Reviving post-mortem diagnostics as a tool to increase porcine herd health and strengthen early detection of pig diseases - the PathoPig project 2014-2016.

INTRODUCTION: Post-mortem diagnostics are an important tool for disease diagnosis and therefore early detection of (re-)emerging animal diseases and zoonoses as well as nationwide disease surveillance programs. To counteract the decline of porcine necropsies in Switzerland over the last ten years, the Federal Food Safety and Veterinary Office (FSVO) launched a national project in 2014 called PathoPig. Post-mortem examinations of pigs from herds with health problems were financially supported by the FSVO. During the first 3 years of the project, the number of pig necropsies increased by 195% (mean). An underlying cause of disease was identified in 74% of the cases. These findings resulted in specific recommendations by the attending veterinarians or by the Swiss Porcine Health Service. A follow-up survey revealed that herd health had improved in 90% of the farms implementing the recommendations.

INTRODUCTION: Les diagnostics post-mortem constituent un outil important pour le diagnostic des maladies et, partant, la détection précoce des maladies animales et des zoonoses (ré)-émergentes ainsi que pour les programmes nationaux de surveillance des maladies. Pour contrer le déclin des nécropsies porcines en Suisse au cours des dix dernières années, l'Office fédéral de la sécurité alimentaire et vétérinaire (OSAV) a lancé en 2014 un projet national baptisé PathoPig. Les examens post-mortem des porcs provenant d'exploitations avec des problèmes de santé ont été soutenus financièrement par l'OSAV. Au cours des trois premières années du projet, le nombre de nécropsies porcines a augmenté de 195% (moyenne). Une cause sous-jacente de maladie a été identifiée dans 74% des cas. Ces constatations ont abouti à des recommandations spécifiques des vétérinaires participants ou du Service sanitaire porcin suisse. Une enquête de suivi a révélé que la santé des troupeaux s'était améliorée dans 90% des exploitations appliquant les recommandations.

Experiences with a voluntary surveillance system for early detection of equine diseases in Switzerland.

Clinical observations made by practitioners and reported using web- and mobile-based technologies may benefit disease surveillance by improving the timeliness of outbreak detection. Equinella is a voluntary electronic reporting and information system established for the early detection of infectious equine diseases in Switzerland. Sentinel veterinary practitioners have been able to report cases of non-notifiable diseases and clinical symptoms to an internet-based platform since November 2013. Telephone interviews were carried out during the first year to understand the motivating and constraining factors affecting voluntary reporting and the use of mobile devices in a sentinel network. We found that non-monetary incentives attract sentinel practitioners; however, insufficient understanding of the reporting system and of its relevance, as well as concerns over the electronic dissemination of health data were identified as potential challenges to sustainable reporting. Many practitioners are not yet aware of the advantages of mobile-based surveillance and may require some time to become accustomed to novel reporting methods. Finally, our study highlights the need for continued information feedback loops within voluntary sentinel networks.

[Does emergency vaccination make sense as a supporting element in control of foot-and-mouth disease in Switzerland]. / Ist die Notimpfung als unterstützende Massnahme zur Tilgung der Maul- und Klauenseuche in der Schweiz sinnvoll?

The outbreak of foot and mouth disease (FMD) in Great Britain in 2001 let to discussions and especially emergency vaccination was deemed as an alternative to the culling of vast numbers of healthy animals. The project emergency vaccination for FMD in Switzerland was conducted to compare the effectiveness of conventional control strategies during a FMD outbreak alone and with ring vaccination of 3 km and 10 km, respectively. The results of this project showed that emergency vaccination conducted at the beginning of an epidemic was not favorable compared to conventional disease control strategy in Switzerland. In case of an advanced FMD epidemic, a 10 km ring vaccination could support the disease control in a positive way. However, the goal of emergency vaccination to save animal live can hardly be achieved due to actual legal basis and the consequent restriction measures within vaccination zones which will lead to welfare culling.

L'épizootie de fièvre aphteuse en Grande Bretagne en 2001 a montré que les abatages de masse d'animaux sains sont plus en plus critiquée. On discute régulièrement de la vaccination d'urgence comme mesure permettant de réduire le nombre d'animaux à tuer en cas d'épizootie. Dans le cadre du projet vaccination d'urgence FA suisse, on a comparé l'effet de la seule lutte conventionnelle avec celui d'une vaccination d'urgence «vaccination to live¼ dans un périmètre de 3 km (GV3) respectivement 10 km (GV10) quant à la durée et à l'importance du foyer. Au début d'une épizootie, la vaccination d'urgence supplémentaire n'apporte pas d'avantage face à la lutte conventionnelle. Si une vaccination V10 est pratiquée plus tardivement, elle peut dans certains cas amener une diminution et un raccourcissement de l'épizootie. Le but visant, grâce à la vaccination d'urgence, à tuer moins d'animaux ne peut toutefois pas, dans les conditions actuelles, être atteint car vu les fortes limitations du trafic d'animaux à l'intérieur des zones de vaccination, on doit compter avec des abattages pour des raisons de protections des animaux.

Waiting for scheduled services in Canada: development of priority-setting scoring systems.

RATIONALE, AIMS AND OBJECTIVES: An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. METHODS: Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. RESULTS: Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. CONCLUSIONS: While the WCWL project has not 'solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere.

[Epidemiological basis and results of the National Survey 2001 conducted in the Swiss pig population]. / Epidemiologische Grundlagen und Resultate der Stichprobenuntersuchung 2001 in der schweizerischen Schweinepopulation.

