THE ECONOMICS OF CONTROLLING INFECTIOUS DISEASES ON DAIRY FARMS

Cost effective disease control on the dairy farm can enhance productivity and subsequently profitability. Previous economic studies on animal disease have focused on production losses and evaluation of disease eradication programs and provided little guidance as to the optimal prevention action. This paper presents a theoretical model on the economics of livestock disease and develops an empirical model to determine the optimal set of control strategies for four production limiting cattle diseases: bovine viral diarrhea (BVD), enzootic bovine leukosis (EBL), Johne's Disease (JD) and neosporosis. Control functions indicating the prevalence of infection with each of the four diseases for each of the ten strategies are estimated. The optimal strategies that minimize total disease cost (direct production losses and control expenditures) are provided for each disease on the basis of farm survey results from the Maritime provinces. The results emphasize the importance of introduction checks before new animals enter the herd and adequate vaccination protection as cost-effective control strategies.Farm Management, Livestock Production/Industries,

Consumers’ questions about antipsychotic medication: revealing safety concerns and the silent voices of young men

PURPOSE: Little is known about consumer information needs regarding antipsychotic medicines. Medicines call centre (MCC)-derived data are underutilised; and could provide insight into issues of importance to consumers. This study aimed to explore consumers' information needs about antipsychotic medication sought from a national MCC in Australia. METHODS: Questions received by the National Prescribing Service Medicines Line relating to antipsychotic medication from September 2002 to June 2010 were examined by antipsychotic subclass and in relation to other medication queries. RESULTS: We identified 6,295 calls related to antipsychotic medication. While female callers predominated, the percentage of males with antipsychotic questions was statistically significantly higher than for other medication calls (33.9 vs 22.6 %; p < 0.001). There were distinct gender differences in medicines information seeking across age ranges. Younger men asked about second-generation antipsychotics, shifting toward first-generation antipsychotics after 45 years of age. Female interest in both subclasses was comparable, irrespective of age. Most callers asking about antipsychotics sought information for themselves (69.4 %). Callers were primarily concerned about safety (57.0 %), especially adverse drug reactions (28.8 %), and were more often prompted by a worrying symptom (23.8 %) compared with the rest of calls (17.2 %). Trends of antipsychotic questions received corresponded with antipsychotic prescription data. CONCLUSIONS: The number of calls received by this MCC over time reveals an ongoing consumer need for additional, targeted information about antipsychotics. Noticeable was the relatively high frequency of young male callers asking about antipsychotics, indicating that call centres could be a way to reach these traditionally poor users of health services

Consumers’ questions about antipsychotic medication: revealing safety concerns and the silent voices of young men

Little is known about consumer information needs regarding antipsychotic medicines. Medicines call centre (MCC)-derived data are underutilised; and could provide insight into issues of importance to consumers. This study aimed to explore consumers' information needs about antipsychotic medication sought from a national MCC in Australia

Medication safety in patients with hepatic impairment:A survey of community pharmacists' knowledge level and their practice in caring for these patients

Aims: To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients. Methods: Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6-item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses. Results: In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment). Conclusion: Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment

Medication safety in patients with hepatic impairment: A survey of community pharmacists’ knowledge level and their practice in caring for these patients

Aims: To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients. Methods: Pharmacists from Dutch community pharmacies (n = 1545) were invited to participate in an online survey. The survey consisted of 27 questions covering 2 main topics: knowledge and current practice. The level of knowledge was measured by a 6-item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses. Results: In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (standard deviation 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment). Conclusion: Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment

Safe use of medication in patients with cirrhosis:pharmacokinetic and pharmacodynamic considerations

