Abstract
OBJECTIVE
To evaluate dogs with total hypercalcemia, azotemia, and normal serum phosphorus concentrations to determine whether a calcium-to-phosphorus ratio (Ca:P) or ionized Ca:P (iCa:P) could be utilized to predict underlying neoplasia.
ANIMALS
105 dogs were included in the study. Thirty-seven percent (n = 39) had known neoplasia, and 63% (66) had no evidence of neoplasia.
PROCEDURES
A retrospective medical records search was performed. An observational cutoff of 2.5 for Ca:P and 0.33 for iCa:P was used for determining sensitivity and specificity between the neoplasia and nonneoplasia groups.
RESULTS
Total hypercalcemia was higher in dogs with neoplasia compared to nonneoplastic cases of hypercalcemia. Ca:P of 2.5 had an 80% sensitivity and 46% specificity for predicting neoplasia. iCa:P of 0.33 had a 92% sensitivity and 77% specificity for predicting neoplasia in azotemic dogs.
CLINICAL RELEVANCE
The sensitivity and specificity of Ca:P was low, making it an unreliable tool to predict neoplasia in this specific study population. However, iCa:P may have some usefulness in determining presence of neoplasia in patients with high calcium, azotemia, and normal phosphorus.
Abstract
OBJECTIVE
To describe the novel PCR diagnosis and outcome of intestinal Echinococcus multilocularis in a dog.
ANIMAL
A 13-month-old female intact dog with naturally occurring intestinal E multilocularis.
CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES
The 13-month-old dog initially presented with a reduced appetite and weight loss and then developed hematochezia. The clinical history included a lack of endoparasite preventive care (fecal testing, deworming), exposure to coyotes, fox, sheep, and rodents and the dog had intermittently been fed a raw food diet. Physical examination revealed a thin dog, with a 2/9 body condition score, that was otherwise clinically unremarkable. A fecal sample was submitted for screening for gastrointestinal parasites as part of an infectious disease assessment. The fecal PCR test reported detection of E multilocularis. This result was sequenced as the European haplotype E3/E4. Centrifugal flotation (same sample) did not detect taeniid eggs.
TREATMENT AND OUTCOME
The dog was treated with metronidazole, maropitant, and milbemycin oxime/praziquantel. Clinical improvement was noted within 48 hours. No DNA of E multilocularis was detected in a fecal sample collected approximately 10 days after treatment. The dog’s owner was advised to provide monthly deworming (praziquantel) for all dogs on the property and to contact their human health-care provider due to potential zoonotic exposure risk.
CLINICAL RELEVANCE
Increasing detection of E multilocularis is occurring in dogs in Canada and the US. Alveolar echinococcosis can cause severe disease in dogs and humans. Fecal PCR detection and surveillance may alert practitioners to canine intestinal cases and allow dogs to serve as sentinels for human exposure risk.
Abstract
OBJECTIVE
To evaluate veterinarian-client communication before and after a 15-month on-site communication skills training intervention.
PROCEDURES
Multipractice, pretest-posttest intervention study.
SAMPLE
A convenience sample of 4 companion animal practices owned by a single practice group in Austin, Texas (n = 9 veterinarians; 170 audio recordings).
RESULTS
After intervention, visits were 8 minutes longer (P = .005), and veterinarians’ client-centered scores increased significantly (2.30 vs 2.72; P = .006). Veterinarians’ biomedical questions decreased by nearly a third (P = .0007), while veterinarians’ facilitation (ie, partnership-building) statements were 1.15 times as great (P = .04) after intervention due to an increase in asking for the client’s opinion (P = .03) and use of back-channel statements (P = .01). Agenda-setting skills, including agenda-setting questions (P = .009), summary of the client’s agenda (P = < .0001), and a check for remaining concerns (P = .013), increased significantly after intervention. Clients asked 1.9 times as many lifestyle-social related questions (P = .02) and provided 1.3 times as much lifestyle-social information (P = .0004) after the intervention. Additionally, clients offered 1.4 times as many emotion-handling statements (P = .0001), including showing concern (P = .03) and optimism, reassurance, or encouragement (P < .0001), after intervention. Paraverbally, clients presented as more anxious/nervous (P = .03) and emotionally distressed/upset (P = .02) after the intervention.
CLINICAL RELEVANCE
Results suggest that client-centered communication skills increased after intervention. This study builds upon previous case-based studies examining practice-based communication training, emphasizing that long-term interventions positively enhance veterinarian-client communication, which is likely to have a positive impact on client and patient care.
Abstract
Objective
To assess the efficacy of a single dose of oral meloxicam as an ancillary therapy to an antibiotic given at the time of respiratory disease identification on average daily gain (ADG), behavioral attitude, clinical respiratory, and lung ultrasound scores in preweaned dairy calves.
Animals
215 male and female Holstein, Jersey, and crossbred preweaned calves enrolled between 1 and 14 days of age at study enrollment on a single commercial dairy in the western US.
