Longitudinal observation of meticillin-resistant Staphylococcus pseudintermedius pulsotypes in six veterinary hospitals in the north-western United States.

Background: Meticillin-resistant Staphylococcus pseudintermedius (MRSP) infections in companion animals are increasing and are difficult to treat. Environmental contamination with MRSP in small animal primary care hospitals may pose an exposure risk to animal patients. Methods: This longitudinal study assessed the genotypic relationships of MRSP isolated from 39 environmental samples collected from six private small animal primary care hospitals, in the north-eastern United States, between August 2018 and April 2019. Results: Of the 39 bacterial isolates, 18 unique pulsotypes were identified based on pulsed-field gel electrophoresis, including six clusters of two or more indistinguishable isolates. Single pulsotypes were frequently detected from multiple hand-contact and animal-contact surfaces within a hospital during a single sampling event, but detection of a single pulsotype within the same hospital on subsequent visits was infrequent. However, one pulsotype was recovered from three separate hospitals, which suggests that either MRSP transmission between hospitals may have occurred via people, animals, or fomites or that there was a dominant community strain. Conclusions: Single strains of MRSP were isolated from various hand-contact and animal-contact surfaces within hospitals, indicating the important role of humans, animals and the environment in MRSP transmission. Additionally, the detection of a single strain between hospitals and over time suggests that either MRSP transmission between hospitals may have occurred via people, animals or fomites or that there was a dominant community strain.

Multidisciplinary, multisite trauma team training during COVID-19: lessons from the first virtual E-S.T.A.R.T.T. course.

Trauma care delivery is a complex team-based task that requires deliberate practice. The COVID-19 pandemic has not diminished the importance of excellent trauma team dynamics. However, the pandemic hampers our ability to gather safely and train together. A mitigating solution is the provision of high-fidelity simulation training in a virtual setting. The Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course has provided multidisciplinary trauma team members with skills in crisis resource management (CRM) for nearly 10 years. It has promoted collaborative learning from coast to coast, as the course typically runs at our national surgical and trauma meetings. In response to COVID-19 challenges, the course content has been modified to virtually connect 2 centres in different provinces simultaneously. High participant satisfaction suggests that the new virtual E-S.T.A.R.T.T course is able to continue to help providers develop important CRM skills in a multidisciplinary setting while remaining compliant with COVID-19 safety precautions.

Prevalence of methicillin-resistant Staphylococcus pseudintermedius on hand-contact and animal-contact surfaces in companion animal community hospitals.

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) is an important companion animal pathogen, but few published studies have evaluated its epidemiology in primary care settings. This study determined MRSP prevalence on hand- and animal-contact surfaces in 11 small animal primary care hospitals in Washington and Idaho, USA. Overall, MRSP was isolated from at least 1 sample from 7 of 11 hospitals (64%) and from 36 of 374 total samples (10%) with no difference in prevalence between hand- and animal-contact surfaces (P = 0.51). Strain typing by pulsed-field gel electrophoresis indicated high within-hospital similarity of MRSP strains, but minimal similarity between strains from different hospitals. Indistinguishable MRSP strains were present on handand animal-contact surfaces within individual hospitals. A questionnaire was administered to a representative from each hospital. Respondents reported that animal-contact surfaces were cleaned and disinfected more frequently than hand-contact surfaces (P < 0.001). Improving hand hygiene and disinfection of hand-contact surfaces may decrease exposure of veterinary patients to MSRP.

