Euthanasia of dogs and cats by veterinarians in New Zealand: protocols, procedures and experiences.

AIMS: To collect data on protocols used by New Zealand veterinarians to perform euthanasia of dogs and cats, and to explore opinions towards the training they received in euthanasia during veterinary school. METHODS: A cross-sectional survey was administered to all veterinarians registered with the Veterinary Council of New Zealand. The survey asked respondents about their practices' policies for euthanasia; protocols for performing euthanasia of dogs and cats; opinions towards euthanasia training received in veterinary school; and subsequent experiences with euthanasia in practice. Descriptive statistics were provided for all quantitative study variables and thematic analysis was performed on the free-text comments. RESULTS: The survey was completed by 361/1,448 (24.9%) veterinarians in companion or mixed animal practice. The mean numbers of dogs and cats euthanised each month were 7.2 (median 5; min 0; max 60) and 7.9 (median 5; min 0; max 60), respectively. Fewer than half of respondents reported that their clinic had a standard protocol for euthanising dogs (147/361; 40.7%) or cats (157/361; 43.5%). For euthanasia of dogs, 119/361 (32.9%) always used sedation while 71/361 (19.7%) indicated that they would not use sedation. For euthanasia of cats, 170/361 (47.1%) always used sedation while 53/361 (14.7%) indicated that they would not use sedation. Placement of IV catheters, methods for patient restraint, preferences towards the presence of owners during euthanasia, services provided with euthanasia, and discussions with owners were also highly variable and handled case-by-case depending on the client, patient, and clinical scenario. When asked about the euthanasia training received at veterinary school, it was generally ranked as below satisfactory, with approximately one-third of respondents indicating that they received no training in dealing with emotional clients (113/361; 31.3%), sedation protocols for euthanasia (107/361; 29.6%), or managing compassion fatigue (132/361; 36.6%). Most respondents (268/361; 74.2%) received no formal training in euthanasia after graduation and learned from experience or discussions with colleagues. Providing animals and owners with a good experience during the euthanasia process was highlighted as important for managing compassion fatigue. CONCLUSIONS: Euthanasia is a common procedure in companion animal practice and there is considerable variation in how veterinarians approach both the technical and non-technical elements. Training provided during veterinary school was generally considered below satisfactory, particularly regarding managing compassion fatigue and clients' emotional needs. CLINICAL RELEVANCE: Providing veterinarians with additional training on adapting their euthanasia protocols to different clinical scenarios may improve the experience for patients, owners and veterinary staff.

How decision-making about euthanasia for animals is taught to Australasian veterinary students.

This study set out to explore how euthanasia decision-making for animals was taught to students in eight Australasian veterinary schools. A questionnaire-style interview guide was used by a representative at each university to interview educators. Educators were interviewed about their teaching of euthanasia decision-making for four categories of animals: livestock, equine, companion and avian/wildlife. Using thematic analysis, the terms provided by participants to describe how (mode of teaching) and what (specific content) they taught to students were categorised. Information about content was categorised into human-centred factors that influence decision-making, and animal-based indicators used to directly inform decision-making. All eight representatives reported some teaching relevant to euthanasia decision-making at their university for livestock, companion animal and avian/wildlife. One representative reported no such teaching for equid animals at their university. Observation of a euthanasia case was rarely reported as a teaching method. Five universities reported multiple modes of teaching relevant information, while two universities made use of modalities that could be described as opportunistic teaching (e.g., 'Discussion of clinical cases'). Factors taught at most universities included financial considerations, and that it is the owner's decision to make, while animal-based indicators taught included QoL/animal welfare, prognosis and behaviour change. Overall, most universities used a variety of methods to cover relevant material, usually including lectures and several other approaches for all animal types. However, because two universities relied on presentation of clinical cases, not all students at these veterinary schools will be exposed to make, or assist in making, euthanasia decisions.

How management of grief associated with ending the life of an animal is taught to Australasian veterinary students.

