Visualization and application of disease diagnosis codes for population health management using porcine diseases as a model

Accurate and timely results of diagnostic investigations and laboratory testing guide clinical interventions for the continuous improvement of animal health and welfare. Infectious diseases can severely limit the health, welfare, and productivity of populations of animals. Livestock veterinarians submit thousands of samples daily to veterinary diagnostic laboratories (VDLs) for disease diagnosis, pathogen monitoring, and surveillance. Individual diagnostic laboratory reports are immediately useful; however, aggregated historical laboratory data are increasingly valued by clinicians and decision-makers to identify changes in the health status of various animal populations over time and geographical space. The value of this historical information is enhanced by visualization of trends of agent detection, disease diagnosis, or both, which helps focus time and resources on the most significant pathogens and fosters more effective communication between livestock producers, veterinarians, and VDL professionals. Advances in data visualization tools allow quick, efficient, and often real-time scanning and analysis of databases to inform, guide, and modify animal health intervention algorithms. Value is derived at the farm, production system, or regional level. Visualization tools allow client-specific analyses, benchmarking, formulation of research questions, and monitoring the effects of disease management and precision farming practices. We present here the approach taken to visualize trends of disease occurrence using porcine disease diagnostic code data for the period 2010 to 2019. Our semi-automatic standardized creation of a visualization platform allowed the transformation of diagnostic report data into aggregated information to visualize and monitor disease diagnosis.     

Stakeholder position paper: food animal veterinarian

Food animal veterinarians practice in a variety of settings with considerable differences between the settings. Due to variability, aggregate data from surveillance of antimicrobial use is not very useful to practitioners unless correlated information is provided, such as the relative disease status, ages of animals, and purpose of use. Of greater utility is use data as it relates to a specific farm or production system. Of greater importance to clinical practitioners is a meaningful surveillance system that tracks trends in antimicrobial resistance in common pathogens causing animal diseases.     

Evidence-based veterinary medicine: evolution, revolution, or repackaging of veterinary practice?

Over time, evidence-based veterinary medicine (EBVM) should integrate with normal clinical practice. Also, clinical knowledge increases with EBVM, reducing the need for information in one area and allowing veterinarians to explore new areas of specialty or cutting-edge advances in the profession. Textbooks, journals, veterinary conferences, and web sites provide nearly unlimited information about EBVM for the practicing veterinarian to help with the transition to EBVM use in daily practice life. EBVM should continue to change and improve how we, as veterinarians, provide the best available care to our clients and patients.     

刍议动物类型自然保护区兽医的素养

传统养殖和动物园养殖的动物发病时,其发病时间、数量和症状等情况,兽医可以仔细询问畜主或饲养人员;而野生动物生活在自然环境中,是动物类型自然保护区从事兽医专业人员的服务对象,发病时及以后的一系列情况无从问及。所以动物类型自然保护区的兽医职业,不同于传统养殖和动物园内的兽医工作,必须掌握多学科基础理论知识,必须主动从野外观察入手,充分掌握野生动物的生物学特性,收集和梳理好有效的本土自然信息、本区内野生动物信息、保护区周边社区家养动物信息,并将它们融为一体,才能分辨出野生动物发病时,是属于个发、散发、群发,还是普通病与传染病。因此,动物类型自然保护区的兽医比传统兽医人员会有更高、更严且更全面的素养。     

Perceived Usefulness of the Collection of Subclinical and other Disease Entities Detected at Slaughter

Based on a survey of 1820 Ontario pork producers and 16 veterinary members of the Ontario Swine Practitioners Association, condemnation/demerit data, while viewed as potentially valuable, are seldom, if ever, utilized in the provision of herd health programs. We found, however, that: 1) 89.4 percent (SD 1.04 percent) of producers and all veterinarians would use the disease information made available by a computerized system that would collect and report on subclinical and other disease entities detected during the slaughter of hogs; 2) Iesion diagnosis should be as detailed as possible and report on severity of disease; and 3) with the exception of those producers who ship larger numbers of hogs to market for which reports were wanted for each kill, monthly reports would be adequate.

Written comments by producers expressed concerns about confidentiality of individual herd data, costs for the information/service, and veterinary expertise in the interpretation of findings.

