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PubMed1993

Turbidimetric-kinetic assay of endotoxin in rumen fluid or serum of cattle fed rations containing various levels of rolled barley.

A new, automated turbidimetric-kinetic (ATK) assay was used to quantitate bacterial endotoxin in rumen fluid or in serum of Holstein steers. The ATK method used Limulus amebocyte lysate (LAL) reagent with added beta-glucan (LAL-ES) which improved specific sensitivity to endotoxin. Design of the feeding trial permitted comparison of endotoxin levels found during consumption of a basal ration with those higher levels detected at various times following the introduction of increasing percentages of rolled barley to that basal ration. Both serum and ruminal endotoxin levels were significantly higher in steers on the higher concentrate rations. Peak endotoxin levels were detected 20 days following the change to the highest concentrate ration which contained 60% barley. Endotoxin levels from both sources subsequently decreased. Ruminal endotoxin stabilized at about 10 times the level, and serum endotoxin stabilized at 2 to 4 times the level, of that previously found during feeding of the basal ration. Test protocol included sample dilution and heating in order to avoid the effects of endotoxin inhibitors. Recovery rates for added endotoxin to either serum or rumen fluid supernates ranged from 120 to 136%. Coefficient of variation for endotoxin concentration in serum was lower than 10%, and in rumen fluid only slightly higher. There was significant correlation between ruminal concentration as measured by the ATK method and an alternative chromogenic substrate assay procedure. Changes in endotoxin level in experimental steers were those predictable from experience with naturally occurring incidents of grain engorgement. The ATK assay appears to be an accurate and rather simple technique which will prove useful for experimental and clinical studies in the future.

Animal Feed↗
PubMed1981

Medical rationalization, cultural lag, and the malpractice crisis.

The theses of this paper are that (1) the practice of medicine has become more formally rationalized in the past century; (2) this rationalization process has been retarded by the professional aspects of medical practice, e.g., the service ethic and the medical profession's exclusive jurisdiction over medicine; (3) this retardation is evident in cultural lag between the development of medical knowledge and how medicine is practiced; and (4) the "malpractice crisis" is a particular force which is accelerating the rationalization process and is overcoming lag. Data from physician surveys and interviews are presented which show the utility of a rationalization-cultural lag model in generating a number of substantive questions pertinent to the quality of rationalized medical care.

Defensive Medicine↗
PubMed2006

Effect of total mixed ration composition on amino acid profiles of different fractions of ruminal microbes in vitro.

The objective was to study the variation in the amino acid profile of microbial fractions obtained after feeding 16 total mixed rations for dairy cows in a Rusitec. Each ration was incubated for 15 d in 3-fold replicate. The rations showed high variation in the inclusion level of different ingredients and the content of proximal nutrients, fiber fractions, and energy. Three microbial fractions were isolated by centrifugation. The reference microbes (RM) were isolated from the liquid effluent of vessels between d 7 and 15 of incubation. Solid-associated microbes (SAM) were detached with methylcellulose from feed residues after incubation, and liquid-associated microbes (LAM) were obtained from the liquid content of the vessel. Both SAM and LAM were obtained only once for each vessel at the end of the incubation period. Across all rations, significant differences were found between RM, LAM, and SAM in amino acid concentration for some, but not all, amino acids. Within each microbial fraction, significant differences in the content of amino acids were found between rations. Multiple linear regression analysis did not show that the content of a certain nutrient or the inclusion rate of single feedstuffs could be used to predict the amino acid profile of microbial protein with an adequate level of accuracy. Further studies are necessary before the supply of individual microbial amino acids to the cows' duodenum can be modeled and predicted in dependence of diet data.

Amino Acids↗
PubMed1977

Effects of dietary fluoride ingestion on ration intake and milk production.

The influence of 1-mo ingestion of a ration containing 50, 100, 150, or 200 ppm fluoride (as sodium fluoride) on milk production and ration intake of Holstein cows was studied. The total amount of fluoride administered was mixed into the grain mix and fed twice each day. The concentrations of fluoride in plasma and urine were related to the concentration of fluoride in the ration. There was no effect of fluoride on hay intake, but there was a decrease in intake of the grain mix at an intake of 200 ppm fluoride. The ingestion of 150 or 200 ppm fluoride for 1 mo had a slight adverse effect on milk production. From these results we suggest that rations containing less than 150 ppm fluoride will not influence ration intake or milk production adversely if they are fed for a short time to mature cattle not suffering from other long-term adverse effects of fluoride ingestion.

