BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Protection Induced in Broiler Chickens following Drinking-Water Delivery of Live Infectious Laryngotracheitis Vaccines against Subsequent Challenge with Recombinant Field Virus.

Infectious laryngotracheitis virus (ILTV) causes acute upper respiratory tract disease in chickens. Attenuated live ILTV vaccines are often used to help control disease, but these vaccines have well documented limitations, including retention of residual virulence, incomplete protection, transmission of vaccine virus to unvaccinated birds and reversion to high levels of virulence following bird-to-bird passage. Recently, two novel ILTV field strains (class 8 and 9 ILTV viruses) emerged in Australia due to natural recombination between two genotypically distinct commercial ILTV vaccines. These recombinant field strains became dominant field strains in important poultry producing areas. In Victoria, Australia, the recombinant class 9 virus largely displaced the previously predominant class 2 ILTV strain. The ability of ILTV vaccines to protect against challenge with the novel class 9 ILTV strain has not been studied. Here, the protection induced by direct (drinking-water) and indirect (contact) exposure to four different ILTV vaccines against challenge with class 9 ILTV in commercial broilers was studied. The vaccines significantly reduced, but did not prevent, challenge virus replication in vaccinated chickens. Only one vaccine significantly reduced the severity of tracheal pathology after direct drinking-water vaccination. The results indicate that the current vaccines can be used to help control class 9 ILTV, but also indicate that these vaccines have limitations that should be considered when designing and implementing disease control programs

The results from assays for viral detection and quantification four days after challenge in birds that were contact-exposed to vaccinated chickens.

<p>^a Values marked with the same superscripts in the same column were not significantly different (p > 0.05).</p><p>^¶ S.D = standard deviation. The lower limit of detection of the assay used to detect and quantify viral genome was 52, or 10^1.72, genome copies per reaction.</p><p>The results from assays for viral detection and quantification four days after challenge in birds that were contact-exposed to vaccinated chickens.</p

Results from assays for virus detection and virus quantification, and tracheal histopathological examination in birds directly vaccinated with different ILTV vaccines, four days after challenge

<p>^a,b,c Values marked with the same superscripts in the same column were not significantly different (p > 0.05).</p><p>^¶ S.D = standard deviation. The lower limit of detection of the assay used to detect and quantify viral genome was 52, or 10^1.72, genome copies per reaction.</p><p>.</p

Percentage body weight changes between the day of vaccination and 20 days after vaccination, and between the day of challenge and days four and seven after challenge, in birds directly vaccinated with different ILTV vaccines.

<p>^a Values marked with the same superscripts in the same column were not significantly different (p > 0.05).</p><p>^¶ SD = standard deviation, dpv = days post vaccination, dpc = days post challenge, N = number of birds.</p><p>Percentage body weight changes between the day of vaccination and 20 days after vaccination, and between the day of challenge and days four and seven after challenge, in birds directly vaccinated with different ILTV vaccines.</p

Percentage body weight changes between the day of vaccination and 20 days after vaccination, and between the day of challenge and day seven after challenge, in birds that were contact exposed to vaccinated chickens.

<p>^a,b, Values marked with the same superscript in the same column at a given time point were not significantly different (p > 0.05).</p><p>^¶ S.D = standard deviation, dpv = days post vaccination, dpc = days post challenge, N = number of birds.</p><p>Percentage body weight changes between the day of vaccination and 20 days after vaccination, and between the day of challenge and day seven after challenge, in birds that were contact exposed to vaccinated chickens.</p

Results from assays for virus detection and virus quantification, and tracheal histopathological examination in birds directly vaccinated with different ILTV vaccines, seven days after challenge.

<p>^a,b,c Values marked with the same superscripts in the same column were not significantly different (p > 0.05).</p><p>^¶ S.D = standard deviation. The lower limit of detection of the assay used to detect and quantify viral genome concentrations was 52, or 10^1.72, genome copies per reaction.</p><p>Results from assays for virus detection and virus quantification, and tracheal histopathological examination in birds directly vaccinated with different ILTV vaccines, seven days after challenge.</p