     

Disease diagnostic coding to facilitate evidence-based medicine: current and future perspectives

Technologic advances in information management have rapidly changed laboratory testing and the practice of veterinary medicine. Timely and strategic sampling, same-day assays, and 24-h access to laboratory results allow for rapid implementation of intervention and treatment protocols. Although agent detection and monitoring systems have progressed, and wider tracking of diseases across veterinary diagnostic laboratories exists, such as by the National Animal Health Laboratory Network (NAHLN), the distinction between detection of agent and manifestation of disease is critical to improved disease management. The implementation of a consistent, intuitive, and useful disease diagnosis coding system, specific for veterinary medicine and applicable to multiple animal species within and between veterinary diagnostic laboratories, is the first phase of disease data aggregation. Feedback loops for continuous improvement that could aggregate existing clinical and laboratory databases to improve the value and applications of diagnostic processes and clinical interventions, with interactive capabilities between clinicians and diagnosticians, and that differentiate disease causation from mere agent detection, remain incomplete. Creating an interface that allows aggregation of existing data from clinicians, including final diagnosis, interventions, or treatments applied, and measures of outcomes, is the second phase. Prototypes for stakeholder cooperation, collaboration, and beta testing of this vision are in development and becoming a reality. We focus here on how such a system is being developed and utilized at the Iowa State University Veterinary Diagnostic Laboratory to facilitate evidence-based medicine and utilize diagnostic coding for continuous improvement of animal health and welfare.     

Use of participatory epidemiology to compare the clinical veterinary knowledge of pastoralists and veterinarians in East Africa

Because of severe resource and logistical constraints in large areas of Africa, disease surveillance systems need to maximize the use of information provided by livestock keepers and make correct interpretations of indigenous livestock knowledge. This paper describes the use of participatory epidemiology (PE) to compare the names, clinical signs and epidemiological features of cattle diseases as perceived by pastoralists and veterinarians. Using results from two previous studies with pastoralists in southern Sudan and Kenya, provisional translations of local disease names into modern veterinary terminology were used to develop a matrix scoring method for use with veterinarians. Matrix scoring data from pastoralists and veterinarians were then compared using simple visual comparison of summarized matrices, hierarchical cluster analysis and multidimensional scaling. The results showed good agreement between pastoralists' and veterinarians' disease names and diagnostic criteria. The matrix scoring method was easy to use and appropriate for use in under-resourced areas with minimal professional support or laboratory services. Matrix scoring could be used to assist livestock disease surveillance workers to design surveillance systems that make better use of pastoralist's indigenous knowledge and correctly interpret local disease names. The method should be combined with conventional veterinary investigation methods where feasible.     

Ehrlichiosis and related infections.

Ehrlichiosis is a term that has been used to describe infection with any of a number of related intracellular, vector-borne pathogens. A recent reclassification has resulted in the transfer of several species previously known as Ehrlichia to the genus Anaplasma or Neorickettsia. Ehrlichia and Anaplasma are transmitted largely through the bite of infected ticks, while vectors for Neorickettsia include trematodes and the intermediate hosts (i.e., fish, snails, and insects) involved in the trematode life cycle. Dogs (and cats) are susceptible to infection with several of these pathogens, and veterinarians should be aware of the similarities and differences between E canis and related infections. Pets with suggestive clinical signs and laboratory abnormalities may be started on doxycycline pending specific diagnostic testing. The veterinarian practicing in endemic areas must understand the implications and limitations of serologic and molecular testing to confirm a diagnosis. For animals in endemic areas, prevention of exposure to vectors can lessen the risk of disease for pets and might lessen the potential for animals to become carriers of disease for their human companions.     

Mastitis control services and utilization of milk somatic cell count data by veterinarians in Ohio

A telephone survey was conducted of 50 randomly selected Ohio-licensed veterinarians engaged in dairy practice. The survey's purpose was to determine the extent of mastitis control services offered by practitioners and to assess their utilization of milk somatic cell count (SCC) data on individual cows available from the Dairy Herd Improvement Association (DHIA). During the preceding year, 96% (48/50) of practitioners surveyed had performed bacteriologic culture of milk samples. Practitioners were twice as likely to have performed culture on milk from mastitic cows that failed to respond to treatment as they were to have performed culture for purposes of identifying pathogen trends within a herd. Veterinarians in predominantly dairy practices were more likely to have completed bacteriologic examination of milk in their own laboratories than were veterinarians who were engaged in less than 50% dairy practice (P = 0.016). Most veterinarians (83%) reported that coagulase test results were available or that Staphylococcus aureus was differentiated from other staphylococcal species. Streptococcus agalactiae was not differentiated from other streptococcal species by 35% of practitioners surveyed. For veterinarians with clients enrolled in the DHIA, 91% (43/47) reported looking at, discussing, or otherwise using the DHIA records. Eighty-one percent (35/43) of veterinarians who had clients using services from the DHIA reported that clients also received individual cow milk SCC results. Veterinarians engaged in predominantly, dairy practice expressed a greater familiarity with the linear score method of SCC reporting than did veterinarians whose practices were less than 50% dairy (P = 0.085); however, both groups reported a preference for raw SCC data.(ABSTRACT TRUNCATED AT 250 WORDS)     

A computerized system for retrieval of case information in a veterinary diagnostic laboratory.

