Web-based personalised information and support for patients with a neuroendocrine tumour: randomised controlled trial.

BACKGROUND: Patients with a neuroendocrine tumour (NET) frequently have physical and psychosocial complaints. Aim of this study is to determine whether a web-based, personalised information and support system (WINS) reduces distress and/or improves patients' perception of and satisfaction with information received. METHODS: Patients with NET, stratified for those newly diagnosed (< 6 months, n = 28) and with a longer history of disease (n = 74), were randomised between standard care (n = 49) and intervention, consisting of access to WINS (n = 53). Primary outcome was change of distress and satisfaction with perceived information measured with the distress thermometer and problem list and the QoL questionnaire (QLQ)-INFO25. The intervention group also completed a questionnaire based on the technical acceptance model (TAM). RESULTS: We observed no difference in distress slope and slope of median global score on perceived information and satisfaction between the intervention and control group. Interestingly, 55% of patients wished to receive more information at baseline. CONCLUSIONS: In a population of NET patients, access to WINS did not improve indicators for distress, perception of information and satisfaction with information received, more than standard care only. Despite the need for more information, the WINS does not have added value to the information and care provided by health care professionals. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02472678 ). Registered 6th Jan 2015. Retrospectively registered 1st May 2017.

The economic evaluation of control and eradication of epidemic livestock diseases.

Many countries have implemented strategies to control and eradicate epidemic diseases. These strategies are usually based on either stamping-out or routine vaccination, sometimes complemented by emergency vaccination. The authors describe these strategies, using examples to illustrate each one. The economic evaluation of control and eradication of epidemic diseases is a complex matter. The authors provide further insight into this area by describing the various elements involved in both the 'non-outbreak periods' and the 'outbreak periods'. In addition, a system of categorisation of the direct costs and consequential losses is suggested for the calculation of costs and losses incurred by outbreaks. The economic impact of epidemic diseases on farmers and the livestock sector as a whole differs; these differences may be influenced by the control and eradication strategies applied. An attempt is made to provide a basic framework for economic evaluation on various economic levels.

[BVD outbreak can be costly: a case report]. / BVD-uitbraak kan kostbaar zijn: een praktijkgeval.

The losses caused by an BVD-outbreak on a Dutch dairy farm with approximately 100 dairy cows were determined. In this particular farm, calves which were born around the same time as a detected carrier calf were not sampled. These carrier calves were kept on as replacement heifers and caused additional loss on top of the losses already caused by the primary outbreak. The total economic loss was more than f 96.000,- or nearly f 1000,-per cow. This case report illustrates the potential for serious economic loss when an BVD free herd is reinfected combined with less adequate control measures.

Economic and reproductive consequences of retained placenta in dairy cattle.

The financial losses due to retained placenta in Dutch dairy cattle were estimated by using two different methods of calculation. A data-set containing the birth records of 160,188 Meuse-Rhine-Yssel cows provided data on the reproductive performance of cows with and without retained placenta. The fertility of cows after retention of the placenta appeared to be affected. An economic calculation made by adding the losses due to increased calving interval, increased culling rate, loss of milk production and the costs of veterinary treatment and drugs revealed that the total loss due to retained placenta was 471 pounds per year for a 100-cow farm with an average incidence of the condition (6.6 per cent). For a 'problem' farm with a 30 per cent rate, the loss was 2139 pounds per year. A computer farm simulation model, based on a stochastic determination of events, was used to make calculations for circumstances closely resembling those on farms. A 6.6 per cent rate of retained placenta caused a small but significant decrease in net return on labour and management; however, a 30 per cent rate caused highly significant changes. The economic effects of retained placenta were similar in magnitude in herds of high or low productivity and high or low fertility. Sensitivity analysis showed that the greatest financial losses were caused by loss of milk production, followed by the number of animals suffering from complications. The financial losses in herds with an average rate of retained placenta were thus of limited economic importance and therapeutic measures alone should be adequate.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic losses due to paratuberculosis in dairy cattle.

