A narrative review of occupational scheduling that impacts fatigue and recovery relevant to veterinarian well-being.

Background: Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor. Objectives and procedures: This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors. Results: Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians. Conclusion and clinical relevance: Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.

Un examen narratif des horaires de travail qui ont un impact sur la fatigue et la récupération en rapport avec le bien-être des vétérinaires. Mise en contexte: L'insuffisance de sommeil est une affection mondiale avec de graves implications pour la santé mentale et physique. Les facteurs liés à l'emploi jouent un rôle important dans la détermination des habitudes de sommeil. Les travailleurs de la santé sont particulièrement sensibles à l'insuffisance de sommeil liée au travail et au repos inadéquat en général. Il y a peu de publications sur les pratiques de sommeil chez les vétérinaires, et la reconnaissance globale des impacts d'un repos inadéquat au sein de la profession vétérinaire est faible. Objectifs et procédures: Cette revue décrit les facteurs professionnels affectant la quantité suffisante de repos et de la récupération, passe en revue la littérature spécifique aux vétérinaires ainsi que celle adjacente pertinente concernant les habitudes de sommeil, et discute des solutions potentielles pour traiter les horaires professionnels contribuant à l'insuffisance de sommeil et au repos inadéquat. Des bases de données en ligne ont été consultées pour extraire la littérature contemporaine relative au sommeil, au repos insuffisant et aux facteurs liés à l'emploi, en mettant l'accent sur la médecine vétérinaire et d'autres secteurs de la santé. Résultats: Les facteurs liés à l'emploi entraînant un repos insuffisant chez les travailleurs de la santé comprennent les charges de travail excessives, les journées de travail prolongées, les jours cumulés d'heures de travail pénibles et les gardes après les heures normales de travail. Ces facteurs sont répandus au sein de la profession vétérinaire et peuvent contribuer à un repos insuffisant généralisé et aux impacts négatifs qui en résultent sur la santé et le bien-être des vétérinaires. Conclusion et pertinence clinique: Une quantité et une qualité de sommeil suffisantes sont essentielles à la santé physique et mentale et sont négativement affectées par de nombreux aspects de la profession vétérinaire. L'examen critique des stratégies actuelles utilisées dans la pratique clinique est essentiel pour promouvoir l'épanouissement professionnel, la santé et le bien-être des vétérinaires.(Traduit par Dr Serge Messier).

Veterinarian burnout demographics and organizational impacts: a narrative review.

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors.

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

A narrative review of the pathophysiology and impacts of insufficient and disrupted sleep.

Background: Despite substantial ramifications of insufficient sleep on mental and physical health and general well-being, many individuals are unaware of what constitutes sufficient sleep, or of the short- and long-term extent of sleep deficiency effects, including those that may not be perceived as fatigue. Objectives and procedures: This review describes the physiology of sleep, defines healthy standards, reviews the pathophysiology and health hazards of acute and chronic sleep insufficiency, and offers concepts for improving individual sleep hygiene. Online databases were searched to extract literature pertaining to sleep, sleep insufficiency, fatigue, and health, with emphasis on literature published in the preceding 5 years. Results: The detrimental effects of acute and chronic sleep loss vary in their range and impact. Individuals often obtain a substandard quantity of sleep, a problem that is poorly recognized by individuals and society. This lack of recognition perpetuates a culture in which sleep insufficiency is accepted, resulting in serious and substantial negative impacts on mental and physical health. Conclusion and clinical relevance: Sleep management is one of the most fundamental and changeable aspects of personal health. Improving awareness of the important physiological roles of sleep, healthy sleep habits, and the consequence of insufficient sleep is essential in promoting general well-being and mental and physical health.

