Effects of a pilot training program on veterinary students' pain knowledge, attitude, and assessment skills

The prevention and management of pain is fundamental to the practice of both human and veterinary medicine. The recognition and treatment of pain represents an important indicator of the quality of care delivered in human hospitals and veterinary hospitals. Yet, both human and veterinary health care professionals have cited inadequate knowledge as a significant barrier to effective pain management. The aims of this pilot study were twofold: (1) to gauge veterinary medical students' current attitudes regarding their training in pain management and (2) to assess the impact of training and practice on the use of a canine acute pain assessment teaching tool. Participants, third-year professional veterinary medical students, completed a 16-item survey questionnaire before a 30-minute training session on pain assessment using the teaching tool and completed it again after training and a one-week practice period. Questions related to canine pain, assessment of canine pain, pain management education in the professional veterinary curriculum, and an example case presentation (video) were included in the survey. The analysis of survey results indicated that professional veterinary medicine students find value in didactic and clinical training in canine pain assessment. Additionally, use of the canine acute pain teaching tool in conjunction with a training program improved students' knowledge and skill in assessment while pointing out the importance of further training. Differences with regard to gender and tracking were found and warrant further exploration.     

Perioperative pain management in horses

The inability to talk does not diminish an animal's ability to experience pain, although it may hinder its recognition and therefore lead to the under-treatment of pain. Pain assessment and treatment in horses has advanced considerably with the recent publication of numerous research papers in this area. This review will summarise these research findings and suggest how advances in knowledge of perioperative pain management can be implemented in equine clinical practice.     

Factors affecting Canadian veterinarians' use of analgesics when dehorning beef and dairy calves

Data collected through a national, randomized mail survey (response rate 50%) were used to identify reasons why veterinarians were likely (i) to use analgesic drugs when dehorning calves, and (ii) to perceive dehorning without analgesia as very painful. Logistic regression analysis indicated that veterinarians were more likely to be analgesic users the more they perceived that dehorning without analgesia was painful (OR = 1.7, P < 0.001). Other positive influences were if the veterinarian worked in British Columbia or Alberta (OR = 5.9, P = 0.005), and if they were primarily in dairy practice (OR = 3.7, P = 0.012) rather than beef practice. This effect of dairy practice was negated if the veterinarian also perceived that owners were unwilling to pay for analgesia (interaction term: OR = 0.25, P = 0.038). Veterinarians were also less likely to perceive dehorning without analgesia as very painful if they perceived that owners were unwilling to pay (OR = 0.58, P = 0.029). However, this effect on pain perception was offset by concern for personal safety (OR = 2.7, P = 0.015). The results are consistent with the relatively high level of outreach about animal welfare among farmers and veterinarians in the western provinces. The results confirm that many veterinarians' approach to pain management for dehorning is influenced considerably by concern about cost. However, pain management for dehorning is not expensive and there is unequivocal evidence that dehorning calves without pain management causes significant distress. Continuing education of veterinarians should help to increase analgesic usage.     

Factors affecting the use of postincisional analgesics in dogs and cats by Canadian veterinarians in 2001

Factors affecting the postincisional use of analgesics for ovariohysterectomy (OVH) in dogs and cats were assessed by using data collected from 280 Canadian veterinarians, as part of a national, randomized mail survey (response rate 57.8%). Predictors of analgesic usage identified by logistic regression included the presence of at least 1 animal health technician (AHT) per 2 veterinarians (OR = 2.3, P = 0.004), and the veterinarians' perception of the pain caused by surgery without analgesia (OR = 1.5, P < 0.001). Linear regression identified the following predictors of veterinarians' perception of pain: the presence of more than 1 AHT per 2 veterinarians (coefficient = 0.42, P = 0.048) and the number of years since graduation (coefficient = -0.073, P < 0.001). Some of these risk factors are similar to those identified in 1994. The results suggest that continuing education may help to increase analgesic usage. Other important contributors may be client education and a valid method of pain assessment.     

