Mining free-text medical records for companion animal enteric syndrome surveillance

Large amounts of animal health care data are present in veterinary electronic medical records (EMR) and they present an opportunity for companion animal disease surveillance. Veterinary patient records are largely in free-text without clinical coding or fixed vocabulary. Text-mining, a computer and information technology application, is needed to identify cases of interest and to add structure to the otherwise unstructured data. In this study EMR's were extracted from veterinary management programs of 12 participating veterinary practices and stored in a data warehouse. Using commercially available text-mining software (WordStat™), we developed a categorization dictionary that could be used to automatically classify and extract enteric syndrome cases from the warehoused electronic medical records. The diagnostic accuracy of the text-miner for retrieving cases of enteric syndrome was measured against human reviewers who independently categorized a random sample of 2500 cases as enteric syndrome positive or negative. Compared to the reviewers, the text-miner retrieved cases with enteric signs with a sensitivity of 87.6% (95%CI, 80.4–92.9%) and a specificity of 99.3% (95%CI, 98.9–99.6%). Automatic and accurate detection of enteric syndrome cases provides an opportunity for community surveillance of enteric pathogens in companion animals.     

Connecting knowledge resources to the veterinary electronic health record: opportunities for learning at point of care

Electronic health records (EHRs) provide clinical learning opportunities through quick and contextual linkage of patient signalment, symptom, and diagnosis data with knowledge resources covering tests, drugs, conditions, procedures, and client instructions. This paper introduces the EHR standards for linkage and the partners-practitioners, content publishers, and software developers-necessary to leverage this possibility in veterinary medicine. The efforts of the American Animal Hospital Association (AAHA) Electronic Health Records Task Force to partner with veterinary practice management systems to improve the use of controlled vocabulary is a first step in the development of standards for sharing knowledge at the point of care. The Veterinary Medical Libraries Section (VMLS) of the Medical Library Association's Task Force on Connecting the Veterinary Health Record to Information Resources compiled a list of resources of potential use at point of care. Resource details were drawn from product Web sites and organized by a metric used to evaluate medical point-of-care resources. Additional information was gathered from questions sent by e-mail and follow-up interviews with two practitioners, a hospital network, two software developers, and three publishers. Veterinarians with electronic records use a variety of information resources that are not linked to their software. Systems lack the infrastructure to use the Infobutton standard that has been gaining popularity in human EHRs. While some veterinary knowledge resources are digital, publisher sites and responses do not indicate a Web-based linkage of veterinary resources with EHRs. In order to facilitate lifelong learning and evidence-based practice, veterinarians and educators of future practitioners must demonstrate to veterinary practice software developers and publishers a clinically-based need to connect knowledge resources to veterinary EHRs.     

Retrospective Review of Carriage Horse and Mule Welfare in Charleston,South Carolina (2009–2012)

Equine Welfare and Carriage Horse Companies have been recently highlighted as matters of public concern, although little data exists to describe working conditions, municipal regulations, and veterinary attention. In light of the current pandemic of unwanted horses in this country, it is prudent for the veterinary community to identify objective measurements of satisfactory equine welfare in the carriage horse industry to regulate and maintain working horses in sound conditions. Retrospective data from a carriage company in South Carolina was collected from 2009 to 2012. Variables included days in work, hours and/or tours worked, veterinary charges, management practices, and environmental conditions. City veterinary reports were also reviewed for all five local carriage companies. The average number of days in work per animal ranged from 163 to 188 per year. On average, each animal performed 4.6 hour long tours per working day, resulting in an average 865 tours per year. Each animal cost on average $2.00 per day in veterinary costs, and $0.84 of each animal's tour went toward veterinary bills. Welfare among carriage horses is a subject on which equine veterinarians should be well versed; not only to answer questions from clientele but also to promote good working and living conditions for these animals in an effort to stem the number of unwanted horses in America. The carriage company reported in detail here provides acceptable welfare for their animals. Prospective studies are needed to collect objective, evidence-based data regarding stress levels in the animals.     

