Effectiveness of a supervisor training on quality of feedback to internal medicine residents: a controlled longitudinal multicentre study.

OBJECTIVES: High-quality feedback on different dimensions of competence is important for resident learning. Supervisors may need additional training and information to fulfil this demanding task. This study aimed to evaluate whether a short and simple training improves the quality of feedback residents receive from their clinical supervisors in daily practice. DESIGN: Longitudinal quasi-experimental controlled study with a pretest/post-test design. We collected multiple premeasurements and postmeasurements for each supervisor over 2 years. A repeated measurements ANOVA was performed on the data. SETTING: Internal medicine departments of seven Dutch teaching hospitals. PARTICIPANTS: Internal medicine supervisors (n=181) and residents (n=192). INTERVENTION: Half of the supervisors attended a short 2.5-hour training session during which they could practise giving feedback in a simulated setting using video fragments. Highly experienced internal medicine educators guided the group discussions about the feedback. The other half of the supervisors formed the control group and received no feedback training. OUTCOME MEASURES: Residents rated the quality of supervisors' oral feedback with a previously validated questionnaire. Furthermore, the completeness of the supervisors' written feedback on evaluation forms was analysed. RESULTS: The data showed a significant increase in the quality of feedback after the training F (1, 87)=6.76, p=0.04. This effect remained significant up to 6 months after the training session. CONCLUSIONS: A short training session in which supervisors practise giving feedback in a simulated setting increases the quality of their feedback. This is a promising outcome since it is a feasible approach to faculty development.

Genome-wide association and genomic prediction for a reproductive index summarizing fertility outcomes in U.S. Holsteins.

Subfertility represents one major challenge to enhancing dairy production and efficiency. Herein, we use a reproductive index (RI) expressing the predicted probability of pregnancy following artificial insemination (AI) with Illumina 778K genotypes to perform single and multi-locus genome-wide association analyses (GWAA) on 2,448 geographically diverse U.S. Holstein cows and produce genomic heritability estimates. Moreover, we use genomic best linear unbiased prediction (GBLUP) to investigate the potential utility of the RI by performing genomic predictions with cross validation. Notably, genomic heritability estimates for the U.S. Holstein RI were moderate (h2 = 0.1654 ± 0.0317-0.2550 ± 0.0348), while single and multi-locus GWAA revealed overlapping quantitative trait loci (QTL) on BTA6 and BTA29, including the known QTL for the daughter pregnancy rate (DPR) and cow conception rate (CCR). Multi-locus GWAA revealed seven additional QTL, including one on BTA7 (60 Mb) which is adjacent to a known heifer conception rate (HCR) QTL (59 Mb). Positional candidate genes for the detected QTL included male and female fertility loci (i.e. spermatogenesis and oogenesis), meiotic and mitotic regulators, and genes associated with immune response, milk yield, enhanced pregnancy rates, and the reproductive longevity pathway. Based on the proportion of the phenotypic variance explained (PVE), all detected QTL (n = 13; P ≤ 5e - 05) were estimated to have moderate (1.0% < PVE ≤ 2.0%) or small effects (PVE ≤ 1.0%) on the predicted probability of pregnancy. Genomic prediction using GBLUP with cross validation (k = 3) produced mean predictive abilities (0.1692-0.2301) and mean genomic prediction accuracies (0.4119-0.4557) that were similar to bovine health and production traits previously investigated.

Impact evaluation of a farm safety awareness workshop in New Zealand.

OBJECTIVE: Farming is a hazardous occupation, with high rates of injury and death. FarmSafe, a whole-country approach, sought to address work-related injury on New Zealand sheep, beef, and dairy farms. More than 10 000 farmers participated in 630 workshops held over two years. This short communication presents the results of an impact evaluation of the FarmSafe Awareness Workshop (FSAW) in its first two years of operation. METHODS: All FSAW participants completed, and received credit for, formal educational assessments. Pass rates were used to assess safety knowledge, and a quasi-experimental design with intervention and comparison groups was applied to assess attitudes, safety behaviors, and environmental determinants of injury. RESULTS: An intervention (N=111) and two comparison groups (C1, N=409, and C2, N=78) completed before and after questionnaires. At follow-up, the intervention group (IG) showed a small improvement in attitudes toward safety (IG=79.3, C1=77.4; C2=77.4, P=0.035), but there were no differences between groups for personal safety practice or the safety environment of the farm. However, if a respondent registered their interest in the workshop, but a different person from the same farm attended, there was some improvement in the safety of the farm environment score. CONCLUSION: Well-conducted safety training tailored to farmers was still not enough to change safety practice. Future interventions may be more likely to achieve progress if they are comprehensive, include environmental and enforcement features, and target more than one participant per farm.

Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial.

BACKGROUND: Strong evidence exists for the efficacy of screening and brief intervention for reducing hazardous drinking. However, problems have been highlighted with respect to its implementation in health-care systems, not least of which is a reluctance of some doctors to discuss alcohol proactively with their patients. AIMS: To determine the efficacy of a novel web-based screening and brief intervention (e-SBI) to reduce hazardous drinking. DESIGN: A double-blind randomized controlled trial. SETTING: A university student health service. PARTICIPANTS: A total of 167 students (17-26 years) were recruited in the reception area and completed a 3-minute web-based screen including the Alcohol Use Disorder Identification Test (AUDIT) questionnaire. Of these, 112 tested positive, and 104 (52 females) who consented to follow-up were included in the trial. MEASUREMENTS: Drinking frequency, typical occasion quantity, total volume, heavy episode frequency (females > 80 g ethanol, males > 120 g ethanol), number of personal problems, an academic problems score. INTERVENTION: Participants were randomized to 10-15 minutes of web-based assessment and personalized feedback on their drinking (intervention, n = 51) or to a leaflet-only control group (n = 53). FINDINGS: Mean baseline AUDIT scores for control and intervention groups were 16.6 (SD = 6.0) and 16.6 (SD = 5.7). At 6 weeks, participants receiving e-SBI reported significantly lower total consumption (geometric mean ratio = 0.74; 95% confidence interval: 0.56-0.96), lower heavy episode frequency (0.63; 0.42-0.92) and fewer personal problems (0.70; 0.54-0.91). At 6 months personal problems remained lower (0.76; 0.60-0.97), although consumption did not differ significantly. At 6 months, academic problems were lower in the intervention group relative to controls (0.72; 0.51-1.02). CONCLUSIONS: e-SBI reduced hazardous drinking among university students, to an extent similar to that found for practitioner-delivered brief interventions in the general population. e-SBI offers promise as a strategy to reduce alcohol-related harm in a way that is non-intrusive, appealing to the target group, and capable of being incorporated into primary care. Research is required to replicate the findings, to determine the duration of intervention effects, and to investigate the mechanisms by which the intervention operates.

[Dermonecrosis along the course of the caudal branch of the lateral saphenous vein in foals due to a Staphylococcus aureus infection]. / Dermonekrose im Verlauf des Ramus caudalis der Vena saphena lateralis beim Fohlen infolge einer Staphylococcus-aureus-Infektion.

Necrosis of the skin on both lateral aspects of the hind limbs following the caudal branch of the lateral saphenous vein in 22 suckling foals is described. The first clinical signs were observed on days 2-5 post natum. S. aureus was isolated from the wounds. Decubitus in the region of the malleolus lateralis tibiae was considered the starting point of an ascending infection. This type of dermonecrosis was only observed in boxes with hard floors where the straw bedding was pushed aside by the lying foals regularly, never, however, in boxes with deep and permanent sawdust or straw bedding. Therapeutic and preventive measures are discussed.

[Arachidonic acid in the liver, ovary and uterus of cows with various reproductive capability]. / Obsah kyseliny arachidonové v játrech, ovariích a deloze krav s ruznou úrovní reprodukce.