Attitudes and concerns of Canadian animal health technologists toward postoperative pain management in dogs and cats.

Three hundred and twenty-two Canadian animal health technologists (AHTs) were surveyed to determine their attitudes toward postoperative pain management in dogs and cats following 6 surgical procedures, their concerns regarding the use of opioid analgesics, and their role within veterinary practices with respect to postoperative pain control. Two hundred and sixty-four (82%) returned the questionnaire. Pain perception was defined as the average of pain rankings for dogs and cats (on a scale of 1 to 10) following abdominal surgery, or the value for dogs or cats if the AHT worked with only 1 of the 2 species. Maximum concern about the risks associated with the postoperative use of morphine or oxymorphone was defined as the highest rating assigned to any of the 6 risks evaluated in either dogs or cats. Animal health technologists reported significantly higher pain perception scores than did veterinarians who completed a similar survey 2 years previously. Higher pain perception scores were associated with decreased satisfaction with the adequacy of analgesic therapy in their practice, higher pain control goals, and attendance at continuing education within the previous 12 months. The majority of AHTs (55%) agreed that one or more risks associated with the use of morphine or oxymorphone outweighed the benefits. The 3 issues that were perceived to pose the greatest risk were respiratory depression, bradycardia, and sedation and excitement, for dogs and cats, respectively. Most AHTs (68%) considered their knowledge related to the recognition and control of pain to be adequate, compared with 24% of veterinarians who responded to a similar previous survey. As for veterinarians, experience gained while in practice was ranked as the most important source of knowledge, while the technical program attended was ranked as least important. Over 88% of the AHTs provided nursing care during the postoperative period, monitored animals for side effects of postoperative analgesic therapy, informed veterinarians when animals were in pain, recommended analgesic therapy when they believed it was warranted, reported that animals received analgesics when they believed it was warranted, administered analgesics under the instruction of a veterinarian, and believed they were part of a team working to provide adequate postoperative pain control.     

Acute pain management.

We encounter patients with acute pain many times each day, and few aspects of veterinary practice offer such an opportunity to help so many in such a profoundly rewarding way. As emphasized here and elsewhere, we now have excellent tools with which to help these animals, and the biggest impediment to optimal treatment of their pain is often our own difficulty in recognizing its presence. Perhaps the single most important aspect of treating acute pain is to cultivate an ability to see past our personal biases and expectations which may limit treatment and to rediscover the common sense we had about pain before we entered the profession. By rededicating ourselves to seeking out, preventing, and relieving pain, we not only perform a vital service for our patients but also elevate our profession even as we reap financial and spiritual rewards for our efforts. What could be better?     

Investigating the opinions of donkey owners and veterinary surgeons towards pain and analgesia in donkeys

The aim of this questionnaire‐based study was to identify which analgesics are currently prescribed to donkeys in clinical practice and to collect opinions from veterinary surgeons and donkey owners on the importance of different pain‐related behaviours in donkeys. Questionnaires were completed by 143 veterinary surgeons and 93 donkey owners. Phenylbutazone, flunixin, detomidine and butorphanol were reported as the most frequently used analgesics in donkeys. Most veterinary surgeons reported administering these drugs at the horse dose rate and dosing interval, which may be inappropriate in the donkey. Four pain‐related behaviours were identified as very important by veterinary surgeons and owners: dullness for colic‐associated pain, keeping the foot lifted, and lameness for foot and limb pain and inability to chew properly for head and dental pain. This is a more limited behavioural repertoire than has recently been identified to be associated with pain in the donkey and suggests that the respondents were reporting perceived wisdom as to what people think are the behavioural signs associated with pain or were not interpreting pain‐related behaviours correctly.     

