Clinical Practice Guidelines: An Opinion of the Legal Implication to Veterinary Medicine

Veterinary students' proximity to and interpretation of a simulated "aggressive" dog before and after training

Dog "aggression" in the veterinary practice is commonplace. Therefore, student knowledge and education about dog behaviour and the ability to interpret "aggressive" behaviour is important from a human injury prevention and dog welfare perspective. The study aimed to compare first-year veterinary students' perceived safest proximity to both an "aggressive" and non-reactive simulated dog, both before and after a teaching intervention about canine behaviour and a handling practical. It also examined student confidence and their ability to identify "aggressive" behaviours. Forty first year veterinary students took part in two surveys. Each survey included two videos: one of a simulated dog displaying "aggressive" behaviour, based on the 'Canine Ladder of Aggression'; and another displaying non-reactive (passive behaviours without reaction to the participants) behaviours. Each video depicted the slow and consistent approach towards the virtual dog within a virtual indoor environment, and participants were asked to press stop if or when they would stop approaching the dog. In the "aggressive" scenario, there was a reduction in the approach-stop time from survey 1 (median = 17.8 s) to survey 2 (median = 15.2 s) in the intervention group (p = 0.018) but not in the control group (p = 0.147). Regarding confidence, there was a significant increase in the self-reported confidence rating relating to a participant's ability to interpret canine behaviour in both the control (p = 0.011) and intervention (p = 0.003). In conclusion, these results indicate that students using approach-stop videos stayed further away from an "aggressive" virtual dog model if they had undertaken a canine behaviour educational intervention. This novel approach has the potential for further use in teaching and assessment of student knowledge and behaviour which may otherwise be difficult to demonstrate.

Drivers of antimicrobial resistance in layer poultry farming: Evidence from high prevalence of multidrug-resistant Escherichia coli and enterococci in Zambia

Background and Aim

Inappropriate use of antimicrobials exacerbates antimicrobial resistance (AMR) in the poultry sector. Information on factors driving AMR in the layer poultry sector is scarce in Zambia. This study examined the drivers of AMR in the layer poultry sector in the Lusaka and Copperbelt Provinces of Zambia.

Materials and Methods

This cross-sectional study employed a structured questionnaire in 77 layer poultry farms in the provinces of Lusaka and Copperbelt, Zambia, from September 2020 to April 2021. Data analysis was conducted using Stata version 16.1. Antimicrobial resistance was defined as the presence of multidrug resistance (MDR) isolates. Multivariable regression analysis was used to identify drivers of AMR.

Results

In total, 365 samples were collected, from which 339 (92.9%) Escherichia coli and 308 (84.4%) Enterococcus spp. were isolated. Multidrug resistance was identified in 39% of the E. coli and 86% of the Enterococcus spp. The overall prevalence of AMR in layer poultry farms was 51.7% (95% confidence interval [CI]: 40.3%-63.5%). Large-scale farmers (Adjusted odds ratio [AOR] = 0.20, 95% CI: 0.04%-0.99%) than small-scale and farmers who were aware of AMR than those who were unaware (AOR = 0.26, 95% CI: 0.08%-0.86%) were less likely to experience AMR problems.

Conclusion

This study found a high prevalence of AMR in layer poultry farming linked to the type of farm management practices and lack of AMR awareness. Evidence of high MDR in our study is of public health concern and requires urgent attention. Educational interventions must increase AMR awareness, especially among small- and medium-scale poultry farmers.

Veterinary Expert: Legal Nature and Responsibility

Veterinary professional practice can be performed in many forms, including expert activity. The importance of veterinary expertise is, however, often underrated and limited to only one of its areas. Nonetheless, veterinary expert opinions have significant social, legal, and economic impacts. This study investigates veterinary expertise from an interdisciplinary, comparative perspective. Ethical and legal analysis and interpretation are performed. Essential concepts and relevant aspects of veterinary expertise are analysed. Legally relevant factors of an expert opinion are identified. The relationship between the law, the language, and the understanding of the role and duties of a veterinary proficient is demonstrated. A variety of possible expert opinions and the multiplicity of veterinary scopes of such activity is presented. It is argued that the ranges of forensic veterinary medicine and of veterinary expertise are broader than is predominantly assumed. Veterinary forensic medicine is a crucial part of veterinary specialisation. Ethical and legal basics, and the scope of veterinary expert's liability, are revealed and discussed. The conclusion is that the duties and responsibilities of expert veterinarians are particularly great due to the exercise of the public trust profession, with large importance for the whole society. Their observance is, however, crucial to ensure the highest quality of expert opinions issued by veterinarians.

Why Veterinarians (Do Not) Adhere to the Clinical Practice Streptococcus suis in Weaned Pigs Guideline: A Qualitative Study

The Netherlands has been very successful in the last decade in reducing antimicrobial use in animals. On about a quarter of farms, antimicrobial use in weaned pigs remains relatively high. As Streptococcus suis (S. suis) infections are responsible for a high consumption of antimicrobials, a specific veterinary guideline to control S. suis was developed, but seemed to be poorly adopted by veterinarians. Guided by the theoretical domains framework, the aim of this study was to identify determinants influencing veterinarians' adherence to this guideline. We interviewed 13 pig veterinarians. Interviewees described multiple approaches to managing S. suis problems and adherence to the guideline. Mentioned determinants could be categorized into 12 theoretical domains. The following six domains were mentioned in all interviews: knowledge, skills, beliefs about capabilities, beliefs about consequences, social influences, and environmental context and resources. The insights derived from this study are relevant for understanding factors influencing veterinarians' adoption of scientific evidence and guidelines and can be used to develop evidence-based implementation strategies for veterinary guidelines.