OBJECTIVE: Veterinarians have an important role in supporting and understanding their clients' grief. Veterinary schools have a duty to teach students how best to manage grief - both that of the students/future veterinarians and the clients. This study explores how grief management, associated with ending the life of an animal, was taught to students in eight Australasian veterinary schools. METHODS: A questionnaire-style interview guide was used by a representative at each university to conduct structured interviews with educators in a snowball sampling approach. Educators were interviewed about the teaching of grief management for four categories of animals: livestock, equine, companion and avian/wildlife. The terms used by participants to describe what they taught were grouped into common themes. Teaching was defined by individual participants and included structured and unstructured approaches. The stage in the degree (preclinical or clinical years) that grief management was taught in the veterinary curriculum and by whom (e.g. clinicians or psychologists) is also described. RESULTS: Grief management was taught more in preclinical than clinical years. However, due to how grief was characterised, much of this teaching was general 'nonspecific' teaching that included all categories of animals. Client grief was taught more generically, whereas, grief of veterinarians was taught using specific examples given by clinicians. CONCLUSION: A more robust end-of-life (EoL) management curriculum that includes all aspects of grief management is likely to increase job satisfaction, client happiness and professional satisfaction.

Cross-sectional survey of surgical techniques used to perform dog and cat spays in New Zealand veterinary practice.

Aims: To describe the variation in surgical techniques used by veterinarians to perform routine dog and cat spays in first-opinion veterinary practice in New Zealand, and how these techniques differed with the number of years since the veterinarian graduated.Methods: A cross-sectional survey of veterinarians registered to practice in New Zealand was conducted online between 1 April and 30 May 2018. Respondents were asked their year of graduation and about the procedures, they would use to perform a routine spay of a healthy, 5 kg, young adult, female domestic shorthair cat, and a healthy, 20 kg, young adult, female mixed-breed dog. The number of years since graduation was calculated by subtracting the reported year of graduation from 2018.Results: Overall, 282 respondents provided details about dog spays, and 361 about cat spays, and the median number of years since graduation was 14 (min 0, max 50). Only 54/282 (19.1%) respondents performing dog spays and 43/361 (11.9%) performing cat spays wore a surgical cap, gown, mask, and gloves. For dog spays, 278 (98.6%) respondents used a ventral midline approach and 147 (52.1%) used manual exteriorisation of the uterus. Most used two clamps (168; 59.6%) and used two encircling ligatures (152; 53.9%) for removal of the uterus. For cat spays, 254 (70.4%) respondents used a ventral midline approach and 313 (86.7%) used a spay hook for exteriorising the uterus. Most used two clamps (250; 69.3%) with one encircling ligature (213; 59.0%) for removal of the uterus. Simple interrupted external or intradermal patterns were mostly used for skin closure for both dog and cat spays. For cat spays, the percentage of respondents using the ventral midline approach decreased with increasing years since graduation (p < 0.001). For both dog and cat spays, the percentage of respondents using two encircling ligatures and transfixation ligation of the uterus, and using a simple continuous suture pattern for the closure of the abdomen, decreased with number of years since graduation (p < 0.05).Conclusions and clinical relevance: Veterinarians responding to this survey used a wide range of techniques to perform routine dog and cat spays, some of which were associated with the number of years since graduation. It may be beneficial to provide veterinarians with resources to reflect on their current approaches for performing routine spays. However further research is needed to determine whether any surgical techniques are superior to others.

Unexpected cardiovascular collapse from massive air embolism during endoscopic retrograde cholangiopancreatography.

A 72 year-old woman with cholangiocarcinoma presented for endoscopic retrograde cholangio pancreatography (ERCP) for diagnostic intraductal endoscopy under GETA. During the technically difficult procedure the patient became suddenly hypoxic, hypotensive, bradycardic, and progressed to PEA code (ETCO2 5 mmHg). ACLS was initiated. Transesophageal echo demonstrated massive right heart air accumulation; abdominal X-Ray showed air filled bile ducts. Central access was obtained, a pulmonary artery catheter floated, and 30 ml of air aspirated from the RV. Within 5 minutes pulses returned; the patient was transferred to the ICU. MRI revealed two watershed infarcts in the right frontal lobe. The patient fully recovered and returned a month later for an uneventful ERCP.

Cost of screening and treatment of cervical dyskaryosis in Germany.

