OBJECTIVE To determine whether simulator-assessed laparoscopic skills of veterinary students were associated with training level and prior experience performing nonlaparoscopic veterinary surgery and other activities requiring hand-eye coordination and manual dexterity.
SAMPLE 145 students without any prior laparoscopic surgical or fundamentals of laparoscopic surgery (FLS) simulator experience in years 1 (n = 39), 2 (34), 3 (39), and 4 (33) at a veterinary college.
PROCEDURES A questionnaire was used to collect data from participants regarding experience performing veterinary surgery, playing video games, and participating in other activities. Participants performed a peg transfer, pattern cutting, and ligature loop-placement task on an FLS simulator, and FLS scores were assigned by an observer. Scores were compared among academic years, and correlations between amounts of veterinary surgical experience and FLS scores were assessed. A general linear model was used to identify predictors of FLS scores.
RESULTS Participants were predominantly female (75%), right-hand dominant (92%), and between 20 and 29 years of age (98%). No significant differences were identified among academic years in FLS scores for individual tasks or total FLS score. Scores were not significantly associated with prior surgical or video game experience. Participants reporting no handicraft experience had significantly lower total FLS scores and FLS scores for task 2 than did participants reporting a lot of handicraft experience.
CONCLUSIONS AND CLINICAL RELEVANCE Prior veterinary surgical and video game experience had no influence on FLS scores in this group of veterinary students, suggesting that proficiency of veterinary students in FLS may require specific training.
OBJECTIVE To evaluate the economic and clinical feasibility of introducing rigid endoscopy and laparoscopy to a small animal general practice.
DESIGN Prospective study.
SAMPLE A single 2-veterinarian small animal practice in southern California.
PROCEDURES In early 2012, endoscopic equipment was purchased, and both veterinarians in the practice undertook training in rigid endoscopic and laparoscopic procedures. Subsequently, information for client-owned animals that underwent endoscopic and laparoscopic procedures during a 12-month period (2012 to 2013) was collected. Cost of equipment and training, revenue generated, specific procedures performed, surgery time, complications, and client satisfaction were evaluated.
RESULTS 78 endoscopic procedures were performed in 73 patients, including 71 dogs, 1 cat, and 1 rabbit. Cost of endoscopic and laparoscopic equipment and training in the first year was $14,809.71; most equipment was financed through a 5-year lease at a total cost of $57,507.70 ($ 10,675.20/y). Total revenue generated in the first year was $50,423.63. The most common procedures performed were ovariectomy (OVE; n = 49), prophylactic gastropexy (6), and video otoscopy (12). Mean ± SD surgery times for OVE (n = 44) and for OVE with gastropexy (5) were 63.7 ± 19.7 minutes and 73.0 ± 33.5 minutes; respectively. Twelve of 54 patients undergoing laparoscopic procedures experienced minor intraoperative complications. Conversion to laparotomy was not required in any patient. There were no major complications. All 49 clients available for follow-up were satisfied.
CONCLUSIONS AND CLINICAL RELEVANCE With appropriate training and equipment, incorporation of basic rigid endoscopy and laparoscopy may be feasible in small animal general practice. However, results of the present study are not applicable to all veterinarians and practice settings, and patient safety considerations should always be paramount.
OBJECTIVE To determine small animal veterinarians’ opinions and actions regarding costs of care, obstacles to client education about veterinary care costs, and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout.
DESIGN Cross-sectional survey.
SAMPLE 1,122 small animal practitioners in the United States and Canada.
PROCEDURES An online survey was sent to 37,036 veterinarians. Respondents provided information regarding perceived effects of client awareness of costs and pet health insurance coverage on various aspects of practice, the influence of client economic limitations on professional satisfaction and burnout, and proposals for addressing those effects.
RESULTS The majority (620/1,088 [57%]) of respondents indicated that client economic limitations affected their ability to provide the desired care for their patients on a daily basis. Approximately half (527/1,071 [49%]) of respondents reported a moderate-to-substantial level of burnout, and many cited client economic limitations as an important contributing factor to burnout. Only 31% and 23% of respondents routinely discussed veterinary costs and pet insurance, respectively, with clients before pets became ill, and lack of time was cited as a reason for forgoing those discussions. Most respondents felt improved client awareness of veterinary costs and pet health insurance would positively affect patient care and client and veterinarian satisfaction.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested most small animal practitioners believe the veterinary profession needs to take action at educational and organizational levels to inform pet owners and educate and train veterinary students and veterinarians about the costs of veterinary care.
