Emergence of multidrug-resistant bacteria isolated from surgical site infection in dogs and cats / [Emergência de bactérias multirresistentes isoladas da infecção no sítio cirúrgico em cães e gatos]

Surgical site infections (SSIs) and antimicrobial resistance among pathogens causing SSI are a growing concern in veterinary hospitals. One major reason, the widespread use of antimicrobials, has led to increased incidence of SSIs. This study identified bacteria and resistance profiles to antimicrobials in the SSI cases diagnosed at the Surgical Clinic of Small Animals in the Veterinary Hospital, Federal University of Viçosa, Brazil. The main genus identified was Staphylococcus, followed by Escherichia, Enterococcus, Bacillus, Shigella, Citrobacter, Proteus, Morganella, Serratia, Enterobacter, Pseudomonas and Klebsiella were also found, but in small number. The results indicated the predominance of Gram-negative bacteria among the collected samples. Most of isolates identified were resistant to more than one of the following antimicrobials: ampicillin, tetracycline, enrofloxacin, amoxicillin/clavulanic acid and cephalotin. Of the 17 Staphylococcus sp. isolates, two (11.8%) were methicillin-resistant Staphylococcus aureus (MRSA) and 11 (64.7%) of them were methicillin-resistant Staphylococcus pseudintermedius (MRSP). There were bacterial genera identified with resistance to all tested antimicrobials in different proportions. This should alert veterinary hospitals to the emergence of multidrug-resistant bacteria and to the requirement for the revision of surgical protocols with regard to antimicrobial prophylaxis and therapy.(AU)

As infecções em sítio cirúrgico (ISCs) e a resistência bacteriana entre os patógenos relacionados constituem uma preocupação crescente nos hospitais veterinários. O aumento na incidência de ISCs possui forte relação com o uso amplo e disseminado de antibióticos. O presente estudo identificou bactérias e perfis de resistência a antibióticos nos casos de ISCs diagnosticados na Clínica Cirúrgica de Pequenos Animais do Hospital Veterinário da Universidade Federal de Viçosa, Brasil. O principal gênero identificado foi Staphylococcus, seguido pelos gêneros Escherichia, Enterococcus, Bacillus, Shigella, Citrobacter, Proteus, Morganella, Serratia, Enterobacter, Pseudomonas e Klebsiella, porém, em menor quantidade. Os resultados demonstraram a predominância de bactérias Gram-negativas entre as amostras coletadas. A maioria dos isolados identificados eram resistentes a um ou a mais de um dos seguintes antibióticos: ampicilina, tetraciclina, enrofloxacina, amoxicilina/ácido clavulânico e cefalotina. Entre os 17 isolados de Staphylococcus sp., dois (11,8%) eram Staphylococcus aureus resistentes à meticilina (SARM) e 11 (64,7%) eram Staphylococcus pseudintermedius resistentes à meticilina (SPRM). Houve identificação de gêneros bacterianos com diferentes proporções de resistência para todos os antibióticos avaliados. Esses achados devem alertar os hospitais veterinários para a emergência de bactérias multirresistentes e para a necessidade de revisar a profilaxia e a terapia antimicrobiana referente aos protocolos cirúrgicos.(AU)

Modelo de indução de osteoporose em coelhas - avaliação radiográfica / Rabbit osteoporosis induction model - radiographic evaluation

In order to establish a bone loss induction model in rabbits to study osteoporosis, 18 rabbits underwent ovariectomy and received methylprednisolone 1mg/kg intramuscularly on alternate days for two weeks. Immediately before ovariectomy up to 42 days after methylprednisolone administration, radiographs of the right olecranon were taken in the mediolateral position to evaluate the radiographic optical density. Before the induction of osteoporosis, rabbits presented mean values of radiographic density of 2.305mm Al and at 42 days of 1.575mm Al. The values obtained were submitted to ANOVA for repeated measures that revealed a significant drop (P< 0.001) in the density over time, proving that the induction was able to trigger bone loss of these animals. With this, it can be affirmed that the adopted protocol was enough to provoke a significant bone loss, characterizing a valid model for the study of new treatments for osteoporosis.(AU)

Treatment of periodontal disease with guided tissue regeneration technique using a hydroxyapatite and polycaprolactone membrane / Tratamento da doença periodontal pela técnica da regeneração tecidual guiada utilizando uma membrana de hidroxiapatita e policaprolactona

