A focus group study exploring dairy farmers' perspectives of cull cow management in Ontario, Canada.

Introduction: Maintaining the welfare of cull dairy cows from the farm to slaughter is an ongoing challenge for the dairy industry. Recent research suggests that some cull dairy cows within the marketing system are in physical states that are below regulatory standards, and further research is required to determine why these unfit cows are found throughout the journey to abattoirs. Since dairy farms are the origin of these cows, decision making by dairy farmers has been identified as key to preventing cull cows that are considered unfit for transport from entering the marketing system. The objectives of this study were to understand dairy farmers' perspectives on their cull dairy cow management practices, recommendations and requirements of regulations, management tools, and welfare issues. Methods: Four focus groups with a total of 21 participants were each conducted virtually, video recorded, and transcribed verbatim, with dairy farmers from Ontario, Canada. A thematic analysis of focus group discussions was conducted utilizing deductive reasoning. Results: There were three themes identified including deciding to cull or not, management of cows being culled, and knowledge and perceptions of cull cow regulations. When making culling decisions, farmers utilize multiple sources of information including personal experiences and values and external referents like veterinarians, family members and other farmers. The welfare of their cows was a high priority but one that was often weighed against the financial outcomes of culling decisions. Finally, most participants considered recent regulatory changes for the management of cows before shipment to be of little importance on their farms. Discussion: In conclusion, the farmers from this study showed the diversity of considerations they make in culling decisions and the large contribution of animal productivity and economic factors. There was a general lack of knowledge of recent regulatory changes for the shipment of cull cows, and there is room for improving the uptake of new recommendations for culling only cows fit for transportation.

A survey of practices and attitudes around cull cow management by bovine veterinarians in Ontario, Canada.

The removal (culling) of dairy cows from the farm is a regular and required management practice. The main objectives of this study were to describe the involvement of bovine veterinarians in Ontario, Canada, in dairy cull cow management decisions, their expectations of current producer practices, and their perspectives on welfare issues and best management practices for cull dairy cows. Between February and May 2021, a province-wide survey was conducted among all members of the Ontario Association of Bovine Practitioners (OABP), with questions addressing veterinarians' background and demographics, veterinary clinic characteristics, cull cow management, down cow management, and learning preferences. The response rate for the survey was 25.1%, with 45 responses meeting all eligibility criteria. Dairy veterinarians would like to have greater involvement in cull cow management; when asked for desired involvement in culling decisions, 57.5% of veterinarians would like to be involved in culling decisions most of the time or always. Most (70.0%) veterinarians believed that cull cow welfare has improved over the last decade. However, most respondents also identified at least one area of management (farm of origin, transportation, auction, slaughter) as currently being a high risk to cull cow welfare. Given the frequency of their visits, trust by dairy producers, and knowledge, herd veterinarians are among those in the best position to improve the care of cull dairy cows. Information generated from this survey can be used to inform the development of improved decision-making tools for culling cows, and this, along with increased veterinarians' involvement in cull cow management, could improve the economic and welfare outcomes of culling decisions for dairy producers.

A survey of dairy cattle farmers' management practices for cull cows in Ontario, Canada.

Removal of cows from dairy cattle production is a routine and unavoidable practice of the dairy industry and is often referred to as culling. The objectives of this study were to use a survey to describe current on-farm cull cow management, farmers' perception of cull cows' journeys to slaughter, and the adoption of current recommendations and regulations by Ontario dairy farmers. All Ontario dairy farmers were invited to complete a cull cow management survey between December 2020 and March 2021 that included 44 questions covering farmer demographic information, farm characteristics, and cull cow management. The survey response rate was 7.4% (n = 248); a total of 226 of the responses were included in this study for analysis. Most respondents indicated they have a written standard operating procedure (SOP) for cull cows (62%), and 48, 13, and 15% of those identified they use their cull cow SOP "always," "sometimes," and "never," respectively. The more confident respondents were that cull cows arrived at slaughter in the condition they left the farm the less likely they were to have a cull cow SOP [odds ratio (OR) 0.83]. The most important sources of information for the management of cull cows were the herd veterinarian (64%) and members of the marketing/regulatory organization the Dairy Farmers of Ontario (44%). Drug withdrawal time was the only factor most respondents (73%) considered "very important" for the assessment of cull cows prior to transport. Most farmers believe cull cows journey from the farm to slaughter is three or less days (55%), and the confidence of farmers that cull cows arrive at slaughter in the condition they left their farm was generally high. Lastly, most farmers (66%) identified they were familiar with recent regulatory changes around the fitness, duration of transport, and lactation status for cull cows. These results highlight farmers' perceptions of the impacts and durations of the journey of cull cows differs from reality, and there are misunderstandings of the requirements for cull cow management. Further research should investigate how different strategies for training farmers may lead to improved cull cow welfare and regulatory compliance.

