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Abstract

OBJECTIVE

To describe veterinarians’ communication of the companion animal physical exam (CAPE) to veterinary clients and to identify factors associated with the number of physical exam components communicated by veterinarians to clients.

SAMPLE

376 video-recorded veterinarian-client-patient interactions, involving 60 veterinarians.

PROCEDURES

18 CAPE components were studied in relation to veterinarians’ use of 7 communication-related parameters. A mixed linear regression model was used to assess veterinarian, patient, and appointment factors associated with the number of components conveyed by a veterinarian.

RESULTS

Veterinarians conveyed 1,566 of 2,794 (56.1%) of the components that they examined to clients, as having been examined. Of those components that were examined and conveyed by veterinarians, the impact of the finding was communicated for 496 of 1,566 (31.7%) of the components. Visual aids and take-home literature were each used in relation to an examined component during 15 of the 376 interactions (4%). A significant association was found between number of CAPE components conveyed and gender of the veterinarian (females conveyed 1.31 more), as well as the type of appointment (2.57 more were conveyed in wellness appointments and 1.37 more in problem appointments, compared to rechecks).

CLINICAL RELEVANCE

Findings identify an opportunity for veterinarians to further emphasize components of the CAPE, which may in turn increase clients’ perceived value of the CAPE due to understanding the benefits for their pet. This may be accomplished with the Talking Physical Exam, in which veterinarians discuss CAPE components findings with clients in real time, and the relevance of the findings to the patient’s health.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations.

ANIMALS

14 dogs and 4 cats that underwent double limb amputations.

PROCEDURES

Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected.

RESULTS

The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days).

CLINICAL RELEVANCE

Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To evaluate dogs and cats undergoing total ear canal ablation with lateral bulla osteotomy (TECA-LBO), document antimicrobial choices, and determine relationships associated with infection-related and neurologic postoperative complications.

ANIMALS

107 client-owned dogs and 13 client-owned cats that underwent TECA-LBO.

PROCEDURES

A retrospective analysis of medicals records of dogs and cats with TECA-LBO from 2 veterinary hospitals with postoperative data for at least 6 months was performed. All information associated with the TECA-LBO surgery including follow-up was recorded. Logistic regression analyses were performed and corrected using a false discovery rate to identify significance between antimicrobial administration and other perioperative variables and the outcomes of short- and long-term neurologic and infection-related complications, need for revision surgery, and euthanasia due to recurrence of infection-related signs.

RESULTS

Intraoperative cultures were performed in 111 animals, and 95 (85.5%) had bacterial growth, with Staphylococcus spp most commonly isolated. Revision surgeries due to infection-related signs occurred in 13 of 120 (10.8%) patients. If intraoperative bacterial cultures were positive and antimicrobials were administered within 1 month of surgery, patients were 85.8% less likely to exhibit infection-related complications, whereas patients not administered antimicrobials were 10.3 times as likely to require a revision surgery. Longer durations of postoperative antimicrobial administration were associated with revision surgery and euthanasia due to infection-related signs.

CLINICAL RELEVANCE

Administration of systemic antimicrobials within the first postoperative month may be necessary to prevent complications when intraoperative cultures exhibit bacterial growth and plays a role in the successful outcome of TECA-LBO.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine whether a single dose of trazodone administered to dogs before a veterinary visit reduced their behavioral and physiologic signs of stress and owners’ stress during veterinary visits.

SAMPLE

20 dogs and their owners.

PROCEDURES

In this randomized double-blinded placebo-controlled crossover clinical trial, dogs with a history of anxiety during veterinary visits were scheduled for 2 veterinary visits 1 week apart and randomly assigned to receive a single oral dose of either trazodone (9 to 12 mg/kg) or a placebo 90 minutes before transport to the veterinary clinic for alternate visits between September 21 and November 3, 2019. For each visit, we collected and assessed owner-completed surveys of dog stress score (DSS) and owner stress score; various investigator-reported scores, including from video-recorded behavior analyses; and patient-related physiologic data.