Animal Welfare Considerations and Ethical Dilemmas Inherent in the Euthanasia of Blind Canine Patients

Simple Summary

Although many dogs with blindness diagnosis can reach a similar age compared to those not affected, often the owners require euthanasia of their animals. This choice leads to conflicting moral principles relating to what is better for the animal and the owner. This article discusses the suitability of euthanasia in blind dogs. To better assess factors influencing the choice of euthanasia, four different scenarios were constructed that described various situations regarding the animal’s aptitude, pet owner, and veterinarian relations.

Abstract

In dogs, several primary or secondary diseases affecting the ocular structures may cause blindness. In cases where the visual impairment is not associated with severe systemic involvement and the animal can still have, predictably, a good “long-term” quality of life, the veterinarian should inform the owner about the differences between humans and animals, concerning the type of visual perception. In the light of the daily findings in veterinary clinic practice, the Authors report four different scenarios with conflicting views between veterinarians and owners about the euthanasia request for a blind dog. They underline how the diagnosis of incipient or already established blindness in dogs can sometimes lead to an inappropriate request for euthanasia.

Developing consensus for definitions of key veterinary-specific quality improvement (QI) terms using an eDelphi-study method

BACKGROUND

Quality improvement (QI) methods are a continuous process of iterative tests to improve the quality of a service or product. Using common language has been linked to the successful implementation of QI in human healthcare. This study aimed to assimilate and achieve consensus on veterinary-specific definitions for terms associated with quality care and QI methods in UK veterinary practice.

METHODS

A four-round modified eDelphi process with a panel of 50 UK veterinary practice stakeholders was used to generate consensus. The panel selected or suggested the definition they best felt 'fitted' each term. Consensus was reached if there was >70% agreement, and terms were eliminated if there was <15% selection.

RESULTS

Thirty-one panellists completed all three rounds of eDelphi; eight participants completed an optional feedback round. From 14 terms, 10 reached consensus, leaving four unresolved definitions.

CONCLUSIONS

A majority of terms reached consensus; 90% were new or amended definitions proposed by panel members. Utilising plain English refined by stakeholders will allow successful implementation of QI in veterinary healthcare. Not all terms achieved consensus, highlighting a need for further research to enable successful integration of QI principles as seen in human healthcare.

Business intelligence tools to optimize the appropriateness of the diagnostic process for clinical and epidemiologic purposes in a multicenter veterinary pathology service

Laboratory tests provide essential support to the veterinary practitioner, and their use has grown exponentially. This growth is the result of several factors, such as the eradication of historical diseases, the occurrence of multifactorial diseases, and the obligation to control endemic and epidemic diseases. However, the introduction of novel techniques is counterbalanced by economic constraints, and the establishment of evidence- and consensus-based guidelines is essential to support the pathologist. Therefore, we developed standardized protocols, categorized by species, type of production, age, and syndrome at the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), a multicenter institution for animal health and food safety. We have 72 protocols in use for livestock, poultry, and pets, categorized as, for example, "bovine enteric calf", "rabbit respiratory", "broiler articular". Each protocol consists of a panel of tests, divided into 'mandatory' and 'ancillary', to be selected by the pathologist in order to reach the final diagnosis. After autopsy, the case is categorized into a specific syndrome, subsequently referred to as a syndrome-specific panel of analyses. The activity of the laboratories is monitored through a web-based dynamic reporting system developed using a business intelligence product (QlikView) connected to the laboratory information management system (IZILAB). On a daily basis, reports become available at general, laboratory, and case levels, and are updated as needed. The reporting system highlights epidemiologic variations in the field and allows verification of compliance with the protocols within the organization. The diagnostic protocols are revised annually to increase system efficiency and to address stakeholder requests.

Quantitative and qualitative analysis of lawsuits against veterinarians and correlation of potential risk factors with court decisions

The increase in lawsuits against veterinarians based on recklessness, negligence and malpractice is a current trend since pets are increasingly viewed as part of the family, and legal action is sought if the owner is frustrated with the services rendered by the veterinarian. However, since scarce data exists on this issue, this study aims to quantify and qualify lawsuits filed against veterinarians in the state of São Paulo, Brazil to identify and correlate potential risk factors that may lead to conviction or acquittal of defendants. For this purpose, the methodology employed a search for lawsuits on the website of the São Paulo State Court of Justice, sorted by year; proceedings (summary or special civil court); plaintiff's claim (non-economic damages, economic damages, malpractice, negligence or recklessness); court decision (case granted or denied); reason for judgment (sufficient or insufficient evidence); reverse burden of proof (present or absent); type of evidence (deposition, documentary and expert testimony); value of damages claimed and awarded; location (greater São Paulo or inner state), and whether the lawsuit was filed against a veterinary clinic or hospital. These categories shed light, through bivariate and Poisson regression analyses, on the potential risk factors relative to court decisions. Results demonstrate that reverse burden of proof and insufficient evidence as the basis for judgment were, respectively, risk factors for conviction and acquittal of veterinary practitioners, and the number of lawsuits increased by 533 % over eight years.