Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology

The recent development of a 20-MHz, high-frequency ultrasound probe has allowed tissue to be visualized at resolutions of 20 to 80 microm, which is similar to a low-power histologic view. This high degree of resolution, however, limits tissue penetration to 5 to 10 mm, which is ideal for examination of the anterior segment of the eye. The detail provided by high-resolution ultrasound readily permits the clinician to distinguish between various anterior segment entities that may appear similar but are treated quite differently, such as anterior uveal tumors, iridociliary cysts, and iris bombé. High-frequency ultrasound is also a valuable aid in creating a surgical plan for treatment of ocular disorders in which the cornea is opaque, such as feline corneal sequestrum and tumor invasion into the cornea. Other applications of this technology include elucidation of the pathogenesis of glaucoma in veterinary patients and evaluation of regions of the lens that are difficult to examine directly.     

The value of biomedical research training for veterinary anatomic and clinical pathologists

Veterinary pathologists traditionally have been actively engaged in research as principal investigators and as collaborators. Pathologists frequently obtain advanced training in research; however, it appears that in the last 10 years there has been a reversal of a previous trend toward increasing numbers of pathologists obtaining PhD degrees. This has arisen despite an established shortage of veterinarians engaged in research. This article evaluates the benefits of research training for individual pathologists, including a wide spectrum of professional opportunities and additional skill development beyond that usually provided by diagnostic pathology training alone. Various training models are discussed, including combined and sequential diagnostic residency and research degree training as well as the nondegree research fellowship programs more commonly pursued in human medicine. Best-practice recommendations for program infrastructure, mentorship, time management, and a team approach to research and research training are advocated to facilitate the development of successful programs and to encourage a continued emphasis on integrated training for pathologists as both clinical diagnosticians and experimentalists. This article is intended to help prospective and active pathology trainees, their mentors, and educational administrators optimize opportunities to ensure the future vitality of veterinary pathologists, and their contributions, in basic and applied research.     

Use of molecular epidemiology in veterinary practice.

Molecular epidemiology is a relatively new branch of epidemiology that uses molecular biology methods to study health and disease in populations. This article gives an introduction to molecular epidemiologic terminology and methodology and its usefulness in large animal medicine and veterinary public health. Applications in source tracing and vaccine studies and insights into transmission dynamics, host specificity, and niche adaptation of infectious organisms are presented. Examples are drawn from a variety of diseases, organisms, and host species and range from the global level to the individual-animal level.     

PCR as a diagnostic and quantitative technique in veterinary parasitology.

Over the past 15 years, there has been a dramatic evolution in molecular approaches to study parasites and parasitic diseases. Many of these advancements have been brought about through the development of new applications of the polymerase chain reaction (PCR). Enhancements in sensitivity that can be achieved using PCR now permit scientists to investigate changes at the level of a single cell, far below what is often needed for parasite-derived applications. PCR has had a substantial impact on advances made in the areas of parasite systematics and epidemiology, immunology and host-parasite interactions, recombinant DNA vaccine development and most recently, the analysis of whole genomes either through directly sequencing the DNA, the analysis of expressed sequence tags (ESTs) or through the rapidly growing field of functional genomics. This paper, however, focuses on the application of PCR methodology to parasite detection and differentiation, and the diagnosis of disease. Specific attention is given to advances provided by multiplex PCR, fluorescence-based "real-time" PCR, and the utilization of PCR as a quantitative technique.     

Echocardiography as a research and clinical tool in veterinary medicine

Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of anesthetic effects on ventricular function and clinically in the diagnosis of congestive cardiomyopathy in a cat, ventricular septal defect in a calf, and pericardial effusion in a dog. Echocardiography is now an important adjunct to the field of veterinary cardiology.     

Use of simulated clients in training veterinary undergraduates in communication skills

A course in communication skills has been developed specifically for veterinary students, based on those delivered at many medical schools, and making extensive use of professional actors as simulated clients. Its aim is to raise awareness of the importance of communication among veterinary undergraduates at all stages of the curriculum, and it allows them to role-play in acted-out scenarios. Facilitated small groups provide an environment in which students can receive feedback on their own performance and also give feedback to their colleagues. An independent evaluation suggests that the opportunity to role-play increased the students' confidence in communicating with others. They were able to identify their personal strengths as communicators and gain insights into the aspects of communication they could improve. Feedback and subsequent discussions were highly valued, with the actors playing a crucial role in providing feedback from the client's perspective. Students were able to use the knowledge they acquired when consulting with real clients. Most of the students suggested that the course should continue in its current format, but with more time provided for it in the curriculum.     

Economic decisions in veterinary practice: a method for field use

A technique is presented that allows economic decision analysis, sensitivity analysis, and threshold analysis to be done rapidly in field situations. The method allows the practitioner to choose between 2 interventions with different costs and different probabilities of success. A graphic approach is presented, which speeds and simplifies the analysis.     