Human papillomavirus (HPV) infection is the principal cause of cervical cancer. Clinical trials with HPV vaccines have shown high efficacy against HPV-induced precancerous cervical lesions. Before implementing a vaccination programme, up-to-date data on cervical dyskaryosis, incidence and annual treatment costs are needed. We assessed resource use and costs for 12 months following diagnosis for women with abnormal Pap smears in Germany based on a sample of 138 women who had received abnormal results on Pap smears taken during March and April of 2004. Most women had a Pap IIID (57%) vs Pap III (20%) or Pap IV (23%). Women with a Pap IV consulted their gynaecologist more frequently than those with a Pap III or Pap IIID (5.6 visits vs 4.2 and 4.6 visits, respectively). Only 9% of patients underwent colposcopy plus biopsy; this may be due to the lack of histological assessment by coloposcopy and biopsy done currently in Germany. More women in the Pap IV group had a cold knife conisation, compared with those in the Pap IIID group, (84% vs 27%) hysterectomy (22% vs 4%) and laser coagulation (12.5% vs 4%). Median treatment duration was shorter for women with a Pap III than for those with Pap IIID and IV (3 vs 5 months, respectively). Overall, 28.3% of the women were hospitalised (median 5; range 1-33 days). The estimated average annual cost per patient was Euro 1,055, Euro 943 and Euro 3,174 for Pap III, IIID and IV, respectively. The cost of managing precancerous cervical lesions in Germany was shown to be high.

A performance investigation of small-bore sewers.

This paper describes a full-scale physical model and its application to investigate the effectiveness/performance of small-bore sewers for a range of operational and design parameters. The implementation methodology involves observing the movement of synthetic gross solids in three small bore sewers (150, 100 and 75 mm diameter) for different volumes of simulated flush waves and gradients. The simulated flush waves were generated, using an automated wave sequencer, for three different flush volumes (3, 4.5 and 6 litres). To investigate the impact of solid shape factor, a number of tests were carried out using synthetic solids in combination with toilet tissue paper. In total, more than 1,000 tests were performed for different operational and design parameter combinations. Results obtained to date have confirmed earlier studies, particularly with respect to the role of flush volume in solids transport, and identified the impact of gradient variation and its significance particularly in small-bore sewers receiving low flush volume. Results from the physical model application exercise will be used to propose new design guidelines for wastewater collection systems with specific consideration to new developments and inform the decision support system, currently being developed as part of a research project on water cycle management for new developments (WaND).

Forces on sanitary solids in small sewers.

An experimental and modelling study has been carried out to investigate the movement mechanisms and behaviour of large sanitary solids in small sewers. The overall performance of the model has already been verified in terms of limiting solids transport distance, but in this paper the wave profile across the solid is also shown to fit model predictions well when compared visually. Further insight into how solids behave is also explored in this paper by plotting the interplay of the main horizontal and vertical forces acting on the solid. These results illustrate the dynamics of movement initiation, transport and deposition and indicate the most important forces. Model predictions of movement 'time per hop' have also been experimentally verified, giving further credence to the model. Experimental verification of the magnitude of the forces involved is planned.

A model for the movement of large solids in small sewers.

An extensive series of experiments has been carried out to investigate the movement mechanisms and behaviour of large solids in small sewers. This paper describes the development, calibration and verification of a model (SOLID) based on data obtained from the experimental rig. It is used to predict solid movement with respect to 'limiting solid transport distance'. Key model parameters are the coefficients of static and dynamic friction, the shape factor of amorphous solids and the flow bypass coefficient. The model is shown to successfully represent the movement of a large solid down a small pipe, where the solid is moving as a sliding, leaking dam, particularly the first 'hop'. Limitations of the model include a limited facility to well represent multiple hops and the need for closely spaced computational nodes leading to small time steps, and long run times.

Movement mechanisms of gross solids in intermittent flow.

Gross solids, such as used tampons, sanitary towels and faecal stools, are introduced into the sewer network via the WC. Although small diameter pipes (< or = 150mm diameter) make up a large proportion of most sewer networks, the transport behaviour of gross solids in these smaller pipes is not fully established. In particular, there are concerns about the effect of water conservation measures on the transport of gross solids in the intermittent flow regime prevalent in small pipes. This paper introduces a study carried out on the movement of solids in this flow regime. An extensive series of experiments has been carried out to investigate the movement mechanisms and behaviour in detail. It was found that there are three different mechanisms of movement, and photographic evidence is provided in the paper. The concept and implications of the "limiting solid transport distance" is also introduced. It is argued that solid movement is dependent on factors other than just WC flush volume and that increased blockage potential is not inevitable.

Evidenced-based airway management.