Prévalence de Staphylococcus pseudintermedius résistant à la méthicilline sur des surfaces en contact avec les mains et des surfaces en contact avec les animaux dans des hôpitaux de première ligne pour animaux de compagnie. Staphylococcus pseudintermedius résistant à la méthicilline (MRSP) est un agent pathogène important chez les animaux de compagnie, mais peu d'études publiées ont évalué son épidémiologie dans les sites de soins de première ligne. Dans la présente étude on détermina la prévalence de MRSP sur les surfaces de contact avec les mains et les surfaces de contact avec les animaux dans 11 hôpitaux de première ligne pour animaux de compagnie dans les états de Washington et de l'Idaho, USA. De manière globale, le MRSP fut isolé à partir d'au moins un échantillon dans 7 des 11 hôpitaux (64 %) et de 36 des 374 échantillons (10 %) sans noter de différence dans la prévalence entre les contacts main-surface ou animal-surface (P = 0,51). Le typage des souches par électrophorèse en champs pulsés indiqua une similarité intra-hôpital élevée des souches de MRSP, mais une similarité minimale entre les souches provenant d'hôpitaux différents. Des souches indistinguables de MRSP étaient présentes sur les surfaces de contact avec les mains et les animaux dans un même hôpital. Un questionnaire fut soumis à un représentant de chaque hôpital. Les répondants rapportèrent que les surfaces de contact avec l'animal étaient nettoyées et désinfectées plus fréquemment que les surfaces de contact avec les mains (P < 0,001). Une amélioration de l'hygiène des mains et de la désinfection des surfaces en contacts avec les mains pourraient diminuer l'exposition de patients vétérinaires au MSRP.(Traduit par Dr Serge Messier).

Interactive effects of dexamethasone and opsonized Mycoplasma bovis on bovine neutrophil function in vitro.

Previously we had reported that exposure to high levels of glucocorticoids, and to unopsonized Mycoplasma bovis, has a negative interactive effect on bovine neutrophil function in vitro, and this interactive effect was a function of M. bovis strain differences. Here we hypothesized that in vitro treatment of bovine neutrophils by glucocorticoid would impair phagocytosis of opsonized M. bovis compared to non-treated neutrophils and such impairment would be a function of M. bovis strain differences. Neutrophils isolated from 20 mid-lactation cows were treated with immunosuppressive dose of 5 × 10-4 M dexamethasone or placebo and incubated with one of four opsonized M. bovis strains that had been isolated from bovine origin. After incubation neutrophil function measured included: percentage reduction in log10 of M. bovis CFU/ml, percentage of phagocytizing neutrophils, phagocytized M. bovis per neutrophil, and killed M. bovis per neutrophil. Least square means of all neutrophil groups were contrasted using linear mixed-effects models. Effects due to strain, treatment, and their interaction on neutrophil function measured by the number of phagocytized M. bovis per neutrophil and number of killed M. bovis per neutrophil were different (P < 0.05). However, no significant strain by treatment interaction effect on percentage reduction in log10 of M. bovis CFU/ml was found. Neither a strain nor a strain by treatment interaction was found to affect the percentage phagocytizing neutrophils. These findings might explain in part the association of stressful events with subsequent outbreaks of Mycoplasma bovis associated bovine diseases.

Stakeholder expectations regarding the ability of new veterinary graduates to perform various diagnostic and surgical procedures.

OBJECTIVE To assess stakeholders' expectations regarding new veterinary graduates' ability to perform various diagnostic and surgical procedures. DESIGN Cross-sectional survey. SAMPLE Veterinary students, recent graduates, clinical veterinary college faculty, and general practitioners at or from AVMA Council on Education-accredited colleges of veterinary medicine in the United States and Caribbean. PROCEDURES Respondents rated how proficient they expected new graduates, on their first day of practice, to be in 8 diagnostic procedures and the degree of independence they expected of new graduates in 8 surgical procedures. RESULTS Response rate was 9% (235/2,500) for practitioners, 12% (151/1,275) for faculty members, 14% (70/500) for recent graduates, and 15% (1,731/11,474) for students. All 4 respondent subgroups expected that new graduates would be able to adequately perform a fine-needle aspirate of a subcutaneous mass (96% to 98% expected new graduates to be able to adequately perform this procedure) and a cystocentesis (93% to 97% expected new graduates to be able to adequately perform this procedure). The greatest variability in responses was noted for performing hand ties, ultrasound-guided liver biopsy, and arthrocentesis. Most respondents expected new graduates to be able to independently perform a canine castration (82% to 94% expecting independence), feline subcutaneous mass removal (66% to 75% expecting independence), and canine ovariohysterectomy (65% to 89% expecting independence). CONCLUSIONS AND CLINICAL RELEVANCE Results revealed a diversity of opinion regarding expected proficiency for new graduates performing various diagnostic and surgical procedures. Findings may help colleges of veterinary medicine refine their curricula by providing end points for student training.

