Current joint therapy usage in equine practice: a survey of veterinarians 2009

Reasons for performing study: Medications are frequently employed to treat intra‐articular (IA) problems in the performance horse. Actual usage of the different IA medications in horses is not available. Objectives: To determine the most common usage of these medications, members of the American Association of Equine Practitioners (AAEP) were surveyed. Methods: An email link to an online survey was electronically sent to 6305 AAEP members and the responses tabulated and analysed with a logistic regression model. Results: A total of 831 survey responses were submitted and tabulated. Eighty per cent of the respondents indicated that they see 100% equine cases in their practice. The majority of respondents (77%) use triamcinolone acetonide (TA) to treat high motion joints and 73% use methylprednisolone acetate (MPA) to treat low motion joints. Veterinarians treating the Western performance and Sport horse were significantly more likely to use TA in high motion joints compared to MPA (P = 0.0201 and P<0.0001, respectively). Triamcinolone acetonide use compared to MPA in high motion joints by racehorse veterinarians was significantly lower compared to other veterinarians (P<0.0001). Polysulphated glycosaminoglycan (Adequan) and hyaluronate sodium (Legend) were the most commonly used disease modifying products (63 and 57% of respondents, respectively). Sport horse practitioners were significantly more likely than race or show horse veterinarians to utilise IRAP products (P = 0.0035 and P = 0.04, respectively). Respondents who had been in practice for more than 10 years were significantly less likely to use antimicrobials in their joint injections compared to those in practice for less than 10 years (P<0.0001). Conclusions: Significant differences existed in usage of medications related to primary discipline treated and years practicing. Potential relevance: The results of this study aid in defining the current usage of different joint therapy medications within equine practice. This knowledge can guide further research as well as education.     

Use of anti-inflammatory and analgesic drugs in dogs and cats

SUMMARY: Responses (486) were collated from a survey of 5054 Australian veterinarians on their use of anti-inflammatory and analgesic drugs in dogs and cats. Almost all respondents used glucocorticoids (usually prednisolone) to treat allergic, pruritic dermatoses in dogs, while two-thirds also gave fatty acid supplements and one-half used antihistamines. Almost 60% of respondents initially injected a glucocorticoid (frequently a long-acting preparation) when treating inflammatory skin diseases in dogs. More than 90% of respondents used glucocorticoids to treat immunemediated haemolytic anaemia or thrombocytopenia, and about one-third also gave cytotoxic drugs. Administration of prednisolone on alternate days was generally favoured for long-term enteral steroid therapy. Phenylbutazone was the most preferred treatment for painful or inflammatory musculoskeletal disorders of dogs, but aspirin and pentosan polysulphate were also used widely. Regarding the use of analgesics drugs generally, both narcotic analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were used more widely in dogs than in cats, but alpha-2 agonists were used similarly in both species. The most commonly used narcotic analgesics were pethidine and buprenorphine in both species, while the NSAIDs used most often were flunixin and dipyrone in dogs and ketoprofen in cats. More than 80% of respondents generally used analgesic drugs with potentially painful surgical procedures, with doses given usually before anaesthetic recovery. Analgesic use rates varied with the condition, ranging from 94% for patients with acute severe trauma, through 60% for cruciate ligament repair and 29% for perineal herniorrhaphy, to about 5% for ovariohysterectomy and dog castration. The three clinical signs most frequently nominated as indicators of pain in dogs and cats were (in descending order) vocalisation, response to handling or palpating the affected area, and mental depression. Other items mentioned frequently were behavioural changes and immobility (in both species), inappetence/anorexia in cats, and altered respiration in dogs.     

Failure to acknowledge high suicide risk among veterinarians

A high suicide risk has been reported among veterinarians in comparison to the general population. Postulated causes have included depression, substance abuse, work-related stress, reluctance to admit psychiatric problems, and access to lethal drugs and/or familiarity with euthanasia. Members of the Student Chapter of the American Veterinary Medical Association (AVMA), all veterinarians licensed in Alabama, and all US veterinary-association executive directors were surveyed regarding their attitudes concerning mental health issues, including veterinarian suicide. Only 10% of veterinary student respondents (N=58) believed that suicide risk is higher among veterinarians than in the general population. Of the 22 state associations' executive directors who participated in the survey, 37% believed that suicide is a significant concern for veterinarians and only 44% indicated that a veterinary wellness program was available in their respective states. Of the 1,455 licensed veterinarians in Alabama, 701 responded to the survey; 11% of respondents believed that suicide among veterinarians was a problem. In addition, 66% of respondents indicated that they had been "clinically depressed," but 32% of those with depression had not sought treatment. More females (27%) than males (20%) admitted that they had "seriously considered suicide" (p<.01). Female veterinarians were more likely than male veterinarians (15% versus 7%) to indicate that they were "not sure they'd made the right career choice" (p<.001), and 4% of all respondents indicated "definitely not being happy with their career." It is of concern that veterinarians not only have a higher risk of suicide but that they also have fewer support structures. The wide discrepancies between the published risk of suicide for veterinarians and their own views of their risk suggests an inadequate awareness of their own mental health vulnerability which could put them at higher risk.     

