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    Dr. Heather Loenser, AAHA senior veterinary officer, speaks during the first keynote address at Connexity. (Courtesy of AAHA)

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    Acorn Animal Hospital in Franklin, Massachusetts, is enrolled in the American Veterinary Medical Foundation's Veterinary Care Charitable Fund. The practice frequently holds fundraisers, including a Paint Your Pet event, to put toward the program. (Courtesy of Lisa Miracle)

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    Horses are rescued from floodwaters unleashed by Hurricane Florence. (Courtesy of North Carolina State University CVM)

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JAVMA News digest

Hurt at work

People working in the veterinary services profession were the second most likely to have nonfatal work-related injuries in 2016.

They are behind only nursing and residential care workers and ahead of truss makers, police officers, and firefighters, according to the Bureau of Labor Statistics. About 12 percent of people in the veterinary services profession reported work-related injuries or illnesses—four times the average for all professions—although the profession had few on-the-job deaths.

Dr. Christa Hale, a senior epidemiologist at the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health, described her own injuries and injury statistics from the veterinary profession during the 2018 AVMA Convention. She presented data indicating clinic staff other than veterinarians—veterinary technicians in particular—are at the highest risk of injury.

And data from the AVMA PLIT indicate about three-quarters of worker's compensation claims the company received in 2014–16 involved animal attacks, with most of those claims representing attacks by cats or dogs.

After injuries stemming from animal attacks, strains and sprains were the second most common injuries for technicians and assistants and third most common for veterinarians, for whom exposure to toxic substances was second.

Veterinary technicians filed about 41 percent of claims, veterinary assistants had 23 percent, and veterinarians had 9 percent. Receptionists, groomers, kennel employees, and others filed the remaining claims.

Across industries, NIOSH statistics indicate people under age 25 are about twice as likely to be treated in an emergency room for a work-related injury as those over 25.

Dr. Hale said young workers tend to have more hazardous jobs, more pressure to work quickly, less experience, and a greater hesitation to speak up about dangers.

Dr. Heather N. Fowler, director of producer and public health for the National Pork Board, said at the AVMA Veterinary Wellbeing Summit this past April that research indicates up to two-thirds of veterinarians and 98 percent of veterinary technicians are injured by animals at some point, and most veterinary workers have been stuck by needles in the past year. But there are also more insidious occupational hazards, she pointed out.

Obstetrics laboratories pose a high risk of zoonotic infections because of the large volumes of fluids in their work, she said. Sound levels in animal shelters regularly exceed 100 dB, and a piglet scream can reach 130 dB. Standards from the Occupational Safety and Health Administration say people should spend less than 15 minutes in a 100 dB environment per day.

Awkward postures, repetitive motion, and vibration also can cause injuries that are more costly than acute ones, Dr. Fowler said.

Dr. John Gibbins, chief veterinary officer of the U.S. Public Health Service Commissioned Corps, is a team leader and epidemiologist in NIOSH. In another presentation at the 2018 AVMA Convention, he said hazards in veterinary clinics can be animal, chemical, electrical, pathogenic, noise-related, or radiation-related, among others. They can be something as simple as blocked exits.

Dr. Gibbins recommends following the hierarchy of controls for hazards—from most to least effective—of elimination, substitution, engineering controls, administrative controls, and personal protective equipment.

Dr. Hale said clinic owners and managers can help protect their workers and create a climate of safety in their practices. Employees should feel safe and free to speak up if they see hazards.

She also recommends wellness and well-being plans to prevent workplace suicides and violence.

A typical veterinarian or practice manager can make a safety and health plan, she said. OSHA's Recommended Practices for Safety and Health Programs can help, but veterinarians may find veterinary industry-focused publications easier to use as starting points.

Condensed from Nov. 1, 2018, JAVMA News

What's in a name?

Two years ago, the National Association of Veterinary Technicians in America formed the Veterinary Nurse Initiative coalition. Its purpose is to unite the profession under a single title—registered veterinary nurse—and push for uniform credentialing requirements and a uniform definition of scope of practice.

Through standardization and increased public awareness of the credentials of registered veterinary nurse, “the profession will make strides towards better recognition, mobility and elevated practice standards, leading to better patient care and consumer protection,” according to the initiative's website.

