The Dolittle factor: 'Talking to the animals' during veterinary consultations.

BACKGROUND: The aim of the study was to identify and analyse the frequency and types of dialogue directed to animals by veterinary surgeons (i.e. pet-directed speech) in 55 routine companion animal consultations in the United Kingdom and United States. METHODS: Instances of pet-directed speech were identified from video transcripts, coded, and analysed for content. RESULTS: All consultations included pet-directed speech, with 779 instances in total, 284 in the United Kingdom and 495 in the United States. There were 12 unique dialogue codes identified, the top three being 'praise,' 'small talk,' and 'explanation'. CONCLUSION: This study identified a wide variety of communication directed to the animal, which, combined with further research, could help enhance understanding of rapport built between the veterinary surgeon, animal, and owner during a consultation.

Preliminary assessment of a tool for measuring relationship-centred communication in veterinary consultations (adapted VR-COPE).

This article was migrated. The article was marked as recommended. Relationship-centred communication is considered a desirable goal in veterinary medicine, and a number of different tools have been developed to measure relationship-centred communication. This study was designed as an initial assessment of an adapted version of the Verona Patient-centred Communication Evaluation (VR-COPE) scale, originally developed for medical communication research, to evaluate its potential for measuring relationship-centredness in veterinary consultations. Fifty-five consultations in the United Kingdom and United States of America were videotaped and analysed. The median VR-COPE total score (out of a potential 100 points) was 76.00 for all consultations. The highest overall score was for "Structuring" (of the consultation), whereas the lowest scores were for "Client Worries," "Psychological Impact," and "Empathy." This initial assessment of the adapted VR-COPE suggests it may be helpful in measuring content, process, and structuring skills related to relationship-centredness in veterinary consultations. It may also help uncover aspects of relationship-centredness that are unique from those uncovered by other tools. Further research is needed to fully assess the role of VR-COPE in veterinary communication research and the contributions it can make to relationship-centredness in veterinary consultations.

Implications of a Novel Method for Analyzing Communication in Routine Veterinary Patient Visits for Veterinary Research and Training.

The patient-centered clinical method (PCCM), a model developed to characterize communication during patient-physician visits in the 1980s, identifies elements of patient-orientated, physician-orientated, and shared dialogue during the encounter. The model also includes elements that reflect the emotional aspects of these interactions, recognizing expressions of feelings and exchanges related to both personal and medical interests. Fifty-five routine veterinary patient visits in the United Kingdom and United States were analyzed using the novel application of a PCCM adapted for veterinary patient visits. The patient visits were video recorded, transcribed, coded, and analyzed for frequency and proportion of PCCM elements observed. Elements representing the greatest proportion of patient visits were related to gathering information and shared decision making. Those representing the smallest proportion were related to signs of the presenting condition and effects of the condition on the clients' lives. Dialogue during the patient visits flowed iteratively and back and forth between the veterinarian and the client perspective. The findings suggest that patient visits are focused more on gathering information and planning rather than exploring effects of the health problem on the client's life, and that patient visits flow very iteratively and randomly between veterinarian and client perspectives. Both of these topics should be studied further and given emphasis in the way that communication models are developed and taught in order to enhance client-centeredness in veterinary patient visits.

Idiopathic Myocardial Fibrosis in Captive Chimpanzees (Pan troglodytes).

Cardiovascular disorders and predominantly idiopathic myocardial fibrosis are frequently associated with mortality among zoo-housed chimpanzees (Pan troglodytes). Formalin-fixed whole hearts of deceased chimpanzees housed in zoos (n = 33) and an African sanctuary (n = 2) underwent detailed macroscopic and histopathologic examination using a standardized protocol. Archived histological slides from the hearts of 23 additional African sanctuary-housed chimpanzees were also examined. Myocardial fibrosis (MF) was identified in 30 of 33 (91%) of the zoo-housed chimpanzees but none of the 25 sanctuary-housed chimpanzees. MF was shown to be characterized by both interstitial and replacement fibrosis. Immunophenotyping demonstrated that the fibrotic lesions were accompanied by the increased presence of macrophages, alpha smooth muscle actin-positive myofibroblasts, and a minimal to mild T-cell-dominant leukocyte infiltration. There was no convincing evidence of cardiotropic viral infection or suggestion that diabetes mellitus or vitamin E or selenium deficiency were associated with the presence of the lesion. However, serum vitamin D concentrations among zoo-housed chimpanzees were found to be lower in seasons of low ultraviolet light levels.