Plasma electrolyte concentrations in dogs receiving diuretic therapy for cardiac failure

Treatment of clinical cases of heart failure in dogs, using frusemide, was associated with statistically significant reductions in plasma concentrations of potassium, magnesium, sodium and chloride, compared with healthy controls and untreated dogs with dysrhythmias. The reductions in sodium and chloride seem too slight to be clinically significant but those in magnesium and potassium could potentially have harmful effects, including the induction of cardiac dysrhythmias. Indeed, diuretic-treated dogs with ventricular ectopic beats in their electrocardiograms had significantly lower plasma potassium concentrations than other dogs undergoing diuretic treatment. As potassium and magnesium are predominantly intracellular cations, the falls in plasma concentration may well be associated with substantial deficits within cells, including those of the myocardium.     

Survey on small animal anaesthesia

OBJECTIVE: To ascertain anaesthetic practices currently for dogs and cats in Australia. METHODS: A questionnaire was distributed to 4,800 veterinarians throughout Australia, seeking data on numbers of dogs and cats anaesthetised per week; drug preferences for anaesthetic premedication, induction and maintenance; use of tracheal intubation, supplemental nitrous oxide and anaesthetic antagonists; and types of vaporisers, breathing systems and anaesthetic monitoring devices used or available. Additional questions concerned proportions of different animal types seen in the practice, and the respondent's university and year of graduation. RESULTS: The response rate was 19%; 95% of respondents graduated from Australian universities, about half since 1985. Most responses (79%) came from mainly small animal practices. On average 16 dogs and 12 cats were anaesthetised each week. Premedication was used more often in dogs than cats, with acepromazine and atropine most favoured in both species. For anaesthetic induction, thiopentone was most preferred in dogs and alphaxalone/alphadolone in cats. Inhaled agents, especially halothane, were preferred for maintenance in both species. Most respondents usually employed tracheal intubation when using inhalational anaesthetic maintenance, but intubation rates were lower during injectable anaesthetic maintenance and a minority of respondents provided supplemental O2. Nitrous oxide was administered regularly by 13% of respondents. The agents most frequently used to speed recovery from anaesthesia were doxapram and yohimbine. The most widely used vaporisers were the Fluotec Mark III and the Stephens machine. Most (95%) respondents used a rebreathing circuit for large dogs and a non-rebreathing system was used for small dogs by 68% of respondents. Most respondents (93%) indicated some form of aid was available to monitor general anaesthesia: the three most mentioned were an apnoea alarm, oesophageal stethoscope and electrocardiogram. CONCLUSION: Diverse approaches were evident, but there appeared to be less variation in anaesthetising dogs: premedication was more frequent and less varied in type, while thiobarbituates dominated for induction and inhalants for maintenance. Injectable maintenance techniques had substantial use in cats, but little in dogs. Evident disparity between vaporisers available and circuits used suggested either confusion in terminology or incorrect use of some vaporisers in-circuit. While most respondents used monitoring equipment or a dedicated observer to invigilate anaesthesia, the common reliance on apnoea alarms is of concern, because of unproven reliability and accuracy.     

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.     

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.     

THE LITERATURE OF VETERINARY IMAGING: THE ANALYSIS OF A QUESTIONNAIRE

250 veterinarians, including 143(57.7%) non-radiologists, replied to a questionnaire on current literature of veterinary imaging. Veterinary Readiology & Ultrasound was considered the best overall journal, being chosen as first choice by 51.6% respondents. It was also judged to have the best photographic reproduction. No book was chosen as first choice by more than 18.4%. Three, Textbook of Diagnostic Radiology, Thrall; Diagnostic Radiology of the Dog & Cat, Kealy and Thoracic Radiography of the Dog & Cat, Suter & Lord, were chosen by 18.4%, 16.8% and 13.2% respondents respectively. Clinically orientated papers and review articles were the preferred contents of journlas. Experience of colleagues and journals were adjudged the best source of information on diagnostic imaging. Differences in results between radiologists and non-radiologists were not great and geographic differences were few. Of the 112 respondents who had published papers on veterinary imaging, 30 (26.4%) were non-radiologists.     

