Use of Non-Steroidal Anti-Inflammatory Drugs and Attitudes to Pain in Pasture-Based Dairy Cows: A Comparative Study of Farmers and Veterinarians.

Pain is a significant welfare concern within the dairy industry. Recognizing and managing pain are important factors for safeguarding animal welfare. A questionnaire was sent via post to Irish dairy farmers and large animal veterinarians to assess attitudes to pain and the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pasture-based dairy cows. The questionnaire could also be completed online. A total of 1,002 surveys were received from dairy farmers and 116 from livestock veterinarians. Veterinarians and farmers generally perceived the same conditions and procedures as the most painful. However, farmers scored surgical procedures significantly higher than veterinarians, and veterinarians scored lameness-related conditions, mastitis (clots in milk only) and hock hair loss significantly higher than farmers. Higher pain scores for conditions and procedures given by dairy farmers and veterinarians were associated with increased NSAID use. However, the use of NSAIDs was low, relative to the pain score, for Burdizzo castration (farmers and veterinarians), white line separation (farmers and veterinarians) and abscess (veterinarians), mastitis with clots in milk only (farmers) and calving with no assistance (farmers). Veterinarians who graduated less recently had significantly lower odds of using NSAIDs, and farmers that completed the survey online, had a larger herd size, completed education up to level four or five (as opposed to level three) and those who seemed to have less knowledge on analgesics, had significantly lower odds of using NSAIDs. Empathy was not found to be associated with NSAID use and no correlation was found between pain and empathy scores. Veterinarians perceived cost as more of a barrier than farmers did; therefore, NSAIDs should be offered more readily. For those working with dairy cows, there is a need to continue education on the benefits of analgesia, especially for conditions and procedures that have low NSAID use relative to pain score. The habituation of humans to pain in animals needs to be prevented to enable pain to be recognized and managed appropriately. Pain scores can be used as a benchmark for veterinarians and farmers to determine how their perception of pain compares to others, and see how this may influence their NSAID use.

Assessing dairy cow welfare during the grazing and housing periods on spring-calving, pasture-based dairy farms.

The different periods characterizing spring-calving, pasture-based dairy systems common in Ireland have seldom been the focus of large-scale dairy cow welfare research. Thus, the aim of this study was to devise and conduct an animal-based welfare assessment during both the grazing and housing periods on spring-calving, pasture-based dairy farms, to identify areas for improvement and establish benchmarks for indicators of good welfare. Assessment of seven animal-based welfare indicators was conducted during two visits (one each at grazing and housing) to 82 commercial dairy farms in southern Ireland. Herd-level descriptive statistics were performed for all welfare indicators at each visit, and differences between visits were analyzed using paired t-tests and Wilcoxon signed-rank tests. A mean of 9% and 10% clinically lame cows (mobility scores 2 and 3) were observed at housing and grazing, respectively. Recommended body condition scores (BCS) were not met for a mean of 13% of cows at grazing and 23% at housing, with more over-conditioned cows present at housing than grazing (P < 0.001). Ocular discharge was uncommon in both periods. Prevalence of moderate and severe nasal discharge combined was lower during housing (5%) than grazing (7%). In both periods, similar mean levels of tail injury were observed: 2% to 3% of cows with tail lacerations, 9% with broken tails, and 8% (measured at housing only) with docked tails. Integument alterations involved primarily hair loss and were most prevalent on the hindquarters (26%) during grazing and on the head-neck-back (66%) and the hindquarter (32%) regions during housing. Cows displayed an avoidance distance of >1 m (indicative of a fearful response) from an approaching human in an average of 82% of grazing cows and 42% to 75% of housed cows, dependent on test location. Opportunities to improve welfare in this system were identified in the areas of tail injury prevention, nasal health, and the management of indoor housing and feeding. The performance of the top 20% of farms for each welfare indicator was used to establish benchmarks of: 0% to 5% clinical lameness, 0% to 12% of cows outside recommended BCS, 0% to 27% ocular discharge, 2% to 16% nasal discharge, 0% tail lacerations and docked tails, 0% to 3% tail breaks, 0% to 14% integument alterations, and 4% to 74% for avoidance distance of >1 m. These represent attainable targets for spring-calving pasture-based farms to promote good dairy cow welfare.

Woundcare Research for Appropriate Products (WRAP): validation of the TELER method involving users.

Woundcare Research for Appropriate Products (WRAP) is a novel collaboration WRAP between industry and clinicians, funded by the Engineering and Physical Research Sciences Council. WRAP objectives included the development and testing of methodologies to identify patients' and clinicians' needs with respect to wound dressings for exudate management. The management of exudate was the focus because it was demonstrated to be the pivotal problem for patients and clinicians in a study of malignant wounds, and is a recurring problem in other wound types. A clinical note-making system (Treatment Evaluation by Le Roux's method--TELER) was validated as a method of collecting observational data of dressing performance in the context of total patient care, thereby involving the users of dressing products. The validation process was a form of consensus where multiple sources of data were used to define patient problems, within the TELER indicators, to measure a change or lack of change in the problems during a period of treatment and care and to draw conclusions about dressing performance and patient experiences.