Describing and Characterizing the Literature Regarding Umbilical Health in Intensively Raised Cattle: A Scoping Review.

The objective of this scoping review was to describe and characterize the existing literature regarding umbilical health and identify gaps in knowledge. Six databases were searched for studies examining umbilical health in an intensively raised cattle population. There were 4249 articles initially identified; from these, 723 full text articles were then screened, with 150 articles included in the review. Studies were conducted in the USA (n = 41), Brazil (n = 24), Canada (n = 13), UK (n = 10), and 37 additional countries. Seventeen were classified as descriptive, 24 were clinical trials, and 109 were analytical observational studies. Umbilical outcomes evaluated in descriptive studies were infection (n = 11), parasitic infection (n = 5), and hernias (n = 2). Of the clinical trials, only one examined treatment of navel infections; the remainder evaluated preventative management factors for navel health outcomes (including infections (n = 17), myiasis (n = 3), measurements (n = 5), hernias (n = 1), and edema (n = 1)). Analytical observational studies examined risk factors for umbilical health (n = 60) and umbilical health as a risk factor (n = 60). Studies examining risk factors for umbilical health included navel health outcomes of infections (n = 28; 11 of which were not further defined), hernias (n = 8), scoring the navel sheath/flap size (n = 16), myiasis (n = 2), and measurements (n = 6). Studies examining umbilical health as a risk factor defined these risk factors as infection (n = 39; of which 13 were not further defined), hernias (n = 8; of which 4 were not further defined), navel dipping (n = 12), navel/sheath scores as part of conformation classification for breeding (n = 2), measurements (n = 3), and umbilical cord drying times (n = 2). This review highlights the areas in need of future umbilical health research such as clinical trials evaluating the efficacy of different treatments for umbilical infection. It also emphasizes the importance for future studies to clearly define umbilical health outcomes of interest, and consider standardization of these measures, including time at risk.

Implementing participation-focused services: A study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi).

BACKGROUND: It is widely agreed that children's services should use participation-focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence-based knowledge translation strategy, to support implementation of participation-focused practice in front-line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers. METHOD: Best-practice guidelines for using audit and feedback were followed. For audit, participation-focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning. RESULTS: A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians' skills in participation-focused behaviours (median = 3.00-5.00, interquartile range [IQR] = 2.25-6.00), social processes (median = 4.00, IQR = 3.00-5.00), and behavioural regulation (median = 4.00-5.00, IQR = 3.00-6.00). CONCLUSIONS: MAPi provides a practical, off-the-shelf method for front-line services to investigate and support their implementation of participation-focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across-services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.

Examining the role of MEDLINE as a patient care information resource: an analysis of data from the Value of Libraries study.

OBJECTIVE: This study analyzed data from a study on the value of libraries to understand the specific role that the MEDLINE database plays in relation to other information resources that are available to health care providers and its role in positively impacting patient care. METHODS: A previous study on the use of health information resources for patient care obtained 16,122 responses from health care providers in 56 hospitals about how providers make decisions affecting patient care and the role of information resources in that process. Respondents indicated resources used in answering a specific clinical question from a list of 19 possible resources, including MEDLINE. Study data were examined using descriptive statistics and regression analysis to determine the number of information resources used and how they were used in combination with one another. RESULTS: Health care professionals used 3.5 resources, on average, to aid in patient care. The 2 most frequently used resources were journals (print and online) and the MEDLINE database. Using a higher number of information resources was significantly associated with a higher probability of making changes to patient care and avoiding adverse events. MEDLINE was the most likely to be among consulted resources compared to any other information resource other than journals. CONCLUSIONS: MEDLINE is a critical clinical care tool that health care professionals use to avoid adverse events, make changes to patient care, and answer clinical questions.

A New Clinically Applicable Measure of Functional Status in Patients With Heart Failure: The 60-Foot Walk Test.

