Veterinarians' perspective on telemedicine in Germany

Introduction Information on the use of telemedical approaches in the context of veterinary medicine is evolving. As in human medicine, veterinary medicine is subject to an increasing digitalization effort. The aim of the current study was to investigate the perspective of German veterinarians regarding their awareness and usage of telemedical approaches. Furthermore, the degree of implementation of different digital approaches in the context of German veterinary medicine was elaborated. Methods A literature review, that also aimed to address the necessary framework or standardization of these digitalization efforts and potential barriers such as legal or infrastructural aspects, provided information for the empirical research. Using a quantitative research approach, the perspective of German veterinarians was surveyed. Results In total, responses from 169 veterinarians were analyzed. The results show that digital approaches were used by veterinarians and the usage was enhanced by the COVID-19 crisis. Discussion However, the lack of a clear legal framework may be a significant barrier for further implementation. This survey provides a basis for a critical discussion on the use of veterinary telemedicine in Germany. The results may contribute to future strategies for the implementation and development of necessary policies, training, and service applications within Germany, which may be transferable for the profession in other countries.

Veterinarians' perspective on telemedicine in Germany.

Introduction: Information on the use of telemedical approaches in the context of veterinary medicine is evolving. As in human medicine, veterinary medicine is subject to an increasing digitalization effort. The aim of the current study was to investigate the perspective of German veterinarians regarding their awareness and usage of telemedical approaches. Furthermore, the degree of implementation of different digital approaches in the context of German veterinary medicine was elaborated. Methods: A literature review, that also aimed to address the necessary framework or standardization of these digitalization efforts and potential barriers such as legal or infrastructural aspects, provided information for the empirical research. Using a quantitative research approach, the perspective of German veterinarians was surveyed. Results: In total, responses from 169 veterinarians were analyzed. The results show that digital approaches were used by veterinarians and the usage was enhanced by the COVID-19 crisis. Discussion: However, the lack of a clear legal framework may be a significant barrier for further implementation. This survey provides a basis for a critical discussion on the use of veterinary telemedicine in Germany. The results may contribute to future strategies for the implementation and development of necessary policies, training, and service applications within Germany, which may be transferable for the profession in other countries.

Key feature-cases as virtual patients in education of veterinary neurology.

To provide students of veterinary medicine with the necessary day 1 competences, e-learning offerings are increasingly used in addition to classical teaching formats such as lectures. For example, virtual patients offer the possibility of case-based, computer-assisted learning. A concept to teach and test clinical decision-making is the key feature (KF) approach. KF questions consist of three to five critical points that are crucial for the case resolution. In the current study usage, learning success, usability and acceptance of KF cases as neurological virtual patients should be determined in comparison to the long cases format. Elective courses were offered in winter term 2019/20 and summer term 2020 and a total of 38 virtual patients with neurological diseases were presented in the KF format. Eight cases were provided with a new clinical decision-making application (Clinical Reasoning Tool) and contrasted with eight other cases without the tool. In addition to the evaluation of the learning analytics (e.g., processing times, success rates), an evaluation took place after course completion. After 229 course participations (168 individual students and additional 61 with repeated participation), 199 evaluation sheets were completed. The average processing time of a long case was 53 min, while that of a KF case 17 min. 78% of the long cases and 73% of KF cases were successfully completed. The average processing time of cases with Clinical Reasoning Tool was 19 min. The success rate was 58.3 vs. 60.3% for cases without the tool. In the survey, the long cases received a ranking (1 = very good, 6 = poor) of 2.4, while KF cases received a grade of 1.6, 134 of the respondents confirmed that the casework made them feel better prepared to secure a diagnosis in a real patient. Flexibility in learning (n = 93) and practical relevance (n = 65) were the most frequently listed positive aspects. Since KF cases are short and highlight only the most important features of a patient, 30% (n = 70) of respondents expressed the desire for more specialist information. KF cases are suitable for presenting a wide range of diseases and for training students' clinical decision-making skills. The Clinical Reasoning Tool can be used for better structuring and visualizing the reasoning process.

Case report: Lympho-histiocytic meningoencephalitis with central nervous system vasculitis of unknown origin in three dogs.

Meningoencephalitis of unknown origin (MUO) is an umbrella term for a variety of subtypes of meningoencephalitis of dogs and cats with no identifiable infectious agent. In dogs, granulomatous meningoencephalitis (GME), necrotizing meningoencephalitis (NME), and necrotizing leukoencephalitis (NLE) are the most commonly reported subtypes. However, sporadically there are reports about other subtypes such as greyhound encephalitis or eosinophilic meningoencephalitis. The following case series presents three dogs with peracute to acute progressive signs of encephalopathy. The magnetic resonance imaging (MRI) of two dogs (post mortem n = 1/2) showed severe, diffuse swelling of the cortical gray matter with increased signal intensity in T2weighted (w) and fluid-attenuated inversion recovery (FLAIR) and decreased signal intensity in T1w. Additionally, focal to multifocal areas with signal void in both dogs and caudal transforaminal herniation of the cerebellum in one dog was observed. Post mortem histopathological examination revealed lympho-histiocytic encephalitis and central nervous system (CNS) vasculitis in all dogs. No infectious agents were detectable by histopathology (hematoxylin and eosin stain), periodic acid-Schiff reaction (PAS), Ziehl-Neelsen stain and immunohistochemistry for Canine adenovirus-1, Parvovirus, Listeria monocytogenes, Parainfluenzavirus, Toxoplasma gondii, Herpes-suis virus, Pan-Morbillivirus, Tick born encephalitis virus, Severe acute respiratory syndrome coronavirus (SARS-CoV) 2. Furthermore, two dogs were tested negative for rabies virus. To the best of the authors' knowledge, this is the first report of a lympho-histiocytic encephalitis with CNS vasculitis with no identifiable infectious agent. It is suggested to consider this as an additional subtype of MUO with severe clinical signs.