The increased polarity of evidenced-based medicine has changed the approach to evaluation of medical interventions and treatments, either placing them on firm scientific foundations or suggesting that evidence is inadequate to strongly support current or innovative practices. Airway management devices and techniques are essential and common components of clinical care. It is the purpose of this review to identify the levels of evidence that support common and novel techniques in airway management. Very few airway management techniques are supported by large, prospective randomized trials. In resuscitation, defibrillation should take priority over airway management. This is supported by animal studies and several reported series of patient experiences and will never be subjected to a prospective randomized trial. Substantial evidence supports the use of noninvasive ventilation, subglottic endotracheal tube secretion removal, changing ventilator circuits no more frequently than every 7 days, and the use of selective digestive decontamination with systemic antibiotics to reduce the incidence of ventilator-associated pneumonia. Little evidence supports using other measures such as elevating the head of the bed to 30% (but this costs nothing and is intrinsically attractive), use of heat and moisture exchangers, kinetic bed therapy, early tracheotomy, or lung secretion removal techniques to reduce ventilator-associated pneumonia. Percutaneous tracheotomy currently can only be recommended over open surgical tracheotomy based on cost, convenience and late stomal complications; it may be associated with a slightly higher morbidity and mortality.

Nonviolent psychiatric inpatients and subsequent assaults on community patients and staff.

Health care staff on psychiatric inpatient units are at high risk for work-related assaults by patients. Recent studies have begun to document similar patient assaults toward staff in community-based residences. Earlier community studies did not control for the level of patient assault prior to community discharge, and it remains unknown whether the community residence assaults were a function of community placement or a reflection of ongoing control issues by the recently discharged patients. This preliminary inquiry retrospectively tracked the nature and frequency of assaults by patients newly discharged to community residences from a state hospital setting where there had been no assaults by these patients for a two-and-one half-year period. While base rates remain to be determined, the findings in this study suggest the assaultive patients to be younger males with diagnoses of schizophrenia and histories of violence toward others, substance abuse, and violence toward self. Nine patients committed the majority of the assaults. There was a significant decline in the frequency of assaults nine months post-discharge. The implications are discussed.

Anesthetic considerations for hepatic cryotherapy.

The evolution of hepatic cryotherapy as an accepted treatment for patients with non-resectable hepatic malignancy has required concurrent evaluation and development of perioperative anesthetic management of these cases. Review of published and institutional experience demonstrates that hepatic cryotherapy presents the anesthesiologist with an array of challenges, all of which are not intuitively apparent. Specifically, such issues as management of coexisting physiologic perturbations of the oncology patient, heat conservation during the procedure, and readiness for a more extensive procedure would be readily anticipated by most clinicians. Description and reasonable management of problems ranging from mild or moderate postoperative thrombocytopenia to the so-called cryoshock syndrome with the possibility of severe postoperative coagulopathy, renal dysfunction, and pulmonary complications, however, could emerge only with the education of experience. The goal of this article is to address the key issues faced by anesthesiologists consulted in the perioperative care of patients undergoing hepatic cryotherapy.

Vitreous haemorrhage after cataract extraction.

One hundred eyes undergoing intracapsular cataract extraction and 100 undergoing extracapsular extraction were examined prospectively within one week postoperatively and again at 6-10 weeks postoperatively. Indirect ophthalmoscopy showed vitreous haemorrhage in 36% of the intracapsular group and 13% of the extracapsular group. Vitreous haemorrhage was significantly related to the occurrence of operative hyphaema (p less than 0.01) but not to iridectomy (p greater than 0.05). In the intracapsular group the use of chymotrypsin significantly reduced the incidence of vitreous haemorrhage (p less than 0.01). Three different types of vitreous haemorrhage were identified--streaks, diffuse haze, and beads in the vitreous base. Wound haemorrhage and operative hyphaema account for most cases, but it is suggested that zonular traction may be responsible for the bead haemorrhages and also for the retinal haemorrhages reported by other authors. Although no difference in visual result or incidence of cystoid macular oedema was observed in this study, a relationship to the vitreoretinal pathology of aphakia is suggested.

Blunt ocular trauma and hyphaema.

138 consecutive cases of traumatic hyphaema treated at Royal Perth Hospital were studied retrospectively. 47% of cases were caused by sporting injuries; 21% by squash alone. 105 cases were available for follow-up examination at 6 weeks. Using chi 2 distribution the finding of worse than 6/12 vision at follow-up was significantly related to the occurrence of major associated ocular injury, and also to the occurrence of secondary haemorrhage. The benefit of hospital admission is doubtful when compared to the cost. Modern therapeutic modalities including anti-fibrinolytics have improved the prognosis of secondary haemorrhage.