The effect of lung consolidation, as determined by ultrasonography, on first-lactation milk production in Holstein dairy calves.

Bovine respiratory disease (BRD) is a complex disease process and many reports emphasize the negative implications of clinical BRD in dairy calves. Early diagnosis can be difficult because of inconsistent or absent clinical signs; however, the use thoracic ultrasonography has the potential to improve detection of respiratory disease. Earlier detection of BRD may result in actions to improve calf welfare and production. The objective of this prospective cohort study was to determine if lung consolidation (LC) in young dairy calves influenced age at first calving (AFC), first-lactation milk production, and survival to the end of first lactation. A total of 215 female calves from 3 dairy herds in southwestern Ontario were enrolled and assessed weekly during their first 8 wk of life for evidence of LC using thoracic ultrasonography (Ibex Pro, Loveland, CO). Consolidation was measured, using gridlines on the screen of the ultrasound, in the first 10 intercostal spaces on both sides of the thorax. Calves were considered LC positive if ≥3 cm of consolidated lung was present. Multivariable linear regression models were used to identify risk factors associated with AFC and first-lactation 305-d milk production. A survival analysis was conducted to determine differences in survival from enrolment until the end of first lactation between calves with and without consolidation. In the study population, the following calfhood conditions were detected: twins (4%; n = 8), diarrhea in the first 21 d of life (31%; n = 66), rib fractures (7%; n = 14), lung abscesses (3%; n = 6), and at least one diagnosis of LC (57%; n = 123). Overall, 7% (n = 15) of calves died, and 18% (n = 38) of animals were sold before the end of first lactation. The presence of LC, at least once in the first 8 wk of life, did not influence AFC, but did result in a 525 kg (95% confidence interval: -992.81 to -60.25) decrease in first-lactation 305-d milk production. No difference in survival was detected between LC groups. These results indicate that LC during the first 56 d of life has a long-term effect on dairy calves, manifested as reduced milk production during first lactation.

Influencing care in acute myocardial infarction: a randomized trial comparing 2 types of intervention.

The purpose of this study was to evaluate performance feedback delivered by on-site presentations compared to mailed feedback on improving acute myocardial infarction (AMI) care. We used a randomized trial including 18 hospitals nested within the Cooperative Cardiovascular Project. Patients comprised AMI Medicare patients admitted before (n = 929, 1994 and 1995) and after intervention (n = 438, 1996). Control hospitals received written feedback by mail. The experimental intervention group received a presentation led by a cardiologist and a quality improvement specialist. We assessed the proportion of patients receiving appropriate AMI care before and after the intervention. Both univariate and multivariate analyses demonstrated no effect of the intervention in increasing the proportion of patients who received reperfusion, aspirin, beta-blockers, or angiotensin-converting enzyme inhibitors. On-site feedback presentations were not associated with a larger improvement in AMI care compared to the mailed feedback. Other interventions, such as opinion leaders and patient-directed interventions, may be necessary in order to improve the care of AMI patients.

Increasing influenza and pneumococcal vaccination and tuberculosis screening among residents of Colorado long-term care facilities.

Persons residing in long-term care facilities are especially vulnerable to potentially preventable morbidity and mortality caused by influenza, S. pneumoniae, and tuberculosis. This project's objective was to increase the rates of pneumococcal vaccination, tuberculosis screening, and annual influenza vaccination. Intervention consisted of staff training videos, sample policies, and educational materials for residents and their families. At baseline during the 1995-1996 flu season, 84% of Colorado long-term care residents were vaccinated for influenza; 16% of residents had ever received pneumococcal vaccination; and 59% had been screened for tuberculosis. At remeasurement during 1997 to 1998, influenza vaccination rates were up to 89%, p = 0.006. The percentage of residents who had ever received pneumococcal vaccination increased to 48% at remeasurement, p < 0.001. Tuberculosis screening rates increased to 83%, p < 0.001. Following an educational intervention targeting both residents and staff, residents were significantly more likely to receive all three preventive services.

Autologous blood transfusion does not reduce postoperative infection rates in elective surgery.

BACKGROUND: The influence of blood transfusions in the risk of postoperative infection remains controversial. We examined the association between autologous (AB) and homologous (HB) blood transfusions with postoperative infection in elective surgery. METHODS: The medical records of 991 Medicare patients aged > or =65 years submitted to hysterectomy and hip and knee replacement were reviewed. Logistic regression analysis was used to control for age, comorbidity, year, and type of procedure. RESULTS: Overall, 451 (46%) patients required transfusions. AB was given to 324 (72%), HB to 94 (21%); 33 (7%) patients received both. Forty-two patients (4%) developed postoperative infections. The infection rate was not different among patients receiving HB (7%), AB (5%), AB+HB (0), and nontransfused patients (4%); P = 0.18). After adjustment for confounders, HB and AB remained not associated with infections. CONCLUSION: In elective surgery with small volume transfusion, neither AB nor HB transfusions were associated with an increased risk of postoperative infections.

Sweet syndrome in a neonate with aseptic meningitis.

A 7-week-old infant with antecedent otitis media, upper respiratory infection, and aseptic meningitis was diagnosed as having Sweet syndrome. Although this disease usually affects adults, it has been reported in 17 children. This is the youngest reported patient with the disorder to date, and the first in whom the syndrome was associated with aseptic meningitis.