Pilot study evaluating the monitoring of canine diabetes mellitus in primary care practice.

OBJECTIVES: This study aimed to describe how canine diabetes mellitus (CDM) is monitored in primary care practice (PCP) and to report outcomes. DESIGN: Retrospective case review. SETTING: PCP. PARTICIPANTS: 40 dogs of 22 different pedigrees and five crossbreeds. Median age at diagnosis was nine years and six months (eight years six months to 10 years five months). Dogs were diagnosed with CDM between January 1, 2008 and December 30, 2012 and remained with the practice to the study end or until death. PRIMARY AND SECONDARY OUTCOME MEASURES: Stability achievement and death or euthanasia. Consultations for each dog were identified and recorded through records collected from the PCP (January 1, 2008 to December 30, 2012). RESULTS: A median of three consultations per dog occurred in the first month, subsequently falling to a median of one consultation every 19 days thereafter. After the first month postdiagnosis, weight and single blood glucose concentrations were most frequently recorded at 66.8 and 42 per cent of consultations respectively and a blood glucose curve was performed infrequently (17.4 per cent). Serum biochemistry was measured at 8 per cent of consultations and urine culture at only 0.8 per cent. Median survival time (MST) for all dogs was eight months (2-21 months). Eighteen dogs stabilised within three months of diagnosis and their MST was 20.5 months, (10.25-25.75 months), significantly longer than the 22 dogs not achieving stability within three months (MST 2.5 months, 0-5.5 months) (P<0.001). Those dogs not surviving beyond the first month had significantly fewer consultations than those still alive (P<0.005). CONCLUSIONS: This pilot study indicates dogs with CDM managed solely in PCP experience limited monitoring tests and have lower MST than reported in the literature. Recruitment of a larger cohort of CDM cases from a larger number of PCP will help determine whether these results accurately represent this demographic and verify if infrequent testing is associated with a poor outcome. Importantly, prospective evaluation of decision-making around monitoring CDM in PCP is required, to help determine the effectiveness and feasibility of more frequent monitoring strategies, such as those recommended by the American Animal Hospital Association, particularly to influence MST.

Validation of text-mining and content analysis techniques using data collected from veterinary practice management software systems in the UK.

Electronic patient records from practice management software systems have been used extensively in medicine for the investigation of clinical problems leading to the creation of decision support frameworks. To date, technologies that have been utilised for this purpose such as text mining and content analysis have not been employed significantly in veterinary medicine. The aim of this research was to pilot the use of content analysis and text-mining software for the synthesis and analysis of information extracted from veterinary electronic patient records. The purpose of the work was to be able to validate this approach for future employment across a number of practices for the purposes of practice based research. The approach utilised content analysis (Prosuite) and text mining (WordStat) software to aggregate the extracted text. Text mining tools such as Keyword in Context (KWIC) and Keyword Retrieval (KR) were employed to identify specific occurrences of data across the records. Two different datasets were interrogated, a bespoke test dataset that had been set up specifically for the purpose of the research, and a functioning veterinary clinic dataset that had been extracted from one veterinary practice. Across both datasets, the KWIC analysis was found to have a high level of accuracy with the search resulting in a sensitivity of between 85.3-100%, a specificity of between 99.1-99.7%, a positive predictive value between 93.5-95.8% and a negative predictive value between 97.7-100%. The KR search, based on machine learning, was utilised for the clinic-based dataset and was found to perform slightly better than the KWIC analysis. This study is the first to demonstrate the application of content analysis and text mining software for validation purposes across a number of different datasets for the purpose of search and recall of specific information across electronic patient records. This has not been demonstrated previously for small animal veterinary epidemiological research for the purposes of large scale analysis for practice-based research. Extension of this work to investigate more complex diseases across larger populations is required to fully explore the use of this approach in veterinary practice.

