Online Case-Based Course in Veterinary Radiographic Interpretation Generates Better Short- and Long-Term Learning Outcomes than a Virtual Lecture-Based Course.

Accurate interpretation of radiographs is necessary for the correct diagnosis and treatment of patients. Research has shown that active learning methods, including case-based learning, are superior to passive learning methods, such as lectures.1,2 Short-term learning outcomes were compared between two groups by enrolling 80 fourth-semester veterinary students in either an online case-based radiology course (n = 40) or a virtual lecture-based course (n = 40). Long-term learning outcomes were compared among three groups: one group completed case-based instruction in the fourth semester, followed by lecture-based instruction in the fourth semester (n = 19); the second group completed only lecture-based instruction in the fourth semester (n = 22), and the third group completed lecture-based instruction in the fourth semester, followed by case-based instruction in the fifth semester (n = 9). Learning was assessed using a multiple-choice examination and two independently written small animal radiograph reports. In the fourth semester, students completing the case-based course had higher examination scores and radiograph report scores than students who took the lecture-based course. Students completing the lecture-based course in the fourth semester and the case-based course in the fifth semester wrote better radiograph reports than students who completed both courses in the fourth semester; both groups wrote better reports than students who did not take the case-based course. A case-based diagnostic imaging course may be better than a lecture-based course for both short- and long-term retention of knowledge; however, there is a significant loss of knowledge following an instructional gap, and spaced refreshers may boost retention.

Validation of a Rubric Used for Skills-Based Assessment of Veterinary Students Performing Simulated Ovariohysterectomy on a Model.

Surgical skills are an important competency for new graduates. Simulators offer a means to train and assess veterinary students prior to their first surgical performance. A simulated ovariohysterectomy (OVH) rubric's validity was evaluated using a framework of content evidence, internal structure evidence, and evidence of relationship with other variables, specifically subsequent live surgical performance. Clinically experienced veterinarians (n = 13) evaluated the utility of each rubric item to collect evidence; each item's content validity index was calculated to determine its inclusion in the final rubric. After skills training, veterinary students (n = 57) were assessed using the OVH model rubric in March and August. Internal structure evidence was collected by video-recording 14 students' mock surgeries, each assessed by all five raters to calculate inter-rater reliability. Relationship with other variables evidence was collected by assessing 22 students performing their first live canine OVH in November. Experienced veterinarians included 22 items in the final rubric. The rubric generated scores with good to excellent internal consistency; inter-rater reliability was fair. Students' performance on the March model assessment was moderately correlated with their live surgical performance (ρ = 0.43) and moderately negatively correlated with their live surgical time (ρ = -0.42). Students' performance on the August model assessment, after a summer without surgical skills practice, was weakly correlated with their live surgical performance (ρ = 0.17). These data support validation of the simulated OVH rubric. The continued development of validated assessment instruments is critical as veterinary medicine seeks to become competency based.

Biobehavioral measures as outcomes: a cautionary tale.

This article discusses the use of biobehavioral measures as outcomes for health care intervention studies. Effect size (ES) values for salivary cortisol and observation-based measures of pain and agitation were examined. Effects pre to post treatment were assessed separately for nursing home residents with and without acute psychotic symptoms. This study revealed large positive effects on both pain and agitation measures in the group with acute psychotic symptoms and small-to-medium positive effects on these same measures in the group without acute psychotic symptoms. In both of these groups, the ES values were not consistently positive on the cortisol measures. Prior to determining whether a measure can be used to estimate minimum clinically important differences, it is essential to consider if the biomarker will be responsive to therapy in the populations and contexts being studied.

Pharmacokinetics of intramuscularly administered morphine in horses.

