Effect of Ewe Breed on Fall Lambing Performance

Seasonality of lamb production continues to plague the industry and feeds the large price swings found in the market place. This translates into a fluctuating economic picture for lamb producer, feeder, packer, and consumer. This wide price fluctuation makes accurate financial projections difficult if not impossible. Fall lambing offers a means of spreading the available supply of fresh American lamb over more months, thus reducing the common practice of holding lambs back or over finishing lambs

The Effect of Exposure to Teaser Rams on Lambing Performance of Hampshire and Columbia Ewes

The common recommendation that use of teaser rams will stimulate earlier estrous activity and increased lambing rates is based on limited data for specific locations. This study was undertaken to measure the responses following exposure to teaser rams in purebred Hampshire and Columbia ewes in South Dakota normally bred during September

Management Systems for Finishing Range Lambs

Increased pressure for native range pasture has prompted investigation of alternative management systems for finishing range lambs. Early weaning coupled with alternative finishing systems offers several advantages to the range sheep operator. Increased base ewe flock numbers and/or less grazing pressure, better range management, less carcass damage from needles, better feed efficiency of the younger lamb in the drylot and lower predator losses are some advantages that can be listed for early weaning. A study was initiated in 1971 at the Antelope Range Field Station to study alternative management systems for range lamb production

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Background Group clinics are a form of delivering specialist-led care in groups rather than in individual consultations. Objective To examine the evidence for the use of group clinics for patients with chronic health conditions. Design A systematic review of evidence from randomised controlled trials (RCTs) supplemented by qualitative studies, cost studies and UK initiatives. Data sources We searched MEDLINE, EMBASE, The Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature from 1999 to 2014. Systematic reviews and RCTs were eligible for inclusion. Additional searches were performed to identify qualitative studies, studies reporting costs and evidence specific to UK settings. Review methods Data were extracted for all included systematic reviews, RCTs and qualitative studies using a standardised form. Quality assessment was performed for systematic reviews, RCTs and qualitative studies. UK studies were included regardless of the quality or level of reporting. Tabulation of the extracted data informed a narrative synthesis. We did not attempt to synthesise quantitative data through formal meta-analysis. However, given the predominance of studies of group clinics for diabetes, using common biomedical outcomes, this subset was subject to quantitative analysis. Results Thirteen systematic reviews and 22 RCT studies met the inclusion criteria. These were supplemented by 12 qualitative papers (10 studies), four surveys and eight papers examining costs. Thirteen papers reported on 12 UK initiatives. With 82 papers covering 69 different studies, this constituted the most comprehensive coverage of the evidence base to date. Disease-specific outcomes – the large majority of RCTs examined group clinic approaches to diabetes. Other conditions included hypertension/heart failure and neuromuscular conditions. The most commonly measured outcomes for diabetes were glycated haemoglobin A1c (HbA1c), blood pressure and cholesterol. Group clinic approaches improved HbA1c and improved systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. Recent RCTs largely confirm previous findings. Health services outcomes – the evidence on costs and feasibility was equivocal. No rigorous evaluation of group clinics has been conducted in a UK setting. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients. The views and attitudes of those who dislike group clinic provision are poorly represented. Little attention has been directed at the needs of people from ethnic minorities. The review team identified significant weaknesses in the included research. Potential selection bias limits the generalisability of the results. Many patients who could potentially be included do not consent to the group approach. Attendance is often interpreted liberally. Limitations This telescoped review, conducted within half the time period of a conventional systematic review, sought breadth in covering feasibility, appropriateness and meaningfulness in addition to effectiveness and cost-effectiveness and utilised several rapid-review methods. It focused on the contribution of recently published evidence from RCTs to the existing evidence base. It did not reanalyse trials covered in previous reviews. Following rapid review methods, we did not perform independent double data extraction and quality assessment. Conclusions Although there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. Much of the evidence was derived from the USA. It is important to engage with UK stakeholders to identify NHS considerations relating to the implementation of group clinic approaches. Future work The review team identified three research priorities: (1) more UK-centred evaluations using rigorous research designs and economic models with robust components; (2) clearer delineation of individual components within different models of group clinic delivery; and (3) clarification of the circumstances under which group clinics present an appropriate alternative to an individual consultation

Interpreting and using meta-analysis in clinical practice

Systematic reviews, which can include a meta-analysis, are considered the gold standard for determination of best practice. Meta-analysis combines the results from many primary studies to identify patterns among the individual study results and then assesses the overall effectiveness of a specific healthcare intervention. The purpose of this article was to describe the process of performing a meta-analysis, discuss advantages and disadvantages of meta-analyses, and interpret the results of a meta-analysis from current research relevant to orthopaedic nursing practice.Cheryl Holly, Jason T. Slye

Caregiver decisions along the Alzheimer's disease trajectory

Paper Session A4: Care-Giving and Care PlanningJason Slyer, Marie Truglio-Londriga