Prevalence of occupational exposures and protective practices in Australian female veterinarians

OBJECTIVE: To identify the prevalence of exposure to potentially harmful occupational hazards in Australian female veterinarians and to report factors associated with prevalence of occupational hazards in this profession. DESIGN: National cross-sectional survey of a cohort population. PROCEDURE: A self-administered questionnaire was mailed to 5748 veterinarians (males and females) graduating from Australian veterinary schools from 1960 to 2000. This paper reports the prevalence of occupational exposures in 1197 female veterinarians in their current job including radiation, anaesthetic gases, pesticides and long working hours. Comparisons were undertaken between respondents by practice type and decades of graduation. Multivariate logistic regression was undertaken to predict the risk for exposure to occupational hazards in female veterinarians by age, type of practice, graduation year and number of hours worked. RESULTS: The response rate for females was 59%. We found that age under 30 years, small and mixed animal practice, graduation year after 1990, and working more than 45 hours per week were all associated with greater exposure to putative risk factors. Mixed animal practitioners worked more than 45 hours per week (53%) and reported the highest exposure to anaesthetic gases (94%) and pesticides (54%). Twenty two percent of those who were exposed to anaesthetic gases did not have waste anaesthetic gas scavenging systems. Small animal practitioners reported they took more X-rays (90%). While taking X-rays, 56% of respondents reported physically restraining animals, and only one in five of respondents used film holders and lead screens. CONCLUSIONS: The high prevalence of potentially harmful exposures among female veterinarians and lack of use of protective equipment at work needs to be considered in developing and planning the safety of veterinary work.     

Continuing veterinary medical education needs and delivery preferences of Alberta veterinarians

The questionnaire component of a continuing-education needs assessment of Alberta veterinarians is described. A questionnaire about work characteristics, topic priorities, and program delivery preferences was mailed to all licensed Alberta veterinarians, 54% of whom responded. Topic-priority data were factor analyzed, and differences in priorities were examined using multivariate analysis of variance (MANOVA). Seven learning areas emerged: veterinary medicine, professionalism and practice management, animal welfare, livestock practice and epidemiology, prophylaxis and therapeutics, specialty diagnostics, and theriogenology. Associations between delivery preferences and work characteristics were sought using MANOVA and contingency tables analysis. Significant differences were identified in learning-area priorities and preferred program types and times when respondents were grouped by species focus, and there were significant associations between respondents' location and their preferred learning locations. There were no significant associations between location or practice size and preferred program type. Group differences support the need for events tailored by species focus. Delivery preferences suggest that workload and distance are barriers to attendance, although face-to-face events were universally preferred.     

Estimation of the potential demand for a bovine babesiosis and anaplasmosis vaccine in Argentina

A survey to estimate the potential demand for a bovine babesiosis and anaplasmosis vaccine was carried out by a postal questionnaire sent to 4407 veterinarians in the north and centre of Argentina. Twenty-three percent of the questionnaires (1047) were answered; 317 (7.2% of the total, 30% of those answered) pointed out the occurrence of the diseases and/or probable demand for the vaccine. The minimum and maximum demands were 407,892 and 982,300 doses for anaplasmosis, and 272,496 and 631,400 doses for babesiosis, respectively. The results presented from here onwards are based on the minimum demand. Sixty-eight and 48% of the anaplasmosis and babesiosis vaccine demand, respectively, came from veterinarians living in the Boophilus microplus-free area, while the remainder came from the tick-infested area, reflecting the fact that many farm owners from the tick-infested area seek professional assistance from veterinarians living in the tick-free area. Most of the demand for both vaccines was aimed at breeding cattle (77.2%), 14.5% at dairy cattle and the rest at studs (8.3%). Veterinarians living in the tick-infested area demanded vaccine for breeding cattle in a higher proportion than veterinarians from the tick-free area, whose demand was greater for dairy cattle. In the tick-free area, the demand for anaplasmosis vaccine was twice that for babesiosis vaccine, whereas in the tick-infested area the demand was equal. This agrees with the fact that the anaplasmosis-stricken area extends beyond the tick-infested region. Sixty percent of the respondents preferred a vaccine frozen in liquid nitrogen, whilst the rest preferred a refrigerated one, the first group accounted for 73% of the total demand. Fifty-six percent of the demand occurred between March and June with the peak in April, which reflects the main weaning date. The elasticity of the demand is discussed in relation to the probable benefits to be accrued by the farmers who make use of it. The annual mortality rates due to both babesiosis and anaplasmosis were estimated at 1.5 and 3.5% in the milk herds of Salta and Tucumán, respectively. In the beef herds of these two provinces, the mortality rate due to both diseases has been estimated at 3.5%. Using these figures and current prices, the systematic application of the vaccine in calves would render a benefit-cost ratio between 4.6 and 9.0, which would warrant its use in the herds of the areas at risk, i.e. in enzootic instability.     

