Training for general practice: a national survey.

OBJECTIVES--(a) To compare current vocational training in general practice with that ascertained by a survey in 1980; (b) to compare the training of trainees in formal training schemes with that of trainees arranging their own hospital and general practice posts. DESIGN--National questionnaire survey of United Kingdom and armed services trainees who were in a training practice on 1 April 1989. Questionnaires were distributed by course organisers. SETTING--Research project set up after an ad hoc meeting of trainees at the 1988 national trainee conference. SUBJECTS--2132 Of the 2281 trainees (93%) known to be in a training practice on 1 April 1989. RESULTS--1657 Trainees returned the questionnaires, representing 73% of all trainees known to be in a training practice on 1 April 1989. Between 1980 and 1989 there were significant improvements in the trainee year, and there was also evidence of improvements in general practice study release courses. There was no evidence of improvement in other aspects of training. General practice trainees spent an average of three years in junior hospital posts, which provided very little opportunity for study related to general practice. Training received during tenure of hospital posts differed significantly between trainees in formal schemes and those arranging their own hospital posts. During the trainee year training was almost the same for those in formal schemes and those arranging their own posts. Regions varied significantly in virtually all aspects of general practice training. CONCLUSIONS--The trainee year could be improved further by enforcing the guidelines of the Joint Committee on Postgraduate Training for General Practice. The poor training in junior hospital posts reflected the low priority that training is generally given during tenure of these posts. A higher proportion of general practice trainees should be attached to vocational training schemes. More hospital trainees could attend general practice study release courses if these were designed specifically with the needs of hospital doctors in mind.     

Assessing the impact of ancient Maya animal use

Tropical forest animals are at high risk worldwide as a result of over-exploitation and forest clearing. Zooarchaeological studies of animal use by the ancient Maya of the southern lowland regions of Guatemala, Honduras, Belize, and Mexico provide long-term historical information on animal populations under conditions of human population growth and climatic change that is valuable to both archaeology and conservation biology. In this paper, zooarchaeological data from 35 chronologically defined faunal sub-samples recovered from 25 ancient Maya archaeological sites are used to assess the effects of ancient hunting on animal populations of the Maya region between the Preclassic and Colonial periods (2000 BC–AD 1697). The variations in species abundance are used as a proxy for describing changes in ancient Maya hunting practices and hunted animal populations, interpreted on the basis of hunting efficiency models from foraging ecology. A significant reduction in the proportion of large mammals, particularly Odocoileus virginianus, in zooarchaeological assemblages between the Late Classic (AD 600–850) and Terminal Classic/Postclassic periods (AD 850–1519) suggest that over-hunting during the Late Classic may have led to a reduction in availability of these animals to the ancient Maya hunters in the later periods. This finding is discussed in relation to important social and environmental variations to evaluate the impact of hunting and other factors such as forest clearance and climate on ancient animal populations in the Maya region.     

A national survey of laboratory animal workers concerning occupational risks for zoonotic diseases

In this cross-sectional survey of laboratory animal workers in the United States, 23 of 1367 persons reported 28 cases of infection with zoonotic agents from research animals at their workplace during the past 5 years, with six persons indicating that their infections were medically confirmed. Based on these data, the annualized incidence rate for work-related transmission of zoonotic agents from laboratory animals was 45 cases per 10,000 worker-years at risk (95% confidence interval, 30 to 65 cases), approximating the rate for nonfatal occupational illnesses in the agricultural production-livestock industry and for those employed in the health services during 2002. Logistic regression analysis found various characteristics of persons and their employers that were significantly associated with the likelihood of having been medically evaluated for exposure to a zoonotic agent from laboratory animals. Most (95.595% +/- 1.1%) persons working with laboratory animals or their tissues indicated that they knew whom to talk to at their institution for medical evaluation and care should they be concerned about the possibility of an occupationally acquired zoonotic disease in future. However, occupational illnesses and exposures among laboratory animal workers was underreported, as 10 of the 28 (36%) alleged zoonotic disease cases were not communicated to the employee's supervisor. Lack of concern about the potential significance to their health and the perception of punitive consequences to the employee were some of the reasons cited for underreporting, an issue which must be vigorously addressed in the interests of continuing progress toward zoonotic disease prevention in this field.     

Agricultural (nonbiomedical) animal research outside the laboratory: a review of guidelines for institutional animal care and use committees

Challenges and published guidelines associated with appropriate care and use of farm animals in agricultural research conducted outside the laboratory are briefly reviewed. The Animal Welfare Act (Title 9 of the 2000 Code of Federal Regulations), which regulates the care and use of agricultural animals in biomedical research, does not include livestock and poultry used in agricultural research. Farm animal research funded (and thereby regulated) by the US Public Health Service is further discussed in the National Research Council's 1996 Guide for the Care and Use of Laboratory Animals. However, neither of these guidelines adequately addresses the unique attributes of research and teaching designed to improve production agriculture. That information is contained in the Guide for the Care and Use of Agricultural Animals in Agricultural Research and Teaching (the Ag Guide), published by the Federation of Animal Science Societies in 1999. The Ag Guide provides excellent general recommendations for agricultural animal research. It serves as an invaluable resource for institutional animal care and use committees, which attempt to balance the welfare of farm animals and the needs of those working to improve animal agriculture.     

