The Change of Practitioner's Self-Efficacy in Triple P Professional Training: Moderating Role of Practitioner Characteristics, Country, and Delivery Mode.

Two studies examined the change in self-efficacy of practitioners after attending Triple P training and the moderators that affect training outcomes. Study 1 used a large multidisciplinary sample of health, education, and welfare practitioners (N = 37,235) came from 30 countries around the world, which all participate in a Triple P professional training course during 2012-2019. This study assessed practitioners' overall self-efficacy and their consultation skills efficacy prior to training, immediately following training, and at six- to eight-weeks follow-up. Participants reported significant improvements of their overall self-efficacy and their consultation skills self-efficacy. There were significantly small differences based on practitioners' gender, disciplines, education levels, and country location. Study 2 examined the training outcomes of videoconference-based training (following the COVID-19 pandemic) compared to in-person training (N = 6867). No significant differences were found between videoconference and in-person training on any outcome measure. Implications for the global dissemination of evidence-based parenting programs as part of a comprehensive public health response to COVID-19 was discussed.

Assessing Adolescent Functioning from Different Perspectives: Extending the Validation of the Adolescent Functioning Scale (AFS).

The study aimed to provide further evidence for the validity of the 33-item Adolescent Functioning Scale (AFS) as a parent- and adolescent-report scale of adolescent adjustment. In separate samples of parents (N = 542; 88% female) and adolescents (N = 303; 60% female), confirmatory factor analyses supported the original 4-factor structure of the AFS. Analyses produced a 28-item parent measure, and a 27-item adolescent measure. Parent and adolescent versions included positive development, oppositional behaviour, antisocial behaviour and emotional problems subscales. Evidence for convergent and construct validity was provided through correlations with existing measures of adolescent functioning and parenting. The AFS demonstrated configural and metric invariance, but not scalar variance. The study provided support for the validity and reliability of the revised AFS for parents and adolescents. The strong psychometric properties, and brief and multi-dimensional nature of the AFS means that it will have utility in research and applied contexts.

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk.

OBJECTIVES: To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS: Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS: Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.

Assessing critical dimensions of the parent-adolescent relationship from multiple perspectives: Development and validation of the Parent-Adolescent Relationship Scale (PARS).

This paper presents two studies outlining the development and validation of a new parent- and adolescent-report measure of the parent-adolescent relationship: the Parent-Adolescent Relationship Scale (PARS). Study 1 involved an exploratory factor analysis on a sample of 256 parents of adolescents aged 11-18 years. Results produced a 21-item measure comprising three subscales, Connectedness, Shared Activities, and Hostility, each with high factor loadings (> .60), strong internal consistency (H index = .84 to .91 for different age groups) and test-retest reliability (r = .73 to .84). Convergent validity was established via correlations between the PARS and established parent-adolescent relationship and parenting measures. Discriminant validity was shown via no association between the PARS and a technology use measure. Study 2 involved confirmatory factor analysis with a second sample of parents of adolescents, along with validation of adolescent and emerging adult versions. Equivalence of the models across the three versions was also assessed. Study 2 provided further support for the 3-factor structure, demonstrating configural, metric, and scalar invariance across the three final 15-item self-report versions: parent, adolescent, and emerging adult. Results show the PARS is a potentially valuable tool for assessing the quality of the parent-adolescent relationship. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The efficacy and acceptability of the Triple P: Positive Parenting Program with Turkish parents.

AIM: To evaluate the effectiveness of Group Teen Triple P with parents who have behaviorally disturbed adolescents. METHODS: The research was conducted in an experimental manner. The sample was 76 parents who were grouped as 38 cases and 38 controls with a block randomization method. Data were collected using the Family Background Questionnaire, General Health Questionnaire (GHQ-12), Strengths and Difficulties Questionnaire (SDQ), Conflict Behavior Questionnaire (CBQ), and Parent Satisfaction Questionnaire. Group Teen Triple P Program was implemented with the case group for 8 weeks. Data were collected immediately after the program and again after 3 months. Data were evaluated using variance analysis, t test, χ2 test, multivariate analysis of covariance, and analysis of covariance test. RESULTS: It was found that participation in Group Teen Triple P resulted in the improvement of parental mental health, decreased problematic behavior of the adolescents, and fewer problems between adolescents and their parents. CONCLUSION: Group Teen Triple P should be made available to more parents of adolescents in Turkey.

