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1.
Objective: To document the clinical practice of cardiopulmonary–cerebral resuscitation (CPCR) among academic veterinarians. Design: Survey. Setting: Eight colleges of veterinary medicine in the United States. Subjects: Two hundred and one academic veterinarians. Interventions: The survey was distributed by hand by the authors into the mailboxes of small animal faculty, residents, and interns. Demographic variables, questions regarding number of cardiopulmonary arrests (CPA) supervised and number successful, do not attempt resuscitation discussions, and Likert‐style questions about client presence during CPCR, appropriateness of CPCR, and CPCR decision‐making were included. Multiple linear regression models were constructed to determine the effect of multiple questions on different target variables of interest. Measurements and main results: Numerous differences were noted based on institution, gender, specialty, and position. Most institutions did not have a standard resuscitation consent form. Most respondents believed the client, house officer, and senior clinician should determine whether to perform resuscitation or not. Quality of life was the most significant determinant of whether to resuscitate or not, followed by long‐term prognosis, then short‐term prognosis. Conclusions: Veterinarians differ in many aspects of their approach to CPA and resuscitation. Creating consensus within the veterinary profession would benefit client service and patient care.  相似文献   

2.
Objective – To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. Design – Internet‐based survey. Setting – Academia, referral practice, and general practice. Subjects – Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board‐certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). Interventions – Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. Main Results – In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug‐dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end‐tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. Conclusions – CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.  相似文献   

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5.
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)  相似文献   

6.
Objective – To review the use of impedance threshold devices (ITD) during CPCR, their proposed mechanism of action, and their application in veterinary medicine. Data Sources – Data sources include scientific reviews and original research publications using the PubMed search engine with the following keywords: ‘impedance threshold device’ and ‘resuscitation’ and the Veterinary Information Network search function using the keywords ‘impedance threshold device.’ Human Data Synthesis – Studies in human medicine have demonstrated that the use of an ITD during CPCR in patients during out‐of‐hospital cardiac arrest improves coronary perfusion pressure and cerebral perfusion pressure. This improvement in vital organ blood flow results in increased cardiac output and faster return of spontaneous circulation. The use of an ITD has been studied in people and currently holds a class IIb level of recommendation according to the 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. This device is recommended as a way to improve hemodynamics during CPCR by enhancing venous return and avoiding hyperventilation, thereby increasing the likelihood of a successful resuscitation. Veterinary Data Synthesis – Multiple controlled studies using pigs with ventricular fibrillation induced cardiopulmonary arrest have demonstrated increased myocardial and cerebral perfusion with the use of an ITD. These studies have emphasized the importance of decreasing intrathoracic pressures during the decompression phase of CPCR and avoiding hyperventilation in order to maximize vital organ blood flow. Conclusions – Use of an ITD during CPCR in human and animal studies has demonstrated improved vital organ perfusion and faster return of spontaneous circulation. However, the majority of these studies have been carried out in people during out‐of‐hospital cardiac arrest and ventricular fibrillation cardiopulmonary arrest pig models. Further studies evaluating the use of an ITD during CPCR in the veterinary hospital setting are warranted.  相似文献   

7.

Objectives

(1) To collect the perceptions of veterinarians performing equine castrations in Australia on techniques, preferences and outcomes, (2) to investigate veterinarian use and experience with the Henderson castrating instrument and (3) to investigate potential associations between demographics, castration methods and techniques, and complications.

Design

Online survey of members of the Australian Veterinary Association’s Special Interest Group, Equine Veterinarians Australia (EVA).

Methods

A link to the survey was included in the EVA e‐newsletter and practices on the EVA website were contacted by telephone and follow‐up email. Fisher’s exact test was used to determine associations between ligation and complications. A generalised linear model with a negative binomial family was used to determine associations between count response variables and categorical independent variables.