Choosing which metrics to use when reporting antimicrobial use information to veterinarians in the Canadian swine industry

The objective of this study was to evaluate preferences for various metrics and denominators among Canadian swine veterinarians, in order to improve reporting of antimicrobial use (AMU) information to these stakeholders and to facilitate enhanced stewardship decisions. An online survey was made available to swine veterinarians across Canada; 12 responses (estimated response rate 17.6%) were submitted and analyzed. Responses represented veterinarians from every major pig-producing province and from a range of year of graduation from veterinary college. Participants self-evaluated their understanding of dose-based metrics as higher than weight- and frequency-based metrics and interpreted most results of AMU analyses correctly. Participants preferred dose-based metrics over others, and had various objectives for AMU information, including improving AMU on their clients’ farms and enabling comparisons with other farms. The results are useful to those making decisions about which AMU metrics to use in reports targeted to swine veterinarians.     

A survey of antimicrobial use during bovine abdominal surgery by western Canadian veterinarians

Members of the Western Canadian Association of Bovine Practitioners were surveyed regarding their use of antimicrobials in bovine abdominal surgery. Perioperative antimicrobials were used in 100% of abdominal surgeries by 96 of 98 respondents. Although postoperative administration was the most common perioperative period for antimicrobial use, intraoperative intraperitoneal use was reported by more than half of the veterinarians surveyed. Procaine penicillin G and oxytetracycline were the most commonly administered perioperative antimicrobials.     

Work-related stress in the veterinary profession in New Zealand

AIM: To investigate sources of work-related stress in the veterinary profession in New Zealand, perceptions of levels of stress being experienced, and the social support that veterinarians are using to manage work-related stress. METHODS: A postal survey was distributed to 1,907 veterinarians registered with the Veterinary Council of New Zealand (VCNZ). The survey collected information on respondents' age, gender, type and number of people in the workplace, stress levels, depression, suicidal thoughts and attempts, causes of stress and sources of support. RESULTS: Nine hundred and twenty-seven (48.6%) veterinarians returned useable responses. Veterinarians who were retired, working overseas or did not provide information about their type of work were excluded from the analysis, leaving data from 849 (44.5%) veterinarians. Women experienced more work-related stress and depression than men, veterinarians in small animal/mixed practice reported more stress and depression than those in other types of work, and younger veterinarians experienced higher levels of stress than older veterinarians. The main sources of stress were hours worked, client expectations, and unexpected outcomes. Respondents were also stressed by the need to keep up their knowledge and technical skills, and by personal relationships, finances and their expectations of themselves. Most respondents reported that they had good networks of family and friends to help them deal with stress. In general, respondents tended to rely on informal networks such as family and friends, other veterinarians and workmates to provide support. The small proportion of respondents who reported clinical depression or suicidal thoughts or attempts were more likely than respondents in general to have used health professionals, counselling, pastoral/spiritual support and the Vets in Stress phone line, but less likely to have sought support from employers and workmates. CONCLUSIONS: There is a need for a wide range of strategies to manage work-related stress among veterinarians. Sources of stress in the workplace must be identified and strategies developed to control those which present a significant hazard. Strategies may include attention to workloads and working hours, design of work processes, and increasing social support. Training in work-related skills such as communication, conflict management and stress management may be helpful where lack of these skills is contributing to stress. Support services such as help lines and mentor schemes are also available and information about these needs to be more accessible.     

