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in Journal of the American Veterinary Medical Association

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.

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in Journal of the American Veterinary Medical Association
Author: Mark Rishniw

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.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To evaluate the diagnostic utility of ECGs acquired with a smartphone-based device, compared with reference 6-lead ECGs, for identification of heart rate and rhythm in dogs and cats.

DESIGN Prospective study.

ANIMALS 51 client-owned dogs and 27 client-owned cats.

PROCEDURES Patients examined by a small animal referral cardiology service between April 2012 and January 2013 were enrolled consecutively. In each patient, a 30-second ECG was simultaneously acquired with a smartphone-based device (a bipolar, single-lead recorder coupled to a smartphone with an ECG application) and a standard 6-lead ECG machine. Recordings were evaluated by 3 board-certified cardiologists, and intra- and interobserver agreement were evaluated for both rhythm diagnosis and QRS polarity identification.

RESULTS Values for instantaneous and mean heart rates for the smartphone-acquired and reference ECGs were within 1 beat of each other when mean heart rates were calculated. Intraobserver agreement for rhythm assessment was very high, with maximum disagreement for any observer for only 2 of 51 dogs and only 4 of 27 cats. There was minimal disagreement in the polarity of depolarization between the smartphone-acquired and reference ECGs in dogs but frequent disagreement in cats. Interobserver agreement for smartphone-acquired ECGs was similar to that for reference ECGs. with all 3 observers agreeing on the rhythm analysis and minimal disagreement on polarity.

CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that ECGs acquired with the smartphone-based device accurately identified heart rate and rhythm in dogs and cats. Thus, the device may allow veterinarians to evaluate and manage cardiac arrhythmias relatively inexpensively at the cage side and could also allow clinicians to rapidly share information via email for further consultation, potentially enhancing patient care.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To assess small animal general practice veterinarians' use and perceptions of synchronous video-based telemedicine before and during the coronavirus disease 2019 (COVID-19) pandemic.

SAMPLE

550 respondent veterinarian members of the Veterinary Information Network (VIN).

PROCEDURES

An anonymous online survey was used to gather data from VIN-member veterinarians in small animal general practice regarding their perceptions and use of synchronous video-based telemedicine. Two emails to all VIN members were used to distribute the web-based questionnaire. For consistency, only responses from North American veterinarians who reported working in small animal general practice were included in analyses. Responses were collected between September 28, 2020, and October 21, 2020.

RESULTS

There were 69,488 recipients and 680 respondents (1.0% response rate), 550 of whom had North American internet protocol addresses and reported working in small animal general practice. Not all respondents answered all questions. Use of video-based telemedicine substantially increased among respondents during the COVID-19 pandemic, and most (86/130 [66.2%]) reported little to no difficulty in adopting videoconferencing. Respondents also reported that telemedicine took less time (61/135 [45.2%]) and resulted in less financial compensation (103/135 [76.3%]) than in-person consultation. Several respondents reported concerns regarding legal issues and potential inferiorities of telemedicine.

CONCLUSIONS AND CLINICAL RELEVANCE

Our results indicated that a substantial proportion of respondents incorporated synchronous video-based telemedicine into their practices during the COVID-19 pandemic. Despite low perceived difficulty in adopting videoconferencing telemedicine, many planned to discontinue it for some clinical applications once the pandemic is over. Further research is required to elucidate the perceptions and challenges in successful use of veterinary telemedicine.

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in Journal of the American Veterinary Medical Association

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.

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in Journal of the American Veterinary Medical Association

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.

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in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

Quality assurance is an implied concept inherent in every consumer's purchase of a product or service. In laboratory testing, quality assurance encompasses preanalytic (sampling, transport, and handling prior to testing), analytic (measurement), and postanalytic (reporting and interpretation) factors. Quality-assurance programs require that procedures are in place to detect errors in all 3 components and that the procedures are characterized by both documentation and correction of errors. There are regulatory bodies that provide mandatory standards for and regulation of human medical laboratories. No such regulations exist for veterinary laboratory testing. The American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards Committee was formed in 1996 in response to concerns of ASVCP members about quality assurance and quality control in laboratories performing veterinary testing. Guidelines for veterinary laboratory testing have been developed by the ASVCP. The purpose of this report was to provide an overview of selected quality-assurance concepts and to provide recommendations for quality control for in-clinic biochemistry testing in general veterinary practice.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To assess the prevalence of medical errors (specifically, near misses [NMs] and adverse events [AEs]) and their personal and professional impact on veterinarians.

DESIGN Cross-sectional study.

SAMPLE Members of the Veterinary Information Network (n = 46,481).

PROCEDURES An electronic survey regarding veterinarians' experiences with NMs and AEs was distributed via email to an online veterinary community between September 24 and October 21, 2015. Responses were summarized and compared between genders by means of the χ2 test.

RESULTS 606 veterinarians completed the survey (1.3% response rate). Overall, 447 (73.8%) respondents reported involvement in ≥ 1 NM (n = 389 [64.2%]) or AE (179 [29.5%]). The NMs had a short-term (≤ 1 week) adverse impact on professional life for 68.0% (261/384) of respondents and longer-term negative impact for 36.4% (140/385). The impact on respondents' personal lives was similar (63.6% [245/385] and 33.5% [129/385], respectively). For AEs, these numbers were 84.1% (148/176), 56.2% (99/177), 77.8% (137/176), and 50.6% (89/175), respectively. Both NMs and AEs were more likely to negatively impact female veterinarians than male veterinarians.

CONCLUSIONS AND CLINICAL RELEVANCE These findings suggested that many veterinarians experience emotional distress after a medical error. Support should be provided to mitigate this adverse impact on the wellbeing of veterinarians and, potentially, their future patients.

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in Journal of the American Veterinary Medical Association