An infectious bursal disease vaccine, registered for use in breeder flocks, was studied for efficacy on the day-old offspring of vaccinated hens and for virulence in susceptible day-old and 6-week-old chickens. When given to susceptible day-old chicks and 6-week-old cockerels, the vaccine was found to induce atrophy and pathology of the bursa of Fabricius similar to that observed in field infections. Chicks vaccinated at day-old had markedly lowered titres in the haemagglutination inhibition test to Newcastle disease virus, when this was given 2 weeks later, but the response of the 6-week-old cockerel was similar to that of control birds. Maternal antibody induced by the vaccine protected chicks against infection at day-old.

Animals↗

PubMed1980

Plasma alkaline phosphatase as a screening test for low zinc status in broiler hybrid chickens affected with 'clubbed down'.

Broiler chickens affected by 'clubbed down' on a number of Victorian farms had low liver zinc concentrations and low plasma alkaline phosphatase activities. The results indicated that the zinc status of affected flocks should be considered in future studies and that measurement of plasma alkaline phosphatase activity may be a useful means of screening large numbers of samples. Nutritional and genetic factors may be involved in the aetiology of 'clubbed down'.

Alkaline Phosphatase↗

PubMedDate not supplied

Improving chronic illness care: translating evidence into action.

The growing number of persons suffering from major chronic illnesses face many obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical management, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely designed for acute illness. Evidence of effective system changes that improve chronic care is mounting. We have tried to summarize this evidence in the Chronic Care Model (CCM) to guide quality improvement. In this paper we describe the CCM, its use in intensive quality improvement activities with more than 100 health care organizations, and insights gained in the process.

Chronic Disease↗

PubMedDate not supplied

A population-based approach to diabetes management in a primary care setting: early results and lessons learned.

OBJECTIVE: To determine the effect of a multifaceted program of support on the ability of primary care teams to deliver population-based diabetes care. DESIGN: Ongoing evaluation of a population-based intervention. SETTING/PARTICIPANTS: Group Health Cooperative of Puget Sound, a staff model HMO in which more than 200 primary care providers treat approximately 15,000 diabetic patients. INTERVENTION: A program of support to improve the ability of primary care teams to deliver population-based diabetes care was implemented. The elements of the program are based on an integrated model of well-validated components of delivery of effective care to chronically ill populations. These elements have been introduced since the beginning of 1995, and some aspects of the program were pilot-tested in a few practice sites before being implemented throughout the organization. The program elements include 1) a continually updated on-line registry of diabetic patients; 2) evidence-based guidelines on retinal screening, foot care, screening for microalbuminuria, and glycemic management; 3) improved support for patient self-management; 4) practice redesign to encourage group visits for diabetic patients in the primary care setting; and 5) decentralized expertise through a diabetes expert care team (a diabetologist and a nurse certified diabetes educator) seeing patients jointly with primary care teams. MAIN OUTCOME MEASURES: Patient and provider satisfaction through existing system-wide measurement processes; process measures, health outcomes, and costs are tracked continuously. RESULTS: Patient and provider satisfaction have improved steadily. Interest in and use of the electronic Diabetes Registry have grown considerably. Rates of retinal eye screening, documented foot examinations, and testing for microalbuminuria and hemoglobin A1c have increased substantially. CONCLUSIONS: Providing support to primary care teams in several key areas has made a population-based approach to diabetes care a practical reality in the setting of a staff model HMO. It may be an important mechanism for improving standards of care for many diabetic patients.

Community Health Planning↗