The results of a study of the economic losses caused by paratuberculosis in dairy cattle are reported. The losses in production and the determination of lost future income due to premature disposal are emphasised. A decrease in milk production of 19.5 per cent compared with the lactation two years before culling was recorded in animals showing clinical signs of paratuberculosis. The decrease in production in the last lactation but one compared with the previous lactation was 5 per cent. In animals with non-clinical forms of paratuberculosis these decreases in production were 16 per cent and 6 per cent, respectively.

[Economic losses to farms due to paratuberculosis in cattle]. / Bedrijfseconomische schade van paratuberculose bij het rund.

The results of a study on economic losses to farms caused by paratuberculosis in dairy cattle are reported. Quantification of the decrease in production and determination of standard losses due to premature disposal using calculations based on a model were stressed. A decrease in production of 19.5 per cent compared with the last lactation but two was recorded in animals showing clinical symptoms of paratuberculosis. The decrease in production was 5 per cent during the last lactation but one compared with the previous lactation. The decrease in production during lactation on disposal was 16 per cent and 6 per cent during the last lactation but one compared with the last lactation but two in animals with non-clinical forms of paratuberculosis. The average cow showing clinical symptoms of paratuberculosis, which was disposed of, caused a total loss of 2,250 guilders, whereas the average cow with a non-clinical form of Johne's disease was estimated to cause a loss of 1,800 guilders.

A three year herd health and management program on thirty Dutch dairy farms. II. Culling strategy and losses caused by forced replacement of dairy cows.

Cows are culled at a relatively low age, which causes considerable economic loss. The annual culling rate in the Netherlands has increased from 18.8 per cent in 1951 to 25-30 per cent of the average number of cows in more recent years. The productive life is now about 3.5 years. On the thirty farms of the program group and thirty-one farms of the control group, the main reasons for culling were reproductive failure followed by mastitis and teat injuries. About 60 per cent of culling was due to health problems, the other 40 per cent to low productive capacity, old age, poor workability etc. The annual culling rate varied per farm per year but also per month. The moment of culling in the current lactation, the slaughter value and the age differed per reason. The calculated loss of forced replacement consists of reduction in both production prior to culling and slaughter value. Additionally, there is an idle production period due to lack of an immediate replacement. The biggest loss is caused by lost future income. There was a considerable difference per farm in the loss caused by culling for health problems. A low culling rate due to health problems was associated with longer longevity and a relatively lower loss. Tangible effects due to changes in the farm culling policy may not be evident for some years. The reduction in loss of culling in the program farms compared with the controls was small because the duration (2 1/2 years) of the herd health and management program was too short.(ABSTRACT TRUNCATED AT 250 WORDS)

A three year herd health and management program on thirty Dutch dairy farms. III. Economic evaluation of fertility control.

Fertility control was part of a herd health and management program on thirty dairy farms in the province of Overijssel. A comparable control group of thirty-one farms was available. After two years of application of the program the improvement in income feedcosts margin per cow on the program farms exceeded that on control farms by Dfl. 176. Within the large variation in income between the farms it was not possible to accurately distinguish the effects of the different aspects of the program, despite the use of detailed techniques such as Factor Analysis: thus another approach to determine the income effect of fertility control was necessary. The total loss per farm due to sub-optimal fertility was determined, using calving interval data, forced replacement data and norm-loss rates. From computation of this loss on program and control farms, the income effect of fertility control was deduced. Excluding the cost of the program, a significant (P less than 0.01) positive effect of fertility control on the total calculated loss due to sub-optimal fertility was determined (average Dfl. 25.50 per cow, or about Dfl. 1,700 per farm, after two years of program application). This income effect differed considerably between farms with an initial good or poor situation regarding fertility. The program contributed more to the improvement of insufficient or moderate fertility than to the prevention of a deterioration in herds with excellent fertility, although on the latter farms the total program had a considerable positive effect.

[The decision to replace dairy cows in case of difficult-to-achieve pregnancy: an economic evaluation]. / De vervangingsbeslissing bij melkvee in geval van moeilijk te verkrijgen dracht: een economische evaluatie.

