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Under temperate climates, cattle are often at pasture in summer and are not necessarily provided with shade. We aimed at evaluating in a temperate region (Belgium) to what extent cattle may suffer from heat stress (measured through body temperature, respiration rate and panting score, cortisol or its metabolites in milk, and feces on hot days) and at assessing the potential benefits of shade. During the summer of 2012, 20 cows were kept on pasture without access to shade. During the summer of 2011, ten cows had access to shade (young trees with shade cloth hung between them), whereas ten cows had no access. Climatic conditions were quantified by the Heat Load Index (HLI). In animals without access to shade respiration rates, panting scores, rectal temperatures, and milk cortisol concentrations increased as HLI increased in both 2011 and 2012. Fecal cortisol metabolites varied with HLI in 2011 only. When cattle had access to shade, their use of shade increased as the HLI increased. This effect was more pronounced during the last part of the summer, possibly due to better acquaintance with the shade construction. In this case, shade use increased to 65% at the highest HLI (79). Shade tempered the effects on respiration, rectal temperature, and fecal cortisol metabolites. Milk cortisol was not influenced by HLI for cows using shade for > 10% of the day. Therefore, even in temperate areas, cattle may suffer from heat when they are at pasture in summer and providing shade can reduce such stress.

Using behavioural indicators of thermal discomfort, that is, shade seeking, panting scores (PS) and respiration rate (RR), we evaluated the effect of hot summer conditions and shade, for a herd of adult Holstein dairy cows and a herd of Belgian Blue beef cows kept on pasture in a temperate area (Belgium). During the summer of 2012, both herds were kept on pasture without access to shade (NS). During the summers of 2011 and 2013 each herd was divided into one group with (S) and one without (NS) access to shade. Shade was provided by young trees with shade cloth (80% reduction in solar radiation) hung between them. For S cows, we investigated how shade use was related to hot conditions as quantified by six climatic indices. The heat load index (HLI), which incorporates air temperature and humidity, solar radiation and wind speed, was the best predictor of the six indices tested. In 2011, there was a relatively high threshold for use of shade. When HLI = 90, shade use probability reached 17% for dairy cows and 27% for beef cows. In 2013, however, at HLI = 90, shade use probability reached 48% for dairy cows and 41% for beef cows. For animals from the NS treatment we determined the effect of hot summer conditions on RR and PS (with 0 = no panting and 4.5 = extreme panting). In both types of cattle, an increase in black globe temperature was the best predictor for increasing RR and PS. Furthermore, we determined how the effect of hot summer conditions on RR and PS was affected by the use of shade. Under hot conditions (black globe temperature ⩾ 30°C), >50% of the animals under shade retained normal PS and RR (PS < 1 and RR < 90 breaths per minute), whereas normal RR and PS were significantly less prevalent for animals outside shade. Our findings suggest that, even in temperate summers, heat can induce thermal discomfort in cattle, as evidenced by increases in shade use, RR and PS, and that shade increases thermal comfort.

Background Clinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm. They are however associated with a high burden of false positive alerts and alert fatigue. The aim of this study was to evaluate a drug–drug interaction (DDI) clinical decision support system in terms of its performance, uptake and user satisfaction and to identify barriers and opportunities for improvement. Methods A quantitative evaluation and end-user survey were performed in a large teaching hospital. First, very severe DDI alerts generated between 2019 and 2021 were evaluated retrospectively. Data collection comprised alert burden, override rates, the number of alert overrides reviewed by pharmacists and the resulting pharmacist recommendations as well as their acceptance rate. Second, an e-survey was carried out among prescribers to assess satisfaction, usefulness and relevance of DDI alerts as well as reasons for overriding. Results A total of 38,409 very severe DDI alerts were generated, of which 88.2% were overridden by the prescriber. In 3.2% of reviewed overrides, a recommendation by the pharmacist was provided, of which 79.2% was accepted. False positive alerts were caused by a too broad screening interval and lack of incorporation of patient-specific characteristics, such as QTc values. Co-prescribing of a non-vitamin K oral anticoagulant and a low molecular weight heparin accounted for 49.8% of alerts, of which 92.2% were overridden. In 88 (1.1%) of these overridden alerts, concurrent therapy was still present. Despite the high override rate, the e-survey revealed that the DDI clinical decision support system was found useful by prescribers. Conclusions Identified barriers were the lack of DDI-specific screening intervals and inclusion of patient-specific characteristics, both leading to a high number of false positive alerts and risk for alert fatigue. Despite these barriers, the added value of the DDI clinical decision support system was recognized by prescribers. Hence, integration of DDI-specific screening intervals and patient-specific characteristics is warranted to improve the performance of the DDI software.