Un examen narratif de la physiopathologie et des impacts d'un sommeil insuffisant et perturbé. Contexte: Malgré les ramifications importantes d'un manque de sommeil sur la santé mentale et physique et le bien-être général, de nombreuses personnes ignorent ce qui constitue un sommeil suffisant ou l'étendue à court et à long terme des effets du manque de sommeil, y compris ceux qui peuvent ne pas être perçus comme de la fatigue. Objectifs et procédures: Cette revue décrit la physiologie du sommeil, définit des normes de santé, passe en revue la physiopathologie et les risques pour la santé de l'insuffisance de sommeil aiguë et chronique et propose des concepts pour améliorer l'hygiène individuelle du sommeil. Des bases de données en ligne ont été consultées pour extraire la littérature relative au sommeil, à l'insuffisance de sommeil, à la fatigue et à la santé, en mettant l'accent sur la littérature publiée au cours des 5 années précédentes. Résultats: Les effets néfastes de la perte de sommeil aiguë et chronique varient dans leur portée et leur impact. Les individus obtiennent souvent une quantité de sommeil inférieure aux normes, un problème mal reconnu par les individus et la société. Ce manque de reconnaissance perpétue une culture dans laquelle l'insuffisance de sommeil est acceptée, entraînant des impacts négatifs graves et substantiels sur la santé mentale et physique. Conclusion et pertinence clinique: La gestion du sommeil est l'un des aspects les plus fondamentaux et les plus imprévisibles de la santé personnelle. Améliorer la prise de conscience des rôles physiologiques importants du sommeil, des habitudes de sommeil saines et des conséquences d'un sommeil insuffisant est essentiel pour promouvoir le bien-être général et la santé mentale et physique.(Traduit par Dr Serge Messier).

A narrative review of the impact of work hours and insufficient rest on job performance.

OBJECTIVE: This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN: Narrative review. METHODS: Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS: Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION: Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT): A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

Muscle regeneration through therapy with estromal stem cells in injury of infraespinhosus muscle of sheep.

PURPOSE: To evaluate the effects of rotator cuff muscle regeneration in sheep and establish an experimental model for the use of autologous stem cells as a treatment option for tendon injuries. METHODS: Infrared muscle tenotomies and Penrose drain implantation were performed on 12 shoulders of six clinically healthy adult sheep. After 60 days, the tendons were submitted to tissue repair, drainage removal, and divided into two groups according to the use of autologous stromal stem cells for treatment. Muscle regeneration was performed by biopsy on days 14 and 34 after repair. RESULTS: The treatment group with cell therapy showed neovascularization and expressive regeneration. Complete regeneration of the muscle pattern did not occur in any sample although some muscle gain was obtained in the group 1 samples at 34 days after repair and introduction of stem cells. Fatty infiltration of these samples from group 1 at 34 days was less intense than that in samples from group 2 at 34 days after repair without the introduction of autologous precursor cells. CONCLUSION: The sheep proved to be a good experimental model to assist in the development of research on muscle regeneration and the autologous manipulation of stem cells as a therapeutic option.

Muscle regeneration through therapy with estromal stem cells in injury of infraespinhosus muscle of sheep

Abstract Purpose: To evaluate the effects of rotator cuff muscle regeneration in sheep and establish an experimental model for the use of autologous stem cells as a treatment option for tendon injuries. Methods: Infrared muscle tenotomies and Penrose drain implantation were performed on 12 shoulders of six clinically healthy adult sheep. After 60 days, the tendons were submitted to tissue repair, drainage removal, and divided into two groups according to the use of autologous stromal stem cells for treatment. Muscle regeneration was performed by biopsy on days 14 and 34 after repair. Results: The treatment group with cell therapy showed neovascularization and expressive regeneration. Complete regeneration of the muscle pattern did not occur in any sample although some muscle gain was obtained in the group 1 samples at 34 days after repair and introduction of stem cells. Fatty infiltration of these samples from group 1 at 34 days was less intense than that in samples from group 2 at 34 days after repair without the introduction of autologous precursor cells. Conclusion: The sheep proved to be a good experimental model to assist in the development of research on muscle regeneration and the autologous manipulation of stem cells as a therapeutic option.

Three dimensional morphologic analysis of the lateral surface of the canine femur.

OBJECTIVES: Analyze the lateral plating surface of the femur to obtain bend and twist angles in dogs with non-chondrodystrophic phenotype. STUDY DESIGN: Retrospective computed tomography (CT) morphologic analysis. SAMPLE POPULATION: Historical cohort, hindlimb CT scans (n = 30). MATERIALS AND METHODS: The CT images of 30 normal femurs were uploaded to surgical planning software and 13 points of interest and their respective bend/twist angles were identified on the lateral surfaces. Mean, standard deviation, coefficient of variation (CV), and range were calculated for each bend/twist angle. Hierarchal clustering and fast Fourier Analyses were used to segment the cohort. Distribution of age, breed, sex, and weight was evaluated between clusters with an exact Wilcoxon-Mann-Whitney test. RESULTS: The CV of bending ranged from 17% to 46% and for twisting ranged from 21% to 58%. The greater trochanter was the most pronounced bend on the lateral surface of the femur (mean ± SD 8.11 ± 1.35°, CV 17%), and the supracondylar region of the distal femur was the most marked twist (mean ± SD 48.98 ± 10.06°, CV 21%). Although there were no differences between dogs in proximal femur anatomy, 2 clusters of 9 and 21 dogs each were identified due to differences in bend/twist angles in the distal femur. There was no difference between clusters for age (P = .85), breed (P = .62), and sex (P = .15); however, weight differed (P = .03) but was not predictive. CONCLUSION: Although distal femoral lateral surfaces varied sufficiently to result in 2 population clusters, further analysis is needed to determine if the differences prevent using the mean bending and twisting parameters as a template for clinical applications.

