Temporarily quadrupling the dose of inhaled steroid to prevent asthma exacerbations : FAST

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 70. See the NIHR Journals Library website for further project information.Peer reviewedPublisher PD

FourFold Asthma Study (FAST): a study protocol for a randomised controlled trial evaluating the clinical cost-effectiveness of temporarily quadrupling the dose of inhaled steroid to prevent asthma exacerbations

BACKGROUND: Asthma is one of the commonest chronic diseases in the UK. Acute exacerbations of asthma are unpredictable, disruptive and frightening. They cause considerable morbidity and account for a large component of the health service costs of asthma. The widespread use of an asthma self-management plan, designed to encourage disease monitoring and timely intervention, can reduce exacerbations and is, therefore, recommended for all patients with asthma. Unfortunately, the majority of patients are not provided with such a plan. There are a variety of reasons for this but uncertainty about what to include in the plan when asthma control is deteriorating, but before the need for orally administered corticosteroids, is a contributing factor. The aim of this trial is to determine whether an asthma self-management plan, which includes a temporary quadrupling of the dose of inhaled corticosteroid when asthma control starts to deteriorate, reduces asthma exacerbations requiring orally administered corticosteroids or unscheduled health care consultation for asthma. METHODS: A multicentre, pragmatic, randomised trial in adults aged over 16 years with a clinical diagnosis of asthma, treated with a licensed dose of inhaled corticosteroid and at least one exacerbation in the previous 12 months requiring treatment with systemic corticosteroids. Participants will be randomised to either a self-management plan, which includes a temporary (maximum of 14 days) fourfold increase in inhaled corticosteroid or the same plan without an increase in inhaled corticosteroid. Participants will be followed up at 6 and 12 months and will attend the clinic for an additional visit if their asthma control deteriorates. The primary outcome is time to first asthma exacerbation, defined as the need for systemic corticosteroids and/or unscheduled health care consultation for asthma. The estimated sample size is 1800 participants. DISCUSSION: The FAST trial is an independent study that has been prioritised and commissioned by the National Institute for Health Research (NIHR) in the United Kingdom. It will provide high-quality evidence to inform clinical decision-making on the role of an asthma self-management plan, which includes a temporary fourfold increase of inhaled corticosteroid, when asthma control starts to deteriorate. The first participant was randomised on 17th May 2013 and recruitment will close on 31 January 2016 with the last patient last visit taking place in January 2017. TRIAL REGISTRATION: ISRCTN: 15441965, registered on 25 April 2013

Barriers and levers of enhancing animal welfare in organic and low-input outdoor production: Insights from a supply chain survey

Animal welfare is an essential part of the sustainability of animal production. While low-input farming, such as organic animal production, is often considered animal-friendly, several ways to enhance animal welfare in low-input animal production exist. However, currently there is little information on how farmers and other supply chain actors view different innovations and tools which may influence animal welfare in low-input outdoor and organic production systems. The aim of this study was to examine farmers’ and experts’ reactions to new approaches to pig and poultry production, with special attention to their animal welfare-related measures. The reactions were tested formally in by using a quantitative survey instrument in nine European countries (Finland, UK, France, Denmark, the Netherlands, Belgium, Germany, Italy, Romania). In the survey, respondents’ views on production practices and novel measures were asked. These included aspects such as applicability and advantages and disadvantages of various measures such as avoiding mutilations, using dual-purpose or local breeds, or in-ovo sexing. The data included altogether 218 responses from nine countries. Differences between countries were tested and groups of respondents were identified. The results suggest that supply side stakeholders foresee the welfare benefits and some disadvantages of welfare improving measures proposed to them. However, they also indicate that several measures were considered inapplicable despite their benefits. Inadequate financial provisions to adopt a measure was considered as one of the most important reasons for inapplicability of a measure. This may imply either high costs of implementing measures of low market incentives or perceived low demand for animal-friendly products. Other barriers for adopting welfare-friendly measures included farm-specific factors such as limitations imposed by housing. The respondents indicated a high relative preference for feeding, breeding, shelter from predators and the use of vaccines and anti-parasitic treatments to the provision of enrichments and nesting material to pigs, and to mutilations. Farmers agreed that environmental enrichments are important welfare-improving levers and preferred their use in low-input pig and poultry production. Animal breeding-related measures in pig production were perceived quite favorably by supply side stakeholders. Despite their welfare benefits, farmers in some countries had quite high preference towards maintaining castration and tail docking in pig and beak trimming in broiler production as part of their production method

Comparison of Flocked and Rayon Swabs for Detection of Nasal Carriage of Staphylococcus aureus among Pathology Staff Members▿

Comparison of flocked swabs (E-swabs; Copan) to the standard rayon swabs (Copan) was undertaken for detection of Staphylococcus aureus nasal carriage among staff at Dorevitch Pathology in Heidelberg, Melbourne, Australia. Among 100 volunteers, 36 were found to be colonized with S. aureus by one or both swab results. The prevalence detected by E-swabs was 35%, and the prevalence through rayon swabs was 34% (95% confidence interval [CI] for the difference in proportions, −12 to 14). Thirty-three volunteers tested positive with both types of swabs, while 2 were detected on E-swabs alone and another on rayon swab testing alone. There was no evidence of a significant difference in carriage detected by E-swabs or rayon swabs

Additional file 1: of FourFold Asthma Study (FAST): a study protocol for a randomised controlled trial evaluating the clinical cost-effectiveness of temporarily quadrupling the dose of inhaled steroid to prevent asthma exacerbations

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 121 kb

One Welfare for farm animals and humans: practitioners’ and citizens’ expectations

International audienc

One Welfare for farm animals and humans: practitioners’ and citizens’ expectations

International audienc