Evaluation of Specific Infection Control Practices Used by Companion Animal Veterinarians in Community Veterinary Practices in Southern Ontario

This study evaluated specific infection control practices in community veterinary practices in southern Ontario. Environmental disinfection, management of infectious patients and antimicrobial use in clean surgical procedures were investigated. Community companion animal veterinary practices (n = 101) in Southern Ontario were recruited, and a questionnaire was administered to one veterinarian and one veterinary technician from each practice. The veterinarian questionnaire gathered data on clinic demographics, management of infectious patients, infectious diseases of concern, environmental disinfection and antimicrobial use in surgical procedures. The veterinary technician questionnaire gathered data on environmental disinfection. None of the veterinary practices had a formal infection control programme. Sixty‐five per cent (n = 66) of the veterinary practices did not have an isolation area and 61% (n = 40) of these practices did not employ any specific infection control measures for infectious cases. The products most frequently used for environmental disinfection were hydrogen peroxide based or quaternary ammonium compounds. Bleach was the agent most commonly used for environmental disinfection of infectious body fluids; however 60% of the veterinarians and 40% of the veterinary technicians did not identify a product for environmental disinfection of infectious body fluids. Twenty‐four per cent of the veterinarians reported using antimicrobials in animals undergoing elective sterilization surgeries and 60% reported using antimicrobials in other clean surgical procedures. There is a need for community veterinary practices to develop infection control programmes specific to their individual practice. In addition, veterinarians should discontinue the common use of antimicrobials for clean elective sterilization surgical procedures.     

The building blocks in the professional education process that lead to best practices and quality medicine

It is time for the faculty of veterinary colleges to take responsibility for the veterinary curriculum, to move beyond the debate over teaching styles, and to understanding what a curriculum needs to accomplish. Our challenge is to engage students, faculty, and all veterinary professionals in evidence-based medicine and medical outcomes assessment and to identify best practices and continually improve the quality of veterinary health care. The education program of students must lay the foundation for this essential approach to veterinary practice.     

A Qualitative Study of State‐Level Zoonotic Disease Surveillance in New England

Zoonotic diseases are infectious diseases transmittable between animals and humans and outbreaks of these diseases in animals can signify that humans are also infected (or vice versa). Thus, communication between animal and human health agencies is critical for surveillance. Understanding how these agencies conduct surveillance and share information is important for the development of successful automated zoonotic monitoring systems. Individual interviews were conducted with 13 professionals who perform animal or human zoonotic disease surveillance in one of the New England states. Questions centred on existing surveillance methods, collaborations between animal and human health agencies, and technological and data needs. The results showed that agencies routinely communicate over suspected zoonotic disease cases, yet there are barriers preventing automated electronic linking of health data of animals and humans. These include technological barriers and barriers due to sensitivity and confidentiality of information. Addressing these will facilitate the development of electronic systems for integrating animal and human zoonotic disease surveillance data.     

An assessment of external biosecurity on southern Ontario swine farms and its application to surveillance on a geographic level

Risk-based surveillance is becoming increasingly important in the veterinary and public health fields. It serves as a means of increasing surveillance sensitivity and improving cost-effectiveness in an increasingly resource-limited environment. Our approach for developing a tool for the risk-based geographical surveillance of contagious diseases of swine incorporates information about animal density and external biosecurity practices within swine herds in southern Ontario. The objectives of this study were to group the sample of herds into discrete biosecurity groups, to develop a map of southern Ontario that can be used as a tool in the risk-based geographical surveillance of contagious swine diseases, and to identify significant predictors of biosecurity group membership. A subset of external biosecurity variables was selected for 2-step cluster analysis and latent class analysis (LCA). It was determined that 4 was the best number of groups to describe the data, using both analytical approaches. The authors named these groups: i) high biosecurity herds that were open with respect to replacement animals; ii) high biosecurity herds that were closed with respect to replacement animals; iii) moderate biosecurity herds; and iv) low biosecurity herds. The risk map was developed using information about the geographic distribution of herds in the biosecurity groups, as well as the density of swine sites and of grower-finisher pigs in the study region. Finally, multinomial logistic regression identified heat production units (HPUs), number of incoming pig shipments per month, and herd type as significant predictors of biosecurity group membership. It was concluded that the ability to identify areas of high and low risk for disease may improve the success of surveillance and eradication projects.     

