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The use of vaccines in the cattle industry is widespread; however, there is limited published guidance for use by decision-makers such as farmers and vets. To best support vets in advising dairy farmers on the optimisation of vaccination strategies, it is important to understand how and why vets make decisions about recommending the vaccination of cattle. The objective of this study was to explore in-depth farm animal vets' motivators and barriers to the implementation of vaccination strategies on British dairy farms. Semistructured interviews were conducted with 15 vets. Results indicated that vets have a positive attitude towards the use of vaccination and have few barriers to advising its implementation. Vets appear to group farmers into three 'character types'. This characterisation influences the vet-farmer relationship and how the vet communicates with the farmer. Vets required evidence of disease or a risk of disease as a motivator to advise vaccination. However, this seemed to be sometimes overruled by a risk-averse attitude; resulting in vaccination being advised 'just in case'. Crucially, the need for resources to support and build on the vet-farmer relationship is highlighted as an area requiring further exploration in order to optimise vaccination strategies on farm.

Background Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery. Objective The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care delivery processes and outcomes for patients and clinicians. Methods Survey data were collected in 2017 from 298 clinicians (nurses, physicians, nurse practitioners, and physician assistants) across 29 ambulatory practices in Michigan. Clinicians provided written comments about favorable and unfavorable aspects of their work environments that affected their ability to deliver high-quality care. We conducted inductive content analysis and used the Systems Engineering Initiative for Patient Safety work system model to organize and explain our findings. Results Clinicians reported factors within all 5 work-system components of the Systems Engineering Initiative for Patient Safety model that affected care delivery and outcomes. Common themes surfaced, such as unfavorable aspects including staffing inadequacy and high patient volume, limited physical space, electronic health record usability issues, and order entry. Frequent favorable aspects focused on the skills of colleagues, collaboration, and teamwork. Some clinicians explicitly reported how work system factors were relational and influenced patient, clinician, and organizational outcomes. Conclusions These findings show how work-system components are interactive and relational reflecting the complex nature of care delivery. Implications for Nursing Practice Data obtained from frontline clinicians can support leaders in making organizational changes that are congruent with clinician observations of practices’ strengths and opportunities for improvement.

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Objective: To examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and describe the patterns and correlates of patient-reported toxicities. Data Sources: Patient survey data from 29 Michigan ambulatory oncology practices collected in 2017. Study Design: Secondary analysis of patient survey data. Descriptive statistics were generated at the patient and practice levels. Thematic analysis of open-text comments identified clusters of frequently reported toxicities. Data Collection Methods: Patients completed 11 items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Using a 5-point Likert scale, patients rated the frequency of nausea, vomiting, diarrhea, and pain; the severity of nausea, vomiting, constipation, numbness/tingling, and pain; and how much numbness/tingling and pain interfered with usual or daily activities. Patients could also report two toxicities in open-text comments. Finally, patients reported unplanned health care service for toxicity or side effect management. Principal Findings: Of 3565 eligible patients, 2245 participated (63%) and 457 (20%) rated at least one toxicity as severe/very severe. Across practices, the proportion of patients who reported at least one severe/very severe toxicity ranged from 8% to 50%. Troubling toxicities included pain frequency (mean 2.3, SD 1.3), pain severity (2.1, 1.1), and diarrhea frequency (1.9, 1.0). From completed assessments, 1653 (74%) reported at least one toxicity in open-text comments; fatigue (n = 182), stomach discomfort (n = 53), and skin/nail changes (n = 41) were most frequently reported. Regarding consequences, 156 patients (7%) reported unplanned health care service use: 41 (26%) visited an emergency department and 32 (21%) were admitted to a hospital. Conclusions: Querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, which informed quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens. | 967 Health Services Research FRIESE Et al. 1 | INTRODUC TI ON Increasingly, health services researchers are soliciting patient-reported outcomes in their studies. 1 Measuring patient-reported outcomes anchors research to patient-centered research paradigms. 2 Nimble survey research platforms and measurement advances have increased the feasibility of collecting patient-reported outcomes. In recognition of these advances, the Food and Drug Administration, among other key agencies, has outlined frameworks to consider "real-world evidence" in evaluating therapeutic benefits of drugs and devices. 3 Real-world evidence, including patient-reported outcomes, is important to consider when differences in traditional outcomes such as overall survival or disease-free progression are negligible. 4 In particular, the oncology ther...

Objective: To examine how physical layouts and space in ambulatory oncology practices influence patient safety and clinician communication. Background: Ambulatory oncology practices face unique challenges in delivering safe care. With increasing patient volumes, these settings require additional attention to support patient safety and efficient clinical work processes. Methods: This study used a mixed methods design with sequential data collection. Eight ambulatory oncology practices (of 29 participating practices) participated in both the quantitative and qualitative phases. In surveys, clinicians ( n = 56) reported on safety organizing and communication satisfaction measures. Qualitative data included observations and semistructured interviews ( n = 46) with insight into how physical layout influenced care delivery. Quantitative analysis of survey data included descriptive and correlational statistics. Qualitative analysis used inductive and thematic content analysis. Quantitative and qualitative data were integrated using side-by-side comparison tables for thematic analysis. Results: Safety organizing performance was positively correlated with clinician communication satisfaction, r(54 df) = .414, p = .002. Qualitative analyses affirmed that the physical layout affected communication around chemotherapy infusion and ultimately patient safety. After data integration, safety organizing and clinician communication were represented by two themes: visibility of patients during infusion and the proximity of clinicians in the infusion center to clinicians in the clinic where providers see patients. Conclusions: Physical layouts of ambulatory oncology practices are an important factor to promote patient safety. Our findings inform efforts to construct new and modify existing infusion centers to enhance patient safety and clinician communication.