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McCreesh K, Guthrie AL, Spiro S, Patterson S. A SYSTEMATIC REVIEW OF RETROSPECTIVE MORBIDITY AND MORTALITY STUDIES ON CAPTIVE WILDLIFE SPECIES. J Zoo Wildl Med 2024; 55:1-12. [PMID: 38453482 DOI: 10.1638/2023-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 03/09/2024] Open
Abstract
Zoological institutions manage animals for conservation, education, entertainment, and research purposes. Zoological staff have a responsibility to safeguard the welfare of animals in their care. Retrospective morbidity and/or mortality studies (MMSs) can be useful tools to highlight common diseases in captive wildlife populations. There is currently no standardized methodology for conducting MMSs. Variation in the methodology of MMSs, particularly the categorization of diseases, can make comparisons between studies challenging and may limit the applicability of the results. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) compliant systematic review was performed, which identified 67 MMSs describing 146 species of captive wildlife. These MMSs are becoming more common and were predominantly performed on mammals (76/146). Prospective authors are encouraged to perform MMSs on amphibians, birds, reptiles, fish, and invertebrates. The studied animals were mostly managed at institutions in the United States of America (28/67, 41.2%) and Europe (14/67, 20.9%). Classifying individuals into age groups facilitates the identification of disease trends within age classes. Only 22/67 (32.8%) studies cited justification for their age classification; classifications should be based on a referenced source on the breeding biology of the studied species. There is variation in the body systems used by authors and into which system a disease is categorized, which makes study comparisons challenging. Diseases were predominantly categorized by etiology and body system (28/77, 36.4%). Because of its ubiquity, the use of the categorization system employed by the pathology module of the Zoological Information Management System is recommended as a useful standard. This system is imperfect, and amendments to it are suggested. The results and recommendations of this study were discussed with a panel of zoo and wildlife experts; guidelines have been formulated for prospective authors aiming to conduct MMSs in captive wildlife.
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Affiliation(s)
- Kyle McCreesh
- Wildlife Health, Department of Pathobiology and Population Sciences, Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom,
| | - Amanda L Guthrie
- Zoological Society of London, Regent's Park, London NW1 4RY, United Kingdom
| | - Simon Spiro
- Zoological Society of London, Regent's Park, London NW1 4RY, United Kingdom
| | - Stuart Patterson
- Wildlife Health, Department of Pathobiology and Population Sciences, Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
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2
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Hill J, Irwin-Porter G, Buckley LA. Surgical safety checklists in UK veterinary practice: Current implementation and attitudes towards their use. Vet Rec 2023; 192:e2484. [PMID: 36607140 DOI: 10.1002/vetr.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Surgical safety checklist (SSC) use benefits veterinary patients, but endorsement and implementation are essential for these benefits to be observed. METHODS A cross-sectional survey assessed UK veterinary professionals' attitudes towards and usage of SSCs and identified factors associated with poorer attitude or failure to use SSCs. RESULTS Of 513 respondents, 70% used SSCs. Of these, 87.1% used SSCs for every surgical procedure, 19.1% adapted SSCs for different procedures and 61.1% had a standard operating procedure detailing how to use SSCs. Attitudes towards SSC use were favourable, with increased positive attitude associated with employing at least one registered veterinary nurse with a post-qualifying qualification (p < 0.001), current SSC use (p < 0.001), undertaking self-directed reading (p = 0.033) or completing SSC-relevant post-qualification continuing professional development (p = 0.005). Factors associated with veterinary practices not using SSCs included Practice Standards Scheme (PSS) non-membership (odds ratio [OR] 2.0, 1.1-3.4), no RCVS hospital status (OR 1.9, 1.1-3.5) or being a mixed first-opinion veterinary practice (OR 2.4, 1.2-5.0). LIMITATIONS Study limitations include sampling methodology and non-validated attitudinal scale usage. CONCLUSION Most respondents used SSCs. Familiarity, education and the RCVS PSS were associated with improved uptake and attitudes, but mixed practice was associated with reduced usage.