Data warehouse for assessing animal health, welfare, risk management and -communication

The objective of this paper is to give an overview of existing databases in Denmark and describe some of the most important of these in relation to establishment of the Danish Veterinary and Food Administrations' veterinary data warehouse. The purpose of the data warehouse and possible use of the data are described. Finally, sharing of data and validity of data is discussed. There are databases in other countries describing animal husbandry and veterinary antimicrobial consumption, but Denmark will be the first country relating all data concerning animal husbandry, -health and -welfare in Danish production animals to each other in a data warehouse. Moreover, creating access to these data for researchers and authorities will hopefully result in easier and more substantial risk based control, risk management and risk communication by the authorities and access to data for researchers for epidemiological studies in animal health and welfare.     

SPIKE and D-PIKE: innovative experiences that engage students early and position them to succeed in food-supply veterinary medicine

Recent trends in urbanization of the population, increased need for bio-security on large farms, and more food-animal or mixed-animal practitioners approaching retirement age are forcing a renewed focus on recruiting and training veterinary students with an interest in production-animal medicine. The increasing number of veterinary students coming from urban backgrounds has led to a need to expose these students to standard animal-production practices and to interest them in a career involving food animals. This article describes one such program developed at Iowa State University, in which 14 students obtained hands-on experience in all aspects of swine and dairy production across a wide sampling of herd size, housing style, bio-security levels, and production phases. The participating students, ranging from senior undergraduates to third-year veterinary students, gained valuable insight not only into daily farming practices but also the knowledge and skills necessary to provide quality veterinary care to these clients. The first year of this program has yielded positive feedback from all participants, including the veterinary practices, private producers, corporate sponsors, and students. Current applicants cite positive comments from past participants as motivating their interest in the program. This program has the potential to expand as an opportunity to educate selected students in the field of food-supply veterinary medicine and to help fill the anticipated void in this area.     

Ethnoveterinary medical practice for ruminants in the subhumid zone of northern Nigeria

Ethnoveterinary medical practice is widespread among herdsmen and village livestock producers in northern Nigeria where livestock in the country are concentrated. For most of these livestock owners, modern veterinary inputs and services are not readily available and are relatively expensive. Traditional remedies are locally available and cheaper. Our questioning of 50 herdsmen and village livestock producers revealed that the ingredients used in these indigenous practices include plant extracts, seeds, leaves, barks of trees, tubers and roots of various plants. These are processed in various ways and administered to animals for a variety of disease conditions. More recently used ingredients include kerosene and spent engine oil. Considering the combination of ingredients used by the traditional animal-health practitioners, it is likely that additive, synergistic and nutritional effects might be involved in alleviating the problem of ill-health in animals. Herdsmen and livestock owners readily identify signs of disease (although some common infectious diseases have several signs and may affect various parts of the animal body). Aspects of indigenous health care practices are contrasted with modern veterinary health care.     

Veterinary medicine protecting and promoting the public's health and well-being

Dr. Calvin Schwabe's vision of "One Medicine" has long inspired many in the public health community to strive toward bringing human and veterinary medicine together to improve the public's health and well-being around the world. In an increasingly human-dominated world, as Dr. Schwabe suggested many years ago, human health provides the most-logical unifying or apical cause in veterinary medicine's hierarchy of values. Veterinarians in all aspects of the profession-have opportunity and responsibility to protect the health and well-being of people in all that they do, including protecting food security and safety; addressing threats to antibiotic sensitivity; preventing and controlling zoonotic emerging infectious diseases; protecting environments and ecosystems; participating in bio- and agro-terrorism preparedness and response; using their skills to confront non-zoonotic diseases (such as malaria, HIV/AIDS, vaccine preventable diseases, chronic diseases and injuries); strengthening the public-health infrastructure; and advancing medical science through research. This article provides an overview of contributions made by veterinarians in each of these areas, and discusses the challenges to be overcome and the need for strategic thinking and action to achieve the vision of "one medicine".     

