Making decisions is the central task of clinical veterinary practice. Performing surgery and other manual skills and communicating with colleagues and clients are important, but there is nothing we do as often or that is ultimately as central to clinical medicine as making decisions. However, veterinarians and veterinary students receive little, if any, formal training in decision making, and there is little explicit discussion in the veterinary literature about this critical activity.
When evaluating a patient, we need to characterize the clinical situation on at least three levels. First, we need to interpret the clinical problem in terms of its
A 13-year-old castrated male mixed-breed dog weighing 33.6 kg (73.9 lb) was evaluated for a history of bilateral, gradually progressive hind limb weakness, reluctance to climb stairs or jump, and intermittent mild left hind limb lameness. The dog had a previous history of severe left-sided hip joint osteoarthritis and dysplasia diagnosed via radiography at 7 years of age; an acute rupture of the right cranial cruciate ligament at 8 years of age, which was treated successfully with a tibial plateau leveling osteotomy (TPLO); and atopy with intermittent mild to moderate pruritus and superficial pyoderma that was well controlled with
Over the past 2 decades, the concepts, methods, and terminology of EBM have come to dominate human medicine. Health-care institutions and physicians have come to recognize that clinical decisions made on the basis of individual experience, intuition, tradition, reasoning from basic principles, and the advice and opinions of respected clinicians and teachers are less reliable than those based on high-quality clinical research and, as a result, have begun to rely on the principles and techniques of EBM as an aid to clinical decision making. The same shift is happening, albeit at a somewhat slower pace, in veterinary medicine. Although veterinarians
Aging is the single most important cause of disease, disability, and death in companion animal species. Contrary to the common view of aging as mysterious and inevitable, it is more usefully understood as a set of complex but comprehensible and modifiable biological processes that are highly conserved across species. The purpose of this Currents in One Health manuscript is to describe key mechanisms of aging at the cellular and molecular level and the manifestations of these in the tissues of the musculoskeletal system, adipose, and the brain. The characteristics of these processes as identified in common laboratory animal models and in humans will be described and compared with the much more limited information available concerning aging in dogs and cats. This will highlight important targets for future research in these species. The consistent patterns across species in the hallmarks of aging and their manifestations at the level of tissues, organ systems, and individual animals signify potential targets for interventions to mitigate the negative health impacts of aging and extend both life span and health span (the period of life free of significant disease or disability). Further research to elucidate aging mechanisms in companion dogs and cats will eventually support development, testing, and implementation of clinical therapies to prevent and ameliorate age-related dysfunction, disease, and death.
“Cured yesterday of my disease, I died last night of my physician.”
–Matthew Prior, 1714
Veterinarians are generally well aware of the risks of misdiagnosis (incorrectly identifying a patient's disease or diagnosing a disease the patient does not have) and missed diagnosis (failing to detect a disease present in a patient). Misdiagnoses and missed diagnoses can lead to direct patient harm from inappropriate treatment, harm due to a delay in obtaining a correct diagnosis and rendering appropriate treatment, and increased costs. However, there seems to be little discussion in the veterinary literature or veterinary curriculum of the problem of overdiagnosis
Aging is the single most important cause of disease, disability, and death in adult dogs. Contrary to the common view of aging as a mysterious and inevitable natural event, it is more usefully understood as a set of complex but comprehensible biological processes that are highly conserved across species. Although the phenotypic expression of these processes is variable, there are consistent patterns both within and between species.
The purpose of this feature is to describe the patterns currently recognized in the physical and behavioral manifestations of aging in the dog and how these impact the health and welfare of companion dogs and their human caregivers. Important gaps in our knowledge of the canine aging phenotype will be identified, and current research efforts to better characterize aging in the dog will be discussed. This will help set the context for future efforts to develop clinical assessments and treatments to mitigate the negative impact of aging on dogs and humans.
Veterinary professionals work daily to prevent and relieve animal suffering and promote animal health and welfare. Accomplishing this means making safe, effective, and economic veterinary care available and accessible to as many animal owners as possible.
Cost is a barrier to access to care, and a pet owner's financial limitations may force decisions that are against the best interest of the pet's well-being. Between 1998 and 2011, a steady increase was observed in the proportion of owned pets in the United States that received no health care from a veterinary practice, from 32% to 45% for cats and 15% to