OBJECTIVE To survey practicing veterinarians regarding their perceptions of and experiences with cases of suspected or confirmed animal abuse and related state laws.
DESIGN Cross-sectional study.
POPULATION Members of the Veterinary Information Network (VIN; n = 34,144) who were in veterinary practice at the time of the survey.
PROCEDURES A survey was designed and distributed online to all VIN members from January 26 to February 28, 2015. Responses were compiled, and binary logistic regression analysis was performed to identify factors that influenced decisions or perceptions regarding animal abuse encounters and related legislation.
RESULTS 1,209 completed surveys were received (3.5% response rate); 1,155 (95.5%) surveys were submitted by currently practicing veterinarians. One thousand five (87.0%) practicing veterinarians reported having encountered at least 1 case of animal abuse while in practice; 561 (55.8%) of these veterinarians indicated that they had reported at least 1 case. The most common reasons selected for reporting abuse were to protect the animal, ethical beliefs, and to protect other animals in the household. The most common reasons selected for not reporting the abuse were uncertainty that the animal had been abused, belief that client education would be better, and belief that the injury or illness was accidental versus intentional. Most respondents were unaware of the current status of laws in their state regarding animal abuse reporting.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested a need for state and national veterinary and humane-law enforcement organizations to increase communication and education efforts on recognition and reporting by veterinarians of animal abuse and the related laws.
OBJECTIVE To determine the lomustine content (potency) in compounded and FDA-approved lomustine capsules.
DESIGN Evaluation study.
SAMPLE 2 formulations of lomustine capsules (low dose [7 to 11 mg] and high dose [40 to 48 mg]; 5 capsules/dose/source) from 3 compounders and from 1 manufacturer of FDA-approved capsules.
PROCEDURES Lomustine content was measured by use of a validated high-pressure liquid chromatography method. An a priori acceptable range of 90% to 110% of the stated lomustine content was selected on the basis of US Pharmacopeia guidelines.
RESULTS The measured amount of lomustine in all compounded capsules was less than the stated content (range, 59% to 95%) and was frequently outside the acceptable range (failure rate, 2/5 to 5/5). Coefficients of variation for lomustine content ranged from 4.1% to 16.7% for compounded low-dose capsules and from 1.1% to 10.8% for compounded high-dose capsules. The measured amount of lomustine in all FDA-approved capsules was slightly above the stated content (range, 104% to 110%) and consistently within the acceptable range. Coefficients of variation for lomustine content were 0.5% for low-dose and 2.3% for high-dose FDA-approved capsules.
CONCLUSIONS AND CLINICAL RELEVANCE Compounded lomustine frequently did not contain the stated content of active drug and had a wider range of lomustine content variability than did the FDA-approved product. The sample size was small, and larger studies are needed to confirm these findings; however, we recommend that compounded veterinary formulations of lomustine not be used when appropriate doses can be achieved with FDA-approved capsules or combinations of FDA-approved capsules.
OBJECTIVE To describe the learning curve for veterinary surgery residents performing hemilaminectomy surgeries in dogs.
DESIGN Retrospective case review and learning curve evaluation.
SAMPLE 13 individuals who completed a 3-year surgery residency program at a university teaching hospital and who had no prior experience performing hemilaminectomies.
PROCEDURES The 13 residents performed hemilaminectomies on 399 dogs between July 2006 and July 2013. Medical records were reviewed, and operative time was recorded. Data were examined with a linear mixed-effects model to quantify fixed and random effects, a curve-fitting technique to find the best-fit curve, and a segmented 2-phase linear model to describe the domains and learning rates for 2 phases of learning.
RESULTS The linear mixed-effects model indicated that increasing patient body weight and increasing surgical complexity (graded on the basis of number and contiguity of hemilaminectomy sites) were associated with longer operative times and that increasing exposure number was associated with shorter operative times. The monoexponential and biexponential parametric curves were of similar quality in modeling the data. The segmented 2-phase linear model showed an early phase of learning during which operative time decreased rapidly and a late phase when operative time decreased more gradually.
CONCLUSIONS AND CLINICAL RELEVANCE The learning curve for the residents suggested that for early exposures, instruction in the form of direct supervision provided substantial benefit. By the tenth exposure, the benefit of instruction diminished and ongoing improvement was primarily a result of refinement. If validated by further study, this understanding of a 2-phase learning curve may inform the design of training programs in veterinary surgery.