The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review

Background Heart failure is a major health burden worldwide. Patient education is the primary process used to increase knowledge of self-care practices for patient with heart failure. Most education occurs during one-to-one visits between a patient and a health care provider. Group visits with a health care provider and a small group of patients provide an alternative method for providing patient education. The goal of group visits for patients with heart failure would be to increase patient knowledge and self-care abilities, while improving self-efficacy. Objective The objective of this review is to identify the effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care behaviors, and hospital readmissions. Inclusion Criteria Types of participants Community living adult patients, years and above, of all races and ethnicities with a diagnosis of heart failure. Types of outcomes Patient knowledge about heart failure, quality of life, self-care behaviors, unplanned readmissions, and emergency room visits for a HF exacerbation. Types of studies Randomized controlled trials, non-randomized controlled trials, and quasi-experimental trials were considered for inclusion. In their absence other qualitative studied designs were considered. Search Strategy Published and unpublished studies in the English language were sought from the inception of the included databases through September, . The databases searched included, PubMed, CINAHL. Embase, Health Source, Nursing, Academic edition. A search for grey literature and hand searching of reference lists were also performed. Methodological Quality Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data Collection Data were extracted using standardized data extraction instruments from the Joanna Briggs Institute. Data Synthesis Due to heterogeneity between included studies, statistical pooling was not possible. Results are presented in a narrative form. Results Three papers describing two pilot studies were included n this review. One study demonstrated an improvement in heart failure knowledge and a trend toward improvement in self-care behaviors. The other study showed improvements in self-care behaviors and depression while reducing the number of hospitalizations. Conclusions The group visit model has the potential for improving knowledge and self-care behaviors, while increasing quality of life and decreasing hospitalizations for patients with heart failure.Jason T. Slyer, Lucille R. Ferrar

Caregiver decisions along the Alzheimer's disease trajectory

Available online 29 November 2018Despite the rising prevalence of Alzheimer's disease (AD), there is limited systematic evidence about disease specific decisions. The aim of this qualitative descriptive study was to identify decisions across the AD trajectory using focus groups of past and present caregivers. Qualitative content analysis revealed three main categories with corresponding categories and sub-categories. Main Category One-Decisions pertaining to self-yielded two categories: decision pertaining to the offering of self and care for the caregiver. Main Category Two-Decisions pertaining to the patient-yielded three categories: decisions about care and treatment, living arrangements, and protecting the patient from harm. Main Category Three-Communication and relationships in decisions-yielded two categories: navigation and negotiations. The results of this study will inform healthcare providers and caregivers as they work together to anticipate, prepare, and plan for care management decisions over the AD trajectory.Marie Truglio-Londrigan, Jason T. Slye

The effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions: a systematic review

Background: Patient-centered self-care education is an educational approach that employs meaningful, targeted education tailored to an individual patient's needs, preferences, and values. Patient-centered educational approaches may empower patients with heart failure to be successful in self-care management and improve outcomes. Objective: To evaluate the effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions. Inclusion criteria: Types of participants: Adult patients, 18 years and older, with a diagnosis of heart failure. Types of interventions: All types of patient-centered, self-care education interventions for adult patients with heart failure provided by any health care provider. Types of outcomes: Heart failure knowledge, heart failure self-care behaviors, heart failure-related quality of life, heart failure admissions or readmissions within one-year post intervention. Types of studies: Randomized controlled trials. Search strategy: The search strategy aimed to find relevant published and unpublished studies in the English language between January 1990 and July 2013. Several electronic databases were searched: CINAHL, Pubmed, PsychINFO, EMBASE, CENTRAL, ERIC, Scopus, and DynaMed. A search for gray literature was also performed. Methodologic al quality: Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection: Data were extracted using a standardized data extraction instrument from the Joanna Briggs Institute. Data synthesis: Due to clinical heterogeneity between included studies, statistical meta-analysis was not possible. Results are presented in a narrative form. Results: A total of seven articles describing five randomized controlled trials and one pseudo-randomized trial were included. Four studies demonstrated reduced readmissions with only one reaching statistical significance at six months follow-up (11.4% intervention, 44.2% control, P=0.01). Five studies demonstrated an improvement in quality of life with only one reaching statistical significance between baseline and 12 months follow-up (P=0.002). One study measured knowledge and demonstrated a statistically significant improvement at the 12 months follow-up (P=0.05). One study measured self-care and demonstrated a statistical significant improvement among the intervention group at one month (P < 0.001) and three months (P=0.005) compared with the control. These statistical significant findings indicate the positive effects of the intervention by demonstrating an improvement in outcomes as measured by patients experiencing a more productive quality of life, an increase in heart failure-related knowledge, improved self-care behaviors, and decreased readmission rates post intervention. Conclusions: Patient-centered self-care education for adult patients with heart failure may have a positive benefit in reducing heart failure readmissions and improving heart failure-related knowledge, self-care behaviors, and quality of life. Factors that may influence outcomes include a multidisciplinary team approach and reinforcement of individualized advice with emphasis during care transitions.Yves E. Casimir, Marvelin M. Williams, Mei Y. Liang, Supawadee Pitakmongkolkul, Jason T. Slye