OBJECTIVE: To determine the pharmacokinetics of morphine after IM administration in a clinical population of horses. DESIGN: Prospective clinical study. ANIMALS: 77 horses. PROCEDURES: Morphine sulfate (0.1 mg/kg [0.045 mg/lb], IM) was administered to horses, and blood samples were obtained at predetermined time points. Plasma morphine concentrations were measured via liquid chromatography and mass spectrometry. In preliminary investigations, samples were obtained from 2 healthy horses at 12 time points (up to 12 hours after drug administration) and analyzed via 2-stage pharmacokinetic analysis. In the clinical phase, blood samples were obtained from 75 hospitalized horses at various times (total, 2 to 3 samples/horse) up to 9 hours after drug administration, and data were analyzed via a naïve pooled pharmacokinetic model. RESULTS: In the clinical phase, the apparent terminal half-life (t(½)) of morphine was approximately 1.5 hours, volume of distribution per bioavailability was approximately 4.5 L/kg, and clearance per bioavailability was approximately 35 mL/kg/min. Peak plasma concentration in naïve pooled analysis was 21.6 ng/mL and occurred approximately 4 minutes after administration. Morphine concentrations were below the limit of quantification ≤ 7 hours after administration in 74 horses. Adverse effects attributed to morphine administration were uncommon and considered mild. CONCLUSIONS AND CLINICAL RELEVANCE: The short t(½) of morphine in horses suggested frequent administration may be needed to maintain targeted plasma concentrations. Variations in plasma concentrations suggested optimal dosages may differ among horses. The drug was well tolerated at the described dose, but patients receiving morphine should be monitored carefully.

Cesarean section in alpacas and llamas: 34 cases (1997-2010).

OBJECTIVE: To determine indications for cesarean section in alpacas and llamas, and clinical management and outcome of alpacas and llamas undergoing cesarean section. DESIGN: Retrospective case series. ANIMALS: 27 alpacas and 7 llamas. PROCEDURES: Medical records were reviewed and information gathered on signalment, anamnesis including reproductive history, physical examination findings, indication for cesarean section, anesthetic protocol, surgical technique, number of crias delivered (alive or dead), additional treatment, duration of hospitalization, and postoperative complications. Follow-up information was gathered via email or telephone interview with owners. RESULTS: Uterine torsion (13/34 [38%]) was the most common reason for cesarean section. The most common surgical approach was the left proximal lateral abdominal approach (21/34 [62%]). Thirty-four crias were delivered via cesarean section. Twenty (59%) were born alive and discharged from the hospital. Retained placenta was the most common complication observed after surgery. A significant association was found between prolonged dystocia and fetal death. Of the 34 dams that underwent cesarean section, 21 were rebred, and 19 of the 21 (90.5%) dams that were rebred became pregnant. Fifteen of 19 dams were confirmed to have ≥ 1 normal vaginal delivery with a live cria following cesarean section. CONCLUSIONS AND CLINICAL RELEVANCE: The results of the present study indicated that cesarean section was an effective method of resolving dystocia in camelids without negatively affecting future fertility or parturition by the dam. Prompt referral of patients with dystocia is advised to improve fetal viability. Retained fetal membranes seemed to be a common complication of cesarean section in camelids but was not associated with negative outcomes.

Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer.

PURPOSE/OBJECTIVES: To determine the effect of psychoeducational interventions on pain in adults with cancer. DATA SOURCES: 25 intervention studies published from 1978-2001. DATA SYNTHESIS: When analyzed across all studies, a statistically significant, beneficial effect on pain was found. However, threats to validity were present in some studies. The most serious of these involved a lack of random assignment to treatment condition and a floor effect on pain. When limited to the studies with the best methodologic quality, the effect on pain continued to be statistically significant. Effect on pain by type of treatment was examined and found to be somewhat variable and limited by the small number of studies testing each type of treatment. CONCLUSIONS: Methodologic quality was variable. Reasonably strong evidence exists for relaxation-based cognitive-behavioral interventions, education about analgesic usage, and supportive counseling. Minimal data were available about the relative effectiveness of different types of psychoeducational interventions because few studies included within-study contrasts of different experimental interventions and usual care was not well documented. IMPLICATIONS FOR NURSING: Psychoeducational interventions are not a substitute for analgesics, but they may serve as adjuvant therapy. Assessment and clinical judgment are critical. The intervention must be acceptable to patients and not too burdensome for patients in pain to use.