Animals↗
PubMed1987

Organ transplant rationing: a window to the future?

Those who advocate rationing access to health care to control escalating costs must adequately examine the field of organ transplantation, where rationing has been a harsh fact of life for many years. In our society, two paradigmatic cases illustrate rationing: a lifeboat with too many passengers aboard for the supply of food and water to keep alive, and battlefield triage with more wounded soldiers than medical personnel available to treat them. Examination of these cases reveals four criteria that must be fulfilled for rationing to be the only possible response to a resource shortage: Nothing can be done to stretch or divide the available resource to meet the needs of all seeking access to it. Those who seek access to the scarce resource need it to survive. Nothing can be done to increase the supply of the resource that is available. The resource is recognized as a benefit by both those who seek it and those who can provide it. For the most part, transplant decisions are surrounded by secrecy, and public input is minimal. Although many centers use psychosocial as well as medical criteria in deciding whom to admit to transplant programs, no consistent criteria have been developed among transplant centers. This secrecy and inconsistency could damage public support of organ transplant programs. If rationing is instituted in other areas of health care, public input must be sought in establishing equitable standards. The scarcity of organs for transplant cannot be changed, but this is not true in other areas of health care, where we can choose to build more facilities, eliminate waste, and dispense with unnecessary services.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Making↗
PubMed1999

Assessment of the need for a training course in rational use of drugs: a cross-sectional pilot study.

Rational use of drugs means need-based use of them keeping in mind the pathological status, therapeutic indices, drugs interactions and adverse drug reactions. Lacunae in the existing undergraduate curriculum cause irrational use of drugs. The present study was undertaken among 2,200 fresh medical graduates from all over the country with a list of questionnaire distributed among them and analysing the answers. The aim was to ascertain the adequacy of present undergraduate curriculum on pharmacology in equipping the doctors on rational use of drugs and to assess the need and feasibility of Refresher's course. More than half (55%) replied prescriptions were not truly rational. Ninety-eight per cent opened Refresher's course is beneficial in rational prescribing. This cross-sectional survey could provide a glimpse of existing undergraduate pharmacology curriculum and its impact on rational prescribing practice. The Refresher's course in the early internship period involving the clinical departments and department of pharmacology is suggested.

Cross-Sectional Studies↗
PubMed1999

Effect of diet composition and ration size on key enzyme activities of glycolysis-gluconeogenesis, the pentose phosphate pathway and amino acid metabolism in liver of gilthead sea bream (Sparus aurata).

The effects of diet composition and ration size on the activities of key enzymes involved in intermediary metabolism were studied in the liver of gilthead sea bream (Sparus aurata). High-carbohydrate, low-protein diets stimulated 6-phosphofructo 1-kinase (EC 2.7.1.11), pyruvate kinase (EC 2.7.1.40), glucose-6-phosphate dehydrogenase (EC 1.1.1.49) and 6-phosphogluconate dehydrogenase (EC 1.1.1.44) enzyme activities, while they decreased alanine aminotransferase (EC 2.6.1.2) activity. A high degree of correlation was found between food ration size and the activity of the enzymes 6-phosphofructo 1-kinase, pyruvate kinase, glucose-6-phosphate dehydrogenase (positive correlations) and fructose-1,6-bisphosphatase (EC 3.1.3.11) (negative correlation). These correlations matched well with the high correlation also found between ration size and growth rate in starved fish refed for 22 d. Limited feeding (5 g/kg body weight) for 22 d decreased the activities of the key enzymes for glycolysis and lipogenesis, and alanine aminotransferase activity. The findings presented here indicate a high level of metabolic adaptation to both diet type and ration size. In particular, adaptation of enzyme activities to the consumption of a diet with a high carbohydrate level suggests that a carnivorous fish like Sparus aurata can tolerate partial replacement of protein by carbohydrate in the commercial diets supplied in culture. The relationship between enzyme activities, ration size and fish growth indicates that the enzymes quickly respond to dietary manipulations of cultured fish.