The question approached is, 'How long will it be profitable to continue breeding dairy cattle in cases of poor reproductive performance, differing in age and milk production potential, until it has to be decided to cull them?' This question was expressed in an economic replacement model for dairy cattle. The essence of the model is a comparison of anticipated incomes from a cow present in the herd an a replacement cow. For herd cows, the critical production level (expressed as a percentage of the herd level, after correction for age and stage of lactation) below which it is no longer profitable to breed empty cows was calculated. This was done at ten stages in each lactation. It was found to be profitable to continue breeding cows with poor reproductive performance for a long period: even up to 8-9 months after calving in young cows showing an average production level or higher. The most important factor affecting the calculated critical production levels was found to be the repeatability of an unduly long calving interval of the cow concerned: if problems regarding reproductive performance are also expected in future lactations, breeding should be stopped earlier in lactation.

[The economic significance of mastitis in current and altered agricultural policies (author's transl)]. / De economische betekenis van mastitis bij huidig en gewijzigd landbouwbeleid.

Animal diseases continue to cause considerable losses among dairy cattle in the Netherlands. A considerable part is due to mastitis, previously quantified at Dfl. 125.-per average cow present, which would account to as much as Dfl. 165.-at current production and price-levels. A major part is caused by milk which was not produced. Under the present market and price policy, the same price is paid for each kg of milk, whatever the quantity produced per farm. In this situation, the milk which is not produced is therefore valued at the current price of Dfl. 0.60 per kg. If a quota-system were to be imposed per farm, an additional kg of milk would have to be valued at a lower price. Yet the losses due to mastitis and conversely, the profits of reducing the disease, remain almost unchanged in this situation. Instead of increased production per farm, there is a possibility of achieving a similar production per farm with less cows and at reduced cost. Calculations show that when a quota-system is imposed on each farm, the economic profitableness of improved health continues to be important.

[Productive life-span of dairy cows and its economic significance. II. The replacement of dairy cows: an economic model (author's transl)]. / De gebruiksduur van melkvee en zijn economische betekenis. II. Een economisch model voor de vervanging

A model, initially based on the work of Zeddies (10), is presented , by which the economic aspects of the replacement problem may be studied. First, the principle underlying the replacement decision is discussed. Then, the data to be included in the model are determined. This mainly concerns the elements associated with age, such as milk production, the value of newborn calves, the slaughter of the cows, the feed cost and the cost of a pregnant heifer just before calving. The age-associated probability of culling is also included in the model. A number of questions regarding the economic importance of the duration of herd life have been studied using this model. In the third paper, the results of this application of the model will be presented.

[Productive life-span of dairy cows and its economic significance. III. Economic evaluation: results obtained by model calculations (authors transl)]. / De gebruiksduur van melkvee en zijn economische betekenis. III een economische evaluatie: uitkomsten van modelberekeningen

A reduction of the forced replacement rate is found to be of major economic importance on the farm level. In the model, the income earned from a fifth lactation of a cow showing an average production is approximately Dfl 440 higher than the earned income per annum over the average herd life of 4.3 lactations. A farm with a herd of fifty cows showing average production and an average herd life of 5.3 years will have approximately Dfl 9600 more earned income each year than a similar farm with an average herd life of 3.3 years. The yield resulting from a longer herd life is subject to the law of diminishing returns. For the annual income from a dairy herd, a sixth lactation is of less importance than a fifth lactation, etc. The economic importance of a long herd life appears to be remarkably stable, i.e. hardly affected by: (a) The average productive capacity of the herd as regards milk and/or meat. (Note: Differences in milk-producing capacity within a herd have a marked effect on the economic value of an additional lactation by an individual cow). (b) The presence or absence of a moderate genetic improvement (1 per cent per annum) in milk-yield.

[Productive life-span of dairy cows and its economic significance. I. Disposal of dairy cows: the current situation (author's transl)]. / De gebruiksduur van melkvee en zijn economische betekenis. I. De huidige situatie met betrekking tot de vervanging

The current situation regarding the replacement of dairy cows is discussed. Attention is successively paid to the duration of herd life and the replacement rate, the reasons for disposal and the relationship between age and the probability of disposal. Little research including all the required elements at the same time has been done in this field. Therefore, the literature can offer only a rough idea of the current situation regarding the replacement of dairy cows (Tables 1 and 2). Further research along a few lines presented in this paper is advocated. However, the findings derived from the literature may be used in an economic model to quantify the economic significance of differences in the herd life of dairy cows. This subject will be elaborated in two subsequent papers.