Results

Responses were obtained from 138 veterinarians (response rate, 13.1%) who performed 5330 castrations over 12 months. Castrations were most commonly performed in the field, on anaesthetised horses, using emasculators, via an open approach and without ligation of the spermatic cord. Estimated complications after use of emasculators were swelling (25%), haemorrhage (5%) and infection (5%). The Henderson instrument was used by approximately 10% of respondents and its use for castration was associated with fewer reports of postoperative swelling compared with emasculators (P = 0.002). Rates of evisceration with the Henderson and emasculator methods were comparable (0.43% and 0.9%, respectively).

Conclusion

Castration preferences varied widely among survey participants. Reported complication types and rates were comparable to those reported previously in other countries. Perceptions that the Henderson instrument was associated with less swelling should be investigated further via a prospective controlled investigation.  相似文献   

8.
In previous studies, it has been demonstrated that, similar to general practitioners, veterinarians find it difficult to discuss overweight in dogs. This study aimed to provide insight in the barriers and motivators for veterinarians to discuss overweight in dogs and to compare the results with findings from human medicine. Sub-hypotheses were postulated based on existing literature to investigate if lack of time, fear of offending clients, or lack of skills were potential barriers, and if feeling responsible and feeling compassion were potential motivators for veterinarians to discuss overweight in dogs. To this end, an online survey (n = 59) was conducted. Furthermore, 15 small animal clinicians working in general practice were interviewed by semi-structured face-to-face interviews. Results from the online survey indicated that veterinarians find it sometimes difficult to discuss overweight in dogs. Veterinarians who responded to the online survey did not experience strong barriers but did make use of motivators (e.g. feeling responsible and feeling compassion) when discussing overweight in dogs. Interestingly, results from the semi-structured face-to-face interviews showed that the responding veterinarians did experience strong barriers, as well as motivators, when discussing overweight in dogs with their clients. The most prominent barrier was customer dissatisfaction, whereas lack of time and lack of skills were also experienced. The most prominent motivator was feeling responsible for animal health and preventive veterinary medicine. These findings were strikingly similar to previous research on discussing childhood overweight by general practitioners. To improve treatment and prevention of overweight in dogs, veterinarians need more communication skills and should be more aware of the motivators that drive their self-motivation. Improving awareness on overweight and its comorbidities should be a One Health issue.  相似文献   

9.
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.  相似文献   

10.
AIM: To investigate sources of work-related stress in the veterinary profession in New Zealand, perceptions of levels of stress being experienced, and the social support that veterinarians are using to manage work-related stress. METHODS: A postal survey was distributed to 1,907 veterinarians registered with the Veterinary Council of New Zealand (VCNZ). The survey collected information on respondents' age, gender, type and number of people in the workplace, stress levels, depression, suicidal thoughts and attempts, causes of stress and sources of support. RESULTS: Nine hundred and twenty-seven (48.6%) veterinarians returned useable responses. Veterinarians who were retired, working overseas or did not provide information about their type of work were excluded from the analysis, leaving data from 849 (44.5%) veterinarians. Women experienced more work-related stress and depression than men, veterinarians in small animal/mixed practice reported more stress and depression than those in other types of work, and younger veterinarians experienced higher levels of stress than older veterinarians. The main sources of stress were hours worked, client expectations, and unexpected outcomes. Respondents were also stressed by the need to keep up their knowledge and technical skills, and by personal relationships, finances and their expectations of themselves. Most respondents reported that they had good networks of family and friends to help them deal with stress. In general, respondents tended to rely on informal networks such as family and friends, other veterinarians and workmates to provide support. The small proportion of respondents who reported clinical depression or suicidal thoughts or attempts were more likely than respondents in general to have used health professionals, counselling, pastoral/spiritual support and the Vets in Stress phone line, but less likely to have sought support from employers and workmates. CONCLUSIONS: There is a need for a wide range of strategies to manage work-related stress among veterinarians. Sources of stress in the workplace must be identified and strategies developed to control those which present a significant hazard. Strategies may include attention to workloads and working hours, design of work processes, and increasing social support. Training in work-related skills such as communication, conflict management and stress management may be helpful where lack of these skills is contributing to stress. Support services such as help lines and mentor schemes are also available and information about these needs to be more accessible.  相似文献   

