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- Author or Editor: Mark Rishniw x
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Abstract
Cats with hypertrophic cardiomyopathy (HCM) have a risk of developing aortic thromboembolism (ATE). Clopidogrel reduces the risk of redeveloping ATE and delays recurrence of ATE in cats that have experienced an ATE episode. Consequently, cardiologists have recommended administering clopidogrel to cats as a primary preventative, suggesting that all cats with severe HCM be administered clopidogrel. However, clopidogrel is unpalatable in its manufactured format, making such administration problematic for many clients. Therefore, estimating the potential benefit of administration might help clinicians determine on a case-by-case basis the need to treat cats with clopidogrel. Relatively simple statistical analyses of currently available data, along with certain assumptions and extrapolations, allow such an estimation of benefit in terms of relative and absolute risk reduction conferred by clopidogrel. Using this approach, and provided certain assumptions are true, clopidogrel likely confers a reduction in risk of ATE in cats with moderate to severe HCM of approximately 3% to 4%. Given the difficulty of administering clopidogrel to cats, clinicians should weigh these relatively small potential benefits against the potential harms (difficulty of administration) and not necessarily insist that clients administer clopidogrel.
Abstract
OBJECTIVE
To examine preferences of veterinary clinical pathologists, clinicians, and students for cytology report formats.
SAMPLE
24 clinical pathologists, 1,014 veterinarians, and 93 veterinary students who were members of the Veterinary Information Network.
METHODS
Members of the Veterinary Information Network responded to an online survey invitation, made available between July 11, 2023, and July 24, 2023. Respondents were randomly directed to 1 of 4 sets of cytology reports, each containing a traditional narrative format, narrative format with terms expressing a degree of confidence and associated numerical ranges, and template format with similar estimates of confidence. Respondents ranked the reports in order of preference and then provided comments about their top-ranked choice. Responses were analyzed mostly with descriptive statistics or comparisons of proportions.
RESULTS
14 of 24 clinical pathologists preferred the traditional narrative format, whereas 449 of 1,042 veterinary clinicians and veterinary students preferred the template format. Respondents (460/1,131) ranked the template format as most preferred, but the narrative format with terms expressing a degree of confidence ranked highest overall. Many respondents appeared to misunderstand the degree of confidence estimates being expressed numerically. Respondents choosing each format often stated that their preferred choice was “easiest to understand” and “most comprehensive.”
CLINICAL RELEVANCE
Given the preferences of veterinary clinicians and veterinary students for a template format, clinical pathologists should consider modifying the way they report evaluations of cytologic specimens. Template formats should help standardize reporting of cytologic specimens, thereby improving communication between clinical pathologists and clinicians. However, both clinicians and clinical pathologists need to better understand the purpose of terminology expressing degrees of confidence in such reports.
Abstract
OBJECTIVE
To compare and contrast the views of benefits and general work conditions of participants working in corporate hospitals compared to those working in privately owned hospitals.
SAMPLE
Veterinary members of the Veterinary Information Network (VIN) working as associate veterinarians in corporate- or privately owned hospitals.
METHODS
An electronic survey distributed via the VIN data collection portal.
RESULTS
A total of 896 responses from associate veterinarians working full time were received, of which 286 (31.9%) reported working in private practice and 610 (68.1%) in corporate practice. Fifty-five percent of participants indicated a preference for working in private practice compared to 12% preferring corporate practice. Veterinarians working in corporate practice were more likely to report receiving insurance (health, dental, life, and short-term disability), mental wellness programs (eg, counseling), wellness mobile apps, VIN membership, and continuing education paid by their employer than those working in privately owned practices. However, participants in private practice reported higher satisfaction with feeling known as an individual by upper management, hospital culture, the ability to fire difficult or abusive clients, and mentorship. Those working in corporate practices reported feeling more pressure than those in private practice to generate revenue and see more clients per shift.
CLINICAL RELEVANCE
There are positives and negatives of corporate-owned hospitals when compared to privately owned practices. Corporate hospitals may be well positioned to make large organizational-level changes that can improve work culture and, as a result, the well-being and retention of small animal practitioners.
Abstract
OBJECTIVE
Explore relief and mobile veterinarians’ views and experiences related to their current job. In addition, examine reasons why these veterinarians opted to pursue careers in relief and mobile practice.
SAMPLE
Veterinary members of the Veterinary Information Network working as relief or mobile veterinarians.
METHODS
An electronic survey distributed via the Veterinary Information Network data collection portal from May 11, 2023, through May 30, 2023.
RESULTS
A total of 444 responses were collected (125 veterinarians in mobile practice and 240 relief veterinarians). Factors most commonly reported to have a strong effect on mobile or relief veterinarians’ decision to leave their previous job included administration, hospital culture, leadership, feeling their voice was heard, and workplace schedule factors. The majority of mobile and relief practitioners reported feeling satisfied with their work-life balance (mobile, 78%; relief, 91%) as well as availability for children (mobile, 84%; relief, 84%) and other family members (mobile, 85%; relief, 87%).