OBJECTIVES: This study reports the development and predictive value of the 60-foot walk test (60ftWT), a brief functional status measure for patients with heart failure (HF). The goal was to develop a test suitable for clinical settings and appropriate for patients with walking impairments. BACKGROUND: The 6-min walk test (6MWT) has considerable predictive value, but requires a long walking course and has limited utility in patients with mobility-related comorbidities. A shorter, more clinically practical test is therefore needed. METHODS: A total of 144 patients (age 57.4 ± 11.4 years; 111 males) with symptomatic HF received baseline assessments using the 60ftWT, 6MWT, and self-reported symptom and health status. Patients were tested 3 months later to determine stability of assessments. HF hospitalizations or death from any cause were recorded for 3.5 years following baseline. RESULTS: Median 60ftWT completion time was 26 s (interquartile range: 22 to 31 s). Longer 60ftWT time was associated with shorter 6MWT distance (r = -0.75; p < 0.001), and with higher symptom severity at baseline (r = -0.40; p < 0.001). Longer 60ftWT times also predicted increases in 6MWT and symptoms from baseline to 3 months (p < 0.01). Both WTs predicted long-term clinical outcomes, with patients taking longer than 31 s to complete the 60ftWT at greatest risk for HF hospitalization or death (hazard ratio: 2.13; 95% confidence interval: 1.18 to 3.84; p = 0.01). CONCLUSIONS: The 60ftWT is an easily administered functional status measure that predicts adverse events, symptoms, and health status. It has the potential for considerable clinical utility to help identify patients at risk for future events and to calibrate treatments designed to improve functional status and quality of life.

Library and information services: impact on patient care quality.

PURPOSE: The purpose of this paper is to explore library and information service impact on patient care quality. DESIGN/METHODOLOGY/APPROACH: A large-scale critical incident survey of physicians and residents at 56 library sites serving 118 hospitals in the USA and Canada. Respondents were asked to base their answers on a recent incident in which they had used library resources to search for information related to a specific clinical case. FINDINGS: Of 4,520 respondents, 75 percent said that they definitely or probably handled patient care differently using information obtained through the library. In a multivariate analysis, three summary clinical outcome measures were used as value and impact indicators: first, time saved; second, patient care changes; and third, adverse events avoided. The outcomes were examined in relation to four information access methods: first, asking librarian for assistance; second, performing search in a physical library; third, searching library's web site; or fourth, searching library resources on an institutional intranet. All library access methods had consistently positive relationships with the clinical outcomes, providing evidence that library services have a positive impact on patient care quality. ORIGINALITY/VALUE: Electronic collections and services provided by the library and the librarian contribute to patient care quality.

Trastuzumab-induced cardiomyopathy: incidence and associated risk factors in an inner-city population.

BACKGROUND: Although it is known that trastuzumab causes cardiotoxicity, its extent and reversibility are still in question. Earlier studies have not evaluated consecutive patients with reproducible nuclear ventriculography. OBJECTIVE: We sought to evaluate the baseline characteristics which predispose patients to increased risk of trastuzumab cardiotoxicity and to determine the natural history of the cardiotoxicity. METHODS AND RESULTS: Left ventricular ejection fraction (LVEF) was measured in 76 women aged 36-73 years who had been treated with trastuzumab at the University of Maryland Greenebaum Cancer Center. LVEF was determined at baseline and then 3, 6, 9, and 12 months after treatment initiation. Cardiotoxicity was defined as ≥ 16% decrease in LVEF or ≥ 10% decrease in LVEF to <50%. There were no differences in comorbidities, earlier treatment, or demographics between patients with and without trastuzumab-induced cardiomyopathy except that African Americans were more likely to develop decreased LVEF (P < .05). Twenty-one patients (28%) met criteria for cardiotoxicity. Four of those patients were continued on trastuzumab and 17 patients had therapy withheld at some point. Only 1 patient developed symptomatic heart failure requiring inpatient hospitalization. LVEF improved in most patients regardless of whether or not trastuzumab was continued. CONCLUSIONS: Decreased LVEF while undergoing trastuzumab therapy occurs frequently and is usually reversible. African Americans had a higher risk of developing decreased LVEF. These findings raise clinically important questions as to whether it is necessary to discontinue trastuzumab for asymptomatic decrease in LVEF and whether African Americans are more predisposed to a decrease in LVEF while receiving trastuzumab. Further studies carefully assessing LVEF should address these hypotheses.

Linking research to practice: the rise of evidence-based health sciences librarianship.

PURPOSE: The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. METHODS: FOUR SOURCES OF EVIDENCE ARE USED TO EXAMINE THE RISE OF EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. RESULTS: These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. IMPLICATIONS: Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.

The Value of Library and Information Services in Nursing and Patient Care.

