Monthly Journal Round-Up - December 2017

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

Clinical practice reviews:

  • Kendon, W.K. et al. (2018) ’Head trauma’. Veterinary Clinics of North America: Small Animal Practice 48 (1), pp. 111-128

Clinical studies:

Prospective:

  • Dickson, D. et al. (2017) ‘Rapid assessment with physical examination in dyspneic cats: the RAPID CAT study’. Journal of Small Animal Practice (Early view doi:10.1111/jsap.12732) + Related podcast.
  • Cambournac, M. et al. (2017) ‘Sonographic assessment of volaemia: development and validation of a new method in dogs’ Journal of Small Animal Practice (Early view doi: 10.1111/jsap.12759).

Retrospective:

  • Smart, L. et al. (2017) ‘Food engorgement in 35 dogs (2009-2013) compared with 36 dogs with gastric dilation and volvulus’ Veterinary Record, 181(21), p.563.
  • Matiasovic M. et al. (2017) ‘Surgical management of impalement injuries to the trunk of dogs: a multicentre retrospective study’ Journal of Small Animal Practice (Early view doi:10.1111/jsap.12767).
  • Kohen, C.J. et al. ‘Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients’. Journal of Veterinary Emergency and Critical Care (Early view doi: 10.1111/vec.12676).
  • Janet, A. et al. (2018) ‘Outcomes in dogs with uroabdomen: 43 cases’ Journal of the American Veterinary Medical Association, 252(1), pp. 92-97.

Case series:

Latimer, C.R et al. (2017) ‘Lung lobe torsion in seven juvenile dogs’ Journal of American Veterinary Medicine Association, 251 (12), pp. 1450-1456.

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

Monthly Journal Round-Up - November 2017

This month Veterinary ECC Small Talk is starting a new initiative - a monthly journal round-up. Each month we will share a list of ECC-related journal articles from some of the main veterinary journals. We will also provide a summary of our 'pick of the month' article.

I say 'we' because this initiative was suggested to me by the wonderful Lara (see below). It is Lara who will be preparing this monthly round-up and the pick of the month summary.

Many of the main veterinary journals are not yet open access. But if you would like a copy of any of the papers, we can share them with you privately for personal educational purposes. Please email lara.brunori@gmail.com.

Lara Brunori DVM CertAVP MRCVS

"I graduated in 2009 from Bologna University (Italy) and spent the first five years post-graduation as an equine/mixed vet practising in several different Countries (UAE, Ireland, South Africa, Belgium and Mexico). In 2014 I moved to the UK. I worked first as a mixed vet in Scotland for a couple of years and then moved down south to dedicate myself to first opinion small animal practice. I achieved the CertAVP status in 2017 and I'm moving to an ECC only practice in January 2018."

Monthly Journal Round-Up

Clinical practice review:

  • Humm, K. and Cortellini, S. (2017) ‘Abdominal trauma in dogs’. In Practice 39(10) , pp.434-445.
  • Reid, J.  et al. (2017) ‘Pain assessment in companion animals: an update’. In Practice 39(10), pp.446-451.
  • Rudloff, E. ‘Diabetic ketoacidosis in the cat: Recognition and essential treatment’. Journal of Feline Medicine and Surgery, 19(11), pp.1167-1174.

Clinical studies:

Prospective:

Spillebeen, A.L. et al. (2017) ‘Negative pressure therapy versus passive open abdominal drainage for the treatment of septic peritonitis in dogs: a randomised prospective study’. Veterinary Surgery, 46(8), pp.1086-1097.

Retrospective:

  • O’Neill, D.G. et al. (2017) ‘Gastric dilation-volvulus’ in dogs attending UK emergency-care veterinary practices: prevalence factors and survival’. Journal of Small Animal Practice 58(11), pp.629-638.
  • Smart, L. et al. (2017) ‘Food engorgement in 35 dogs (2009-2013) compared with 36 dogs with gastric dilation and volvulus’. Vet Record, 181(21), pp.563.
    • Related commentary of above paper: Humm, K. & Barfield, D. (2017) 'Differentiating between food bloat and gastric dilatation and volvulus in dogs’. Vet Record, 181(21), pp. 561-562.
  • Burton, A.G. et al. (2017) ‘Risk factors for death in dogs treated for oesophageal foreign body obstruction: a retrospective cohort study of 222 cases (1998-2017)’. Journal of Veterinary Internal Medicine, 31(6), pp.1686-1690.
  • Balakrishnan A. et al. (2017) ‘Retrospective evaluation of the prevalence, risk factors, management, outcome and necropsy findings of acute lung injury and acute respiratory distress syndrome in dogs and cats: 29 cases (2011-2013)’. Journal of Veterinary Emergency and Critical Care, 27(6), pp.662-673.
  • Thies, M. et al. (2017) ‘Retrospective evaluation of the effectiveness of xylazine for inducing emesis in cats: 48 cats (2011-2015)’. Journal of Veterinary Emergency and Critical Care, 27(6), pp.658-661.
     

Pick of the Month

Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors and survival

O’Neil et al. (2017) Journal of Small Animal Practice 58(11), pp.629-638

This article stems from a collaboration between VetCompass, a non-profit international initiative focused on investigating companion animal health and common disorders, and Vets Now, the largest provider of first opinion emergency pet care in the UK. 

In this study, the authors aim to report prevalence, risk factors and clinical outcomes among dogs presented with gastric dilation and volvulus (GDV) to a first opinion UK emergency care provider.
Electronic Patient Records (EPRs) of 77,088 dogs were analysed from the 1st of September 2012 to the 28th of February 2014. 