OBJECTIVE To determine attitudes of small animal practitioners toward veterinary clinical trials and variables influencing their likelihood of participating in such trials.
DESIGN Cross-sectional survey.
SAMPLE Small animal practitioners with membership in 1 of 2 online veterinary communities (n = 163 and 652).
PROCEDURES An online survey was developed for each of 2 veterinary communities, and invitations to participate were sent via email. Each survey included questions designed to collect information on the respondents’ willingness to enroll their patients in clinical trials and to recommend participation to clients for their pets.
RESULTS More than 80% of respondents to each survey indicated that they spend no time in clinical research. A high proportion of respondents were likely or extremely likely to recommend clinical trial participation to clients for their pets when those trials involved treatments licensed in other countries, novel treatments, respected investigators, or sponsoring by academic institutions, among other reasons. Reasons for not recommending participation included distance, time restrictions, and lack of awareness of ongoing clinical trials; 28% of respondents indicated that they did not usually learn about such clinical trials. Most respondents (79% to 92%) rated their recommendation of a trial as important to their client's willingness to participate.
CONCLUSIONS AND CLINICAL RELEVANCE Participation in veterinary clinical trials by small animal practitioners and their clients and patients appeared low. Efforts should be increased to raise practitioner awareness of clinical trials for which patients might qualify. Specific elements of trial design were identified that could be modified to increase participation.
OBJECTIVE To evaluate methods used to ascertain, define, and report adverse events (AEs) in companion animal clinical trials involving cancer treatment.
DESIGN Systematic review.
SAMPLE English-language articles describing prospective clinical trials involving dogs and cats with naturally occurring cancer published in peer-reviewed journals between 2008 and 2014.
PROCEDURES Reports were identified via MEDLINE and CAB database searches combined with a hand-searching strategy. General article characteristics were abstracted and summarized. Data for AE reporting were collected with a 14-item checklist adapted from the 2004 CONSORT extension for reporting harms. Study characteristics associated with the AE reporting checklist score were identified by means of linear regression analysis.
RESULTS 168 articles with data for 6,132 animals were included. Standardized terminology was significantly more likely to be used to describe AEs for trials that included chemotherapy (92/115 [80.0%]) than for trials that did not (16/53 [30.2%]). Median AE reporting checklist score was 5 out of 14 (range, 0 to 12). Poorly reported items included methods and time frame of AE ascertainment, AE data analysis, and reasons for treatment discontinuation and death. Trials with industry funding, a single-arm design, and treatment with chemotherapy were associated with a significantly higher quality of AE reporting.
CONCLUSIONS AND CLINICAL RELEVANCE Reporting of adverse events in veterinary clinical trials evaluating cancer treatment was selective and heterogeneous. Harms associated with cancer treatments could be underestimated because of suboptimal collection and reporting of AE data. Findings supported the adoption of a higher standard for AE surveillance and reporting in veterinary patients.
OBJECTIVE To identify patterns of referral to US small animal rehabilitation facilities, document referring veterinarians’ perceptions of rehabilitation services, and examine factors that encouraged and impeded referral of veterinary patients to rehabilitation facilities.
DESIGN Cross-sectional survey.
SAMPLE 461 completed surveys.
PROCEDURES Referral lists were obtained from 9 US rehabilitation facilities, and surveys were emailed or mailed to 2, 738 veterinarians whose names appeared on those lists. Data obtained from respondents were used to generate descriptive statistics and perform χ2 tests to determine patterns for referral of patients to rehabilitation facilities.
RESULTS 461 surveys were completed and returned, resulting in a response rate of 16.8%. The margin of error was < 5% for all responses. Most respondents (324/461 [70.3%]) had referred patients for postoperative rehabilitation therapy. Respondents ranked neurologic disorder as the condition they would most likely consider for referral for future rehabilitation therapy. The most frequently cited reason for not referring a patient for rehabilitation therapy was perceived cost (251/461 [54.4%]) followed by distance to a rehabilitation facility (135/461 [29.3%]). Specialists were more likely than general practitioners to refer patients for rehabilitation therapy. The majority (403/461 [87.4%]) of respondents felt that continuing education in the field of veterinary rehabilitation was lacking.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated a need for continuing education in small animal rehabilitation for veterinarians. Improved knowledge of rehabilitation therapy will enable veterinarians to better understand and more specifically communicate indications and benefits for pets receiving this treatment modality.