Web-based documentation of clinical skills to assess the competency of veterinary students

Kansas State University implemented a Web-based program to assess students' competency to perform technical skills during clinical rotations throughout the fourth year of the veterinary curriculum. The classes of 2009 and 2010 recorded a minimum number of procedures (104 and 103, respectively) from a menu of more than 220 recommended procedures. Procedures were categorized by species (small animal, equine, food animal) and disciplines (imaging, anesthesia, diagnostic medicine/necropsy). Ophthalmology was added as a fourth discipline for the class of 2010. Students recorded procedures into the Web-based system, including information about the patient, procedure performed, supervisor, and a self-assessment of performance. Faculty, staff, and house officers evaluated the procedures electronically by confirming that they witnessed the procedure and providing qualitative and written feedback. The class of 2009 recorded 18,492 procedures (M=171/student) and the class of 2010 recorded 16,935 procedures (M=158/student). Two students from each class (2009 and 2010) did not complete the minimum required skills during clinical rotations and returned to perform procedures immediately before (n=3) or immediately after (n=1) graduation to receive their diploma. The Web-based system captured a large number of assessments of technical competency performed in the clinical setting. The system provided students with formative feedback throughout the clinical year, ensured equitable distribution of procedural opportunities across the student body, and required minimal additional resources.     

An ethogram of post-anesthetic recovery behaviors in horses: comparison of pre- and post-anesthetic behaviors

Pain management is an important post-operative concern. Pain scales may rely on the observer's subjective assessment of the level of discomfort and may not correlate with physiologic or pharmacologic measures of pain. The purpose of this study was to develop an objective measure of behavior in healthy pain-free horses recovering from anesthesia that could be used for comparison with the behavior of horses recovering from a surgical procedure.
Focal sampling with videotape and observation was done on five healthy horses before anesthesia to establish baselines. Behavioral measures included head turns, tail swishes, eyelid aperture/size, ear position, angle of neck, weight shifts, and ambulation. Physiologic measures included heart rate, respiratory rate, and temperature. The horses were anesthetized for 2 hours with isoflurane, and in the recovery stall, data were collected continuously on videotape from the time of extubation to standing. Focal sampling of 15 minutes was repeated at 1, 2, 4, and 24 hours after the horses returned to their stalls. Video data were analyzed using the Noldus Observer Video Analysis System.
A wide variation in behavior was observed between horses in the recovery stall. Observations at 1, 2, and 4 hours revealed change from the up/forward ear position to the down ear position, and a decrease in weight bearing of the hind limb from a baseline of 11–12 minutes out of 15 minutes to 7–9 minutes with an increase in toe pointing. Time spent standing was similar to baseline of 93.8%, and the neck angle was not changed from baseline of 173.5°. Values had returned to baseline at 24 hours.
Changes in behavior were induced by anesthesia alone and must be taken into consideration when evaluating analgesic treatments.     

Heparin: A Review of its Pharmacology and Therapeutic Use in Horses

Heparin is used clinically in horses to treat hemostatic abnormalities associated with severe gastrointestinal disease, septicemia, and endotoxemia. The primary anticoagulant effect of heparin is through the suppression of thrombin-dependent amplification of the coagulation cascade, and inhibition of thrombin-mediated conversion of fibrinogen to fibrin. Heparin may be of benefit in preventing the complications associated with hypercoagulable states such as jugular vein thrombosis, laminitis, and organ failure. Heparin may also be beneficial in the prevention of intraabdominal adhesions after gastrointestinal surgery, and in amelioration of hemodynamic abnormalities associated with endotoxic shock. Because a sequential rise in serumheparin concentration occurs during a uniform dosage regimen, a decreasing dosage regimen is recommended. The initial dose recommended is 150 U heparin/kg body weight subcutaneously, followed by 125 U heparin/kg body weight subcutaneously, every 12 hours for six doses. The dose should be decreased to 100 U heparin/kg body weight subcutaneously, every 12 hours, after the seventh dose. Anemia, hemorrhage, thrombocytopenia, and painful swelling at injection sites are complications of heparin administration in horses.     