Cardiopulmonary Effects of Constant-Rate Infusion of Lidocaine for Anesthesia during Abdominal Surgery in Goats.

Lidocaine is commonly used in ruminants but has an anecdotal history of being toxic to goats. To evaluate lidocaine's effects on selected cardiopulmonary parameters. Isoflurane-anesthetized adult goats (n = 24) undergoing abdominal surgery received a loading dose of lidocaine (2.5 mg/kg) over 20 min followed by constant-rate infusion of lidocaine (100 µg/kg/min); control animals received saline instead of lidocaine. Data collected at predetermined time points during the 60-min surgery included heart rate, mean arterial blood pressure, pO2, and pCO2. According to Welch 2-sample t tests, cardiopulmonary variables did not differ between groups. For example, after administration of the loading dose, goats in the lidocaine group had a mean heart rate of 88 ± 28 bpm, mean arterial blood pressure of 70 ± 19 mm Hg, pCO2 of 65 ± 13 mm Hg, and pO2 of 212 ± 99 mm Hg; in the saline group, these values were 90 ± 16 bpm, 76 ± 12 mm Hg, 61 ± 9 mm Hg, and 209 ± 83 mm Hg, respectively. One goat in the saline group required an additional dose of butorphanol. Overall our findings indicate that, at the dose provided, intravenous lidocaine did not cause adverse cardiopulmonary effects in adult goats undergoing abdominal surgery. Adding lidocaine infusion during general anesthesia is an option for enhancing transoperative analgesia in goats.

Effects of an optional clinical skills laboratory on surgical performance of third-year veterinary students.

OBJECTIVE: To determine whether addition of an optional clinical skills laboratory (OCSL) to the traditional surgery curriculum would affect total surgery time or incision closure time in veterinary students performing ovariohysterectomy of a dog during a third-year surgery course. DESIGN: Retrospective and prospective study of veterinary student attendance at OCSL sessions and student performance during the third-year surgery course. SAMPLE: Students from the classes of 2012, 2013, and 2014 at the Washington State University College of Veterinary Medicine. PROCEDURES: For all students, total surgery time and incision closure time were recorded when students performed an ovariohysterectomy of a dog during their third-year live-animal surgery course. Times were analyzed to identify differences among classes and determine whether times were associated with number of OCSL sessions attended, previous experience performing ovariohysterectomies, or enrollment in an elective clinical skills course. RESULTS: Total surgery and incision closure times were not significantly different between students in the class of 2012 (no access to the OCSL prior to the third-year surgery course) and students in the class of 2013 (ie, access to 4 OCSL sessions during the spring semester prior to the third-year surgery course). However, times were significantly shorter for students in the class of 2014 (ie, students who had access to OCSL sessions during the 3 semesters prior to the third-year surgery course) than for students in the other 2 classes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that attendance in the OCSL sessions was associated with improvements in surgical performance, as reflected in faster total surgery and incision closure times while performing an ovariohysterectomy during the third-year surgery course.

Trauma simulation in bilingual Canada: Insurmountable barrier or unexpected strength? Insights from the first bilingual S.T.A.R.T.T. course.

SUMMARY: The Standardized Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course focuses on training multidisciplinary trauma teams: surgeons/physicians, registered nurses (RNs), respiratory therapists (RTs) and, most recently, prehospital personnel. The S.T.A.R.T.T. curriculum highlights crisis management (CRM) skills: communication, teamwork, leadership, situational awareness and resource utilization. This commentary outlines the modifications made to the course curriculum in order to satisfy the learning needs of a bilingual audience. The results suggest that bilingual multidisciplinary CRM courses are feasible, are associated with high participant satisfaction and have no clear detriments.

