Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary-care emergency practice.

BACKGROUND: The paucity of published veterinary clinical audits suggests that clinical audit is an under-used tool for quality improvement (QI) in the veterinary profession. Therefore, a continuous QI process was designed and implemented at a UK multisite small animal emergency practice, focusing on audit of clinical management of canine dystocia. METHODS: Data collection phases were undertaken in 2014, 2019 and 2021, with intervening knowledge dissemination activities. Nine variables relating to clinical management of canine dystocia were selected as audit criteria in the initial dataset, and 21 variables were measured in each subsequent phase. RESULTS: Between 2014 and 2021, statistically significant increases (p < 0.05) were demonstrated in recording of bodyweight, use of diagnostic imaging, use of ultrasonography, recording of fetal heart rates, use of calcium gluconate, and use during caesarean section of intravenous fluid therapy, multimodal analgesia, full agonist opioids, paracetamol and local anaesthesia. Statistically significant decreases were demonstrated in median first quantity and median first dose of oxytocin, and in the use of NSAIDs during caesarean section. A clinical audit planning template was created for future audits. LIMITATIONS: Typical case presentation and management of canine dystocia cases may vary between dedicated emergency and non-emergency primary-care settings. CONCLUSION: This study demonstrates the feasibility of large-scale veterinary clinical audit and suggests that the application of the clinical audit process promotes learning within the veterinary team and improved clinical outcomes.

Bovine tuberculosis control in Fiji: Retrospective study findings for 2015 to 2020.

Control of bovine tuberculosis (bTB) is a priority for animal health, biosecurity, and human health authorities in Fiji as evident from the long-term funding of the Bovine Brucellosis and Tuberculosis Eradication and Control program (BTEC) and notable improvements to the program described in this paper. To evaluate the performance of the Fiji BTEC program from 2015 to 2020, all available bTB data for cattle were analyzed. Data sources included BTEC bTB testing records, abattoir records and laboratory records. We integrated all information to quantify the bTB tests applied, bTB positive farms and animals, meat inspection and laboratory findings. Test coverage was highest among dairy cattle in Central Division (~73%), where bTB was highly prevalent with 7.8% of dairy cattle and 61.7% of dairy farms found to be positive between 2015 and 2020. There was no visible downward trend in the apparent prevalence of bTB over the 6-year period. During 2019 and 2020, only 21.3% (51/239) of the tested dairy farms maintained their clear status, another 8.4% (20/239) reverted to infected status after 1 year or more of being bTB clear, and most farms remained infected during these 2 years. Factors observed to be contributing to this situation were persistent infections, related in part to the significant number of untested animals, uncontrolled animal movements, and larger farm size. Similar to other developing countries, bTB remains a serious concern and further strengthening of the program targeting the main contributors to bTB persistence, along with maintenance of a comprehensive reporting and traceability system, industry awareness and government support are needed. Control of bTB in Fiji is a long-term objective that must have multiple stakeholder engagement and regular review to measure success.

Mongoose (Herpestes auropunctatus) May Not Be Reservoir Hosts for Mycobacterium bovis in Fiji Despite High Population Density and Direct Contact with Cattle.

The presence of a wildlife reservoir for Mycobacterium bovis complicates the eradication of bovine tuberculosis (BTB) from domestic cattle populations. For the BTB eradication program in Fiji, there is concern about the small Indian mongoose (Herpestes auropunctatus), which is overabundant and in direct contact with cattle. Consequently, a survey of mongooses trapped on three BTB affected dairy farms led to necropsy of 85 mongooses during January-February 2017. Thirty (35%) mongooses had gross pathological changes including possible granulomas detected at necropsy, and tissues from these animals were taken for histopathological examination. Granulomatous lesions were present in 53% of animals examined histopathologically but acid-fast bacilli were not observed and the majority of lesions in lung and kidney were associated with the nematodes Pulmostrongylus herpestis and Capillaria sp., respectively. Nevertheless, assuming test sensitivity of 35% for the current study, from this sample of 85 mongooses it can be concluded with 95% confidence that if present in the mongoose population susceptible to trapping, M. bovis prevalence was ≤10%. The prevalence of intercurrent lesions raised concerns about gross pathology as a screening test for M. bovis infection in mongooses in Fiji, and therefore pathogen detection methods such as bacterial culture and direct tissue PCR are recommended for future surveys. These are needed to completely rule out the mongoose as a reservoir host for M. bovis in Fiji.

Comparison of computed radiography and multi-detector computed tomography in the detection of post mortem metacarpal index.

BACKGROUND: The sudden, unexpected death of young persons from ruptured thoracic aortic dissection is suggestive of Marfan syndrome (MFS), a genetic disorder of fibrillin. Establishing such a diagnosis is important so that the same fate might be avoided in living relatives. MFS diagnosis is difficult in the deceased but the presence of arachnodactyly, a common morphological feature of MFS, can be established by assessing the metacarpal index (MCI). MCI is routinely determined using radiographic techniques including computed radiography (CR). The wider availability of computed tomography (CT) in the forensic environment provides an alternative method. CT is predicted to produce measurements at least as accurate as CR. The aims of this study therefore were to (1) validate MCI measurements by comparing CT and CR with direct measurement using calipers on human skeletonised hands, and (2) compare cadaveric CT and CR MCI measurements. METHODS: The metacarpals of 12 human skeleton hands were measured using CT and CR, and compared with direct measurement using calipers (the "gold standard"). Fifty randomly selected cadavers between 20 and 40 years had the MCI of both hands measured using CT and CR. RESULTS: CT was found to be more accurate in the measurement of MCI than CR. There were significant differences in the MCIs obtained for CT and CR (females: p=0.01; males: p<0.0001) and between CR and calipers (p=0.004). There were no significant differences between MCIs obtained for CT and calipers (p=0.71). CR was found to consistently overestimate the MCI by an average of 7.97%. CONCLUSION: CT is more accurate in determination of the MCI than CR and should provide the basis for future skeletal measurements.