Added value of Joint ENT-Rheumatology clinic in the management of ANCA-associated vasculitis: One year's experience.

PURPOSE: ANCA-associated vasculitides (AAV) represent a group of diagnoses, including granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA). Most commonly, they present initially with ENT-associated symptomatology, and therefore they often pose a diagnostic challenge. We aim to present our one-year experience in the joint management of AAV in a multi-disciplinary setting. METHODS: We performed a retrospective analysis based on the records of 39 patients who were seen in the joint clinic, during a period of one year. RESULTS: After clinical assessment, 13 patients had changes made to their ENT treatment, 2 had some changes in their immunosuppression, while 11 had changes in both ENT and Rheumatology treatment. Six patients did not require any alterations to their therapeutic scheme. On average three separate appointments were reduced to a single appointment in the joint clinic where definitive treatment decisions were made. This led to significant cost reductions. CONCLUSIONS: Cost-effectiveness, patient satisfaction, rapid multi-disciplinary evaluation, avoidance of unnecessary immunosuppression, patient education and medical training are only a few of the many advantages of this proposed joint service.

Ripples in a pond: an open system model of the evolution of safety culture.

The development of an effective safety culture is essential to promote safe operations. Previous studies have either identified the characteristics of effective safety culture analytically, inferring them from signs and symbols derived from working practices, or have restricted the study of the development of safety culture to workers within an organisation. This paper describes a large-scale survey-based study in which the factors influencing the evolution of safety culture are identified empirically and, drawing upon open systems theory, are also extended beyond the bounds of the organisation. Three major determinants of safety culture are identified: safety concerns, influences and actions. Sub-components within each of these categories are also identified and the relationship between them is hypothesised.

Effects of helminth infection on the pre-weaning production of ewes and lambs: comparison between safe and contaminated pasture.

Comparison was made of the performances of cross-bred ewes and their lambs on pastures of low helminth infectivity ("safe" pastures) or contaminated pastures and at high or low stocking rates. Ewes grazing the safe, but not the contaminated, pastures were given a single pre-lambing drench. The largest difference in parasite infection between treatments was the level of exposure of sheep to Trichostrongylus spp, which was negligible on the safe pastures. The effects of parasite control on lamb growth were significant only in twins during the last 2 months before weaning. However, 22% of lambs on contaminated plots became soiled in the breech area and 38% were flystruck, compared with 8% and 10% respectively for lambs on the safe pastures. Ewe bodyweight gains were greater at low than at high stocking rate and were not affected by the parasite control treatments; differences in breech soiling and fly strike were similar to those in the lambs. Most importantly the parasite treatment produced a highly significant effect on ewe fleece weight at weaning. Ewes drenched and lambing on the safe pastures produced an extra 0.43 kg of wool, calculated to represent an increase of at least 40% during this period at the low-level of parasitic infection.

Effects of helminth infection on the pre-weaning production of ewes and lambs: evaluation of pre- and post-lambing drenching and provision of safe lambing pasture.

The pre-weaning production of ewes and lambs in spring on pastures grazed during the previous autumn and early winter by either weaner sheep, adult sheep, or cattle was investigated together with estimating the benefits of pre- and post-lambing drenches to ewes. These treatments were compared with one in which parasitism was uncontrolled in ewes lambing on pastures grazed previously by untreated weaner sheep, and another where parasitism was suppressed by 2-weekly drenching of the weaner sheep and also of the ewes and their lambs. Prior grazing by cattle effectively eliminated infection of pastures with intestinal Trichostrongylus and Nematodirus spp, but less so for Ostertagia spp. Worthwhile reductions in contamination were also achieved by grazing by adult sheep compared with grazing by undrenched weaners. Despite differences in the parasitological status of the pastures, there were no indications that pre-weaning growth rates of lambs were affected. However, wool growth in ewes was reduced by 10 to 20% by parasite infection. Wool growth of ewes on pastures grazed by cattle during the pre-experimental period exceeded that on any other treatment, and was significantly greater than that of ewes on pastures grazed by undrenched weaners. There was no production benefit in giving a pre-lambing drench to ewes on plots contaminated by weaners, or in giving the additional post-lambing drench to ewes grazing on plots contaminated by weaners, adult sheep or cattle.

The effect of calfhood vaccination with strain 19 on the serological diagnosis and eradication of bovine brucellosis.

Data from 42,224 cattle from 694 herds collected during the brucellosis eradication campaign were used to examine the effects of calfhood strain 19 vaccination. The prevalence to infection in vaccinated herds was 1.8% compared with 9.1% in non-vaccinated herds (p less than 0.005). The mean titre in the former group was lower (p less than 0.001). Vaccinated herds required 3.3 herd tests to achieve a provisionally free status compared with 4.8 in non-vaccinated herds (0.001 less than p less than 0.005). Vaccination did not significantly reduce the number of herd test in herds with less than 100 breeding females. In tests after the initial herd test only 0.5% reactors were found in vaccinated herds compared with 6.9% in non-vaccinated herds (p less than 0.005). There were 0.9% false positive to the Rose Bengal plate test in non-vaccinated and 2.1% in vaccinated animals (p less than 0.005) in non-infected herds. In infected herds this percentage was 3.0% and 4.2% respectively by (p less than 0.05). In the non-infected herds there were 0.04% false positives to the complement fixation tests out of 10,506 non-vaccinated cattle tested and 0.2% out of 24,734 vaccinated cattle.

Blowfly strike in the breech region of sheep in relation to helminth infection.

The incidence of breech strike in radically mulesed weaner sheep was reduced from about 50% to about 5% by suppression of helminth infection. Prediposition of sheep to flystrike appeared to result from the helminths causing diarrhoea and soiling of the wool in the breech region. Wethers were struck more frequently than ewes. The efficiency of control of breech strike in mulesed weaners is considered in relation to helminth control and crutching.