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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.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To identify the preferences of small animal veterinary clients for the timing of communication during CPR and whether these clients prefer the veterinarian or pet owner to decide on the termination of resuscitation.

SAMPLE

Surveys (n = 1,648) were completed between January 20 and February 3, 2023, by clients of the Wilford and Kate Bailey Small Animal Teaching Hospital.

METHODS

This cross-sectional observational study used an anonymous internet-based survey distributed to 28,000 clients of an academic small animal veterinary hospital. The survey included 16 questions asking for the respondents’ demographics, healthcare professional status, questions pertaining to CPR, and preference for timing of communication during CPR, veterinary team members to speak to, and the decision on termination of resuscitation. An optional open comment section was provided.

RESULTS

The response rate was 7.5%, including 2,127 responses, with 1,648 complete responses used for further analysis. Of the respondents, 56% and 63% (when asked using a short and long scenario question, respectively) would prefer to be informed about their pet undergoing CPR after CPR has ended. Most clients (84%) wanted the veterinarian to decide when to stop CPR. In the comments section, clients predominantly emphasized that patient care should always be prioritized over client communication.

CLINICAL RELEVANCE

This study contributes to a better understanding of veterinary clients’ preferences and may help improve client communication and decision-making during CPR. More studies are warranted to reach a wider population before broad recommendations can be made.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To describe misoprostol pharmacokinetics and anti-inflammatory efficacy when administered orally or per rectum in endotoxin-challenged horses.

ANIMALS

6 healthy geldings.

PROCEDURES

A randomized 3-treatment crossover design was performed with a minimum washout period of 28 days between treatment arms. Prior to endotoxin challenge (lipopolysaccharide, 30 ng/kg IV over 30 minutes), horses received misoprostol (5 µg/kg once) per os (M-PO) or per rectum (M-PR) or water as control (CON). Clinical parameters were evaluated and blood samples obtained to measure plasma misoprostol free acid concentration, leukocyte counts, and tumor necrosis factor-α (TNFα) and interleukin 6 (IL-6) leukocyte gene expression and serum concentrations.

RESULTS

In the M-PO treatment arm, maximum plasma concentration and area under the concentration-versus-time curve (mean ± SD) were higher (5,209 ± 3,487 pg/mL and 17,998,254 ± 13,194,420 h·pg/mL, respectively) and median (interquartile range) time to maximum concentration (25 min [18 to 34 min]) was longer than in the M-PR treatment arm (854 ± 855 pg/mL; 644,960 ± 558,866 h·pg/mL; 3 min [3 to 3.5 min]). Significant differences in clinical parameters, leukocyte counts, and TNFα or IL-6 gene expression or serum protein concentration were not detected. Downregulation of relative gene expression was appreciated for individual horses in the M-PO and M-PR treatment arms at select time points.

CLINICAL RELEVANCE

Considerable variability in measured parameters was detected among horses within and between treatment arms. Misoprostol absorption and systemic exposure after PO administration differed from previous reports in horses not administered LPS. Investigation of multidose administration of misoprostol is warranted to better evaluate efficacy as an anti-inflammatory therapeutic.

Open access
in American Journal of Veterinary Research