Evaluation of the effects of weaning diets on Escherichia coli O157 shedding, body weight, and fecal bacterial communities in beef calves.

Cattle are considered to be one of the primary reservoirs of Escherichia coli O157. In this study, the effects of weaning diets on E. coli O157 shedding, body weight, and fecal bacterial communities in beef calves were evaluated. A total of 60 calves (28 heifers and 32 steers) were weaned and randomly assigned into two groups. A peanut/soy hull-based diet (Dry Feed, DF) and a corn silage-based diet (High Moisture, HM) were fed to the two groups, respectively, during the weaning and preconditioning period. Calf body weight was measured before weaning (BW) and 14 days after weaning (AW14), and a fecal sample was collected from each calf at BW, AW14, as well as 56 days after weaning (AW56). The prevalence of O157 in feces was determined by CHROMagar(™) O157 and polymerase chain reaction (PCR). Denaturing gradient gel electrophoresis (DGGE) was employed to analyze fecal bacterial communities. A significant decrease in body weight was observed during weaning, regardless of the calf diet (p<0.05). Calves fed the HM diet lost more weight than the DF-fed calves determined at 14 days after weaning (p<0.05). Both the CHROMagar(™) and PCR results showed that the overall prevalence of O157 increased significantly during weaning. Based on the CHROMagar(™) method, O157 increased from 16.6% at BW to 38.3% at AW14 (p<0.05) and stayed at the higher level during the preconditioning period (AW56). The increase in O157 prevalence was observed in HM-fed calves during weaning but not in DF-fed ones. Weaning also changed the profile of fecal bacterial communities (p<0.05). These results showed that weaning is a critical step in beef cattle production, not only because of its effects on body weight but also due to its impact on O157 shedding and gastrointestinal tract bacterial community establishment.

CFOs and quality managers: bridging the disconnect.

A survey of hospitals to assess the impact of selected organizational factors on achieving optimal patient outcomes found several barriers. To improve clinical and financial outcomes healthcare organizations should: Perform a self-assessment and discuss different perspectives and perceptions among stakeholders. Redesign structures and processes that support multidisciplinary input and involvement. Realign roles and responsibilities. Address problem personalities. Ensure open lines of communication among stakeholders.

Improved treatment of hospitalized coronary artery disease patients with the get with the guidelines program.

Adherence to evidence-based interventions for hospitalized cardiovascular disease patients is not optimal. This study assesses the impact of a national quality improvement program on adherence to guidelines in these patients. Data from 92 hospitals from across the United States participating in the Get With The Guidelines program for at least 1 year for 11 acute and secondary prevention measures from a preintervention baseline period and the subsequent 4 quarters of a quality improvement intervention were analyzed. A patient group of 45,988 patients with acute myocardial infarction, unstable angina, revascularization, or peripheral vascular disease was included in this evaluation. Significant improvement from baseline was seen in 10 of 11 measures by the fourth quarter: use of early aspirin for acute myocardial infarction, 76.4% to 88.0% (P < 0.0001); early beta-blocker for acute myocardial infarction, 64.4% to 79.5% (P < 0.0001); beta-blocker at discharge, 75% to 82.1% (P < 0.0001); smoking cessation counseling, 58.7% to 74.3% (P < 0.0001); angiotensin-converting enzyme inhibitor use for acute myocardial infarction, 64.5% to 69.9% (P < 0.0001); lipid treatment, 58.5% to 63.4% (P < 0.0001); lipid treatment for low-density lipoprotein > or =100 mg/dL, 60.4% to 67.0% (P < 0.0001); low-density-lipoprotein measurement, 48.8% to 53.2% (P < 0.0001); discharge blood pressure <140/90 mm Hg, 65.9% to 68.0% (P = 0.03); and referral to cardiac rehabilitation or exercise counseling, 65.0% to 88.3% (P < 0.001). Discharge aspirin use at 89.9% did not change. Statistically and clinically significant improvement in 10 of 11 quality-improvement measures for the treatment of patients hospitalized for cardiovascular disease was seen in hospitals participating in Get With The Guidelines.

The wearing of compression hosiery for leg problems other than leg ulcers.

Many people have leg problems other than ulceration. Practitioners from one primary care trust in Suffolk considered nursing assessment of these patients and the fitting of prescribed compression hosiery where appropriate as a health promotion initiative. However, ongoing assessment adds to heavy clinical demands on community practitioners. Engaging with people to take greater responsibility for their health, and recognition that practice should be underpinned by credible evidence, provided the backdrop to a two-staged retrospective audit. Results are based on the nursing records of 101 patients wearing prescribed compression hosiery other than for previous venous ulceration. It was concluded that following an initial detailed holistic assessment, including ankle brachial pressure index, those patients who meet identified characteristics can be empowered to return for reassessment only if there is a change in their health status, or skin changes to their legs. An information leaflet is considered critical to this strategy.

Aligning financial incentives with "Get With The Guidelines" to improve cardiovascular care.

OBJECTIVE: To describe the impact of a commercial insurer's financial incentives to hospitals in conjunction with collaboration with the American Heart Association (AHA) to accelerate implementation of Get With The Guidelines-Coronary Artery Disease (GWTG-CAD), a quality improvement program to rapidly improve cardiovascular secondary prevention in hospitalized patients. STUDY DESIGN: Observational assessment of quality improvement program participation and implementation in response to financial incentives. METHODS: The study population included all hospitals that participated with the Hawaii Medical Service Association (HMSA, Blue Cross Blue Shield of Hawaii) Hospital Quality and Service Recognition Program and had more than 30 annual admissions for acute coronary artery disease. These 13 hospitals were given encouragement and financial incentives to implement GWTG-CAD. Financial incentives were determined by a prorated amount of the total HMSA hospital reimbursement for all acute services, as part of a more comprehensive hospital "pay for performance" program. RESULTS: Incentives to 10 of 13 eligible hospitals included reimbursement for half the annual cost of the AHA Patient Management Tool. In addition, HMSA's pay for performance program--the Hospital Quality and Service Recognition Program--distributed monetary awards totaling 354,883 dollars, based on points awarded for GWTG-CAD workshop attendance documentation (10 hospitals), recognition by the AHA as a GWTG-CAD hospital, and attainment of 85% adherence to the GWTG-CAD performance measures (4 hospitals). CONCLUSIONS: Community-based promotion of GWTG-CAD and financial incentives provided by a commercial insurer resulted in the rapid implementation of a secondary prevention program for coronary artery disease in most hospitals in the State of Hawaii within a single year.

A collaborative model for hospital-based cardiovascular secondary prevention.

This article presents a collaborative model for hospital-based cardiovascular secondary prevention. The model employs a stake holder consortium to provide hospitals with a unified approach to improve care and conform to regulatory requirements. Hospital teams use a Web-based tool that embeds data collection in the process of care and supports rapid cycle improvement. Recognition of participation and achievement by the American Heart Association helps to obtain administrative support for the program.