Current attitudes to, and use of, peri-operative analgesia in dogs and cats by veterinarians in New Zealand

AIM: To investigate the attitudes of veterinary practitioners in New Zealand to pain and analgesia, and their use of analgesic drugs, in dogs and cats. METHODS: A questionnaire posted to 1,200 practising veterinarians was used to gather information about the use of analgesia in dogs and cats, assessment of pain, attitudes to pain relief, analgesic drugs and procedures used, factors affecting choice of analgesic agent, and veterinary demographics, continuing education and staffing. RESULTS: Three hundred and twenty questionnaires with useable data were returned, a response rate of 28%. Male and female veterinarians were evenly represented. The analgesic agents most commonly used were morphine (opioids) and carprofen (a non-steroidal anti-inflammatory drug; NSAID). Use of peri-operative pain relief ranged from 50% for castration of cats to 91% for fracture repair in dogs. For most procedures, female veterinarians scored pain at a significantly higher level than their male colleagues. Fifty-eight percent of respondents considered their knowledge in the area of assessment and treatment of pain was adequate. CONCLUSIONS: This survey was considered representative of veterinarians working in companion animal practice in New Zealand. Results indicated a relatively high use of peri-operative analgesia, including both pre-emptive and multi-modal analgesia, in cats and dogs, although there was still some disparity between the perception of how painful a procedure was and the consequent use of pain relief. CLINICAL RELEVANCE: The establishment of current attitudes and practices indicates to practising veterinarians how their own use of analgesics compares with that of their colleagues. It also provides information to educators on potential areas of focus, given that 42% of respondents felt their knowledge in the area of assessment and treatment of pain was inadequate.     

Equine Nutrition in the United States: A Review of Perceptions and Practices of Horse Owners and Veterinarians

Nutrition plays a critical role in equine health. The horse owner and/or manager has a multitude of equine nutrition sources available to them, with preferences for how, and from whom, this information is delivered. Despite this, poor feeding practices continue to negatively affect the health, wellness, and welfare of equids and have a detrimental impact on the environment. The veterinarian is the primary expected source of equine nutrition information; yet, little is known about their recognition and acceptance of such a role. Doubt has arisen concerning the quality and provision of nutrition education within the veterinary curriculum and subsequent continuing education. Moreover, the value equine nutrition education plays in the veterinarian's practice philosophy, and the resulting provision of such in clinical practice, remains under evaluated. This review examines the present state of equine nutrition and how horses are being fed in practice, in the United States. It considers feeding horses from the horse owner's perspective and the expected role the veterinarian plays in such. Last, it goes on to evaluate this expected role from the veterinarian's perspective, examining how current nutrition education and practices may be falling short and offering recommendations for future research.     

Current attitudes to,and use of,peri-operative analgesia in dogs and cats by veterinarians in New Zealand

AIM: To investigate the attitudes of veterinary practitioners in New Zealand to pain and analgesia, and their use of analgesic drugs, in dogs and cats.

METHODS: A questionnaire posted to 1,200 practising veterinarians was used to gather information about the use of analgesia in dogs and cats, assessment of pain, attitudes to pain relief, analgesic drugs and procedures used, factors affecting choice of analgesic agent, and veterinary demographics, continuing education and staffing.

RESULTS: Three hundred and twenty questionnaires with useable data were returned, a response rate of 28%. Male and female veterinarians were evenly represented. The analgesic agents most commonly used were morphine (opioids) and carprofen (a non-steroidal anti-inflammatory drug; NSAID). Use of peri-operative pain relief ranged from 50% for castration of cats to 91% for fracture repair in dogs. For most procedures, female veterinarians scored pain at a significantly higher level than their male colleagues. Fifty-eight percent of respondents considered their knowledge in the area of assessment and treatment of pain was adequate.

CONCLUSIONS: This survey was considered representative of veterinarians working in companion animal practice in New Zealand. Results indicated a relatively high use of peri-operative analgesia, including both pre-emptive and multi-modal analge- sia, in cats and dogs, although there was still some disparity between the perception of how painful a procedure was and the consequent use of pain relief.