Use of a Mobile Device Simulation as a Preclass Active Learning Exercise.

BACKGROUND: Research shows that preclass activities introducing new material can increase student performance. In an effort to engage students in an active learning, preclass activity, the authors developed a mobile application. METHOD: Eighty-four nursing students were assigned a preclass reading exercise, whereas 32 students completed the preclass simulation scenario on their mobile device. All students completed the same electronic fetal monitoring (EFM) quiz 1 week following the lecture. The effects of reading or simulation on student quiz performance was evaluated with a student's paired t test, using an alpha of .05. RESULTS: Students completing the preclass simulation scored higher on the EFM quiz, compared with students assigned the preclass reading (85% versus 70% correct answers, p = .01). Student survey data indicated that the mobile device simulation was perceived as an engaging and desirable instructional tool. CONCLUSION: Nursing students completing the mobile device EFM preclass simulation outperformed the students who were given the traditional reading assignment.

Simulated Trauma and Resuscitation Team Training course-evolution of a multidisciplinary trauma crisis resource management simulation course.

BACKGROUND: We previously reported on a pilot trauma multidisciplinary crisis resource course titled S.T.A.R.T.T. (Simulated Trauma and Resuscitative Team Training). Here, we study the course's evolution. METHODS: Satisfaction was evaluated by postcourse survey. Trauma teams were evaluated using the Ottawa global rating scale and an Advanced Trauma Life Support primary survey checklist. RESULTS: Eleven "trauma teams," consisting of physicians, nurses, and respiratory therapists, each completed 4 crisis simulations over 3 courses. Satisfaction remained high among participants with overall mean satisfaction being 4.39 on a 5-point Likert scale. As participants progressed through scenarios, improvements in global rating scale scores were seen between the 1st and 4th (29.8 vs 36.1 of 42, P = .022), 2nd and 3rd (28.2 vs 34.6, P = .017), and 2nd and 4th (28.2 vs 36.1, P = .003) scenarios. There were no differences in Advanced Trauma Life Support checklist with mean scores for each scenario ranging 11.3 to 13.2 of 17. CONCLUSIONS: The evolved Simulated Trauma and Resuscitative Team Training curriculum has maintained high participant satisfaction and is associated with improvement in team crisis resource management skills over the duration of the course.

Comparison of Pneumoperitoneum Volumes in Lift Laparoscopy With Variable Lift Locations and Tensile Forces.

OBJECTIVE: Evaluate the effect of peritoneal lift location and tensile force on peritoneal volume. STUDY DESIGN: Complete randomized block design. ANIMALS: Eleven fresh canine cadavers. METHODS: Cadavers underwent abdominal computed tomography (CT) scans after each treatment; 1) no lift, 2) umbilical lift with 15% body weight (BW) tension, 3) umbilical lift with 20% BW, 4) umbilical lift with 25% BW, 5) caudal lift with 15% BW, and 6) both umbilical and caudal lift with 15% BW shared equally between devices (dual lift). Isobaric pneumoperitoneal volume, instrument working distances, and transverse measures were calculated and normalized for each dog and compared across treatments. RESULTS: Increasing tensile force created a correspondingly larger pneumoperitoneal volume for the umbilical lift (0.34-0.40 total abdominal volume). Dual lifting created a larger pneumoperitoneal volume than either location alone at the same tension (0.39 total abdominal volume). Increasing lift tensions increased working distances, except to caudal abdominal structures. Increasing lift tensions at the umbilical location reduced the transverse diameter of the abdomen at the level of the kidney (0.92-0.86 total abdominal volume) and increased the transverse diameter at the midperitoneum (1.0-1.05 total abdominal volume). CONCLUSIONS: Larger isobaric penumoperitoneal volumes are produced with increased tensile force, or with dual lifting at lower force. A caudal lift leads to a small pneumoperitoneal volume but equivalent working space to caudal abdominal structures. Using an umbilical lift with moderate tensile force is preferable, providing good visualization and working space. Caudal lifting may be utilized to access caudal abdominal structures.