Student Perceptions of Veterinary Anatomy Practical Classes: A Longitudinal Study.

Using cadaveric material to teach veterinary students poses many challenges. However, little research exists on the contribution of this traditional approach to student learning. This longitudinal study aimed to investigate student perceptions of cadaver-based anatomy classes in a vertically integrated veterinary curriculum at the University of Nottingham's School of Veterinary Medicine and Science. Likert-scale statements and free-text boxes were used in a questionnaire distributed to second-year veterinary students (response rate 59%, 61/103). The same questionnaire was subsequently distributed to the same cohort 2 years later, in the students' fourth year of study (response rate 68%, 67/98). Students agreed that cadaver-based activities aid their learning, and they particularly value opportunities to develop practical skills while learning anatomy. There are few changes in perception as undergraduates progress to clinical years of teaching. Students perceive anatomy to be important, and feel that their learning has prepared them for clinical placements. This study emphasizes the importance of using cadaveric materials effectively in anatomy teaching and, in particular, using clinical skills training to enhance the anatomy curriculum.

The SEISICAT study: a pilot study assessing efficacy and safety of spironolactone in cats with congestive heart failure secondary to cardiomyopathy.

INTRODUCTION: The pathophysiology of heart failure involves activation of several neurohormonal systems including the renin-angiotensin-aldosterone system. The mineralocorticoid receptor antagonist spironolactone has been shown to be beneficial in humans and dogs with heart failure. The objective of this pilot study was to investigate the efficacy and safety of spironolactone in cats with heart failure secondary to cardiomyopathy already treated with furosemide and an angiotensin-converting enzyme inhibitor. ANIMALS: Twenty cats with heart failure due to cardiomyopathy. METHODS: The study was a double-blind, randomised, placebo-controlled, multicentre clinical study assessing the effect of spironolactone on survival and clinical parameters in cats with heart failure due to cardiomyopathy. The primary end point was mortality, defined as death (spontaneous or by euthanasia) due to cardiac causes. RESULTS: Twenty cats were enrolled: 9 in the spironolactone group and 11 in the placebo group of which 56% (5/9) and 0% (0/11) completed the 15-month period respectively. At inclusion, differences in systemic blood pressure, body condition score, electrocardiographic abnormalities and LA/Ao ratio suggested that disease may be less severe in the spironolactone group. Twenty-two percent (2/9) of cats in the spironolactone group and 82% (9/11) in the control group reached the primary end point (Fisher's exact test, p = 0.0216). No safety issues were identified in either group. CONCLUSIONS: This study suggests that spironolactone is well tolerated, and preliminary results support further investigation to evaluate the efficacy of spironolactone in the treatment of cats with cardiac failure due to cardiomyopathy.

Student Perceptions of Veterinary Anatomy Practical Classes: A Longitudinal Study.

Using cadaveric material to teach veterinary students poses many challenges. However, little research exists on the contribution of this traditional approach to student learning. This longitudinal study aimed to investigate student perceptions of cadaver-based anatomy classes in a vertically integrated veterinary curriculum at the University of Nottingham's School of Veterinary Medicine and Science. Likert-scale statements and free-text boxes were used in a questionnaire distributed to second-year veterinary students (response rate 59%, 61/103). The same questionnaire was subsequently distributed to the same cohort 2 years later, in the students' fourth year of study (response rate 68%, 67/98). Students agreed that cadaver-based activities aid their learning, and they particularly value opportunities to develop practical skills while learning anatomy. There are few changes in perception as undergraduates progress to clinical years of teaching. Students perceive anatomy to be important, and feel that their learning has prepared them for clinical placements. This study emphasizes the importance of using cadaveric materials effectively in anatomy teaching and, in particular, using clinical skills training to enhance the anatomy curriculum.

