Tissue predictability of elastography is low in collagenase induced deep digital flexor tendinopathy.

Elastography is an emerging imaging modality for characterizing tendon injury in horses, but its ability to differentiate tissue deformability relative to treatment group and biochemical properties using a prospective, experimental study design remain unknown. Objectives of the current study were to (a) to investigate differences in glycosaminoglycan, DNA, and soluble collagen levels in mesenchymal stem cell (MSC) treated limbs compared to untreated control limbs utilizing a collagenase model of tendinopathy; (b) compare elastographic features between treatment groups; and (c) determine tissue-level predictive capabilities of elastography in relation to biochemical outcomes. Bone marrow was collected for MSC culture and expansion. Tendinopathy of both forelimb deep digital flexor tendons (DDFTs) was induced with collagenase under ultrasonographic guidance. One randomly assigned limb was treated with intra-lesional MSC injection with the opposite limb serving as an untreated control. Horses were placed into a controlled exercise program with elastographic evaluations performed baseline (0) and 14, 60, 90, and 214 days post-treatment. Postmortem biochemical analysis was performed. MSC-treated limbs demonstrated significantly less (42%) glycosaminoglycan (P = .006). Significant differences in elastographic region of interest (ROI) percent hardness, ROI color histogram, and subjective lesion stiffness were appreciated between treatment groups at various study time points. Elastographic outcome parameters were weak predictors of biochemical tissue analysis, with all R2 values ≤ 0.50. Within this range of differences in glycosaminoglycan content between treatment groups, elastography outcomes did not predict biochemical differences. Tissue-specific differences between DDFTs treated with MSCs compared to controls were apparent biochemically, but not predicted by elastography.

Evaluation of peer teaching and deliberate practice to teach veterinary surgery.

OBJECTIVE: To assess the impact of peer teaching and deliberate practice on surgical skills acquisition and retention in first- and second-year veterinary students. STUDY DESIGN: Randomized, prospective, comparative study. SAMPLE POPULATION: Eighteen first-year and 25 second-year students from 1 college of veterinary medicine who had previously demonstrated proficiency in basic surgical skills. METHODS: Forty-three participants were divided into 3 groups: the test group (group A, n = 15), who participated in a structured peer-assisted learning program using deliberate practice; the time-practice control group (group B, n = 15), who participated in an unstructured peer-supported environment; and the assessment-only control group (group C, n = 13), who participated in the assessments. Participants performed a subcutaneous mass removal on a cadaver model and were assessed via a global rating system. Three assessment points were evaluated: pretraining, immediate posttraining, and retention. RESULTS: The number of participants who achieved acceptable or excellent grand total scores in group A increased after training. Among all participants, 22% in group A, 35% in group B, and 38% in group C did not achieve an acceptable total score at the retention assessment. CONCLUSION: The study population improved in skill level and retention through the use of standardized video and peer instruction with attention to effective learning strategies, particularly deliberate practice. CLINICAL SIGNIFICANCE: Use and enhancement of the format introduced in this study could augment veterinary surgical education.

Stakeholder expectations regarding the ability of new veterinary graduates to perform various diagnostic and surgical procedures.

OBJECTIVE To assess stakeholders' expectations regarding new veterinary graduates' ability to perform various diagnostic and surgical procedures. DESIGN Cross-sectional survey. SAMPLE Veterinary students, recent graduates, clinical veterinary college faculty, and general practitioners at or from AVMA Council on Education-accredited colleges of veterinary medicine in the United States and Caribbean. PROCEDURES Respondents rated how proficient they expected new graduates, on their first day of practice, to be in 8 diagnostic procedures and the degree of independence they expected of new graduates in 8 surgical procedures. RESULTS Response rate was 9% (235/2,500) for practitioners, 12% (151/1,275) for faculty members, 14% (70/500) for recent graduates, and 15% (1,731/11,474) for students. All 4 respondent subgroups expected that new graduates would be able to adequately perform a fine-needle aspirate of a subcutaneous mass (96% to 98% expected new graduates to be able to adequately perform this procedure) and a cystocentesis (93% to 97% expected new graduates to be able to adequately perform this procedure). The greatest variability in responses was noted for performing hand ties, ultrasound-guided liver biopsy, and arthrocentesis. Most respondents expected new graduates to be able to independently perform a canine castration (82% to 94% expecting independence), feline subcutaneous mass removal (66% to 75% expecting independence), and canine ovariohysterectomy (65% to 89% expecting independence). CONCLUSIONS AND CLINICAL RELEVANCE Results revealed a diversity of opinion regarding expected proficiency for new graduates performing various diagnostic and surgical procedures. Findings may help colleges of veterinary medicine refine their curricula by providing end points for student training.

Effects of an optional clinical skills laboratory on surgical performance of third-year veterinary students.