Mortality rate and prognostic factors for dogs with severe anaphylaxis: 67 cases (2016-2018).

OBJECTIVE: To determine mortality rates for dogs with severe anaphylaxis and identify potential prognostic factors. ANIMALS: 67 dogs with suspected anaphylaxis graded as severe. PROCEDURES: Dogs were classified on the basis of outcome as survivors and nonsurvivors. Medical records were reviewed, and data were extracted including signalment, examination findings, time to hospital admission from onset of clinical signs, CBC results, serum biochemical analysis results, coagulation testing results, and findings on abdominal ultrasonography. Initial treatment within the first 6 hours after hospital admission was recorded for analysis, specifically including the use of epinephrine, diphenhydramine, corticosteroids, antimicrobials, fresh-frozen plasma, and supplemental dextrose. RESULTS: The overall mortality rate was 14.9% (10/67) for dogs with anaphylaxis graded as severe. Serum phosphorus concentration and prothrombin time (PT) were significantly higher in nonsurvivors, compared with survivors. Nonsurvivors had lower presenting body temperatures than survivors. Serum phosphorus concentration ≥ 12.0 mmol/L, hypoglycemia within 6 hours after hospital admission, high PT value, concurrently high PT and partial thromboplastin time (PTT) values > 50% above the reference range limit, and the need for supplemental dextrose were associated with death. The incidences of coagulopathy and peritoneal effusion were unexpectedly high (85.2% and 65.5% of dogs, respectively) but were not indicative of survival. CONCLUSIONS AND CLINICAL RELEVANCE: Despite the poor presenting clinical condition seen in dogs with severe anaphylaxis, the rate of survival with treatment was fairly high. Coagulopathy and the presence of peritoneal effusion were common findings in dogs with severe anaphylaxis. Serum phosphorus concentration ≥ 12.0 mmol/L, high PT value, concurrent increases of PT and PTT values > 50% above reference range limits, hypoglycemia within 6 hours after hospital admission, and the need for supplemental dextrose were associated with death.

Intensity and duration of lifestyle interventions for long-term weight loss and association with mortality: a meta-analysis of randomised trials.

OBJECTIVES: To evaluate the importance of the frequency and duration of lifestyle interventions for achieving weight loss over ≥1 year and associations with all-cause mortality. DESIGN: Meta-analysis of randomised trials using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and RevMan software version 5·2 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen). DATA SOURCES: MEDLINE, CENTRAL, Google and Science Direct databases alongside reference lists of appropriate articles and meta-analyses. ELIGIBILITY CRITERIA: Randomised studies published in English-language journals from 1980 to June 2018 that assessed lifestyle compared with control interventions on weight loss and that included ≥100 subjects and reported weight change and mortality for ≥1 year. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% CI and OR with 95% CI as appropriate. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation score was used to assess the certainty of the evidence. RESULTS: 31 randomised trials with a total of 20 816 overweight or obese participants were included. 70% of participants had cardiometabolic risk factors. Body weight was lower for lifestyle intervention compared with the control at 1 year (3.63 kg, 95% CI 2.58 to 4.67) and at 3 years (2.45 kg, 95% CI 1.17 to 3.73). Weight loss at 1 year was greater in studies with >28 compared with ≤28 interventions per year (4.50 kg, 95% CI 3.03, 5.97 vs 2.38, 95% CI 0.78 to 3.98 kg, p=0.001). In all studies, there were 593 deaths (~0.3%/year). The ORs for mortality for weight loss interventions compared with the controls was 0.86 (95% CI 0.73 to 1.02), p=0.09. CONCLUSION: In predominantly healthy populations with risk factors, there is a dose response with number of lifestyle interventions and weight loss. Frequent and sustained interventions are needed to achieve a clinically significant 5% weight loss. There was insufficient evidence to reliably evaluate the benefits in persons with known cardiovascular disease or cancer. TRIAL REGISTRATION NUMBER: CRD42018095067.

