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2.  Qualitative methods in a randomised controlled trial: the role of an integrated qualitative process evaluation in providing evidence to discontinue the intervention in one arm of a trial of a decision support tool 
Quality & Safety in Health Care  2007;16(3):224-229.
Objective
To understand participants' experiences and understandings of the interventions in the trial of a computerised decision support tool in patients with atrial fibrillation being considered for anti‐coagulation treatment.
Design
Qualitative process evaluation carried out alongside the trial: non‐participant observation and semistructured interviews.
Participants
30 participants aged >60 years taking part in the trial of a computerised decision support tool.
Results
Qualitative evidence provided the rationale to undertake a decision to discontinue one arm of the trial on the basis that the intervention in that arm, a standard gamble values elicitation exercise was causing confusion and was unlikely to produce valid data on participant values.
Conclusions
Qualitative methods used alongside a trial allow an understanding of the process and progress of a trial, and provide evidence to intervene in the trial if necessary, including evidence for the rationale to discontinue an intervention arm of the trial.
doi:10.1136/qshc.2006.018499
PMCID: PMC2464994  PMID: 17545351
3.  Library Collection Needed 
PMCID: PMC1790547  PMID: 17422396
5.  Warfarin anticoagulation in primary care: a regional survey of present practice and clinicians' views. 
The demand for anticoagulation services is rising. Warfarin anticoagulation has been shown to reduce the risk of stroke in patients with non-valvular atrial fibrillation by 68%. This raises issues about how services are best organized to initiate and monitor anticoagulation in this potentially large group of patients. We report the results of a regional postal survey undertaken to describe the views of general practitioners and consultants regarding warfarin anticoagulation in light of this potentially high increase in demand.
PMCID: PMC1313007  PMID: 9219409
7.  Service provision and use of anticoagulants in atrial fibrillation. 
BMJ : British Medical Journal  1995;311(7004):558-560.
Several large trials have shown that the risk of stroke in patients with non-valvar atrial fibrillation is reduced by treatment with warfarin. Implementing this research evidence requires not only an understanding of the trials' results and of the changes that they imply for clinicians' treatment decisions but also an appreciation of the organisation, quantity, and quality of services required to support these changes. Understanding of these implications is crucial for developing services that allow changes in practice to produce reductions in stroke incidence while minimising the risks of treatment. This article considers the developments in service provision that will probably be required to support the changes in clinical practice suggested by the trials' results. These services will be provided largely by doctors, and their development has implications for doctors in both primary and secondary care.
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PMCID: PMC2550612  PMID: 7663216
8.  An audit of distribution and use of guidelines for management of head injury. 
Quality in Health Care  1993;2(1):27-30.
Ensuring effective distribution of guidelines is an important step towards their implementation. To examine the effectiveness of dissemination of a guidelines card on management of head injury and determine its usefulness to senior house officers (SHOs), a questionnaire survey was performed in May 1990, after distribution of the cards in induction packs for new doctors and at postgraduate lectures and displaying the guidelines in accident and emergency departments and wards. A further survey, in March 1992, assessed the impact of modifying the distribution. All (175) SHOs working in general surgery, accident and emergency medicine, orthopaedics, and neurosciences on 1 February 1990 in 19 hospitals including two neurosurgical units in Northern region were sent self completion questionnaires about awareness, receipt, use, and perceived usefulness of the guidelines. 131 of 163(80%) SHOs in post responded (median response from hospitals 83% (range 50%-100%)). Over three quarters (103, 79%) of SHOs were aware of the guidelines and 82(63%) had ever possessed a guidelines card. Only 36(44%) acquired the card in the induction pack. 92%(98/107) found them useful and 81% (89/110) referred to them to some extent. Owning and carrying the card and referring to guidelines were associated with departmental encouragement to use the guidelines. Increasing the displays of guidelines in wards and departments and the supply of cards to consultants in accident and emergency medicine as a result of this survey did not increase the number of SHOs who received cards (52/83, 63%), but more (71/83, 86%) were aware of the guidelines. The guidelines were welcomed by SHOs and used in treating patients with head injury, but their distribution requires improvement. Increased use of the guidelines may be achieved by introducing other distribution methods and as a result of encouragement by senior staff.