Main findings:

  • The overall incidence of presumed GDV cases was 0.6% 
  • Pure-bred dogs had 5.6 times the odds of developing GDV compared with cross-bred ones 
  • Breeds with the highest prevalence included Great Dane (14%), Akita (9.2%), Dogue de Bordeaux (7.2%), Irish setter (7.1%) and Weimaraner (7.1%)
  • The prevalence of cross-breeds was 0.1%
  • Mean body weight of GDV cases was 38.8kg and mean age was 8 years old
  • Dogs weighing > 40kg were shown to be 148.7 times more likely to be affected than dogs weighing < 10kg 
  • The odds of GDV diagnosis increased with age 
  • 1.8% of GDV cases arrived dead at arrival and 50.3% did not survive to discharge, but of these deaths, 88.5% were due to euthanasia
  • Reasons for euthanasia: in 69.8% of cases to avoid further animal suffering; the remainder were due to financial concerns 
  • Dogs that went ahead with surgery had a survival rate of 79.3% (young and insured dogs were more likely to undergo surgery)
  • 97% of surgical cases had a gastropexy procedure performed at the same time
  • 14.9% had concurrent splenectomy, but survival did not differ between splenectomised and non-splenectomised cases
  • Dogs that presented as ambulatory were significantly more likely to survive, but they also were more likely to have surgery
  • Dogs with blood lactate < 4mmol/L had increased probability of survival among both surgical and non-surgical cases 

Study limitations: 

  • Case definition was of “presumptive GDV” because a definitive diagnosis with imaging or surgery was not always achieved (39.3% of cases did not receive any diagnostic imaging, 40.2% did not go to surgery and 1.8% arrived dead)  
  • There were missing data of demographic and clinical relevance in some EPRs 
  • Lack of availability of patients’ previous clinical history 
  • No long-term follow-up available; survival was defined as discharged alive from the emergency clinic.

Clinical relevance: 

The unique value of this study relies on the use of primary care clinical records. First opinion data are inherently more likely to better reflect health information of a wider animal population then referral-based studies or retrospective breed-specific surveys.

The current study confirmed that ageing, large, deep-chested and pure-bred dogs are at a higher risk of developing GDVs. However, surgery might be more successful than previously thought. As the authors themselves state in the discussion:

“although the relatively high survival rate for surgical cases may reflect effective case selection for surgical intervention, it is possible that many animals that did not receive surgery may also have survived if this option had been elected […] in addition many of the mortalities in the current study involved euthanasia and over 30% of these mortalities were related to financial concerns, which may have biased the survival rates downwards”. 

The study also showed that gastropexy is a widely accepted technique to prevent GDV recurrence in the UK. It was performed in 97% of GDV surgical interventions.

Less clear is the relationship between ambulatory status and lactate values with subsequent survival. This is because these data were not consistently collected in all presented cases. Furthermore non-ambulatory and high lactate dogs might have been considered a priori to have a poor prognosis and therefore been more likely to have been euthanised. 

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

Medical Presenting: Less is More

Challenge - keep even the ones at the back awake!

Challenge - keep even the ones at the back awake!

All kinds of people have to give presentations. This post is about medical educators. But the principles apply widely.

I first started giving presentations more than a decade ago. One or two as an intern in 2002-2003. A few more as an ECC resident 2006-2009. And then a significant ramp up as I started delivering Continued Professional Development (CPD).

As most do, I started off copying what I had been exposed to. Slides full of bullet points and text. The text often too small to read. Some complex graphs, tables and other images. Too packed. Too much redundant detail for the needed transfer of information. Often photos because they seemed obligatory rather than added value.  For me, the biggest accomplishment was trying to remove as many words as possible so I could at least get the font as large as I could!

This is a road well trodden, especially in academic circles. "What are all the things I want to say and how do I fit them all into my slides?" Some people then proceed to read their slides, even with their back turned to their ignored audience.

Then some years ago, I came across a discussion in medical education circles about what we should be doing differently. It seemed so right to me. I spent a long time redoing almost 1,000 CPD slides to try and improve them.

So, what should we be doing?

The first thing is realising that the best presentations are based on stories. Story-telling engages and holds interest. It takes a lot of forward planning, preparation and practice to produce a gem of a talk based on stories. I will say here and now, I do not manage this. I listen to how much time and effort some medical educators put into their talks with admiration. And with confusion where such busy people find the time!

The second thing is realising that slides do not make a presentation. The presenter does. The slides are the icing on the cake, not the cake. The slides are the backing singers, you are the star. The slides are the orchestra, you are the conductor. You get the point. Know your stuff very well so the slides are not your script; you should be able to do the talk without them! Especially when you apply the third point below. Oh and face the audience not the screen. Don't hide behind lecterns or tables. Get closer.

The third thing is to 'reduce, reduce, reduce' (Ross Fisher). Reduce what is in your slides; replace bullet points and text with pictures. Reduce how much you try to convey. Reduce, reduce, reduce. I believe there is some evidence suggesting that people remember as little as four key messages from a one-hour session. And generally what is at the start and at the end. Know your key messages and repeat them often.

Use a small number of contrasting colour schemes: e.g. black and white; e.g. dark blue and yellow.

If you do have text lists, consider building them up over consecutive slides, e.g. one point per slide. This way the slides change frequently helping to hold the audience's attention.

If you want to provide your audience with lots of information, do it in the form of a handout. Given out at the end of the talk - or emailed to save paper. Or, use a flipped classroom approach. Send your notes to the audience ahead of time. Some might even read them and come with more informed questions.

Again, I am no expert. Above is what I have absorbed from acclaimed medical educators via podcasts and other ways. One such person is Ross Fisher.

I would love to hear your experiences of good speakers, bad speakers, indifferent speakers.