Morbidity and mortality data are necessary bases for the decision-making processes relevant to allocation of public funds for animal disease diagnoses and research. A system for information storage and retrieval capable of handling diagnostic data such as results of microbiology, parasitology, necropsy, and histopathology as well as demographic data such as owner, species, sex, breed, or geographic origin of the animal is described. This information is available to veterinarians, epidemiologists, herdsmen, and others involved in disease prevention or control efforts. The system described utilizes natural language, thus overcoming difficulties encountered in systems with numerical intermediates. Used and revised for the last 10 years, the system described has proved useful for annual administrative quantitation of services performed. In fact, the Concordance Index serves as the annual report of the University of Missouri Veterinary Medical Diagnostic Laboratory. Having accurate detailed information on individual cases, as well as a variety of composite data, has been extremely helpful in the documentation necessary for attracting funding for study of specific disease states.     

Academic food-supply veterinarians: future demand and likely shortages

The future demand for and potential shortages of food-supply veterinarians have been the subject of much concern. Using the Delphi forecasting method in a three-phase Web-based survey process, a panel of experts identified the trends and issues shaping the demand for and supply of academic food-animal veterinarians, then forecasted the likely future demand and shortages of food-supply veterinarians employed in academic institutions in the United States and Canada through 2016. The results indicate that there will be increasing future demand and persistent shortages of academic food-supply veterinarians unless current trends are countered with targeted, strategic action. The Delphi panel also evaluated the effectiveness of several strategies for reversing current trends and increasing the number of food-supply veterinarians entering into academic careers. Academic food-supply veterinarians are a key link in the system that produces food-supply veterinarians for all sectors (private practice, government service, etc.); shortages in the academic sector will amplify shortages wherever food-supply veterinarians are needed. Even fairly small shortages have significant public-health, food-safety, animal-welfare, and bio-security implications. Recent events demonstrate that in an increasingly interconnected global economic food supply system, national economies and public health are at risk unless an adequate supply of appropriately trained food-supply veterinarians is available to counter a wide variety of threats ranging from animal and zoonotic diseases to bioterrorism.     

Dairy APHIN— an information service for the dairy industry in Prince Edward Island, Canada

A computerized health and production information network (APHIN: Animal Productivity and Health Information Network) was developed in Prince Edward Island (P.E.I.) to serve the livestock industries. The dairy portion of the network is designed primarily to aid in the reduction of the unit cost of production in dairy herds through the routine monitoring of key parameters. The network also supports the distribution of detailed data for more intensive investigation of specific problems. The network consists of microcomputers in various locations in the province plus a central database housed a the Atlantic Veterinary College, University of P.E.I. Computerized data ffrom three sources are shipped to the central database on a monthly basis, analyzed and summarized. This summarized information is then distributed to veterinarians and dairy extension specialists who convert it into graphs of performance for presentation to dairy producers.     

Utilizing technology to enhance laboratory–client interaction while encouraging best behavior

As client interactions with veterinary diagnostic laboratories have evolved, so have client expectations: faster results, enhanced accessibility to cases, and more seamless data transfer from the laboratory database; all of these factors have encouraged the evolution of diagnostic laboratory systems. This evolution started with 24-h access to laboratory results via the web, yet data quality remained at the mercy of the person filling out the form. If bad (incomplete) information was flowing in, then the data coming out was equally bad (incomplete or inconsistent). By designing a web-based system integrated into our existing reporting platform, the Iowa State University Veterinary Diagnostic Laboratory (ISU-VDL) set out to improve the quality of submission data by including the premises identification number (PIN) and obtaining consistent location data, all while presenting to the client an easy-to-use interface. Efforts continued by incentivizing the use of this tool and client submission practices. As clients transitioned, data have become more complete, resulting in easier queries and an improved ability to leverage the diagnostic data. To further enhance the client experience, a streamlined daily reporting summary was designed to communicate laboratory results succinctly. The use of these web-based tools had a positive impact on the quality and consistency of the diagnostic data. As new ideas develop, the ISU-VDL strives to foster continuous improvement and positively impact the clients’ experience.     

