Increasing adherence in practice: making your clients partners in care.

Clients may appear compliant but may not fully adhere to recommendations made by the veterinarian or veterinary technician for many reasons. Client adherence is directly related to one's communication skills, which can be practiced by all members of the health care team in each client encounter. The four habits approach to enhancing communication skills has been tested in a large human health care organization and shown to result in greater satisfaction between patients and doctors as well as in improved adherence to recommendations. This model is easily adapted to small animal practice and provides the foundation for a relationship-centered approach to care.     

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

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

End-of-life communication in veterinary medicine: delivering bad news and euthanasia decision making.

Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.     

Stakeholder perspectives on the use of pig meat inspection as a health and welfare diagnostic tool in the Republic of Ireland and Northern Ireland; a SWOT analysis

Background

A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis is a strategic management tool applied to policy planning and decision-making. This short report presents the results of a SWOT analysis, carried out with n?=?16 stakeholders i) involved in the pig industry in the Republic of Ireland and Northern Ireland, and ii) in general animal welfare and food safety policy areas. As part of a larger study called PIGWELFIND, the analysis sought to explore the potential development of pig meat inspection as an animal welfare and diagnostic tool.

Findings

The final SWOT framework comprised two strengths, three opportunities, six weaknesses, and five threats. Issues around relationships and communication between producers and their veterinary practitioner, processors and producers were common to both the strengths and weakness clusters. Practical challenges within the processing plant were also named. Overall, the SWOT framework complements results reported in Devitt et al. (Ir Vet J 69:2, 2016) regarding problematic issues within the current system of information feedback on meat inspection especially within the Republic of Ireland, and the wider challenges of communication and problems of distrust.

Conclusion

The results of the SWOT analysis support the conclusions from Devitt et al. (Ir Vet J 69:2, 2016), that trust between all stakeholders across the supply chain will be essential for the development of an effective environment in which to realise the full diagnostic potential of MI data. Further stakeholder engagement could seek to apply the findings of the SWOT analysis to a policy Delphi methodology, as used elsewhere.

     

Compliance: crafting quality care.

The concept of compliance involves the consistency and accuracy with which a client follows the regimen recommended by the veterinarian or other veterinary health care team member. Contrary to common belief, most compliance failures are not the direct result of a client's unwillingness to comply. This article will help the reader better appreciate the critical importance of effective communication by the entire veterinary health care team in achieving compliance. Success is predicated on an alliance between the practice team and the client. Certain paradigms surrounding compliance in veterinary practice are discussed, and the positive outcomes of compliance, including optimal patient care, exceptional client service, employee career growth, and economic ramifications, are explored.     

Lumbo-sacral epidural anaesthesia as a complement to dissociative anaesthesia during scrotal herniorrhaphy of livestock pigs in the field

Background

In Sweden, scrotal or inguinal herniorrhaphy of livestock pigs in the field has traditionally been an important part of the surgical skills training of veterinary students. Few substances meet the legal requirements for field anaesthesia of production animals in the European Union but a protocol based on azaperone-detomidine-butorphanol-ketamine does. Unfortunately the anaesthesia is characterised by unpredictable duration and depth and of abrupt awakenings which is not acceptable from an animal welfare perspective and impedes surgical training. Lumbo-sacral epidural analgesia is proven to provide sufficient analgesia to allow abdominal surgery, but there are few reports on the field use of this loco-regional technique. The study aim was to evaluate whether lumbo-sacral anaesthesia can be safely and successfully used in the field by a veterinary student and whether the combination of dissociative and lumbo-sacral epidural anaesthesia improves analgesia and anaesthesia to guarantee animal welfare during herniorrhaphy in livestock pigs, enabling surgical skills training.

Results

Pigs in the control-group (placebo) responded significantly stronger to surgery, with five out of 11 requiring additional doses of detomidine and ketamine. There were no significant differences between groups in respiratory rate, heart rate, blood pressure, SpO₂ or blood gases. SpO₂ levels <94 % were recorded in several pigs in both groups. No post-injection complications were reported at follow-up.

Conclusions

The results from this study showed that lumbo-sacral epidural anaesthesia with lidocaine could successfully be administered during dissociative anaesthesia of livestock pigs by a veterinary student and without reported post-injection complications. It improved analgesia and anaesthesia during herniorrhaphy of sufficient duration to enable surgical skills training. The risks and consequences of hypoxaemia and hypoventilation should be considered.     