11.
The purpose of this study was to assess the objective bioterrorism-related knowledge base and the perceived response readiness of veterinarians in Hawaii to a bioterrorism event, and also to identify variables associated with knowledge-based test performance. An anonymous survey instrument was mailed to all licensed veterinarians residing in Hawaii (N = 229) up to three times during June and July 2004, using numeric identifiers to track non-respondents. The response rate for deliverable surveys was 59% (125 of 212). Only 12% (15 of 123) of respondents reported having had prior training on bioterrorism. Forty-four percent (55 of 125) reported being able to identify a bioterrorism event in animal populations; however, only 17% (21 of 125) felt able to recognize a bioterrorism event in human populations. Only 16% (20 of 123) felt they were able to respond effectively to a bioterrorist attack. Over 90% (106 of 116) expressed their willingness to provide assistance to the state in its response to a bioterrorist event. Veterinarians scored a mean of 70% correct (5.6 out of 8 questions) on the objective knowledge-based questions. Additional bioterrorism preparedness training should be made available, both in the form of continuing educational offerings for practicing veterinarians and as a component of the curriculum in veterinary schools.  相似文献   

12.
Cardiovascular or pulmonary system failure in neonatal foals requires rapid recognition and initiation of cardiopulmonary cerebral resuscitation (CPCR). Foals may require resuscitation immediately after birth or after arrest from progression of a disease process such as severe sepsis or septic shock. Initial treatment is aimed at establishing an airway and providing ventilation. Circulation is provided by closed-chest compressions. Circulatory access is important to provide intravenous fluid and pharmacologic therapy for cardiovascular support. Ventricular fibrillation and pulseless ventricular tachycardia are arrhythmias not commonly recognized with arrest in foals, whereas asystole and cardiovascular collapse are frequently encountered. Training of personnel, preparation of supplies, and organization during CPCR is essential to a successful outcome.Most of the information used for CPCR in neonatal foals is derived from human medical research and clinical medicine. As new advances are made in human neonatal and pediatric CPCR, many of these treatments and techniques can be applied to foals. This article reviews currently available CPCR guidelines in foals and highlights new perspectives in human medicine that may be applicable to foals.  相似文献   

13.
Objective: To describe the clinical manifestations and successful outcome following an inadvertent overdose of ketamine to a cat. Case summary: A 4‐year‐old neutered male domestic shorthair cat was evaluated for a urethral obstruction. Because of an inadvertent miscalculation of ketamine, 20 times the intended dose was administered intravenously, which resulted in cardiopulmonary arrest. Cardiopulmonary‐cerebral resuscitation was successful, and short‐term mechanical ventilation, fluids and intensive monitoring were utilized to achieve full recovery and subsequent discharge of the animal. New or unique information provided: Ketamine is a common anesthetic agent used in cats that is considered to have a wide therapeutic index and minimal cardiopulmonary depressant effects at recommended doses. Successful management of inadvertent ketamine overdose has been reported in children, but not in cats. Prompt CPCR and short‐term mechanical ventilation may be necessary to treat a significant ketamine overdose. In cats, yohimbine may act as a partial antagonist of ketamine.  相似文献   

14.
Reasons for performing study: To determine the sedative, analgesic and anaesthetic drugs and techniques that are used by equine veterinarians. Hypothesis or objectives: To provide equine veterinarians with information concerning veterinary use of anaesthetic techniques, a reflection of the collective experiences of the profession. Methods: A survey was conducted of those members of the American Association of Equine Practitioners (AAEP) with an electronic mail address on file with the organisation using proprietary, web‐based software. The survey was comprised of 30 questions divided into 8 sections: nonsteroidal anti‐inflammatory drugs; local anaesthesia; alternative techniques; standing chemical restraint; epidural anaesthesia; short‐term anaesthesia; long‐term anaesthesia; and a place for the respondent to make comments. Results: The response rate was 13.8% (952/6911) AAEP member veterinarians primarily use phenylbutazone and flunixin as anti‐inflammatory drugs, and lidocaine and mepivacaine for local anaesthesia. Combinations of drugs are preferred for standing chemical restraint. While many veterinarians frequently utilise short‐term anaesthesia, longer anaesthesia is less frequently performed. Conclusions: Most AAEP member veterinarians use sedatives in combination to provide standing chemical restraint. Extra‐label use of drugs is a core component of current equine sedation and anaesthetic practice. Potential relevance: Equine veterinarians can compare their choices of anaesthetic drugs with others practising equine medicine and surgery and may be stimulated to investigate alternative methods of providing comfort to horses.  相似文献   

