Specifications Grading for Veterinary Medicine.

Assigning grades in a traditional manner is often problematic: grades may or may not reflect actual student achievement, and students may base their self-worth on grades. Specifications (spec) grading claims to remedy these through a novel grading scheme. The scheme also purports to uphold high academic standards, reflect student learning, motivate students to focus on learning (rather than a grade), discourage cheating, reduce student stress, give students control over their grade, minimize conflict between students and faculty, save faculty time, make expectations clear, and facilitate higher-order learning. In spec grading, students must achieve 80% or higher to pass selected assignments, which include exams and quizzes, with the number and nature of assignments dictating the student's final letter grade for the course. Students may resubmit assignments until they pass. Implementing spec grading requires creating assignments, determining assignment bundles, and communicating the new scheme to students to set clear expectations. The purpose of this tip is to describe how to develop a course using spec grading for didactic and clinical applications.

Specifications Grading in a Cardiovascular Systems Course: Student and Course Coordinator Perspectives on the Impacts on Student Achievement.

This study investigated students' and a course coordinator's perceptions about specifications (spec) grading in a cardiovascular systems course and assessed its effects on student performance. Spec grading was hypothesized to result in lower perceived student stress about the course, improved student performance, and less work for the course coordinator. The study used a mixed methods approach consisting of student pre-, peri-, and post-course surveys; student focus group interviews; analysis of student course evaluations; and course coordinator reflection. Participants were from a cross-section of one course in the veterinary professional curriculum. Results demonstrated significantly more A grades assigned to students than in the previous year's course, where traditional grading was used (p = .024). The focus group produced two primary themes: pros and cons. Pros included flexibility, student control over grades, generally lower perceived stress, opportunities to resubmit assignments, and more motivation to learn. Cons included confusion about the process, some disorganization, perceived higher workload for the professor, and communication concerns. The course coordinator's positive perceptions included students being less combative about grades than with the traditional system, students appreciating opportunities to resubmit assignments, and students demonstrating improved learning outcomes. Negative course coordinator perceptions were that reduced student stress was inconsistently achieved and that there was increased time commitment compared with traditional grading. Course evaluation themes included skepticism about spec grading in the beginning, varying stress experiences, improved learning, and increased workload. In conclusion, spec grading variably reduced student stress and did not result in less work for the course coordinator.

Non-coagulopathic hemothorax in a dog: A case report.

An 8-year-old, female-spayed, Blue Heeler presented with suspected non-coagulopathic spontaneous, hemothorax with neoplasia as the most likely differential as coagulation parameters were normal and no obvious history of trauma was reported. Computed tomography scan was crucial for diagnosis of a traumatic partial vascular avulsion injury that was successfully managed supportively.

Development of a Formative Assessment Rubric for Peer Evaluation of Teaching (FARPET) and Pilot Use in Veterinary Online Teaching.

Peer evaluation of teaching (PET) serves an important role as a component of faculty development in the medical education field. With the emergence of COVID-19, the authors recognized the need for a flexible tool that could be used for a variety of lecture formats, including virtual instruction, and that could provide a framework for consistent and meaningful PET feedback. This teaching tip describes the creation and pilot use of a PET rubric, which includes six fixed core items (lesson structure, content organization, audiovisual facilitation, concept development, enthusiasm, and relevance) and items to be assessed separately for asynchronous lectures (cognitive engagement-asynchronous) and synchronous lectures (cognitive engagement-synchronous, discourse quality, collaborative learning, and check for understanding). The instrument packet comprises the rubric, instructions for use, definitions, and examples of each item, plus three training videos for users to compare with authors' consensus training scores; these serve as frame-of-reference training. The instrument was piloted among veterinary educators, and feedback was sought in a focus group setting. The instrument was well received, and training and use required a minimum time commitment. Inter-rater reliability within 1 Likert scale point (adjacent agreement) was assessed for each of the training videos, and consistency of scoring was demonstrated between focus group members using percent agreement (0.82, 0.85, 0.88) and between focus members and the authors' consensus training scores (all videos: 0.91). This instrument may serve as a helpful resource for institutions looking for a framework for PET. We intend to continually adjust the instrument in response to feedback from wider use.

