Search

International audience

Patients with jaundice require rapid diagnosis and treatment, yet such patients are often subject to delay.An open referral, rapid access jaundice clinic was established by reorganisation of existing services and without the need for significant extra resources.A large general hospital in a largely rural and geographically isolated area.Waiting times for referral, consultation, diagnosis, and treatment, length of stay in hospital, and general practitioners' and patients' satisfaction with the service. STRATEGIES OF CHANGE: Referrals were made through a 24 hour telephone answering machine and fax line. Initial assessment of patients was carried out by junior staff as part of their working week. Dedicated ultrasonography appointments were made available.Of 107 patients seen in the first year of the service, 62 had biliary obstruction. The mean time between referral and consultation was 2.5 days. Patients who went on to endoscopic retrograde cholangiopancreatography waited 5.7 days on average. The mean length of stay in hospital in the 69 patients who were admitted was 6.1 days, compared with 11.5 days in 1996, as shown by audit data. Nearly all the 36 general practices (95%) and the 30 consecutive patients (97%) that were surveyed rated the service as above average or excellent.An open referral, rapid access service for patients with jaundice can shorten time to diagnosis and treatment and length of stay in hospital. These improvements can occur through the reorganisation of existing services and with minimal extra cost.

An on-farm animal manure, such as chicken manure, can be a source of nutrients for the growth and production of agricultural crops. However, use of manures at rates that are considered adequate for crop production may cause excessive accumulation of phosphorus (P) and also result in leaching of nitrogen (N), thus leading to potential pollution of ground and surface water. Composting of manures with a carbon (C) source can reduce P and N to manageable levels to support production of crops. In order to determine the potential of composted manure for crop production, we studied growth and production of sweet corn by using poultry manure composted with a carbon source of crimson clover hay or wheat straw. These experiments, conducted during 2002 and 2003, compared six treatments: 1) uncomposted chicken manure alone; 2) composted with wheat straw turned weekly; 3) composted with wheat straw turned bi-weekly; 4) composted with crimson clover hay turned weekly; 5) composted with crimson clover hay turned bi-weekly; and 6) a control with a commercial recommendation rate of N fertilizer. These treatments resulted in 9244; 13,866; 15,688; 16,734; and 11,977 marketable ears/acre, respectively, indicating significant superiority of treatments 4 and 5 over all others. Similar results were obtained for ear length, ear fresh weight, and plant height. Results indicated that composting of poultry litter with wheat straw or crimson clover hay is a viable way to utilize poultry manure for production of sweet corn and other agricultural crops. This study implies that composting of on-farm animal manure with organic material, such as hay and straw, could play an important role in development of an environmentally friendly, economically feasible, and sustainable organic production of agricultural crops.