RESULTS

Dogs treated with trazodone versus placebo had lower mean DSSs, assessed by owners for physical examination and assessed by video analysis for time spent in the examination room; lower mean SD of normal-to-normal intervals, root mean square of successive heartbeat interval difference, and respiratory rate; and higher mean heart rate. No meaningful differences were observed in other behavioral or physiologic outcomes, including serum cortisol concentrations.

CLINICAL RELEVANCE

A single dose of trazodone before transport reduced signs of stress during veterinary visits for dogs in the present study and may be useful as an anti-anxiety medication for similarly affected dogs, potentially resulting in higher-quality clinical examinations and improved patient welfare.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

Doses of buffered tricaine methanesulfonate (MS-222) up to 1000 mg/L for 15 minutes are reported inefficient to produce euthanasia in goldfish. The goal of this study was to determine if goldfish can be euthanized by more prolonged immersion in MS-222.

ANIMALS

24 healthy goldfish (weight range: 1 to 10 g) were randomly assigned to 4 groups of 6 fish.

PROCEDURES

The first group (G1) was exposed to 500 mg/L buffered MS-222 for 15 minutes then placed in freshwater for 3 hours. The second (G2) and third groups (G3) were exposed to 1000 mg/L of buffered MS-222 for 15 minutes then placed in freshwater for 3 hours and 18 hours respectively. The fourth group (G4) was exposed to 1000 mg/L of buffered MS-222 for 60 minutes then placed in freshwater for 3 hours. Time to cessation and return of operculation were recorded. If the goldfish did not resume operculation, heart rate was evaluated by Doppler ultrasonic flow detector.

RESULTS

Median times to apnea were 35 seconds at 1000 mg/L and 65 seconds at 500 mg/L. Re-operculation occurred only in G1 in 5 out of 6 individuals. All fish from G1, 3 fish from G2, 0 fish from G3, 1 fish from G4 had remaining heartbeats at the end of the observation period.

CLINICAL RELEVANCE

Overall, a dose of 1000 mg/L of buffered MS-222 for 15 minutes was efficient to euthanize juvenile goldfish at 20 °C. Different fish body mass and water quality parameters might explain different results compared to previous studies.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the contributions of veterinarians and support staff to revenue and veterinarian productivity (ie, number of patients seen/full-time–equivalent veterinarian/wk) in private mixed and companion animal practices in the US and identify staff-to-veterinarian labor ratios (SVLRs) that maximized these 2 practice outputs.

SAMPLE

409 owners of mixed and companion animal practices who participated in the 2020 AVMA Practice Owner Survey.

PROCEDURES

Data regarding owner demographics, practice characteristics, labor (defined as mean total hours worked/wk), and gross revenue in 2019 were obtained from participating practices. Multivariable ordinary least-squares regression was used to identify factors associated with revenue and productivity as well as the SVLRs at which revenue and productivity were maximized.

RESULTS

For each 10% increase in total veterinarian hours worked per week, revenue increased by a mean of approximately 9%. A 1-unit increase in total number of technician hours used to support 1 hour of veterinarian work was associated with a 20.5% increase in revenue but with no change in productivity. The same increase in total number of nonmedical staff hours was associated with a 17.0% increase in revenue and 14.4% increase in productivity. In terms of revenue, the optimal SVLRs for veterinary technicians and nonmedical staff were 9:1 and 8:1, respectively. In terms of productivity, the optimal SVLR for nonmedical staff was 10:1.

CLINICAL RELEVANCE

Findings confirmed the important role of nonveterinarian staff in revenue and veterinarian productivity in mixed animal and companion animal practices and may be useful for making evidence-based staffing decisions.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the impact of a free One Health clinic with human and veterinary services on the veterinary-client relationship for underserved pet owners. A secondary aim was to understand the experience of veterinary students and volunteers who participated in the clinic.

SAMPLE

78 pet owners, 55 students and 32 volunteers who attended the Delaware Humane Association One Health Clinic between December 2018 and November 2019.