Methods
The study took place from March 4, 2021, to November 21, 2021. In this double-blind placebo-controlled study, calves were given an antibiotic (1.1 mL of tulathromycin/kg, SC, once) and either a placebo (1 mg of lactose monohydrate/kg, in a gelatin capsule) or oral meloxicam (1 mg/kg) at the time of respiratory disease identification. Behavioral attitude, clinical respiratory, and lung ultrasound scores and ADG were assessed in preweaned dairy calves at different time points including the next health examination, 1 week later, or at weaning.
Results
There was no association between treatment (placebo vs meloxicam) on ADG or respiratory disease status at weaning (P > .05). There was no effect of treatment on behavioral attitude, clinical respiratory, or lung ultrasound scores at the next health examination or 1 week later (P > .05).
Clinical Relevance
The present study did not provide evidence that oral meloxicam given once is beneficial for growth, behavioral attitude, or clinical or lung ultrasound scores.
Abstract
OBJECTIVE
To compare outcomes and short-term complications of dogs with laryngeal paralysis treated with unilateral arytenoid lateralization performed on an outpatient versus inpatient basis.
ANIMALS
44 client-owned dogs.
PROCEDURES
Medical records were retrospectively reviewed to identify dogs that underwent unilateral arytenoid lateralization for the treatment of laryngeal paralysis between 2018 and 2022. Signalment, surgical technique, anesthesia time, comorbidities, laryngeal examination, concurrent procedures, use of prokinetics and sedatives, episodes of vomiting, episodes of regurgitation, duration of hospitalization, postoperative complications, anxiety scores, and pain scores were recorded. Variables were compared between dogs and grouped by outpatient or inpatient management.
RESULTS
The overall complication rate was 22.7% (10/44), with 35% (7/20) being in the inpatient group and 12.5% (3/24) being in the outpatient group. The overall mortality rate was 6.8% (3/44). The overall morbidity for hospitalized patients versus those undergoing and outpatient procedure was 5% (1/20) and 4.2% (1/24), respectively. There was no significant difference between overall rate of complications and mortality rates between the inpatient and outpatient groups.
CLINICAL RELEVANCE
Results suggested that outpatient management of dogs with laryngeal paralysis treated with elective unilateral arytenoid lateralization is an appropriate method of postoperative management with no difference in complication or mortality rates. Further prospective studies with standardized surgical, sedative, and antiemetic protocols are warranted to evaluate more definitely.
Abstract
OBJECTIVE
To assess and compare the quality of smartphone ECG tracings to standard (base-apex) ECG tracings and assess agreement of ECG parameters between smartphone-based ECG and standard ECG.
ANIMALS
25 rams.
PROCEDURES
The rams were consecutively examined with standard ECG and smartphone-based ECG (KardiaMobile; AliveCor Inc) after physical examination. ECGs were compared for quality score, heart rate, and ECG waves, complexes, and intervals. Quality scores were based on the presence or absence of baseline undulation and tremor artifacts using a 3-point scoring system (lowest possible = 0; highest possible = 3). A lower score was indicative of a better-quality ECG.
RESULTS
Smartphone-based ECGs were interpretable in 65% of cases, while 100% of standard ECGs were interpretable. Standard ECG quality was superior to smartphone-based ECG quality, with no agreement in the quality between devices (κ coefficient, –0.0062). There was good agreement for heart rate with mean difference 2.86 beats/min (CI, –3.44 to 9.16) between the standard and smartphone ECGs. Good agreement was observed for P wave amplitude with mean difference 0.02 mV (CI, –0.01 to 0.05), QRS duration with mean difference –10.5 ms (CI, –20.96 to –0.04), QT interval with mean difference –27.14 ms (CI, –59.36 to 5.08), T wave duration with mean difference –30.00 ms (CI, –66.727 to 6.727), and T wave amplitude with mean difference –0.07 mV (CI, –0.22 to 0.08) between the 2 devices.
CLINICAL RELEVANCE
Our findings indicate good agreement between standard and smartphone ECG for most parameters, although 35% of smartphone ECGs were uninterpretable.
Abstract
Studies in human medicine indicate that between 22,000 and 400,000 people die every year as a direct result of medical errors. In veterinary medicine, 42% of human-caused incidents caused harm to the patient, including 5% resulting in death. In a university veterinary teaching hospital, there were 5.3 errors/1,000 patient visits, and 4 of these resulted in death. Veterinary medicine falls far behind other safety-critical industries in adopting a culture of patient safety. Organizations should respond in a just and effective way when errors occur. Psychological safety for team members to identify and speak up about areas of concern must be created and the results of improvements made based on these concerns shared within the professional group. If veterinary medicine is going to embrace patient safety culture, it needs to be included in the curriculum. Accrediting and licensing bodies need to require the teaching and application of principles of patient safety culture. Faculty must be trained to deliver patient safety–oriented care. Experts in human systems engineering should be brought in to educate veterinarians on how the systems we work in impact patient outcomes. If we are going to fulfill the promise of the Veterinarian’s Oath, we must embrace patient safety culture and all the difficult changes it requires of our professional culture.
