Clinical remission of feline sino-nasal aspergillosis despite evidence of persistent infection.

Case summary: Feline sino-nasal aspergillosis is a rare condition with only sparse heterogeneous reports in the literature regarding its treatment. This report describes the presentation, treatment and outcome of a cat with sino-nasal aspergillosis treated by meticulous debridement in combination with topical and systemic azole therapy. Diagnosis was based on MRI, in combination with rhinoscopic assessment and visualisation of fungal plaques, followed by histopathology, fungal culture and panfungal PCR. The cat was treated by debridement of fungal plaques via anterior rhinoscopy and frontal sinusotomy and local instillation of 1% clotrimazole solution, followed by a 4-week course of oral itraconazole. Histopathology confirmed fungal rhinitis and culture identified Aspergillus fumigatus and Aspergillus versicolor. Clinical remission was achieved after treatment; however, evidence of persistent infection was confirmed in the post-mortem examination 8 months after the cat was euthanased for unrelated reasons. Relevance and novel information: Despite clinical remission, the persistence of fungal infection post mortem highlights the challenges of monitoring the response to treatment and illustrates that the resolution of clinical signs does not necessarily equate with a disease cure.

An Exploration of Diversity, Equity, Inclusion, and Antiracism in Standardized Patient Simulations.

A trending topic in pharmacy education is the importance of educating and exposing student pharmacists to topics of diversity, equity, inclusion, and antiracism (DEIA). Incorporation of diverse patient populations is one emerging learning opportunity for students in the DEIA space. This commentary presents the findings of seven pharmacy programs reporting similarities and differences in standardized patient (SP) recruitment and training, and their use in DEIA simulation learning activities. Common barriers of DEIA-centric SP activities in pharmacy programs were also identified and included recruitment of diverse SPs, lack of faculty knowledge for implementation of DEIA-focused simulations, and emotional protection of SPs involved. While no best practices or standardized processes exist, the authors provide suggestions for addressing barriers, and make a call to action for further research to determine best practices related to recruitment, training, and utilization of diverse SPs in simulation activities in pharmacy education.

Surgical management of a laryngeal rhabdomyosarcoma in a cat.

Case summary: An 11-year-old male castrated British Shorthair was referred for investigations into an upper respiratory tract mass. A partial laryngectomy was performed to excise the mass. Marginal resection of the mass involved excision of parts of the thyroid cartilage and left arytenoid cartilage. A tracheostomy tube was maintained for 48 h postoperatively. The cat recovered without complication and was discharged at 72 h postoperatively. Histopathology of the mass was deemed most consistent with a rhabdomyosarcoma (RMS). Relevance and novel information: Telephone follow-up 12 months postoperatively confirmed resolution of the clinical signs. To our knowledge, this is the first report of a laryngeal RMS in a cat. RMS should be considered a differential diagnosis for a laryngeal mass in a cat. This case demonstrates that resection via a partial laryngectomy may be a viable therapeutic option.

Connecting improvisational exercises and pharmacy communication skills: A how-to guide.

BACKGROUND AND PURPOSE: Medical improvisation (improv) is increasingly being used to teach physicians, nurses, and other caregivers how to better communicate with patients and other members of the healthcare team. This article describes how improvisational activities were incorporated within an existing pharmacy practice lab course and how to implement improv games targeting specific communication skills. EDUCATIONAL ACTIVITY AND SETTING: Three hours of improvisational activities were incorporated into a semester-long pharmacy practice lab course. Partner games such as "the mirror" and group games such as "out-of-order story" were played and connected to communication skills related to counseling or taking a patient's history. Additional activities were introduced targeting specific areas of weakness identified in a formative assessment. FINDINGS: A survey was used to assess student perceptions of the improv activities. Students were largely able to connect the skills learned in improv to pharmacy, and some provided examples of how they were already implementing these skills in practice. SUMMARY: This article provides a user manual so that faculty with little to no improv experience can include these activities in their communications courses.

Assessing veterinary professionals' ability to estimate length.