CLINICAL RELEVANCE: The establishment of current attitudes and practices indicates to practising veterinarians how their own use of analgesics compares with that of their colleagues. It also provides information to educators on potential areas of focus, given that 42% of respondents felt their knowledge in the area of assessment and treatment of pain was inadequate.     

Guidelines on the recognition of pain, distress and discomfort in experimental animals and an hypothesis for assessment

Under the 1876 Cruelty to Animals Act it is necessary to recognise pain so that an assessment may be made to determine if it is 'an experiment calculated to give pain' and 'to prevent the animal feeling pain'. Under the conditions of the licence it is also necessary to recognise 'severe pain which is likely to endure' and 'suffering considerable pain'. In the White Paper May 1983 (Command 8883) it is stated that: 'in the application of controls the concept of pain should be applied in a wide sense' and 'the Home Secretary's practice has been to interpret the concept of pain to include disease, other disturbances of normal health, adverse change in physiology, discomfort and distress'. The draft European Convention for the Protection of Vertebrate Animals used for Experimental and other Purposes, aims to control, subject to specific exceptions, any experimental or other scientific procedure which 'may cause pain, suffering, distress or lasting harm'. (The White Paper states that UK control will be stricter than the Council of Europe proposals.) Thus, there is a considerable onus on the experimenter to recognise pain (not to define it) and to alleviate it. It is intended that this article should be of help, not only to newcomers inexperienced in the recognition of pain, but also possibly to those relatively experienced workers who may be called upon to evaluate the pain involved in a new model or an individual animal.(ABSTRACT TRUNCATED AT 250 WORDS)     

开展研究性实践教学,创新实践教育模式

高校现有的社会实践存在诸多问题,而制度化是实践教育发展的趋势。目前实践教育还处于探索初期,需要加强创新,构建行之有效的模式。文中以研究性实践教学为基础,构建实践教育模式。     

The welfare significance of the castration of cattle: A review

Castration is an ancient husbandry procedure used to produce docile cattle for draught work, to reduce unwanted breeding, and to modify carcass quality. All the physical methods used to castrate cattle have side-effects and cause pain. The plasma cortisol response to castration using Burdizzo clamps and, by inference, the acute pain experienced, is less than that caused by surgical, rubber-ring or latex-band castration. The cortisol response may be influenced by the age of the animal castrated, but this has not been well defined. Local anaesthesia virtually eliminates the cortisol response, and thus the acute pain, caused by rubber-ring or latex-band castration, but needs to be combined with a systemic analgesic such as the non-steroidal anti-inflammatory drug ketoprofen to eliminate the cortisol response to Burdizzo or surgical castration. When used alone, ketoprofen sometimes reduces the cortisol response to Burdizzo or surgical castration but may need to be accompanied by local anaesthesia to eliminate the pain-induced behaviour seen during the castration process itself. Thus, pharmacological methods are available to virtually eliminate the acute pain experienced by calves during the 12 h following castration. The use of these methods is an additional cost for farmers and may be limited by the availability of drugs for farmers to use and the scarcity of veterinarians in farm animal practice.     

Use of analgesic drugs for pain management in sheep

Awareness of pain and its effects is increasing within the veterinary profession, but pain management in food animals has been neglected. Sheep seldom receive analgesics despite various conditions, husbandry practice and experimental procedures being known to be painful, e.g. footrot, mastitis, vaginal prolapse, castration, vasectomy, penis deviation, and laparoscopy. The evidence supporting use of analgesic drugs in this species is reviewed here. Opioid agonists are of dubious efficacy and are short acting. α?-agonists such as xylazine are good, short-lived analgesics, but induce hypoxaemia. Non-steroidal anti-inflammatory drugs (NSAID) such as ketoprofen provide long-lasting analgesia, but not as marked as that from α?-agonists; they should be more widely used for inflammatory pain. Local anaesthetics reliably block pain signals, but may also induce motor blockade. Balanced analgesia using more than one class of drug, such as an α? agonist (e.g. medetomidine) and N-methyl-D-aspartate antagonist (e.g. ketamine), with the combination selected for the circumstances, probably provides the best analgesia for severe pain. It should be noted that there are no approved analgesic drugs for use in sheep and therefore the use of such drugs in this species has to be off-label. This information may be useful to veterinary practitioners, biomedical researchers, and regulators in animal welfare to develop rational analgesic regimens which ultimately may improve the health and welfare of sheep in both farming and experimental conditions.     