Early this year, the VNI pursued amendments to veterinary practice acts in Tennessee (HB 2288/SB 2154) and Ohio (HB 501) that would establish the professional title of registered veterinary nurse. Both bills saw fierce opposition from the state nurses associations, and as a result, neither passed.

The VNI hopes to pursue the name change to veterinary nurse in a handful of states in 2019, including Ohio and Tennessee. Indiana is also a likely candidate.

The initiative has so far gained 32 sponsors and supporters, including 17 position statements of support. A few entities have switched to the title “veterinary nurse” in award names or adopted the new title, including Purdue University's veterinary technology program, which has now become its veterinary nursing program.

But it's not all smooth sailing. Janet Haebler, senior associate director of policy and state government affairs for the American Nurses Association, said that while it encourages the efforts of veterinary technicians to standardize their education and licensure, it opposes the title change.

“The issue at hand is the title ‘nurse’ and the connotations and respect that come with that title,” Haebler said.

Condensed from Nov. 15, 2018, JAVMA News

AAHA Connexity takes on topics that keep veterinarians up at night

The American Animal Hospital Association took a radically new approach to its annual conference this year. It forewent scientific subjects in favor of topics in practice management and personal well-being such as improving workplace culture, finding a balance between caring for others and caring for oneself, and marketing a practice's charitable activities.

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Dr. Heather Loenser, AAHA senior veterinary officer, speaks during the first keynote address at Connexity. (Courtesy of AAHA)

Citation: American Journal of Veterinary Research 79, 12; 10.2460/ajvr.79.12.1232

AAHA Connexity, Sept. 12–16 in Denver, was an interactive conference for individuals from AAHA-accredited hospitals, with themes of connecting and community. AAHA limited attendance at Connexity, and the conference attracted a total of 619 attendees.

Dr. Michael Cavanaugh, AAHA chief executive officer, gave an update on AAHA news during the first keynote address. He said the association is closing in on 4,500 accredited practices as members. In October 2016, the association had announced that it was discontinuing hospital membership for nonaccredited practices. As of Sept. 24, the association's membership encompassed a little more than 4,300 accredited practices as well as 5,680 individuals.

Dr. Heather Loenser, AAHA senior veterinary officer, spoke during the first keynote address about the new conference format. “We polled our members to find out what was keeping you up at night,” Dr. Loenser said. “We designed a conference with you in mind.”

Members wanted to learn how to improve workplace culture, increase profitability, manage staff more creatively, decrease drama, and attract new clients. AAHA categorized the concerns into healthy practices, healthy leaders, and healthy teams, and devoted a day to each—along with a last half-day titled “Thank you, go-getters!”

Condensed from Nov. 15, 2018, JAVMA News

Four flea, tick products linked to seizures, ataxia

Four flea and tick products may cause seizures, tremors, and lost coordination in some cats and dogs.

Food and Drug Administration officials have received thousands of reports of adverse events connected with three products—Bravecto, Nexgard, and Simparica—containing drugs in the isoxazoline class. The agency approved a fourth product, Credelio, containing a drug in the class this year.

FDA officials are working with drug makers to add label information about the risk of neurologic events, a Sept. 20 announcement states.

The agency has approved all four products since 2013 for treatment and prevention of flea infestations and treatment and control of tick infestations. They are safe and effective for most pets, but veterinarians should use patient medical histories to decide whether isoxazoline-class drugs are appropriate, the announcement states.

Siobhan DeLancey, who is a spokeswoman for the FDA Center for Veterinary Medicine, said the agency has received about 5,400 reports of adverse events connected with the drugs.

She provided a statement that said agency officials are seeing reports of neurologic events at similar rates across the isoxazoline product class, when those reports are compared with sales data. But the agency is unable to compare among products because it's impossible to know how many of the doses sold have been administered.

Most of the reports involve dogs, but whether the risk is higher in dogs or cats is unknown. Only one of the products—Bravecto—is approved for use in cats.

Condensed from Nov. 15, 2018, JAVMA News

AVMF fund bridges gap between owners in need, veterinary costs

Three years ago, the American Veterinary Medical Foundation launched its Veterinary Care Charitable Fund, a 501(c)(3) nonprofit program for AVMA members that helps practicing veterinarians provide charitable care in cases of financial need, neglect, or abuse.

Dr. Karen L. Davis, AVMF chair, said, “More than 1,000 hospitals (have) enrolled in this valuable program, resulting in increased access to medical care for animals who would otherwise be ineligible for treatment. Administration of the program is provided through the American Veterinary Medical Foundation, which simplifies the process for the practitioner. Truly, the VCCF ‘helps veterinarians help animals.'”

