Postgraduate training programs in veterinary clinical pathology in the United States and Canada (1998 to 2002)

Background: Residency and graduate programs in veterinary clinical pathology provide specialized training for board certification and are important pathways to careers in clinical pathology diagnostics, teaching, and research. Information about training opportunities is useful for assessing disciplinary needs, outcomes, and changes, garnering program support, and providing objective data for program evaluation by faculty, trainees, and prospective applicants. Objectives: The goals of this study were to 1) compile detailed information on the number and types of postgraduate training programs in veterinary clinical pathology in the United States and Canada, 2) describe the goals, activities, strengths, and weaknesses of the programs, 3) assess the desirability of program accreditation and program standards, 4) identify supplemental training opportunities, and 5) evaluate changes in programs, trainees, and faculty 4 years later. Methods: In July 1998, the American Society for Veterinary Clinical Pathology Education Committee sent a survey to representatives at the 31 schools and colleges of veterinary medicine in the United States and Canada and 31 diagnostic laboratories, private hospitals, and pharmaceutical companies. Survey data were compared with updated information obtained from training program coordinators in November 2002. Results: Survey response rate was 94% for universities, 39% for nonuniversity institutions, and 66% overall. In 1998, there were 20 clinical pathology training programs, including residencies (n=10) and graduate programs combined with residency training (n=10), with 36 total training positions. In 2002, there were 25 training programs (14 residencies, 11 combined), with 52 total positions. The median faculty: trainee ratio was 2.0 in both years. Of 67 faculty members involved in training in 1998, 57 (85.1%) were board‐certified in clinical pathology and 53 (79.1%) had DVM/PhD degrees. Net faculty numbers increased by 17 (25.4%) but the median per institution remained at 3.0. Primary program goals were 1) eligibility for and successful achievement of board certification in clinical pathology by the American College of Veterinary Pathologists, 2) proficiency in laboratory diagnostics, and 3) contemporary basic or applied research training. Many programs cited research opportunities, caseloads, and training in hematology and cytology as strengths. Program weaknesses included insufficient funding, too few faculty, and limited training in clinical chemistry and laboratory operations/quality assurance. Trainees completing programs within the past 5 years (n=70) were employed in academia (28.6%), diagnostic laboratories (32.9%), and industry (18.6%). For trainees completing programs between 1999 and 2002 (n=38), these percentages were 52.6%, 21.1%, and 7.9%, respectively. Most (62.5%) respondents supported program standards and accreditation, and 76% supported board review sessions for trainees. Conclusions: Opportunities for postgraduate training in veterinary clinical pathology increased between 1998 and 2002, with 5 new programs and 16 new training positions. These additions and the increased emphasis on diagnostic proficiency, efforts to strengthen training in clinical chemistry and quality assurance, and continuation of combined PhD‐residency programs will help address the perceived need for increased numbers of qualified clinical pathologists in academia, diagnostic laboratories, and industry.     

Comparison of ultrasonic Doppler flow monitor,oscillometric, and direct arterial blood pressure measurements in ill dogs

Objective – To compare blood pressure measurements obtained via ultrasonic Doppler flow monitor (DOP) and 2 oscillometric noninvasive blood pressure monitors (CAR and PAS) to invasive blood pressure (IBP) in hospitalized, conscious dogs with a range of blood pressures. Design – Prospective clinical study. Setting – University teaching hospital. Animals – Eleven client‐owned dogs aged between 4 months and 11.5 years (median 6 y), and weighing between 5.8 and 37.5 kg (median 30.2 kg). Interventions – Blood pressure measurement. Measurements and Main Results – Three consecutive measurements of systolic, diastolic, and mean arterial pressure (MAP) were recorded for each of the 3 indirect devices (only systolic for DOP), along with concurrent IBP measurements. The data were categorized into 3 groups: hypotensive (direct MAP<80 mm Hg), normotensive (80 mm Hg≤direct MAP≥100 mm Hg), and hypertensive (direct MAP>100 mm Hg). Each indirect method was compared with the corresponding direct arterial pressure using the Bland‐Altman method. Within the hypotensive group, each indirect method overestimated the corresponding IBP. Within the normotensive group all indirect systolic measurements and the PAS diastolic measurements underestimated the corresponding IBP. The remaining indirect measurements overestimated the corresponding IBP. Within the hypertensive group, DOP and CAR systolic measurements underestimated the corresponding IBP, and the remaining indirect measurements overestimated the corresponding IBP. In hypertensive dogs oscillometric systolic measurements were more accurate than MAP. In hypotensive dogs MAP measurements were more accurate than systolic measurements. All indirect measurements were most accurate in hypertensive dogs. Conclusions – The noninvasive blood pressure monitors in our study did not meet the validation standards set in human medicine. However, CAR diastolic and MAP measurements within the normotensive group, CAR MAP measurements within the hypertensive group, and PAS diastolic measurements in all groups were close to these standards. All indirect measurements showed greater bias during hypotension. Precision was poorer for all indirect systolic measurements than for MAP.     