Research was carried out at two localities ecologically different, i.e. in the "relatively" clean region of Klatovy, designed according to the standards of the Czech Ministry of Environment as a region with above-average quality environment and in the considerably affected region of Prague-East, designed as a region with below-average quality environment. The first group included 33 cows from herds with good fertility (average conception rate after 1st insemination 61.5 and service period 88 days) and the dairy cows were eliminated for reasons different as reproductive disorders (Klatovy), in the second group all 18 cows were eliminated because of reproductive disorders (Prague-East) and they were from the herds with much lower fertility (average conception rate after 1st insemination 46.9% and service period 107 days). Samples of liver, uterus and ovarian tissues of the cows were processed according to the method after Jarý et al. (1987), analysed on the gas chromatograph Varian--Aerogramm 2100. The data obtained were processed on a computer IBM PC--AT with a numeric co-processor, and the programme Quatro Pro, version 2.0 was used. Differences in average amounts measured in both regions are objectively characterized in Figs. 1, 2 (with marked scatterings) and correspond to the amount given in Tab. I. As regards the saturated acid, stearic acid and oleic acid, no remarkable differences were found according to the localities (Klatovy and Prague), with the exception of the average contents of those acids in uterine horns. In that case the region of Klatovy is dominating.(ABSTRACT TRUNCATED AT 250 WORDS)

[Therapeutic use of synthetic Gn-RH-Dirigestran in disorders of the reproductive cycle in cows from low-fertility herds]. / Terapeutické pouzití syntetického Gn-RH-Dirigestranu pri poruchách reprodukcního cyklu krav v chovech s nízkou plodností.

Synthetic Gn-RH-Dirigestran Spofa was used for the treatment of 121 cows with functional ovarial disorders. Out of this total number, 41 cows showed no postpartal and no post-service symptoms of oestrus, 59 returned to oestrus with irregular cycles, and 21 cows showed an irregular course of oestrus. The treatment was made in herds with a low conception rate (32-37% conceptions after the first insemination, service period 108 to 142 days). On the whole, 80.1% of the treated cows got in calf, 53.7% conceived after the first insemination. The average time from treatment to successful insemination was 39 days. The treatment was started 148 days from parturition, on an average. The average insemination index of the treated cows was 1.44. As to cows out of heat, 70.7% got in calf on the whole and 51.2% after the first insemination, the therapeutic service period (TSP) being 44 days. Out of the cows returning to oestrus with an irregular cycle, 84.7% got in calf and 52.5% got in calf after the first insemination with the TSP of 37 days, and the cows with irregular cycle the conception was recorded in 85.7% (61.9% after the first insemination with the average TSP of 35 days). On the whole, 82% of treated cows showed clearly visible symptoms of oestrus after the application of Dirigestran. The pregnancy of the whole set (121 treated cows) was higher by 15 to 21% after the first insemination and by 41 to 49% after all inseminations, as compared with the pregnancy of normally inseminated cows in these herds. The results show that the treatment of the functional disorders of ovaries is also practicable in cows in herds with a decreased fertility if this treatment is not impaired by spermiotoxicity or embryotoxicity owing to the effects of inadequate secretions of sexual organs caused by incorrect nutrition or infections.

[Changes in sperm ultrastructure of bulls with decreased sperm activity and freezability]. / Zmeny v ultrastruktue spermií býku se snízenou aktivitou a mrazitelností spermatu.

A decrease of sperm freezability occurred at the K. breeding station, and this situation lasted longer than a year. Out of the 2550 ejaculates taken from 42 breeding bulls within 12 months, 685, i.e. 26.7%, were unfit for use immediately after sperm collection, mostly owing to a low activity of spermatozoa and pathological forms of their motility, and another 469 ejaculates, i. e. 18.3%, were unfit for use after sperm freezing; on the whole, 1154 (i. e. 45.2%) ejaculates had to be excluded. It was revealed by the vital-lethal primuline test that the spermatozoa died quickly after collection. The findings obtained during an electron-microscopic examination of the spermatozoa at the beginning of the process included visible changes in the ultrastructure of the flagellum, particularly its middle piece (deformed shape, incomplete set of axial filaments, vacuolization of the flagellum, abnormal arrangement of the mitochondrial spiral), numerous abnormities of the external cytoplasmic membrane and invagination, vacuolization, and abnormal density of nucleoplasm. The primary changes on the flagella and in the nucleus give evidence that the testicular tissues were altered. The etiological factors behind these processes are believed to include a reduction in the resistance of bulls due to long-lasting consumption of feeds contaminated with the fungus Aspergillus fumigatus, insufficient movement and bad zoo-hygienic practices, all this combined with the secondary action of the infectious germs of Mycoplasma bovigenitalium, which were revealed by cultivation tests in 50% of the ejaculates of the bulls; a positive antibody titre was demonstrated in all bulls.