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- Author or Editor: Elizabeth A. Stone x
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Abstract
Objective—To elucidate factors influencing practitioner decisions to refer dogs with cancer to veterinary oncology specialists.
Design—Cross-sectional study.
Sample—2,724 Ontario primary care companion animal veterinarians.
Procedures—Practitioners were invited to participate in a survey involving clinical scenarios of canine cancer patients, offered online and in paper format from October 2010 through January 2011. Analyses identified factors associated with the decision to refer patients to veterinary oncology specialists.
Results—1,071 (39.3%) veterinarians responded, of which 603 (56.3%) recommended referral for dogs with multicentric lymphoma and appendicular osteosarcoma. Most (893/1,059 [84.3%]) practiced within < 2 hours’ drive of a specialty referral center, and most (981/1,047 [93.7%]) were completely confident in the oncology service. Few (230/1,056 [21.8%] to 349/1,056 [33.0%]) were experienced with use of chemotherapeutics, whereas more (627/1,051 [59.7%]) were experienced with amputation. Referral was associated with practitioner perception of patient health status (OR, 1.54; 95% confidence interval [CI], 1.15 to 2.07), the interaction between the client's bond with the dog and the client's financial status, practitioner experience with treating cancer (OR, 2.79; 95% CI, 1.63 to 4.77), how worthwhile practitioners considered treatment to be (OR, 1.66 to 3.09; 95% CI, 1.08 to 4.72), and confidence in the referral center (OR, 2.20; 95% CI, 1. 11 to 4.34).
Conclusions and Clinical Relevance—Several factors influenced practitioner decisions to refer dogs with lymphoma or osteosarcoma for specialty care. Understanding factors that influence these decisions may enable practitioners to appraise their referral decisions and ensure they act in the best interests of patients, clients, and the veterinary profession.
Abstract
OBJECTIVE
To establish the components of a best-practice, baseline companion animal physical exam (CAPE).
SAMPLE
25 small animal veterinary internists and 20 small animal primary care veterinarians, all teaching the CAPE at veterinary colleges in the US, Canada, and Australia.
PROCEDURES
Using the Delphi Method of Consensus, 3 rounds of online questionnaires were sent to participants. The first round included demographic questions, questions about teaching the physical exam, and an open-ended question allowing participants to record details of how they conduct a CAPE. In the second round, participants were asked to rate components of the CAPE, which were derived from round 1, as “always examine,” “only examine as needed,” or “undecided.” Following round 2, any component not reaching 90% consensus (set a priori) for the response “always examine” was put forth in round 3, with a summary of comments from the round 2 participants for each remaining component.
RESULTS
35 components of a baseline CAPE were identified from round 1. The 25 components that reached 90% consensus by the end of round 3 were checking the oral cavity, nose, eyes, ears, heart, pulse rate, pulse quality, pulse synchrony, lungs, respiratory rate, lymph nodes, abdomen, weight, body condition score, mucous membranes, capillary refill time, general assessment, masses, haircoat, skin, hydration, penis and testicles or vulva, neck, limbs, and, in cats only, thyroid glands.
CLINICAL RELEVANCE
The findings establish an expert panel’s consensus on 25 components of a baseline, best-practice CAPE that can be used to help inform veterinary curricula, future research, and the practice of veterinarians.
Abstract
OBJECTIVE To evaluate mean body weight (BW) over the lifespan of domestic cats stratified by breed and sex (including reproductive status [neutered vs sexually intact]).
ANIMALS 19,015,888 cats.
PROCEDURES Electronic medical records from veterinary clinics in the United States and Canada from 1981 to 2016 were collected through links to practice management software programs and anonymized. Age, breed, sex and reproductive status, and BW measurements and measurement dates were recorded. Data were cleaned, and descriptive statistics were determined. Linear regression models were created with data for 8-year-old domestic shorthair, medium hair, and longhair (SML) cats to explore changes in BW over 3 decades (represented by the years 1995, 2005, and 2015).
