Identifying animal welfare impacts of livestock air transport

Air transport of livestock occurs frequently from most Australian major cities. The total journey time starts with road transport from the farm or pre-export facility to the departing airport where livestock are crated, and ends with the unloading of animals at the premises or farm in the importing country. We reviewed the literature regarding airfreight and conclude that there was minimal information on current practices within this industry, particularly for procedures after arrival at the Australian airport, and during the on-board phase.

Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study

Background

Improving a patient's experience with their care through an online interface for communication (an eHealth patient portal) has been shown to be beneficial in some studies of chronic disease populations. However, little is known about the effectiveness of an eHealth portal for delivery of care to home dialysis patients.

Objectives

Primary: To determine whether an eHealth portal is effective at improving a patient's experience with their home dialysis care. Secondary: (1) To determine whether an eHealth portal improves health-related quality of life for home dialysis patients, (2) to assess patient satisfaction with an eHealth portal and perceived impact on aspects of their home dialysis therapy and health, (3) to determine the acceptability of the eHealth portal software, and (4) to determine the change in telephone usage for communication after patient adoption of an eHealth portal.

Design

Single-arm pilot trial with recruitment over a 4-month period.

Setting

The multidisciplinary home dialysis clinic in Halifax Nova Scotia Canada.

Patients

Adults (>18 years) receiving either home hemodialysis or peritoneal dialysis.

Measurements

Consumer quality index (CQI), health-related quality of life using the EuroQol Five Dimensions Questionnaire (EQ-5D), acceptability of the eHealth portal software (using the Acceptability E-scale), and satisfaction/perceived impact (using a modified questionnaire).

Methods

A web-based application (McKesson, Canada, RelayHealth®) allowed patients and health care workers to communicate through a secure, password-protected online portal that permitted visualization of the messaging history by patient and provider. Patients and the home dialysis health care team had the ability to send messages related to patient care at any time including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations, or questions about care. Patient experience with home dialysis care using the CQI, health-related quality of life using the EQ-5D, acceptability of the eHealth portal software, and satisfaction/perceived impact were assessed at baseline, 6, and 12 months of follow-up (where applicable). Total minutes of telephone communication was assessed prior to and after adoption of the portal.

Results

Of the 41 patients who consented to join the portal, 27 (66%) created an online account. At baseline, patients had a positive experience for the care and communication provided by their nephrologist (CQI: 3.63, 95% confidence interval [CI]: 3.50-3.76) and this did not change significantly over the study period. Similar results were observed for the care provided by other nephrology health care team members. Health-related quality of life using the EQ-5D score was 0.80 (interquartile range [IQR]: 0.71-0.83) at baseline and this also did not significantly change over the study period. Patients were satisfied with the eHealth portal (mean Likert scale score of 6.5 ± 0.6 in overall satisfaction, scale ranging from 1 completely dissatisfied to 10 completely satisfied), but only a minority (N = 12) completed a satisfaction questionnaire. Median monthly phone usage decreased from 12.5 to 10 minutes (P = .02) after adoption of the portal.

Limitations

The study is limited by the small sample size, high rate of patient dropout, and limited response rate.

Conclusions

In this study of home dialysis patients, we identified that an eHealth communication did not lead to significant improvements in patient experience with home dialysis care.

Trial Registration

ClinicalTrials.gov number NCT02128347.

An education initiative modifies opinions of hemodialysis nurses towards home dialysis

Background

It has been shown that in-center hemodialysis (HD) nurses prefer in-center HD for patients with certain characteristics; however it is not known if their opinions can be changed.

Objective

To determine if an education initiative modified the perceptions of in-center HD nurses towards home dialysis.

Design

Cross-sectional survey of in-center HD nurses before and after a three hour continuing nursing education (CNE) initiative. Content of the CNE initiative included a didactic review of benefits of home dialysis, common misconceptions about patient eligibility, cost comparisons of different modalities and a home dialysis patient testimonial video.

Setting

All in-center HD nurses (including those working in satellite dialysis units) affiliated with a single academic institution

Measurements

Survey themes included perceived barriers to home dialysis, preferred modality (home versus in-center HD), ideal modality distribution in the local program, awareness of home dialysis and patient education about home modalities.

Methods

Paired comparisons of responses before and after the CNE initiative.

Results

Of the 115 in-center HD nurses, 100 registered for the CNE initiative and 89 completed pre and post surveys (89% response rate). At baseline, in-center HD nurses perceived that impaired cognition, poor motor strength and poor visual acuity were barriers to peritoneal dialysis and home HD. In-center HD was preferred for availability of multidisciplinary care and medical personnel in case of catastrophic events. After the initiative, perceptions were more in favor of home dialysis for all patient characteristics, and most patient/system factors. Home dialysis was perceived to be underutilized both at baseline and after the initiative. Finally, in-center HD nurses were more aware of home dialysis, felt better informed about its benefits and were more comfortable teaching in-center HD patients about home modalities after the CNE session.

Limitations

Single-center study

Conclusions

CNE initiatives can modify the opinions of in-center HD nurses towards home modalities and should complement the multitude of strategies aimed at promoting home dialysis.

Electronic supplementary material

The online version of this article (doi:10.1186/s40697-015-0051-z) contains supplementary material, which is available to authorized users.

Qualitative behavioral assessment of transport-naive and transport-habituated sheep

Objective and issue-neutral qualitative assessments of livestock behavior could provide a powerful assessment of welfare, augmenting quantitative measures such as autonomic and endocrine changes, which are often difficult to assess under many commercial livestock conditions. We set out to validate the use of qualitative behavioral assessment (QBA) in sheep using controlled experimental conditions (transport as a challenge) and comparing assessments against physiological variables. The behavioral expression of 14 Merino wethers, which had never experienced land transport, were assessed during their first road event (naïve to transport), and then again on their seventh event, 8 d later (habituated to transport). Blood samples were collected immediately before loading and after unloading, and heart rate and core body temperature were measured continuously throughout each event. Continuous video footage recorded during each event was used to provide clips of individual animals that were shown to observers for QBA. There was significant consensus (P < 0.001) amongst 63 observers in terms of their assessment of the behavioral expression of the sheep. Transport-naïve sheep were assessed as being more 'alert', 'anxious', and 'aware', whereas transport-habituated sheep were more 'comfortable', 'tired', and 'confident' (P = 0.015). Heart rate and heart rate variability, core body temperature and a stress leukogram were greater (P < 0.05) in sheep during the first (naïve) event compared with the habituated event, and were significantly correlated with the QBA scores (P < 0.05). In conclusion, QBA is a valid, practical and informative measure of behavioral responses to transport.

Health-seeking behavior as an outcome of a homeless population

Health care is an ever-present concern for homeless individuals. Health-Seeking Behaviors within this population are examined from a nursing perspective. Complex Relationship Building, considered essential in addressing Health-seeking Behaviors for the homeless, is examined in regard to access, trust, and follow-up. It is believed that access and follow-up are related to convenience of site and the matter of trust. A pilot study of how to measure the concept of trust was conducted. Factor analysis for the Gibson Trust Instrument shows two factors: (1) interpersonal attributes and (2) behavior attributes. The Gibson Trust Instrument can be used to measure trust, which is crucial for Complex Relationship Building.