The aim of this study was to evaluate the use of a malleable membrane composed of hydroxyapatite (60%) and polycaprolactone (40%) as treatment of periodontal disease experimentally induced in dogs. A bone defect of standardized dimensions was created between the roots of the third and fourth premolar of 12 dogs for periodontal disease induction. Six dogs had the defect covered by the membrane and six dogs received only standard treatment for periodontal disease, also applied to dogs in the treated group. The animals were clinically monitored during the experiment. Radiographs were taken after surgery and at 60 days after treatment initiation. Clinical attachment level was also assessed in those moments. On the 60th day, dental sample of all animals, containing tooth, defect and periodontal tissues, were harvested, fixed in formalin and analyzed by microtomography and histology. During the experimental period, the animals showed no pain and purulent discharge, however, there was dehiscence in 50% of animals and membrane exposure in five out of six animals in the treated group. Clinical attachment level showed no difference between groups. Radiographs showed radiopacity equal to the alveolar bone in both groups. The microtomography revealed that the control group had higher bone volume in the defect compared to the treated group; however, the furcation was not filled by new alveolar bone in any animal. Histological analysis revealed that junctional epithelium invasion was lighter in the control group. New bone was only observed in the apical edge of the defect in both groups. Although the composite is biocompatible and able to keep the space of the defect, it did not promote periodontal tissue regeneration within 60 days of observation.(AU)

O objetivo do presente trabalho foi avaliar a utilização de membrana moldável constituída por hidroxiapatita (60%) e policaprolactona (40%) como tratamento da doença periodontal, induzida experimentalmente em cães. Um defeito ósseo de dimensões padronizadas foi realizado entre as raízes do terceiro e do quarto pré-molares de 12 cães para indução da doença periodontal. Todos os cães receberam tratamento padrão para doença periodontal, e seis desses animais foram tratados também com a aplicação da membrana sobre o defeito. Os animais foram acompanhados clinicamente durante o experimento. Radiografias foram realizadas no pós-operatório e aos 60 dias após o início do tratamento. O nível clínico de inserção também foi avaliado nesses momentos. Aos 60 dias, a amostra dental de todos os animais contendo o dente, o defeito e os tecidos periodontais foi coletada, fixada em formol e analisada por microtomografia e histologia. Durante o período experimental, os animais não apresentaram dor e secreção purulenta, entretanto houve deiscência em 50% dos animais e exposição de membrana em cinco dos seis animais do grupo tratado. Nível clínico de inserção não apresentou diferença entre os grupos. As imagens radiográficas mostraram radiopacidade igual ao osso alveolar em ambos os grupos. A microtomografia revelou que o grupo controle apresentou maior volume ósseo no defeito em relação ao grupo tratado, no entanto, em todos os animais, a região de furca não foi preenchida por novo osso alveolar. A análise histológica revelou que a invasão por epitélio juncional foi mais discreta no grupo controle. Osso novo foi apenas observado na borda apical do defeito em ambos os grupos. Embora o compósito seja biocompatível e tenha sido capaz de manter o espaço do defeito, ele não promoveu a regeneração dos tecidos periodontais no período de 60 dias de observação.(AU)

Hydroxyapatite, polycaprolactone and alendronate composites for bone regeneration in rabbits' olecranon: histological features / Compósitos de hidroxiapatita, policaprolactona e alendronato na regeneração óssea em olécrano de coelhos: características histológicas

O presente trabalho teve como objetivo avaliar a biocompatibilidade e a osseointegração de compósitos de hidroxiapatita (HA), policaprolactona (PCL) e alendronato (ALN) em defeitos ósseos produzidos no olécrano de coelhos. Trinta e seis coelhos foram distribuídos em quatro grupos, recebendo como tratamento: (1) compósito de HA (49,5%), PCL (49,5%) e ALN (1%); (2) HA (50%) e PCL (50%); (3) PCL (100%); e (4) solução salina 0,9%. As amostras para análise histológica foram coletadas de três animais de cada grupo aos oito, 45 e 90 dias de pós-operatório. No oitavo dia, as bordas do defeito ainda eram identificáveis em todos os grupos. Tecido ósseo novo era formado em contato com o biomaterial apenas nas formulações que incluíam HA. Essas características continuaram evidentes nos outros momentos analisados, embora o defeito estivesse preenchido pelo tecido regenerado. A presença dos biomateriais foi verificada nos três momentos em todos os grupos. Não houve evidências de reação indesejável ao biomaterial. As análises histológicas e histomorfométricas mostraram que os biomateriais são biocompatíveis e aqueles contendo a hidroxiapatita favoreceram a formação óssea no início do processo de regeneração, embora o alendronato não tenha apresentado qualquer efeito.