Drug Calculations in Veterinary Medical Education-Where Are We?

Veterinary studies tracking medical errors and their underlying causes are lacking. In human health care, the importance of drug calculation errors in patient safety is well documented. As much as 25% of all medical errors in people are reportedly drug errors, and as much as 14% of those can be attributed to poor drug calculation skills among doctors and nurses. Assessment of the math and analytical skills needed to perform drug calculations accurately is not standardized in veterinary medical education, and there is potential for significant deficit. The purposes of this "Challenges and Issues" article are to briefly discuss the potential impact of poor drug calculation skills on veterinary patients; share one instructor's experience incorporating drug calculations into a veterinary curriculum; and promote further discussion and research that might yield more insight into the assessment and delivery of drug calculation education in veterinary medicine.

A 7-week-old male Golden Retriever with extreme leukocytosis: A case report.

Although neoplasia should be a top concern for extreme leukocytosis in dogs, infectious causes must also be considered to avoid delays in treatment or undue recommendations for humane euthanasia. Blood film review is of paramount importance.

Evaluation of Two Training Methods for Teaching the Abdominal Focused Assessment with Sonography for Trauma Technique (A-FAST) to First- and Second-Year Veterinary Students.

Ultrasound techniques, including focused assessment with sonography for trauma (FAST) examinations, are commonly used in veterinary practice, making inclusion of ultrasound in veterinary curricula increasingly important. The best approach for teaching ultrasound techniques in veterinary medicine has not been evaluated. This study compared the results of two training techniques, live-animal training and online video instruction, on students' performance during abdominal FAST (A-FAST) examinations. Thirty-eight first- and second-year veterinary students were randomly assigned to learn A-FAST via a live-animal laboratory or an instructional video. The live-animal group received one-on-one instruction in A-FAST techniques during a single laboratory. The video group received a link to an instructional video demonstrating A-FAST techniques, allowing unlimited viewing opportunities over a two-week period. Both groups were also provided written instructional information. All participants were assessed on their ability to find and correctly name the four A-FAST quadrants on a live animal. We found a significant difference between the two groups in the students' ability to identify the diaphragmatic-hepatic (DH) view, but for the other three views (hepatorenal, splenorenal, and cystocolic), training method did not affect performance. Results suggest the potential for using a multi-modal instructional approach to teach ultrasound techniques to veterinary students.

Comparison of Two Veterinary Emergency and Critical Care Clerkship Grading Protocols.

Universal guidelines for evaluating veterinary students' clinical clerkship performance are unavailable. At our institution, each service determines its own grading protocol. In this study, researchers compared clinician, staff, and student perceptions of a traditional and newly devised grading practice on the Emergency and Critical Care (ECC) clerkship. ECC clinicians and technicians were asked to assess the existing grading protocol for the clerkship. The system was then revised to better align with clerkship objectives. The revised protocol evaluated students on 12 items encompassing knowledge, clinical, and communication skills. Following the assignment of values for each category, letter grades were calculated automatically. Clinicians and staff were invited to rate the revised grading system. Throughout the study period, a corresponding survey was sent to students shortly after they had received their clerkship grades. Students' open-ended comments were analyzed qualitatively to identify common themes. Clinicians and technicians reported that the revised protocol was more inclusive and better able to provide fair and accurate assessments of students' performances. Students were generally satisfied with both grading protocols, however, in the open-ended comments students' frequently expressed desire for more directed and timely feedback on their performance. The results of this study indicate that the graders' believed that the revised evaluation protocol provides opportunities to provide fair and accurate assessments of student performance. Overall, students were satisfied with the new protocol and have a desire for tailored feedback provided in a timely fashion.

Thromboelastography in wild Florida manatees (Trichechus manatus latirostris).