Self-Regulation Approach to Training Child and Family Practitioners.

Evidence-based psychotherapies or programs (EBPs) exist for most mental health disorders that occur in childhood; however, the majority of children with a mental health disorder do not receive such treatments. This research-practice gap has been attributed to a range of factors that complicate the delivery of EBPs in everyday practice. While most suggestions to bridge this gap have focused on how to develop EBPs that will have a better fit for the clinical settings in which they will ultimately be deployed, a useful adjunct is to enhance practitioners' capacity to flexibly deliver EBPs to manage these factors. We propose that the extent to which a practitioner is able to change their own behaviour in response to cues and information about the current needs of their clients, and do so while maintaining the integrity of an EBP, may be a function of practitioners' self-regulatory capacity. In this conceptual paper, we describe a model of self-regulation that can be applied to child and family practitioners. We argue that practitioners with greater self-regulatory capacity are more likely to take up EBPs, sustain their use of them and have superior outcomes with clients. We draw on our experience in disseminating a system of parenting support to illustrate how practitioners' self-regulatory capacity can be enhanced while simultaneously receiving training in an EBP. Advantages and disadvantages of a self-regulatory approach to training are discussed and directions for future research are offered.

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3-Defining antithrombotic protocols.

OBJECTIVES: To systematically examine the evidence for use of a specific protocol (dose, frequency, route) of selected antithrombotic drugs, in comparisons to no therapy or to other antithrombotic therapies, to reduce the risk of complications or improve outcomes in dogs and cats at risk for thrombosis. DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. SETTINGS: Academic and referral veterinary medical centers. RESULTS: Databases searched included Medline via PubMed and CAB abstracts. Eight different antithrombotic drugs were investigated using a standardized Patient, Intervention, Comparison, Outcome (PICO) question format both for dogs and cats, including aspirin, clopidogrel, warfarin, unfractionated heparin (UFH), dalteparin, enoxaparin, fondaparinux, and rivaroxaban, generating a total of 16 worksheets. Most studies identified were experimental controlled laboratory studies in companion animals (LOE 3) with only four randomized controlled clinical trials in companion animals (LOE 1). CONCLUSIONS: Overall, evidence-based recommendations concerning specific protocols could not be formulated for most antithrombotic drugs evaluated, either because of the wide range of dosage reported (eg, aspirin in dogs) or the lack of evidence in the current literature. However, clopidogrel administration in dogs and cats at risk of arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature, and specific protocols were recommended. Comparably, aspirin should not be used as a sole antithrombotic in cats with cardiomyopathy. Using the available safety profile information contained in the literature, the panel reached consensus on suggested dosage schemes for most antithrombotics. Significant knowledge gaps were highlighted, which will hopefully drive novel research.

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 5-Discontinuation of anticoagulant therapy in small animals.

OBJECTIVES: To systematically evaluate the evidence supporting the timing and mechanisms of permanent or temporary discontinuation of antiplatelet or anticoagulant medications in small animals DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality (poor, fair, or good), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. SETTINGS: Academic and referral veterinary medical centers. RESULTS: Databases searched included Medline via PubMed and CAB abstracts. Two specific courses of inquiry were pursued, one focused on appropriate approaches to use for small animal patients receiving antiplatelet or anticoagulant drugs and requiring temporary discontinuation of this therapy for the purposes of invasive procedures (eg, surgery), and the other aimed at decision-making for the complete discontinuation of anticoagulant medications. In addition, the most appropriate methodology for discontinuation of heparins was addressed. CONCLUSIONS: To better define specific patient groups, a risk stratification characterization was developed. It is recommended to continue anticoagulant therapy through invasive procedures in patients at high risk for thrombosis that are receiving anticoagulant therapy, while consideration for discontinuation in patients with low to moderate risk of thrombosis is reasonable. In patients with thrombosis in whom the underlying cause for thrombosis has resolved, indefinite treatment with anticoagulant medication is not recommended. If the underlying cause is unknown or untreatable, anticoagulant medication should be continued indefinitely. Unfractionated heparin therapy should be slowly tapered rather than discontinued abruptly.