Effects of dexamethasone and Mycoplasma bovis on bovine neutrophil function in vitro.

It is well established that exposure either to elevated levels of glucocorticoids, or to Mycoplasma bovis (M. bovis), has a negative effect on bovine neutrophil function. The objective of this research was to determine whether in vitro treatment of bovine neutrophils by M. bovis strains (n=4) and glucocorticoids would additively impair phagocyte function. Twenty, healthy, dairy cows were enrolled. Whole blood was collected from all cows for neutrophil isolation. Phagocytosis and the generation of superoxide anion (O2(-)) were tested in vitro by incubation of neutrophils with FITC labeled Escherichia coli (E. coli) and cytochrome c after treatment. Treatments included: NM1-4D (neutrophils treated with dexamethasone and exposed to one of the four M. bovis strains); NM1-4 (neutrophils exposed to one of the four M. bovis strains only); ND (neutrophils treated with dexamethasone only); and N (non-treated control neutrophils). The overall percentages of neutrophils phagocytizing E. coli were: 32%, 51%, 37%, and 53% ± 5.25% for treatments NM1-4D, NM1-4, ND, and N, respectively. The overall statistically transformed means of phagocytized E. coli per neutrophil were: 1.37, 1.72, 1.33, and 1.67 ± 0.057 for treatments NM1-4D, NM1-4, ND, and N, respectively. The overall statistically transformed means of neutrophil O2(-) production were: 8.60, 11.91, 9.01, and 12.21 ± 0.21 nmol/10(6) for treatments NM1-4D, NM1-4, ND, and N, respectively. Exposure of neutrophils to M. bovis plus dexamethasone had an additive effect on generation of reactive oxygen species (p=0.0057), but not on the percentage of neutrophils phagocytizing E. coli (p=0.0817) or number of E. coli phagocytized per neutrophil (p=0.2946). Only one of the four M. bovis strains had a negative effect on neutrophil phagocytic function. Dexamethasone treatment consistently decreased neutrophil function as indicated by decreased percentage of neutrophils phagocytizing E. coli, decreased number of E. coli phagocytized per neutrophil, and decreased neutrophil O2(-) production, compared to controls (p<0.0001). Results suggested a synergistic effect of in vitro incubation of glucocorticoids and M. bovis on reduction of bovine neutrophil function as measured by generation of reactive oxygen species. These findings may explain in part the interaction between stressful events and outbreak of Mycoplasma bovis associated bovine disease.

Incidence of and risk factors for postoperative regurgitation and vomiting in dogs: 244 cases (2000-2012).

OBJECTIVE: To determine the incidence of and risk factors for postoperative regurgitation and vomiting (PORV) in dogs. DESIGN: Retrospective cohort study. ANIMALS: 244 client-owned dogs. PROCEDURES: Dogs referred for nonelective surgery in the first 3 months of 2000 and 2012 were included. Breed; sex; age; weight; body condition score; emergency status; food withholding status; history of vomiting or regurgitation; American Society of Anesthesiologists score; presence of diabetes or hypothyroidism; preoperative PCV and total solids concentration; anesthesia protocol; corticosteroid, opioid, neuromuscular blocking agent, and nitrous oxide usage; anesthesia time; surgery time; type of surgery; and occurrence of vomiting or regurgitation within 24 hours after recovery from anesthesia were recorded. Data were analyzed by means of the Fisher exact test, Wilcoxon rank sum test, and logistic regression. RESULTS: 30 of 244 (12.3%) dogs meeting study inclusion criteria developed PORV. There was no significant difference in the incidence of PORV between the 2000 (12/111 [10.8%]) and 2012 (18/133 [13.5%]) cohorts, although the incidence of regurgitation was higher in 2012. Univariate logistic regression identified the most significant risk factors as gastrointestinal surgery (OR, 11.15; 95% confidence interval [CI], 3.11 to 40.03), premedication without strong sedatives including either an α2-adrenoceptor agonist or acepromazine (OR, 5.36; 95% CI, 1.89 to 15.17), American Society of Anesthesiologists score of 4 (OR, 5.25; 95% CI, 1.05 to 26.15), history of vomiting or regurgitation (OR, 5.12; 95% CI, 1.83 to 14.31), emergency surgery (OR, 4.08; 95% CI, 1.29 to 12.90), neurologic surgery (OR, 3.18; 95% CI, 1.02 to 9.92), sevoflurane inhalation anesthesia (OR, 2.78; 95% CI, 1.25 to 6.13), and being sexually intact (OR, 2.37; 95% CI, 1.07 to 5.27). Multivariate analysis was not clinically useful owing to the low sensitivity and specificity of the model. CONCLUSIONS AND CLINICAL RELEVANCE: Between 2000 and 2012, there was no change in the incidence of PORV for dogs undergoing neurologic, orthopedic, and soft tissue surgical procedures; however, the proportion of dogs that regurgitated increased significantly in 2012. Preoperative antiemetic prophylaxis should be considered in dogs undergoing gastrointestinal surgery and in those in which other risk factors are present.