Hydroxyapatite, polycaprolactone and alendronate composites for bone regeneration in rabbits' olecranon: histological features / Compósitos de hidroxiapatita, policaprolactona e alendronato na regeneração óssea em olécrano de coelhos: características histológicas

O presente trabalho teve como objetivo avaliar a biocompatibilidade e a osseointegração de compósitos de hidroxiapatita (HA), policaprolactona (PCL) e alendronato (ALN) em defeitos ósseos produzidos no olécrano de coelhos. Trinta e seis coelhos foram distribuídos em quatro grupos, recebendo como tratamento: (1) compósito de HA (49,5%), PCL (49,5%) e ALN (1%); (2) HA (50%) e PCL (50%); (3) PCL (100%); e (4) solução salina 0,9%. As amostras para análise histológica foram coletadas de três animais de cada grupo aos oito, 45 e 90 dias de pós-operatório. No oitavo dia, as bordas do defeito ainda eram identificáveis em todos os grupos. Tecido ósseo novo era formado em contato com o biomaterial apenas nas formulações que incluíam HA. Essas características continuaram evidentes nos outros momentos analisados, embora o defeito estivesse preenchido pelo tecido regenerado. A presença dos biomateriais foi verificada nos três momentos em todos os grupos. Não houve evidências de reação indesejável ao biomaterial. As análises histológicas e histomorfométricas mostraram que os biomateriais são biocompatíveis e aqueles contendo a hidroxiapatita favoreceram a formação óssea no início do processo de regeneração, embora o alendronato não tenha apresentado qualquer efeito.(AU)

Chondroitin sulfate and glucosamine in the cartilage and subchondral bone repair of dogs - Histological findings / Sulfato de condroitina e glucosamina na reparação da cartilagem e do osso subcondral de cães - Achados histológicos

Chondroitin and glucosamine sulfate nutraceuticals are commonly used in the management of degenerative articular disease in veterinary routine. However, there are controversies on the contribution of these substances to articular cartilage. The purpose of this study was to evaluate the efficiency of a chondroitin and glucosamine sulfate-based veterinary nutraceutical on the repair of an induced osteochondral defect in a dog femoral condyle, by macroscopic, histological and histomorphometric analyses. The nutraceutical was orally administered the day following injury induction, every 24 hours (treated group, TG, n=24), compared with animals that did not receive the product (control group, CG, n=24). Six animals per group were anaesthetized for sample collection at 15, 30, 60 and 90 days after surgery. At 15 days, defects were macroscopically filled with red-pinkish tissue. After 30 days, whitish color tissue was observed, both in TG and CG animals, with firmer consistency to touch at 60 and 90 postoperative days. Histological analysis demonstrated that, in both groups, there was initial blood clot formation, which was subsequently substituted by a fibrin net, with capillary proliferation from the adjacent bone marrow and infiltration of mesenchymal cells in clot periphery. As cellular differentiation developed, repair tissue presented a fibrocartilage aspect most of the time, and new subchondral bone formation occurred in the deepest area corresponding to the defect. Histomorphometry suggested that the nutraceutical did not favor the articular cartilage repair process. It was concluded that nutraceutical did not significantly influence chondrocytes proliferation or hyaline architecture restoration.(AU)

