Facilitating interprofessional affective learning in health professional students through digital client documentation: a comparison of simulation modes.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

Influence of dietary roughage level and Megasphaera elsdenii on feedlot performance and carcass composition of thin cull beef cows fed for a lean market.

One hundred forty-four cull cows (body condition score = 2.10 ± 0.61; BW = 456 ± 47 kg) were organized into a 2 × 2 factorial design (48 pens, 12 pens/treatment, and 3 cows/pen) to evaluate the effect of dietary roughage level and oral drenching of Megasphaera elsdenii NCIMB 41125 (M. elsdenii culture; Lactipro Advance; MS Biotec Inc., Wamego, KS) on performance and carcass characteristics. Cattle were finished over a 42-day realimentation period, and aggressively stepped up over a 10-day period to either a high roughage finisher (HRF; 25% roughage) or a low roughage finisher (LRF; 10% roughage). Within diet, cattle were administered no probiotic or 100 mL of M. elsdenii culture (M. elsdenii NCIMB 41125, 2 108 cfu/mL) on day 0. No diet × probiotic interactions were detected (P ≥ 0.15), suggesting that the magnitude of the response was not influenced by the concentrate level of the diet. The main effect of diet triggered several significant responses. Decreasing roughage level tended to improve average daily gain (ADG) by 9.7% (0.26 kg, P = 0.08), while decreasing dry matter intake (DMI) by 0.9 kg (P = 0.09), provoking a 19.7% enhancement of feed efficiency (0.036 units, P < 0.01). However, interim data revealed declines of performance parameters among both diets with a significant difference between treatments only documented during the final phase of the realimentation period. During the final 14 days, LRF posted a 0.68 kg increase in ADG (P = 0.05) and a 2.0 kg decrease in DMI (P = 0.01), translating to improved feed efficiency (0.054 units, P = 0.03). This suggests that increasing the caloric density of finishing diets may help offset the regression of performance typically observed following a compensatory gain. No carcass traits were impacted by either diet or M. elsdenii culture (P ≥ 0.08). Overall, oral drenching of M. elsdenii culture tended to augment ADG (0.26 kg, P = 0.08) and carcass ADG (0.20 kg, P = 0.10). Implying that M. elsdenii culture was effective at alleviating the acidosis risk prompted by the rapid step-up period employed in the trial and may help capitalize on the narrow timeline of compensatory gain in cull cow realimentation.

Influence of ractopamine hydrochloride and days on feed on feedlot performance and red meat yield in thin cull beef cows targeted for a lean market.

Thin, beef, cull cows [n = 144; initial body weight (BW) = 465.8 ± 56.9 kg, initial body condition score (BCS) = 2.13 ± 0.68] were serially slaughtered to evaluate the relationship between ractopamine hydrochloride (RH) administration and days on feed (DOF) on feedlot performance and carcass cutout value in a lean cow market. Cows were organized into a 3 × 2 factorial arrangement of treatments (48 pens, 8 pens per treatment, 3 cows per pen) and blocked by BW nested within pregnancy status. Treatment pens were top-dressed 400 mg per cow per day of RH (Actogain 45; Zoetis, Parsippany, NJ) for the final 28 d prior to slaughter to cows spending 28, 42, or 56 DOF. Pen served as the experimental unit, for all calculations. No RH × DOF interactions were detected (P ≥ 0.11), indicating that despite a majority of compensatory gain occurring during the first 28 d of the trial, the magnitude of the RH response was not affected by DOF. Compared to controls, RH incited improvements in feedlot performance, but had a greater extent on carcass weight gain and efficiency. Specifically, RH improved average daily gain (ADG) by 13.7% (P = 0.04) and carcass ADG by 16.9% (P = 0.02) Cattle fed RH displayed a 15.5% improved gain to feed ratio (P = 0.02) and a 20% improved carcass gain to feed ratio (P = 0.05). Inclusion of RH in the finishing diet increased hot carcass weight by 4.5% (P = 0.05; 12.9 kg). However, supplementation of RH did not alter red meat yield (P ≥ 0.16), but provoked a 11.1% improvement in lean maturity (P < 0.01). Evaluation of the main effect of DOF provided insight into the compensatory state of beef cull cows on a high-concentrate diet. Serial slaughter offal weights presented confounding results. With additional DOF, a numerical increase in liver weights (P = 0.20) suggested that organ tissue replenishment occurred throughout the trial, and cattle experienced compensatory gain during the entire feeding phase. In contrast, lung and heart weights were not altered, while kidney tended to decrease linearly (P = 0.08) despite additional DOF. Furthermore, extending DOF generated a linear increase in dry matter intake (P < 0.01) yet a tendency for a decline in ADG (P = 0.10), reinforcing the premise that most of compensatory gain occurred during the first 28 d of the trial. If thin (BCS ≤ 4), healthy candidates can be finished, feeders can reap the benefits of an additive relationship between compensatory gain and RH.