15.
ObjectiveTo better document anesthetic and analgesic protocols used by veterinarians in general practice within the United States (US) when performing elective ovariohysterectomy in cats.Study designCross-sectional survey.PopulationVeterinary practitioners in the US who are members of the Veterinary Information Network Inc. (VIN).MethodsAn online anonymous survey was distributed to VIN members. The survey included questions pertaining to preanesthetic evaluation, premedication, induction, monitoring and maintenance protocols, and postoperative analgesia and sedation protocols when performing ovariohysterectomy in cats.ResultsA total of 1324 veterinarians completed the survey. Respondents (number; %) reported performing preanesthetic laboratory tests [packed cell volume (256; 19.3%), complete blood cell count (893; 67.4%) and biochemistry panels (1101; 83.2%)] and preanesthetic examinations (1186; 89.6%) on the morning of surgery. The most frequently administered drugs for premedication were dexmedetomidine (353; 26.7%) and buprenorphine (424; 32.0%). The most frequently administered induction agent was propofol (451; 61.3%), and isoflurane (668; 50.4%) was the most common agent for maintenance of anesthesia. The majority of respondents reported placing intravenous catheters (885; 66.8%), administering crystalloid fluids (689; 52.0%) and providing heat support (1142; 86.3%). Participants reported using perioperative and postoperative analgesia including opioids (791; 59.7%), non-steroidal anti-inflammatory drugs (NSAIDs; 697; 52.6%) and NSAIDs dispensed for home use (665; 50.2%). Cats were commonly released home on the day of surgery (1150; 86.9%), and most participants reported contacting owners for follow-up within 1–2 days (989; 74.7%).Conclusions and clinical relevanceAnesthetic protocols and management techniques for routine feline ovariohysterectomy differ widely among US veterinarians who are VIN members, and results from this study may be of use to evaluate anesthetic practices from this population of veterinarians.  相似文献   

16.
The objectives of this study were to identify factors associated with zoonotic infections in veterinarians, the incidence of physician consultation and treatment and the incidence of diagnostic and treatment errors. Veterinarians in any area of practice were solicited to participate in an online survey through an invitation letter sent to the Oregon Veterinary Medical Association. Proportions of respondents to various factors were analyzed for differences among gender, age, time since graduation and type of practice in which they worked. In all, 216 complete responses were received. In all, 13.9% of respondents had never been vaccinated against rabies, and 20.8% had been exposed to suspect rabid animals, mostly (64.4%) a single time. Other zoonoses were reported by 47.2% of respondents: mostly diseases transmitted via contact (57.4%) especially ringworm, followed by those with oral transmission (21.7%). Most zoonotic infections were reportedly acquired by young veterinarians working in primary care veterinary practice. Cats were the species most commonly reported as the animal source of a zoonotic infection. Veterinarians likely self-diagnosed zoonotic diseases, especially those transmitted by contact. Medical care providers were consulted for diagnosis of more serious diseases. Diagnosis and treatment errors were uncommon. Results of this study emphasize the need to educate future veterinarians during their early years in veterinary school about the risks associated with their future jobs.  相似文献   