Measuring positive and negative aspects of youth behavior: Development and validation of the Adolescent Functioning Scale.

This paper outlines the development and validation of the Adolescent Functioning Scale (AFS) in an Australian sample of parents of young people aged 11-18 years (N = 278). The AFS, a parent self-report measure, was designed to assess problem behavior and positive development in adolescents. Principal components analysis produced a 33-item measure comprising four subscales: Positive Development, Oppositional Defiant Behavior, Antisocial Behavior and Emotional Difficulties. Convergent validity was established via correlations between the AFS and established measures of adolescent functioning and parenting, and discriminant validity was shown through no association between the AFS and a measure of technology use. Internal consistency for the subscales was high (H = .82-.92 for different age groups), as was test-retest reliability (r = .77-.86). The study indicated that the AFS is a potentially valuable tool for assessing levels of problem behaviors and positive development in adolescents.

Cardioversion of atrial fibrillation in a dog with structural heart disease using an esophageal-right atrial lead configuration.

Atrial fibrillation is a common arrhythmia in dogs with structural cardiac disease and can result in significant clinical signs. Several methods of electrical cardioversion of atrial fibrillation have been described. Biphasic transthoracic cardioversion of atrial fibrillation in dogs with naturally occurring heart disease has been described in veterinary medicine and has been shown to be highly successful. In humans and research animals intracardiac and transesophageal cardioversion of atrial fibrillation has been described as an alternative to transthoracic cardioversion. While transesophageal cardioversion is very successful in humans and research animals, this technique has not been previously described in a clinical patient with naturally occurring heart disease in veterinary medicine. This report describes the use of transesophageal cardioversion in a dog with atrial fibrillation and structural cardiac disease. Cardioversion was unsuccessful using two electrodes positioned within the esophagus. Cardioversion of atrial fibrillation to normal sinus rhythm was successfully achieved and maintained using one electrode positioned within the esophagus and one electrode positioned within the right atrium using a synchronized monophasic shock of 50 J.

Systematic evaluation of evidence on veterinary viscoelastic testing part 5: Nonstandard assays.

OBJECTIVE: To systematically examine the evidence on nontraditional uses of viscoelastic coagulation monitoring in veterinary species. DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. SETTING: Academic and referral veterinary medical centers. RESULTS: Databases searched included Medline, CAB abstracts, and Google Scholar. CONCLUSIONS: Nontraditional assays identified included thrombelastography (TEG)-PlateletMapping (PM), functional fibrinogen assessment, and rapid-TEG (r-TEG). Direct veterinary evidence was found for only the ADP-activated PM, which appears to generate valid data in dogs but not cats or horses. Arachidonic acid activated PM shows high variability and requires further assessment and validation in veterinary species. Functional fibrinogen assays may be performed in veterinary species but may require modification due to species differences in response to abciximab. While tissue factor (TF)-activated TEG has been well described in the veterinary literature, the specific r-TEG assay has not been assessed, but presumably would be effective for generating TEG tracings and values for maximum amplitude and angle in shorter periods of time than some traditional assays.

Sonoclot evaluation of whole blood coagulation in healthy adult dogs.