Equine recurrent airway obstruction: pathogenesis, diagnosis, and patient management.

Recurrent airway obstruction is a condition that affects some older horses maintained in confinement. Clinical signs range from exercise intolerance with occasional cough to dyspnea at rest. Bronchoalveolar lavage cytology is characterized by neutrophilic leukocytosis (15%-85%) and is recommended for making the diagnosis in horses with mild to moderate disease. Environmental management combined with periodic bronchodilator and antiinflammatory corticosteroid therapy yields the best prognosis for disease remission.     

Prospective clinical evaluation of an ELISA B-type natriuretic peptide assay in the diagnosis of congestive heart failure in dogs presenting with cough or dyspnea

BACKGROUND: B-type natriuretic peptide (BNP) is increased in dogs with congestive heart failure (CHF). HYPOTHESIS: The purpose of this study was to evaluate the clinical utility of a novel canine-specific enzyme-linked immunosorbent assay of BNP for the diagnosis of CHF in dogs presenting with either cough or dyspnea. ANIMALS: Three hundred and thirty dogs from 2 large university teaching hospitals. METHODS: We prospectively measured plasma BNP concentrations in 3 groups of dogs: (1) normal adult dogs (n = 75), (2) dogs with asymptomatic heart disease (n = 76), and (3) dogs with cough or dyspnea (n = 179). The final diagnosis of dogs with cough or dyspnea and the severity of CHF (International Small Animal Cardiac Health Council Heart Failure Classification [ISACHC]) were determined by medical record review by a study cardiologist who was blinded to the results of the BNP assay. RESULTS: Dogs with CHF had a higher median BNP concentration (24.6 pg/mL) than dogs with noncardiac causes of cough or dyspnea (2.6 pg/mL) (P < .0001). The area under the curve was 0.91 for the receiver operating curve analysis of the diagnostic accuracy of the BNP measurement to differentiate CHF from other causes of cough or dyspnea. The median BNP concentrations in dogs were 3.0 pg/mL with ISACHC I, 17.8 pg/mL with ISACHC II, and 30.5 pg/mL with ISACHC III. (P < .0001) CONCLUSION AND CLINICAL IMPORTANCE: Measurement of BNP is useful in establishing or in excluding the diagnosis of CHF in dogs with cough or dyspnea. B-type natriuretic peptide concentrations rose significantly as a function of severity of CHF.     

Relationship of Body Size to Metabolic Markers and Left Ventricular Hypertrophy in Cats

Background

Cats with hypertrophic cardiomyopathy (HCM) are larger and have higher insulin‐like growth factor‐1 (IGF‐1) concentrations than cats without HCM.

Hypothesis/Objectives

The aim of this study was to assess echocardiographic findings in a colony of adult cats to determine the relationship between early growth and left ventricular hypertrophy (LVH).

Animals

Twenty‐eight neutered adult cats (20 males, 8 females) from a colony ≥3 years of age for which growth curves were available.

Methods

Case–control study. Physical examination and echocardiography were performed, and body weight, body condition score (BCS), and head length and width were measured. Circulating glucose, insulin, N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), and IGF‐1 concentrations were measured and growth data were collected. Stepwise multivariate analyses were performed.

Results

Mean age was 5.2 ± 1.1 years. Current BCSs ranged from 4 to 9 (median, 6) and mean body weight was 4.88 ± 1.29 kg. Variation in body weight was apparent by 6 (mean = 3.26 ± 0.80 kg) and 12 months of age (mean = 4.02 ± 1.02 kg). Cardiac abnormalities included a cardiac murmur (n = 7; 24%), gallop (n = 3; 10%), and arrhythmia (n = 1; 4%). Fourteen of 28 cats (50%) had echocardiographic evidence of LVH. Head width (P = .017), body weight (P < .001), NT‐proBNP (P = .023), and IGF‐1 (P = .013–.022) were significantly associated with selected measures of LVH.

Conclusions and Clinical Importance

Potential associations between body size, IGF‐1, LVH, and HCM warrant future prospective studies.