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Abstract
Objective—To describe the process aspects (communication) of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer.
Design—Qualitative analysis of data acquired during in-person single and dyadic interviews.
Sample—43 dog owners participating in 30 interviews.
Procedures—Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions.
Results—The participants expected information to be communicated in a forthright manner; in multiple formats; with understandable language; in an unrushed environment wherein staff took the time to listen, answer all questions, and repeat information when necessary; on a continuous basis, with 24-hour access to address questions or concerns; in a timely manner; with positivity; with compassion and empathy; with a nonjudgmental attitude; and through staff with whom they had established relationships.
Conclusions and Clinical Relevance—Results indicated that the manner in which information is communicated is vitally important to clients of dogs with life-limiting cancer in that it not only facilitates comprehension but also creates a humanistic environment from which clients derive the psychosocial support needed to successfully cope with their pet's condition.
Abstract
Objective—To evaluate the content aspects of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer.
Design—Qualitative analysis of data acquired during in-person single and dyadic interviews.
Sample—43 dog owners participating in 30 interviews.
Procedures—Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions.
Results—For the clients, the central qualification was that the information given had to be the truth. Information was expected about all aspects of their dog's cancer and its treatment, varying in relation to clients’ basic understanding of cancer, their previous experience with cancer, and their information preferences. Provision of information generated the trust and confidence necessary to engage in treatment, the ability to make informed decisions, and the ability to be prepared for the future. Provision of information also engendered a sense of control and capability and fostered hope.
Conclusions and Clinical Relevance—When dealing with owners of dogs with life-limiting cancer, results indicated that in addition to abiding by the principle of truth-telling, it is important for health-care service providers to ascertain clients’ understanding of and experiences with cancer as well as their information preferences and thereby adopt a tailored approach to information giving. Provision of information enabled client action and patient intervention but also enhanced clients’ psychosocial well-being. Veterinary healthcare service providers can purposely provide information to build and sustain clients’ ability to successfully cope with their pet's condition.
Abstract
Objective—To compare in vitro security of 6 friction knots used as a first throw in the creation of a vascular ligation.
Design—Experimental study.
Sample—20 constructs of 6 friction knots created with 2–0 polyglyconate suture.
Procedures—Security of the surgeon's throw, Miller's knot, Ashley modification of the Miller's knot, modified Miller's hand-tie, constrictor knot, and strangle knot was evaluated. Each knot configuration was constructed around each of 2 balloon dilation catheters used as small- and large-diameter vascular pedicle models and pressure tested to failure (leakage) 10 times. Results were compared by means of ANOVA and Student t tests.
Results—Mean leakage pressure for the surgeon's throw was significantly lower than that of all other knots tested in both pedicle models. The Miller's knot, constrictor knot, and strangle knot had mean leakage pressures > 360 mm Hg regardless of model diameter, whereas the surgeon's throw, Ashley modification of the Miller's knot, and modified Miller's hand tie consistently leaked at pressures at or below those found in arteries under normal physiologic conditions (pressures of 90 to 140 mm Hg).
Conclusions and Clinical Relevance—Security of the Miller's knot, constrictor knot, and strangle knot was considered excellent. In vitro results suggested that, when constructed correctly, these friction knots may be preferable first-throw constructs during vascular pedicle ligation and should be further evaluated for clinical use. The surgeon's throw was less reliable as a first throw for vascular pedicle ligation in the model tested.
Abstract
Objective—To determine the role of veterinary team effectiveness regarding job satisfaction and burnout in companion animal veterinary practice.
Design—Cross-sectional observational study.
Sample—48 companion animal veterinary health-care teams.
Procedures—274 team members participated in an online survey. Overall job satisfaction was evaluated with a 1-item measure, and the 3 dimensions of burnout (exhaustion, cynicism, and professional efficacy) were measured with the Maslach Burnout Inventory-General Survey. Team effectiveness was assessed with a survey developed for this study. Demographic and team effectiveness factors (coordinated team environment, toxic team environment, team engagement, and individual engagement) associated with job satisfaction and burnout were evaluated.
Results—Overall mean job satisfaction score was 5.46 of 7 (median, 6.00); veterinary technicians and kennel attendants had the lowest scores. According to the Maslach survey results, 22.4% of participants were in the high-risk category for exhaustion, 23.2% were in the high-risk category for cynicism, and 9.3% were in the high-risk category for professional efficacy. A coordinated team environment was associated with increased professional efficacy and decreased cynicism. A toxic team environment was negatively associated with job satisfaction and positively associated with exhaustion and cynicism. Individual engagement was positively associated with job satisfaction and professional efficacy and negatively associated with exhaustion and cynicism.
Conclusions and Clinical Relevance—Results suggested the effectiveness of a veterinary team can significantly influence individual team members’ job satisfaction and burnout. Practices should pay specific attention to the effectiveness with which their veterinary team operates.
Abstract
Objective—To evaluate the magnitude and consequences of work-related injuries and associated factors among veterinary technicians certified in Minnesota.
Design—Cross-sectional survey.
Sample—1,427 certified veterinary technicians (CVTs).
Procedures—Surveys were used to collect data on demographics, personal characteristics, injury occurrences in the 12 months prior to survey completion, and injury consequences. Annual injury rates were estimated on the basis of demographic and work-related characteristics. Risk of injury associated with various factors was estimated by calculation of incidence rate ratios, controlling for multiple factors.