BACKGROUND: Thromboelastography (TEG) provides a comprehensive evaluation of blood clot formation. This test can be used to identify abnormalities in coagulation by assessing multiple aspects of the clotting cascade, including the speed of clot initiation and formation, clot strength, and ultimately fibrinolysis. Thromboembolic disease has been hypothesized to play a role in the pathophysiology of cold stress syndrome (CSS), an important cause of mortality in the threatened Florida manatee (Trichechus manatus latirostris). OBJECTIVES: The objective of this study was to establish thromboelastography RIs using the TEG 5000 with citrated whole blood samples and kaolin activation in wild, healthy manatees. METHODS: In December 2014 and January 2015, 29 wild manatees (17 male and 12 female) were blood sampled as part of the annual wild manatee health assessments organized by United States Geological Survey (USGS). TEG was performed using citrated kaolin-activated samples. RESULTS: The samples were obtained from manatees caught in Crystal River, Citrus County, and used to identify the mean ± SD of normal TEG parameters: R = reaction time 2.1 minutes (0.8), K = clot formation time 0.8 min (0), α angle = 83.1° (2), MA = maximum amplitude 75 mm (7.6), and LY30 = clot lysis 0.41% (0.68). No significant differences were found between manatee size, sex, or time between sampling and running the test. CONCLUSIONS: Manatee TEG parameters demonstrate a relatively hypercoagulable condition when compared to other mammals. This information will facilitate detection of changes in hemostasis during injury and disease and provide a valuable reference range.

Identifying coagulopathies in the pathophysiology of cold stress syndrome in the Florida manatee Trichechus manatus latirostris.

Cold stress syndrome (CSS) in the Florida manatee Trichechus manatus latirostris has been defined as morbidity and mortality resulting from prolonged exposure to water temperatures <20°C. The pathophysiology is described as multifactorial, involving nutritional, immunological and metabolic disturbances; however, the exact mechanisms are unknown. We hypothesized that thromboembolic complications contribute to the pathophysiology of CSS in addition to the previously described factors. During the winter of 2014-2015, 10 Florida manatees with clinical signs of CSS were presented to Lowry Park Zoo, Tampa, FL, USA. Thromboelastography (TEG) and coagulation panels were performed at admission. In addition, coagulation panel data from 23 retrospective CSS cases were included in the analyses. There were numerous differences between mean values of TEG and coagulation parameters for healthy manatees and those for CSS cases. Among TEG parameters, reaction time (R), clot formation time (K) and percentage of clot lysed after 30 min (LY30) values were significantly different (p < 0.05) between the 2 groups. CSS cases also had significantly higher mean D-dimer concentration and coagulation factor XI activity, prolonged mean activated partial thromboplastin time (aPTT) and significantly decreased mean antithrombin activity. These combined abnormalities include clinicopathologic criteria of disseminated intravascular coagulation, indicating an increased risk of thromboembolic disease associated with manatee CSS.

Use of a non-invasive surgical skin closure device in dogs following dorsolateral hemilaminectomy.

The ZipLine 16 surgical skin closure device (ZipLine 16; Zipline Medical, Campbell, California, USA) provides noninvasive surgical wound closure. This prospective study investigated its use in dogs undergoing a dorsolateral hemilaminectomy. Although the device produced normal appositional healing compared with controls, unacceptable traumatic dermatitis that is likely related to the device adhesive was noted after removal.

Utilisation d'un dispositif chirurgical non invasif pour la fermeture de la peau chez les chiens après une hémilaminectomie dorsolatérale. Le dispositif chirurgical de fermeture de la peau ZipLine 16 (ZipLine 16; Zipline Medical, Campbell, Californie, États-Unis) permet de fermer une plaie chirurgicale de manière non invasive. Cette étude prospective a réalisé une enquête sur son utilisation chez les chiens subissant une hémilaminectomie dorsolatérale. Même si le dispositif a produit une guérison apositionnelle normale comparativement aux témoins, une dermatite traumatique inacceptable, qui est probablement associée à l'adhésif du dispositif, a été observée après l'enlèvement.(Traduit par Isabelle Vallières).

PROPOSAL AND APPLICATION OF A NOVEL DISSEMINATED INTRAVASCULAR COAGULATION SCORING SYSTEM IN THE FLORIDA MANATEE (TRICHECHUS MANATUS LATIROSTRIS).