Survey of western Canadian veterinary practices: A demographic profile

A mixed-mode survey was used to describe the demographics of the veterinary profession in western Canada and to assess the demand for veterinary practitioners. Data were received from 655 practices (response rate = 52%), providing demographic data on 1636 individual practitioners. Most (60%) respondents self-classified their practices as exclusively small animal, while 25% and 4% were mixed animal or exclusively food animal practices, respectively. Across all practices, 77% of practitioners’ time was devoted to small animals and the average mixed animal practice devoted 60% of practitioners’ time to small animals. After accounting for practices that did not respond, there were ~300 full-time equivalent (FTE) vacant positions for veterinary associates; however, only 12% of practices were in urgent need of hiring an associate veterinarian. This report informs both prospective employees and employers on the state of the marketplace for veterinary associates, and provides an overview of the demographics of the veterinary profession in western Canada.     

Disease and destiny-mystery and mastery

When early people made their appearance, zoonotic infectious diseases were already waiting, but epidemic diseases did not appear in human history until people began to live in large numbers under conditions of close contact, mainly during the last 10,000 years. Disease has decimated urban populations, conquered armies, and disrupted society. The focus here is on (1) the plague of Athens and the Black Death; (2) smallpox, influenza, and rabies; (3) avian influenza prion diseases, and foot & mouth disease; and (4) emerging and re-emerging diseases. All have veterinary public health associations. In Athens, Greece, in 430 BC, when the Spartans ravaged the countryside, hordes crowded into Athens so that orderly movements, space in which to live, and adequate supplies of food became impossible. Crowding of any population fosters disease transmission; chaos and disorder enhance it all the more. Out of northern Egypt came a terrible plague from across the Mediterranean Sea. The identity of the plague of Athens remains unsure, but the well-considered conclusion is Rift Valley Fever, a mosquito borne, viral zoonosis. The Black Death, also called the Plague, raged in Asia for centuries. In 1347, the Black Death was brought by a ship out of Asia to Sicily. The scenes of devastation were repeated throughout Europe, with 90% or more of the people dying in city after city. Influenza, too, has been a cause of periodic human epidemics, but the great pandemic of influenza occurred in the last months of World War I. In the years of highest occurrence, more than half the world's population became clinically infected. If veterinary public health had been born earlier, it could have led to elucidating the epidemiology of influenza and the plagues of Athens, Europe, and Asia. In turn, smallpox had also caused continual tragedy. In 1796, Edward Jenner began to harvest pustules of cowpox from children or infected cows and inject them into susceptible children. In 1980, the World Health Organization declared that smallpox had been eliminated from the world. Rabies, though, still strikes terror. A number of animal diseases, broadly termed emerging and re-emerging diseases, need surveillance because they have the potential to impact human health. From late in 2003 to 2007, the highly pathogenic H5N1 influenza virus in poultry infected at least 121 people and caused 62 deaths in four countries. The prion diseases, too, all have very high numbers in concentrated contacts. To control these diseases, veterinary public health is essential, with diagnosis, epidemiological surveillance, clinical manifestations, and prevention as primary measures.     

Safety issues in the exotic pet practice.

Small animal practitioners are well versed in the potential zoonoses from dogs and cats. Although these account for the vast majority of documented cases of zoonotic disease in humans, there are documented as well as potential zoonotic diseases that the nontraditional companion animal is capable of transmitting. This article is a compilation of potential disease risks to veterinarians, staff, and owners of nontraditional companion animals. In addition, the article may serve as a training tool for veterinary practices.     