Australian veterinarians who work with horses: an analysis

OBJECTIVE: To define and describe the population of Australian veterinarians who work with horses. METHOD: Questionnaires were mailed to 866 veterinarians who had been identified as working with horses, and 87% were completed and returned. Data were entered onto an Excel spreadsheet, and analysed using the SAS System for Windows. RESULTS: About 12% of Australia's veterinarians were doing all the veterinary work with horses, and about 3% worked exclusively (> 90%) with horses, but did more than half (58%) of the horse work. Veterinarians working with horses included more males (80%) than the veterinary population as a whole (approximately 60%). Males had an average age of 47 years, females 35. Almost all (94%) worked in private practice, with 31% being employees, 28% partners and 41% sole owners. Females were more likely to be employees than males. Males reported working 55 hours/week; females 49. More females (44%) than males (16%) had worked less than full-time for more than a year. Males expected to work for another 12 years in full-time equivalents, and females for 16. One quarter (24%) saw only horses, but treated 58% of total horse cases. One-half had < 25% horses, and 29% had < 10% of horses in their caseloads. More of the older (54% of those aged > 60) than younger respondents (27% of those < 40) had grown up on farms with animals. One-quarter (24%) decided to become a veterinarian while in primary school, and females decided at a younger age than males. Overall, younger respondents decided at a younger age than did their older counterparts. A veterinarian contributed to the decision for 21% of these veterinarians. CONCLUSION: In this survey, Australian veterinarians who work with horses were found to be typically male, and advanced in their careers. As these older veterinarians retire, there may not be enough veterinarians who are committed to and competent with horses to take their places.     

Australian veterinarians who work with horses: attitudes to work and career

OBJECTIVE: To describe the attitudes to their work and career of those Australian veterinarians who work with horses. METHOD: Questionnaires were mailed to 866 veterinarians who had been identified as working with horses, and 87% were completed and returned. Data were entered onto Excel spreadsheets, and analysed using the SAS System for Windows. RESULTS: The main attractions of veterinary work with horses were the horses themselves and the equine industries, but working outdoors and with rewarding clients, and the satisfaction of successful outcomes were attractions for many. The list of disadvantages was longer, and included unreasonable and disagreeable clients as well as those who provided inadequate facilities, could not control their horses or did not care for them. The physical demands and risks of injury, the amount of time required, low rates of return and difficulties in collecting payment, were other major disadvantages. Some mentioned concerns about litigation, unethical behaviour, and recruiting and retaining veterinarians competent with horses. For many in mixed practice, the difficulties in affording modern equipment, and of developing and maintaining their own competence with horses, was a real concern. More than three-quarters of the respondents reported that their careers had lived up to expectations and that they would become veterinarians again; 70% of equine veterinarians would become an equine veterinarian again. Almost all (93%) of the respondents were either very glad, or 'generally glad though with some misgivings' that they had done the veterinary course. Older veterinarians reported suffering less stress, and being more content with their career, than younger colleagues. CONCLUSIONS: The advantages of doing veterinary work with horses outweigh the disadvantages for most veterinarians, especially those well advanced in their careers.     

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.     

Infection control practices and zoonotic disease risks among veterinarians in the United States

OBJECTIVE-To assess the knowledge and use of infection control practices (ICPs) among US veterinarians. DESIGN-Anonymous mail-out population survey. PROCEDURES-In 2005 a questionnaire was mailed to US small animal, large animal, and equine veterinarians who were randomly selected from the AVMA membership to assess precaution awareness (PA) and veterinarians' perceptions of zoonotic disease risks. Respondents were assigned a PA score (0 to 4) on the basis of their responses (higher scores representing higher stringency of ICPs); within a practice type, respondents' scores were categorized as being within the upper 25% or lower 75% of scores (high and low PA ranking, respectively). Characteristics associated with low PA rankings were assessed. RESULTS-Generally, respondents did not engage in protective behaviors or use personal protective equipment considered appropriate to protect against zoonotic disease transmission. Small animal and equine veterinarians employed in practices that had no written infection control policy were significantly more likely to have low PA ranking. Male gender was associated with low PA ranking among small animal and large animal veterinarians; equine practitioners not working in a teaching or referral hospital were more likely to have low PA ranking than equine practitioners working in such institutions. CONCLUSIONS AND CLINICAL RELEVANCE-Results indicated that most US veterinarians are not aware of appropriate personal protective equipment use and do not engage in practices that may help reduce zoonotic disease transmission. Gender differences may influence personal choices for ICPs. Provision of information and training on ICPs and establishment of written infection control policies could be effective means of improving ICPs in veterinary practices.     