PMCID: PMC1055058  PMID: 10132074
10.  The possible role of stress in the induction of pneumonic pasteurellosis. 
Five groups of range bred calves (four calves per group) were used to investigate the effect of stress on susceptibility to aerosol exposures with bovine herpesvirus-1 or Pasteurella haemolytica. Twelve calves were weaned, transported, processed at a commercial feedlot and transported to isolation facilities three days later. An aerosol challenge of either 10 colony forming units of P. haemolytica or 10 plaque forming units of bovine herpesvirus-1 virus was given to two groups of calves and the third group was not challenged. The fourth group was transported directly to the isolation facilities after weaning and aerosol challenged with P. haemolytica. The fifth group remained at the farm after weaning and was not challenged. All transported animals had elevated plasma cortisol levels which remained above normal for at least three days postchallenge. The blastogenic response of all calves was depressed after leaving the farm and remained depressed throughout the experiment. The suppression correlated well with elevated serum cortisol levels. Calves processed through the feedlot encountered bovine herpesvirus-1 because eight out of 12 animals seroconverted to this antigen. Most calves seroconverted to P. haemolytica whether they were experimentally challenged or not. Where the unchallenged calves encountered P. haemolytica is unknown. Calves challenged with bovine herpesvirus-1 but not with P. haemolytica, had significant clinical signs of pneumonia and two animals died due to bovine herpesvirus-1 infection.(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC1236058  PMID: 6089981
12.  The pulmonary clearance of Pasteurella haemolytica in calves infected with bovine virus diarrhea or Mycoplasma bovis. 
Based on current literature which commonly associates bovine virus diarrhea virus and Mycoplasma bovis with "pneumonic pasteurellosis," an investigation was conducted into the effect of these two pathogens on the capacity of bovine lung to clear inhaled Pasteurella haemolytica. There was no significant effect (p less than 0.05) of either bovine virus diarrhea virus or M. bovis on the mean clearance rate of P. haemolytica, nor did the time interval of three, five or seven days between the first inoculation and exposure to P. haemolytica and adversely affect the lung clearance rates. However, it was found that the left lungs and a higher bacterial retention (p less than 0.05) than the right lungs.
PMCID: PMC1320328  PMID: 7127194
13.  A Mouse Model for Estimation of Pasteurella haemolytica Deposition in Calf Lungs Following Aerosol Exposure 
A method used to calculate the number of Pasteurella haemolytica reaching the lungs of calves during an aerosol exposure is described. This method is based on a linear relationship of bacterial deposition in lungs of mice and calves when exposed to the same bacterial aerosol.
PMCID: PMC1320330  PMID: 7127195
16.  Normal Postpartum Involution of the Uterus in the Dog 
Ninety-eight reproductive tracts from dogs at different postpartum time periods were used to investigate stages of normal involution. Seventy-eight reproductive tracts were obtained from the field, and 20 obtained surgically for gross and microscopic examination. Plasma progesterone was measured in 22 dogs at various times postpartum.
The uterine horns during the first week postpartum were dilated and edematous. The placental sites were 1.5-3 cm in width, rough, granular and covered with mucus and a few blood clots. By the fourth week the placental sites were thick, grayish-tan and nodular with a few blood clots within nodules. The uterine horns during the seventh week were greatly contracted and the placental sites were narrow and light in color. A few nodules were still present on the surface. By the ninth week the uterine horns were uniform in shape and contracted with a narrow lumen. The placental sites appeared as a narrow brown band.
Histologically the placental sites during the first week postpartum were covered by an eosinophilic staining necrotic mass and a few intact epithelial cells scattered on the surface as an interrupted single layer. Under the necrotic mass, large eosinophilic staining cells in moderate number were scattered throughout the lamina propria of the placental site. These cells were considered to be decidual cells. By the fourth week the placental sites were covered by a large lobulated mass of collagen fibers. The uterine glands were greatly dilated and degenerate, and mononuclear cell infiltration in the lamina propria was pronounced. By the seventh week, large masses of collagen fibers were detached from the surface, and endometrial glands were normal in size and shape. By the ninth week surface sloughing was completed. However, regeneration and replacement of the endometrial lining from the mouth of the uterine glands continued until the end of the twelfth week when the involution process was completed.
The progesterone levels were very low for eight weeks postpartum.
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PMCID: PMC1320212  PMID: 7340907
17.  A Review of the Lesions in Shipping Fever of Cattle 
A review of literature concerning the information published on the macroscopic and microscopic lung lesions in “shipping fever” of cattle is presented as reported in naturally occurring cases as well as the experimental disease.
PMCID: PMC1789854  PMID: 7018660
18.  A Perspective on Respiratory Disease in Feedlot Cattle 
The Canadian Veterinary Journal  1980;21(6):181-185.
The etiological factors causing acute pneumonia in feedlot cattle are complex in terms of their interactions with the host to cause clinical disease or death. The most significant agent is Pasteurella hemolytica, but it may be acting relatively late in the overall sequence of events.
It is necessary to develop an overall strategy to determine the pathogenesis of the disease in the field. Approaches to this objective are discussed, with the emphasis on the role of the epidemiologist.