Elbow denervation in dogs: development of an in vivo surgical procedure and pilot testing.

The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on limb function was assessed in vivo in four dogs with the elbow randomly selected for the procedure. Primary outcome measures were static bodyweight distribution and distal limb mechanical sensory thresholds; secondary outcome measures were subjectively scored lameness, neurological function and pain on manipulation. Histology was performed on all resected tissues to determine whether nerves had been resected. Denervation was achieved by separate medial and lateral surgical approaches. In testing the developed surgical protocol, 111/130 resected samples contained nerve tissue in the healthy cadaveric elbows and 18/20 in the in vivo study. Limb function and sensation were not altered by elbow joint denervation. The protocol developed for denervation of the canine elbow appears feasible and does not result in any sensory or motor deficits of the forelimb.

Item generation and design testing of a questionnaire to assess degenerative joint disease-associated pain in cats.

OBJECTIVE: To determine the items (question topics) for a subjective instrument to assess degenerative joint disease (DJD)-associated chronic pain in cats and determine the instrument design most appropriate for use by cat owners. ANIMALS: 100 randomly selected client-owned cats from 6 months to 20 years old. PROCEDURES: Cats were evaluated to determine degree of radiographic DJD and signs of pain throughout the skeletal system. Two groups were identified: high DJD pain and low DJD pain. Owner-answered questions about activity and signs of pain were compared between the 2 groups to define items relating to chronic DJD pain. Interviews with 45 cat owners were performed to generate items. Fifty-three cat owners who had not been involved in any other part of the study, 19 veterinarians, and 2 statisticians assessed 6 preliminary instrument designs. RESULTS: 22 cats were selected for each group; 19 important items were identified, resulting in 12 potential items for the instrument; and 3 additional items were identified from owner interviews. Owners and veterinarians selected a 5-point descriptive instrument design over 11-point or visual analogue scale formats. CONCLUSIONS AND CLINICAL RELEVANCE: Behaviors relating to activity were substantially different between healthy cats and cats with signs of DJD-associated pain. Fifteen items were identified as being potentially useful, and the preferred instrument design was identified. This information could be used to construct an owner-based questionnaire to assess feline DJD-associated pain. Once validated, such a questionnaire would assist in evaluating potential analgesic treatments for these patients.

Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats.

OBJECTIVE: To determine the prevalence of radiographic signs of degenerative joint disease (DJD) in a randomly selected sample of domestic cats. STUDY DESIGN: Prospective observational study. ANIMALS: Client-owned cats. METHODS: Cats (n=100) from a single practice and equally distributed across 4 age groups (0-5; 5-10; 10-15, and 15-20 years old) were randomly selected (regardless of heath status) and sedated for orthogonal radiographic projections of all joints and the spine. Quasi-Poisson regression analysis was used to investigate the relationship between patient demographics, blood biochemistry, hematologic and urine analysis variables, and DJD severity. RESULTS: Most (92%) cats had radiographic evidence of DJD; 91% had at least 1 site of appendicular DJD and 55% had > or = 1 site of axial column DJD. Affected joints in descending order of frequency were hip, stifle, tarsus, and elbow. The thoracic segment of the spine was more frequently affected than the lumbosacral segment. Although many variables were significantly associated with DJD, when variables were combined, only the association between age and DJD was significant (P<.0001). For each 1-year increase in cat age, the expected total DJD score increases by an estimated 13.6% (95% confidence interval: 10.6%, 16.8%). CONCLUSION: Radiographically visible DJD is very common in domesticated cats, even in young animals and is strongly associated with age. CLINICAL RELEVANCE: DJD is a common disease of domesticated cats that requires further investigation of its associated clinical signs.