Adaptation, Physiological↗
PubMed2002

[Cereal products as a source of selenium in Polish food rations].

The aim of the study was to update the data concerning the level of selenium in cereal products and to determine its uptake with daily food rations and percentage of cereal products in the 24-hour pool of selenium ingested. Selenium was determined fluorometrically after the reaction of Se (IV) with 2.3-diaminonaphthalene and extraction of naphtho-[2.3-d]-2-seleno-1.3-diazole to cyclohexane. Compared to the results found several years ago, the selenium levels observed in cereals, flour and bakery products were significantly lower. The mean levels of selenium in the above-mentioned products ranged from 22.9 micrograms/kg to 53.0 micrograms/kg and were markedly lower compared with pasta which reach to level 528 micrograms/kg, especially when pasta was made from semoline or contained eggs. The average daily intake of selenium with reconstructed rations was 37.9 micrograms while with home made rations 60.4 micrograms. The values calculated on the basis of the data collected in the 80-ties were significantly stray to analytical results, and those based on our findings was comparable. The percentage of the most important products in the daily selenium pool changed significantly after taking into account these new results because according to the data from 80-ties, the major sources of selenium in home and reconstructed rations were cereal products which share to 48%. According to the new results the main source of selenium in daily rations were meat one its products about 26% and cereal products somewhat less than 20%.

Edible Grain↗
PubMed1992

Effect of soil on aflatoxin tissue retention in chicks when added to aflatoxin-contaminated poultry rations.

The effects of silty clay loam soil on aflatoxin B1 (AFB1) absorption were investigated when added to the diets of chicks fed aflatoxin-contaminated rations. Sixty 1-d-old White Leghorn chicks were fed a control ration (< 5 ng AFB1/g), a low aflatoxin-contaminated ration (55 ng AFB1/g), a high aflatoxin-contaminated ration (4,488 ng AFB1/g), or high aflatoxin-contaminated rations (4,488 ng AFB1/g) + 25% or 50% soil. Livers in each group were pooled and analyzed for AFB1 and metabolites. The addition of soil significantly reduced the levels of AFB1 in the livers, although the reduction was less when 25% soil was fed compared with the 50% soil feeding.

Aflatoxins↗
PubMed2003

[Comparative assessment of vitamin C content and evaluation of energy intake in children daily food rations].

The aim of this study was comparative assessment of content of vitamin C in daily food rations orphans children aged 1-6 years by using two methods--analytical and calculation and evaluation of energy intake by calculation. The levels of energy and vitamin C intake in daily food rations were calculated using menu data and data of food composition tables and compared with the recommended dietary intake (RDI). In addition vitamin C was determined in daily food rations by high performance liquid chromatography method (HPLC). Differences between two methods for evaluation of content of vitamin C were not statistically significant. Contribution of energy to individual meals and share of main nutritive components in supply of energy to daily food rations did not correspond with recommendations. Beyond this daily food rations orphans children were plentiful, monotonous and uniform without using seasonal products.

Antioxidants↗
PubMed2006

[Assessment of antibiotic use and comparison with recommendations for their rational use].

Irrational and excessive use of antibiotics increases resistance to these preparations. Antimicrobial resistance is a serious public health problem worldwide. The main goal of our study was to evaluate the use of antibiotics (indications, dosage, and treatment duration) in daily family doctors' practice and nonadherence to guidelines on rational antibiotic therapy. A retrospective study of records regarding the prescription of antibiotics for patients in two outpatient settings during the period of January 1, 2005, to December 31, 2005 was performed in Clinic of Family Medicine at Kaunas University of Medicine. Rationality of antibiotic therapy was evaluated according for adherence to published guidelines. A descriptive and comparative statistical analysis of data was processed with SPSS 13.0 program. There were 2935 patients in both outpatient settings (1285 and 1650, respectively). During the period of January 1, 2005, to December 31, 2005, antibiotics were prescribed in 210 cases for various reasons (71 (33.8%) and 139 (66.2%), respectively). A total of 184 (6.3%) patients received antibiotic therapy. It was determined that only in 9.5% of all cases, antibiotics were administered in keeping with the recommendations for rational antibiotic therapy. Only two treatment cases (1%) were based on bacteriological analysis. According to indications, appropriate antibiotics were prescribed in 42.9% of cases. The dosage of antibiotics was adjusted properly in 56.2% of cases, and even in 82.9% of cases, the duration of antibiotic therapy fulfilled the guidelines on rational antibiotic use. More rational antibiotic therapy was practiced in the second outpatient setting (10.8%) compared to the first outpatient setting (7%) (p<0.05). The most irrationally antibiotics were prescribed for the treatment of urinary tract and ocular infections.

