterns, clinical and ancillary diagnostic findings, treatments and long-term response to treatments were obtained and analysed. A total of 60 maxillary and 17 mandibular idiopathic CT fractures were diagnosed in 68 horses. Fracture patterns included maxillary CT lateral slab fractures (45%), maxillary CT midline sagittal fractures (16%) and various other patterns of maxillary CT fractures (17%). In the mandibular CT, lateral slab fractures were found (12%) and various other CT fracture patterns were present in 10%. The more centrally positioned CT (maxillary and mandibular Triadan 08s and 09) were preferentially fractured. Clinical signs included quidding in 47% of cases; bitting and behavioural problems (28%); signs of apical infection, including bony swellings and nasal discharge (21%); anorexia/weight loss (15%); halitosis (13%); and buccal food impaction (12%). The treatment of all cases was conservative whenever possible and included corrective rasping of the remaining tooth (46% of cases); oral extraction of the smaller and loose dental fragment (32%) and extraction of the entire fractured tooth by oral extraction (28%) or by repulsion (13%). Prophylactic treatment of adjacent, nonfractured CT with carious infundibula was possibly of value in preventing further midline sagittal maxillary CT fractures. Horses referred with idiopathic CT fractures frequently have clinical signs of apical infection of the fractured CT and these teeth require extraction, orally if possible. More conservative treatment of idiopathic CT fractures without signs of gross apical infection can resolve clinical signs in most cases. In the absence of apical infection, extraction of only the loose dental fragments of CT with idiopathic fractures is usually successful.

Overview of large randomized trials of ACE inhibitors in patients with stable vascular disease without left ventricular systolic dysfunction or heart failure, in the context of previous large trials

Clinical CardiologyVolume 29, Issue 12 p. 549-549 Progress in Clinical TrialsOpen Access Overview of large randomized trials of ACE inhibitors in patients with stable vascular disease without left ventricular systolic dysfunction or heart failure, in the context of previous large trials First published: 18 December 2006 https://doi.org/10.1002/clc.20031AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Presenter GR Dagenais, MD, at the 2006 World College of Cardiology Background ACE inhibitors reduce cardiovascular (CV) mortality and morbidity in patients with heart failure or left ventricular systolic dysfunction (LVSD). Three large trials, HOPE (ramipril), EUROPA (perindopril) and PEACE (trandolapril), have assessed their impact in stable patients without these conditions but with atherosclerosis. Among these trials, only PEACE failed to meet its primary outcome (4% relative risk reduction in CV death, nonfatal MI or coronary revascularization, p = 0.043). Objective To determine (i) if there is any consistency with which ACE inhibitors reduce total mortality and fatal and nonfatal CV events in these trials and (ii) to determine if the benefits vary among patients with varying levels of risks or by ancillary treatments. Methodology Data were assessed from HOPE, EUROPA, PEACE and from five other trials carried out among patients with heart failure and LVSD: SOLVD-T, SOLVD-P, SAVE, AIRE and TRACE. Antiplatelet therapy consisted of aspirin at 81–325 mg daily. Study Populations HOPE, EUROPA and PEACE included nearly 30,000 patients. Age, blood pressure and diabetes rates were higher in HOPE. More patients in PEACE received lipid-lowering agents, but it also had more patients with prior PCI or CABG surgery. Results All-cause mortality was 6.1 vs. 6.9%, 7.2 vs. 8.1% and 10.4 vs. 12.2% for EUROPA, PEACE and HOPE, respectively. Results across all the eight trials were consistent in that they all revealed reduced all-cause mortality for ACE inhibition vs. placebo. In the three trials, the overall all-cause mortality odds ratio was 0.86 for those without heart failure or LVSD and 0.80 for those with these problems. Of the 12 trials, noted in the Methodology Section, only PEACE failed to show any reduction in nonfatal MI. There was reduced stroke in EUROPA, PEACE and HOPE (OR 0.77) but not in the other trials (OR 0.96). Conclusions This review of 30,000 patients without any known heart failure or LVSD demonstrates consistency and clear benefits for ACE inhibition on different outcomes. In the 12,000 patients with heart failure or LVSD, there was a consistent fourfold risk reduction across a broad range of outcomes except stroke. In patients with coronary artery disease, it is unlikely that the benefits of ACE inhibition will vary among patients with varying levels of risks or by ancillary treatments. ACE inhibition should be considered in all patients with any evidence of vascular atherosclerotic disease. Comment (Gilles R Dagenais, MD) PEACE results appear to differ, most likely because the trial was underpowered and used a single soft endpoint (coronary revascularization). (Discussant: Nicholas Danchin, MD, Canada) The difference in the results of PEACE from that of HOPE and EUROPA is possibly accounted for by a lower risk in the PEACE population, but more likely due to insufficient doses of trandolapril. Copyright © 2006 Wiley Periodicals, Inc. Volume29, Issue12December 2006Pages 549-549 RelatedInformation

Assessing observational studies of medical treatments.

BackgroundPrevious studies have assessed the validity of the observational study design by comparing results of studies using this design to results from randomized controlled trials. The present study examined design features of observational studies that could have influenced these comparisons.MethodsTo find at least 4 observational studies that evaluated the same treatment, we reviewed meta-analyses comparing observational studies and randomized controlled trials for the assessment of medical treatments. Details critical for interpretation of these studies were abstracted and analyzed qualitatively.ResultsIndividual articles reviewed included 61 observational studies that assessed 10 treatment comparisons evaluated in two studies comparing randomized controlled trials and observational studies. The majority of studies did not report the following information: details of primary and ancillary treatments, outcome definitions, length of follow-up, inclusion/exclusion criteria, patient characteristics relevant to prognosis or treatment response, or assessment of possible confounding. When information was reported, variations in treatment specifics, outcome definition or confounding were identified as possible causes of differences between observational studies and randomized controlled trials, and of heterogeneity in observational studies.ConclusionReporting of observational studies of medical treatments was often inadequate to compare study designs or allow other meaningful interpretation of results. All observational studies should report details of treatment, outcome assessment, patient characteristics, and confounding assessment.