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- Author or Editor: Mark Rishniw x
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Abstract
Occult feline hypertrophic cardiomyopathy (HCM) can result in unexpected sudden death or congestive heart failure (CHF) following routine interventions such as anesthesia, fluid administration, or, potentially, administration of corticosteroids. Consequently, clinicians would like to be able to screen at-risk cats to detect occult HCM and either avoid the risky intervention or attempt to reduce the risk of death or CHF. Currently, the feline N-terminal-proBrain natriuretic peptide test is the only potential screening test for detecting occult HCM. However, some cardiologists have pointed out the poor sensitivity of the test precludes its use as a screening test. This interpretation appears somewhat flawed. Using the current rapid test will allow clinicians to correctly identify half of the cats with moderate-to-severe occult HCM. A small number of cats without HCM will also test positive, necessitating an ultimately needless echocardiographic evaluation to demonstrate their disease-free status. However, the low prevalence of HCM in the general cat population and the apparently much lower rate of adverse events than would be predicted brings into question whether clinicians should bother screening. Therefore, until a more sensitive and accurate screening test becomes available, clinicians will have to decide for themselves whether identifying half of the at-risk cats of sudden death and CHF with this test is better than identifying none of them.
Abstract
OBJECTIVE To describe the occurrence and management of reflex epilepsy (ie, seizure activity triggered by exposure to specific locations or situations) in dogs.
DESIGN Retrospective case series.
ANIMALS 43 client-owned dogs.
PROCEDURES Discussions by veterinarians participating in the Veterinary Information Network online community for the years 2000 through 2014 were reviewed to identify dogs with a diagnosis of reflex epilepsy and seizure activity in response to stimuli. History, signalment (including age at onset), the specific stimulus or stimuli that provoked seizures, treatments, and any concurrent neurologic diagnoses were recorded.
RESULTS A variety of breeds were affected. Median age at onset was 5 years (range, 3 months to 11 years). Reflex seizures were reported as being repeatedly triggered by visits to a veterinary clinic (35/43 dogs), grooming facility (24/43 dogs), or boarding facility (13/43 dogs) and, less commonly, by other situations (eg, pet store or car ride). Over half of the dogs (24/43) had multiple triggers. Eight (19%) dogs had seizures at other times that were not induced by location or a specific situation. A variety of sedatives and maintenance antiepileptic drugs administered to affected dogs failed to prevent the stimulus-specific seizure activity.
CONCLUSIONS AND CLINICAL RELEVANCE Results of the present study suggested that seizures provoked by specific situations or locations occur in dogs with reflex epilepsy and that common triggers were visits to veterinary and grooming facilities. Further studies are necessary to elucidate the characteristics of reflex epilepsy in dogs and to determine the most effective means to manage these patients.
Abstract
OBJECTIVE
Assess US veterinarians’ perceptions regarding vaccine concerns (their own and owners’) and the association between owners’ vaccine concerns and COVID-19 antivaccination sentiments.
SAMPLE
Members of the Veterinary Information Network.
PROCEDURES
An electronic survey distributed via the Veterinary Information Network data collection portal.
RESULTS
1,341 US veterinarians completed the survey. Top veterinarian concerns for vaccinating a healthy adult dog were anaphylaxis, soreness at injection site, and lethargy; for cats, these concerns included vaccine-associated sarcoma, lethargy, and soreness at injection site. Veterinarians reported that the most common concerns mentioned by owners included that the pet does not go outside, that vaccinations are unnecessary, that vaccinations can lead to chronic or severe illness, and cost. Veterinarians reported an increased number of dog and cat owners reluctant about or resistant to the idea of rabies vaccines and core vaccines since the time that COVID-19 vaccines became widely available. There was an association between veterinarians’ perceptions of local COVID-19 antivaccination sentiments and the increase in the number of vaccine-resistant or -concerned clients.
CLINICAL RELEVANCE
There appears to be little overlap between veterinarians’ primary concerns related to vaccinations and their perception of dog and cat owners’ primary concerns. The fact that the number of resistant clients is positively associated with the presence of veterinarians’ perceptions of a local COVID-19 antivaccination sentiment suggests that human antivaccination sentiments impact pet owners’ views of companion animal vaccinations. A better understanding of the cognitive biases that impact owners’ vaccine decisions can help veterinarians better communicate with vaccine-reluctant clients and increase vaccination compliance rates.
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
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
To examine the probability estimates for modifying terms used by clinical pathologists when interpreting cytologic samples and compare these to probability estimates assigned to these terms by clinicians, and to provide restricted, standardizing terms used in cytology reports.
SAMPLE
49 clinical pathologists and 466 Veterinary Information Network members responded to 2 similar surveys.
PROCEDURES
Online surveys were distributed to diplomates of the European College of Veterinary Clinical Pathologists and clinician members of the Veterinary Information Network, made available between March 17, 2022, through May 5, 2022. Respondents assigned a range of probabilities to each of 18 modifier terms used by clinical pathologists to denote probability associated with diagnoses; clinicians identified terms that would affect their treatment decisions in cases of canine lymphoma. Respondents then provided thoughts about restricting and standardizing modifying terms and assigning numeric estimates in reports.