Pet Virginia Opossums and Skunks

The Virginia opossum (Didelphis virginiana) and the striped skunk (Mephitis mephitis) are often kept as pets, although they are both wild animals. The opossum and striped skunk are usually docile and sociable when raised from infancy. Many states and municipalities restrict ownership, and veterinarians should familiarize themselves with local laws and regulations pertaining to these animals. The biology, husbandry, diet, and general disease information is available for both species. Vaccination recommendations are included for skunks.     

Digital imaging advances and the future.

Digitization of clinical data is becoming increasingly important in veterinary medicine. Current veterinary applications range from digital cameras to computed radiography. The opportunity for increased productivity and diagnostic capabilities makes the computerization of veterinary medicine especially exciting. Future trends seem to indicate that more veterinarians should have better technology available in their practices and more veterinarians should be connected to experts, clients, and each other.     

Avian Atherosclerosis: Parrots and Beyond

Atherosclerotic lesions are prevalent in companion psittacine species. Parrots account for much of the veterinary scientific information on avian atherosclerosis, but the lesions have been described in virtually all avian orders. This review presents a synthesis of the epidemiologic, clinical, diagnostic, and therapeutic information known in psittaciformes, at this time, which may help in the veterinary management of atherosclerotic diseases. The article further expands on nondomestic avian species for which information is restricted to pathologic and prevalence studies. A thorough knowledge of atherosclerosis is of the upmost importance for avian clinicians as the disease is common, affects most species of birds, and seems to be associated with captive lifestyles characterized by decreased activity and nonnative diets. Therefore, avian veterinarians are expected to be largely exposed to this chronic medical condition through patient presentation and should be prepared to properly manage this disease.     

Diagnostic testing patterns for Streptococcus equi subsp. equi in Ontario horses during the years 2008 to 2018

This retrospective study describes testing patterns and the incidence of Streptococcus equi subsp. equi in Ontario to assess the utility of laboratory data for surveillance purposes. Laboratory records for equine infectious disease test submissions were extracted from the Animal Health Laboratory (AHL) at the University of Guelph for the years 2008 to 2018. Yearly and seasonal trends in S. equi testing and the proportion of tests that returned positive results were assessed. The number of samples submitted for S. equi testing decreased over the 11-year period (odds ratio = 0.96, 95% confidence interval: 0.92 to 0.999; P = 0.04). A generalized linear model identified a significant seasonal effect for animals recognized as clinically ill, with the highest test positivity noted in the winter. Although this study identified important trends in the incidence of S. equi in Ontario, the variability in information accompanying test submissions made the data challenging to interpret, highlighting the need for more complete diagnostic submission data for S. equi.     

Clinical Update on Diagnosis and Management of Disorders of the Digestive System of Reptiles

The diagnosis and treatment of digestive system disorders in reptile species continues to provide challenges owing to the differences in anatomy and physiology in this diverse group of animals. Continued research efforts into diagnostic techniques, in particular imaging (e.g., contrast radiography and ultrasonography), of gastrointestinal tract have resulted in clinical advancements for practicing veterinarians. The aim of this article is to provide veterinarians up-to-date and clinically relevant summaries on the diagnosis and therapy of digestive system disorders of reptiles commonly maintained as companion animals.     

Look before you leap.

Learning to critically evaluate therapeutic claims is vital to the success of the practicing veterinarian and the veterinary profession as a whole. Until such time as good scientific data in support of therapies are obtained, veterinarians should be careful in their advocacy and employment of new and unproved practices. They should also be aware of the many reasons why therapeutic "success" may be the result of a variety of factors unrelated to the treatment modality itself. Only by relying on rigorous standards of evidence can equine veterinarians prevent a return to the sincere but misguided ways of yesteryear.     

Clinical Evaluation of Methods of Treatment

Veterinary clinicians can make a significant contribution to the knowledge of the practical value of using alternative treatment methods by conducting clinical trials. By following a logical sequence of steps the clinician can design and participate in a clinical trial in his clinic without interfering with his normal practice. The successive stages of a field trial were presented along with an example to demonstrate the application of the principles involved. These stages are: design and planning, implementation, collection of data, and analysis of data.

The veterinary clinician who initiates clinical trials to answer questions plaguing him provides two services to the veterinary profession. First, he helps answer questions facing private practitioners throughout the profession. Second, he can demonstrate that not all research must be done in a laboratory setting isolated from “real world” complications. Seeing the results that can be derived from individual practicing veterinarians participating in clinical trials should act as a stimulus to other veterinarians to logically organize the data coming from their practices.