Libraries are a primary resource for evidence-based practice. This study, using a critical incident survey administered to 6,788 nurses at 118 hospitals, sought to explore the influence of nurses' use of library resources on both nursing and patient outcomes. In this article, the authors describe the background events motivating this study, the survey methods used, and the study results. They also discuss their findings, noting that use of library resources showed consistently positive relationships with changing advice given to patients, handling patient care differently, avoiding adverse events, and saving time. The authors discuss the study limitations and conclude that the availability and use of library and information resources and services had a positive impact on nursing and patient outcomes, and that nurse managers play an important role both by encouraging nurses to use evidence-based library resources and services and by supporting the availability of these resources in healthcare settings.

The value of library and information services in patient care: results of a multisite study.

OBJECTIVE: The research conducted a large-scale, multisite study on the value and impact of library and information services on patient care. METHODS: THE STUDY USED: (1) 2 initial focus groups of librarians; (2) a web-based survey of physicians, residents, and nurses at 56 library sites serving 118 hospitals; and (3) 24 follow-up telephone interviews. Survey respondents were asked to base their responses on a recent incident in which they had sought information for patient care. RESULTS: Of the 16,122 survey respondents, 3/4 said that they had definitely or probably handled aspects of the patient care situation differently as a result of the information. Among the reported changes were advice given to the patient (48%), diagnosis (25%), and choice of drugs (33%), other treatment (31%), and tests (23%). Almost all of the respondents (95%) said the information resulted in a better informed clinical decision. Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%). CONCLUSIONS: Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.

Hypoxia, not the frequency of sleep apnea, induces acute hemodynamic stress in patients with chronic heart failure.

OBJECTIVES: This study was conducted to evaluate whether brain (B-type) natriuretic peptide (BNP) changes during sleep are associated with the frequency and severity of apneic/hypopneic episodes, intermittent arousals, and hypoxia. BACKGROUND: Sleep apnea is strongly associated with heart failure (HF) and could conceivably worsen HF through increased sympathetic activity, hemodynamic stress, hypoxemia, and oxidative stress. If apneic activity does cause acute stress in HF, it should increase BNP. METHODS: Sixty-four HF patients with New York Heart Association functional class II and III HF and ejection fraction <40% underwent a baseline sleep study. Five patients with no sleep apnea and 12 with severe sleep apnea underwent repeat sleep studies, during which blood was collected every 20 min for the measurement of BNP. Patients with severe sleep apnea also underwent a third sleep study with frequent BNP measurements while they were administered oxygen. This provided 643 observations with which to relate apnea to BNP. The association of log BNP with each of 6 markers of apnea severity was evaluated with repeated measures regression models. RESULTS: There was no relationship between BNP and the number of apneic/hypopneic episodes or the number of arousals. However, the burden of hypoxemia (the time spent with oxygen saturation <90%) significantly predicted BNP concentrations; each 10% increase in duration of hypoxemia increased BNP by 9.6% (95% confidence interval: 1.5% to 17.7%, p = 0.02). CONCLUSIONS: Hypoxemia appears to be an important factor that underlies the impact of sleep abnormalities on hemodynamic stress in patients with HF. Prevention of hypoxia might be especially important for these patients.

The health sciences librarian in medical education: a vital pathways project task force.

OBJECTIVES: The Medical Education Task Force of the Task Force on Vital Pathways for Hospital Librarians reviewed current and future roles of health sciences librarians in medical education at the graduate and undergraduate levels and worked with national organizations to integrate library services, education, and staff into the requirements for training medical students and residents. METHODS: Standards for medical education accreditation programs were studied, and a literature search was conducted on the topic of the role of the health sciences librarian in medical education. RESULTS: Expectations for library and information services in current standards were documented, and a draft standard prepared. A comprehensive bibliography on the role of the health sciences librarian in medical education was completed, and an analysis of the services provided by health sciences librarians was created. CONCLUSION: An essential role and responsibility of the health sciences librarian will be to provide the health care professional with the skills needed to access, manage, and use library and information resources effectively. Validation and recognition of the health sciences librarian's contributions to medical education by accrediting agencies will be critical. The opportunity lies in health sciences librarians embracing the diverse roles that can be served in this vital activity, regardless of accrediting agency mandates.

Test-retest reliability of assessment for intraventricular dyssynchrony by tissue Doppler imaging echocardiography.

