Survey investigating factors affecting recruitment and retention in the UK veterinary nursing profession.

BACKGROUND: Recruitment and retention have been identified as contributing factors to workforce shortages in the veterinary team. METHODS: Results from veterinary nurses to an online questionnaire regarding recruitment and retention were analysed. RESULTS: Veterinary nurses had few job changes (median 2); however, 53.8% (n = 1060) reported they were likely or very likely to leave their employment within 2 years. Respondents who were recently qualified (p < 0.001) and on lower salaries (p < 0.001) were significantly more likely to plan to leave. The most frequently chosen reasons to stay in a position were team, location and working hours, while reasons to leave were salary, management and work-life balance. Respondents most disliked 'dealing with people', remuneration and work-life balance and would like to change the salary, management and team aspects. Employers reported difficulty in employing an experienced veterinary nurse. LIMITATIONS: A questionnaire simplifies the nature of retention. Also, a comparatively low number of responses was received, with overrepresentation of some groups. It was conducted in 2018; however, it still provides a useful comparison for studies regarding recent world events. CONCLUSION: The shortage of veterinary nurses is due in part to the lack of retention within the profession. Adequate recompense for work undertaken and value attributed to the role are suggested as contributing factors.

Palmar/plantar oblique projections improve radiographic detection of fractures of the palmar/plantar processes of the equine distal phalanx.

Radiography is a standard diagnostic test for horses with suspected fractures of the palmar/plantar processes (PP) of the distal phalanx, however published studies evaluating the diagnostic utility for radiography are currently lacking. The objectives of this retrospective, diagnostic case-control study were to determine the sensitivity of radiographs for the detection of PP fractures, and determine the diagnostic utility of the palmar/plantar oblique projections of the PP for the identification of PP fractures compared to standard radiographic series. The medical records of horses undergoing MRI examination were reviewed and 23 horses diagnosed with a PP fracture were included as cases for analysis. Forty-six control horses were selected. Radiographs, including palmar/plantar oblique (palmaro/plantaro50o -proximal 45o -medial(lateral)-dorsodistolateral (medial) oblique (PPrM(L)-DDiL(M)O) projections, and MRI images were assessed independently for the presence or absence of PP fractures and the sensitivity and specificity of radiographs for their detection were calculated, using MRI as the gold-standard. A second, blinded, radiographic evaluation excluding the palmar/plantar oblique views was performed. Twenty-seven PP fractures were identified in the 23 case horses on MRI examination. Twenty-two fractures were identified in 20/23 horses on examination of the full radiographic series (sensitivity and specificity of 81.5% and 100% respectively). Fractures were most frequently identified on the palmar/plantar oblique projections (19/22 fractures), followed by the lateromedial projection. Radiographic assessment excluding the palmar/plantar oblique projections identified 18 PP fractures in 16/23 horses. Careful assessment of a standard radiographic series of the foot will allow identification of PP fractures but palmar/plantar oblique projections will improve the detection of these fractures.

Use of quantitative real-time PCR to determine the local inflammatory response in the intestinal mucosa and muscularis of horses undergoing small intestinal resection.