OBJECTIVE: To determine whether addition of an optional clinical skills laboratory (OCSL) to the traditional surgery curriculum would affect total surgery time or incision closure time in veterinary students performing ovariohysterectomy of a dog during a third-year surgery course. DESIGN: Retrospective and prospective study of veterinary student attendance at OCSL sessions and student performance during the third-year surgery course. SAMPLE: Students from the classes of 2012, 2013, and 2014 at the Washington State University College of Veterinary Medicine. PROCEDURES: For all students, total surgery time and incision closure time were recorded when students performed an ovariohysterectomy of a dog during their third-year live-animal surgery course. Times were analyzed to identify differences among classes and determine whether times were associated with number of OCSL sessions attended, previous experience performing ovariohysterectomies, or enrollment in an elective clinical skills course. RESULTS: Total surgery and incision closure times were not significantly different between students in the class of 2012 (no access to the OCSL prior to the third-year surgery course) and students in the class of 2013 (ie, access to 4 OCSL sessions during the spring semester prior to the third-year surgery course). However, times were significantly shorter for students in the class of 2014 (ie, students who had access to OCSL sessions during the 3 semesters prior to the third-year surgery course) than for students in the other 2 classes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that attendance in the OCSL sessions was associated with improvements in surgical performance, as reflected in faster total surgery and incision closure times while performing an ovariohysterectomy during the third-year surgery course.

Medical treatment of horses with deep digital flexor tendon injuries diagnosed with high-field-strength magnetic resonance imaging: 118 cases (2000-2010).

OBJECTIVE: To describe the location and severity of deep digital flexor tendon (DDFT) lesions diagnosed by means of high-field-strength MRI in horses and to identify variables associated with return to activity following medical treatment. DESIGN: Retrospective case series. ANIMALS: 118 horses. PROCEDURES: Medical records of horses with DDFT injury diagnosed with MRI over a 10-year period (2000-2010) and treated medically (intrasynovial administration of corticosteroids and sodium hyaluronan, rest and rehabilitation, or both) were reviewed. History, signalment, use, results of lameness examination and diagnostic local anesthesia, MRI findings, and treatment details were recorded. Outcome was obtained by telephone interview or follow-up examination. Horses were grouped by predictor variables and analyzed with logistic regression to identify significant effects. RESULTS: Overall, of 97 horses available for follow-up (median time to follow-up, 5 years; range, 1 to 12 years), 59 (61%) returned to activity for a mean duration of 22.6 months (median, 18 months; range, 3 to 72 months), with 25 (26%) still sound at follow-up. Of horses with mild, moderate, and severe injury, 21 of 29 (72%), 20 of 36 (56%), and 18 of 32 (56%), respectively, returned to use. Horses treated with intrasynovial corticosteroid injection and 6 months of rest and rehabilitation returned to use for a significantly longer duration than did horses treated without rest. Western performance horses returned to use for a significantly longer duration than did English performance horses. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study suggested that outcome for horses with DDFT injuries treated medically depended on injury severity, presence of concurrent injury to other structures in the foot, type of activity, and owner compliance with specific treatment recommendations. Although some horses successfully returned to prior activity, additional treatment options are needed to improve outcome in horses with severe injuries and to improve long-term prognosis.

Relative stiffness of 3 bandage/splint constructs for stabilization of equine midmetacarpal fractures.

OBJECTIVE: Determine the relative stiffness of 3 bandage/splint constructs intended for emergency fracture stabilization. DESIGN: Experimental model. A single plane free end deflection model was developed to simulate the forces placed on a bandage/splint construct during stabilization of a complete mid-metacarpal bone fracture. The total deflection of the model in one plane was measured following application of 3 different bandage/splint combinations including a classic, 3 layered Robert Jones Bandage (RJB) with a splint placed on the outside of the bandage (RJB-3), an RJB with splint placed after the first of 3 bandage layers (RJB-1), and a single layer full limb bandage with external splint (SS). Comparisons were made between the deflections of the model with each bandage/splint combinations in an effort to determine the most effective method for field fracture stabilization. SETTING: Laboratory. ANIMALS: No animals were utilized in data collection for this study. Two live horses were utilized during the pilot study. INTERVENTIONS: Application of bandage and splint to a model intended to simulate the bending force on a lower forelimb fracture in a horse MEASUREMENTS AND MAIN RESULTS: Deflection was determined by the difference between the height of the model's supported free end before application of a 4.5 kg weight and at the conclusion of the deflection test. There was no significant difference in the amount of deflection between bandage/splint combinations (78 ± 32 mm (RJB-1), 94 ± 44 mm (RJB-3), and 93 ± 33 mm (SS)) CONCLUSIONS: The one-layer bandage with splint was equivalent to either RJB configuration in the mean amount of deflection in the simple model of a fracture.

Integrating clinical communication with clinical reasoning and the broader medical curriculum.