BACKGROUND: This study aimed to assess the accuracy of veterinary professionals' psychomotor and visual estimation of lengths. METHODS: Members of staff at a single veterinary referral hospital were asked a series of demographic questions. Respondents were first asked to draw lines of a specified length, while being blinded to their previous responses. Respondents were then shown lines on separate non-standard-size laminated sheets of paper and asked to estimate their length. A total of five estimations were made in each section, with lengths varying from 3 to 120 mm. RESULTS: A total of 101 respondents were assessed. The median absolute percentage error was 24.4% for psychomotor estimation and 33.3% for visual estimation. Respondents were significantly more accurate at psychomotor than visual estimation (p = 0.00024). Respondents tended to underestimate with psychomotor estimation and overestimate with visual estimation. There was no significant difference between the accuracy of veterinarians and veterinary nurses. LIMITATION: When divided by demographic, not all sample sizes met the power calculation threshold, thus limiting their interpretation. CONCLUSION: Veterinary professionals must recognise the limitations of estimating length using visual appraisal alone. Measuring devices should be utilised where appropriate.

Reshaping surgical specialist training in small animal surgery during and after the COVID-19 pandemic.

OBJECTIVE: To assess the perceived effects of the COVID-19 pandemic on small animal surgical specialist training, among trainees and supervisors and to propose changes, based upon the results, that could be incorporated into training programs. STUDY DESIGN: Anonymous online questionnaire survey. SAMPLE POPULATION: Eighty-one eligible responses were collected in September 2020, including 52 European College of Veterinary Surgeons (ECVS) residents and 29 ECVS Diplomates acting as supervisors. METHODS: Descriptive statistics were used to analyze the data. Fisher's exact test was used to test for significance. RESULTS: A reduction in surgical case load was reported by 82% (n = 66/81) of respondents, with 82% (n = 54/66) of those believing that COVID-19 had a mild-to-moderate impact on training. Compared to supervisors, residents were less likely to feel that appropriate guidance, a safe working environment, and measures to preserve training had been provided (p < .01). Only 45% (n = 22/49) of residents reported confidence with performing teleconsultations. Ninety percent (n = 73/81) of respondents considered online "case presentations" and "edited surgical video footage" as a positive ancillary tool. CONCLUSION: COVID-19 has resulted in a reduction in case load and training for the majority of residents. A discrepancy between the opinions of residents and supervisors was noted on various aspects of COVID-19 related effects. IMPACT: Open communication, as well as the use of additional training tools through digital platforms may help to preserve safe and effective training during times of decreased clinical activity. While this study has focused on surgical specialist training, the results could be applied to other disciplines.

Influence of radiographic examination findings on recommendations made during routine clinical re-evaluation of dogs with uncomplicated tibial plateau leveling osteotomy.

OBJECTIVE: To determine the influence of follow-up radiographic examination on recommendations made during routine clinical re-evaluation of dogs that had undergone uncomplicated tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective multi-institutional case series. ANIMALS: Client-owned dogs (N = 1010) that underwent uncomplicated TPLO. METHODS: Records from 11 institutions were searched for dogs that had been treated with unilateral TPLO and had no history of postoperative complications before their routine follow-up examination. The frequency of change in further clinical recommendations resulting from client- or clinician-voiced concerns or radiographic abnormalities was investigated. RESULTS: Follow-up evaluation was performed at a median of 6 (range, 4-15) weeks after TPLO. Radiographic examination findings contributed to a change in recommendations in 4.15% (38/915) of dogs presented without client concerns and without abnormalities at orthopedic examination. Abnormal radiographic findings alone influenced the management of 3.76% (38/1010) of dogs. An association was detected between clinical features and radiological findings leading to a change in recommendations (P < .0001). Administration of analgesia at the time of follow-up was associated with radiographic abnormalities (P = .017) and change in postoperative plans (P = .0007). CONCLUSION: Radiographic examination findings at follow-up did not influence the management of most dogs with uncomplicated TPLO. CLINICAL SIGNIFICANCE: Radiographic examination findings are unlikely to influence the treatment of dogs that seem to be recovering uneventfully from an uncomplicated TPLO without concerns from clients, analgesia, or abnormal findings on thorough orthopedic examination by a surgical specialist, at the time of the planned clinical re-evaluation.

Cholesteatoma in a cat.

CASE SUMMARY: A 14-year-old neutered female Burmese cat was referred for investigation of a caudal oropharyngeal mass. CT showed a thin walled cyst-like structure filling and expanding from the right tympanic bulla. Histopathology showed fragments of mildly dysplastic squamous epithelium and aggregates of keratin. These findings were considered consistent with a diagnosis of cholesteatoma. RELEVANCE AND NOVEL INFORMATION: To the best of our knowledge, this is the first reported case of a cholesteatoma in a cat. Cholesteatoma should be considered a differential diagnosis for cats presenting with a caudal oropharyngeal mass, a history of chronic ear disease or a history of previous, surgically managed middle ear disease. Advanced imaging and biopsies should be considered important in the diagnosis of these lesions.