Disseminated intravascular coagulopathy (DIC) is an acquired disorder of hemostasis resulting in activation of the coagulation and fibrinolytic pathways. It is reported secondarily to multiple disease processes and can be associated with increased mortality. Previous research at Tampa's Lowry Park Zoo (LPZ) demonstrated that Florida manatees ( Trichechus manatus latirostris) with cold stress syndrome (CSS) demonstrated thromboembolic disease. The object of this retrospective study was to establish the presence and clinical relevance of DIC in Florida manatees admitted to LPZ for rehabilitation from 07 March 2010 to 15 August 2015. A coagulation panel, including prothrombin time, partial thromboplastin time, platelet count, fibrinogen level, and D-dimer level was used to diagnose DIC. There were 100 cases identified in the study period: 35 trauma, 43 CSS, 17 secondary to harmful algae blooms (HAB), and five miscellaneous. Manatees with CSS had the highest incidence of DIC with 24 of 43 cases (56%) affected, followed by trauma with 18 of 35 cases (52%) affected. None of the manatees with HAB were found to have DIC. Manatees that developed DIC during rehabilitation or when DIC progressed did not survive. Due to the clinical implications of DIC, identifying its presence and recognizing its severity could improve clinical outcomes by enabling more intensive treatment protocols.

COAGULATION ASSESSMENT: UNDERUTILIZED DIAGNOSTIC TOOLS IN ZOO AND AQUATIC ANIMAL MEDICINE.

Veterinarians specializing in nondomestic species are faced with unique challenges regarding research and diagnostic capabilities given the wild and frequently dangerous nature of their patients. Standard diagnostic techniques used in small or large animal practice are not always possible due to anatomical constraints, size, tractability, or the inherent risk of anesthesia in highly valued, rare species. Diagnostic modalities that utilize simple, relatively noninvasive techniques show promise in evaluating nondomestic species and elucidating the pathophysiology behind poorly characterized disease processes in both wild and captive populations. Coagulation profiles, which may include prothrombin time (PT), partial thromboplastin time (PTT), D-dimer concentration, platelet count, and thromboelastography (TEG) are frequently used in domestic species but often overlooked in exotic medicine due to lack of normal reference values and/or availability. Whenever possible, coagulation profiles should be utilized in the evaluation of various disease processes including neoplasia, sepsis, trauma, inflammation, toxin exposure, and envenomation. There are several reports of coagulopathies in both wild and captive species; however, few studies on coagulation profiles have been published on nondomestic species. Clinicians should consider coagulation testing as part of the diagnostic work-up in nondomestic species. A review of available coagulation diagnostic tests is provided here in addition to summarizing the pertinent coagulation disorders currently established in the literature.

Treating Hypoalbuminemia.

Hypoalbuminemia is common and associated with a variety of disease processes, including those leading to systemic inflammatory response syndrome, gastrointestinal disorders, hepatic disorders, and glomerular diseases. Some animals develop clinical signs directly caused by low serum albumin concentration. There is strong evidence that hypoalbuminemia is associated with worse outcomes; however, evidence justifying albumin supplementation is lacking. Severe adverse events are frequently reported with administration of human serum albumin and there is little evidence of benefit from other products. Most patients will not require administration of albumin-containing products. Clinicians should consider early enteral nutritional supplementation in critically ill patients.

Normal Hemostatic Profiles and Coagulation Factors in Healthy Free-Living Florida Manatees ( Trichechus manatus latirostris).

Hemostatic disorders presumptively play an important role in the pathophysiology of several important disease conditions in the Florida manatee ( Trichechus manatus latirostris). Prior to pursuing such clinical implications, it is essential to establish normal hemostatic profiles in clinically healthy animals. During annual health assessments of free-living manatees organized by the US Geological Survey, blood samples were collected from 12 healthy animals from the Atlantic coast and 28 from the Gulf of Mexico coast of Florida, with body lengths of 210-324 cm. The following analyses were performed on citrated plasma: prothrombin (PT), partial thromboplastin time (PTT), and concentrations of fibrinogen, D-dimers, and coagulation factors VII, VIII, IX, X, XI, and XII. Compared to other mammalian species, manatees had short PT (9.2±1.5 s) and PTT (10.7±0.5 s), fibrinogen was 369±78.7 mg/dL, antithrombin III was 132±11%, and D-dimer was 142±122 ng/mL. Baseline concentrations for the listed coagulation factors were established. When comparing coagulation factors between locations, Atlantic coast manatees had significantly higher factors VIII, IX, and X than did Gulf Coast manatees. This finding may reflect differences in water salinity, diet, or genetics. There were no differences in coagulation factors when among sexes and sizes. These baselines for hemostatic profiles and coagulation factors in healthy free-living manatees lay the foundation for diagnosis and future research of hemostatic disorders and contribute to understanding their role in the pathophysiology of manatees affected by various diseases.