Proof of Concept: Game-Based Mobile Learning—The First Experience With the App Actionbound as Case-Based Geocaching in Education of Veterinary Neurology

Case-based learning is a valuable tool to impart various problem-solving skills in veterinary education and stimulate active learning. Students can solve imaginary cases without the need for contact with real patients. Case-based teaching can be well performed as asynchronous remote-online class. In time of the COVID-19-pandemic, many courses in veterinary education are provided online. Therefore, students report certain fatigue when it comes to desk-based online learning. The app “Actionbound” provides a platform to design digitally interactive scavenger hunts based on global positioning system (GPS)—called “bounds” —in which the teacher can create a case study with an authentic patient via narrative elements. This app was designed for multimedia-guided museum or city tours initially. The app offers the opportunity to send the students to different geographic localizations for example in a park or locations on the University campus, like geocaching. In this way, students can walk outdoors while solving the case study. The present article describes the first experience with Actionbound as a tool for mobile game-based and case-orientated learning in veterinary education. Three veterinary neurology cases were designed as bounds for undergraduate students. In the summer term 2020, 42 students from the second to the fourth year of the University of Veterinary Medicine Hannover worked on these three cases, which were solved 88 times in total: Cases 1 and 2 were each played 30 times, and case 3 was played 28 times. Forty-seven bounds were solved from students walking through the forest with GPS, and 41 were managed indoors. After each bound, students evaluated the app and the course via a 6-point numerical Likert rating scale (1 = excellent to 6 = unsatisfactory). Students playing the bounds outdoors performed significantly better than students solving the corresponding bound at home in two of the three cases (p = 0.01). The large majority of the students rated the course as excellent to good (median 1.35, range 1–4) and would recommend the course to friends (median 1.26, range 1–3). Summarizing, in teaching veterinary neurology Actionbound's game-based character in the context of outdoor activity motivates students, might improve learning, and is highly suitable for case-based learning.

Teaching clinical practical and communication skills of the clinical skills lab of the University of Veterinary Medicine Hannover, Foundation, Germany during the COVID-19 pandemic.

Objective: The aim of the project is to teach clinical practical and communication skills in the Clinical Skills Lab (CSL) of the University of Veterinary Medicine Hannover, Foundation (TiHo) during the COVID-19 pandemic. Methodology: As a measure to limit potential SARS-CoV2 infections, the CSL learning stations were digitised and made available on the Moodle learning platform of the TiHo. Online quiz stations were also developed, as well as improvisations that allowed students to practise practical skills at home using everyday materials. Courses for Practical Year (PY) students were digitised and again combined with classroom exercises throughout the year. The teaching formats could be evaluated by the students by means of a questionnaire using a Likert scale (1=agree; 4=disagree). Results: A total of 24.92% of students (n=1272) completed the learning stations with improvisations. The quiz stations were completed with a percentage of 75.08%. Students indicated that the improvisations were easily implementable from home (M=1.33) and assisted in learning the practical skills in question (M=1.89). The quiz stations were considered helpful (M=1.40) and complementary to previous CSL offers (M=1.13). The PY students found the amount of teaching materials adequate (M=1.76) and described communication with the lecturers as problem-free (compulsory electives=1.24). Conclusions: Digital teaching is suitable as a supplement to existing face-to-face courses at the CSL, but cannot replace on-site training under the guidance of trained personnel. The CSL will continue to strive for a combination of online and face-to-face courses for some learning stations in the future.

Meningoencephalomyelitis of Unknown Origin in Cats: A Case Series Describing Clinical and Pathological Findings.

Meningoencephalomyelitis of unknown origin (MUO) is an umbrella term describing inflammatory changes of the central nervous system (CNS) with suspected non-infectious etiology. Diagnosis of MUO mostly remains presumed in a clinical setting. Histopathological and immunohistochemical examination of CNS tissue represent additional tools for detection of inflammation and the exclusion of specific infectious agents. While MUO is well-described in canine patients, only little is known about MUO in cats. Previous reports of feline MUO involve either clinical findings or histopathological examination but not both. The present case series is the first report describing both clinical and histopathological findings of feline MUO: Four cats (age: 1.7-17.8 years) showed acute to chronic progressive neurological signs of encephalopathy or myelopathy. Three cats had extraneural signs (hyperthermia, weight loss, hyporexia, leukocytosis). Magnetic resonance imaging (MRI) showed multifocal intraparenchymal lesions in forebrain, brainstem or spinal cord with homogenous contrast enhancement (2/2). Cerebrospinal fluid (CSF) examination was normal or displayed albuminocytologic dissociation. Histopathology revealed a multifocal, lympho-histiocytic meningoencephalitis in three cases and a lympho-histiocytic myelitis in one case. Immunohistochemistry for feline parvovirus, feline coronavirus, feline herpesvirus, tick borne encephalitis virus, Borna disease virus, morbillivirus, rabies virus, suid herpesvirus-1, and Toxoplasma gondii were negative in all cases. ONE SENTENCE SUMMARY: This case series is the first one reporting both clinical and histopathological findings in cats with MUO. Feline MUO incorporates heterogeneous subtypes of sterile CNS inflammation.