She also pointed out that clinics often have angel funds to cover charity cases that come through the door, but because the fund is a nonprofit organization, contributions are tax-deductible. Donations received by the AVMF fund for a particular clinic can be used at the veterinarian's discretion. The AVMF does not charge an annual fee. Instead, the Foundation withholds a small portion of donated funds to cover the program's administrative costs.

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Acorn Animal Hospital in Franklin, Massachusetts, is enrolled in the American Veterinary Medical Foundation's Veterinary Care Charitable Fund. The practice frequently holds fundraisers, including a Paint Your Pet event, to put toward the program. (Courtesy of Lisa Miracle)

Citation: American Journal of Veterinary Research 79, 12; 10.2460/ajvr.79.12.1232

The VCCF has enrolled 1,171 practices in all 50 states and Puerto Rico since its inception, and $378,837 has been reimbursed in total. The mean reimbursement amount is $382, and 1,234 animals have been helped overall, according to AVMF data.

Lisa Miracle, hospital administrator for Acorn Animal Hospital in Franklin, Massachusetts, said her nine-doctor practice enrolled in the VCCF because staff members wanted to avoid economic euthanasia situations.

Condensed from Nov. 15, 2018, JAVMA News

AVMA seeks volunteers to serve profession

The AVMA seeks candidates for president-elect and vice president and for two seats on the Board of Directors as well as nominations or applications for council, committee, and liaison positions. Details and forms are available by visiting http://jav.ma/AVMAvolunteers or emailing OfficeEVP@avma.org.

The AVMA is calling for candidates to run for president-elect for the 2020–21 Association year and for vice president for 2020–22. While the Association will accept applications through summer 2020, candidates who submit materials by April 1, 2019, can formally announce their candidacy and present to the AVMA House of Delegates in conjunction with AVMA Convention 2019.

The Association is distributing a letter to AVMA voting members in districts III and V to invite nominations for a representative from each district to serve on the Board of Directors for a six-year term starting in August 2019. Feb. 1, 2019, is the deadline for nominations.

In May 2019, the Council on Education Selection Committee will select one new member for the AVMA Council on Education. The committee will post a call for applications in late December for a COE member to represent private equine practice. The deadline is Feb. 15, 2019.

The AVMA House of Delegates will elect members of councils other than the COE in August 2019 during its regular annual session preceding AVMA Convention 2019. The deadline for nominations is April 1, 2019.

The AVMA Board of Directors will fill a number of committee and liaison positions in April 2019. The deadline for applications and nominations is March 13, 2019.

Condensed from Nov. 1, 2018, JAVMA News

Updated model practice act goes to HOD

The AVMA House of Delegates this January will vote on an updated version of the AVMA Model Veterinary Practice Act.

Last updated in 2013, the MVPA is a set of guiding principles for regulating the practice of veterinary medicine within the states.

Meeting at AVMA headquarters in September in Schaumburg, Illinois, the AVMA Board of Directors voted to refer this latest iteration of the MVPA to the HOD with a recommendation for approval.

One of the changes to the act is the expanded definition of the veterinarian-client-patient relationship. The proposed wording states: “Such a relationship can exist only when the veterinarian has seen the patient(s) or is personally acquainted with the keeping and care of the patient(s) by virtue of a physical examination of the patient(s), by medically appropriate and timely visits to the operation where the patient(s) are kept, or both.”

The amended MVPA states that a VCPR “cannot be established solely by telephonic or other electronic means,” consistent with the prevailing interpretation in most states and the federal government's view in applying the VCPR to prescribing drugs for extralabel use and issuing veterinary feed directives. The MVPA contains language restricting the ability of local governments to prohibit state-sanctioned veterinary procedures within their jurisdiction.

Federal definitions of “veterinary feed directive” and “veterinary feed directive drug” are included in the MVPA, which clarifies that veterinarians and nonveterinarians employed by state governments or the federal government are not exempted from following federal law concerning extralabel drug use and VFDs.

Condensed from Nov. 1, 2018, JAVMA News

Let's talk about pot

California has become the first state in the nation to allow veterinarians to legally talk with clients about cannabis as a treatment option for pets.