Evaluation of transpulmonary ultrasound dilution cardiac output in piglets: accuracy,precision and trending ability with room temperature injectate

ObjectiveTranspulmonary ultrasound dilution (TPUD) is a minimally invasive technique to measure cardiac output (CO) using a 1 mL kg^–1 isotonic 37 °C saline injectate indicator. The objective was to evaluate the performance of TPUD using a room temperature saline injectate.Study designProspective experimental trial.AnimalsA total of seven anesthetized male Yorkshire piglets.MethodsPiglets aged 1 month and weighing 7.7–9.0 kg were anesthetized with detomidine–ketamine–hydromorphone–isoflurane and a pulmonary artery flow probe (PAFP) placed via a median sternotomy. The thoracic cavity remained open during measurement of CO by PAFP and TPUD. The TPUD indicators of 1 mL kg^–1 0.9% saline at 37 °C and 20 °C were compared during infusions of phenylephrine and dobutamine, blood withdrawal and replacement. Bias, limits of agreement (LoAs) and percentage error (PE) between each iteration of PAFP and TPUD were measured with Bland–Altman plots. Trending ability via concordance, angular bias and radial LoA were compared.ResultsBland–Altman plots showed negligible bias with varying LoAs. PEs of 22% and 38% were found for 37 °C and 20 °C saline injectates, respectively. In the four-quadrant plots, the concordance rate was 94% and 100% for measurements obtained with 37 °C and 20 °C saline injectates, respectively. Angular bias for both were < ±5 °, with radial LoA < ±7 °.ConclusionsTPUD was accurate when using 1 mL kg^–1 of isotonic saline at 37 °C in a range of CO within 0.2–0.8 L minute^–1, and it reliably tracked positive and negative changes in CO. Room temperature (20 °C) indicator was less accurate but equally able to track direction of changes in CO.Clinical relevanceThe use of room temperature injectates allows an easy, readily available clinical application of TPUD CO monitoring while preserving the trending ability of the monitor.     

Epidemiology,clinical management,and outcomes of dogs involved in road traffic accidents in the United Kingdom (2009–2014)

Objective

To estimate the prevalence and risk factors for road traffic accidents (RTA) in dogs and describe the management and outcome of these dogs attending primary‐care veterinary practices in the United Kingdom.

Design

Retrospective cross‐sectional study.

Setting

Primary‐care veterinary practices in the United Kingdom.

Animals

The study population included 199,464 dogs attending 115 primary‐care clinics across the United Kingdom.

Measurements and main results

Electronic patient records of dogs attending practices participating in the VetCompass Programme were assessed against selection criteria used to define RTA cases. Cases identified as RTAs were identified and manually verified to calculate prevalence. Univariable and multivariable logistic regression methods were used to evaluate associations between risk factors and RTA. The prevalence of RTA was 0.41%. Of the RTA cases, 615 (74.9%) were purebred, 322 (39.2%) were female, and 285 (54.8%) were insured. The median age at RTA was 2.5 years. After accounting for the effects of other factors, younger dogs had increased odds of an RTA event: dogs aged under 3 years showed 2.9 times the odds and dogs aged between 6–9 years showed 1.8 times the odds of an RTA event compared with dogs aged over 14 years. Males had 1.4 times the odds of an RTA event compared with females. Overall, 22.9% of cases died from a cause associated with RTA. Of dogs with information available, 34.0% underwent diagnostic imaging, 29.4% received intravenous fluid‐therapy, 71.1% received pain relief, 46.0% were hospitalized, and 15.6% had surgery performed under general anesthetic.