BACKGROUND: Studies in rodents and humans have demonstrated that intestinal manipulation or surgical trauma initiates an inflammatory response in the intestine which results in leucocyte recruitment to the muscularis externa causing smooth muscle dysfunction. OBJECTIVES: To examine the intestinal inflammatory response in horses undergoing colic surgery by measuring relative differential gene expression in intestinal tissues harvested from surgical colic cases and control horses. STUDY DESIGN: Prospective case-control study. METHODS: Mucosa and muscularis externa were harvested from healthy margins of resected small intestine from horses undergoing colic surgery (n = 12) and from intestine derived from control horses euthanised for reasons unrelated to the gastrointestinal tract (n = 6). Tissue was analysed for genes encoding proteins involved in the inflammatory response: interleukin (IL) 6 and IL1ß, C-C motif chemokine ligand 2 (CCL2), tumour necrosis factor (TNF), prostaglandin-endoperoxide synthase 2 (PTGS2) and indoleamine 2,3-dioxygenase (IDO1). Relative expression of these genes was compared between the two groups. Further analysis was applied to the colic cases to determine whether the magnitude of relative gene expression was associated with the subsequent development of post-operative reflux (POR). RESULTS: Samples obtained from colic cases had increased relative expression of IL1ß, IL6, CCL2 and TNF in the mucosa and muscularis externa when compared with the control group. There was no difference in relative gene expression between proximal and distal resection margins and no association between duration of colic, age, resection length, short-term survival and the presence of pre-operative reflux and the relative expression of the genes of interest. Horses that developed POR had significantly greater relative gene expression of TNF in the mucosa compared with horses that did not develop POR. MAIN LIMITATIONS: Small sample size per group and variation within the colic cases. CONCLUSIONS: These preliminary data support an upregulation of inflammatory genes in the intestine of horses undergoing colic surgery.

Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study.

BACKGROUND: Incisional complications are a common cause of morbidity following laparotomy. Although uncommon, acute abdominal dehiscence (AAD) is a potentially fatal post-operative complication. However, few AAD cases are described in the literature. OBJECTIVES: To describe common features of cases of AAD following ventral midline laparotomy, management and outcomes. STUDY DESIGN: Retrospective case series. METHODS: Hospital records of horses that underwent a ventral midline laparotomy at nine hospitals in the UK, Ireland and USA over a 10-year period (2009-2019) were reviewed. Data were collected for pre-, intra- and post-operative factors that were considered relevant. Descriptive statistical analysis was performed. RESULTS: A total of 63 cases of AAD were identified. AAD occurred due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line in 46 horses (73%). AAD occurred at a median of 5 days (0.5-70 days) post-operatively and broodmares accounted for 25% of the cases (n = 16). Surgical site infection developed prior to AAD in 28 horses (44%); leakage of peritoneal fluid occurred in 5% of horses prior to AAD being identified. Surgical repair was performed in 27 horses (43%), 10 (16%) were treated conservatively and 26 (41%) were euthanised immediately. Repair was most frequently performed using suture (n = 14), wire (n = 5) or a combination (n = 5). Overall survival to hospital discharge was 39% (24/63). Where surgical repair was performed, 15 horses (56%) survived to hospital discharge; 9 horses (90%) managed conservatively survived to hospital discharge. MAIN LIMITATIONS: Follow-up was not performed for all cases following hospital discharge and some data were incompletely recorded in hospital files. CONCLUSIONS: Previously stated causative factors for AAD were not consistent features in the present study. Surgical site infection following laparotomy and pregnant or early post-partum mares may be important risk factors for AAD and warrant further investigation.

Equine nutrition in the post-operative colic: Survey of Diplomates of the American Colleges of Veterinary Internal Medicine and Veterinary Surgeons, and European Colleges of Equine Internal Medicine and Veterinary Surgeons.

BACKGROUND: Evidence is lacking concerning re-introduction of feed and water following colic surgery. OBJECTIVES: To describe current approaches of European and American specialists to re-introduction of feed and water in adult horses following surgical treatment of common intestinal lesions, assuming an uncomplicated recovery. STUDY DESIGN: Cross-sectional survey. METHODS: Electronic invitations, with a link to the online survey, were sent to 1,430 large animal specialists, including Diplomates of the ECVS, ACVS, ECEIM and ACVIM colleges. RESULTS: The response rate was 12.6% including partial respondent data. Responses for each multiple-choice question were between 123 and 178. Results are expressed as the percentage of the total number of responses and as a range where specific lesions are grouped together. Respondents reported that horses with large intestinal displacements were offered free choice water (63%-65%) within 3 hours (55%-63%), whereas horses with a small intestinal strangulating lesion were offered < 2 L water (64%-74%) 12-24 hours (28%-34%) post-operatively. Horses with a large colon displacement were offered feed within 3 hours of surgery (16%) with the majority offered feed 6-12 hours (35%-36%) post-operatively. Horses with small intestinal strangulating lesions and small colon lesions were offered feed 24-48 hours (34%-42%) after surgery. Following small intestinal, small colon or caecal lesions, horses were re-introduced feed in handfuls (79%-93%) and initially with grass (41%-54%). Horses with large colon displacements were mostly fed handfuls (49%-50%) of forage initially, but a number of respondents would offer larger quantities such as a small bucket (35%-37%) and predominantly of hay (50%-51%). MAIN LIMITATIONS: Low response rate. This study did not take into account common post-operative complications that may alter the clinical approach. CONCLUSIONS: This post-operative colic nutrition survey is the first to describe current clinical practice. Further research is required to investigate nutritional strategies in post-operative colic cases.