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Affiliation(s)
- Jessica Hill
- Bristol Veterinary School, University of Bristol, Langford, UK
- Paragon Veterinary Referrals, Wakefield, UK
| | | | - Louise A Buckley
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
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3
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Leicester L, Reid A, Gilbert S, Marshall R, O'Neill DG. Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary-care emergency practice. Vet Rec 2023; 192:e2485. [PMID: 36628550 DOI: 10.1002/vetr.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The paucity of published veterinary clinical audits suggests that clinical audit is an under-used tool for quality improvement (QI) in the veterinary profession. Therefore, a continuous QI process was designed and implemented at a UK multisite small animal emergency practice, focusing on audit of clinical management of canine dystocia. METHODS Data collection phases were undertaken in 2014, 2019 and 2021, with intervening knowledge dissemination activities. Nine variables relating to clinical management of canine dystocia were selected as audit criteria in the initial dataset, and 21 variables were measured in each subsequent phase. RESULTS Between 2014 and 2021, statistically significant increases (p < 0.05) were demonstrated in recording of bodyweight, use of diagnostic imaging, use of ultrasonography, recording of fetal heart rates, use of calcium gluconate, and use during caesarean section of intravenous fluid therapy, multimodal analgesia, full agonist opioids, paracetamol and local anaesthesia. Statistically significant decreases were demonstrated in median first quantity and median first dose of oxytocin, and in the use of NSAIDs during caesarean section. A clinical audit planning template was created for future audits. LIMITATIONS Typical case presentation and management of canine dystocia cases may vary between dedicated emergency and non-emergency primary-care settings. CONCLUSION This study demonstrates the feasibility of large-scale veterinary clinical audit and suggests that the application of the clinical audit process promotes learning within the veterinary team and improved clinical outcomes.
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Affiliation(s)
| | | | | | | | - Dan G O'Neill
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
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Rockow M, Griffenhagen G, Landolt G, Hendrickson D, Pezzanite L. Current Antimicrobial Use in Horses Undergoing Exploratory Celiotomy: A Survey of Board-Certified Equine Specialists. Animals (Basel) 2023; 13:ani13091433. [PMID: 37174470 PMCID: PMC10177570 DOI: 10.3390/ani13091433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
In the past decade, there has been a considerable increase in the recognition of antimicrobial resistance in equine practice. The objective of this study was to survey the current clinical use of antimicrobials for a commonly performed surgical procedure (exploratory celiotomy) with the goal of understanding how recent literature and changes in microbial resistance patterns may have impacted antimicrobial selection practices. An electronic survey was distributed to veterinary professionals within the American College of Veterinary Internal Medicine (ACVIM) and the American College of Veterinary Surgery (ACVS). A total of 113 completed surveys were returned. Practitioners reported antimicrobials were most frequently given 30-60 min preoperatively (63.1%). Two antimicrobial classes were typically administered (95.5%), with gentamicin (98.2%) and potassium penicillin (74.3%) being the most common. Antimicrobials were typically not re-dosed intraoperatively (78.6%). Factors that affected overall treatment length postoperatively included resection (81.4%), bloodwork (75.2%), enterotomy (74.3%), fever (85.0%), incisional complications (76.1%), and thrombophlebitis (67.3%). The most common duration of antimicrobial use was 1-3 d for non-strangulating lesions (54.4% of cases) and inflammatory conditions such as enteritis or peritonitis (50.4%), and 3-5 d for strangulating lesions (63.7%). Peri-incisional and intra-abdominal antimicrobials were used by 24.8% and 11.5% of respondents, respectively. In summary, antimicrobial usage patterns were highly variable among practitioners and, at times, not concordant with current literature.
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Affiliation(s)
- Meagan Rockow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gregg Griffenhagen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gabriele Landolt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Dean Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Lynn Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Campbell M, Hagen BNM, Gohar B, Wichtel J, Jones-Bitton A. A qualitative study exploring the perceived effects of veterinarians' mental health on provision of care. Front Vet Sci 2023; 10:1064932. [PMID: 36825229 PMCID: PMC9941564 DOI: 10.3389/fvets.2023.1064932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Veterinary medicine is a rewarding, yet demanding profession with a myriad of occupational stressors that can impact the mental health of veterinarians. Stress, mental health outcomes, and associated risk factors amongst veterinarians have been well-researched. Much less research has investigated how high stress and/or poor mental health can impact veterinarians' provision of care. Methods One-on-one research interviews were conducted with 25 veterinarians at a Canadian veterinary conference in July 2016 and verbatim transcripts were produced from the audio recordings. The research team collaboratively analyzed the interviews using thematic analysis. Results Five themes described the perceived impacts of high stress and/or poor mental health: perceived negative impacts on interactions with (1) co-workers and (2) clients; (3) reduced concentration; (4) difficulty in decision making; and (5) reduced quality of care. Discussion These results highlight the perceived impacts of self-reported high stress and/or poor mental health on veterinary team dynamics, the potential to impact case outcomes, and possibly endanger patient safety. Interventions to help mitigate the impacts of high stress and poor mental health are discussed.
