ABSTRACT
This study was conducted to evaluate the effect of Saccharomyces cerevisiae yeast cell walls (YCWs) in diets with low doses of aflatoxin B1 (AFB1) and ochratoxin A (OTA), alone or in combination, on broiler performance and immune response. A total of 210 male broilers aged 1-21 days were used. Broilers were completely randomized into seven treatments with five replicates of six broilers each, as follows: 1) control diet; 2) control + 350 µg/kg AFB1; 3) Control + 350 µg/kg OTA; 4) Control + 350 µg/kg AFB1 and 350 µg/kg OTA; 5) Control + 350 µg/kg AFB1 and 1.5 kg/ton YCW; 6) control + 350 µg/kg OTA and 1.5 kg/ton YCW; 7) control + 350 µg/kg AFB1, 350 µg/kg OTA, and 1.5 kg/ton YCW. The broilers were housed under environmentally controlled conditions in Petersime battery cages. Weight gain, feed intake, and feed conversion index were measured. The relative weights of the thymus, spleen, and bursa of Fabricius (BF) were evaluated. The local immune response was assessed by quantifying the level of intestinal immunoglobulin A (IgA). The cellular immune response was evaluated using a delayed hypersensitivity test. Hemograms and blood cell counts were also performed. The results showed that mycotoxins decreased performance and reduced the immune response (p<0.05) of broilers. Weight gain and feed conversion improved in the groups receiving YCWs. The YCWs increased (p<0.05) intestinal IgAs and the cellular immune response (p<0.05). The addition of YCWs also affected the relative weight of the thymus, spleen, and BF (p<0.05), and the leukocyte, lymphocyte, and heterophil counts (p<0.05). The addition of YCWs can be an alternative to counterage the negative effect of low doses of AFB1 and OTA in broilers diets.
ABSTRACT
Fossil fuel derived pollutants (SO2, NO), dry air and cold increase the incidence of S. pneumoniae infections http://ow.ly/RnLW30gogb1.
ABSTRACT
OBJECTIVE: Patient choice of healthcare centers to be treated for specific diseases is compromised by the low accessibility of understandable information. Physicians are rarely involved in healthcare quality assessment, despite their potentially valuable input. The purpose of this study was to develop a methodology for evaluating the quality of care that specifically incorporates advice from medical specialists and provides accessible information for patients in search of high-quality healthcare. MATERIALS AND METHODS: A pilot Delphi study was conducted among 28 Spanish otolaryngology experts, seeking their opinion on the quality-of-care indicators and on their ability to recommend the most suitable department for the treatment of specific otolaryngologic diseases. RESULTS: The average acceptance rate was 91.9% for quality-of-care indicator and 96.5% for the resources needed for improving the quality of care. Furthermore, 93% experts reported that patients frequently ask for physician advice on which center provides better care for a specific disease, 92.6% experts believe they could recommend the best centers for specific otolaryngologic diseases, and 80% experts agreed that expert opinion on the quality of care offered by different centers would be a valuable addition to quality-of-care assessment. CONCLUSION: The incorporation of physician advice into healthcare quality assessment may improve the usefulness of healthcare quality indicators for patients. Assessment tools incorporating physician advice should be developed and validated.
Subject(s)
Otolaryngology , Physician's Role , Quality of Health Care/standards , Delphi Technique , Female , Humans , Male , Quality Indicators, Health Care/standards , SpainABSTRACT
BACKGROUND AND OBJECTIVE: The objective of this study was to evaluate the effect of age and comorbidities, smoking and alcohol use on microorganisms in patients with community-acquired pneumonia (CAP). METHODS: A prospective multicentre study was performed with 4304 patients. We compared microbiological results, bacterial aetiology, smoking, alcohol abuse and comorbidities in three age groups: young adults (<45 years), adults (45-64 years) and seniors (>65 years). RESULTS: Bacterial aetiology was identified in 1522 (35.4%) patients. In seniors, liver disease was independently associated with Gram-negative bacteria (Haemophilus influenzae and Enterobacteriaceae), COPD with Pseudomonas aeruginosa (OR = 2.69 (1.46-4.97)) and Staphylococcus aureus (OR = 2.8 (1.24-6.3)) and neurological diseases with S. aureus. In adults, diabetes mellitus (DM) was a risk factor for Streptococcus pneumoniae and S. aureus, and COPD for H. influenzae (OR = 3.39 (1.06-10.83)). In young adults, DM was associated with S. aureus. Smoking was a risk factor for Legionella pneumophila regardless of age. Alcohol intake was associated with mixed aetiology and Coxiella burnetii in seniors, and with S. pneumoniae in young adults. CONCLUSION: It should be considered that the bacterial aetiology may differ according to the patient's age, comorbidities, smoking and alcohol abuse. More extensive microbiological testing is warranted in those with risk factors for infrequent microorganisms.