Os nutracêuticos compostos de sulfato de condroitina e glucosamina são comumente utilizados no manejo da doença articular degenerativa na rotina veterinária. Entretanto, existem controvérsias sobre a contribuição dessas substâncias à cartilagem articular. O objetivo deste trabalho foi avaliar a eficácia de um nutracêutico veterinário à base de sulfato de condroitina e glucosamina na reparação de defeitos osteocondrais induzidos no côndilo femoral de cães, através de análises macroscópica, histológica e histomorfométrica. O nutracêutico foi administrado no dia seguinte à indução da lesão, pela via oral, a cada 24 horas (grupo tratado - GT, 24 animais), sendo comparado a animais que não receberam o produto (grupo controle - GC, de igual número de animais). Aos 15, 30, 60 e 90 dias após a cirurgia, seis animais por grupo foram anestesiados para ser realizada a coleta das amostras. Aos 15 dias, os defeitos eram macroscopicamente preenchidos por tecido de coloração rósea a avermelhada. Já a partir dos 30 dias, observou-se preenchimento por tecido de coloração esbranquiçada, tanto nos animais do GT quanto nos do GC, com consistência mais firme ao toque digital aos 60 e 90 dias de pós-operatório. A análise histológica revelou que, em ambos os grupos, houve inicialmente formação de coágulo sanguíneo que, posteriormente, foi substituído por uma rede de fibrina, com proliferação de capilares a partir da medula óssea adjacente e infiltração de células mesenquimais na periferia do coágulo. À medida que se processou a diferenciação celular, o tecido de reparação se apresentou na maioria das vezes com aspecto de fibrocartilagem e, na região mais profunda da área correspondente ao defeito, ocorreu formação de osso novo subcondral. A histomorfometria sugeriu que o nutracêutico não favoreceu o processo de reparação da cartilagem articular. Concluiu-se que o nutracêutico não influenciou consideravelmente na proliferação de condrócitos nem na restauração da arquitetura hialina.(AU)

A new surgical technique to treat corneal perforations using amniotic membrane and surgical adhesive / Nova técnica cirúrgica para tratamento de perfuração de córnea utilizando membrana amniótica e adesivo cirúrgico

The objectives of this study were to compare surgical techniques and the effects of using n-butyl 2-cyanoacrylate and bovine amniotic membrane to repair perforated lesions in corneas. Penetrating keratoplasty was performed in sixty New Zealand White rabbits under general anesthesia. Group 1 (G1) was treated with n-butyl 2-cyanoacrylate, group 2 (G2) received a fragment of amniotic membrane through the anterior chamber and application of n-butyl 2-cyanoacrylate over the lesion, group 3 (G3) was treated with the same technique as G2 with the addition of an amniotic membrane bandage covering the cornea and sutured in the limbus region, and group 4 (G4) was treated with an amniotic membrane sutured to the lesion and an amniotic membrane bandage sutured in the limbus region. Clinical, histological and histomorphometric examinations of the corneas were performed. The membrane acted as a barrier for aqueous humor in G2 and G3, thereby keeping the surface dry for adhesive application; it also prevented the adhesive from contacting intraocular structures. The groups treated with amniotic membrane and surgical adhesive showed better results than the groups treated with either material alone. Thus, the combination of the membrane with the adhesive is recommended for this type of lesion...

Os objetivos deste estudo foram comparar técnicas cirúrgicas e efeitos do n-butil 2-cianoacrilato e da membrana amniótica bovina na reparação de lesões perfuradas em córneas. Sessenta coelhos da raça Nova Zelândia Branca foram submetidos à ceratoplastia penetrante sob anestesia geral. O grupo 1 (G1) foi tratado com n-butil 2-cianoacrilato; o grupo 2 (G2) recebeu um fragmento de membrana amniótica pela câmara anterior e aplicação de n-butil 2-cianoacrilato sobre a lesão; o grupo 3 (G3) foi tratado com a mesma técnica aplicada ao G2, adicionando-se uma bandagem de membrana amniótica cobrindo a córnea e suturada à região do limbo; e o grupo 4 (G4) foi tratado com membrana amniótica suturada nas bordas da lesão e bandagem de membrana amniótica suturada na região do limbo. Foram realizados exames clínico, histológico e histomorfométrico. A membrana atuou como barreira contra o extravasamento do humor aquoso nos grupos 2 e 3, manteve a superfície seca para posterior aplicação do adesivo e impediu o contato do adesivo com as estruturas intraoculares. Os grupos tratados com o adesivo associado à membrana amniótica demonstraram melhores resultados do que aqueles tratados com cada material isoladamente. Assim, a combinação da membrana com o adesivo é indicada neste tipo de lesão...

Molecular sexing of unusually large numbers of Spheniscus magellanicus (Spheniscidae) washed ashore along the Brazilian coast in 2008.