Free trade with animals and animal products requires transparency concerning health information of animal populations. On the basis of the bilateral agreement with the European Union (EU), Switzerland is obliged to document freedom from Aujeszky's disease (AD) in its pig population by conducting surveys on a regular basis. Such a survey was planned for the first time for the year 2001. In this context, it was evaluated whether additional pig diseases should be included in the survey. This article describes the evaluation procedure for the selection of pig diseases integrated in the survey 2001. Additionally, it reports and interprets the results of this survey. All of the 2537 farms and 41,719 blood samples were tested negative. Therefore, it could be documented with a confidence of 99.98% that the AD-prevalence in Switzerland is below 1%.

Setting priorities for waiting lists: defining our terms. Steering Committee of the Western Canada Waiting List Project.

In order to develop standardized measures to assess patients' relative priority for services for which there are waiting lists, it is essential that key terms be clearly defined. We propose that severity be defined as the degree or extent of suffering, limits to activities or risk of death; that urgency be defined as severity combined with considerations of the expected benefit and the natural history of the condition; that need be considered equivalent to urgency; and that priority be defined in terms of urgency (or need) with or without consideration of social factors.

Anticoagulation in chronic nonvalvular atrial fibrillation: a critical appraisal and meta-analysis.

OBJECTIVE: To assess the outcomes associated with warfarin treatment of patients with chronic nonvalvular atrial fibrillation (CNVAF) for prevention of primary stroke. DATA SOURCES: MEDLINE was searched for literature published from 1987 to August 1996. Search terms used were 'atrial fibrillation' and 'anticoagulants'. STUDY SELECTION: Five published randomized controlled trials concerning primary stroke prevention. DATA EXTRACTION: Data were pooled across trials to estimate the magnitude of the effect for each of nine reported end-points. The annual probability of occurrence of each outcome was calculated, including standard errors and Mantel-Haenszel significance tests with 95% CIs. DATA SYNTHESIS: In view of the lack of blinded assessment and documented low inter-rater reliability of soft neurological end-points, the analysis was limited to the relatively objective end-points of major strokes, fatal strokes, major bleeding and fatal bleeding. Warfarin did not reduce the incidence of fatal strokes to a statistically significant extent, nor was incidence of fatal bleeding increased significantly. Warfarin reduced the absolute annual incidence of major strokes in patients with CNVAF by 0.89%, while at the same time it increased the absolute annual risk of major bleeding incidents by 1.8%. Though small, these differences were statistically significant. CONCLUSIONS: On balance, the margin between expected benefit and harm for warfarin prophylaxis in patients with CNVAF is uncomfortably thin. These results and conclusions differ from those of a previously published meta-analysis of these same studies.

The New Zealand priority criteria project. Part 1: Overview.

New Zealand restructured its health system in 1992 with the aim of achieving greater levels of assessment and accountability in the publicly funded health sector. A committee was established specifically to advise the minister of health on the kinds, and relative priorities, of health services that should be publicly funded. One of its projects has been to develop standardised sets of criteria to assess the extent of benefit expected from elective surgical procedures. These have been developed with the help of professional advisory groups using a modified Delphi technique to reach consensus. So far the committee has developed criteria for cataract surgery, coronary artery bypass grafting, hip and knee replacement, cholecystectomy, and tympanostomy tubes for otitis media with effusion. These criteria incorporate both clinical and social factors. Use of priority criteria to ensure consistency and transparency regarding patients' priority for surgery is required for access to a dedicated NZ$130m (pounds 57m; US$90m) pool of money, created to help eliminate surgical waiting lists and move to booking systems. The criteria will also be used in surgical outcome studies, currently in the planning phase.

The New Zealand priority criteria project. Part 2: Coronary artery bypass graft surgery.

Priority criteria developed during a national project were used to conduct an audit of all 662 patients on waiting lists for coronary artery bypass surgery in New Zealand during spring 1996. Based on the observed distribution of priority scores, the cost of providing surgery to all patients down to various levels of priority was estimated. Descriptions incorporating life expectancy and quality of life implications of surgery were developed of the kinds of patients who would or would not receive surgery at each of several possible funding levels. Cardiologists and cardiac surgeons agreed that a threshold of 25 points was a reasonable clinical goal but to work with a threshold of 35, which can be sustained with current levels of funding. All agree that the gap between these clinically preferred and currently afforded thresholds is a subject for wider societal dialogue and decision. The ability to measure the size of the gap between clinical desirability and financial sustainability provides a new transparency to the problem of healthcare resource allocation.

Kinds of patients.

The basic goal of health outcomes research is to identify the kinds of patients who do (or do not) benefit substantially from specified medical or surgical treatments and procedures. Similarly, clinicians must determine whether particular patients are the kinds of patients who do (or do not) benefit from specified interventions. Such a kinds-based approach to clinical practice is often resisted, however, when physicians are asked to standardize their practices based on the results of health outcome data. In such settings, clinicians often assert that "every patient is unique". The present paper explores the coherence of this claim. In particular, I examine the applicability of the philosophical notion of natural kinds to a kinds-based approach to clinical research and practice. I conclude that the claim of patient uniqueness is misguided. Two key difficulties with a kinds-based approach are examined: the problems associated with (1) assigning single-case probabilities and (2) stereotyping and discrimination.

Rating the quality of evidence for clinical practice guidelines.

This article describes the system for rating the quality of medical evidence developed and used during creation of the Agency for Health Care Policy and Research-sponsored heart failure guideline. Previous approaches to rating evidence were not designed for use in the setting of clinical practice guidelines. The present system is based on the tenet that flaws in research design are serious to the extent they threaten the validity of the results of studies. A taxonomy of major and minor flaws based on that tenet was developed for randomized controlled trials and for cohort and medical registry studies. The use of the system is described in the context of two difficult clinical issues considered by the Panel: the role of coronary artery revascularization and the use of metoprolol.