RESULTS 9,886,899 of 19,015,888 (52%) cats had only 1 BW on record. Mean BW for cats of the 4 most common recognized breeds (Siamese, Persian, Himalayan, and Maine Coon Cat) peaked between 6 and 10 years of age and then declined. Mean BW of SML cats peaked at 8 years and was subjectively higher for neutered than for sexually intact cats. Mean BW of neutered 8-year-old SML cats increased between 1995 and 2005 but was steady between 2005 and 2015.
CONCLUSIONS AND CLINICAL RELEVANCE The large dataset for this study yielded useful information on mean BW over the lifespan of domestic cats. This could be a basis for BW management discussions during veterinary visits. A low frequency of repeated BW measurements suggested a low frequency of repeated veterinary visits, especially after 1 year of age, making engagement of cat owners in the health of their animals particularly relevant.
Abstract
Objective—To evaluate the content aspects of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer.
Design—Qualitative analysis of data acquired during in-person single and dyadic interviews.
Sample—43 dog owners participating in 30 interviews.
Procedures—Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions.
Results—For the clients, the central qualification was that the information given had to be the truth. Information was expected about all aspects of their dog's cancer and its treatment, varying in relation to clients’ basic understanding of cancer, their previous experience with cancer, and their information preferences. Provision of information generated the trust and confidence necessary to engage in treatment, the ability to make informed decisions, and the ability to be prepared for the future. Provision of information also engendered a sense of control and capability and fostered hope.
Conclusions and Clinical Relevance—When dealing with owners of dogs with life-limiting cancer, results indicated that in addition to abiding by the principle of truth-telling, it is important for health-care service providers to ascertain clients’ understanding of and experiences with cancer as well as their information preferences and thereby adopt a tailored approach to information giving. Provision of information enabled client action and patient intervention but also enhanced clients’ psychosocial well-being. Veterinary healthcare service providers can purposely provide information to build and sustain clients’ ability to successfully cope with their pet's condition.
Abstract
OBJECTIVE
To describe veterinarians’ communication of the companion animal physical exam (CAPE) to veterinary clients and to identify factors associated with the number of physical exam components communicated by veterinarians to clients.
SAMPLE
376 video-recorded veterinarian-client-patient interactions, involving 60 veterinarians.
PROCEDURES
18 CAPE components were studied in relation to veterinarians’ use of 7 communication-related parameters. A mixed linear regression model was used to assess veterinarian, patient, and appointment factors associated with the number of components conveyed by a veterinarian.
RESULTS
Veterinarians conveyed 1,566 of 2,794 (56.1%) of the components that they examined to clients, as having been examined. Of those components that were examined and conveyed by veterinarians, the impact of the finding was communicated for 496 of 1,566 (31.7%) of the components. Visual aids and take-home literature were each used in relation to an examined component during 15 of the 376 interactions (4%). A significant association was found between number of CAPE components conveyed and gender of the veterinarian (females conveyed 1.31 more), as well as the type of appointment (2.57 more were conveyed in wellness appointments and 1.37 more in problem appointments, compared to rechecks).
CLINICAL RELEVANCE
Findings identify an opportunity for veterinarians to further emphasize components of the CAPE, which may in turn increase clients’ perceived value of the CAPE due to understanding the benefits for their pet. This may be accomplished with the Talking Physical Exam, in which veterinarians discuss CAPE components findings with clients in real time, and the relevance of the findings to the patient’s health.
Abstract
Objective—To describe the process aspects (communication) of the information expectations of clients accessing oncology care services at a tertiary referral center for dogs with life-limiting cancer.
Design—Qualitative analysis of data acquired during in-person single and dyadic interviews.
Sample—43 dog owners participating in 30 interviews.
Procedures—Independent in-person interviews were conducted with standardized open- and closed-ended questions from April to October 2009. Thematic analysis was performed on transcripts of the interview discussions.
