Use of an online gaming tool, the Veterinary DialogueTrainer, for teaching clinical communication skills to bovine veterinary practitioners.

Effective clinical communication is essential for bovine veterinary practitioners to establish and maintain positive client relationships. When applied properly in herd health consultancy, it increases client satisfaction and adherence to veterinary advice, and improves patient health and welfare. Although communication skills are often taught by providing feedback on simulated conversations, this has limitations, including time constraints, subjective assessments, and cost. The Veterinary DialogueTrainer (VDT) is an online serious game platform using 'digital role-play' with avatars, recently developed to enhance and assess learning outcomes, improve use of learned skills, and increase cost-effectiveness of communication training. The objective was to evaluate its suitability and applicability. Finnish (n = 24) and Swedish (n = 21) bovine veterinarians participated in communication training using VDT for training and assessment. Participants completed the provided scenario at least twice. After playing a bovine health communication simulation, participants received their scores and feedback on selected conversation options. VDT scores measured multiple aspects of communication on a 0-100% scale, based on motivational interviewing methodology and Calgary-Cambridge guidelines. Mean (±SD) number of attempts participants played the scenario was 4.1 (±2.6, Finland) and 3.9 (±1.3, Sweden), with highest total score reached after a mean of 3.5 (±2.1, Finland) and 3.1 (±1.1, Sweden) attempts. On the first attempt, 39 participants (87%) scored <50% of the highest possible score, whereas most (n = 34, 76%) achieved a higher score on the second attempt. Mean total score increased from 15 (±14) to 77% (±33) for Finish participants and from 40 (±22.0) to 87% (±19.4) for Swedish participants. The majority (n = 33, 73%) of participants reached a score >80% after 4.0 (±1.6, Finland) or 2.8 (±1.0, Sweden) attempts. Net Promoter Score of the training was +89 (Finland), +88 (Finland) and + 83 (Sweden) on a scale from -100 to +100, indicating that most participants were very likely to recommend the training to other veterinarians. Use of VDT increased communication skills scores but whether it will improve communication skills in practice requires further study. We concluded there is a likely benefit of using the VDT in teaching and monitoring veterinary communication competencies and preparing for offline role-plays and real-life conversations in veterinary practice.

Incidence and risk factors for acute kidney injury in head and neck cancer patients treated with concurrent chemoradiation with high-dose cisplatin.

BACKGROUND: Three-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Concurrent chemoradiation (CRT) with high-dose cisplatin is associated with significant acute and late toxicities, including acute kidney injury (AKI). The aims of this study were to investigate the incidence of AKI in patients with LA-SCCHN during and after treatment with high-dose cisplatin-based CRT, to identify risk factors for cisplatin-induced AKI, and to describe the impact of AKI on long-term renal function and treatment outcomes. METHODS: This is a retrospective cohort study with measurements of renal function before CRT, weekly during CRT, every 1 or 2 days during hospitalizations, and 3 and 12 months after CRT in patients with LA-SCCHN. AKI was defined as increase in serum creatinine (sCr) of ≥1.5 times baseline or by ≥0.3 mg/dL (≥26.5 µmol/L) using the Kidney Disease Improving Global Outcomes (KDIGO) classification. Logistic regression models were estimated to analyze renal function over time and to identify predictors for AKI. RESULTS: One hundred twenty-four patients completed all measurements. AKI was reported in 85 patients (69%) with 112 episodes of AKI. Sixty of 85 patients experienced 1 AKI episode; 20 patients experienced ≥2 AKI episodes. Ninety-three (83%) AKI episodes were stage 1, 13 (12%) were stage 2, and 6 (5%) AKI episodes were stage 3. Median follow-up time was 29 months (Interquartile Range, IQR 22-33). Hypertension (Odds Ratio, OR 2.7, 95% Confidence Interval, CI 1.1-6.6; p = 0.03), and chemotherapy-induced nausea and vomiting (CINV; OR 4.3, 95% CI 1.6-11.3; p = 0.003) were associated with AKI. In patients with AKI, renal function was significantly more impaired at 3 and 12 months post-treatment compared to patients without AKI. AKI did not have a negative impact on treatment outcomes. CONCLUSION: AKI occurred in 69% of patients with LA-SCCHN undergoing CRT with high-dose cisplatin. Long-term renal function was significantly more impaired in patients with AKI. Hypertension and CINV are significant risk factors. Optimizing prevention strategies for CINV are urgently needed.