A RETROSPECTIVE REVIEW OF WESTERN LOWLAND GORILLA (GORILLA GORILLA GORILLA) MORTALITY IN EUROPEAN ZOOLOGIC COLLECTIONS BETWEEN 2004 AND 2014.

An understanding of the main causes of mortality among captive gorillas is imperative to promoting their optimal care, health, and welfare. A retrospective observational review of mortality among the European zoo-housed western lowland gorilla ( Gorilla gorilla gorilla) population from 2004 to 2014 was carried out. This is the first published study of mortality in this population. Relevant postmortem data were requested from each collection reporting a death during the study period. Age at death enabled grouping into discrete age categories. Deaths were classified according to cause. The main causes of death overall and for each age category and sex were identified. In total, 151 gorillas from 50 European collections died during the study period. Postmortem data were available for 119 (79%) of the deaths, of which 102 (86%) were classified by cause. Diseases of the digestive system were responsible for most (23%) deaths overall. Also of significance (each accounting for 15% overall mortality) were deaths due to external causes (especially trauma) among young gorillas and cardiovascular disease among adult and aged animals. Being a male gorilla was associated with an 8.77- and 5.40-fold increase in risk of death due to cardiovascular and respiratory disease, respectively. Death due to external causes was 4.45 times more likely among females than males. There was no statistically significant difference in life expectancy between male and female gorillas. The authors conclude that further work is needed to understand risk factors involved in the main causes of death and suggest a need for standardization with regard the approach to postmortem examination and data collection, sample collection, and storage across European zoos.

Accuracy of the electronic patient record in a first opinion veterinary practice.

The use of electronic patient records (EPRs) in veterinary research is becoming more common place. To date no-one has investigated how accurately and completely they represent the clinical interactions that happen between veterinary professionals, and their clients and patients. The aim of this study was to compare data extracted from consultations within EPRs with data gathered by direct observation of the same consultation. A secondary aim was to establish the inter-rater reliability of two researchers who examined the data extracted from the EPRs. A convenience sample of 36 small animal consultations undertaken by 2 veterinary surgeons (83% by one veterinary surgeon) at a mixed veterinary practice in the United Kingdom was studied. All 36 consultations were observed by a single researcher using a standardised data collection tool. The information recorded in the EPRs was extracted from the Practice Management Software (PMS) systems using a validated XML schema. The XML extracted data was then converted into the same format as the observed data by two independent researchers who examined the extracted information and recorded their findings using the same tool as for the observation. The issues discussed and any action taken relating to those problems recorded in the observed and extracted datasets were then compared. In addition the inter-rater reliability of the two researchers who examined the extracted data was assessed. Only 64.4% of the observed problems discussed during the consultations were recorded in the EPR. The type of problem, who raised the problem and at what point in the consultation the problem was raised significantly affected whether the problem was recorded or not in the EPR. Only 58.3% of observed actions taken during the consultations were recorded in the EPR and the type of action significantly affected whether it would be recorded or not. There was moderate agreement between the two researchers who examined the extracted data. This is the first study that examines how much of the activity that occurs in small animal consultations is recorded in the EPR. Understanding the completeness, reliability and validity of EPRs is vital if they are to continue to be used for clinical research and the results to direct clinical care.

A SYSTEMATIC REVIEW OF THE LITERATURE RELATING TO CAPTIVE GREAT APE MORBIDITY AND MORTALITY.