RESULTS
49 clinical pathologists and 466 clinicians provided responses. For many terms, probability ranges agreed between the 2 groups. However, differences in estimated probability inferred by a term existed for at least 6 terms. Modifying terms could be restricted to 7 largely nonoverlapping terms that spanned the range of probabilities. Clinicians preferred having numeric estimates of probability, but clinical pathologists resisted providing such estimates in reports.
CLINICAL RELEVANCE
Reducing and standardizing the number of modifying terms to reflect specific probability ranges would reduce disagreement between the clinical pathologist’s intended probability range and the clinician’s interpretation of a modifying term. This could result in fewer errors in interpretation and better patient care.
Abstract
OBJECTIVE
The term asymptomatic and its antonyms symptomatic and symptom apply exclusively to humans. However, veterinarians commonly use these terms instead of subclinical and clinical. We examined the use of these terms to determine how, by whom, and in what context they are used.
SAMPLE
Veterinary articles on PubMed.
PROCEDURES
We searched PubMed for the terms asymptomatic, subclinical, and symptomatic within the title and abstract or as MeSH terms, restricting the search to veterinary (nonhuman) species, and downloaded and categorized each article based on species, topic, field of study, and presumed primary language of the authors. We noted whether the term appeared in the title or abstract or as a MeSH term and described the frequencies of use of these terms within each category.
RESULTS
The term asymptomatic appeared in 2,248 entries, mostly in the title or abstract. The term symptomatic appeared in 956 entries, also mostly in the title or abstract. Non-English–speaking authors used asymptomatic but not symptomatic relatively more frequently in the past decade. Certain fields of study, or disease specialties, used the terms more frequently; conversely, other fields of study, or specific journals, avoided the terms.
CLINICAL RELEVANCE
Authors of articles about animals use the term asymptomatic interchangeably with subclinical and symptomatic interchangeably with clinical. Distinct language cultures appear to exist within different veterinary fields. However, no ambiguity appears to exist with the use of these terms. Therefore, asymptomatic is the same as subclinical and symptomatic is the same as clinical in the veterinary lexicon. Both terms should be equally acceptable.
Abstract
OBJECTIVE
Assess veterinarians’ reported levels of moral distress and professional well-being. Determine the predictive value of moral distress, controlling for demographic factors, on veterinarians’ levels of Professional Fulfillment, Work Exhaustion, Disengagement, and Burnout.
SAMPLE
Members of the Veterinary Information Network.
PROCEDURES
An electronic survey distributed via the Veterinary Information Network data collection portal.
RESULTS
A total of 1,919 veterinarians completed the survey. For both associates and owners, gender and age were significant predictors of moral distress with younger female veterinarians reporting higher levels of distress than older male veterinarians. For associates, age was a positive predictor and moral distress score was a negative predictor of Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors for Work Exhaustion. For Interpersonal Disengagement and Burnout, age was a negative predictor and moral distress score was a positive predictor. For owners, age was a positive predictor and moral distress score was a negative predictor for Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors of Work Exhaustion, Interpersonal Disengagement, and Burnout.
CLINICAL RELEVANCE
We found that, controlling for age and gender, higher levels of moral distress predicted lower levels of Professional Fulfillment and higher levels of Work Exhaustion, Interpersonal Disengagement, and Burnout. Given the prevalence of moral distress and its impact on mental health, it is imperative that the veterinary field provide training and education on how to recognize and navigate ethical conflicts.
Abstract
OBJECTIVE To determine small animal veterinarians’ opinions and actions regarding costs of care, obstacles to client education about veterinary care costs, and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout.
DESIGN Cross-sectional survey.
SAMPLE 1,122 small animal practitioners in the United States and Canada.
PROCEDURES An online survey was sent to 37,036 veterinarians. Respondents provided information regarding perceived effects of client awareness of costs and pet health insurance coverage on various aspects of practice, the influence of client economic limitations on professional satisfaction and burnout, and proposals for addressing those effects.
RESULTS The majority (620/1,088 [57%]) of respondents indicated that client economic limitations affected their ability to provide the desired care for their patients on a daily basis. Approximately half (527/1,071 [49%]) of respondents reported a moderate-to-substantial level of burnout, and many cited client economic limitations as an important contributing factor to burnout. Only 31% and 23% of respondents routinely discussed veterinary costs and pet insurance, respectively, with clients before pets became ill, and lack of time was cited as a reason for forgoing those discussions. Most respondents felt improved client awareness of veterinary costs and pet health insurance would positively affect patient care and client and veterinarian satisfaction.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested most small animal practitioners believe the veterinary profession needs to take action at educational and organizational levels to inform pet owners and educate and train veterinary students and veterinarians about the costs of veterinary care.