Evaluation of several methodological challenges in circulating miRNA qPCR studies in patients with head and neck cancer.

Circulating microRNAs (ci-miRNAs) in blood have emerged as promising diagnostic, prognostic and predictive biomarkers in cancer. Many clinical studies currently incorporate studies that assess ci-miRNAs. Validation of the clinical significance of candidate biomarker miRNAs has proven to be difficult, potentially resulting from vast discrepancies in the detection methodology as well as biological variability. In the current study, the influence of several methodological factors on ci-miRNA detection was evaluated as well as short-term biological variability in patients with head and neck cancer. RNA was isolated from 124 serum and plasma samples originating from patients with head and neck cancer and healthy volunteers. The miRNA levels were measured using RT-qPCR and the influence of pre-analytical factors, different normalization strategies and temporal reproducibility was assessed. RNA carriers improved ci-miRNA detection in serum and plasma specimens. A prolonged pre-processing time correlated with an increased hemolytic index in serum samples only. Hemolysis differentially affected the detection of individual miRNAs. Optimal normalization was achieved using the averaged detection values of spike-in cel-miR-39-3p and endogenous miR-16-5p. Comparing biological replicates from patients with head and neck cancer, the intra-individual miRNA levels were relatively stable (average interval 7 days). Differences in the ci-miRNA detection methodology and limitations of currently used technologies can greatly affect the results and may explain inconsistent outcomes between studies. Prior to the implementation of ci-miRNAs as useful clinical biomarkers, further advances in the standardization of the detection methodology and reduction of technical variability are needed.

Invited review: Determinants of farmers' adoption of management-based strategies for infectious disease prevention and control.

The prevention and control of endemic pathogens within and between farms often depends on the adoption of best management practices. However, farmers regularly do not adopt recommended measures or do not enroll in voluntary disease control programs. This indicates that a more comprehensive understanding of the influences and extension tools that affect farmers' management decisions is necessary. Based on a review of relevant published literature, we developed recommendations to support policy-makers, industry representatives, researchers, veterinarians, and other stakeholders when motivating farmers to adopt best management practices, and to facilitate the development and implementation of voluntary prevention and control programs for livestock diseases. Farmers will make management decisions based on their unique circumstances, agricultural contexts, beliefs, and goals. Providing them with rational but universal arguments might not always be sufficient to motivate on-farm change. Implementation of recommended management practices is more likely if farmers acknowledge the existence of a problem and their responsibility to take action. The perceived feasibility and effectiveness of the recommended management strategy and sufficient technical knowledge further increase the likelihood of adequate adoption. Farmers will also weigh the expected advantages of a proposed change against the expected disadvantages, and these considerations often include internal drivers such as pride or the desire to conform with perceived standards. Extension tools and farmers' social referents (e.g., veterinarians, peers) not only provide technical information but also influence these standards. Whereas mass media have the potential to deliver information to a broad audience, more personal approaches such as participatory group learning or individual communication with farm advisors can enable the tailoring of recommendations to farmers' situations. Approaches that appeal to farmers' internal motivators or that unconsciously elicit the desired behavior will increase the success of the intervention. Collaboration among stakeholders, assisted by social scientists and communication specialists, is necessary to provide a context that facilitates on-farm change and transfers consistent messages across extension tools in the most effective way.

The role of communication in improving udder health.

Our findings provide insight into Dutch dairy farmers' behavior and mindset toward mastitis management, and into the way these can be affected by communication strategies. They may differ from those of North American dairy farmers, but probably many findings are comparable. Elements of farmer mindset are important determining factors in mastitis control, including the perceived threat (ie, "Do I have a problem?") and the perceived efficacy of mastitis management measures (ie, "Can I solve the problem easily?"). These issues need to be addressed in communication strategies. Veterinarians can be important intermediaries in communication about udder health, provided that they are aware of their role as proactive advisor and apply the accompanying communication skills. To be effective, a mastitis control program should do more than distributing technical information about best management practices to dairy farmers. Prevention of complex diseases such as mastitis requires customized communication strategies as well as an integrated approach between various stakeholders and different scientific disciplines. Because farmers are part of, and are influenced by a wide institutional context, such programs need to be supported by a combination of several policy measures to change farm management in the long run.