Evaluating the curriculum of the veterinary school of Firat University, Turkey, in terms of professional and technical skills

A significant portion of the problems faced by veterinarians is related to communication. These problems are intensely experienced between veterinary practitioners and animal owners; yet no lectures or courses aiming to improve professional skills are available in the curriculum of veterinary schools in Turkey. In this study, all students currently enrolled at, and 1992 and 1998 graduates of, the Veterinary School of Firat University (VSFU), Turkey, were surveyed to evaluate the attitudes of veterinary students and graduates toward technical and professional skills. Data were collected from 581 students and 61 recent graduates via personal interviews with students and questionnaires mailed to graduates; information was obtained about participants' technical and professional skills. The overall response rate was 85%. The results show that learning about technical and professional skills is highly valued; competence and comfort in skill sets are associated with comfort in establishing communication with instructors. Positive correlations were also noted between feeling comfortable with and feeling competent in both skill sets. In conclusion, it appears to be essential to introduce courses addressing improvement of professional skills to the curriculum of veterinary schools in Turkey, given that a successful veterinarian profile requires feeling competent in and comfortable with both technical and professional skills.     

Teaching and learning communication in veterinary medicine

Drawing on extensive evidence and experience in human medicine, this article offers a practical conceptual framework for thinking more precisely about how to teach and learn communication systematically and intentionally in veterinary medicine. The overarching goal is to promote the development of communication programs so as to improve communication in veterinary practice to a professional level of competence. A three-part conceptual framework is presented that first explores the rationale behind teaching and learning communication, including the evidence base regarding the impact of communication on clinician-client interactions and outcomes of care and the research on teaching and learning communication skills in medicine. The second part considers four ways to conceptualize what to teach and learn, as explicated by (a) the domains of communication in veterinary medicine; (b) 'first principles' of effective communication; (c) evidence-based goals or outcomes for communication programs; and (d) delineation and definition of the specific individual skills that research evidence supports, as presented in the Calgary-Cambridge Guides. The last part of the conceptual framework examines how to teach communication, including the use of models, a primary focus on skill development as the backbone of communication programs, and the value of other methods supported by the evidence, such as simulated patients, videotape, small groups, and feedback and facilitation skills. Communication impacts the clinician- client interaction and outcomes of care in very significant ways. Communication can and should be taught and learned with as much rigor as other aspects of clinical competence. Veterinary programs at all levels should include the teaching of communication.     

Perceived importance and integration of the human-animal bond in private veterinary practice

OBJECTIVE: To determine perceptions of the human-animal bond (HAB) among veterinarians in private practice and evaluate how these veterinarians incorporate the HAB in their practices. DESIGN: Survey. SAMPLE POPULATION: 1,602 veterinarians in private practice in Washington state. PROCEDURE: Participants were contacted and asked to complete a survey. RESULTS: Response rate was 26% (415/1,602). Most respondents agreed that veterinarians will be more successful if they recognize and facilitate the HAB, that facilitating the HAB was important to their practices, that they actively evaluated the degree of bonding between clients and their animals, and that the bonding between a client and his or her animal affected the way they practiced medicine. However, > 50% of respondents did not train veterinary technicians and front office staff members in the HAB or encourage veterinary technicians or front office staff members to learn about the HAB. Fifty-one percent of respondents offered few or no HAB resources to clients. When asked to quantify the importance of 10 nontechnical skills associated with private veterinary practice, respondents ranked communication skills, ethical reasoning, and business management first, second, and third; the HAB was ranked fifth. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that for veterinarians in private practice in Washington state, there is a dichotomy between how important they consider the HAB to be in their practice and the degree to which they facilitate the HAB with regard to communication, training, and client resources. More research on the HAB is necessary to better understand what the HAB encompasses and its implications for private practitioners.     

Ethical dilemmas in veterinary medicine.

Veterinarians frequently encounter situations that are morally charged and potentially difficult to manage. Situation involving euthanasia, end-of-life care, economics, and inadequate provision of care create practical and moral dilemmas. Ethical tension may be attributable to differences in beliefs regarding the moral value of animals, client and veterinary responsibilities, and deciding what is best for an animal. Veterinarians can employ communication skills used in medical situations to explore the reasons underpinning ethical dilemmas and to search for solutions with clients, staff, and colleagues.     