Adult↗
PubMed1991

[Evaluation of cadmium, mercury and lead intake with reproduced weekly food rations].

In Lublin, Olsztyn, Poznań, Warszawa and Wrocław, weekly food rations characteristic of families other than those of manual workers, with medium incomes, were reproduced. Food rations comprised ca. 90 food products whose average weekly intakes were established consistently with the results of questionnaires of the Chief Census Bureau. Namely, from these results we calculated and prepared the average weekly food rations (from 11 470 g to 14 732 g), in which cadmium, mercury and lead were assayed by the ASA method. These average food rations afforded weekly intakes of 105-147 micrograms Cd, 441-931 micrograms Pb and 50.5-119.0 micrograms Hg. According to these results, the average food rations from the above-mentioned cities are moderately contaminated with the heavy metals tested, because in no case 50% of the provisional tolerable weekly intake (PTWI) were exceeded. The present results are lower than those obtained in the same year for families of manual workers; this is probably due to the fact that in the families of manual workers, as compared with other families, the weight of meals is usually higher. It is noteworthy that in the cities with greater numbers of industrial plants the contents of the metals tested, particularly of mercury and lead, in food are higher.

Cadmium↗
PubMed1979

Body water content and turnover in cats fed dry and canned rations.

Body water content and total body water turnover in cats fed commercially available dry food and then given canned rations were determined with tritiated water. Cats during the feeding of either ration did not differ in body water content or turnover. Cats during the feeding of the dry ration derived a greater fraction of their total water turnover from drinking water, and these cats drank more water per gram of dry matter intake than when fed the canned ration. On the basis of total water intake, however, those given the canned ration had significantly greater water intake per gram of dry matter; also, their total water turnover per gram of dry matter was greater. Compared with other animals, cats have a similar ratio of body water to body solids, but the rate of water turnover per unit of body weight is slower.

Animal Feed↗
PubMed1983

[Effect of different-sized rations on the physiology of the digestive and metabolic processes in sheep].

Tested was the effect of differently sized rations with sheep supplied with fistulae. The change in the size of the ration was said to bring about a change in the physiology of the digestive and metabolic processes as well as of the lung ventilation. The almost twice lowered size of the normal ration did not improve digestion and conversion when the ration had an improper structure. At an appropriate structure, though with a greater size the ration did not lower the level of the digestive and metabolic process, while the coefficients of digestibility substantially rose. It is believed, however, that the distribility coefficients alone cannot reflect thoroughly the physiology of digestion.

Animal Feed↗
PubMed1981

Influence of ration composition and energy balance on blood beta-hydroxybutyrate (ketone) and plasma glucose concentrations of dairy cows in early lactation.

The effect of ration composition, with respect to concentrate, crude protein, and methionine hydroxyanalog content, on blood beta-hydroxybutyrate and plasma glucose concentrations was assessed in Holstein cows every 2 weeks over the first 6 weeks of lactation. The correlation of these metabolites with estimated energy balance, and the effects of these ration variables on this correlation were studied. High concentrate diets (60% of dry matter) compared with low concentrate diets (40% of dry matter) increased mean plasma glucose values and reduced mean blood beta-hydroxybutyrate concentration. Variation in crude protein and methionine hydroxyanalog supplementation did not affect metabolite concentration. The correlations between blood beta-hydroxybutyrate and energy balance and between plasma glucose and energy balance were weak and subject to the influence of variation in ration composition. It was concluded that plasma glucose and blood beta-hydroxybutyrate concentrations cannot be used as valid indicators of energy balance. However, it did appear that blood beta-hydroxybutyrate might be used as an indicator of the relative glucogenic potential of dairy rations and that blood concentrations of this metabolite could potentially be used to adjust factors in the ration which influence glucose availability to the cow.

