Design and Implementation of a Safe Equine Radiation-Free Radiographic Simulator for Veterinary Skills Training in the Pre-clinical Curriculum.

The ninth standard of accreditation as outlined by the American Veterinary Medical Association (AVMA) Council on Education (COE) mandates that all accredited colleges of veterinary medicine must provide instruction in medicine and surgery, including principles of practice, hands-on experiences with diagnostic methods, and interpretation of clinical findings. In equine practice, diagnostic imaging is used as a first-line diagnostic approach and is an integral part of pre-purchase and lameness examinations. Accuracy and consistency of radiographic interpretation relies heavily upon procedural techniques to acquire diagnostic images and overcome both motion artifacts and obliquity. Because the sizes and temperaments of equine patients potentiate hazardous working conditions for the veterinary team, learners might benefit from simulations that allow them to practice holding the x-ray generator and the imaging plate for diagnostic image acquisition in the absence of live horses. This teaching tip describes the development of a novel equine radiographic simulator for skills training in the veterinary curriculum. The model allows learners to handle imaging equipment safely and without radiation exposure as they develop proficiency positioning radiographic plates and placing directional markers. Learners can also test their understanding of radiographic positioning in reverse: if given a radiograph, they can be asked to describe how the x-ray generator was positioned to obtain the diagnostic image. Future iterations will investigate the simulator's efficacy with respect to learning outcomes when the model is paired with an assessment rubric as part of an objective standardized clinical examination.

Evaluating Communication Training at AVMA COE-Accredited Institutions and the Need to Consider Diversity within Simulated Client Pools.

The push for competency-based veterinary medical education by accrediting bodies has led to the inclusion of non-technical skills within curricula. Communication, self-awareness, and cultural humility are considered essential for post-graduate success. To facilitate skills development, veterinary educators have incorporated a variety of modalities including lecture, group discussions, virtual and peer-assisted learning, role play, video review of consultations, and simulated clients (SCs). The overarching goal is developing students into self-reflective practitioners through exposure to clinical scenarios that enhance and embody diversity. Decision making about case management is subject to stereotypes, bias, and assumptions. Racial and ethnic disparities reported in health care can adversely impact patient outcomes. This study was conducted to evaluate communication training and diversity among SC pools within veterinary colleges. A questionnaire was electronically disseminated to assistant/associate deans and/or directors of curriculum/education at 54 American Veterinary Medical Association Council on Education-accredited or provisionally accredited colleges of veterinary medicine. Twenty-one institutions are represented within the data set. Participating institutions summarized their communication curricula: 18 (85.71%) used SCs. Over 55% of these did not track SC demographic data or social identities; among institutions that did track, SCs were primarily monolingual English-speaking (77%), non-disabled (94.2%), white (90.4%), non-Hispanic/Latinx (98.6%) women (57%) over age 56 (64%). Sixteen institutions agreed with the statement "I do not feel that our SC pool is adequately diverse." Respondents shared that lack of time and capacity for recruitment were barriers to diversifying SC pools and proposed strategies to improve outreach.

Integrating Communication Skills, Awareness of Self and Others, and Reflective Feedback into One Inclusive Anatomical Representation of Relationship-Centered Health Care.

The American Veterinary Medical Association Council on Education mandates in standard 11 that all accredited colleges of veterinary medicine must develop and deliver formal processes by which students are observed and assessed in nine competencies. The eighth competency combines clinical communication and sensitivity toward soliciting and understanding individual narratives across a diverse clientele to facilitate health care delivery. Several frameworks have been designed to structure health care consultations for teaching and coaching purposes. The Calgary-Cambridge guide (CCG) provides an evidence-based approach to outlining the flow of consultations, incorporating foundational communication skills and elements of relationship-centered care into a series of sequential tasks. Although the CCG was intended for use as a flexible tool kit, it lacks visible connections between concrete experiences (e.g., the consultation) and reflective observation (e.g., the feedback). This teaching tip describes the development of a novel anatomical representation of the consultation that integrates process elements of the CCG with other core curricular concepts. By combining knowledge, technical skills, critical thinking, reflection, cultural humility, and self-awareness into a skeletal consultation model, linkages are established between communication and intergroup dialogue skills, diversity and inclusion (D&I). This model has been further adapted as feline, caprine, porcine, equine, avian, and reptilian versions for in-class use as strategic visual aids that highlight key areas of focus for Professional Skills class sessions. Future developments by the authors will explore how to link species-specific consultation models to assessment rubrics to reinforce the connection between content (what) and process (how).

Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters.

The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.

Using a Standardized Client Encounter to Practice Death Notification after the Unexpected Death of a Feline Patient Following Routine Ovariohysterectomy.

Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what not to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.

The Effect of Simulation Training in Anesthesia on Student Operational Performance and Patient Safety.

A veterinary anesthesia simulated environment (VASE) with clinical scenarios has been integrated into the pre-clinical curriculum at Midwestern University College of Veterinary Medicine to simulate anesthesia of a live patient within a surgical suite. Although this modality was shown to significantly improve veterinary students' perceived preparedness to perform anesthesia on live patients, whether this would improve anesthesia competency in the actual clinical environment, described as operational performance, remained unclear. Our goal was to examine the relationship between anesthesia simulation training and student anesthesia operational performance. Anesthesia operational performance assessment of students was determined by quantifying critical event occurrences that negatively impacted patient safety during the anesthesia of 287 patients during students' initial surgical experience in 2015 and 2016. The relationship between total numbers of critical incidents to students having anesthesia simulation training was determined through evaluation of anesthesia records from 2015 and 2016, where students did not have anesthesia simulation training or they had pre-clinical training, respectively. Results showed a significant relationship between simulation training and critical incident occurrence, with a critical incident more likely to occur during patient anesthesia for students who did not experience pre-clinical anesthesia simulation training. Of the total critical incidents that occurred in the two-year study, 88% were in patients anesthetized by students who did not have simulation training. Our findings suggest that students who were given the opportunity to participate in anesthesia-focused simulations before a live-animal anesthesia encounter demonstrated significant improvements in anesthesia operational performance and improved patient safety.

Using a Standardized Client Encounter in the Veterinary Curriculum to Practice Veterinarian-Employer Discussions about Animal Cruelty Reporting.

Animal cruelty is the antithesis of animal welfare. Because veterinarians take an oath to protect animal welfare, they are professionally obligated to report animal cruelty. Several US states have mandatory reporting laws for veterinarians, and both the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association support reporting. Some state veterinary practice acts, such as Arizona's, also require reporting. Despite this, animal cruelty is not always emphasized in veterinary curricula. As a result, not all veterinary students and graduates feel comfortable recognizing signs of animal cruelty and may not be aware of the resources that are available to them when considering reporting. AVMA suggests that practices develop their own protocols for identifying signs that patients may have been victims of cruelty and consulting on cases with senior colleagues with regard to when to report. To enhance student comfort with these conversations, Midwestern University College of Veterinary Medicine developed a standardized client encounter titled "Grizabella's Final Fight." I hope that other colleges of veterinary medicine will adapt this teaching tool to allow students the opportunity to practice discussions surrounding animal cruelty reporting in the context of state-specific legislation that guides their code of professional conduct.

Evaluating Dog- and Cat-Owner Preferences for Calgary-Cambridge Communication Skills: Results of a Questionnaire.