Wild bonobos (Pan paniscus), chimpanzees (Pan troglodytes), Western gorillas (Gorilla gorilla), and orangutans (Pongo pygmaeus, Pongo abelii) are threatened with extinction. In order to help maintain a self-sustaining zoo population, clinicians require a sound understanding of the diseases with which they might be presented. To provide an up-to-date perspective on great ape morbidity and mortality, a systematic review of the zoological and veterinary literature of great apes from 1990 to 2014 was conducted. This is the first review of the great ape literature published since 1990 and the first-ever systematic literature review of great ape morbidity and mortality. The following databases were searched for relevant articles: CAB Abstracts, Web of Science Core Collection, BIOSIS Citation Index, BIOSIS Previews, Current Contents Connect, Data Citation Index, Derwent Innovations Index, MEDLINE, SciELO Citation Index, and Zoological Record. A total of 189 articles reporting on the causes of morbidity and mortality among captive great apes were selected and divided into comparative morbidity-mortality studies and case reports-series or single-disease prevalence studies. The content and main findings of the morbidity-mortality studies were reviewed and the main limitations identified. The case reports-case series and single-disease prevalence studies were categorized and coded according to taxa, etiology, and body system. Subsequent analysis allowed the amount of literature coverage afforded to each category to be calculated and the main diseases and disorders reported within the literature to be identified. This review concludes that reports of idiopathic and infectious diseases along with disorders of the cardiovascular, respiratory, and gastrointestinal body systems were particularly prominent within the great ape literature during 1990-2014. However, recent and accurate prevalence figures are lacking and there are flaws in those reviews that do exist. There is therefore a critical need for a robust, widespread, and more up-to-date review of mortality among captive great apes.

A method for extracting electronic patient record data from practice management software systems used in veterinary practice.

BACKGROUND: Data extracted from electronic patient records (EPRs) within practice management software systems are increasingly used in veterinary research. The use of real patient data gives the potential to generate research that can readily be applied to clinical practice. The use of veterinary EPRs for research in the United Kingdom is hindered by the number of different Practice Management System (PMS) providers used by practices, as obtaining and combining data from different systems electronically can be problematic. The use of extensible mark up language (XML) to extract clinical data for research would potentially resolve the compatibility issues between systems. The aim of this study was to establish and validate a method for the extraction of small animal patient records from a veterinary PMS that could potentially be used across multiple systems. An XML schema was designed to extract clinical information from EPRs. The schema was tested and validated in a test system, and was then tested in a real small animal practice where data was extracted for 16 weeks. A 10 % sample of the extracted records was then compared to paper copies provided by the practice. RESULTS: All 21 fields encoded by the XML schema, from all of the records in the test system, were extracted with 100 % accuracy. Over the 18 week data collection period 4946 records, from 1279 patients, were extracted from the small animal practice. The 10 % printed records checked and compared with the XML extracted records demonstrated all required data was present. No unrequired, sensitive information e.g. costs or services/products or personal client information was extracted. CONCLUSIONS: This is the first time a method for data extraction from EPRs in veterinary practice using an XML schema has been reported in the United Kingdom. This is an efficient and accurate way of extracting data which could be applied to all PMSs nationally and internationally.

Multiple Genetic Associations with Irish Wolfhound Dilated Cardiomyopathy.

Cardiac disease is a leading cause of morbidity and mortality in dogs and humans, with dilated cardiomyopathy being a large contributor to this. The Irish Wolfhound (IWH) is one of the most commonly affected breeds and one of the few breeds with genetic loci associated with the disease. Mutations in more than 50 genes are associated with human dilated cardiomyopathy (DCM), yet very few are also associated with canine DCM. Furthermore, none of the identified canine loci explain many cases of the disease and previous work has indicated that genotypes at multiple loci may act together to influence disease development. In this study, loci previously associated with DCM in IWH were tested for associations in a new cohort both individually and in combination. We have identified loci significantly associated with the disease individually, but no genotypes individually or in pairs conferred a significantly greater risk of developing DCM than the population risk. However combining three loci together did result in the identification of a genotype which conferred a greater risk of disease than the overall population risk. This study suggests multiple rather than individual genetic factors, cooperating to influence DCM risk in IWH.

Genetics of Human and Canine Dilated Cardiomyopathy.