There have been few studies on Magellanic penguins (Spheniscus magellanicus). In 2008, these penguins washed ashore along the Brazilian coast in unusually high numbers, some reaching as far as northeast Brazil. As Magellanic penguins show little sexual dimorphism, sex determination by morphological features is not accurate. Here, we tested a molecular procedure for sexing specimens of S. magellanicus washed ashore along the coasts of Sergipe, Rio de Janeiro and Rio Grande do Sul in 2008, comparing the sex ratio between these localities. Tissue samples were collected from 135 dead, beached specimens. We carried out total genomic DNA extraction and CHD-Z/CHD-W gene amplification by PCR using P2 and P8 primers. Amplicons were separated by 12% acrylamide gel electrophoresis. We found a greater proportion of females (70%). Sex could be determined because females have two intronic regions of CHD gene of different size in the sex chromosomes, visualized as two bands on the gel (380 and 400 bp approximately), while males have only one (400 bp). Therefore, this method proved to be effective and sensitive for sex determination of S. magellanicus individuals. Data on sex ratios are useful for understanding the dynamics and ecology of Magellanic penguin populations.

Avaliação histológica do biovidro particulado na reparação de defeito experimental em mandíbula de cães / Histological evaluation of particulate bioglass in repair of mandible experimental defects in dogs

Avaliou-se histologicamente o biovidro particulado como substituto ósseo na regeneração de defeitos no osso alveolar da mandíbula, utilizando-se 28 cães adultos, divididos em dois grupos. Foram criados defeitos ósseos na superfície vestibular da mandíbula, entre as raízes mesial e distal do quarto pré-molar direito. No grupo tratado, o defeito foi preenchido com biovidro enquanto no outro, o grupo-controle, o defeito permaneceu sem preenchimento. Aos 8, 14, 21, 42, 60, 90 e 120 dias do pós-operatório, foram coletadas amostras da região da falha óssea de dois animais de cada grupo para a análise histológica sob microscopia de luz. No grupo-controle, observou-se início do processo de reparação óssea aos 14 dias que evoluiu até que, aos 120 dias, não havia mais limite entre as margens do defeito e o novo osso. No grupo tratado, aos oito dias, observou-se a presença de tecido conjuntivo frouxo altamente vascularizado ao redor das partículas de biovidro, até que aos 60 dias o biovidro havia sido totalmente reabsorvido, e o defeito apresentava-se completamente preenchido por osso trabecular. Conclui-se que o biovidro é biocompatível, é osteocondutor e diminui o tempo de reparação do osso alveolar.

By histological analyses, bioglass was evaluated as a bone substitute in the regeneration of alveolar bone defects in mandibles of 28 dogs, which were distributed in two groups. Defects were made in the vestibular surface of the mandible between the roots of the right fourth premolar tooth. In treated group, defects were filled with bioglass, while it did not receive any treatment in the other, being used as control. For histological analyses, samples including the bone defect area of two animals per group were collected after 8, 14, 21, 42, 60, 90, and 120 days after surgery. In the control group, bone repair began on the day 14th, developing until the day 120th, when no limit between the margins of the defect and the new bone existed. In the treated group, at the day eightieth, loose connective tissue highly vascularized around the bioglass particles was observed and on the day 60th, bioglass had been totally reabsorbed and the defect was completely filled by trabecular bone. It can be concluded that the bioglass is biocompatible and osteoconductive, and shortens the time needed for alveolar bone repair.

Detection of polymorphisms of the mtDNA control region of Caretta caretta (Testudines: Cheloniidae) by PCR-SSCP.

Marine turtles are increasingly being threatened worldwide by anthropogenic activities. Better understanding of their life cycle, behavior and population structure is imperative for the design of adequate conservation strategies. The mtDNA control region is a fast-evolving matrilineal marker that has been employed in the study of marine turtle populations. We developed and tested a simple molecular tracing system for Caretta caretta mtDNA haplotypes by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). Using this technique, we were able to distinguish the SSCP patterns of 18 individuals of the haplotypes CC-A4, CC-A24 and CCxLO, which are commonly found in turtles sampled on the Brazilian coast. When we analyzed 15 turtles with previously unknown sequences, we detected two other haplotypes, in addition to the other four. Based on DNA sequencing, they were identified as the CC-A17 and CC-A1 haplotypes. Further analyses were made with the sea turtles, Chelonia mydas (N = 8), Lepidochelys olivacea (N = 3) and Eretmochelys imbricata (N = 1), demonstrating that the PCR-SSCP technique is able to distinguish intra- and interspecific variation in the family Cheloniidae. We found that this technique can be useful for identifying sea turtle mtDNA haplotypes, reducing the need for sequencing.