Ventral Slot Surgery to Manage Cervical Intervertebral Disc Disease in Three Cats.

OBJECTIVE: This case series describes the clinical presentation, management and outcome of three cats diagnosed with cervical intervertebral disc disease that underwent decompressive ventral slot surgery. METHODS: This is a retrospective case series evaluating client-owned cats undergoing a ventral slot surgical procedure to manage cervical intervertebral disc disease (n = 3). RESULTS: A routine ventral slot surgery was performed in each case without complication, resulting in postoperative neurological improvement in all three cases. CLINICAL SIGNIFICANCE: Ventral slot surgery can be used to achieve effective cervical spinal cord decompression with a good long-term outcome in the management of feline cervical intervertebral disc herniation. To avoid creating an excessively wide slot with the potential for postoperative complications including vertebral sinus haemorrhage, vertebral instability or ventral slot collapse, careful surgical planning was performed with preoperative measurement of the desired maximum slot dimensions.

Student pharmacists' perceptions and awareness of community pharmacy practice residency programs.

OBJECTIVES: To assess student exposure to types of pharmacy practice, evaluate awareness and perceptions of community pharmacy residencies, and identify areas of postgraduate training of interest to student pharmacists. DESIGN: Cross-sectional, descriptive, online survey study. SETTING: United States, January to April 2008. PARTICIPANTS: Student pharmacists in the final 2 years of the doctor of pharmacy (PharmD) program. INTERVENTION: An online survey was administered to students in the final 2 years of the PharmD program at randomly selected schools of pharmacy by region throughout the United States. MAIN OUTCOME MEASURES: Awareness of student pharmacists regarding community pharmacy residencies and interest in postgraduate training. RESULTS: 254 surveys were completed during the study period. Of the respondents, 95% had previous experience working in a community pharmacy setting. Nearly 90% were aware of community pharmacy residencies. Students who indicated opportunities to publish (odds ratio 2.4 [95% CI 1.34-4.1]), teaching students (2.1 [1.36-3.14]), enjoying the job atmosphere (4.9 [1.54-15.60]), and clinically challenging (4.3 [2.15-8.67]) as desirable career attributes were more likely to be interested in postgraduate training. No significant differences existed in the information sources sought by students interested in community pharmacy residency programs (CPRPs) compared with those interested in other types of postgraduate training. CONCLUSION: The significant predicators of student pharmacists interested in pursuing postgraduate training are in alignment with CPRP training. Further research is needed to market the value of CPRPs through the identified information sources.

Integration of collaborative medication therapy management in a safety net patient-centered medical home.

OBJECTIVE: To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH). SETTING: Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010. PRACTICE DESCRIPTION: A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up. PRACTICE INNOVATION: CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals. MAIN OUTCOME MEASURES: Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations. RESULTS: Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted. CONCLUSION: Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons.

An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need. Pharmacist services are provided in the mental health and medical clinics. A satisfaction survey showed that the providers and staff (n = 13) in the clinic were very satisfied with the integration of pharmacist services. The quality and safety of medication use has improved as a result of the academic-community collaborative. Education and research initiatives have also resulted from the collaborative. This manuscript describes the implementation, outcomes and benefits of the partnership for both the HCH clinic and the school of pharmacy.

Revealing undetected problems with medication therapy management services.

Implementation of Medication Therapy Management (MTM) services under the Medicare Modernization Act of 2003 has highlighted the innovative roles that pharmacists are assuming in progressive, community-based practice settings. MTM underscores the vital role that community pharmacists have in helping patients achieve desirable therapeutic outcomes and reduce health care expenses. Pharmacists can: 1) obtain detailed medication histories, 2) assess patient adherence and the development of side effects, 3) educate patients on their medications and disease states, and 4) perform cost-effective therapeutic interchanges in collaboration with prescribers. This case describes an MTM session with a 68-year-old Caucasian male who is a regular prescription customer at a local grocery-store chain pharmacy. The patient was screened and identified by his Medicare Part D plan as one who qualifies for MTM services. He has a history of dyslipidemia, depression, and epilepsy. The patient was contacted by the pharmacist to participate in a MTM appointment to discuss his current medications and disease states. After obtaining a detailed history, the pharmacist identified significant medication-related problems including inappropriate prescribing of medication, self-treatment, and the patient's lack of knowledge concerning his medications. After discussions with the patient and his health care providers, a medication plan was created for the patient to follow. Open communication among the patient, pharmacist, and prescribers is a crucial component to ensure the success of MTM services.