OBJECTIVE: To establish a standard protocol for analysis of canine whole blood and generate reference intervals for healthy dogs using the Sonoclot analyzer, and to compare Sonoclot values to standard and viscoelastic coagulation tests. DESIGN: Prospective study. SETTING: Veterinary University research facility and teaching hospital. ANIMALS: Twelve healthy random source dogs and 52 healthy dogs from the general veterinary school population. INTERVENTIONS: Blood sampling for viscoelastic coagulation testing. MEASUREMENTS AND MAIN RESULTS: Blood was collected from 12 healthy adult dogs by jugular venipuncture. After a rest period at room temperature of 30, 60, or 120 minutes, 340 µL of citrated blood was added to 20 µL of 0.2 M CaCl(2) in 1 of 2 cuvette types warmed to 37° C. Cuvettes contained a magnetic stir-bar with glass beads (gbACT+) or only a magnetic stir-bar (nonACT). Reference interval samples were collected from 52 healthy adult dogs and analyzed in duplicate. The ACT, CR, and PF were not affected by duration of rest period for either cuvette type. ACT variability was decreased when using gbACT+ cuvettes (P < 0.05). In normal dogs reference intervals (mean ± 2 SD) using gbACT+ cuvettes were: ACT 56.0-154.0 seconds, CR 14.85-46.0, and PF 2.1-4.05. ACT correlated to TEG R-time, K-time, and angle, while CR correlated with all TEG parameters. Fibrinogen correlated with ACT, CR, and PF. Sonoclot did not correlate with other common coagulation tests. CONCLUSIONS: Sonoclot provides viscoelastic evaluation of canine whole blood coagulation and correlated to several TEG parameters and fibrinogen. A standard protocol and reference intervals were established.

A commentary on evidenced-based parenting programs: redressing misconceptions of the empirical support for Triple P.

A meta-analytic review of the Triple P-Positive Parenting program by Wilson et al., recently published in BMC Medicine, claimed to demonstrate that although Triple P is widely disseminated and adopted, the evidence attesting to the effectiveness of the program is not as convincing as it may appear. Although this review addresses the important issue of evaluation and reporting methods within evidence-based interventions, we contend that the Wilson et al. review contains a number of significant conceptual, methodological and interpretational inadequacies that render the key conclusions of their review problematic.

Update on disseminated intravascular coagulation: when to consider it, when to expect it, when to treat it.

Disseminated intravascular coagulation (DIC) spans a continuum in which clinical signs can range from a prothrombotic to a hemorrhagic phenotype, with some patients suffering from both concurrently. DIC is always caused by an underlying condition, with most cases linked to systemic inflammation or infection. Numerous factors contribute to the development of DIC, including aberrations in endothelial function, and altered levels of endogenous procoagulant, anticoagulant, and fibrinolytic factors. Excessive thrombin generation, or failure to localize thrombin production, is the unifying theme throughout this broad condition. DIC can be described as overt or nonovert, each with varying degrees of severity. The ability to concisely define and diagnose such a broad condition has proven challenging, especially in veterinary medicine, where interspecies differences result in phenotypic variability. In most patients, DIC is recognized when a patient experiences noteworthy hematologic changes, such as a drop in circulating platelet count in concert with a 20% to 30% prolongation in the activated partial thromboplastin time. Similar to diagnosing, proven benefits of any particular therapy are difficult to identify. Despite these difficulties, therapy can be optimized with an understanding of the underlying pathology(ies). With appropriate care and a committed owner/veterinary team, patients with DIC can have a favorable outcome.

Effects of rest temperature, contact activation, and sample technique on canine thrombelastography.

OBJECTIVE: To determine the effects of rest temperature, contact activation (CA), and sample collection technique on thrombelastography (TEG) using canine whole blood. DESIGN: Prospective, experimental study. SETTING: University-based research facility. ANIMALS: Twelve healthy, adult, mixed-breed dogs. INTERVENTIONS: Blood was collected by jugular venipuncture. Tubes containing 3.2% sodium citrate, with and without 75 µg/mL corn trypsin inhibitor (CTI), were filled by vacuum. Samples rested for 30 minutes at 3 temperatures: 37°C, room temperature (RT, 20-22°C), or warmed to 37°C 5 minutes prior to analysis (prewarmed). Samples were analyzed at 37°C. CTI-treated samples were analyzed with and without 1:50,000 tissue factor (TF) as activator. Six dogs were also tested similarly using a needle/syringe collection technique. MEASUREMENT AND MAIN RESULTS: Prewarmed samples exhibited greater MA compared to RT (55.5 ± 7.2 mm vs. 53.5 ± 6.0, P< 0.05), while 37°C samples exhibited a steeper angle (56.7 ± 10.4°C vs. 52.4 ± 8.6°C) and greater MA (55.9 ± 7.5 mm vs. 53.5 ± 6.0 mm) than RT samples (both P< 0.05). CTI-treated samples were hypocoagulable (R time 45 min [7.5-56.8 min], angle 8.2°C [5.1-42.5°C], MA 29.2 ± 9.7 mm, P< 0.001), with TF activation returning all but the angle (42.5 ± 7.6°C) to values similar to citrated samples (angle = 56.7 ± 10.4°C, P = 0.017). Collection using a syringe/needle method revealed a shorter R time for prewarmed samples only (R time 4.7 ± 0.7 min, vs. 5.6 ± 0.8 min for vacuum-collected samples, P = 0.008). CONCLUSIONS: Even in the absence of exogenous activators, CA has an impact on canine TEG results. The effects of rest temperatures and sample collection technique on TEG appear to be minimal.