Conclusions

This study identified important demographic factors associated with RTA in dogs, notably being young and male.

     

Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007–2008)

Objective – To characterize the clinical presentation, management, and in‐hospital outcomes of dogs and cats diagnosed with acute congestive heart failure (CHF). Design – Retrospective study of animals seen between January 2007 and May 2008. Setting – Emergency service at a university teaching hospital. Animals – Ninety dogs and 55 cats with CHF. Measurements and Main Results – Patient characteristics, including age, clinical signs, clinicopathologic abnormalities, diagnostic testing, and outcome were recorded. Forty‐eight of the animals already were receiving cardiac medications at the time of presentation. The most common diseases represented were chronic valvular disease and cardiomyopathies. Cats had significantly lower median body temperature at admission compared with dogs (P<0.001). The most common abnormalities were elevated lactate (64%), elevated BUN (52%), hypochloremia (31%), hyperglycemia (27%), and elevated liver enzymes (26%). Many of these became even more prevalent during hospitalization. One hundred and sixteen animals were discharged from the hospital, for a survival rate of 80%. There was no survival difference between dogs and cats (P=0.39). Dogs that developed hypokalemia during hospital stay (P=0.04) were more likely to survive compared with those without hypokalemia and initial body temperature was lower for those cats that did not survive (P=0.02). Of those that did not survive, the majority were euthanized (n=25), while 4 dogs died. Conclusions – Dogs and cats presented to the emergency service with CHF had a high survival rate. In cats, initial body temperature was lower for those cats that did not survive. Although clinicopathologic abnormalities were common in both species, only dogs with hypokalemia had improved survival to hospital discharge.     

Causes of cardiopulmonary arrest, resuscitation management, and functional outcome in dogs and cats surviving cardiopulmonary arrest

Objective: To describe the functional outcome of canine and feline survivors of cardiopulmonary arrest (CPA) and the clinical characteristics surrounding their resuscitation. Design: Retrospective study. Setting: Veterinary teaching hospital. Animals: Client‐owned dogs (15) and cats (3) with CPA. Interventions: None. Measurements and main results: Eighteen animals were identified to have survived to discharge following CPA. Cardiopulmonary arrest was associated with anesthesia with or without pre‐existing disease in 10 animals, cardiovascular collapse in 5 animals, and chronic disease with an imposed stress in 3 animals. All CPAs were witnessed in the hospital. The most common initial rhythm at CPA was asystole (72%). Return of spontaneous circulation (ROSC) was achieved in less than 15 minutes from the onset of cardiopulmonary cerebral resuscitation (CPCR) in all animals. No animals had a recurrence of CPA after the initial CPA. Animals were of a wide range of ages (0.5–16 years) and breeds. Two animals were neurologically abnormal at discharge, one of which was normal at 2 months following CPA. Conclusions: A good functional recovery after CPCR was documented in the small number of CPA survivors presented in this study. This may be due to the reversible nature of their inciting cause of CPA, early detections of CPA (‘witnessed’), and/or the animal's underlying normal health status.     

高职畜牧兽医专业实训课程和实训教学方法改革与探索

实训教学是高职教学中最为重要的环节，是人才培养的重要途径。高职畜牧兽医专业实训教学应重点把握实训课程的设置和实训教学方法的改革。总结了高职畜牧兽医专业实训课程设计的理念与思路，以及所采用的行之有效的实训教学方法。     

Focused cardiac ultrasound examination in the emergency and critical care horse: Training for non‐specialist veterinarians and evaluation of proficiency

BackgroundFocused cardiac ultrasound examination (FoCUS) is rapidly emerging for point‐of‐care cardiac assessment using hand‐carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available.HypothesisTo gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device.AnimalsThree healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS).MethodsProspective educational study. An eFoCUS protocol and 1‐day training course were developed. Pre‐ and post‐course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post‐course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience.ResultsParticipants'' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre‐course ranged from 40% to 90% (mean score, 65.7%) and post‐course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%‐95%). Image quality did not differ between participants with some practical experience compared to participants with no experience.Conclusions and Clinical ImportanceVeterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1‐day training course.