Comparison of Two Clinical Teaching Models for Veterinary Emergency and Critical Care Instruction.

Standards to oversee the implementation and assessment of clinical teaching of emergency and critical care for veterinary students do not exist. The purpose of this study was to assess differences in the learning environment between two veterinary emergency and critical care clinical rotations (one required, one elective) with respect to caseload, technical/procedural opportunities, direct faculty contact time, client communication opportunities, and students' perception of practice readiness. The authors designed a 22-item survey to assess differences in the learning environment between the two rotations. It was sent electronically to 35 third- and fourth-year veterinary medicine students. Bivariate analysis, including the Wilcoxon signed-rank test and the t-test, were used to compare differences between pre-test and post-test scores among students. Twenty-six students' responses were included from the required rotation and nine from the elective rotation. Findings showed that students preferred the elective community emergency department setting to the required academic setting and that there were statistically significantly more positive experiences related to the variables of interest. Students saw significantly more cases at the community emergency department setting. Findings from this study offer guidance to assess students' emergency department rotations, suggest how teaching interactions can be modified for optimal learning experiences, and ensure that students receive maximal opportunities to treat patients that are representative of what they would encounter in practice.

Establishment of reference values for various coagulation tests in healthy Florida manatees (Trichechus manatus latirostris) and evaluation of coagulation in debilitated manatees during rehabilitation.

OBJECTIVE: To establish reference ranges for coagulation parameters in healthy Florida manatees (Trichechus manatus latirostris) and compare results with those for debilitated manatees undergoing treatment at a rehabilitation facility. DESIGN: Prospective study. ANIMALS: 29 healthy manatees and 45 debilitated manatees with various diseases. PROCEDURES: Manatees considered healthy on the basis of results of physical examination, CBC, and serum biochemical analysis underwent coagulation testing including measurement of prothrombin time, partial thromboplastin time, D-dimer concentration, platelet count, and fibrinogen concentration to establish reference ranges. For comparison, a group of manatees undergoing rehabilitation was also tested, and the results were compared. Thromboelastography was also performed on some animals. RESULTS: Values for D-dimer concentration were significantly higher in debilitated versus healthy animals. There was no significant difference for prothrombin time, partial thromboplastin time, platelet count, or fibrinogen concentration between groups. Thromboelastography was performed on 8 healthy animals. CONCLUSIONS AND CLINICAL RELEVANCE: Reference ranges were established for various tests of coagulation that may assist clinicians during the initial evaluation and rehabilitation of Florida manatees. Future research to evaluate the effect of specific disease processes on the coagulation cascade is recommended.

Severe Pit Viper Envenomation with Extended Clinical Signs and Treatment Complications in a Dog.

This manuscript describes the extended clinical abnormalities that can occur in severe snake envenomation and the clinical signs associated with antivenom hypersensitivity in a 3 yr old dog. Treatment consisted of IV fluid therapy, analgesics, a vasopressor, cardiac antiarrhythmia drugs, and polyvalent pit viper antivenom. Following initial response to treatment, relapse of clinical signs occurred. Most interesting was the recrudescence of clinical signs on day 7 that may have been caused by the release of deposited venom during surgical debridement of necrotic skin. The resulting extensive clinical signs required multiple vials of antivenom (22 vials over a 7 day period). Both F(ab')2 antivenom and antivenin (Crotalidae) polyvalent were used in this dog because of availability logistics. It is thought that this large amount of antivenom resulted in type I (anaphylaxis) and type III hypersensitivity (serum sickness) reactions. The dog made a complete clinical recovery. This description of extended, fluctuating clinical abnormalities that were associated with envenomation together with the development of hypersensitivity reactions that were presumably secondary to antivenom administration is information that can be useful for the management of patients afflicted with severe pit viper envenomation.