Intrastriatal administration of 5-aminolevulinic acid induces convulsions and body asymmetry through glutamatergic mechanisms.

The involvement of glutamatergic and GABAergic mechanisms in the behavioral effects induced by the intrastriatal injection of 5-aminolevulinic acid (ALA) (1-8 mgr;mol/2 mgr;l), a metabolite that accumulates in porphyrias, was evaluated. ALA administration to adult female rats increased locomotor activity, induced clonic convulsions and elicited dose-dependent body asymmetry assessed by the elevated body swing test. ALA-induced convulsions were prevented by intrastriatal preadministration of the glutamate antagonists, 6, 7-dinitroquinoxaline-2,3-dione (8 nmol/0.5 microl) or dizocilpine (2. 5 nmol/0.5 microl), but not by the GABA agonist, muscimol (46 pmol/0. 5 microl). Body asymmetry was prevented only by 6, 7-dinitroquinoxaline-2,3-dione pretreatment. A higher dose of muscimol (92 pmol/0.5 microl) prevented both ALA-induced convulsions and body asymmetry. However, this dose of muscimol induced motor biases, which make difficult to ascertain the involvement of GABA(A) receptors in ALA-induced behavioral effects. This study suggests that glutamatergic mechanisms underlie the ALA-induced convulsions and body asymmetry. The present results may be of value in understanding the physiopathology of the neurological dysfunction occurring in acute porphyrias.

The impact of anti-drug advertising. Perceptions of middle and high school students.

OBJECTIVES: To examine the perceived impact of anti-drug advertising on the knowledge, beliefs, attitudes, and behavior pertaining to youth drug use and to evaluate the influence of demographic characteristics, media exposure, and substance use on the likelihood of perceiving a deterrent effect of anti-drug advertisements. DESIGN: Anonymous, self-administered survey. SETTING: Urban and suburban public schools. PARTICIPANTS: Eight hundred thirty-seven students in middle and high school (52% suburban, 50% male, 48% white) were studied in group convenience samples. OUTCOME MEASURES: Self-report of the impact of anti-drug advertising on knowledge, beliefs, attitudes, and behavior pertaining to drug use. RESULTS: Overall, 83% (95% confidence interval [CI], 80% to 86%) of the student sample was exposed to anti-drug advertising. A majority of these students reported a positive impact of anti-drug advertisements: 92% (95% CI, 89% to 95%) perceived an increase in their knowledge of drugs; 60% (95% CI, 56% to 64%) felt they gained stronger beliefs about the dangers of drugs; 52% (95% CI, 48% to 56%) felt they developed more negative attitudes toward drug users; and 75% (95% CI, 72% to 78%) reported that they had decreased, stopped, or been convinced never to initiate drug use. Multivariate analysis revealed that the non-drug-using, urban, and younger students were most likely to perceive a deterrent impact on behavior. CONCLUSION: Anti-drug advertising was perceived to have a deterrent effect on self-reported substance use among this population of adolescents.

Barriers to use of oral rehydration therapy.

OBJECTIVE: To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners. DESIGN: Cross-sectional, anonymous, self-administered survey of physicians' ORT knowledge, attitudes, and practice. SETTING: A national continuing medical education conference. PARTICIPANTS: One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%). MEASUREMENTS AND RESULTS: Most respondents (83%) reported that ORT plays an important role in their management of dehydration. However, compliance with guidelines from the American Academy of Pediatrics for use of oral therapy is limited: 30% withhold ORT in children with vomiting or moderate dehydration, 50% fail to advise prompt refeeding, and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians' practice was negatively associated with reported lack of convenience of ORT administration in the practice setting (P < .001), support staff preference for intravenous versus ORT (P < .001), need for additional training of support staff to implement ORT (P < .01), and likelihood of reimbursement for intravenous versus ORT (P = .07). Notably, degree of importance of ORT was not associated with physician ORT knowledge. CONCLUSION: Efforts to improve use of ORT should be expanded beyond physician education and focus on such barriers as support staff limitations and financial constraints.