The influence of Megasphaera elsdenii on rumen morphometrics of cull cows immediately stepped up to a high-energy finishing diet.

Forty-five beef cull cows [body weight (BW) = 503 ± 58 kg; body condition score (BCS) = 2.1 ± 0.6] were randomized into two treatments to compare the effects of oral drenching of no probiotic vs. 100 mL of Megasphaera elsdenii NCIMB 41125 ( M. elsdenii culture; Lactipro Advance; 2 × 108 cfu/mL; MS Biotec, Inc., Wamego, KS) on the realimentation of cull cows. The study featured a rapid 0-d step-up of concentrate-naïve cull cows to a 90% concentrate diet (1.43 Mcal/kg of NEg). The cows were finished for 35 d and were fitted with a wireless rumination tag (Allflex Flex Tag; SCR Engineers, Ltd, Netanya, Israel), which tracked head movement to record eating and chewing activity. Rumen morphometrics was recorded on the harvest floor, with each carcass assigned a rumenitis score, and a fragment of the cranial sac removed for further papillae analysis. An additional 23, thin, non-fed cull cows were harvested at the same abattoir to compare the effects of concentrate realimentation on ruminal morphometrics. Megasphaera elsdenii culture-drenched cattle registered a 13.3% increase in rumination time (39.27 min/d, P = 0.03) during the first week of the trial compared to controls. A numerical rumination advantage for M. elsdenii culture-administered cattle was observed during week 2 of trial (P = 0.17), with no differences between treatments from weeks 3 to 5 (P ≥ 0.40). Subjective rumenitis evaluations approached a tendency (P = 0.12), with non-M. elsdenii culture-drenched concentrate-fed cattle logging twice the score of their day 0 cohorts (2.52 vs. 1.17) suggesting considerable lactic insults occurred to the ruminal epithelium in the short 35-d trial. Despite the short feeding duration, concentrate realimentation prompted a significant improvement in mean papillae area (P < 0.01). Among concentrate-fed treatments, M. elsdenii culture-drenched cattle posted superior absorptive surface area (P = 0.01) and a greater ratio of papillae area of absorptive surface area (P = 0.05), suggesting that M. elsdenii culture is favorably altering the ecology of the rumen and promoting papillae growth perhaps by mitigating lactate-driven pH drops. In conclusion, M. elsdenii culture application in a 0-d step-up protocol to finishing diets can help mitigate the effects of ruminal acidosis.

Influence of Megasphaera elsdenii and feeding strategies on feedlot performance, compositional growth, and carcass parameters of early weaned, beef calves.

Simmental-Angus calves [n = 135; 72 steers and 63 heifers; body weight (BW) = 212.4 kg ± 36.1] were early weaned (~5 mo) to evaluate multiple feeding regimens (conventional vs. aggressive energy diets ± Megasphaera elsdenii NCIMB 41125 (M. elsdenii culture (MEC); Lactipro Advance; MS Biotec Inc., Wamego, KS) in order to elucidate the optimal development strategy. Objectives were measured by tracking the effects of caloric density and oral drenching of growing phase performance and subsequent carcass traits. The 72-d experiment featured three groups: 1) control (CON), fed exclusively a 35% roughage diet; 2) aggressive (AGR), fed a blend of a 10% and 35% roughage diets; 3) MEC, fed the same diet as AGR and drenched with 50 mL of M. elsdenii NCIMB 41125 on day 1. A subset of calves (n = 45) was equipped with wireless rumination tags (Allflex Flex Tag; SCR Engineers, Ltd; Netanya, Israel), which logged daily rumination and general activity. Skeletal growth variables were assessed by measuring wither and hip height pretrial and posttrial. Ultrasonography provided additional resolution concerning growing phase compositional gain, which was later verified by carcass data collection. Data were analyzed as a nested analysis of variance with BW and gender serving as blocking factors. The increased caloric density of the diets administered to MEC and AGR calves resulted in greater average daily gain and gain:feed values compared with CON even during the first 21 d of diet acclimation (P ≤ 0.05). Additional fiber concentration of CON diets led to increased rumination times in 9 of the 10 wk of trial (P ≤ 0.10). No differences amongst treatments were detected for skeletal variables or ultrasound 12th rib fat. Cattle fed CON diets posted 3.4% inferior BW at the end of the growing period trial and a 3.8% reduction in hot carcass weight (HCW), reinforcing the theory that intensifying caloric intake during the growing phase does not compromise future feedlot performance. Ultrasound marbling scores for MEC-treated cattle were 19° greater than AGR treated cattle (P ≤ 0.05) at the end of the growing phase trial. Nearly the exact same advantage (22°) was observed in the cooler 5 mo later (P = 0.42). Implying MEC metabolically imprinted cattle to favor marbling development. It appears that maximizing dietary caloric density in light-weight calves does not adversely affect the growth curve, while oral dosing of MEC during the growing period may be a precursor for enhanced quality grade.