The use of vertical flow constructed wetlands for on-site treatment of domestic wastewater: New Danish guidelines

Official guidelines for the on-site treatment of domestic sewage have recently been published by the Danish Ministry of Environment as a consequence of new treatment requirements for single houses and dwellings in rural areas. This paper summarises the guidelines for vertical constructed wetland systems (planted filter beds) that will fulfil demands of 95% removal of BOD and 90% nitrification. The system can be extended with chemical precipitation of phosphorus with aluminium polychloride in the sedimentation tank to meet requirements of 90% phosphorus removal. The necessary surface area of the filter bed is 3.2 m²/person equivalent and the effective filter depth is 1.0 m. The filter medium must be filtersand with a d₁₀ between 0.25 and 1.2 mm, a d₆₀ between 1 and 4 mm, and a uniformity coefficient (U = d₆₀/d₁₀) less than 3.5. The sewage is, after sedimentation, pulse-loaded onto the surface of the bed using pumping and a network of distribution pipes. The drainage layer in the bottom of the bed is passively aerated through vertical pipes extending into the atmosphere in order to improve oxygen transfer to the bed medium. Half of the nitrified effluent from the filter is recirculated to the first chamber of the sedimentation tank or to the pumping well in order to enhance denitrification and to stabilise the treatment performance of the system. A phosphorus removal system is installed in the sedimentation tank using a small dosing pump. The mixing of chemicals is obtained by a simple airlift pump, which also circulates water in the sedimentation tank. The vertical flow constructed wetland system is an attractive alternative to the common practice of soil infiltration and provides efficient treatment of sewage for discharge into the aquatic environment.     

Evolution of Toxoplasma-PCR methods and practices: a French national survey and proposal for technical guidelines

The molecular diagnosis of toxoplasmosis lacks standardisation due to the use of numerous methods with variable performance. This diversity of methods also impairs robust performance comparisons between laboratories. The harmonisation of practices by diffusion of technical guidelines is a useful way to improve these performances. The knowledge of methods and practices used for this molecular diagnosis is an essential step to provide guidelines for Toxoplasma-PCR. In the present study, we aimed (i) to describe the methods and practices of Toxoplasma-PCR used by clinical microbiology laboratories in France and (ii) to propose technical guidelines to improve molecular diagnosis of toxoplasmosis. To do so, a yearly self-administered questionnaire-based survey was undertaken in proficient French laboratories from 2008 to 2015, and guidelines were proposed based on the results of those as well as previously published work. This period saw the progressive abandonment of conventional PCR methods, of Toxoplasma-PCR targeting the B1 gene and of the use of two concomitant molecular methods for this diagnosis. The diversity of practices persisted during the study, in spite of the increasing use of commercial kits such as PCR kits, DNA extraction controls and PCR inhibition controls. We also observed a tendency towards the automation of DNA extraction. The evolution of practices did not always go together with an improvement in those, as reported notably by the declining use of Uracil-DNA Glycosylase to avoid carry-over contamination. We here propose technical recommendations which correspond to items explored during the survey, with respect to DNA extraction, Toxoplasma-PCR and good PCR practices.     

Impact of the economic recession on companion animal relinquishment, adoption, and euthanasia: a Chicago animal shelter's experience

This study investigated how the current economic recession (since December 2007) has affected dog and cat relinquishment, adoption, and euthanasia at the Anti-Cruelty Society animal shelter in Chicago, Illinois. The study compared temporal patterns of the investigated statistics before (2000-2007) the start of the current recession with the patterns after the start of the recession (2008-2010). The results showed that once the guardianship (ownership) of a nonhuman animal had been established, the recession did not greatly affect the owner's decision on relinquishment-except for the relinquishment of senior dogs, which may be associated with increased costs of care. However, an unfavorable economic environment may have reduced adoption of animals. The consequences of a decline in adoptions might be reflected in an increase in the proportion or number of sheltered animals euthanized. This study demonstrated how monitoring changes in temporal patterns in these shelter statistics can help guide animal shelters to better prepare for the current recession.     

Antibiotic use in aesthetic surgery: a national survey and literature review

Although much has been written regarding the use of antibiotics in surgery, no clear guidelines exist in the literature regarding the use of antibiotics in aesthetic surgery. To determine the pattern of antibiotic use in aesthetic surgery, a comprehensive survey was mailed to 6000 American Society of Plastic and Reconstructive Surgeons members and candidates. A total of 1767 completed responses were returned, which represents a response rate of 30 percent. The type, route, and duration of antibiotic administration are reported for 10 common cosmetic surgical procedures. The results of the survey confirmed that there is widespread use of antibiotics in aesthetic surgery. To provide guidelines for proper antibiotic use, the current literature was extensively reviewed. The authors found little or no correlation between reported clinical practice and the literature. It is hoped that this study will stimulate further investigation into this area of aesthetic surgery.     