Cardiorespiratory Changes and Pain Response of Lift Laparoscopy Compared to Capnoperitoneum Laparoscopy in Dogs.

OBJECTIVE: To compare intraoperative physiologic variables and post-operative pain associated with lift laparoscopy and conventional capnoperitoneum laparoscopy. STUDY DESIGN: Prospective randomized case controlled study. ANIMALS: Healthy dogs (n = 30). METHODS: Dogs having laparoscopic ovariohysterectomy were randomly assigned to lift laparoscopy (n = 14) or capnoperitoneum (16) laparoscopy. Physiologic variables measured intraoperatively were documented. Postoperatively, pain response was assessed in a blinded fashion using the short Glasgow pain scale and von Frey filament aesthesiometry. RESULTS: Lift laparoscopy was associated with less frequency of hypercapnia, required less anesthetic gas, and was not more time-consuming or painful than capnoperitoneum laparoscopy. CONCLUSIONS: Lift laparoscopy is a feasible alternative to capnoperitoneum laparoscopy, especially in dogs where pressurized capnoperitoneum is not desired.

Ultrasound elastography of the liver, spleen, and kidneys in clinically normal cats.

A large amount of overlap exists in the B-mode ultrasound appearance of normal and abnormal liver, spleen, and kidney tissues in cats. Therefore, invasive tissue sampling procedures remain the standard method for diagnosing diseases in these organs. The purpose of our study was to assess the feasibility of ultrasound elastography as a technique for improving noninvasive characterization of the feline liver, spleen, and kidneys. Elastography was performed on 10 unsedated, clinically healthy cats. Numeric (strain) values (0 = softest to 255 = firmest) assigned to color pixels within regions of interest resulted in median scores (interquartile ranges) of body wall, 207.50 (189.75-224.00); liver, 119.00 (105.00-138.25); spleen, 127.50 (121-00-142.00); right renal cortex, 83.50 (64.00-130.00); right renal near field, 125.50 (110.75-139.75); left renal cortex, 77.50 (52.00-116.25); and left renal near field, 126.00 (114.00-145.25). Strain values were not different between organs. Body wall median was the only significantly different value (P < 0.05). Strain ratio values of body wall:organ were as follows: liver, 1.76 (1.38-2.00); spleen, 1.68 (1.47-1.83); right renal cortex, 2.31 (1.61-3.15); right renal near field, 1.62 (1.41-2.01); left renal cortex, 2.66 (1.45-4.13); and left renal near field, 1.51 (1.29-1.89). Subjectively, hepatic and splenic parenchymal tissues were homogeneous in compressibility and similar in elasticity to one another. Renal cortical tissue was softer compared to medullary tissue. Findings indicated that ultrasound elastography is a feasible technique for objectively and subjectively characterizing the feline liver, spleen, and kidneys. Further research is needed in cats with confirmed diseases of these organs, to compare the diagnostic sensitivity of ultrasound elastography vs. B-mode ultrasonography.