The welfare significance of the castration of cattle: a review

Castration is an ancient husbandry procedure used to produce docile cattle for draught work, to reduce unwanted breeding, and to modify carcass quality. All the physical methods used to castrate cattle have side-effects and cause pain. The plasma cortisol response to castration using Burdizzo clamps and, by inference, the acute pain experienced, is less than that caused by surgical, rubber-ring or latex-band castration. The cortisol response may be influenced by the age of the animal castrated, but this has not been well defined. Local anaesthesia virtually eliminates the cortisol response, and thus the acute pain, caused by rubber-ring or latex-band castration, but needs to be combined with a systemic analgesic such as the non-steroidal anti-inflammatory drug ketoprofen to eliminate the cortisol response to Burdizzo or surgical castration. When used alone, ketoprofen sometimes reduces the cortisol response to Burdizzo or surgical castration but may need to be accompanied by local anaesthesia to eliminate the pain-induced behaviour seen during the castration process itself. Thus, pharmacological methods are available to virtually eliminate the acute pain experienced by calves during the 12 h following castration. The use of these methods is an additional cost for farmers and may be limited by the availability of drugs for farmers to use and the scarcity of veterinarians in farm animal practice.     

Postoperative pain and perioperative analgesic administration in dogs: practices, attitudes and beliefs of Queensland veterinarians

Objective The aim of this study was to describe the practices, attitudes and beliefs of Queensland veterinarians in relation to postoperative pain and perioperative analgesia in dogs. Methods One veterinarian from each of the 50 randomly selected Queensland veterinary practices was enrolled after selection by convenience sampling. Results The study response rate was 94.3%. Demeanour, vocalisation and heart rate were the most common postoperative pain assessment tools used, even though the most sensitive tools were considered to be demeanour, heart rate and respiratory rate. Only 20% of respondents used formalised pain scoring systems. Preoperative analgesic administration was always used by 72% of respondents. There was marked variability in the frequency with which analgesia was administered perioperatively for ovariohysterectomy. Only 24% of veterinarians discharged animals with ongoing analgesia even though 38% agreed that pain is still present 7 days postoperatively. Multimodal analgesia was used by 82% of respondents. Epidural and local anaesthetic analgesic techniques were not being utilised by any respondents. Conclusions These results indicate that management of postoperative pain in dogs in Queensland is frequently suboptimal and, at times, is not consistent with the veterinarian's attitudes and beliefs. Continuing education into analgesic use and pain evaluation may be effective in addressing this.     

高校实践创新型人才培养体系研究

创新和实践能力的培养是建立创新型社会对人才的需要,是高校教育改革的重要内容。目前国内大学生的创新实践能力培养模式尚不完善,与国外还存在一定的差距。以培养大学生创新和实践能力为目的,借鉴国外先进的大学生创新实践能力培养模式、方法和经验,结合日常创新实践教学工作中取得的经验,提出了一套切实可行的人才培养模式,以期为提高应用型人才培养质量提供参考。     

Handheld computers in veterinary medical education: a view from human medical education

Handheld computers are widely used in clinical practice, and their use in both human medical education and veterinary medical education is increasing, especially, for the former, in activities involving point-of-care access. This article references the insights that can be obtained from the usage and activities that are gaining a strong foothold in human medical education. Handheld computer technology gives students access to a large and changing knowledge base for clinical practice, especially when they are geographically dispersed. Differences in use between education and practice largely relate to the importance clinicians place on patient information. Student use focuses on progress mapping and ready access to clinical reference material. Suggestions are made for future use in medical education.