17.
Equine nutrition plays a critical role in equine health. The veterinarian is an expected major source of equine nutrition information, yet little evidence exists to evaluate this assumed role, particularly from the veterinarian’s perspective. The aim of this study was to investigate the knowledge and confidence levels and practices and perceptions regarding equine nutrition by surveying equine clinicians in Georgia, USA. A sample representative of a cross-section of equine veterinarians participated in the survey: response rate was 20%. Veterinarians reported that although their level of equine nutrition knowledge had improved since graduation, their confidence levels varied when giving nutritional advice on a number of prevalent nutritional-related conditions. Their confidence level in giving nutritional advice on colic was the highest and on hyperkalemic periodic paralysis the lowest. The majority of veterinarians had not taken any recent equine nutrition continuing education, mainly owing to lack of courses available; however, the majority expressed an interest in taking future courses, particularly if offered online. Although the veterinary profession was considered to be an important source of equine nutrition information, almost one-quarter of veterinarians offered no equine nutrition counseling to their clients. More than two-thirds of veterinarians reported having no access to a referral equine nutrition service, but would be likely to use one if it were available. The results of this survey reveal equine nutrition perceptions and practices from an equine clinician perspective. Several areas of concern are highlighted, questioning the quality, responsibility, and provision of equine nutrition in Georgia, USA, and are suggestive of a far more wide-reaching problem, requiring further research.  相似文献   

18.
OBJECTIVE: To gain a better understanding of sources and frequency of use of pet health information accessed by owners and assess the level of confidence in information accuracy as reported by pet owners who visit their veterinarians. DESIGN: Prospective study. SAMPLE POPULATION: 412 participants from 17 small animal veterinary clinics. PROCEDURES: Questionnaires pertaining to pet owners' habits related to pet health information (sources and frequency of their use and confidence in accuracy of information accessed) were distributed by front desk staff at 17 participating veterinary clinics. A cover letter was included with each survey that offered instructions for completion and assured respondents of their anonymity. All completed surveys were placed in an envelope and returned to the researchers for analysis. RESULTS: Results indicated that pet owners who visited their veterinarians acquired pet information from veterinarians via the telephone or in person and from family or friends more frequently than they acquired such information from the World Wide Web. Pet owners also reported more confidence in information received from veterinarians (in person and via telephone conversations), compared with information from any other accessible source. CONCLUSIONS AND CLINICAL RELEVANCE: The use of Web sites by owners as sources of pet health information will undoubtedly continue to grow. Veterinarians can play a more proactive role in helping pet owners to access reliable Web sites that provide useful pet health information, thereby providing a benefit to all parties.  相似文献   

19.
OBJECTIVE: To compare veterinarians' and pet owners' perceptions of client expectations with respect to the monetary aspects of veterinary care and identify challenges encountered by veterinarians in dealing with pet owners' expectations. DESIGN: Qualitative study based on focus group interviews. PARTICIPANTS: 6 pet owner focus groups (32 owners) and 4 veterinarian focus groups (24 companion animal veterinarians). PROCEDURES: Independent focus group sessions were conducted with standardized open-ended questions and follow-up probes. Content analysis was performed on the focus group discussions. RESULTS: Pet owners expected the care of their animal to take precedence over monetary aspects. They also expected veterinarians to initiate discussions of costs upfront but indicated that such discussions were uncommon. Veterinarians and pet owners differed in the way they related to discussions of veterinary costs. Veterinarians focused on tangibles, such as time and services. Pet owners focused on outcome as it related to their pet's health and well-being. Veterinarians reported that they sometimes felt undervalued for their efforts. A suspicion regarding the motivation behind veterinarians' recommendations surfaced among some participating pet owners. CONCLUSIONS: Results suggested that the monetary aspects of veterinary care pose barriers and challenges for veterinarians and pet owners. By exploring clients' expectations, improving communication, educating clients, and making discussions of cost more common, veterinarians may be able to alleviate some of the monetary challenges involved in veterinarian-client-patient interactions.  相似文献   

20.
Cardiopulmonary resuscitation in small animal medicine: an update   总被引：1，自引：0，他引：1  
In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to <10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.  相似文献   

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