Use of a saliva-based diagnostic test to identify tapeworm infection in horses in the UK.

BACKGROUND: Anthelmintic resistance combined with limited chemotherapeutic options has prompted a change in approaches to control of equine helminth infections. Targeted selective treatment strategies use diagnostics to reduce anthelmintic use by treating individuals with worm burdens or egg shedding levels above a set threshold. While faecal egg count analysis has limitations for informing tapeworm treatment, a commercially available saliva-based diagnostic test accurately diagnoses horses with tapeworm infection. OBJECTIVES: Evaluation of a saliva-based diagnostic test to identify horses naturally infected with tapeworm and assess the impact of using the test to inform anthelmintic administration. STUDY DESIGN: Retrospective longitudinal study. METHODS: Saliva was collected from horses (n = 237) at a UK welfare charity from autumn 2015 to autumn 2016. Horses diagnosed as positive for tapeworm infection using the EquiSal® Tapeworm test were anthelmintic treated according to weight. The number of horses that received anthelmintic treatment based on the test result was compared with an all-group treatment approach and the reduction in anthelmintic usage calculated. Incoming horses were also tested (n = 143) and the information was used to inform quarantine treatments. RESULTS: In autumn 2015, 85% of 237 horses tested received no anthelmintic and the majority (71%) of these remained below the treatment threshold throughout the study. Of the 69 horses that received treatment, seven required treatment following three subsequent tests, while >50% of horses administered with anthelmintic fell below the treatment threshold at the following test. No increase in tapeworm prevalence within the 237 horses was observed during the study despite a substantial reduction in the application of antitapeworm treatments. A total of 41% of incoming horses required anticestode treatment. MAIN LIMITATIONS: Other management practices were not included in the analysis. CONCLUSIONS: Compared with an all-group treatment strategy, the diagnostic-led approach used here considerably reduced application of anticestode anthelmintics. This could reduce selection pressure for anthelmintic resistance.

Managing information resources: a study of ten healthcare organizations.

This article presents the results of information technology management audits conducted by senior executives at ten healthcare organizations. The audits evaluated how well the following seven information technology management responsibilities were carried out: (1) strategic information systems planning; (2) employment of a user focus in system development; (3) recruiting of competent personnel; (4) information systems integration; (5) protection of information security and confidentiality; (6) employment of effective project management in system development; and (7) post-implementation evaluation of information systems. The audit results suggest that most of these responsibilities are being met to a considerable extent by a majority of the organizations studied. However, substantial variation across organizations was noted. Executives participating in the study were able to define areas in which the management of information resources in their organizations was in need of attention. The audit process encourages senior management to provide the leadership required to ensure that information technology is used to maximum advantage.

Achieving clinical excellence.

Clinical excellence can be divided into three defining categories: procedures, systems, and communications. Six steps have been introduced to guide our journey. New systems will produce less stressful, more profitable dentistry, and with this commitment to clinical excellence, patient care will improve automatically. Evaluating our practices and making the necessary changes will bring significant rewards. In Designing the Future, Visions and Strategies, I state, "Maximum efficiency, profitability, and security, the rewards of business momentum, come only to those who start paddling early. To avoid dead water, we must view business strategies in the context of social, technological, and economic currents. It's the difference between actively engaging trends and being destroyed by them."

Developing a health information network within an integrated delivery system: a case study.

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.

Marketing strategies for the cosmetic practice.

Appropriate marketing business systems need to be in place to attract and sustain a cosmetic dentistry patient base. Marketing for this sector is most effective when consistently patterned after businesses with high-end consumer services and products. Motivating patients of record and potential new patients to choose cosmetic dental services involves implementing both basic marketing and a series of cosmetic-specific marketing strategies. Consultants are valuable for the process of developing a strategic plan and making recommendations for developing new marketing business systems.

Information technology and managed care.

Information processing in the managed care marketplace is becoming increasingly complicated and expensive. Managed care organizations are finding that the ability to process information effectively and efficiently is the only way to maintain a competitive edge. This article provides an overview of information needs and system requirements from the perspective of healthcare providers. It offers information about computer software, electronic data interchange and databases, as well as brief case reports on some of their uses.

Monocular congenital cataracts: psychological effects of treatment.

Visual success in the treatment of monocular congenital cataracts requires early surgery, and aggressive, long-term amblyopia management and optical correction. These children will have their only normally seeing eye patched for a significant percentage of their early childhood years. We have been concerned about the possibility of an adverse psychological impact of this form of treatment. This study utilized two standardized testing instruments to evaluate the incidence of developmental delay and behavioral problems in children treated for monocular congenital cataracts. A total of 22 children were evaluated with one or both of these instruments and compared to a control group of 18 normal siblings. There was no statistically significant evidence of developmental delay or increased behavioral problems in the treatment group.

Information technology and the clinical laboratory. Agenda for the '90s.

The innovative use of information technology will be an essential response to the intense pressures and challenges health-care institutions face entering the final decade of the 20th century. Those pressures will affect the clinical laboratory and will result in significant use of improved information technology. The implications for laboratory management are significant. Changes in work methods, human resource needs, knowledge of information technology, and even laboratory organization will refocus the manager's attention. Routine, day-to-day activities that consumed the manager's attention will be handled automatically; long-range strategic planning, quests for productivity, and quality improvements will become more important and demanding. This article reviews current and evolving innovations in information technology and projects their impact on the clinical laboratory. Hardware, software, and communications technologies are examined. The effects on the laboratory, its manager, and the hospital are discussed.

The leading edge. Data systems can provide the tools needed to meet goals.

Management information systems--essential for strategic planning and management in today's complex healthcare environment--must be designed in concert with goals and strategies developed at the executive or corporate level. Healthcare organizations need management information to support four major functions: strategic planning and marketing, resource allocation, performance assessment, and evaluation of products and services. Computer systems fall into three general categories--administrative, clinical, and decision support (management information systems). Management information systems are the least advanced of the three. The need for strategic planning and managerial control in the face of complexity and competition, however, will result in rapid advances. The chief executive officer must be responsible for the following areas to ensure the effective use of information systems: strategic planning, information systems planning, user-driven focus, systems integration, and monitoring of results. Many larger healthcare organizations have established the position of chief information officer (CIO) to assist in these tasks. The CIO coordinates information systems, telecommunications, management engineering, and office automation.

Information technology and the future of health services delivery.

This article examines the dramatic ways that information technology will influence clinical care, strategic management, and organization of the health care delivery system in the years ahead. Advancements in microprocessors, telecommunications, mass storage of data and images, and input-output devices will be accompanied by increased use of health-related software packages. Standardized patient record formats and coding systems will facilitate system integration and networking of computers. Clinical decision support systems will assist physicians in medical diagnosis and treatment. Computer-enhanced medical imaging and other noninvasive procedures will reduce surgery, patient pain and discomfort, and lower costs. Automation will get closer to the patient. Management information and decision support systems will be central to effective management in a highly competitive environment. Information systems will support strategic planning, cost control, productivity enhancement, quality improvement, and evaluation of products and services.