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Abstract

OBJECTIVE

Access to veterinary care is critical for pet, human, and community health. However, inequities in how easily pet owners can access veterinary care may exacerbate health disparities in vulnerable populations. This research analyzed pet owners’ perceptions of access to veterinary care in order to understand how demographic characteristics and financial fragility predict perceived access to veterinary services.

SAMPLE

This study utilized survey data (n = 750) from a larger cross-sectional survey of adults in the US conducted by the Tufts University Equity Research Group.

PROCEDURES

Survey data were collected in May and June of 2020 from a nationally representative group of pet owners via an online panel. Descriptive statistics, ANOVAs, and a sequential linear regression model were conducted in order to predict perceived access to veterinary care.

RESULTS

Results of a sequential linear regression model indicated that race or ethnicity, education, and financial fragility significantly predicted perceived ease of access to veterinary care (F[7,617] = 19.80; P < .001). Additionally, financial fragility was prevalent among most pet owners of almost all income brackets, highlighting the need for more research into the cost burden of veterinary care.

CLINICAL RELEVANCE

Future studies should focus on diverse sampling strategies that capture the experiences of minority pet owners in order to further understand issues of access in veterinary medicine.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To report clinical experience using virtual surgical planning (VSP) and surgical application of 3D printed custom surgical guides to facilitate uni- and biapical correction of antebrachial deformities in dogs.

ANIMALS

11 dogs (13 antebrachial deformity corrections).

PROCEDURES

Using CT-based bone models, VSP was performed, and surgical guides were designed and 3D printed. The guides were used to execute osteotomies and align bone segments. Postoperative CTs were obtained to compare limb alignment with the VSP. Long-term assessment of lameness and cosmesis were compared with preoperative status.

RESULTS

Guides were successfully utilized and postoperative analysis was available for 10 of 13 deformities. Guides were abandoned in 2 deformities due to soft tissue tension. Evaluation of postoperative frontal, sagittal, axial, and translational limb alignment revealed that over 90% of parameters were within the acceptable range of ≤ 5° angulation and rotation or ≤ 5 mm of translation from the VSP. Lameness scores were improved in 7/8 deformities with associated preoperative lameness, and posture was improved in 10/10 deformities in which guides were deployed. Complications included reduced range of carpal motion (n = 2), implant sensitivity (n = 2), fracture (n = 1), and tendon laceration (n = 1).

CLINICAL RELEVANCE

VSP and customized surgical guide application facilitated accurate antebrachial limb deformity correction in the majority of deformities in this case series. The use of VSP and 3D printed guides would appear to be a viable and accurate approach for correction of both uni- and biapical antebrachial deformities in dogs.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the utility of blood symmetric dimethylarginine (SDMA) concentration measurement as a diagnostic tool for chronic kidney disease (CKD) in tigers (Panthera tigris) by comparing results for SDMA with those for traditional renal biomarkers and investigating correlations between these biomarkers and histopathologic kidney changes in tigers with CKD.

SAMPLE

Blood, urine, and kidney samples from 35 tigers with CKD from 2 sanctuaries.

PROCEDURES

Blood (serum or plasma) and urine samples were collected antemortem. Necropsy, including gross and histologic assessment, was performed for tigers that died or were euthanized for quality-of-life reasons. Results for CKD biomarkers in blood (BUN, creatinine, phosphorus, and SDMA concentrations) and urine (protein concentration, urine protein-to-creatinine ratio, and urine specific gravity) were evaluated for correlation with histologic kidney damage scored with an objective grading scale defined by percentage of inflammation, fibrosis, and tubular atrophy.

RESULTS

Symmetric dimethylarginine had the strongest significant correlation (ρ = 0.667) with histologic kidney damage score, followed by urine specific gravity (ρ = –0.639), blood creatinine concentration (ρ = 0.624), and BUN (ρ = 0.588). No significant correlation with kidney score was identified for blood phosphorus concentration, urine protein concentration, or the urine protein-to-creatinine ratio.

CLINICAL RELEVANCE

We recommend SDMA be prioritized as a renal biomarker in tigers, with SDMA results considered in addition to those of other traditional renal biomarkers when assessing kidney function in tigers. Additionally, the grading scale we developed could be replicated across patients and pathologists for more consistent postmortem assessment of CKD in tigers.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To better understand spatial relationships between principal bronchi and other intrathoracic structures by use of CT images of dogs of various somatotypes.

ANIMALS

93 dogs that underwent thoracic CT.

PROCEDURES

Information was collected from medical records regarding signalment and physical examination and echocardiographic findings. Two investigators recorded multiple measurements on a thoracic axial CT image from each dog.

