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Abstract

OBJECTIVE To assess the prevalence of medical errors (specifically, near misses [NMs] and adverse events [AEs]) and their personal and professional impact on veterinarians.

DESIGN Cross-sectional study.

SAMPLE Members of the Veterinary Information Network (n = 46,481).

PROCEDURES An electronic survey regarding veterinarians' experiences with NMs and AEs was distributed via email to an online veterinary community between September 24 and October 21, 2015. Responses were summarized and compared between genders by means of the χ2 test.

RESULTS 606 veterinarians completed the survey (1.3% response rate). Overall, 447 (73.8%) respondents reported involvement in ≥ 1 NM (n = 389 [64.2%]) or AE (179 [29.5%]). The NMs had a short-term (≤ 1 week) adverse impact on professional life for 68.0% (261/384) of respondents and longer-term negative impact for 36.4% (140/385). The impact on respondents' personal lives was similar (63.6% [245/385] and 33.5% [129/385], respectively). For AEs, these numbers were 84.1% (148/176), 56.2% (99/177), 77.8% (137/176), and 50.6% (89/175), respectively. Both NMs and AEs were more likely to negatively impact female veterinarians than male veterinarians.

CONCLUSIONS AND CLINICAL RELEVANCE These findings suggested that many veterinarians experience emotional distress after a medical error. Support should be provided to mitigate this adverse impact on the wellbeing of veterinarians and, potentially, their future patients.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Quality assurance is an implied concept inherent in every consumer's purchase of a product or service. In laboratory testing, quality assurance encompasses preanalytic (sampling, transport, and handling prior to testing), analytic (measurement), and postanalytic (reporting and interpretation) factors. Quality-assurance programs require that procedures are in place to detect errors in all 3 components and that the procedures are characterized by both documentation and correction of errors. There are regulatory bodies that provide mandatory standards for and regulation of human medical laboratories. No such regulations exist for veterinary laboratory testing. The American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards Committee was formed in 1996 in response to concerns of ASVCP members about quality assurance and quality control in laboratories performing veterinary testing. Guidelines for veterinary laboratory testing have been developed by the ASVCP. The purpose of this report was to provide an overview of selected quality-assurance concepts and to provide recommendations for quality control for in-clinic biochemistry testing in general veterinary practice.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To characterize sleeping respiratory rates (SRRs) and resting respiratory rates (RRRs), collected in the home environment, of dogs with subclinical heart disease that could result in left-sided congestive heart failure.

Design—Prospective cross-sectional study.

Animals—190 adult dogs with subclinical left-sided heart disease.

Procedures—Most dogs had mitral valve disease or dilated cardiomyopathy of various severities. Clients collected ten 1-minute SRRs or RRRs during a period ranging from 1 week to 6 months. Clinicians provided echocardiographic and medical data on each patient.

Results—The within-dog mean SRR (SRRmean; 16 breaths/min) was significantly lower than the within-dog mean RRR (RRRmean; 21 breaths/min). Seven dogs had SRRmean and 33 dogs had RRRmean > 25 breaths/min; 1 dog had SRRmean and 12 dogs had RRRmean > 30 breaths/min; these dogs mostly had a left atrial (LA)-to-aortic ratio > 1.8. Dogs with moderate LA enlargement had a significantly higher SRRmean than did other dogs. However, median SRRmean for each of 4 levels of LA enlargement was < 20 breaths/min; median RRRmean for each of 4 levels of LA enlargement was < 25 breaths/min. Both within-dog SRR and RRR remained stable for 10 consecutive measurements. Treatment with cardiac medications or presence of pulmonary hypertension was not associated with SRRmean or RRRmean.

Conclusions and Clinical Relevance—Results suggested that dogs with confirmed subclinical left-sided heart disease of various severities generally had SRRmean < 25 breaths/min, which was infrequently exceeded at any time, and that SRR and RRR remained stable, regardless of individual within-dog SRRmean or RRRmean. (J Am Vet Med Assoc 2013;243:839–843)

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the knowledge and use of safe surgical checklists (SSCs) and surgical safety practices (SSPs) in different sectors of veterinary medicine.

SAMPLE

1,235 small animal veterinarians who perform surgery in the United States and Canada.