OBJECTIVE: The objectives of this paper are to discuss the results of a workshop conducted at EACH 2012. Specifically, we will (1) examine the link between communication, clinical reasoning, and medical problem solving, (2) explore strategies for (a) integrating clinical reasoning, medical problem solving, and content from the broader curriculum into clinical communication teaching and (b) integrating communication into the broader curriculum, and (3) discuss benefits gained from such integration. METHODS: Salient features from the workshop were recorded and will be presented here, as well as a case example to illustrate important connections between clinical communication and clinical reasoning. RESULTS: Potential links between clinical communication, clinical reasoning, and medical problem solving as well as strategies to integrate clinical communication teaching and the broader curricula in human and veterinary medicine are enumerated. CONCLUSION: Participants expressed enthusiasm and keen interest in integration of clinical communication teaching and clinical reasoning during this workshop, came to the idea of the interdependence of these skills easily, and embraced the rationale immediately. PRACTICE IMPLICATIONS: Valuing the importance of communication as clinical skill and embracing the interdependence between communication and thought processes related to clinical reasoning and medical problem solving will be beneficial in teaching programs.

Telephone communication in emergency cases: a training program for veterinary students.

The purpose of this project was to evaluate the incorporation of a telephone communication exercise into the junior surgery laboratory at Washington State University. Subjectively, the communication component seemed to encourage greater student preparedness and participation or ownership of cases in the surgical laboratory. Simulated clients were asked to score students on specific tasks and give any specific feedback. Students evaluated themselves on identical material. Areas of communication most likely to result in disparity of scores between the client's evaluation and the student's self-assessment were related to the patient's aftercare. Student survey results were consistently positive in regard to the value of the telephone communications exercise. Communication training in the veterinary curriculum could benefit from identifying opportunities to further integrate client communication experiences into other courses or laboratory experiences.

Analgesic effects of butorphanol tartrate and phenylbutazone administered alone and in combination in young horses undergoing routine castration.

OBJECTIVE: To compare the analgesic efficacy of administration of butorphanol tartrate, phenylbutazone, or both drugs in combination in colts undergoing routine castration. DESIGN: Randomized controlled clinical trial. ANIMALS: 36 client-owned colts. PROCEDURES: Horses received treatment with butorphanol alone (0.05 mg/kg [0.023 mg/lb], IM, prior to surgery and then q 4 h for 24 hours), phenylbutazone alone (4.4 mg/kg [2.0 mg/lb], IV, prior to surgery and then 2.2 mg/kg [1.0 mg/lb], PO, q 12 h for 3 days), or butorphanol and phenylbutazone at the aforementioned dosages (12 horses/group). For single-drug-treated horses, appropriate placebos were administered to balance treatment protocols among groups. All horses were anesthetized, and lidocaine hydrochloride was injected into each testis. Physical and physiological variables, plasma cortisol concentration, body weight, and water consumption were assessed before and at intervals after surgery, and induction of and recovery from anesthesia were subjectively characterized. Observers assessed signs of pain by use of a visual analogue scale and a numerical rating scale. RESULTS: Significant changes in gastrointestinal sounds, fecal output, and plasma cortisol concentrations were evident in each treatment group over time, compared with preoperative values. At any time point, assessed variables and signs of pain did not differ significantly among groups, although the duration of recumbency after surgery was longest for the butorphanol-phenylbutazone-treated horses. CONCLUSIONS AND CLINICAL RELEVANCE: With intratesticular injections of lidocaine, administration of butorphanol to anesthetized young horses undergoing routine castration had the same apparent analgesic effect as phenylbutazone treatment. Combined butorphanolphenylbutazone treatment was not apparently superior to either drug used alone.

Comparison of endotracheal intubation techniques in llamas.

This study evaluated a retrograde orotracheal intubation technique and compared it to the traditional normograde intubation technique used in llamas. Oral anatomical features, which can impair visualization of the epiglottis and laryngeal structures, and the production of excessive salivary secretions make it difficult to establish an airway under emergency conditions. Normograde intubation involves placing a stylet through the mouth into the trachea and advancing the endotracheal tube over the stylet into the trachea. For retrograde intubation, a nested trochar with cannula is placed into the cervical trachea and a stylet is advanced through the cannula and out the mouth. The endotracheal tube is advanced over the stylet back into the trachea. Our evaluation of both techniques found no statistical difference in time to place the stylet or endotracheal tube; however, fewer attempts were needed to place the tube using the retrograde technique. We found the retrograde technique to be a viable option for intubating llamas.

A comparison of electroejaculation and epididymal sperm collection techniques in stallions.

The purpose of this study was to evaluate 2 methods of semen collection that could be used as terminal procedures in stallions with irreparable conditions, such as fractures or colic. Electroejaculation was attempted under general anesthesia. Forty-eight hours later, the ponies were castrated and 2 different epididymal sperm collection techniques were attempted by using a flushing or floating method. Additionally, the effect of supplemental seminal plasma was evaluated. Experimentally, electroejaculation was found to be a safe but ineffective method of terminal semen collection. Viable sperm cells were successfully recovered with both types of epididymal collection. The flotation method was least cumbersome and showed a tendency to be superior to flushing in terms of sperm motility and percentage of cells passing through glass wool/sephadex filtration, although differences did not reach significance. The addition of seminal plasma to epididymal spermatozoa prior to cryopreservation was of no value. In conclusion, either method of epididymal sperm collection is an acceptable method of terminal semen collection.