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Affiliation(s)
- Megan Campbell
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada,*Correspondence: Megan Campbell ✉
| | - Briana N. M. Hagen
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada
| | - Basem Gohar
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada,Centre for Research in Occupational Safety and Health, Sudbury, ON, Canada
| | - Jeffrey Wichtel
- Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Andria Jones-Bitton
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada
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6
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Gibson J, White K, Mossop L, Oxtoby C, Brennan M. 'We're gonna end up scared to do anything': A qualitative exploration of how client complaints are experienced by UK veterinary practitioners. Vet Rec 2022; 191:e1737. [PMID: 35661168 DOI: 10.1002/vetr.1737] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND UK veterinary practitioners are reported to be fearful of client complaints, but their experiences have not been formally captured. Understanding how complaints impact veterinary practitioners is key to mitigating detrimental consequences. METHODS A qualitative exploration of how UK veterinary practitioners experience and respond to adverse events was conducted. Data were collected via focus groups and interviews, which were transcribed and simultaneously analysed. Coding and theme development were inductive rather than restricted by preconceived theories. RESULTS Twelve focus groups and 15 individual interviews took place. One theme identified focused on the impact of client complaints. Practitioners experienced unintentional distraction and disengagement from clinical work, as well as employing defensive strategies as a direct result of complaints. The vexatious nature of some complainants was highlighted, along with concerns about practice and regulatory complaint management, lack of appropriate support, discriminatory behaviours and the influence of 'trial by media'. CONCLUSIONS Client complaints present a threat to practitioner mental health and workforce sustainability, as well as having implications for patient safety. Mitigating these effects is a complex and multifaceted undertaking, but fairness, transparency and timeliness of practice and regulatory complaint investigation must be prioritised, along with provision of tailored support for those facing complaints.
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Affiliation(s)
- Julie Gibson
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK.,Centre for Evidence Based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Kate White
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Liz Mossop
- Vice Chancellors Office, University of Lincoln, Brayford Campus, Lincoln, UK
| | | | - Marnie Brennan
- Centre for Evidence Based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
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Scollo A, Fasso M, Nebbia P, Mazzoni C, Cossettini C. Managing Shiga Toxin-Producing E. coli Using Statistical Process Control Charts for Routine Health and Production Monitoring in Pig Farming. Front Vet Sci 2022; 9:814862. [PMID: 35372552 PMCID: PMC8968397 DOI: 10.3389/fvets.2022.814862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/21/2022] [Indexed: 12/03/2022] Open
Abstract
Oedema disease (ED) caused by Shiga-toxin-producing E. coli in pigs is a serious life-threatening disease, particularly among weaned piglets. When a preventive protocol is adopted in a specific farm, interpretation of effectiveness is often complicated in field conditions due to natural or “common cause” variation. For this reason, in this study a Statistical process control (SPC) approach was used to retrospectively evaluate the application of an ED preventive protocol (lower protein diet, ad-libitum fiber, vaccination at 5 days of age) in an infected commercial piglets' weaning site. The analysis was established over a 9-years period (n = 75 consecutive batches; 1,800 weaners per batch) using mortality for each batch as the key parameter of health and production; the statistics and the control limits (mean ± 3-fold sd; UCL, upper control limit; LCL, lower control limit) were based on data from the first 28 batches (Period 1) before the onset of the first ED clinical signs. The charts allowed the detection of defined out of control batches (i.e., with mortality out of the intervention limits) from batch 29 ongoing, exploring a Period 2 (unstable production and ED clinical signs; 36 batches) and a Period 3 (application of the ED preventive protocol; 11 batches). Mortality evaluation using SPC revealed a production system defined under-control (mean moving range bar = 1,34%; UCL = 4,37%; LCL = 0%) during Period 1. During Period 2, charts lost the state of statistical control, as showed by several signals of special cause variation due to the ED outbreak. Period 3 was characterized again by a state of statistical control, where no signals of special cause variation was showed. In conclusion, the retrospective application of SPC charts in the present study was able to confirm the efficacy of an ED preventive protocol in reducing mortality in a piglets' weaning site. SPC charting is suggested as an useful tool to provide insights into relationships between health, managerial, and welfare decision and some selected iceberg parameters in livestock.