PMCID: PMC1789722  PMID: 7000330
19.  Factors associated with mortality in feedlot cattle: the Bruce County Beef Cattle Project. 
The design of and the analysis of data from the Bruch County Beef Cattle Project, particularity the field study, are presented and discussed. A major value of the study may lie in its ability to relate laboratory findings to events in the field. The factor most strongly related to mortality was ration, with cattle on hay based rations having a much lower mortality on average than cattle on corn based rations. In general, management activities associated with growing cattle (as opposed to fattening) over the first winter were sparing for mortality. Groups of cattle given prophylactic vaccines or drugs within two days of arrival tended to experience higher mortality (not statistically higher) than those cattle not receiving those measures, or cattle groups recieving the same prophylactics more than 48 hours after arrival. However, these results require validation in the remaining years of the study. Fibrinous pneumonia was the most frequent diagnosis in the calves on postmortem examination.
PMCID: PMC1320028  PMID: 7397593
20.  Atypical Interstitial Pneumonia in Cattle 
The Canadian Veterinary Journal  1979;20(5):141-142.
Atypical interstitial pneumonia is described as two clinical syndromes in young cattle. One syndrome occurs in animals which have clinical evidence of pneumonic pasteurellosis, responds initially to treatment for one to two days and then develops acute signs of atypical interstitial pneumonia. The second syndrome involves acute respiratory distress in young calves due to atypical interstitial pneumonia with antecedents of enzootic pneumonia. The postmortem lesions are described along with discussion of the possible pathogenesis of the condition and treatment.
PMCID: PMC1789549  PMID: 487361
21.  Pathological Studies of “Sudden Death Syndrome” in Broiler Chickens 
Sudden death syndrome usually occurs in heavy, fast-growing and healthy-looking broilers. Most of the affected birds are males. The characteristic necropsy changes are seen in well-fleshed broilers with edema and generalized pulmonary congestion, recently ingested feed in the crop and gizzard, distended intestine with creamy content and empty gall bladder. The liver and kidneys are slightly enlarged and the latter have patchy areas of subcapsular hemorrhage. The heart contains clotted blood in the atria but the ventricles are often empty and the left ventricle in particular assumes a hypertrophied appearance.
Microscopic examination of heart muscle reveals degeneration of fibers, separation of cardiac muscle fibers by edema and infiltration of heterophils. The lungs have severe vascular congestion, inflammatory cell infiltration in the mucosa of the secondary bronchi and edema fluid in the tertiary bronchi and interlobular connective tissue. The liver has moderate bile duct hyperplasia, periportal hepatitis and mononuclear cell infiltration adjacent to bile ducts which possibly leads to bile duct constriction. The kidneys have subcapsular and parenchymatous hemorrhage.
Images
PMCID: PMC1789498  PMID: 436100
22.  Studies on Effect of Lighting on “Sudden Death Syndrome” in Broiler Chickens 
Broiler chicken flocks were studied to determine the mortality from sudden death syndrome occurring in the flocks. The difference in the incidence of the syndrome in pullets and cockerels, and the age at which the most birds are affected were also studied. The weight of sudden death syndrome birds was compared with the flock average and the effect of continuous lighting as opposed to intermittent lighting was examined.
The results suggest that; continuous lighting produces more sudden death syndrome deaths than intermittent lighting; that the incidence of sudden death syndrome is higher in cockerels than pullets; that the highest death rate occurred during the third and fourth weeks of life, and that sudden death syndrome birds on the average were heavier than the flock average.
PMCID: PMC1789497  PMID: 436101
23.  Subchronic toxicity test for two thermotolerant filamentous fungi used for single cell protein production. 
Safety evaluations of two thermotolerant filamentous fungi, Cephalosporium eichhorniae 152 (C. 152) and Rhizopus chinensis 180 (R. 180), grown on a sugar-salts medium were carried out through feeding the biomases to rats at 20% or 40% dietary levels for 90 days. There was a control group fed soybean meal. Weight gain and feed consumption for rats fed 20% C. 152 were equal to those for the control animals, but were depressed in the other three groups, especially the rats fed R. 180. All animals appeared normal and healthy except that transient alopecia was found for a short duration in the fungi-treated rats in the initial period. The cause of this lesion is not clear. At the end of the feeding trial, clinical determinations of constituents in blood and urine samples were conducted. The animals were autopsied and weights for four organs were taken. Histopathological examinations for 26 different tissues were carried out. Mild changes were found in both C. 152 and R. 180-treated rats but most of the these were not considered to be related to treatment.
PMCID: PMC1319938  PMID: 570875
25.  The bovine alveolar macrophage. II. In vitro studies with Pasteurella haemolytica. 
Bovine alveolar macrophages were cultured in vitro and challenged with suspensions of live and dead bacteria. These cells showed severe cytotoxic morphological changes and a low rate of phagocytosis after exposure to live Pasteurella haemolytica type I was readily phagocytosed and produced only mild cytotoxic changes.
PMCID: PMC1277652  PMID: 688077

Results 1-25 (73)