CLINICAL RELEVANCE
The majority of mobile and relief practitioners who participated in this survey reported feeling satisfied or very satisfied with managing their work and life, in their ability to be present and available for their children, and having opportunity to support and care for elderly family members and those with medical needs. As the field of veterinary medicine becomes increasingly feminized, schedule flexibility and work-life balance will likely increase in importance, making careers in nonpractice settings more desirable. Traditional brick-and-mortar clinics should note that dissatisfaction with administration and office/hospital culture might drive their employees to pursue other career avenues such as relief or mobile practice.
Abstract
OBJECTIVE
Clinicians commonly use thyroid-stimulating hormone (TSH) concentrations to diagnose thyroid disorders in humans and dogs. In cats, canine TSH chemiluminescent immunoassays (CLIA) assays are commonly used to measure TSH, but these TSH-CLIAs cannot measure low TSH concentrations (< 0.03 ng/mL) and therefore cannot distinguish between low-normal concentrations and truly low TSH concentrations (characteristic of hyperthyroidism). Our aim was to evaluate a novel TSH assay based on bulk acoustic wave (BAW) technology that has lower functional sensitivity (0.008 ng/mL) than TSH-CLIAs.
ANIMALS
169 untreated hyperthyroid cats, 53 cats treated with radioiodine (131I), 12 cats with chronic kidney disease (CKD), and 78 clinically healthy cats.
METHODS
Serum concentrations of T4, TSH-CLIA, and TSH-BAW were measured in all cats. Untreated hyperthyroid cats were divided into 4 severity groups (subclinical, mild, moderate, and severe), whereas 131I-treated cats were divided into euthyroid and hypothyroid groups.
RESULTS
Test sensitivity, specificity, and positive predictive value for identifying hyperthyroidism were higher for TSH-BAW (90.5%, 98.9%, and 86.9%) than TSH-CLIA (79.9%, 76.7%, and 21.7%; P < .001). Test sensitivity for identifying 131I-induced hypothyroidism was only 45.5% for T4 versus 100.0% for both TSH-CLIA and TSH-BAW (P = .03), whereas TSH-BAW had a higher positive predictive value (100%) than did either TSH-CLIA (81.2%) or T4 (71.9%).
CLINICAL RELEVANCE
Serum TSH-BAW alone or together with T4 is a highly sensitive and specific diagnostic test for evaluating feline hyperthyroidism and iatrogenic hypothyroidism. Finding low serum TSH-BAW concentrations is most useful for diagnosing subclinical and mild hyperthyroidism, in which serum T4 remains within or only slightly above the reference interval.
Abstract
OBJECTIVE
To assess attempts to proficiency of experienced veterinary surgeons for 2 surgical tasks when using a robotic simulator (Mimic dV-Trainer; Surgical Sciences) and determine factors associated with the successful performance of these tasks.
METHODS
Veterinary surgeons with rigid, minimally invasive surgery experience performed 2 tasks (“pick and place” and “knot the ring 1”) using the simulator until they attained proficiency. Individual performance variables were recorded. The number of attempts to proficiency was recorded. Performance variables were also assessed for effect on proficiency by the Kendall tau correlation and hierarchical multiple linear regression. The study period was from July 25, 2022, through December 14, 2022.
RESULTS
The 18 surgeons enrolled required a median of 8.5 attempts (95% CI, 7 to 12; range, 6 to 22) to reach proficiency for the basic task versus 27 attempts (95% CI, 21 to 38; range, 10 to 63) for the advanced task. Surgeons took a median of 6 minutes (range, 3 to 11 minutes) to complete training for the basic task and 12 minutes (range, 4 to 46 minutes) for the advanced task. The number of attempts to reach proficiency correlated strongly with economy of motion (tau = 0.72), instrument collisions (tau = 0.72), and time to completion (tau = 0.96).
CLINICAL RELEVANCE
Although experienced surgeons required a high number of attempts to gain proficiency in robotic simulator tasks, they did achieve proficiency quickly, encouraging future investigations into their use for training. Specific motion metrics were identified which improved efficiency during training.
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.
Abstract
OBJECTIVE
To compare the differences in the healing of surgically created full-thickness wounds in dogs treated with a novel extracellular matrix (ECM) dressing as compared with a standard wound management protocol and to investigate the effect of antibiotics in these 2 populations.
ANIMALS
15 purpose-bred Beagles, 8 female spayed and 7 males neutered, operated on, and monitored between March 14, 2022, and April 18, 2022.
METHODS
Four 2 X 2-cm full-thickness skin wounds were created on the trunks of each dog. The right-sided wounds were treated with the novel ECM wound dressing, and the left-sided wounds served as the controls. Wound planimetry and qualitative wound scores were obtained at 12 time points. Wound biopsies for histopathologic assessment of wound repair and wound inflammation were obtained at 6 time points.
RESULTS
Wounds treated with ECM had higher percent epithelization at days 7, 9, 12, and 18 postoperatively (P < .001) and better histologic repair scores (P = .024) than wounds treated by the standard protocol. Subjective wound assessment scores of wounds treated with ECM did not differ from those treated by the standard protocol at any time point.
CLINICAL RELEVANCE
Wounds treated with the novel ECM dressing epithelialized more rapidly than wounds treated by a standard protocol.