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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
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
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.
