Clinical effects of an optimised care program with telehealth in heart failure patients in a community hospital in the Netherlands.

BACKGROUND: Our hypothesis was that telehealth in combination with an optimised care program coordinated amongst care professionals in primary, secondary and tertiary care can achieve beneficial outcomes in heart failure. The objective was to evaluate the clinical effects of introduction of telehealth in an optimised care program in a community hospital in the north of the Netherlands. METHODS: We compared the number of unplanned admissions for heart failure in the year before and after adding telehealth to the optimised care program. Furthermore, blood pressure and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were evaluated at baseline and 3, 6 and 12 months after telehealth. Quality of life and knowledge about the disease were regularly evaluated via surveys on the telehealth system. FINDINGS: The number of unplanned admissions for heart failure decreased from on average 1.29 to 0.31 admissions per year after telehealth introduction. Blood pressure decreased independent of medication and NT-proBNP levels improved as well. Quality of life increased during the telehealth intervention and disease knowledge remained high throughout the follow-up period. Unplanned admissions that remained after telehealth introduction could be accurately predicted at baseline by a multivariate regression model.

Somatic cell count during and between milkings.

The objectives of the study were to determine 1) how sampling time between milkings affects the sensitivity and specificity of somatic cell count (SCC) as an indicator for intramammary infection (IMI) status, and 2) which cells are responsible for the diurnal variation in SCC. Six Prince Edward Island, Canada, dairy herds were selected. Quarter samples for SCC were collected immediately before the a.m. milking (pre-a.m.), halfway through the a.m. milking, immediately after the a.m. milking, every 60 min after detachment of the milking unit, and immediately before the p.m. milking (pre-p.m.). Compared with the geometric mean SCC at the pre-a.m. milking, SCC of quarters with no IMI between milkings was higher up to 7 h after milking. The pre-p.m. SCC was significantly lower than the pre-a.m. SCC in quarters with no IMI. Specificity of SCC at a cutoff of 200,000 or 500,000 cells/mL as an indicator for IMI status declined substantially after the a.m. milking. In quarters with elevated SCC, the proportion of polymorphonuclear leukocytes was larger immediately after milking. For accurate interpretations of SCC tests--whether by a laboratory, portable SCC device, or the California Mastitis Test--veterinarians, researchers, and udder health advisors should take milk samples immediately before milking.

Evaluation of a multidisciplinary treatment for patients with chronic non-specific upper-limb musculoskeletal disorders: a pilot study.

BACKGROUND: Upper-limb musculoskeletal disorders (ULMSDs) are considered a major health and socio-economic problem. However, knowledge about the effect of treatment programmes is scarce. Objective To evaluate the effect of a multidisciplinary treatment programme on well-being, disability and return to work in patients with chronic non-specific upper-limb disorders. METHODS: A longitudinal and uncontrolled design with pre-post measurements was used. Forty-one patients on long-term sick leave attended for multidisciplinary treatment aimed at training in personal coping strategies and improving activities of daily living. Outcome measures were generic well-being (SF-36), disability (DASH) and return to work (working hours). RESULTS: General well-being improved significantly between pre-treatment and post-treatment. Level of disability declined significantly between pre-treatment and post-treatment. In 63% of the patients, return to own work was complete at follow up, 4 months post-treatment. CONCLUSION: The results of this uncontrolled intervention study suggest that multidisciplinary treatment programmes improve general well-being, reduce disability and facilitate return to work in patients with chronic non-specific ULMSDs.