Indicators of 'critical' outcomes in 941 horses seen 'out-of-hours' for colic.

BACKGROUND: This study aimed to describe the presentation and outcomes of horses with signs of colic (abdominal pain) seen 'out-of-hours' in equine practice. METHODS: This was a retrospective study of horses seen 'out-of-hours' with colic by two equine veterinary practices between 2011 and 2013. Case outcomes were categorised as 'critical' or 'not critical'. A critical outcome was defined as requiring medical or surgical hospital treatment, or resulting in euthanasia or death. A non-critical outcome was defined as resolving with simple medical treatment. A hierarchical generalised linear model was used to identify 'red flag' parameters (aspects of signalment, history and presenting clinical signs) associated with critical outcomes. RESULTS: Data were retrieved from 941 cases that presented with colic; 23.9 per cent (n=225/941) were critical. Variables significantly associated with the likelihood of a critical outcome in the final multivariable model were increased heart rate (P<0.001), age of the horse (P=0.013) and abnormal mucous membrane colour (P<0.001). Overall 18 per cent (n=168/941) of cases were euthanased. CONCLUSIONS: This study highlights the mortality associated with colic. The 'red flag' parameters identified should be considered an essential component of the primary assessment of horses with colic.

Retrospective case series to identify the most common conditions seen 'out-of-hours' by first-opinion equine veterinary practitioners.

BACKGROUND: The study aim was to describe conditions seen 'out-of-hours' in equine practice. METHODS: This was a retrospective case series of first opinion 'out-of-hours' cases seen at two equine practices between 2011 and 2013. Data were retrieved on case presentation, diagnostic testing, treatment administered and outcome, and diseases categorised using a systems-based coding system. A hierarchical logistic regression, formulated using a generalised linear model, was used to identify clinical variables associated with a binary outcome of 'critical' cases (required hospitalisation or euthanasia or died). RESULTS: Data from 2602 cases were analysed. The most common reasons for 'out-of-hours' visits were colic (35 per cent, n=923/2620), wounds (20 per cent, n=511/2620) and lameness (11 per cent, n=288/2,620). The majority of cases required a single treatment (58 per cent, n=1475/2550), 26 per cent (n=656/2550) needed multiple treatments and 13 per cent (n=339/2550) were euthanased. Eighteen per cent (n=480/2602) of cases had a critical outcome. Increased heart rate at primary presentation was associated with critical outcome in both practices (Practice A, OR 1.07 (95 per cent confidence interval 1.06 to 1.09), Practice B OR 1.08 (95 per cent confidence interval 1.07 to 1.09; p<0.001)). CONCLUSION: Colic, wounds and lameness were the most common equine 'out-of-hours' conditions; 13 per cent of cases were euthanased. Further research is required into out-of-hours euthanasia decision-making.

Equine penile squamous cell carcinoma: expression of biomarker proteins and EcPV2.