The wound dressing supply chain within England's National Health Service: unravelling the context for users.

AIM: To explore the representation of user needs (nurses and patients, both individuals and groups) at the industrial (wound dressing manufacture) and National Health Service interface. MAIN ISSUES: The wound dressing supply chain is outlined, tracking organizational changes. The methods that are used to transfer user information between industries that produce dressings and those using the products are reviewed in terms of their ability to communicate what users need from dressings. Organizational policies and systems are outlined, with the focus on their role in facilitating the communication of user needs. CONCLUSION: Methods for generating user information that can directly inform dressing design are needed together with interactive communication routes within the supply chain, specifically between users, manufacturers, purchasers and suppliers. This will facilitate dual benefits for nursing management through improvements in purchasing decisions and nurses' management of wound care.

Quality and efficacy of educational materials on cancer-related fatigue: views of patients from two European countries.

Cancer-related fatigue is a symptom with great implications for the quality of life of those that experience it. It is regarded as one of the most distressing symptoms that people with cancer develop. Its aetiology is complex, and although the mechanisms underlying fatigue have not been fully clarified it is evident that it is exacerbated by treatments intended to cure or palliate the disease. Patients at risk of cancer-related fatigue need access to information that will enable them to manage it effectively. There are a growing number of materials available to patients in different European countries on this topic, but it is unclear how useful patients find these. This study was undertaken to explore this through conducting focus groups with patients in the United Kingdom and Switzerland. One focus group was conducted in each country. Findings from these determined that individuals voiced common concerns: fatigue had not been addressed in the clinical setting - individuals surmised why this occurred; participants had not accessed materials on cancer-related fatigue previously; they made recommendations for future resources for patients. However, what was evident was that unless patients can access materials on this topic, their quality becomes purely an academic issue.

[Attitude of cancer patients to fatigue: patient attitude in Switzerland and England]. / Was Krebskranke von den Informationen über Fatigue halten: eine Beurteilung durch Patienten in der Schweiz und in England.

UNLABELLED: In the course of a cancer trajectory, many patients suffer from distressing fatigue. In past years, research has shown that care givers tend to underestimate or even to ignore this frequent phenomenon. Despite increasing knowledge, fatigue seems to remain an orphan topic in symptom management. AIM: A qualitative research strategy was used to explore the perception of cancer patients regarding the awareness of fatigue in professionals and the way they deal with it. Patients also evaluated the usefulness of some currently available information material about fatigue. METHODS: The expert-opinion of cancer patients in Switzerland and England was analysed. Convenient sampling guided the selection process of seven patients in each country. A tape-recorded focus-group interview served as method to collect and transcribe data. Data were analysed according to the framework analyses by Richie & Spencer. RESULTS: Results were very similar in both countries. Patients stated a great need for more information regarding fatigue. They feel that care givers are not sufficiently aware of it and that a specific support is not part of current standard practice. The information material was well received and generally judged as very good and helpful. CONCLUSIONS: Communication barriers in professionals as well as in patients continue to exist. Patients wish to be better informed by care givers. The available information material serves well to support this information as they provide words for the unmentioned phenomenon. Far more professional fatigue education is needed to raise care givers' awareness.

A Delphi study on the research priorities of European oncology nurses.

The importance of establishing priorities for cancer nursing research has been repeatedly acknowledged (Corner 1993, Hunt 2001). A Delphi survey designed to capture research priorities of European cancer nurses was undertaken to document issues perceived as important to European Oncology Nursing Society (EONS) members and to set priorities to underpin an evolving research strategy. The survey comprised three phases, beginning at the second EONS Spring Convention (2000) when European cancer nurses were approached to complete a phase 1 questionnaire. In phase 2, research priority categories generated from responses to the phase 1 questionnaire were reviewed by a group of European cancer nurses. The categories and the placement of all the research questions within these categories were comprehensively reviewed. The final phase involved the distribution of the second questionnaire. Two hundred and twenty three nurses responded to the first questionnaire and 117 responded to the second questionnaire. Prioritisation of research categories reflected diverse views between respondents, with many categories receiving similar overall scores, of almost equal priority. Nonetheless, a number of categories demonstrated high priority throughout Europe namely needs of patients related to communication, information and education; symptom management; experiences of disease and its treatment; cancer nursing research issues (e.g. research facilitation) and cancer nursing education issues. It is recommended that future research examines clusters of research questions around the highest ranked priorities. This may provide both direction and focus to European-wide cancer nursing research, whilst ensuring clinically relevant investigation.