Veterinary syndromic surveillance: Current initiatives and potential for development

This paper reviews recent progress in the development of syndromic surveillance systems for veterinary medicine. Peer-reviewed and grey literature were searched in order to identify surveillance systems that explicitly address outbreak detection based on systematic monitoring of animal population data, in any phase of implementation. The review found that developments in veterinary syndromic surveillance are focused not only on animal health, but also on the use of animals as sentinels for public health, representing a further step towards One Medicine. The main sources of information are clinical data from practitioners and laboratory data, but a number of other sources are being explored. Due to limitations inherent in the way data on animal health is collected, the development of veterinary syndromic surveillance initially focused on animal health data collection strategies, analyzing historical data for their potential to support systematic monitoring, or solving problems of data classification and integration. Systems based on passive notification or data transfers are now dealing with sustainability issues. Given the ongoing barriers in availability of data, diagnostic laboratories appear to provide the most readily available data sources for syndromic surveillance in animal health. As the bottlenecks around data source availability are overcome, the next challenge is consolidating data standards for data classification, promoting the integration of different animal health surveillance systems, and also the integration to public health surveillance. Moreover, the outputs of systems for systematic monitoring of animal health data must be directly connected to real-time decision support systems which are increasingly being used for disease management and control.     

Protection of domestic animals from infectious diseases in an economic community without control at the interior borders--an orientation

In relation to the plans for introducing the free inner market in the Member States of the EEC the principles for the future veterinary control of domestic animals and animal products are described. The traditional frontier control will be replaced by official primary control at the place of production (herd of origin, slaughter house, dairy etc.). The technical conditions are described: Effective disease surveillance and notification, eradication and control schemes for contagious diseases, control of animals in relation to trade. Decentralized veterinary control stations have the best possibility to carry out these functions. They should be staffed and equipped with special regard to the structure of the animal population and the production systems in the area concerned. The EEC-Commission has the task to coordinate and standardize this work with the national veterinary services. It is essential that this work functions identically everywhere in the Community. The herd owner should introduce common measures for protecting his animals against infectious diseases. This could be done by veterinary advisers within the frame of voluntary animal health schemes.     

Discussion of the Compendium of Veterinary Standard Precautions: preventing zoonotic disease transmission in veterinary personnel

Veterinary practices are unique environments that bring humans into close contact with many different species of animals; therefore, the risk of exposure to infectious pathogens is inherently different in veterinary medicine than in human medicine. In contrast to the risk of exposure to blood in human medicine, infections from zoonotic diseases in veterinary personnel are primarily related to exposure to animal faeces, infected skin, wounds, droplets and puncture wounds. Infection-control measures in veterinary practices are often insufficient to prevent zoonotic disease transmission. The Veterinary Standard Precautions (VSP) Compendium is designed to help prevent transmission of zoonotic pathogens from animal patients to veterinary personnel in private practice.     

Pet poultry training for veterinary practitioners

Keeping backyard poultry in urban areas is a burgeoning trend in the United States. As such, we believe urban pet poultry owners are increasingly likely to seek veterinary services from urban companion-animal practitioners. Traditionally, poultry species have been classified as production animals. Most small-animal practitioners have limited experience or knowledge of these species and hesitate to accept these animals at their practices. We developed a one-day course to train veterinarians in pet poultry (as opposed to commercial poultry) medicine. The course covers poultry examination, diseases, and treatments and provides an introduction to poultry breeds and behavior and the basics of nutrition and husbandry. We believe this type of continuing education program is important for veterinarians because they are often on the front line of human public health issues. In addition, courses of this type increase the number of veterinarians trained to spot serious avian diseases, including foreign diseases and diseases with zoonotic potential. Most important, veterinarians with this training develop the knowledge to contribute to the health and well-being of pet poultry along with their clients' other companion animals.