PROCEDURES

Pet owners completed an anonymous questionnaire prior to and following their veterinary appointment regarding their trust in the veterinary profession, feelings of enablement and veterinarian-client concordance. Students and volunteers completed a questionnaire within 72 hours of clinic participation about their perceptions of the educational value of the clinic.

RESULTS

Following the One Health clinic, client trust in the veterinary profession increased significantly (t = –5.50, P < 0.001). Clients also reported high levels of enablement and veterinarian-client concordance. Students and volunteers agreed the clinic was a valuable educational experience (97.7%) and reported increased compassion, enhanced leadership, communication and teamwork skills, and an improved ability to identify social issues and think critically.

CLINICAL RELEVANCE

The results support the utilization of One Health clinics to improve access to veterinary care for underserved pet owners. Clients reported high levels of trust, enablement and concordance following the clinic which could have long-lasting effects on their willingness to seek veterinary care and comply with veterinarians’ recommendations. The positive experiences of students and volunteers also highlights the potential of low-cost veterinary clinics as unique educational experiences.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To analyze the results of transoral ventral bulla osteotomy (TOVBO) in cats.

ANIMALS

13 client-owned cats treated by TOVBO between February 2016 and February 2019.

PROCEDURES

Medical records of cats with a diagnosis of middle ear disease (MED) that underwent TOVBO were reviewed. The procedure was similar to the one described for dogs. Short-term follow-up was obtained via clinical examination before discharge and at day 15 postoperatively. Long-term follow-up was performed via telephone interview.

RESULTS

13 cats (age range, 8 months to 12 years) underwent unilateral (n = 10) or bilateral (3) TOVBO (16) for the treatment of tympanic bulla (TB) infection (10), nasopharyngeal inflammatory polyps (5), or bullet retrieval from the TB (1). There were no intraoperative complications. One cat with a poor preoperative status died at postoperative day 3 from pneumonia. Eight cats experienced postoperative complications including head tilt (n = 2), Horner syndrome (3), loss of appetite (2), and temporary blindness (1). Collected samples confirmed the presence of nasopharyngeal inflammatory polyps (5), or otitis media (8). Six months after surgical intervention, 9 cats were free of MED signs.

CLINICAL RELEVANCE

This oral approach provided a good access to the TB in all cases. The complications observed after TOVBO were similar to those for VBO. In cats, TOVBO seems to be an acceptable and safe minimally invasive alternative to the other approaches of the TB to address MED.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To establish the components of a best-practice, baseline companion animal physical exam (CAPE).

SAMPLE

25 small animal veterinary internists and 20 small animal primary care veterinarians, all teaching the CAPE at veterinary colleges in the US, Canada, and Australia.

PROCEDURES

Using the Delphi Method of Consensus, 3 rounds of online questionnaires were sent to participants. The first round included demographic questions, questions about teaching the physical exam, and an open-ended question allowing participants to record details of how they conduct a CAPE. In the second round, participants were asked to rate components of the CAPE, which were derived from round 1, as “always examine,” “only examine as needed,” or “undecided.” Following round 2, any component not reaching 90% consensus (set a priori) for the response “always examine” was put forth in round 3, with a summary of comments from the round 2 participants for each remaining component.

RESULTS

35 components of a baseline CAPE were identified from round 1. The 25 components that reached 90% consensus by the end of round 3 were checking the oral cavity, nose, eyes, ears, heart, pulse rate, pulse quality, pulse synchrony, lungs, respiratory rate, lymph nodes, abdomen, weight, body condition score, mucous membranes, capillary refill time, general assessment, masses, haircoat, skin, hydration, penis and testicles or vulva, neck, limbs, and, in cats only, thyroid glands.

CLINICAL RELEVANCE

The findings establish an expert panel’s consensus on 25 components of a baseline, best-practice CAPE that can be used to help inform veterinary curricula, future research, and the practice of veterinarians.

Open 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