S.T.A.R.T.T.: development of a national, multidisciplinary trauma crisis resource management curriculum-results from the pilot course.

BACKGROUND: Most medical errors are nontechnical and include failures in team communication, situational awareness, resource use, and leadership. Other high-risk industries have adopted team-based crisis resource management (CRM) training strategies to address "nontechnical" skills and to improve human error and safety. Here, we describe the development and evaluation of a national multidisciplinary trauma CRM curriculum. METHODS: A needs analysis survey was distributed to general surgery program directors across Canada. With the use of this feedback, a course called STARTT [Standardized Trauma and Resuscitation Team Training] was developed and held in conjunction with the Canadian Surgery Forum. Participants completed a precourse and postcourse evaluation exploring changes in attitudes toward simulation and CRM principles using previously validated instruments. RESULTS: Twenty surgical residents, 6 nurses, 4 respiratory therapists, and 11 instructors (trauma surgeons, emergency physicians, nurses, and intensivists) participated. Of the participants, 100% completed the survey. Satisfaction was very high, with 97.5% of the participants rating the course as "good" or "excellent" and 97.5% recommending it to others. The presurvey and postsurvey showed statistically significant improvement in attitudes toward simulation and overall CRM principles (136.3 vs. 140.3 of 170, p = 0.004) following the course, primarily in the domain of teamwork (69.1 vs. 72.0 of 85, p = 0.002). CONCLUSION: Creation of a national multidisciplinary trauma CRM curriculum is feasible, has high satisfaction among participants, and can improve attitudes toward the importance of simulation and CRM principles with the ultimate goal of improving patient safety and care.

Evaluation of vincristine-associated myelosuppression in Border Collies.

OBJECTIVE: To determine whether Border Collies (ATP binding cassette subfamily B1 gene [ABCB1] wildtype) were more likely than other breeds to develop vincristine-associated myelosuppression (VAM) and, if so, whether this was caused by a mutation in ABCB1 distinct from ABCB1-1Δ. ANIMALS: Phase 1 comprised 36 dogs with the ABCB1 wildtype, including 26 dogs with lymphoma (5 Border Collies and 21 dogs representing 13 other breeds) treated with vincristine in a previous study; phase 2 comprised 10 additional Border Collies, including 3 that developed VAM and 7 with an unknown phenotype. PROCEDURES: For phase 1, the prevalence of VAM in ABCB1-wildtype Border Collies was compared with that for ABCB1-wildtype dogs of other breeds with data from a previous study. For phase 2, additional Border Collies were included. Hematologic adverse reactions were graded with Veterinary Co-operative Oncology Group criteria. Genomic DNA was used to amplify and sequence all 27 exons of the canine ABCB1. Sequences from affected dogs were compared with those of unaffected dogs and dogs of unknown phenotype. RESULTS: 3 of 5 Border Collies with the ABCB1 wildtype developed VAM; this was significantly higher than the proportion of other dogs that developed VAM (0/21). A causative mutation for VAM in Border Collies was not identified, although 8 single nucleotide polymorphisms in ABCB1 were detected. CONCLUSIONS AND CLINICAL RELEVANCE: Breed-associated sensitivity to vincristine unrelated to ABCB1 was detected in Border Collies. Veterinarians should be aware of this breed predisposition to VAM. Causes for this apparent breed-associated sensitivity should be explored.

Evaluation of the drawer test and the tibial compression test for differentiating between cranial and caudal stifle subluxation associated with cruciate ligament instability.

