Evaluation of the Western Australian Department of Health telehealth project

In 1999, the Department of Health in Western Australia began a telehealth project, which finished in 2004. The 75 videoconferencing sites funded by the project were part of a total state-wide videoconference network of 104 sites. During the period from January 2002 to December 2003, a total of 3266 consultations, case reviews and patient education sessions took place. Clinical use grew to 30% of all telehealth activity. Educational use was approximately 40% (1416 sessions) and management use was about 30% (1031 sessions). The average overhead cost per telehealth session across all regions and usage types was $A192. Meaningful comparisons of the results of the present study with other public health providers were difficult, because many of the available Websites on telehealth were out of date. Despite the successful use of telehealth to deliver clinical services in Western Australia, sustaining the effort in the post-project phase will present significant challenges.

An e-health needs assessment of medical residents in Cameroon

Medical residents from Yaounde I University in Cameroon are required to spend periods of time in rural or remote locations to complete their training. To determine if e-health might lessen their isolation and enhance patient care, a needs assessment of the residents was performed using a brief questionnaire (five items) about the situation in which residents found themselves outside their medical school environment. We gave the questionnaires to 45 residents. Seventeen questionnaires had been returned at the time of the site visit, a response rate of 38%. Most residents indicated that the ability to contact a mentor would have either made them feel more confident (16, or 94%) or altered their handling of recent cases (15, or 88%). All residents had access to a mobile phone, and many (11, or 65%) had used it to contact a medical colleague for guidance. A low-cost and technologically simple telemedicine solution that maximized use of mobile phone capability, provided access to medical and health-care information, and permitted exchange of images would be an appropriate response to the identified needs.

A survey of e-mentoring among New Zealand midwives

Mentoring is a strategy that may assist the midwifery profession to support new graduates and midwives working in rural and remote areas. We conducted a survey of 1577 New Zealand midwives about their opinions and experiences of mentoring. The questionnaire comprised 33 questions, nine of which were open questions. There was a 44% response rate. While the telephone was commonly utilized by mentors (37%) and mentored midwives (37%), the Internet and email played only a small part. Participants acknowledged the potential of these avenues for communication, but midwives felt that mentoring could be provided only by immediate, face-to-face contact. Nevertheless, e-mentoring could be a viable option and requires further investigation. About one-third of midwives identified geographical isolation as a barrier to being a mentor (38%) and being mentored (36%). The use of e-mentoring could remove the barrier of location and allow the midwife to chose a mentor who meets her needs, rather than because she is the only mentor available.

The effect of active immunization against adrenocorticotropic hormone on cortisol, beta-endorphin, vocalization, and growth in pigs

Because the poor growth performance of intensively housed pigs is associated with increased circulating glucocorticoid concentrations, we investigated the effects of glucocorticoid suppression by inducing a humoral immune response to ACTH on physiological and production variables in growing pigs. Grower pigs (28.6 0.9 kg) were immunized with amino acids 1 through 24 of ACTH conjugated to ovalbumin and suspended in diethylaminoethyl (DEAE) dextran-adjuvant or adjuvant alone (control) on d 1, 28, and 56. The ACTH-specific antibody titers generated suppressed increases in cortisol concentrations on d 63 in response to an acute stressor (P = 0.002; control = 71 +/- 8.2 ng/ mL; ACTH-immune = 43 +/- 4.9 ng/mL) without altering basal concentrations. Plasma beta-endorphin concentrations were also increased (P < 0.001) on d 63 (control = 18 +/- 2.1 ng/mL; ACTH-immune = 63 +/- 7.3 ng/mL), presumably because of a release from negative feedback on the expression of proopiomelanocortin in pituitary corticotropes. Immunization against ACTH did not alter ADG (P = 0.120; control = 1,077 25; ACTH-immune = 1,143 25 g) or ADFI (P = 0.64; control = 2,719 42; ACTH-immune = 2,749 42 g) and did not modify behavior (P = 0.681) assessed by measuring vocalization in response to acute restraint. In summary, suppression of stress-induced cortisol responses through ACTH immunization increased beta-endorphin concentrations, but it did not modify ADG, ADFI, or restraint vocalization score in growing pigs.

Temperature changes in dental pulp associated with use of power grinding equipment on equine teeth

Objective To quantify the temperature changes in the dental pulp associated with equine dental procedures using power grinding equipment. Design A matrix experimental design with replication on the same sample was followed to allow the following independent variables to be assessed: horse age (young or old), tooth type (premolar or molar), powered grinding instrument (rotating disc or die grinder), grinding time (15 or 20 seconds) and the presence or absence of water coolant. Procedure Sound premolar and molar teeth from a 6-year-old horse and a 15-year-old horse, which had been removed postmortem, were sectioned parallel to the occlusal plane to allow placement of a miniature thermocouple at the level of the dental pulp. The maximum temperature increase, the time taken to reach this maximum and the cooling time were measured (n=10 in each study). The teeth were placed in a vice and the instrument used on the tooth as per clinical situation. Results Significant differences were recorded for horse age (P < 0.001), instrument type (P < 0.001), grinding time (P < 0.001) and presence or absence of coolant (P < 0.001). There was no significant difference for tooth type. Conclusion Thermal insult to the dental pulp from the use of power instruments poses a significant risk to the tooth. This risk can be reduced or eliminated by appropriate selection of treatment time and by the use of water irrigation as a coolant. The increased dentine thickness in older horses appears to mitigate against thermal injury from frictional heat.

Preliminary findings of a systematic review and expert opinion workshop on Biosecurity on cattle farms in the UK

In this paper risk factors for the introduction of IBR, BVD, Salmonella and Johne's disease to cattle farms are reported. Two sources of information were used: literature was searched systematically and an expert opinion workshop was held. The findings from both indicate that direct contact between cattle is an important risk factor. Indirect and occasional contact is considered of less importance. Therefore, in the development of biosecurity programmes for cattle farms emphasis should be put on preventing direct contact with cattle from outside the herd.