Veterinary client retention by companion animal practices is influenced by whether the client feels connected to the healthcare provider. Effective communication between the veterinarian and the client facilitates that connection. To prepare new graduates for success in clinical practice, many colleges of veterinary medicine are now incorporating communication into the curriculum to emphasize its importance in establishing and maintaining the veterinarian-client relationship. A 2016 focus group study by Englar et al. evaluated dog and cat owner communication preferences for Calgary-Cambridge Guide (CCG) communication skills and concluded that dog and cat owners may have different communication needs. This study was conducted to confirm whether species-based communication preferences exist among veterinary clients. A questionnaire was distributed online and on-site, within veterinary teaching hospitals and private practices. Based upon 215 submissions from dog owners and 166 from cat owners, the communication preferences of dog and cat owners overlap. Both dog and cat owners prioritize reflective listening as the most important foundational CCG communication skill, and both prioritize asking permission as the most important core CCG skill. However, dog owners valued open-ended questions more than cat owners, and cat owners valued empathy more than dog owners. Survey limitations were largely demographic: participants were predominantly female and between the ages of 18-40 years. Survey data may therefore not be representative of the perspective of males and/or those >40 years of age.

Perceptions of the Veterinary Profession among Human Health Care Students before an Inter-Professional Education Course at Midwestern University.

Conflicts among health care professionals often stem from misperceptions about each profession's role in the health care industry. These divisive tendencies impede progress in multidisciplinary collaborations to improve human, animal, and environmental health. Inter-professional education (IPE) may repair rifts between health care professions by encouraging students to share their professional identities with colleagues in unrelated health care disciplines. An online survey was conducted at Midwestern University (MWU) to identify baseline perceptions about veterinary medicine among entry-level human health care students before their enrollment in an inter-professional course. Participation was anonymous and voluntary. The survey included Likert-type scales and free-text questions. Survey participants expressed their interest in and respect for the discipline of veterinary medicine, but indicated that their unfamiliarity with the profession hindered their ability to collaborate. Twenty percent of human health care students did not know the length of a Doctor of Veterinary Medicine (DVM) program and 27.6% were unaware that veterinarians could specialize. Although 83.2% of participants agreed that maintaining the human-animal bond is a central role of the veterinary profession, veterinary contributions to stem cell research, food and water safety, public health, environmental conservation, and the military were infrequently recognized. If IPE is to successfully pave the way for multidisciplinary collaboration, it needs to address these gaps in knowledge and broaden the definition of veterinary practice for future human health care providers.

Teaching Tip: Development of Veterinary Anesthesia Simulations for Pre-Clinical Training: Design, Implementation, and Evaluation Based on Student Perspectives.

Anesthesia simulations have been used in pre-clinical medical training for decades to help learners gain confidence and expertise in an operating room environment without danger to a live patient. The authors describe a veterinary anesthesia simulation environment (VASE) with anesthesia scenarios developed to provide a re-creation of a veterinarian's task environment while performing anesthesia. The VASE uses advanced computer technology with simulator inputs provided from standard monitoring equipment in common use during veterinary anesthesia and a commercial canine training mannequin that allows intubation, ventilation, and venous access. The simulation outputs are determined by a script that outlines routine anesthesia scenarios and describes the consequences of students' hands-on actions and interventions during preestablished anesthetic tasks and critical incidents. Patients' monitored physiologic parameters may be changed according to predetermined learner events and students' interventions to provide immediate learner feedback and clinical realism. A total of 96 students from the pre-clinical anesthesia course participated in the simulations and the pre- and post-simulation surveys evaluating students' perspectives. Results of the surveys and comparisons of overall categorical cumulative responses in the pre- and post-simulation surveys indicated improvement in learners' perceived preparedness and confidence as a result of the simulated anesthesia experience, with significant improvement in the strongly agree, moderately agree, and agree categories (p<.05 at a 95% CI). These results suggest that anesthesia simulations in the VASE may complement traditional teaching methods through experiential learning and may help foster classroom-to-clinic transference of knowledge and skills without harm to an animal.

A Novel Approach to Simulation-Based Education for Veterinary Medical Communication Training Over Eight Consecutive Pre-Clinical Quarters.