RESULTS

Thoracic height-to-width ratio (H:W) was associated with left principal bronchus (LPB) and right principal bronchus (RPB) H:W, aortic-LPB separation, focal LPB narrowing, and aortic-vertebral overlap. Thoracic H:W was not associated with dog age, weight, sex, or brachycephalic breed. Twenty-five (27%) dogs had focal LPB narrowing, compared with 5 (5%) dogs with focal RPB narrowing (P < 0.001). Ten of 25 dogs had overlap or contact between vertebrae, aorta, LPB, and heart, suggesting a cumulative compressive effect on the LPB, while 15 had LPB-aorta contact and lack of contact between the aorta and thoracic vertebrae, suggesting an aortic constrictive effect on the LPB. None had LPB narrowing without contact from surrounding structures. Inter-rater agreement was high.

CLINICAL RELEVANCE

In dogs that underwent CT and were not selected for clinical suspicion of bronchial disease, principal bronchial morphology was associated with thoracic conformation. Focal LPB narrowing occurred more often than RPB narrowing. Focal LPB narrowing occurred with evidence of extraluminal compression, with or without contact between aorta and vertebrae. Brachycephalic breed could not be used for predicting thoracic H:W.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To explore the role of the hidden curriculum in residents’ development of professional identity during postgraduate training in laboratory animal medicine.

SAMPLE

24 residents enrolled in 1 of 7 laboratory animal medicine training programs in the eastern US.

PROCEDURE

24 qualitative, semistructured interviews were conducted and recorded. Deidentified transcriptions were analyzed by each author using open and axial coding. Constant comparative methodology was used to develop themes and subthemes. Member checks were performed to verify trustability of the conclusions drawn.

RESULTS

3 themes and their related subthemes emerged from the qualitative analysis: 1) building relationships through competent communication (building rapport, practicing clinical empathy, overcoming language barriers, communicating in the “authorized” way, and navigating email limitations), 2) tension within the process of identity formation (acting as the middleman among stakeholders, overcoming the stigma of the policing role, experiencing a lack of power to impact change, and managing a culture of conditional value of veterinary knowledge), and 3) outlets for tension in identity formation (reliance on residency mates, limitations of venting).

EDUCATIONAL RELEVANCE

Our findings suggest that residents are navigating professional identity formation under challenging circumstances that include conflicting stakeholder needs, conditional value of veterinary knowledge, and lack of power to influence change. Residents have limited outlets for relieving the discord between their ideal professional role and their lived experiences. These results provide an important background for refining curricula and creating effective support systems for residents.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To assess the impact of a communication program on a cohort of veterinary students’ knowledge and performance of communication skills.

SAMPLE

Class cohort of veterinary students at Colorado State University.

PROCEDURES

Year 3 students’ knowledge of communication skills was evaluated using quizzes, administered before and after the fall 2016 and spring 2017 Clinical Communication Skills-I and II junior practicum. In year 4, student performance of 22 Calgary-Cambridge Guide communication skills was assessed by coding video-recordings of student-client interactions collected during their second and fourth weeks of the Community Practice rotation in the summer and fall of 2017 and spring of 2018. The impact of training, association with demographic factors, and correlation between knowledge and performance of communication skills were investigated.

RESULTS

In year 3, 136 students completed both fall and spring quizzes; in year 4, 65 week-2 and 29 week-4 appointments were video-recorded during Community Practice rotation. Students’ knowledge assessed via quizzes containing skill spotting and skill demonstrating questions increased significantly after the fall and spring junior practicums; however, knowledge of communication skills was not associated with performance during year 4 Community Practice rotations. Communication skills most frequently demonstrated by students during the fourth year Community Practice rotation were open-ended questions, closed-ended questions, empathy toward the client and patient, providing “chunks” of information, and signposting. Students received high quality scores for non-verbal behaviors and logical clinical interview structure.

CLINICAL RELEVANCE

Results suggest that experiential learning techniques, including a flipped classroom approach, role-play, and communication laboratories contributed to increased student knowledge of communication skills.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

CASE DESCRIPTION

5 dogs with a history of ventriculocordectomy were anesthetized with isoflurane for ovariohysterectomy, dental prophylaxis, or intracapsular lens extraction.

CLINICAL FINDINGS

No remarkable, abnormal clinical signs such as exercise intolerance, respiratory distress, or stridor were found in 4 dogs. However, 1 dog had cough after drinking, which had started after the ventriculocordectomy. During intubation, laryngeal web, suspected to be a complication of ventriculocordectomy, was accidentally discovered.

TREATMENT AND OUTCOME

Laryngeal web was observed during intubation, necessitating the use of a smaller-diameter endotracheal tube (ETT) for intubation. However, the smaller cuff volume of the smaller ETT did not prevent the air leak. Therefore, the ETT with the inflated cuff was pulled cranially until the narrowed laryngeal lumen was plugged with the cuff behind the vocal cords. The ETT was secured to prevent slippage. No air leakage around the ETT cuff or complications related to the ETT placement were observed in the peri-anesthetic period in any dog.