Effects of dipyrone, meloxicam, or the combination on hemostasis in conscious dogs.

OBJECTIVE: To compare the effects of dipyrone, meloxicam, and of the combination of these drugs on hemostasis in dogs. DESIGN: Prospective, blinded, randomized crossover study. SETTING: Research laboratory at a veterinary teaching hospital. ANIMALS: Six adult dogs. INTERVENTIONS: Animals received 4 intravenous treatments with 15-day washout intervals: control (physiological saline, 0.1 mL/kg), meloxicam (0.2 mg/kg), dipyrone (25 mg/kg), and dipyrone-meloxicam (25 and 0.2 mg/kg, respectively). A jugular catheter was placed for drug injection and for collecting samples for whole blood platelet aggregation (WBPA) and thromboelastometry assays at baseline, 1, 2, 3, 5, and 8 hours after treatment administration. The percent change from baseline of lag time and of the area under the curve (AUC) of impedance changes in response to collagen-induced platelet activation were recorded during WBPA. Thromboelastometry-derived parameters included clotting time, clot formation time, alpha-angle, and maximum clot firmness. The buccal mucosal bleeding time was evaluated by a blinded observer at baseline, 1, 3, and 5 hours after treatment injection. MEASUREMENTS AND MAIN RESULTS: No significant changes in WBPA and thromboelastometry were recorded in the control treatment. Dipyrone significantly (P < 0.05) increased the lag time for 2 hours and decreased the AUC for 3 hours after injection. Meloxicam did not alter WBPA. Dipyrone-meloxicam significantly increased lag time for 2 hours and decreased the AUC for 5 hours after treatment injection. Experimental treatments did not differ from the control treatment for thromboelastometry and buccal mucosal bleeding time. CONCLUSIONS: While meloxicam does not alter hemostasis by the methods evaluated, dipyrone inhibits platelet aggregation for up to 3 hours. Meloxicam-dipyrone combination causes more prolonged inhibition of platelet function than dipyrone alone. Decreased platelet aggregation induced by dipyrone and dipyrone-meloxicam does not appear to impact the viscoelastic properties of the blood clot nor increase the risk of bleeding in dogs without preexisting hemostatic disorders.

Coagulation abnormalities in 5 cats with naturally occurring cytauxzoonosis.

OBJECTIVE: To characterize hemostasis and determine if disseminated intravascular coagulation (DIC) is present in cats with cytauxzoonosis. DESIGN: Cross-sectional study. SETTING: University teaching hospital. ANIMALS: Five client-owned cats with cytologic and PCR-confirmed cytauxzoonosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Admission samples were collected for hemostasis testing including platelet count, activated partial thromboplastin time, prothrombin time, fibrinogen, antithrombin (AT), d-dimer, protein C, plasminogen, antiplasmin, factors VII, VIII, IX, X, and XI, von Willebrand factor, and thromboelastography. Results were compiled for combined criteria used to define DIC, and all 5 cats satisfied criteria using a previously described modified scoring system for DIC in cats. The abnormalities found in all 5 cats included thrombocytopenia, low protein C activity, and prolonged prothrombin time; however, none of the cats had low AT activity. None of the cats had clinical signs of hemorrhage despite thrombocytopenia, coagulation factor deficiency (5/5 cats), and thromboelastographic evidence of hypocoagulability (2/5 cats). Three of 5 cats survived to hospital discharge. The nonsurvivors had disseminated cytauxzoonosis with schizont-laden macrophages in vessels of various organs. CONCLUSIONS: This is the first report that comprehensively describes the hemostastic status of cats with naturally occurring infection with Cytauxzoon felis. All 5 cats had laboratory evidence of overt DIC. Unlike human and canine models of sepsis-induced DIC, AT deficiency was not found in this series of cats. Further research is warranted to investigate therapeutic strategies targeting thrombotic DIC to improve survival in cats with cytauxzoonosis.