Results—465 of 873 eligible CVTs reported 1,827 injury events (total and bite injury rates, 237 and 78 injuries/100 persons/y). Primary injury sources were cats and dogs, and most injuries occurred during animal restraint or treatment. Self-reported most severe injuries involved bites; cuts, lacerations, or scratches; bruises or contusions; and abrasions. Injury consequences included treatment and restricted work activity. Risk of work-related injury was lower for CVTs who worked < 40 h/wk than for those who worked ≥ 40 h/wk. The risk was higher for CVTs working in small animal or mixed mostly small animal facilities and lower for those working in mixed large and small animal facilities, commercial or industry operations, and government or regulatory facilities, compared with CVTs in colleges or universities. Handling 4 to > 6 (vs < 4) animal species during the 12 months prior to the survey and belief that injuries are not preventable were also associated with higher risk of injury.
Conclusions and Clinical Relevance—Several factors associated with the risk of work-related injury among CVTs were identified. Beyond these risk factors, investigation of additional exposures is integral to relevant intervention strategies.
Abstract
Objective—To identify risk and protective factors for work-related bite injuries among veterinary technicians certified in Minnesota.
Design—Nested case-control study.
Sample—868 certified veterinary technicians (CVTs).
Procedures—A questionnaire was mailed to CVTs who previously participated in a survey regarding work-related injuries and did (cases; 301 surveys sent) or did not (controls; 567) report qualifying work-related animal bite injuries in the preceding 12 months. Descriptive statistics were summarized. Demographic and work-related variables for the month preceding the bite injury (for cases) or a randomly selected month (controls) were assessed with univariate analysis (489 CVTs) and multivariate analysis of a subset of 337 CVTs who worked in small or mixed mostly small animal facilities.
Results—Responses were received from 176 case and 313 control CVTs. For the subset of 337 CVTs, risk of bite injury was higher for those < 25 years of age (OR, 3.82; 95% confidence interval [CI], 1.84 to 7.94) than for those ≥ 35 years of age, for those who had worked < 5 years (OR, 3.24; 95% CI, 1.63 to 6.45) versus ≥ 10 years in any veterinary facility, and for those who handled ≥ 5 species/d (OR, 1.99; 95% CI, 1.06 to 3.74) versus < 3 species/d. Risk was lower for CVTs who handled < 10 versus ≥ 20 animals/d (OR, 0.23; 95% CI, 0.08 to 0.71).
Conclusions and Clinical Relevance—Several work-related factors were associated with the risk of work-related bite injury to CVTs. These findings may serve as a basis for development of intervention efforts and future research regarding work-related injuries among veterinary staff.
Abstract
Objective—To describe reporting of key methodological elements associated with type II error in published reports of small animal randomized controlled trials (RCTs) and to determine the statistical power in a subset of RCTs with negative results.
Design—Descriptive literature survey.
Sample—Reports of parallel-group clinical RCTs published in 11 English-language veterinary journals from 2005 to 2012.
Procedures—Predefined criteria were used to identify trial primary outcomes and classify results as negative or positive. Details of sample size determination and use of confidence intervals in results reporting were recorded. For each 2-group RCT with negative results, the statistical power to detect 25% and 50% relative differences in outcome was calculated.
Results—Of 238 RCTs, 42 (18%) stated a primary outcome, 52 (22%) reported a sample size calculation, and 18 (9%) included a confidence interval around the observed treatment effect. Reports of only 2 (0.8%) RCTs included all 3 elements. Among 103 two-group RCTs with negative results, only 14 (14%) and 40 (39%) were sufficiently powered (β < 0.20) to detect 25% and 50% relative differences in outcome between treatments, respectively.
Conclusions and Clinical Relevance—The present survey found that small animal RCTs with negative results were often underpowered to detect moderate-to-large effect sizes between study groups. Information needed for critical appraisal was missing from most reports. The potential for clinicians to base treatment decisions on inappropriate interpretations of RCTs was worrisome. Design and reporting of small animal RCTs must be improved.
Abstract
Objective—To identify common errors in film and digital radiographs provided by referring veterinarians and determine the effect of such errors on the perceived diagnostic quality of image sets.
Design—Prospective study.
Sample—135 sets of radiographic images acquired by referring veterinarians for client-owned small animals evaluated at a university hospital.
Procedures—Sets of radiographs were prospectively collected and evaluated for proper performance of various radiographic technical variables including exposure, collimation, positioning, inclusion of all appropriate views, presence of artifacts, radiation safety, and labeling. Sets of radiographs were subjectively determined to be of diagnostic or nondiagnostic quality by 2 evaluators.
Results—The variables exposure, correct positioning, absence of artifacts, and acquisition of all appropriate views were significantly associated with a determination of diagnostic quality for radiograph sets. Correct patient labeling, radiation safety, and x-ray beam centering and collimation were not associated with a determination of diagnostic quality for radiograph sets. The number of categories with errors was significantly associated with identification of radiograph sets as having diagnostic or nondiagnostic quality. Digital radiographs had a significantly lower number of image artifacts and significantly higher frequency of proper labeling versus film radiographs.
Conclusions and Clinical Relevance—Results of this study suggested the technical variables proper exposure, proper positioning, absence of artifacts, and acquisition of all appropriate views were important for acquisition of sets of radiographs of high diagnostic quality. Identification of these errors and adjustment of radiographic technique to eliminate such errors would aid veterinarians in obtaining radiographs of high diagnostic quality and may reduce misinterpretation.