Experiential learning through the use of standardized patients (SPs) is the primary way by which human medical schools teach clinical communication. The profession of veterinary medicine has followed suit in response to new graduates' and their employers' concerns that veterinary interpersonal skills are weak and unsatisfactory. As a result, standardized clients (SCs) are increasingly relied upon as invaluable teaching tools within veterinary curricula to advance relationship-centered care in the context of a clinical scenario. However, there is little to no uniformity in the approach that various colleges of veterinary medicine take when designing simulation-based education (SBE). A further complication is that programs with pre-conceived curricula must now make room for training in clinical communication. Curricular time constraints challenge veterinary colleges to individually decide how best to utilize SCs in what time is available. Because it is a new program, Midwestern University College of Veterinary Medicine (MWU CVM) has had the flexibility and the freedom to prioritize an innovative approach to SBE. The author discusses the SBE that is currently underway at MWU CVM, which incorporates 27 standardized client encounters over eight consecutive pre-clinical quarters. Prior to entering clinical rotations, MWU CVM students are exposed to a variety of simulation formats, species, clients, settings, presenting complaints, and communication tasks. These represent key learning opportunities for students to practice clinical communication, develop self-awareness, and strategize their approach to future clinical experiences.

Development of Veterinary Anesthesia Simulations for Pre-Clinical Training: Design, Implementation, and Evaluation Based on Student Perspectives.

Anesthesia simulations have been used in pre-clinical medical training for decades to help learners gain confidence and expertise in an operating room environment without danger to a live patient. The authors describe a veterinary anesthesia simulation environment (VASE) with anesthesia scenarios developed to provide a re-creation of a veterinarian's task environment while performing anesthesia. The VASE uses advanced computer technology with simulator inputs provided from standard monitoring equipment in common use during veterinary anesthesia and a commercial canine training mannequin that allows intubation, ventilation, and venous access. The simulation outputs are determined by a script that outlines routine anesthesia scenarios and describes the consequences of students' hands-on actions and interventions during preestablished anesthetic tasks and critical incidents. Patients' monitored physiologic parameters may be changed according to predetermined learner events and students' interventions to provide immediate learner feedback and clinical realism. A total of 96 students from the pre-clinical anesthesia course participated in the simulations and the pre- and post-simulation surveys evaluating students' perspectives. Results of the surveys and comparisons of overall categorical cumulative responses in the pre- and post-simulation surveys indicated improvement in learners' perceived preparedness and confidence as a result of the simulated anesthesia experience, with significant improvement in the strongly agree, moderately agree, and agree categories (p<.05 at a 95% CI). These results suggest that anesthesia simulations in the VASE may complement traditional teaching methods through experiential learning and may help foster classroom-to-clinic transference of knowledge and skills without harm to an animal.

Applicability of the Calgary-Cambridge Guide to Dog and Cat Owners for Teaching Veterinary Clinical Communications.

Effective communication in health care benefits patients. Medical and veterinary schools not only have a responsibility to teach communication skills, the American Veterinary Medical Association (AVMA) Council on Education (COE) requires that communication be taught in all accredited colleges of veterinary medicine. However, the best strategy for designing a communications curriculum is unclear. The Calgary-Cambridge Guide (CCG) is one of many models developed in human medicine as an evidence-based approach to structuring the clinical consultation through 71 communication skills. The model has been revised by Radford et al. (2006) for use in veterinary curricula; however, the best approach for veterinary educators to teach communication remains to be determined. This qualitative study investigated if one adaptation of the CCG currently taught at Midwestern University College of Veterinary Medicine (MWU CVM) fulfills client expectations of what constitutes clinically effective communication. Two focus groups (cat owners and dog owners) were conducted with a total of 13 participants to identify common themes in veterinary communication. Participants compared communication skills they valued to those taught by MWU CVM. The results indicated that while the CCG skills that MWU CVM adopted are applicable to cat and dog owners, they are not comprehensive. Participants expressed the need to expand the skillset to include compassionate transparency and unconditional positive regard. Participants also expressed different communication needs that were attributed to the species of companion animal owned.

Recasting the gold standard - part II of II: communicating healthcare options along a continuum of care.