3-Hydroxybutyric Acid↗
PubMed1980

[Digitalis therapy used according to the "rational" method. Techniques of application and clinical advantages (author's transl)].

Digitalis therapy in cardiac failure is used by physicians according to conventional dosages; we call this type of digitalization "empiric". With this method digitalis intoxication in hospitalized patients is likely to occur in 8 to 20% of the cases. Another method of digitalization which we call "rational" is based upon an initial dosage of 0.015 mg per Kilo of digoxin, followed by a maintenance dosage determined by the relationship between initial dosage and daily rate of elimination. The latter depends upon the individual value of endogenous creatinine clearance (determined by age, weight and sex). Blood level of digoxin during steady state was measured in 454 patients divided randomly in four groups, each of whom following a different protocol of digitalization: 31 patients were treated with the rapid "empiric" digitalization (group I), 249 patients with the slow "empiric" digitalization (group II), 81 patients with the "rational" digitalization (group III), and 93 patients after a initial "empiric" dosage were treated with a maintenance dosage calculated by the "rational" method. An excessive initial dosage (blood level of digoxin > 2 ng/ml) was observed in 47.9% of patients of group I, in 15.9% of patients in group II, in 9.8% of patients of group III and in 14.7% of patients of group IV. manifestations of digitalis intoxication occurred in 30% patients of group I, in 10% of patients of group II, in 4.9% of patients of group III, and in 2.1% of group IV. Blood value of digoxin below therapeutic levels (under 0.5 ng/ml) was observed in only 13.1% of patients of group II, in 8.6% of patients of group III, and in 8% of patients of group IV. The lower percentage of digitalis intoxication observed in patients treated with "rational" method of digitalization is highly significant if compared with that observed in patients treated with empiric digitalization. The use of the "Lanoxin-rulex" makes the rational digitalization easier to handle, and gives the physicians the habit of considering the more important determinants of digoxin blood level. Conditions more likely to determine a wrong digitalis dosage are discussed in detail.

Digitalis Glycosides↗
PubMed2004

Rationing critical care beds: a systematic review.

OBJECTIVE: Rationing critical care beds occurs daily in the hospital setting. The objective of this systematic review was to examine the impact of rationing intensive care unit beds on the process and outcomes of care. DATA SOURCE: We searched MEDLINE (1966-2003), CINAHL (1982-2003), Ovid Healthstar (1975-2003), EMBASE (1980-2003), Scisearch (1980-2003), the Cochrane Library, PUBMED related articles, personal files, abstract proceedings, and reference lists. STUDY SELECTION: We included studies of seriously ill patients considered for admission to an intensive care unit bed during periods of reduced availability. We had no restriction on study design. Studies were excluded if rationing was performed using a scoring system or protocol and if cost-effectiveness was the only outcome. DATA EXTRACTION: In duplicate and independently, we performed data abstraction and quality assessment. DATA SYNTHESIS: We included ten observational studies. Hospital mortality rate was increased in patients refused intensive care unit admission vs. those admitted (odds ratio, 3.04; 95% confidence interval, 1.49-6.17). Factors associated with both intensive care unit bed refusal and increased mortality rate were increased age, severity of illness, and medical diagnosis. When intensive care unit beds were reduced, admitted patients were sicker, were less often admitted primarily for monitoring, and had a shorter intensive care unit length of stay, without other observed adverse effects. CONCLUSIONS: These studies suggest that patients who are perceived not to benefit from critical care are more often refused intensive care unit admission; refusal is associated with an increased risk of hospital death. During times of decreased critical bed availability, several factors, including age, illness severity, and medical diagnosis, are used to triage patients, although their relative importance is uncertain. Critical care bed rationing requires further investigation.

Adolescent↗
PubMed2000

[Rational therapy].

In a time of scarce resources, the demand for a rational therapy is important in the present discussion to reform the health system. This article describes rational therapy and introduces practical approaches like drug therapy, evidence-based medicine, and clinical practice guidelines. The development of efficient cost-benefit relations may lead to more rationalization in the health sector. It is important to attain acceptance also among the patients that rationing in the health system is a necessary measure in diagnosis and therapy.

Cost Control↗