Cardiovascular disease is a leading cause of death in both humans and dogs. Dilated cardiomyopathy (DCM) accounts for a large number of these cases, reported to be the third most common form of cardiac disease in humans and the second most common in dogs. In human studies of DCM there are more than 50 genetic loci associated with the disease. Despite canine DCM having similar disease progression to human DCM studies into the genetic basis of canine DCM lag far behind those of human DCM. In this review the aetiology, epidemiology, and clinical characteristics of canine DCM are examined, along with highlighting possible different subtypes of canine DCM and their potential relevance to human DCM. Finally the current position of genetic research into canine and human DCM, including the genetic loci, is identified and the reasons many studies may have failed to find a genetic association with canine DCM are reviewed.

Veterinarian-Client Communication Skills: Current State, Relevance, and Opportunities for Improvement.

Communication is increasingly recognized as a core skill for veterinary practitioners, and in recent years, attention to communication competency and skills training has increased. To gain an up-to-date assessment of the current state of veterinary communication skills and training, we conducted a survey among veterinary practitioners in the United Kingdom and United States in 2012/2013. The questionnaire was used to assess the current state, relevance, and adequacy of veterinary communication skills among veterinary practitioners, to assess interest in further training, and to understand perceived challenges in communicating with clients. There was an overall response rate of 29.6% (1,774 of 6,000 recipients), with a higher response rate for UK-based practitioners (39.7%) than practitioners in the US (19.5%). Ninety-eight percent of respondents agreed that communication skills were as important as or more important than clinical knowledge. Forty-one percent of respondents had received formal veterinary communication skills training during veterinary school, and 47% had received training post-graduation. Thirty-five percent said their veterinary communication skills training during veterinary school prepared them well or very well for communicating with clients about the health of their pets, compared to 61% of those receiving post-graduate training. Forty percent said they would be interested in further veterinary communication skills training, with the preferred methods being simulated consultations and online training. While there has been increased emphasis on communication skills training during and after veterinary school, there is a need for more relevant and accessible training.

Agreement between veterinary patient data collected from different sources.

Determining the accuracy of the electronic medical record (EMR) is vital to the progress of practice-based research. The aim of this study was to determine the agreement between the EMR and other sources of signalment data. Data were gathered during direct observation of small animal consultations in eight veterinary practices. Breed, age, sex and neuter status were recorded, where available, from the EMR, owner and observer and then compared for agreement. Agreement was 'almost perfect' or 'strong' for 18/28 comparisons, although there was variation between the species. The results have implications for researchers collecting data from the EMR of first opinion practices. Future work could focus on the accuracy of other data obtained from the EMR.

A predictive model for canine dilated cardiomyopathy-a meta-analysis of Doberman Pinscher data.

Dilated cardiomyopathy is a prevalent and often fatal disease in humans and dogs. Indeed dilated cardiomyopathy is the third most common form of cardiac disease in humans, reported to affect approximately 36 individuals per 100,000 individuals. In dogs, dilated cardiomyopathy is the second most common cardiac disease and is most prevalent in the Irish Wolfhound, Doberman Pinscher and Newfoundland breeds. Dilated cardiomyopathy is characterised by ventricular chamber enlargement and systolic dysfunction which often leads to congestive heart failure. Although multiple human loci have been implicated in the pathogenesis of dilated cardiomyopathy, the identified variants are typically associated with rare monogenic forms of dilated cardiomyopathy. The potential for multigenic interactions contributing to human dilated cardiomyopathy remains poorly understood. Consistent with this, several known human dilated cardiomyopathy loci have been excluded as common causes of canine dilated cardiomyopathy, although canine dilated cardiomyopathy resembles the human disease functionally. This suggests additional genetic factors contribute to the dilated cardiomyopathy phenotype.This study represents a meta-analysis of available canine dilated cardiomyopathy genetic datasets with the goal of determining potential multigenic interactions relating the sex chromosome genotype (XX vs. XY) with known dilated cardiomyopathy associated loci on chromosome 5 and the PDK4 gene in the incidence and progression of dilated cardiomyopathy. The results show an interaction between known canine dilated cardiomyopathy loci and an unknown X-linked locus. Our study is the first to test a multigenic contribution to dilated cardiomyopathy and suggest a genetic basis for the known sex-disparity in dilated cardiomyopathy outcomes.