Cross-sectional prospective survey to study indication-based usage of antimicrobials in animals: Results of use in cattle

Background

Indication-based data on the use of antimicrobials in animals were collected using a prospective cross-sectional survey, similarly as for surveys carried out in human medicine, but adapting the questionnaire to include veterinary-specific issues. The participating veterinarians were randomly selected from a sample population of practising veterinarians. The sampling was stratified to take into account the proportions of different types of veterinary practice in the country. All patients consulting the veterinary practice during a 1-week period were included in the study and veterinarians returned a completed questionnaire for each patient receiving antimicrobial treatment. As cattle received most of the treatments, results from the survey are given using cattle as an example species.

Results

The survey was sent to 681 veterinarians, of whom 262 (39%) responded. In total 2850 questionnaires were completed. The largest quantities of antimicrobials, measured in kilograms, were used for cattle, followed by pigs, dogs and horses. The species that were treated most were cattle (n = 1308), dogs (n = 989) and cats (n = 311). For cattle, the most common reason for treatment was acute mastitis (52%), followed by dry-cow therapy (21%), subclinical mastitis (6%) and treatment for acute enteritis (4%). The remaining treatments covered 17% of cattle patients and 15 different indications. For acute mastitis, parenteral or intramammary treatment was used in 36% and 34% of the cases, respectively. The remaining 30% received both treatments simultaneously. Of the parenteral treatments (n = 459), benzyl penicillin was used in 83% of the treated animals (n = 379), while fluoroquinolones were used in 49 cases (11%). Of the 433 cows receiving intramammary treatment, ampicillin combined with cloxacillin was most commonly used (n = 157; 36%), followed by cephalexin+streptomycin (n = 113; 26%).

Conclusion

This cross-sectional prospective survey provided a useful method for the collection of information on the indication-based use of antimicrobials in different animal species. Cattle were the most commonly treated animal species during the study period. The most common indication for antimicrobial use in cows was mastitis. Benzyl penicillin was the drug most frequently used for the treatment of mastitis, which seems appropriate according to the national guidelines on the use of antimicrobials in cattle in Finland.

     

Returning a recently adopted companion animal: adopters' reasons for and reactions to the failed adoption experience

The return of a recently adopted companion animal places the nonhuman animal in jeopardy and may be painful and frustrating to the humans involved. However, if returners learn from the failed adoption experience, future adoptions may be more satisfactory for all concerned. In this study, 78 people who had adopted and returned dogs or cats to an animal shelter in a U.S. Midwestern city were interviewed regarding their reasons for return, reactions to the experience, and plans for future adoptions. Although some returners adjusted their pet ownership plans in potentially beneficial ways, most reacted by counseling greater forethought and planning before adopting. The last, although sound advice, had little to do with reasons for return, which primarily were problems that arose postadoption: pet behavior such as not getting along with other pets or children. Changing expectations about the development of new pet-family relationships and the provision of postadoption services might help adopters tolerate the adjustment period and handle problems without resorting to returning the animal.     

Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey

ObjectiveTo evaluate the prevalence of the use of lipid lowering agents and its relation to blood lipid concentrations in English adults.DesignCross sectional survey.SettingEngland, 1998.ParticipantsNationally representative sample of 13 586 adults (aged ⩾16 years) living in non-institutional households.Results Mean total cholesterol concentrations were 5.47 (SE 0.02) mmol/l in men and 5.59 (0.02) mmol/l in women. Mean HDL cholesterol concentrations were 1.28 (0.01) mmol/l in men and 1.55 (0.01) mmol/l in women. Overall, of 10 569 adults who had a valid cholesterol measurement taken 7133 (67.5%; 95% confidence interval 66.5% to 68.4%) had a total cholesterol concentration ⩾5 mmol/l, 2804 (26.5%; 25.7% to 27.4%) had a ratio of total cholesterol to HDL cholesterol ⩾5 mmol/l, and 237 (2.2%; 1.9% to 2.5%) reported taking lipid lowering drugs. Of 117 participants with no history of cardiovascular disease but whose estimated 10 year risk of coronary heart disease was ⩾30% and whose total cholesterol concentration was ⩾5 mmol/l, four (3%) were taking lipid lowering drugs. Of 385 adults aged 16-75 with a history of coronary heart disease and eligible for lipid lowering treatment, 114 (30%; 25% to 34%) were taking lipid lowering drugs, of whom only 50 (44%; 35% to 53%) had a total cholesterol concentration <5 mmol/l.ConclusionsDespite the high prevalence of dyslipidaemia in English adults, the proportion of adults taking lipid lowering drugs in 1998 was only 2.2%. Rates of treatment were low among high risk patients eligible for primary prevention with lipid lowering drugs, and less than one third of patients with established cardiovascular disease received such treatment.