Results—The participants expected information to be communicated in a forthright manner; in multiple formats; with understandable language; in an unrushed environment wherein staff took the time to listen, answer all questions, and repeat information when necessary; on a continuous basis, with 24-hour access to address questions or concerns; in a timely manner; with positivity; with compassion and empathy; with a nonjudgmental attitude; and through staff with whom they had established relationships.
Conclusions and Clinical Relevance—Results indicated that the manner in which information is communicated is vitally important to clients of dogs with life-limiting cancer in that it not only facilitates comprehension but also creates a humanistic environment from which clients derive the psychosocial support needed to successfully cope with their pet's condition.
Abstract
Objective—To determine clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in cats with ureteral calculi.
Design—Retrospective study.
Animals—163 client-owned cats.
Procedure—Medical records were reviewed, and information on signalment, history, clinical signs, and results of clinicopathologic testing and diagnostic imaging was obtained.
Results—The number of cats in which ureterolithiasis was diagnosed each year increased progressively during the study period. Clinical signs tended to be nonspecific and included inappetence, vomiting, lethargy, and weight loss. A combination of survey radiography and abdominal ultrasonography revealed ureteral calculi in 66 of 73 (90%) cats in which the diagnosis was confirmed at surgery or necropsy. Ultrasonography revealed that ureteral calculi were causing ureteral obstruction in 143 of 155 (92%) cats. One hundred thirty-four of 162 (83%) cats had azotemia, 84 of 156 (54%) had hyperphosphatemia, and 22 of 152 (14%) had hypercalcemia. Urinary tract infection was documented in 10 of 119 (8%). Fifty-eight of 76 (76%) cats with unilateral ureterolithiasis had azotemia and 33 (43%) had hyperphosphatemia, indicating impairment of renal function in the contralateral kidney or prerenal azotemia. Ultrasonographic imaging of the contralateral kidney in cats with unilateral ureteral calculi suggested that preexisting renal parenchymal disease was common in cats with ureterolithiasis. Ninety-one of 93 (98%) ureteral calculi contained calcium oxalate.
Conclusions and Clinical Relevance—Results suggest that abdominal imaging should be performed in all cats with chronic nonspecific signs or with acute or chronic renal failure to rule out ureterolithiasis. Preexisting renal disease may be common in cats with ureteral calculi. (J Am Vet Med Assoc 2005;226: 932–936)
Abstract
Objective—To determine outcome of medical and surgical treatment in cats with ureteral calculi.
Design—Retrospective study.
Animals—153 cats.
Procedure—Medical records were reviewed. Owners and referring veterinarians were contacted for follow-up information.
Results—All cats were initially treated medically before a decision was made to perform surgery. Medical treatment included parenteral administration of fluids and diuretics to promote urine production and passage of the ureteral calculus and supportive treatment for renal failure. Ureteral calculi in the proximal portion of the ureter were typically removed by ureterotomy, whereas ureteral calculi in the distal portion of the ureter were more likely to be removed by partial ureterectomy and ureteroneocystostomy. Ureterotomy could be performed without placement of a nephrostomy tube for postoperative urine diversion. Postoperative complication rate and perioperative mortality rate were 31% and 18%, respectively. The most common postoperative complications were urine leakage and persistent ureteral obstruction after surgery. Chronic renal failure was common at the time of diagnosis and continued after treatment, with serum creatinine concentration remaining greater than the upper reference limit in approximately half the cats. Twelve-month survival rates after medical and surgical treatment were 66% and 91%, respectively, with a number of cats dying of causes related to urinary tract disorders, including ureteral calculus recurrence and worsening of chronic renal failure.
Conclusions and Clinical Relevance—Results suggest that medical and surgical management of ureteral calculi in cats are associated with high morbidity and mortality rates. Treatment can stabilize renal function, although many surviving cats will continue to have impaired renal function. (J Am Vet Med Assoc 2005;226:937–944)