Subject(s)
Community-Acquired Infections , Gram-Negative Bacteria/isolation & purification , Haemophilus influenzae/isolation & purification , Pneumonia, Bacterial , Staphylococcus aureus/isolation & purification , Streptococcus pneumoniae/isolation & purification , Adult , Age Factors , Aged , Alcoholism/epidemiology , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/therapy , Comorbidity , Female , Humans , Male , Middle Aged , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/therapy , Prospective Studies , Risk Factors , Smoking/epidemiology , Spain/epidemiology , Sputum/microbiologyABSTRACT
Antecedentes: La libre elección no es fácil cuando se carece de información adecuada. Para ello son necesarios métodos de evaluación de la calidad asistencial que ofrezcan al paciente una información integral y comprensible de los servicios hospitalarios. Objetivos: Definir una propuesta metodológica para evaluar la calidad asistencial de los servicios hospitalarios, cuyos resultados sirvan para ofrecer una información útil al ciudadano. La propuesta debe fundamentarse en el consenso y en la experiencia de los especialistas médicos y definir complementariamente vías de mejora. Métodos: Estudio Delphi sobre calidad asistencial en Nefrología, estructurado en tres apartados: evaluación de resultados, medios necesarios para la calidad, e importancia del consejo médico y de la encuesta a especialistas. El cuestionario fue cumplimentado por un panel formado por 32 nefrólogos. Resultados: Los nefrólogos aceptaron 55/62 (89 %) de los criterios de resultados en calidad asistencial. También aceptaron 87/92 (95 %) de los medios propuestos para la calidad asistencial. El 81 % de los nefrólogos consideró de actualidad el consejo médico de un especialista a un paciente acerca del servicio donde podrían tratar mejor su enfermedad. Un 86 % creyó oportuno incluir encuestas sobre consejo médico como criterio adicional en la evaluación de la calidad asistencial. Conclusiones: Es posible obtener una propuesta metodológica consensuada para la evaluación y mejora de la calidad asistencial que incluya resultados de calidad asistencial, medios para la calidad asistencial y el consejo médico derivado de encuestas a especialistas para identificar los mejores servicios. Este método podría facilitar una orientación fiable y comprensible para el ciudadano (AU)
Background: Free choice is not easy when there is a lack of information. Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary. Objectives: To draft a methodological proposal for evaluating quality of care of hospital departments, the data of which can provide citizens with useful care quality information. The proposal should be based on consensus and on the experience of medical specialists, defining thus complementary paths to improvement. Methods: A Delphi study on the quality of care in Nephrology, comprising three phases: assessment results, necessary means for quality, and importance of medical advice and surveys among specialists. The questionnaire was administered to a panel of 32 nephrologists. Results: The nephrologists accepted the outcome criteria on quality of care 55/62 (89%), as well as the proposed means for quality of care 87/92 (95%). 81% of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases. 86% of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care. Conclusions: It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care, means for quality of care, and medical advice based on surveys carried out among specialists to identify the best Nephrology departments. This method could provide reliable and understandable guidance for citizens (AU)
Subject(s)
Humans , Quality Improvement/organization & administration , /methods , Nephrology/trends , Hospital Units/organization & administration , Quality Indicators, Health Care , Health Services Accessibility/statistics & numerical dataABSTRACT
BACKGROUND: Free choice is not easy when there is a lack of information. Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary. OBJECTIVES: To draft a methodological proposal for evaluating quality of care of hospital departments, the data of which can provide citizens with useful care quality information. The proposal should be based on consensus and on the experience of medical specialists, defining thus complementary paths to improvement. METHODS: A Delphi study on the quality of care in Nephrology, comprising three phases: assessment results, necessary means for quality, and importance of medical advice and surveys among specialists. The questionnaire was administered to a panel of 32 nephrologists. RESULTS: The nephrologists accepted the outcome criteria on quality of care 55/62 (89%), as well as the proposed means for quality of care 87/92 (95%). 81% of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases. 86% of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care. CONCLUSIONS: It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care, means for quality of care, and medical advice based on surveys carried out among specialists to identify the best Nephrology departments. This method could provide reliable and understandable guidance for citizens.
Subject(s)
Delphi Technique , Kidney Diseases/therapy , Nephrology/standards , Quality Assurance, Health Care/methods , Quality Improvement , Humans , Quality Indicators, Health Care , Surveys and QuestionnairesABSTRACT
Se estudiaron los efectos de la combinación del clorhidrato de tolperisona, como relajante muscular, y acetaminofén, cuyo efecto es analgésico, en 32 pacientes adultos que presentaban contractura muscular de los maseteros, acompañada de dolor. Los pacientes no habían recibido tratamiento alguno durante las 72 horas anteriories; la dosificación empleada fue de una cápsula cada 8 horas por un periodo de 3 a 5 días. Los efectos secundarios fueron mínimos, sólo 2 pacientes acusaron náusea que se corrigió al ajustar la dosis. En ningún caso hubo necesidad de suspender el tratamiento. Los autores consideran de utilidad la asociación terapéutica mencionada, en el posoperatorio de cirugía bucal