SERIES OUTLINE: This is the second part of a two-part series on spectrum of care that encourages practitioners to tailor case management to the patient along a continuum of acceptable options. Part I defined the spectrum of care and broadened its approach beyond initial cost-of-care considerations. This second article introduces strategies for initiating conversations with clients about their needs, wants and expectations specific to healthcare options and case management decisions. It will explore how open inquiry, reflective listening, transparency and unconditional positive regard facilitate dialogue between providers and their clients as they collaborate on decision-making along a spectrum of care. RELEVANCE: Contextual case management prioritizes interventions that are appropriate for both the patient and the client. To identify and explore which healthcare options represent the best fit for those impacted most by medical decisions, veterinarians need to make space for clients to feel comfortable sharing their perspectives. Clients are more likely to be engaged in decision-making when their insight is actively solicited. They have much to share with us as experts about their cat's overall health and wellness needs. Inviting clients to contribute to the consultation and being receptive to hearing what motivates their choices helps us to structure conversations around healthcare options. The ability to communicate healthcare options is as vital as the provision of healthcare, if not more so.

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care.

AIM: This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed. RELEVANCE: Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery. SERIES OUTLINE: This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

Clinical findings and prognostic factors for mortality in hospitalized dogs with leishmaniosis: aretrospective study.

This retrospective study evaluated factors responsible for mortality of dogs hospitalized for Canine Leishmaniosis. Medical records of 31 dogs with leishmaniosis from a Portuguese Veterinary Teaching Hospital were examined between August 2018 and January 2022. Females (n = 18) and pure breed dogs (n = 27) were overrepresented, with higher frequency of Labrador Retriever (n = 4). Median age was 7 years (interquartile range=7). Most had historical findings of lethargy (n = 26) and the commonest clinicopathological abnormality was hypoalbuminemia (n = 26). Eleven dogs were classified as LeishVet stage II, 10 stage III and 10 stage IV. Fourteen dogs (45.2%) died or were euthanized, with azotemia, leukocytosis, stage IV, absence of diagnosis before hospitalization and lack of leishmaniosis specific treatment during hospitalization contributing to mortality. Absence of hypoalbuminemia and stages II/III increased survival. Mean hospitalization length prior to discharge was 5.41days ( ± 1.84) and diarrhea prolonged hospital stay.

Ultrasonographic Detected Adrenomegaly in Clinically Ill Cats: A Retrospective Study.

This retrospective study aimed to assess the prevalence of ultrasonographic detected adrenomegaly in clinically ill cats, evaluating the final established diagnosis, describe adrenal ultrasound findings and if the adrenomegaly was suspected or incidental. Abdominal ultrasonography reports of cats presenting to a veterinary teaching hospital between October 2018 and February 2021 were retrospectively reviewed. Cats showing adrenomegaly (one or both glands having a dorsoventral axis >4.8 mm) were selected and medical records respectively evaluated. Nine-hundred and eighty-three ultrasonographical reports were selected, of which, 68 (7%) disclosed adrenomegaly. European/Domestic Short-Hair (62/68; 91%) male (44/68; 65%) castrated (35/44; 80%) cats were overrepresented. Adrenomegaly was an incidental finding in 62/68 (91%) cats while in 6/68 (9%) it was identified in the context of investigating a potential adrenal disease. Concerning established diagnosis, chronic kidney disease was overrepresented (25/68; 37%), followed by endocrinopathies (20/68; 29%). Adrenomegaly was bilateral in 53% (36/68) of cases. In unilateral cases (32/68; 47%), it was more prevalent on the left side (23/32; 72%), with a normal-sized contralateral adrenal gland. Left adrenal demonstrated a larger size and a tendency to oval shape. This study assesses the prevalence of adrenomegaly in clinically ill cats, reinforcing it can be an incidental ultrasound finding.

Xanthinuria secondary to allopurinol treatment in dogs with leishmaniosis: Current perspectives of the Iberian veterinary community.