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Affiliation(s)
- Annalisa Scollo
- Department of Veterinary Sciences, University of Torino, Torino, Italy
- *Correspondence: Annalisa Scollo
| | | | - Patrizia Nebbia
- Department of Veterinary Sciences, University of Torino, Torino, Italy
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8
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Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice. Animals (Basel) 2021; 11:ani11113010. [PMID: 34827742 PMCID: PMC8614270 DOI: 10.3390/ani11113010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Veterinary care of companion animals, particularly dogs and cats, continues to advance, with some companion animals receiving a standard of care equal to or exceeding that of human patients. While this has the potential to improve animal welfare and benefit other stakeholders, including animal owners and veterinary team members, it also poses ethical challenges. We discuss key ethical challenges associated with AVC, including its relationship to standards of veterinary care, its potential to perpetuate poor quality of life and suffering, cost and accessibility of veterinary care, conflicts of interest, and concerns about experimentation without appropriate ethical review. We conclude by suggesting some strategies for veterinary teams and other stakeholders, such as professional bodies and regulators, to address these concerns. Abstract Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reenforces the need for a spectrum of veterinary care for companion animals.
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Gates MC, McLachlan I, Butler S, Weston JF. Building Veterinarians beyond Veterinary School: Challenges and Opportunities for Continuing Professional Development in Veterinary Medicine. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:383-400. [PMID: 34161200 DOI: 10.3138/jvme.2019-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Continuing professional development (CPD) is an important mechanism for veterinarians to acquire, maintain, and enhance their capability to perform competently in their chosen practice area over their career. Although most licensing bodies require veterinarians to complete a minimum number of CPD hours each registration cycle, there are known issues with verifying that these activities are having the desired effects of ensuring professional competence and improving outcomes for patients, owners, and veterinarians. In this review, we summarize the literature across different health care professions to highlight three key challenges for veterinary CPD programs. These are (a) defining what it means to be professionally competent across different career stages from graduation to retirement, (b) delivering CPD activities that are effective in promoting evidence-based medicine and behavioral change in practice, and (c) developing reliable and sustainable systems to formally assess the continued professional competence of veterinarians. A common theme across all challenges was the importance of interacting with colleagues as an opportunity to receive external feedback on their professional strengths and weaknesses and to develop stronger support networks for managing common stressors in clinical practice. There was also a recognized need to develop more transparent outlines of the available and acceptable options for managing different animal health concerns as a first step toward identifying new opportunities for the veterinary profession to elevate the level of care provided. Based on these findings, we propose a new framework for defining, delivering, and evaluating CPD that promotes stronger collaboration between veterinarians to improve professional and personal well-being.
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Assessing the Feasibility of Retrospective and Prospective Clinical Audit in Farm Animal Veterinary Practice. Vet Sci 2021; 8:vetsci8040062. [PMID: 33924376 PMCID: PMC8069272 DOI: 10.3390/vetsci8040062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
As a quality improvement tool, clinical audit has been extensively described in the medical literature. There is scant literature on the use of clinical audit in the farm animal veterinary setting. This study describes the process and feasibility of prospective and retrospective data collection for farm animal clinical audit performed at three different farm animal practices in the United Kingdom. Retrospective clinical audit was difficult in all three practices due to barriers in establishing diagnosis and patient identity from clinical records. Prospective data collection proved feasible but depended on adequate case accrual and practitioner engagement. The decision to conduct clinical audit retrospectively or prospectively will depend on the topic to audit, the availability of data and the wishes of the team members involved. Further work is required looking at the use of clinical coding and alternatives to using practice management software to improve retrospective data availability for clinical audit.