PROCEDURES

An online survey was distributed to veterinarians through social media platforms, specialty listservs, and the Veterinary Information Network. Respondents provided information regarding their role, practice type, as well as knowledge, attitudes, and use of SSCs. Respondents also provided information about performance of SSPs including team introductions; confirmation of antibiotic prophylaxis, patient identity, procedure to be performed; and confirmation of completion of all procedures.

RESULTS

A greater proportion of Diplomates of the American College of Veterinary Surgeons (49/77 [64%]) reported using an SSC than other veterinarians (257/1157 [22%]; P < .0001). A greater proportion of veterinarians working in university and multispecialty hospitals reported using a SSC (71/142 [50%]) than in other practice settings (235/1092 [22%]; P < .0001). Use of a SSC correlated with consistent performance of surgical safety practices listed above (P < .0001). Primary care veterinarians commonly reported not using a SSC because they did not know about them (359/590 [61%]). Of the 507 respondents who had ever used a SSC, 333 (66%) believed the checklist had prevented an error or complication.

CLINICAL RELEVANCE

Despite widespread knowledge and adoption of SSC use in human medicine, knowledge and use of SSCs is lacking in primary care veterinary practice. Checklist use has previously been shown to decrease post operative complications and in this study was correlated with increased use of SSPs that decreased complications.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To compare complications between central and peripheral administration of high-osmolarity (approx 700 to 1,000 mOsm/L) amino acid (± lipid) infusions.

ANIMALS

18 client-owned dogs diagnosed with aminoaciduric canine hypoaminoacidemic hepatopathy syndrome or superficial necrolytic dermatitis receiving parenteral amino acid ± lipid infusions.

METHODS

In this retrospective case series, medical records were reviewed for administration route (central vs peripheral), catheter details and infusion characteristics (product osmolarity, concurrent lipid administration, infusion volume, duration, and rate), and complications for each infusion.

RESULTS

18 dogs received 277 infusions (median, 8.5; range, 1 to 84). Effective infusion osmolarities were 683 mOsm/L in 22% of infusions, 791 mOsm/L in 8%, 802 mOsm/L in 2%, 837 mOsm/L in 45%, and 998 mOsm/L in 23% (65% peripheral, 35% central). Most (n = 230 [83%]) infusions were given peripherally. The osmolarities of solutions administered by each route (P = .53), the infusion rate indexed to body weight (P = .17), or the lipid infusion rates indexed to body weight (P = .89) did not differ. One dog suffered 2 complications in 63 infusions—1 mild, 1 severe—both occurring with peripheral infusions. Thus, the overall complication rate was 2 of 277 (0.9%) infusions.

CLINICAL RELEVANCE

Short-term peripherally administered amino acid ± lipid infusions < 1,000 mOsm/L confer little risk compared to centrally administered infusions. Additional studies are needed to determine the safety of infusions with longer durations. Due to the relative ease of peripheral catheterization, clinicians should consider this route for medically managing aminoaciduric canine hypoaminoacidemic hepatopathy syndrome and superficial necrolytic dermatitis in dogs.

Open access
in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To develop and validate a Burden Transfer Inventory (BTI) of stressful client behaviors and to evaluate whether those behaviors are associated with client caregiver burden and contribute to veterinarian stress and burnout.

DESIGN 3-stage cross-sectional psychometric validation study.

SAMPLE 1,151 small animal veterinarians and 372 dog and cat owners.

PROCEDURES During stage 1, a pool of 34 items representing stressful client behaviors was created through open-ended surveys of practicing veterinarians and 3 phases of pilot testing. During stage 2, 1,151 veterinarians recruited through the Veterinary Information Network completed a survey including those behavior items and validated measures of stress and burnout. Completed surveys were randomly assigned to either a measure development or validation database for factor and item analyses. Data were then combined to determine whether the BTI was correlated with measures of stress and burnout. During stage 3, owners of dogs and cats with a serious illness completed an online survey to assess how frequently they engaged in each BTI item as well as a validated measure of caregiver burden.

RESULTS For dog and cat owners, there was a significant positive correlation between caregiver burden and the frequency that those owners reported engaging in BTI items. The frequency that veterinarians reported encountering BTI items was positively correlated with measures of stress and burnout, which suggested burden transfer from owners to veterinarians. The extent to which veterinarians reported being bothered by BTI items was a more robust predictor of stress and burnout than the frequency with which those items occurred.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated the BTI can be used to understand how client behaviors associated with caregiver burden affect veterinarian stress and burnout. The BTI may be useful to identify specific stressors affecting individual veterinarians and how they react to those stressors.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objectives

To evaluate the effects of 2 compounds with α-adrenergic antagonist properties on the urethral pressures of anesthetized, healthy, sexually intact male cats, and to evaluate one of the compounds for effect on striated muscle.