The new law, signed by Gov. Jerry Brown on Sept. 27, prevents the California Veterinary Medical Board from disciplining a veterinarian or denying, revoking, or suspending the license of a veterinarian solely for discussing the use of cannabis in an animal for medicinal purposes.

The veterinary board must develop guidelines for such discussions on or before January 2020 and post them on its website.

The California law authorizes veterinarians only to discuss medical marijuana with clients; prohibitions against recommending, prescribing, dispensing, or administering cannabis or cannabis products to an animal patient remain in place.

Additionally, the law prohibits a veterinarian from having a financial relationship with a licensed cannabis business in California, with violators facing fines and loss of their veterinary license.

States where medical marijuana is legal—29 so far, plus the District of Columbia—shield physicians from criminal and disciplinary actions for discussing marijuana with patients or recommending or prescribing marijuana to patients. With the recent exception of California, no similar allowances are made for veterinarians.

Introduced in February, Assembly Bill 2215 enjoyed broad support within the state's veterinary community and was endorsed by both the California and Southern California VMAs. “With the signing of the bill, at least now veterinarians can play the role of advisers and educators to pet owners seeking further information, rather than having to play a passive role and watching the multitude of nonprofessional resources be the educators and advisers to the pet owners,” said Dr. Laura Weatherford, president of the SCVMA.

Condensed from Nov. 15, 2018, JAVMA News

North Carolina after Florence

When Hurricane Florence made landfall in southeastern North Carolina on Sept. 14, it was as a weakened Category 1 hurricane, not the Category 4 monster brewing over the Atlantic Ocean days before.

Florence dumped buckets of rain for several days across the region—a record 35 inches in one area—causing rivers to surge over their banks, across roads, and into farms and neighborhoods. State officials attribute 39 deaths to the storm, which displaced over 5,200 people.

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Horses are rescued from floodwaters unleashed by Hurricane Florence. (Courtesy of North Carolina State University CVM)

Citation: American Journal of Veterinary Research 79, 12; 10.2460/ajvr.79.12.1232

Just over a thousand animals were evacuated or rescued from the floodwaters. Four million poultry and roughly 5,500 hogs did not escape the deluge, however. Livestock losses were projected at $23.1 million, a fraction of the total $1.1 billion hit to North Carolina's agriculture industry.

Faculty, staff, and students from North Carolina State University College of Veterinary Medicine helped rescue, shelter, and care for pets and livestock impacted by Florence. The AVMA supported these efforts with a $100,000 donation to the veterinary college through the American Veterinary Medical Foundation.

The week of the storm, Dr. Paul Lunn, dean of the veterinary college, loaded a van with donated supplies and delivered them to referring veterinarians in communities near the city of Wilmington, close to where Florence made landfall.

The veterinary college opened temporary shelter space for horses at the Equine Health Center. The NC State Veterinary Hospital remained open for the duration of the storm and its aftermath, caring for many pets with a range of health issues stemming from the storm's impact.

Condensed from Nov. 15, 2018, JAVMA News

U.S. watches, prepares for African swine fever

A disease deadly to pigs has spread to at least 29 locations in China.

African swine fever, a highly contagious hemorrhagic disease, has infected pigs in some Chinese provinces with the highest densities of swine production, according to the U.S. Department of Agriculture.

Dr. Tom Burkgren, executive director of the American Association of Swine Veterinarians, said the causative virus is hardy, and there is no vaccine.

The Food and Agriculture Organization of the United Nations published a warning in September that African swine fever almost certainly will spread in Asia. China raises half the world's pigs and has a half-billion pig population.

The most virulent viral strain is fatal to all infected pigs, although it has no direct effects on human health, FAO information states. It travels through processed and raw pork and live animals, and the virus can survive months in cured or salted pork or in animal feed.

The U.S. lacks surveillance for ASF, so veterinarians’ best protection is awareness of the clinical signs, Dr. Burkgren said. Look at any case that might be compatible with ASF, and include the disease in the differential diagnosis, he said.

The virus can cause sudden death with few signs. It also can cause high fever, vomiting, diarrhea, constipation, anorexia, skin hemorrhages, abortion, lost coordination, leukopenia, thrombocytopenia, and red spots on the ear tips, tail, and lower legs or hams, according to the World Organisation for Animal Health (OIE) and information from the Iowa State University College of Veterinary Medicine.

Condensed from Nov. 15, 2018, JAVMA News