Monitoring and documentation of side effects from depot antipsychotic medication: an interdisciplinary audit of practice in a regional mental health service.

This audit reviewed current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. A sample of 60 case files, care plans and prescriptions were audited, which is 31% of the total number of service users receiving depot injections in the mental health service region (n= 181). The sample audited had a range of diagnoses, including: schizophrenia, schizoaffective disorder, bipolar affective disorder, depression, alcoholic hallucinosis and autism. The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only five (8%) case notes examined had documentation recorded describing the condition of the injection site, and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded. In 57 (95%) of case notes, no documentation of recorded information on the depot and on side effects was given. The failure to monitor and record some blood tests was partly attributed to a lack of clarity regarding whose responsibility it was. A standardized checklist has been developed as a result of the audit and this will be introduced by all teams across the service.

How many pigs? Statistical power considerations in swine nutrition experiments.

Replication refers to the assignment of more than one experimental unit to the same treatment. Each replication of a treatment is an independent observation; thus, each replication involves a different experimental unit. In swine nutrition research, the experimental unit may be an individual animal, as in sow reproduction experiments, or a group of animals, as in growing-finishing pig experiments. In either case, calculation of the number of replicates needed to give an accurate and reliable outcome is an important step in deriving an experimental protocol. Although investigators often seem to choose replication arbitrarily on the basis of cost or availability of animals, housing considerations, convenience, or tradition, the question of how many pigs (i.e., how much replication is necessary) is a statistical one that has a statistical answer. A power analysis, performed while designing an experiment, will provide an investigator with an estimate of the number of replicates needed for an experiment of known power and sensitivity. This a priori, or prospective, power analysis ensures that an investigator does not waste time and resources carrying out an experiment that has little chance of finding a significant effect, if one exists. It also makes sure resources are not wasted by including more experimental units than are necessary to detect an effect. A retrospective, or a posteriori, power analysis may also be conducted. If no significant effects are found in an experiment, an investigator can assess the observed power of the experiment, or may determine the size of treatment effect that could have been detected using the standard deviation and number of replicates in the experiment. The latter may be useful in explaining results. However, the former may be misleading because a high P-value will invariably result in a low observed power, and little new information will be gained from the post hoc power analysis. In most cases, the time for making power calculations is before, not after, an experiment is conducted.

Effect of chlortetracycline on the spread of R-100 plasmid-containing Escherichia coli BEL15R from experimentally infected pigs to uninfected pigs and chicks.

Swine from two herds with different histories of antibiotic exposure were fed diets containing 0 or 55 mg of chlortetracycline (CTC)/kg. One of five pigs in each herd-diet treatment group was infected orally with Escherichia coli strain BEL15R that was resistant to nalidixic acid (NA), chloramphenicol (C), streptomycin (S), sulfamethizole (TH) and tetracycline (TE). Effects of CTC on the quantity and duration of fecal shedding of E. coli BEL15R and on the transmission of strain BEL15R and its R-100 plasmid from infected pigs to uninfected pigs and chicks were determined. Quantity and duration of shedding were greater in infected antibiotic-herd pigs than in infected nonantibiotic-herd pigs. Feeding on CTC increased the duration of shedding in infected pigs from both herds. Strain BEL15R colonized and was shed in one uninfected antibiotic pig in each treatment group, but it did not colonize in any of the uninfected nonantibiotic-herd pigs or in the uninfected chicks. In vivo transfer of resistance to C, S, TH and TE occurred in the infected antibiotic-herd pigs but not in the infected nonantibiotic-herd pigs. Transfer of the R-100 plasmid occurred from the infected to the uninfected antibiotic-herd pigs and to the uninfected chicks housed near the antibiotic-herd pigs fed CTC, but not to the chicks housed with the antibiotic-herd pigs fed the control diet. No transfer of resistance occurred from the infected nonantibiotic-herd pigs fed either CTC or control diet.

Interactive effects of dietary calcium, phosphorus and copper on performance and liver stores of pigs.

Three experiments involving 304 pigs were conducted to determine the related effects of copper (Cu), calcium (Ca) and phosphorus (P) on the performance and liver Cu stores of growing-finishing pigs. Rate and efficiency of gain were improved by the addition of 250 ppm of Cu to the diets. Improvements in rate of gain averaged 6.6% (652 vs 696 g/d) to 60.5 kg body weight and 1.7% (713 vs 725 g/d) to 94.5 kg body weight. Feed:gain ratio was improved by 1.4% to 60.5 kg and 1.6% to 94.5 kg body weight when Cu was added to the diet. Increasing the dietary Ca and P levels from .65% Ca and .55% P to 1.2% Ca and .86 or 1.0% P resulted in increased (P less than .01) growth rate to 60 and 95 kg (649 vs 699 g/d and 700 vs 737 g/d, respectively), but feed efficiency was not affected (2.86 vs 2.84 and 3.18 vs 3.17 kg feed/kg gain, respectively.) Feeding the higher Ca and P levels resulted in increased liver Cu levels in pigs fed 250 ppm Cu (189 vs 323 ppm), but Ca and P did not affect liver Cu of pigs fed low Cu diets (29 vs 28 ppm). When dietary Ca and P were varied independently, the high Ca level increased liver Cu, but P had little effect on liver Cu. Increasing the dietary P level partially alleviated the effect of Ca on liver Cu.

Antibiotic resistance of fecal coliforms after long-term withdrawal of therapeutic and subtherapeutic antibiotic use in a swine herd.

Tetracycline resistance of fecal coliforms isolated from swine decreased from 82 to 42%, a decrease of less than 50%, after the use of all forms of antimicrobial agents were discontinued in the herd for 126 months.

Effect of feeding chlortetracycline or virginiamycin on shedding of salmonellae from experimentally-infected swine.

Swine from a herd routinely fed subtherapeutic levels of chlortetracycline (CTC) were fed a diet containing 55 mg of CTC/kg, a diet containing 55 mg of virginiamycin/kg, or a control diet. All animals were inoculated with Salmonella typhimurium that was susceptible to tetracycline. The quantity, duration and prevalence of shedding of S. typhimurium were determined. The infecting organism was first recovered from the animals fed CTC or the control diet on d 2, from animals fed virginiamycin on d 7 and from animals in a second control group on d 10. The infecting organism was recovered in fewer samples obtained during the initial 7 d postinfection than in those obtained during the last 24 d of the study. Little transfer of resistance to the infecting organism seemed to have occurred from the resident microflora because only two isolates (1%) had resistant patterns that differed from that of the infecting organism. Feeding CTC or virginiamycin to swine did not significantly increase or prolong shedding of an experimentally infected tetracycline-susceptible strain of S. typhimurium. Neither antibiotic affected the drug resistance of the infecting organism.