Ethical issues in geriatric feline medicine

Most veterinarians hold a 'pediatric' rather than 'garage mechanic' view of their function. In recent years, sophisticated medical modalities have allowed veterinarians to keep animals alive, and increased value of companion animals in society has increased demand for such treatment. But whereas humans can choose to trade current suffering for extended life, animals seem to lack the cognitive apparatus required to do so. Thus, veterinarians must guard against keeping a suffering animal alive for too long. Clients may be emotionally tied to the animal and blind to its suffering. Part of the veterinarian's role, therefore, is to lead the client to 'recollect' quality of life issues. A second major role for the veterinarian in treating geriatric or chronically ill animals is control of pain and distress. Unfortunately, pain and distress have historically been neglected in both human and veterinary medicine for ideological reasons. It is ethically necessary to transcend this ideology which leads to both bad medicine and bad ethics.     

The effect of experience,simulator-training and biometric feedback on manual ventilation technique

Objective

To determine the frequency of provision and main providers (veterinary surgeons, nurses or trainees) of manual ventilation in UK veterinary practices. Furthermore, to determine the variation in peak inspiratory (inflation) pressure (PIP), applied to a lung model during manual ventilation, by three different groups of operators (inexperienced, experienced and specialist), before and after training.

Misconceptions surrounding the relationship between journal impact factor and citation distribution in veterinary medicine

Objective

To define the relationship between journal impact factor (JIF) and citation distribution in veterinary journals. Citation distribution is a summary of the number of citations of individual papers published in a defined period, and JIF is said to represent the mean number of citations received by a paper published in a given journal. JIF is criticized for promoting unimportant differences between journals, exaggerating small differences in journal citation distributions by misrepresenting a skewed citation distribution. The hypothesis was that veterinary journals have a skewed citation distribution and that median citation rates between journals would be smaller than that indicated by JIF.

Herd and cow characteristics affecting the odds of veterinary treatment for disease – a multilevel analysis

Background

Research has indicated that a number of different factors affect whether an animal receives treatment or not when diseased. The aim of this paper was to evaluate if herd or individual animal characteristics influence whether cattle receives veterinary treatment for disease, and thereby also introduce misclassification in the disease recording system.

Methods

The data consisted mainly of disease events reported by farmers during 2004. We modelled odds of receiving veterinary treatment when diseased, using two-level logistic regression models for cows and young animals (calves and heifers), respectively. Model parameters were estimated using three procedures, because these procedures have been shown, under some conditions, to produce biased estimates for multi-level models with binary outcomes.

Results

Cows located in herds mainly consisting of Swedish Holstein cows had higher odds for veterinary treatment than cows in herds mainly consisting of Swedish Red cows. Cows with a disease event early in lactation had higher odds for treatment than when the event occurred later in lactation. There were also higher odds for veterinary treatment of events for cows in January and April than in July and October. The odds for veterinary treatment of events in young animals were higher if the farmer appeared to be good at keeping records. Having a disease event at the same date as another animal increased the odds for veterinary treatment for all events in young animals, and for lameness, metabolic, udder and other disorders, but not for peripartum disorders, in cows. There were also differences in the odds for veterinary treatment between disease complexes, both for cows and young animals.The random effect of herd was significant in both models and accounted for 40–44% of the variation in the cow model and 30–46% in the young animal model.

Conclusion

We conclude that cow and herd characteristics influence the odds for veterinary treatment and that this might bias the results from studies using data from the cattle disease database based on veterinary practice records.     

The economics of a veterinary hospital

The costs involved in building a small animal hospital are discussed. Running costs and gross turnover are compared immediately before and after building.

SUMMARY

We have attempted to discuss in the frankest possible manner the economics of a purpose-built small animal hospital. It must be remembered, however, that the financial return is only one factor to be considered in such a project. Pleasant working conditions for veterinary surgeon and lay staff, improved waiting facilities, more efficient reception, better surgical facilities and better patient accommodation have led in this practice to a much improved standard of veterinary medicine and surgery. Thus animal, client, staff and veterinary surgeon all benefit from improved facilities.
During the next decade there is little doubt many more hospitals will be built in this country. At the moment many of our colleagues are considering taking what is probably the biggest, single, financial investment of their lives. We hope this paper will assist them in making this decision.
Résumé. Les auteurs donnent des précisions sur les dépenses à engager pour la construction d'un hôpital pour petits animaux et sur les frais généraux et le chiffre d'affaires brut immé-diatement avant et après la construction.
Zusammenfassung. Die bei der Errichtung einer kleinen Tierklinik entstehenden Kosten werden besprochen. Laufende Kosten und Bruttoumsatz unmittelbar vor und nach dem Bau werden miteinander verglichen.     