The purpose of this study was to evaluate the test-retest reliability of intraventricular dyssynchrony (IVD) assessment by tissue Doppler imaging (TDI) echocardiography. Limited response rates to cardiac resynchronization may improve with TDI screening for appropriate recipients. However, the clinical applicability of TDI will depend on the reliability of the test. Repeat TDI was prospectively performed (11 +/- 11 days apart) in 15 patients with QRS intervals >120 ms and left ventricular ejection fractions <35% and 25 normal controls using the same machine, sonographer, and blinded readers for the 2 tests. There was no change in clinical status or treatment between tests. Established and clinically feasible criteria for IVD were evaluated. These were based on differences of TDI-derived activation time between 2, 4, or 12 left ventricular segments. Reliability was assessed by linear correlation and Bland-Altman analysis for quantified measures, along with percentage agreement and kappa statistics for IVD diagnosis. Despite good intrareader (r = 0.98, p <0.0001) and interreader (2 segments: r = 0.96, p <0.0001; 4 segments: r = 0.85, p <0.0001) reliability, test-retest correlations were uniformly modest for the 2-segment (r = 0.26, p = 0.11), 4-segment (r = 0.36, p = 0.021), and 12-segment (r = 0.50, p = 0.0009) measures. Test-retest agreement for IVD diagnosis by either criterion was equally limited (2 segments: 83%, kappa = 0.27; 4 segments: 75%, kappa = 0.47; 12 segments: 68%, kappa = 0.35). Bland-Altman analysis demonstrated wide confidence intervals, exceeding the diagnostic cutoff values for the respective criteria. In conclusion, the accurate assessment of IVD by TDI may be limited by poor test-retest reliability.

A randomized, controlled trial of the renal effects of ultrafiltration as compared to furosemide in patients with acute decompensated heart failure.

OBJECTIVES: This study was designed to evaluate the consequences of ultrafiltration (UF) and standard intravenous diuretic (furosemide) therapy on glomerular filtration rate (GFR) and renal plasma flow in patients with acute decompensated heart failure. BACKGROUND: It has been hypothesized that treatment with diuretics may worsen renal function as the result of systemic neurohormonal activation and direct renal vascular effects. UF also removes fluid, but its actions on intrarenal hemodynamics, and therefore renal function, are unknown. METHODS: Patients hospitalized for acute decompensated heart failure with an ejection fraction less than 40% and two or more signs of hypervolemia were randomized to receive UF or intravenous diuretics. Urine output, GFR (as measured by iothalamate), and renal plasma flow (as measured by para-aminohippurate) were assessed before fluid removal and after 48 hours. RESULTS: Nineteen patients (59 +/- 16 years, 68% were male) were randomized to receive UF (n = 9) or intravenous diuretics (n = 10). The change in GFR (-3.4 +/- 7.7 mL/min vs. -3.6 +/- 11.5 mL/min; P = .966), renal plasma flow (26.6 +/- 62.7 mL/min vs. 16.1 +/- 42.0 mL/min; P = .669), and filtration fraction (-6.9 +/- 13.6 mL/min vs. -3.9 +/- 13.6 mL/min; P = .644) after treatment were not significantly different between the UF and furosemide treatment groups, respectively. There was no significant difference in net 48-hour fluid removal between the groups (-3211 +/- 2345 mL for UF and -2725 +/- 2330 mL for furosemide, P = .682). UF removed 3666 +/- 2402 mL. Urine output during 48 hours was significantly greater in the furosemide group (5786 +/- 2587 mL) compared with the UF group (2286 +/- 915 mL, P < .001). CONCLUSIONS: During a 48-hour period, UF did not cause any significant differences in renal hemodynamics compared with the standard treatment of intravenous diuretics.

Measuring the value and impact of health library and information services: past reflections, future possibilities.

OBJECTIVES: To summarize the context, history and results of research studies conducted on the value and impact of health library and information services by the author since 1975 and to use this as a basis for examining ongoing developments related to evaluation research. To provide a comprehensive bibliography of library value and impact studies. METHODS: Literature review and background based on personal involvement in the studies under discussion. RESULTS: The author's studies demonstrate an ongoing evolution of value and impact studies since the mid-1970s. In health sciences libraries, the approach taken to measuring value and impact has been strongly influenced by the type of research being conducted in the health sciences field as a whole. As a result, health sciences library researchers have become early adopters of methods that incorporate outcome and impact measures and rigorous research designs, and the concept of evidence-based library and information practice. The paper recommends that a range of research approaches from various disciplines be used to guide future evaluation research. CONCLUSIONS: Value and impact studies will continue to be important resources for evidence-based practice as health information professionals deal with evolving user needs and new ways of delivering information to a variety of audiences.