OBJECTIVE: To determine the sensitivity and specificity of the drawer test (DT) alone and in combination with the tibial compression test (TCT) to detect stifle subluxation after transection of the cranial cruciate (CrCL), caudal cruciate (CdCL) or both cruciate ligaments (total cruciate ligament or TCL). STUDY DESIGN: Experimental study. SAMPLE POPULATION: Cadaveric, skeletally mature canine pelvic limb pairs (n = 8). METHODS: Pelvic limbs disarticulated at the coxofemoral joint were randomly assigned to the following 1 of 4 groups: (1) limbs had complete transection of the CrCL; (2) limbs had complete transection of the CdCL; (3) limbs had complete transection of both ligaments; and (4) both ligaments were left intact. Participants performed the DT and the TCT and a diagnosis was given based on the DT and on the combination of these tests. RESULTS: DT had a poor sensitivity for correctly identifying CrCL (69%), CdCL (45%), and TCL (26%) rupture, but had a high sensitivity when identifying intact limbs (97%). Specificity for DT was greatest when identifying limbs with CdCL (97%) and TCL (92%) rupture, and the lowest when palpating limbs with CrCL rupture (75%). Combining DT and TCT did not increase sensitivity or specificity values, nor did an increased level of evaluator training. CONCLUSIONS: Independent of evaluator training, the DT alone or combined with the TCT poorly differentiates the cause of stifle instability associated with CrCL, CdCL, and TCL rupture.

Comparison of thoracic and abdominal cavity volumes during abdominal CO2 insufflation and abdominal wall lift.

OBJECTIVE: To compare thoracic and abdominal cavity volumes during abdominal CO2 insufflation and abdominal wall lift (AWL) conditions. STUDY DESIGN: In vitro cadaveric study. ANIMALS: Mature medium-to-large breed fresh canine cadavers (n = 6). METHODS: Each cadaver was imaged with computed tomography (CT) under baseline, abdominal CO2 insufflation, and AWL conditions. Measurements of thoracic and abdominal cavities were performed for each condition using image-analyzing software. Resulting volumes for each cadaver were converted to percent change from baseline to normalize the data. The t-tests were used to compare percent changes of both thoracic and abdominal volumes. RESULTS: Thoracic volume significantly decreased from baseline during CO2 insufflation (P < .01). No significant difference in thoracic volume occurred with AWL when compared with baseline. Abdominal volume increased by 80% with CO2 insufflation (95% CI: 56.4-107.0%) but only 25% with AWL (95% CI: 12.3-37.8%). CONCLUSIONS: Abdominal CO2 insufflation results in decreased thoracic volume when compared with baseline. AWL preserved thoracic volume similar to baseline. Abdominal volumes achieved with abdominal CO2 insufflation are significantly greater than those attained with AWL.

A biomechanical study of laparoscopic 4S-modified Roeder and Weston knot strength in 3-0 polyglactin 910 and 3-0 polydioxanone.

OBJECTIVE: To (1) evaluate biomechanical strength of 4 different laparoscopic knots using 2 suture types, and (2) evaluate carotid artery ligature bursting pressure of 2 knots using a single suture type. STUDY DESIGN: Biomechanical materials testing. SAMPLE POPULATION: Suture material (3-0 polydioxanone, 3-0 polyglactin 910). METHODS: Four knot types were tested: 4S-modified Roeder (4SMR) Weston plus 3 square throws (W3S); Weston plus 3 granny throws (W3G); and a 4 square throw knot as a control (control); 24 specimens of each knot type were tied with 3-0 polyglactin 910 and 24 of 3 knot types (4SMR, W3S, control) were tied with 3-0 polydioxanone. Suture loop constructs were tested to 3 mm displacement failure and ultimate failure. Carotid artery ligation bursting pressure was tested using 10 samples each of 4SMR and W3S knots with 3-0 polyglactin 910. RESULTS: The W3S, W3G, and controls were similar. The 4SMR was similar to W3S using 3-0 PDS but the 4SMR had lower load to failure and greater elongation than the Weston using 3-0 polyglactin 910. The 4SMR had a higher slippage rate with 3-0 polyglactin 910. All ligatures withstood supraphysiologic pressures. CONCLUSIONS: Surgeons using 3-0 polyglactin 910 should consider using the Weston knot with added throws during laparoscopic procedures.