Pig producer perspectives on the use of meat inspection as an animal health and welfare diagnostic tool in the Republic of Ireland and Northern Ireland

Background

Currently, there is growing interest in developing ante and post mortem meat inspection (MI) to incorporate measures of pig health and welfare for use as a diagnostic tool on pig farms. However, the success of the development of the MI process requires stakeholder engagement with the process. Knowledge gaps and issues of trust can undermine the effective exchange and utilisation of information across the supply chain. A social science research methodology was employed to establish stakeholder perspectives towards the development of MI to include measures of pig health and welfare. In this paper the findings of semi-structured telephone interviews with 18 pig producers from the Republic of Ireland and Northern Ireland are presented.

Results

Producers recognised the benefit of the utilisation of MI data as a health and welfare diagnostic tool. This acknowledgment, however, was undermined for some by dissatisfaction with the current system of MI information feedback, by trust and fairness concerns, and by concerns regarding the extent to which data would be used in the producers’ interests. Tolerance of certain animal welfare issues may also have a negative impact on how producers viewed the potential of MI data. The private veterinary practitioner was viewed as playing a vital role in assisting them with the interpretation of MI data for herd health planning.

Conclusions

The development of positive relationships based on trust, commitment and satisfaction across the supply chain may help build a positive environment for the effective utilisation of MI data in improving pig health and welfare. The utilisation of MI as a diagnostic tool would benefit from the development of a communication strategy aimed at building positive relationships between stakeholders in the pig industry.

     

Dispensing law and sale of animal feed

For the veterinarian, drug sale is generally permitted by his licence of drug dispensing. According to the law on animal feed, feedstuffs are not regarded as drugs and thus they are not licensed to be sold by veterinarians. Drugs, however, may only be released for the treatment of individual animals, which are previously examined by the vet. The sale of animal feed is not regarded as part of veterinary practice. Only in case of a registered additional business, a veterinarian is allowed to sale feedstuffs. Dietetic animal feedstuffs are also regulated by the Animal Feed Act. Dietetic drugs, however, are regulated by the Drug Act and are strongly to be delineated from dietetic feed. Thus, the term "dietetic" alone does not automatically give any legitimatization for a sale of feedstuffs in veterinary practice.     

Aspects of the owning/keeping and disposal of horses, and how these relate to equine health/welfare in Ireland

Background

Ireland has long been renowned as a major centre for the breeding, rearing and keeping of horses. Since 2007, however, there has been increasing concern for horse health and welfare standards, and links between these concerns and the structures, governance and funding of the Irish equine industries have been reported. This paper addresses two central issues: firstly the local governance of, trade in and disposal of unwanted horses; and secondly mechanisms employed to improve standards of care given to horses owned by certain communities.

Method

Primary information was gathered through visits to horse pounds run by and on behalf of Local Authorities, to social horse projects, to horse dealer yards, ferry ports, horse slaughter plants and knackeries.

Results

The approach adopted by members of a given group, e.g. ferry ports, is described and differences are highlighted, for example in how different Local Authorities implement the Control of Horses Act of 1986, and how the choice, for example, of disposal route affects the standard of animal welfare.

Conclusions

There is a pressing need for a more centrally mandated and uniformly applied system of governance to safeguard the health and promote the keeping of horses to a higher welfare standard in Ireland. Fundamental to an understanding of why there is insufficient oversight of the keeping and proper disposal of horses is the lack of a comprehensive, integrated system for the registration, identification and tracing of equidae in Ireland.     

Meat inspection education in Finnish veterinary curriculum

This article describes the Finnish meat-inspection curriculum and presents an expert-panel evaluation of meat-inspection education. The work tasks of the meat-inspection veterinarian are challenging and include classical meat inspection, meat hygiene, hygiene control, and animal disease and welfare. The meat-inspection veterinarian is not only an inspector, which by itself is very demanding, but also an expert or "consultant" on food safety. The significant role of the meat-inspection veterinarian in society puts high demands on meat-inspection education, which should provide veterinary students with sufficient tools to perform meat inspection and hygiene control in slaughterhouses, cutting premises, and further processing plants. To be of high quality, such education must be evaluated from time to time. An expert panel evaluated Finnish undergraduate meat-inspection education and found that it provides veterinary students with good knowledge of meat inspection. The structure of the curriculum, with theoretical studies followed by four weeks of practice in a slaughterhouse, was considered vital for learning and for creating interest in meat inspection. The evaluation also revealed that certain subjects should receive greater emphasis and some new subjects should be introduced. Hygiene-control tasks, in particular, have increased and should receive more emphasis in education. Personnel management and interaction skills should be introduced into the curriculum as these skills influence all the duties of the meat-inspection veterinarian. This article outlines the subjects to be included in the modern, high-quality meat-inspection curriculum recommended by the expert panel.