Animals

20 healthy, sexually intact male cats.

Procedure

Cats were anesthetized with halothane, and urethral pressure profilometry was performed before and after treatment. 125l-labeled α-bungarotoxin bound to nicotinic receptors of murine skeletal muscle was used in a competitive binding study with acepromazine maleate.

Results

Acepromazine maleate significantly decreased intraurethral pressures in the preprostatic (19%) and pro-static (21%) regions of the urethra. There was no effect on the postprostatic/penile segment. Acepromazine did not inhibit 125l-labeled α-bungarotoxin binding to nicotinic receptors in murine skeletal muscle. Phenoxybenzamine significantly decreased intraurethral pressures (14%) in the preprostatic region of the urethra only.

Conclusions

Acepromazine maleate and phenoxy-benzamine have effects on the smooth muscle of the urethra of healthy, male cats. Acepromazine has no effect on striated muscle.

Clinical Relevance

α-Adrenergic compounds may be used in the pharmacologic management of feline urinary tract disease. (Am J Vet Res 1996;57:1497-1500)

Free access
in American Journal of Veterinary Research

SUMMARY

The effects of the skeletal muscle-relaxing drug dantrolene sodium alone, and in combination with the α1-adrenergic antagonist prazosin, on the urethral pressure profile were investigated in male cats with obstructive lower urinary tract disease. Decreases in mean segmental intraurethral pressure induced by dantrolene (n = 3) or dantrolene in combination with prazosin (n = 3) were evaluated statistically, using a paired design. Statistical analysis was applied to absolute (mm of Hg) pressure values. Intravenous administration of dantrolene alone (1 mg/ kg of body weight, n = 3) significantly decreased pressure in the postprostatic/penile urethral segment, but did not decrease prostatic urethral pressures. Dantrolene in combination with prazosin (0.03 mg/kg, iv) caused a 20% pressure decrease in the prostatic segment (P = 0.060). Preprostatic urethral pressure was not significantly affected by either treatment regimen in the small pool of cats studied. There was no difference in baseline pressures (mm of Hg) in the 3 intraurethral segments of these 6 recently obstructed male cats, compared with historic baseline pressures (mm of Hg) in the 3 intraurethral segments of 28 healthy male cats.

These results indicate that dantrolene and prazosin may be effective in relaxing intraurethral skeletal and smooth musculature in male cats clinically afflicted with obstructive lower urinary tract disease. However, it is not certain that administration of muscle relaxants would facilitate urethral catheterization and removal of the obstruction in male cats with blockage of the lower urinary tract. Strikingly, results of this study suggest that urethral muscle spasm had a minor role in these cats.

Free access
in American Journal of Veterinary Research

Abstract

Objective—To determine the gene sequences of canine and feline cardiac troponin I (cTnI), express the protein from the cloned gene in vitro, and validate the use of a commercial cTnI serum analyzer in these species via detection of the expressed protein or comparison of sequence homology.

Sample Population—Samples of ventricular myocardium from 5 healthy adult mixed-breed dogs and 5 healthy adult domestic shorthair cats.

Procedure—The RNA was extracted from myocardial samples, and cDNA was synthesized via reverse transcriptase polymerase chain reaction and sequenced. The canine cDNA for the coding region was expressed in cell culture and analyzed by western blot and sandwich enzyme-linked immunosorbent assays.

Results—Canine and feline cTnI genes were cloned and sequenced. Homology of the nucleotide and amino acid sequences of the canine and feline cTnI genes with human and rodent cTnI genes were high; the greatest homology was detected between canine and feline genes (95% and 96%, respectively). Recombinant canine cTnI protein was detected by a commercial serum cTnI analyzer and by western blot analysis.

Conclusions and Clinical Relevance—Results indicated that commercial cTnI analyzers can be used to measure serum cTnI concentration from dogs and cats. Additionally, our preliminary characterization of the feline cTnI gene may facilitate further investigation of cTnI and its role in familial hypertrophic cardiomyopathy in cats. ( Am J Vet Res 2004;65:53–58)

Full access
in American Journal of Veterinary Research