Xanthinuria is a significant adverse effect in dogs on long-term allopurinol for treatment of leishmaniosis. The study aims to investigate how the Iberian veterinary community (IVC) identifies, manages, and proactively prevents xanthinuria secondary to allopurinol treatment. A cross-sectional study was conducted using an online survey, translated into two languages, and disseminated to the IVC via social networking forums. Respondents were asked to share their treatment regimens, adverse effects attributed to treatment, as well as preventive and reactive measures against xanthuria. Of two-hundred and thirty respondents, 99.6% prescribe allopurinol for canine leishmaniosis. Xanthinuria was estimated to happen in less than one out of every four dogs by 91.7% of the clinicians. Xanthinuria has been detected by 71.6% of respondents at least once. Three out of every four respondents inform owners about deleterious effects of allopurinol, and 28.4% consider implementing a change in diet in advance of treatment as a proactive measure. To monitor xanthinuria, urinalysis and diagnostic imaging are used by 71.2% and 31% of clinicians respectively. When xanthinuria is detected, 43.2% of the respondents discontinue allopurinol, 24% replace it by nucleotide-analogs, 14.9% reduce its dosage, and 3.1% split its dosage but increase administration frequency. Additional measures are taken by 72.1% of the respondents, 59.4% of whom prescribe a low-purine diet. The IVC recognizes xanthinuria as a fairly common secondary effect of long-term allopurinol treatment in dogs with leishmaniosis and recommends periodically monitoring and preventive measures.

Survey of communication challenges that impact relationships between veterinarians and dog or cat breeders and proposed solutions for retaining breeders as clients.

OBJECTIVE: To characterize communication challenges between veterinarians and dog or cat breeders and elicit their perspectives on how professional relationships between the two might be improved. SAMPLE: 793 dog breeders, 540 cat breeders, and 514 veterinarians. PROCEDURES: Veterinarians, cat breeders, and dog breeders were recruited through social media and electronic newsletters from breed registries to complete online surveys about their professional interactions with one another and proposed strategies for improving dialogue. Data used for the study were gathered as categorical or free-text responses. RESULTS: Dog breeders commented that an apparent lack of training in theriogenology among veterinarians was a primary concern. Both dog breeders and cat breeders felt sidelined from patient care when veterinarians were dismissive, made assumptions about their character or motivation for breeding, or expressed disapproval of mating companion animals for profit. Breeders also wanted veterinarians to learn more about reproductive health and disease. Veterinarians expressed disinterest in working with breeders who seemed arrogant, argumentative, or inflexible. Financial constraints and breeders' apparent tendencies to trust anecdotal reports over evidence-based medicine contributed to veterinarians' biases about breeders and presented additional challenges. Each group proposed that communication challenges could be overcome through mutual engagement in active listening, eliciting perspective, assessing knowledge, offering partnership, and withholding judgment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that veterinarians and dog and cat breeders are more alike than dissimilar in terms of communication preferences that facilitate a positive veterinarian-breeder relationship. Understanding how to improve interactions is an important step toward dialogue that facilitates patient care.

Cardiorespiratory Effects of Three Infusion Doses of Adenosine in Conscious Goats: A Preliminary Study.

Adenosine (AD) has been implicated in human healthcare as an endogenous signaling nucleotide in both physiologic and pathologic states. The effects of AD on cardiorespiratory parameters in ruminants has not yet been studied. The objective of this study was to evaluate the cardiac and respiratory changes that resulted from an intravenous AD infusion in goats. Six clinically healthy adult goats weighing 28 ± 2 kg were randomly assigned to one of four treatments in a crossover design with a seven day washout period. The goats received a 0.9 % saline solution (SAL treatment) and three AD treatments (AD 50, 100 and 200) intravenously at a dose rate of 50, 100 and 200 µg/kg/min. Cardiorespiratory and key cardiac parameters were measured before the treatment (baseline), during the infusion (dInf) and at 1, 3, 5 and 10 min after each infusion was discontinued. The AD 100 produced a significant increase in HR (p = 0.001) and the AD 200 resulted in significant rises in HR (p = 0.006) and RR (p = 0.001) compared with the baseline. This study concluded that the AD infusion could trigger an increase in HR and RR in a dose-dependent manner in healthy goats.