Coaching and feedback: enhancing communication teaching and learning in veterinary practice settings

Communication is a critical clinical skill closely linked to clinical reasoning, medical problem solving, and significant outcomes of care such as accuracy, efficiency, supportiveness, adherence to treatment plans, and client and veterinarian satisfaction. More than 40 years of research on communication and communication education in human medicine and, more recently, in veterinary medicine provide a substantive rationale for formal communication teaching in veterinary education. As a result, veterinary schools are beginning to invest in communication training. However, if communication training is to result in development of veterinary communication skills to a professional level of competence, there must be follow-through with effective communication modeling and coaching in practice settings. The purpose of this article is to move the communication modeling and coaching done in the "real world" of clinical practice to the next level. The development of skills for communication coaching and feedback is demanding. We begin by comparing communication coaching with what is required for teaching other clinical skills in practice settings. Examining both, what it takes to teach others (whether DVM students or veterinarians in practice for several years) and what it takes to enhance one's own communication skills and capacities, we consider the why, what, and how of communication coaching. We describe the use of teaching instruments to structure this work and give particular attention to how to engage in feedback sessions, since these elements are so critical in communication teaching and learning. We consider the preconditions necessary to initiate and sustain communication skills training in practice, including the need for a safe and supportive environment within which to implement communication coaching and feedback. Finally we discuss the challenges and opportunities unique to coaching and to building and delivering communication skills training in practice settings.     

Ability of veterinary pathologists to diagnose classical swine fever from clinical signs and gross pathological findings

Clinical signs recorded in a classical swine fever (CSF)-suspect situation and the results of the subsequent post-mortem examination (PME) from swine submitted to post-mortem during the 1997–1998 CSF epidemic in the Netherlands, were presented in an experiment as anonymous cases (without knowledge of the actual infection status of the submission) to five veterinary pathologists for their judgment: CSF-suspect or non-suspect. It was presented to them in two hypothetical situations: country was free of CSF for 5 years and CSF was detected in the country 2 weeks ago. Subsequently, their judgment was compared to the gold standard (infection status of the submission on the basis of an immunofluoresence assay on tissue samples) and the sensitivity (Se) and specificity (Sp) of clinical diagnosis was estimated. Furthermore, intra- and inter-pathologist agreement on pathological diagnosis was measured. Adding information on clinical signs to information on PME resulted in a significant increase in median Se and a significant decrease in median Sp for a clinical judgment by pathologists. Also, median Se was significantly higher—and Sp significantly lower—for a clinical judgment by pathologists in a situation in which CSF was detected 2 weeks ago in the country compared to the situation in which the country had been free of CSF for 5 years. Apparently, the internal threshold of pathologists is severely adjusted depending on the actual disease situation in a country. Intra-rater agreement ranged from fair to almost perfect for a clinical diagnosis on the basis of PME. There was considerable variation between pathologists, especially if clinical diagnosis was based on the combined information on PME and clinical signs observed in the herd. Inter-rater agreement was substantial for the diagnosis based on information on PME. Inter-rater agreement was considerably lower for the diagnosis based on the combined information on PME and clinical signs observed in the herd.     

Use of fluorescent tagging for assessment of environmental cleaning and disinfection in a veterinary hospital

Environmental cleaning was assessed at a small animal veterinary referral hospital and associated primary healthcare facility. A convenience sample of surfaces was contaminated with fluorescent dye, and then cleaning was assessed 24 hours later by UV light visualisation. Five hundred sixty-three sites were assessed; however, 70 sites were unable to be evaluated 24 hours later because equipment had been removed or because rooms were occupied at the time of re-evaluation. Overall, dye was removed from 212/493 (43%) of sites. Site-specific rates ranged from 14% (computer keyboards and mice, 9/66 site cleaned) to 81% (examination tables, 44/54 sites cleaned). There was a significant difference in the prevalence of successful cleaning by general location (P < 0.0001) and surface type (P < 0.0001). Environmental tagging was an easy and low-cost tool to assess cleaning practices. Results prompted further infection control investigations to explain selected deficiencies, leading to identification of inadequacies in protocols and practices. Environmental tagging may be a useful infection control tool for establishing baseline cleaning rates, identifying deficiencies in protocols, evaluating the effects of interventions and education of personnel.     

Use of drama in teaching the human side of veterinary practice

Objective To describe a teaching experiment in which fifth year veterinary students were given the opportunity, using dramatic scenarios, to consider ways of dealing with emotive issues relevant to veterinary practice, that demand good communication skills.
Design Workshops were devised using dramatised scenarios of several critical incidents in practice, including euthanasia. A clinical psychologist and several veterinary practitioners participated in discussions. Both live performances and video scenarios were presented to fifth year veterinary students and were followed by group discussions. Each workshop was evaluated and modifications were made where necessary.
Results The teaching format involving drama was well received. The combination of drama and discussion was more effective than a formal talk and discussion, provoking animated participation and maintaining audience attention. The majority of students considered that comments and advice from attending veterinarians were the most useful parts of the workshops in preparing them for veterinary practice. The large audience (up to 45 attendees) was considered to be desirable for enhancing discussion. Requests for more similar sessions were made by students.
Conclusion Drama was found to be a satisfactory modality in teaching communication skills in preparing veterinary students for practice.     

Changes in prevalence and susceptibility of obligate anaerobes in clinical veterinary practice

Of 3,133 clinical specimens obtained from domestic animals, 26% contained species of bacteria that were obligate anaerobes. Members of the genera Bacteroides, Fusobacterium, and Peptostreptococcus accounted for 77% of the isolates. On the average, 2 species of obligate anaerobes were found in each specimen, usually admixed with facultatively anaerobic bacteria. Of those specimens containing an obligate anaerobe, 20% contained one isolate that was resistant to penicillin, ampicillin, and cephalothin. These resistant isolates belonged to the genus Bacteroides, the most common being Bacteroides fragilis. Approximately one third of these penicillin-resistant isolates was resistant to tetracycline as well. All isolates were susceptible to chloramphenicol, tetracycline (excluding penicillin-resistant Bacteroides), metronidazole, and clindamycin.