Equine penile squamous cell carcinoma (EpSCC) is a relatively common cutaneous neoplasm with a poor prognosis. In this study, we aimed to determine the protein expression and colocalisation of FRA1, c-Myc, Cyclin D1, and MMP7 in normal (NT), tumour (T), hyperplastic epidermis and/or squamous papilloma (Hyp/Pap), poorly-differentiated (PDSCC), or well-differentiated (WDSCC) EpSCC using a tissue array approach. Further objectives were to correlate protein expression to (i) levels of inflammation, using a convolutional neural network (ii) equine papillomavirus 2 (EcPV2) infection, detected using PCR amplification. We found an increase in expression of FRA1 in EpSCC compared to NT samples. c-Myc expression was higher in Hyp/Pap and WDSCC but not PDSCC whereas MMP7 was reduced in WDSCC compared with NT. There was a significant increase in the global intersection coefficient (GIC) of FRA1 with MMP7, c-Myc, and Cyclin D1 in EpSCC. Conversely, GIC for MMP7 with c-Myc was reduced in EpSCC tissue. Inflammation was positively associated with EcPV2 infection in both NT and EpSCC but not Hyp/Pap. Changes in protein expression could be correlated with EcPV2 for Cyclin D1 and c-Myc. Our results evaluate novel biomarkers of EpSCC and a putative correlation between the expression of biomarkers, EcPV2 infection and inflammation.

Magnetic resonance imaging findings of equine solar penetration wounds.

The magnetic resonance (MR) imaging features, signalment, clinical history and outcome of 55 horses with a penetrating sole injury were evaluated. Our aim was to describe MR imaging findings within the hoof capsule, assess the utility of the technique and give recommendations for the optimal MR imaging protocol to evaluate such injuries. Data from five equine hospitals were analyzed retrospectively. The tract was more likely to be visualized in animals scanned within the first week postinjury. There was no significant predisposition based on breed, age, or gender. T2*W transverse sequences were the most useful for assessment of solar penetrations due to their orientation perpendicular to the deep digital flexor tendon, the reduced scanning time, and the T2* capability of enhancing magnetic susceptibility caused by hemorrhage.

Evidence-based gastrointestinal surgery in horses.

Colic surgery is now performed at many equine hospitals around the world. Despite the tremendous improvements in survival rates over the past 30 years, the morbidity and mortality rates remain relatively high. This fact, coupled with the high cost of treatment, makes it important to apply evidence-based medicine principles to establish the best possible treatment plans and surgical techniques whereby the outcomes can be optimized. Factors affecting survival rates and rates of major complications (incisional complications and postoperative ileus) are discussed. Preoperative assessment and postoperative care are not considered in this review.

Deep digital flexor tendonitis in the equine foot diagnosed by low-field magnetic resonance imaging in the standing patient: 18 cases.

Injury to the distal aspects of the deep digital flexor tendon (DDFT) is an important cause of lameness in horses. The purpose of this study was to review the magnetic resonance imaging (MRI) findings of 18 horses affected by DDFT injuries in the foot. The MRI was performed with the horses standing using an open low-field (0.21 T) MRI scanner. The results were compared with those previously reported for horses using high-field MRI. Eighteen of 84 horses (21%) with undiagnosed forefoot pain were found to have lesions affecting the DDFT. The history, clinical findings and results of radiography, diagnostic ultrasonography and nuclear scintigraphy of these horses were reviewed. The duration of lameness ranged from 1 to 12 months, and the severity varied from 1/10 to 6/10. Fifteen horses had unilateral lameness (right fore in nine, left fore in six), whereas three horses were bilaterally foreleg lame. Radiological changes, considered of equivocal significance, were found in six of 18 horses. Ultrasonographic changes involving the DDFT were identified in only one of nine horses. DDFT lesions were detected in both T1- and T2-weighted MRI sequences. Four different types of lesions were identified: core lesions, sagittal splits, dorsal border lesions, and insertional lesions. Combinations of different lesion types within the same horse were common. The types and locations of the DDFT lesions were similar to those previously reported using high-field MRI. The use of low-field standing MRI avoids the necessity for general anesthesia and access to conventional high-field MRI scanners. However, studies comparing the results of standing low-field MRI with high-field MRI (and other imaging procedures) are required before the sensitivity and specificity of the technique can be assessed.