Simulated patient contributions to enhancing exercise physiology student clinical assessment skills.

BACKGROUND: The aim of this study was to evaluate exercise physiology students' perceptions of two simulation-based learning modules focused on communication and interpersonal skills during history taking. METHODS: A prospective, repeated-measures cohort study was conducted with 15 participants. The study evaluated two simulation-based learning modules in a 1-year Graduate Diploma of Exercise Science program. Surveys were administered at four time points: prior to each module and following each module. Students rated their confidence in communication and history taking, and perception of preparedness for practice, motivation for learning, and benefits of undertaking simulation-based learning. Quantitative data were analyzed descriptively and by using repeated measures tests. Qualitative data underwent thematic analyses. RESULTS: Students reported a significant improvement in their confidence in communication (P = 0.043) and in two parameters related to history taking (P = 0.034 and 0.035) following the completion of the two modules. There was 96% agreement that the simulation-based learning better prepared students for practice as an exercise physiologist. Significant changes occurred in all aspects of motivation for learning (P ranging from < 0.001 to 0.036) except for usefulness, where there was a ceiling effect (medians of 7 on a 7-point scale). Qualitative analysis demonstrated benefit to participants around themes of experiential learning, realism, opportunity to develop clinical skills, and debriefing. Students also made suggestions with respect to the activity structure of the simulation-based learning modules. CONCLUSIONS: The results of this study indicated that simulation-based learning employing SPs increased the confidence and preparedness of exercise physiology students for conducting history taking, a requisite exercise physiology skill. Future studies should include behavioral measures of skill attainment and include follow-up evaluation to appraise the application of these skills into clinical practice.

Using simulation-based learning to provide interprofessional education in diabetes to nutrition and dietetics and exercise physiology students through telehealth.

BACKGROUND: Current workforce demands require new graduates to competently work within health care teams and often in remote settings. To better prepare students for this work, universities have spent much time developing interprofessional education (IPE) activities. The body of literature supporting IPE of allied health students is growing. Simulation-based learning with simulated patients is one platform through which IPE can be implemented in a dedicated, supported environment and potentially at scale. This study describes an interprofessional simulation-based learning experience with nutrition and dietetics and exercise physiology students. The common practice area of interacting with patients who have type 2 diabetes was targeted, and the simulation was delivered in partnership with simulated patients via a telehealth platform to allow interprofessional teams to work collaboratively in remote locations. METHODS: Ten nutrition and dietetics and 13 exercise physiology students participated in a simulation module in which students observed and collaborated in the development and delivery of an interprofessional treatment plan for patients with diabetes. Learning outcomes were measured according to the first two levels of Kirkpatrick's (1994) model for training evaluation (i.e. reaction and learning), as well as the perceived impact on behaviour. RESULTS: The students' confidence in communication, assessment, management and ability to work with another health professional significantly increased (p < 0.05) post-activity. Students perceived that the simulation-based learning would have a positive impact on their clinical skills and ability to work with other health professionals. Students reported that the most effective aspects of the simulation module were learning from and about each other, the opportunity for experiential learning and the supportive learning environment. However, the telehealth platform audio clarity and delay had negative impact on the learning experiences for students. CONCLUSION: The overall positive results demonstrate the potential of simulation-based learning activities for preparing allied health students for working in interprofessional teams. Although remote access was possible, the telehealth platform was identified as a limiting factor to this simulation-based learning experience. However, videoconferencing technology has advanced considerably since this study. Hence, there is an opportunity to employ more reliable technology for future simulations.

Successful treatment of suckling Red Angus calves for bovine respiratory disease is not associated with increased mean pulmonary arterial pressures at weaning.

The purposes of this study were to determine if the successful treatment of bovine respiratory disease (BRD) in suckling calves was associated with a long-term increase in mean pulmonary arterial pressure (mPAP) and, to screen for associations between blood leukogram variables and mPAP. A cohort of Red Angus calves (n = 74) were followed from birth to weaning at an altitude of 975 m. Calves were weaned at 172 ± 14 d when their mPAP was measured and whole blood collected. Thirty calves that had been treated for BRD (34 to 45 d prior) and 30 calves that had not required treatment for BRD were sampled. Treatment for BRD had no effect on mPAP (P = 0.37). Mean mPAP was 48 ± 8 mm Hg (± SD) with a minimum of 34 mm Hg and a maximum at 69 mm Hg. Weaning weight and sex tended to be associated with mPAP, but they explained just 5% of the variation in mPAP (P = 0.08; Adj. r2 = 0.05). Fibrinogen (P = 0.008) and absolute lymphocyte count (P = 0.06) were negatively associated with mPAP, whereas absolute monocyte count was positively associated with mPAP (P = 0.01). The findings of this study suggest that pre-weaning treatment for BRD does not increase a calves' post-weaning risk of congestive right heart failure. Further, components of the immune and acute phase response system may play a role in the development and progression of pulmonary hypertension.