Contains fulltext : 218240.pdf (Publisher’s version ) (Open Access)Introduction: The global burden of cirrhosis is rising, and clinicians increasingly face the challenge of safely prescribing medicines for complications of hepatic disease and comorbidities. Prescribing in patients with cirrhosis is complicated by alterations that can occur in the pharmacology of medicines.Areas covered: This paper provides an overview of current knowledge on the pharmacokinetics and pharmacodynamics of medicines in patients with cirrhosis. We describe the pathophysiological changes that occur and their consequences on pharmacokinetic parameters. We explain that the influence of cirrhosis on the pharmacokinetics depends on several drug and patient characteristics. Patients with cirrhosis also have an increased susceptibility to some toxicological effects of medicines, such as renal impairment and hematological toxicity, which we describe in detail. In addition, we discuss approaches to apply this knowledge in practice and improve safe medication use in patients with cirrhosis.Expert opinion: Tailored pharmacotherapy is needed to ensure safe and appropriate use of medicines in patients with cirrhosis. Clinicians are supported by freely available recommendations on safe drug use in cirrhosis published on a website. In addition, a regular evaluation of medication use in patients with cirrhosis could resolve and prevent medication-related problems

Clinical characteristics and outcome of drug-induced liver injury in the older patients: from the young-old to the oldest-old

Older patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought the distinctive characteristics of DILI in older patients across age groups. A total of 882 DILI patients included in the Spanish DILI Registry (33% ≥ 65 years) were categorized according to age: “young” (< 65 years); “young-old” (65–74 years); “middle-old” (75–84 years); and “oldest-old” (≥ 85 years). All elderly groups had an increasingly higher comorbidity burden (P < 0.001) and polypharmacy (P < 0.001). There was a relationship between jaundice and hospitalization (P < 0.001), and both were more prevalent in the older age groups, especially in the oldest-old (88% and 69%, respectively), and the DILI episode was more severe (P = 0.029). The proportion of females decreased across age groups from the young to the middle-old, yet in the oldest-old there was a distinct female predominance. Pattern of liver injury shifted towards cholestatic with increasing age among top culprit drugs amoxicillin-clavulanate, atorvastatin, levofloxacin, ibuprofen, and ticlopidine. The best cutoff point for increased odds of cholestatic DILI was 65 years. Older patients had increased non–liver-related mortality (P = 0.030) as shown by the predictive capacity of the Model for End-Stage Liver Disease score (odds ratio (OR) = 1.116; P < 0.001), and comorbidity burden (OR = 4.188; P = 0.001) in the 6-month mortality. Older patients with DILI exhibited an increasingly predominant cholestatic phenotype across a range of culprit drugs, other than amoxicillin-clavulanate, with increased non–liver-related mortality and require a different approach to predict outcome. The oldest DILI patients exhibited a particular phenotype with more severe DILI episodes and need to be considered when stratifying older DILI populations

Nonperturbative Evaluation of the Sphaleron Transition Rate

We review nonperturbative calculations of the rate of sphaleron transitions on the lattice in $1+1$-dimensional field theories and introduce a way to perform the gauge-invariant Gibbs averages in the classical non-Abelian Higgs theories.Comment: 4 pages, uuencoded Postscript file. Talk given at NATO Advanced Research Workshop on Electroweak Physics and the Early Universe, Sintra, Portugal, 23-25 March 199

Occurrence of yeast bloodstream infections between 1987 and 1995 in five Dutch university hospitals

The aim of this study was to identify retrospectively trends in fungal bloodstream infections in The Netherlands in the period from 1987 to 1995. Results of over 395,000 blood cultures from five Dutch university hospitals were evaluated. Overall, there were more than 12 million patient days of care during the nine-year study period. The rate of candidemia doubled in the study period, reaching an incidence of 0.71 episodes per 10,000 patient days in 1995. The general increase in candidemia was paralleled by an increase in non-Candida albicans bloodstream infections, mainly due toCandida glabrata. However, more than 60% of the infections were caused byCandida albicans. Fluconazoleresistant species such asCandida krusei did not emerge during the study period. The increasing rate of candidemia found in Dutch university hospitals is similar to the trend observed in the USA, but the rate is lower and the increase is less pronounced