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Ceriotti S, Westerfeld R, Bonilla AG, Pang DSJ. Use of Clinical Audits to Evaluate Timing of Preoperative Antimicrobials in Equine Surgery at a Veterinary Teaching Hospital. Front Vet Sci 2021; 8:630111. [PMID: 33842572 PMCID: PMC8032889 DOI: 10.3389/fvets.2021.630111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022] Open
Abstract
Based on human surgical guidelines, intravenous antimicrobials are recommended to be administered within 60 min of surgical incision. Achieving this target in horses is reportedly challenging and influenced by hospital policies. The objectives of this study were to evaluate and improve: (1) the timing of antimicrobial administration to surgical incision (tAB-INC), (2) contributions of anesthesia pre-induction (tPRI) and surgical preparation (tPREP) periods to tAB-INC, and the (3) completeness of antimicrobial recording. Two clinical audits were conducted before and after the policy changes (patient preparation and anesthesia record keeping). tPRI, tPREP, and tAB-INC were calculated and compared for elective arthroscopies and emergency laparotomies within and between the audits. The percentage of procedures with a tAB-INC <60 min was calculated. Antimicrobial recording was classified as complete or incomplete. A median tAB-INC <60 min was achieved in laparotomies (audit 1; 45 min, audit 2; 53 min) with a shorter tPREP than arthroscopies (p < 0.0001, both audits). The percentage of procedures with tAB-INC <60 min, tAB-INC, tPRI, and tPREP durations did not improve between the audits. There was a positive correlation between the number of operated joints and tPREP (audit 1, p <0.001, r = 0.77; audit 2, p < 0.001, r = 0.59). Between audits, antimicrobial recording significantly improved for elective arthroscopies (82–97%, p = 0.008) but not emergency laparotomies (76–88%, p = 0.2). Clinical audits successfully quantified the impact of introduced changes and their adherence to antimicrobial prophylaxis guidelines. Antimicrobial recording was improved but further policy changes are required to achieve a tAB-INC <60 min for arthroscopies.
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Affiliation(s)
- Serena Ceriotti
- Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Roxane Westerfeld
- Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Alvaro G Bonilla
- Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Daniel S J Pang
- Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
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Rose N, Pang DSJ. A practical guide to implementing clinical audit. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2021; 62:145-152. [PMID: 33542553 PMCID: PMC7808188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clinical audit is a quality improvement tool for evaluating and improving patient care and outcomes. This is achieved by systematically reviewing current practices against explicit criteria and measuring the impact of change(s) introduced to generate improvement. The clinical audit process can be described by "Plan," "Do," "Study," "Act" phases that comprise an audit cycle. The phases are moved through in turn to attempt quality improvement. Clinical audits are widely used in human medicine at both local (individual clinic or hospital) and national (to achieve nationwide improvements in care) levels. Substantial and sustained improvements in patient care have been attributed to the use of clinical audits. Clinical audits have been described in the veterinary literature since the 1990s, but their adoption does not appear widespread. This paper is intended as a practical, "how to" guide to applying clinical audit in veterinary practice.
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Affiliation(s)
- Nicole Rose
- Didsbury Veterinary Services, Didsbury, Alberta T0M 0W0 (Rose); Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta T2N 4Z6 (Pang); Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, St. Hyacinthe, Quebec J2S 2M2 (Pang)
| | - Daniel S J Pang
- Didsbury Veterinary Services, Didsbury, Alberta T0M 0W0 (Rose); Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta T2N 4Z6 (Pang); Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, St. Hyacinthe, Quebec J2S 2M2 (Pang)
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13
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Affiliation(s)
- Mickey Tivers
- Paragon Veterinary Referrals, Paragon Business Village, Wakefield, UK
| | - Sophie Adamantos
- Paragon Veterinary Referrals, Paragon Business Village, Wakefield, UK
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14
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Laferriere CA, Pang DSJ. Review of Intraperitoneal Injection of Sodium Pentobarbital as a Method of Euthanasia in Laboratory Rodents. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2020; 59:343. [PMID: 32156325 PMCID: PMC7210732 DOI: 10.30802/aalas-jaalas-19-000081] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/17/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
Abstract
Euthanasia is one of the most commonly performed procedures in biomedical research, involving tens of millions of animals in North America and Europe every year. The use of sodium pentobarbital, injected intraperitoneally, for killing rodents is described as an acceptable technique by the AVMA and CCAC euthanasia guidelines. This drug and route are recommended over inhalant anesthetics, carbon dioxide, and physical methods for ethical and aesthetic reasons as well as efficiency. However, a growing body of evidence challenges the efficacy and utility of intraperitoneal pentobarbital. This methodology has been described as inconsistent and may induce pain and stress. With these considerations in mind, a review of the literature is needed to assess the evidence surrounding this killing method, the associated welfare implications, and potential for refinement.