Towards a public health approach to parenting programmes for parents of adolescents.

BACKGROUND: Poor parenting practices have been associated with adolescent emotional and behavioural problems which are potentially preventable. Parenting interventions that are based on behavioural and social learning theories have been repeatedly shown to be effective. However, few evidence-based parenting programmes are implemented and sustained at a population level. Little research is available on supporting the general population of parents during the adolescent years. Further, a substantial research-practice gap exists regarding the impact of a universal approach to parenting programmes for parents of adolescents. METHOD: This article will first examine the effects of parenting practices on adolescent outcome. Afterwards, it addresses the effectiveness of parenting programmes for parents of adolescents. Finally, it discusses the need for a public health approach to parenting programmes.

Spontaneous echocardiographic contrast in three dogs.

OBJECTIVE: To describe the clinical presentation and outcome in 3 dogs with spontaneous echocardiographic contrast (SEC). CASE OR SERIES SUMMARY: SEC was identified in 3 dogs with concurrent hyperfibrinogenemia. The dogs were diagnosed with different underlying conditions including infective endocarditis of the mitral valve (Case 1), presumptive Evan's syndrome (Case 2), and presumptive sepsis (Case 3). Various therapies were used in each case directed at their underlying condition, in addition to thromboprophylaxis that were based upon a perceived risk of thromboembolic disease. The 3 dogs in this series survived to discharge and had good outcome during the follow-up period, which ranged from 3 weeks to 7 months. NEW OR UNIQUE INFORMATION PROVIDED: SEC is considered a marker for thromboembolic disease in people and can occur in dogs in the absence of significant cardiomegaly. SEC in these 3 dogs may be related to the documented hyperfibrinogenemia. Further investigation is warranted to determine whether dogs with SEC are at an increased risk for thromboembolic complications.

Thoracoscopic thoracic duct ligation and thoracoscopic pericardectomy for treatment of chylothorax in dogs.

OBJECTIVE: To report the use of thoracoscopic thoracic duct ligation (TDL) and pericardectomy for treatment of chylothorax. STUDY DESIGN: Case series. ANIMALS: Dogs with chylothorax (n=12). METHODS: Dogs with secondary or idiopathic chylothorax had thoracoscopy performed in sternal recumbency through 3 portals in the caudal right hemithorax for TDL and were then repositioned in dorsal recumbency for pericardectomy. Portals were placed in the 5th and 7th intercostal spaces of the right hemithorax with 1 transdiaphragmatic portal in the right paraxiphoid position. Follow-up was performed by recheck examination or telephone interview to determine outcome. RESULTS: Seven dogs (58%) had idiopathic chylothorax; 6 dogs (85.7%) had complete resolution of their effusion, whereas only 2 of the 5 nonidiopathic dogs (40%) had complete resolution. CONCLUSIONS: Thoracoscopy is minimally invasive, provides excellent observation, and allows for ligation of the thoracic duct in the caudal thorax. Patients with idiopathic chylothorax may have a better prognosis after TDL and pericardectomy than dogs with nonidiopathic chylothorax. CLINICAL RELEVANCE: Thoracoscopy for ligation of the thoracic duct and pericardectomy is an acceptable surgical technique for treatment of chylothorax.