CLINICAL RELEVANCE

Laryngeal web can be found in patients with a history of larynx-related surgeries and may allow only a small-diameter ETT to pass through. The sealing technique used for peri-cuff air leak using a small ETT described here that can pass through a laryngeal web could be useful to seal an air leak around the cuff without complications.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To evaluate the pharmacokinetics of acetaminophen (APAP) after single-dose IV and PO in the goose; to quantify APAP and its main metabolites in goose muscle, heart, lung, liver, and kidney; and to perform a histopathologic evaluation of goose stomach, duodenum, liver, and kidney tissues for potential signs of toxicity.

ANIMALS

24 geese.

PROCEDURES

Geese were randomly divided into 3 groups (n = 8). Group I received APAP (10 mg/kg) IV, and groups II and III received the same dose PO. Groups I and II were used for the pharmacokinetic assessment, and group III was used for the residue analysis and histopathologic evaluation. APAP and its metabolites were quantified in plasma and tissues by ultra–high-performance liquid chromatography–tandem mass spectrometry, and the pharmacokinetic analysis was performed using a noncompartmental approach.

RESULTS

APAP plasma concentrations were lower than those of the metabolites in similar selected time points after both treatments. After IV treatment, the APAP area under the curve value was statistically higher than that after PO administration, resulting in an oral bioavailability of 46%. In contrast, the area under the curve of the metabolites following PO administration was statistically higher than those found after IV administration. Tissue residues of APAP were highest in the liver, with an accumulation index > 1. Fatty degeneration of hepatocytes was observed 24 hours after administration of APAP.

CLINICAL RELEVANCE

In geese, treatment by PO administration of APAP shows incomplete absorption and a slight accumulation in lung and liver. Tissue alterations occurred in the liver at 24 hours, while no signs of toxicity were found in the other tested organs.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

CASE DESCRIPTION

A 2-year-old intact male Mini Lop rabbit (Oryctolagus cuniculus) exhibited acute paraplegia and was suspected of having a traumatic spinal injury after leaping from the owner’s arms.

CLINICAL FINDINGS

In the physical examination, the patient was conscious and responsive and presented a loss of hind-limb motor function. The results of the neurologic examination indicated a T3-L3 spinal cord lesion. Vertebral column radiography and CT showed a fracture of the dorsal arch in the right caudal part of vertebra L1 and a fracture of the caudal end plate of vertebra L1 without displacement.

TREATMENT AND OUTCOME

The vertebral fracture was stabilized by a monolateral external fixator placed percutaneously with fluoroscopy guidance. The rabbit was discharged 48 hours after surgery. Three days later, the rabbit was able to walk with mild paraparesis, and 2 weeks after surgery, the rabbit showed full recovery of neurologic function. The follow-up performed 6 weeks after surgery showed normal gait, good alignment and complete consolidation of the fracture. The external fixator was then removed. The follow-up examination and radiographic findings showed complete recovery at 2 and 6 months after surgery.

CLINICAL RELEVANCE

The most common cause of traumatic posterior paralysis in rabbits is vertebral fracture. This article describes the possibility and successful outcome of stabilizing a vertebral fracture in a rabbit with an external fixator using a minimally invasive fluoroscopic technique. This technique, described to the authors’ knowledge for the first time in a rabbit, allows a fracture to be stabilized accurately without any incisions while minimizing complications and postoperative pain.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

CASE DESCRIPTION

A male Major Mitchell’s cockatoo (Lophochroa leadbeateri) of unknown age presented with an ulcerated mass on the ventral tail caudodorsal to the cloaca.

CLINICAL FINDINGS

An impression smear of the mass showed spindle cell atypia. Multiple biopsies were submitted for histopathology with inconclusive results. A CT scan revealed a soft tissue mass causing compression of the cloacal lumen. The patient underwent surgical debulking, and a core of the mass was submitted again for histopathology, which reported it as fibrosarcoma.

TREATMENT AND OUTCOME

Under repeated general isoflurane gas anesthesia, the patient received a course of definitive radiation therapy totaling 60 Gy and divided in 3 Gy X 20 fractions. By treatment completion, the lesion had decreased in size with necrotic debris on the surface. Surrounding tissues appeared healthy and no adverse effects were observed. As of 1.5 years post-treatment, the mass appears completely healed with no signs of reoccurrence.

CLINICAL RELEVANCE

This case suggests that radiation therapy with this protocol could be an effective treatment option for fibrosarcoma in avian species.

Restricted access
in Journal of the American Veterinary Medical Association