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Affiliation(s)
- Colin A Laferriere
- Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Québec, Canada, and
| | - Daniel SJ Pang
- Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Québec, Canada, and
- Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, Alberta, Canada
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15
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Cullen MD, Archer DC, Mair TS. Clinical audit in equine practice, and the International Colic Surgery Audit. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. D. Cullen
- School of Veterinary Science Philip Leverhulme Equine Hospital Neston Cheshire UK
| | - D. C. Archer
- School of Veterinary Science Philip Leverhulme Equine Hospital Neston Cheshire UK
| | - T. S. Mair
- Bell Equine Veterinary Clinic Mereworth, Maidstone Kent UK
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Pang DSJ, Rousseau-Blass F, Pang JM. Morbidity and Mortality Conferences: A Mini Review and Illustrated Application in Veterinary Medicine. Front Vet Sci 2018; 5:43. [PMID: 29560359 PMCID: PMC5845710 DOI: 10.3389/fvets.2018.00043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/21/2018] [Indexed: 11/30/2022] Open
Abstract
This mini review presents current knowledge on the role of morbidity and mortality conferences (M&MCs) as a powerful educational tool and driver to improve patient care. Although M&MCs have existed since the early twentieth century, formal evaluation of their impact on education and patient care is relatively recent. Over time, M&MCs have evolved from single discipline discussions with a tendency to focus on individual errors and assign blame, to multidisciplinary, standardized presentations incorporating error analysis techniques, and educational theory. Current evidence shows that M&MCs can provide a valuable educational experience and have the potential to generate measurable improvements in patient care.
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Affiliation(s)
- Daniel S J Pang
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Frédérik Rousseau-Blass
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Jessica M Pang
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
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Schuster CJ, Pang DSJ. Forced-air pre-warming prevents peri-anaesthetic hypothermia and shortens recovery in adult rats. Lab Anim 2017; 52:142-151. [PMID: 28599579 DOI: 10.1177/0023677217712539] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
General anaesthesia disrupts thermoregulation in mammals, which can cause hypothermia. Decreases in core body temperature of 1℃ cause significant postoperative complications in humans, and peri-anaesthetic hypothermia in mice increases data variability, which can potentially increase animal use. In rats, the impact of different temperature management strategies on the incidence and severity of hypothermia, and the accuracy of different temperature measurement methods, is unknown. Eighteen adult male and female SD rats were block-randomized to one of three treatment groups: no-warming (NW), limited-warming (LW, heat pad during anaesthesia), and pre-warming (PW, warm air exposure before anaesthesia, followed by heat pad). Anaesthesia (isoflurane) duration was for 40 min. Core body temperature (intra-abdominal telemetric temperature capsule) was recorded during anaesthesia and recovery. During anaesthesia, rectal, skin, and tail temperatures were also recorded. In the PW group, core temperature was maintained during anaesthesia and recovery. By contrast, the NW group was hypothermic (11% temperature decrease) during anaesthesia. The LW group showed a decrease in temperature during recovery. Recovery to sternal recumbency was significantly faster in the PW (125 [70-186] s, P = 0.0003) and the LW (188 [169-420] s, P = 0.04) groups than in the NW group (525 [229-652] s). Rectal temperature underestimated core temperature (bias -0.90℃, 95% limits of agreement -0.1 to 1.9℃). Skin and tail temperatures showed wide 95% limits of agreement, spanning 6 to 15℃, respectively. The novel strategy of PW was effective at maintaining core temperature during and after anaesthesia. Rectal temperature provided an acceptable proxy for core body temperature.
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Affiliation(s)
- C J Schuster
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D S J Pang
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
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Mosedale P. Learning from mistakes: the use of significant event audit in veterinary practice. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/coan.2017.22.3.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pamela Mosedale
- The Cottage, The Wash, Chapel en le Frith, High Peak SK23 0QW
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Dugdale AHA. “PDSA” - but not as you know it?! J Small Anim Pract 2016; 57:445-6. [DOI: 10.1111/jsap.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/14/2016] [Indexed: 11/30/2022]
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Rose N, Kwong GPS, Pang DSJ. A clinical audit cycle of post-operative hypothermia in dogs. J Small Anim Pract 2016; 57:447-52. [DOI: 10.1111/jsap.12547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/08/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022]
Affiliation(s)
- N. Rose
- Western Veterinary Specialist and Emergency Centre; Calgary Alberta T3C 0J8 Canada
| | - G. P. S. Kwong
- Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta T2N 4Z6 Canada
| | - D. S. J. Pang
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta T2N 4N1 Canada
- Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta T2N 4Z6 Canada
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