Attitudes of Spanish-speaking veterinarians interested in anaesthesia towards use of total intravenous anaesthesia in dogs: a survey study

ObjectivesTo describe Spanish-speaking veterinary anaesthetists’ attitudes towards use of total intravenous anaesthesia (TIVA) in dogs.Study designProspective online voluntary survey.PopulationData from 300 answered surveys.MethodsAn anonymous questionnaire was sent via e-mail to representatives of the four largest Spanish-speaking veterinary anaesthesia and analgesia associations. It was distributed through mailing lists (Spain, Argentina, Mexico) or social media (Spain, Chile) to gather information on the use, opinions and perceived advantages of TIVA, as well as on preferred alternatives to isoflurane for providing general anaesthesia. Logistic regression was used to test for response associations.ResultsA total of 275 (92%) respondents had used TIVA (24% rarely, 36% sometimes, 40% very often or always). There was an association between a higher rate of TIVA usage and a low specialization level, less clinical experience and unavailability of anaesthetic gas scavenging systems. The main reasons for not using TIVA were lack of familiarity with the technique (92%), unavailability of infusion pumps (32%), established institutional anaesthetic protocol (32%), and technical difficulty (20%). Among frequent TIVA users, a higher proportion reported the greater ease of TIVA use (52%) compared to those that did not perceive such benefit (17%) [odds ratio (OR) = 5.2; 95% confidence interval (CI95), 1.7–16.6; p = 0.004). More respondents did not consider TIVA more expensive (60%) (OR = 2.1; CI95, 1.0–4.3; p = 0.034), more difficult to perform (59%) (OR = 2.5; CI95, 1.3–4.9; p = 0.006) or to manage the equipment (53%) (OR = 3.3; CI95, 1.4–7.8; p = 0.008), than inhalational anaesthetics. During isoflurane shortages, respondents reportedly preferred using an alternative inhalational agent (59%) rather than TIVA (47%).Conclusions and clinical relevanceTIVA use is widespread among veterinarians within the surveyed associations. Frequent TIVA users reported greater perceived advantages. In situations of isoflurane shortage, an alternative inhalational anaesthetic was preferred over TIVA.     

Efficacy of inotropic support of the failing heart

The clinical literature on the subject of inotropic therapy of heart failure, particularly use of digitalis glycosides, is full of contradictions. Most of this disparity can be accounted for if not reconciled by taking the methodology of the clinical trials into consideration. Because drug interventions may produce subtle effects requiring a subjective determination, the questions being asked in these studies cannot be answered without removing as many sources of bias as possible from the patient management and data analysis. If a study has not been adequately randomized, double-blinded, and placebo-controlled, the clinical findings will be inconclusive at best. Systolic myocardial dysfunction plays a pivotal role in the pathogenesis of CHF in many patients and is a prerequisite for the use of cardiotonic drugs. Although the clinical signs of heart failure may be relieved initially by diuretics and vasodilators, compensation may require the addition of a positive inotrope, particularly in advanced cases. In veterinary medicine, the choice of positive inotrope is limited to digoxin, digitoxin, dobutamine, or amrinone. Digoxin possesses superior pharmacokinetics and is the cardiac glycoside of choice for use in the dog. Dobutamine and amrinone are more potent inotropes, but since they must be administered by continuous intravenous infusion, their use is limited to critical care therapy. At the present time, only digoxin can be administered orally for sustained long-term maintenance therapy. Milrinone, a more potent derivative of amrinone, also offers this option, but it has not been available since its brief trial debut as an investigational drug. None of the nonglycoside alternatives couples the benefits of positive inotropic and negative chronotropic effects. Consequently, digoxin remains the mainstay for chronic inotropic support of the heart. Atrial fibrillation with a rapid ventricular response rate is the prime indication for digoxin. In the last few years, evidence from methodologically sound clinical trials on humans has also restored faith in the efficacy of digoxin for treating heart failure in patients with normal sinus rhythm. From these studies, the profile of a digitalis responsive heart failure patient has emerged. Digoxin is most likely to be efficacious when heart failure is associated with chronic, severe ventricular systolic dysfunction, which has resulted in ventricular dilatation. The most reliable clinical marker is the presence of a third heart sound (gallop rhythm). Although the patients in the worst heart failure generally have the shortest survival time, they may also have the most dramatic short-term clinical benefit. However, once cardiac reserve is exhausted in the terminal stages of failure, cardiotonic stimulation ceases to be effective.(ABSTRACT TRUNCATED AT 400 WORDS)