Frequency of interactions between veterinarians and other professionals to guide interprofessional education.

The objective of this study was to determine the frequency with which veterinarians interact with individuals in other health professions and related fields of work. Four thousand members of the American Veterinary Medical Association (AVMA) were surveyed. Demographic information was collected, and participants were asked how frequently they interacted with members of various professions. General comments were solicited regarding which professions veterinarians should reach out to in order to enhance veterinary health care and which professions veterinarians could interact with to improve human health care. The overall response rate was 18.6%. Demographic information suggested that the sample was representative of the profession. Frequency of interactions ranged from never to regularly, but for no group or profession was frequent interaction the norm. For practitioners, interactions with pharmacists, both dispensing and compounding, and with drug company representatives were most common. For educators, interaction with pharmacists and drug company representatives was also high compared to other professions, and they were also more likely to interact with laboratory technicians and physicians. For those in industry, interactions with laboratory technicians, physicians, drug and food company representatives, and public health officials were most common. All other respondents described their most common interactions as being with public health officials. The veterinarians surveyed cited a need for greater interaction with physicians regarding zoonotic disease and parasitism. Veterinarians do not frequently interface with human health care professionals. Those with whom practitioners have the greatest interaction are pharmacists and representatives of drug companies. Greater interaction may benefit management of zoonotic disease and parasitism.

Pharmacokinetics of N-acetylcysteine after oral and intravenous administration to healthy cats.

OBJECTIVE: To describe the pharmacokinetics of N-acetylcysteine (NAC) in healthy cats after oral and IV administration. ANIMALS: 6 healthy cats. PROCEDURES: In a crossover study, cats received NAC (100 mg/kg) via IV and oral routes of administration; there was a 4-week washout period between treatments. Plasma samples were obtained at 0, 5, 15, 30, and 45 minutes and 1, 2, 4, 8, 12, 24, 36, and 48 hours after administration, and NAC concentrations were quantified by use of a validated high-performance liquid chromatography-mass spectrometry protocol. Data were analyzed via compartmental and noncompartmental pharmacokinetic analysis. RESULTS: Pharmacokinetics for both routes of administration were best described by a 2-compartment model. Mean ± SD elimination half-life was 0.78 ± 0.16 hours and 1.34 ± 0.24 hours for the IV and oral routes of administration, respectively. Mean bioavailability of NAC after oral administration was 19.3 ± 4.4%. CONCLUSIONS AND CLINICAL RELEVANCE: The pharmacokinetics of NAC for this small population of healthy cats differed from values reported for humans. Assuming there would be similar pharmacokinetics in diseased cats, dose extrapolations from human medicine may result in underdosing of NAC in cats with acute disease. Despite the low bioavailability, plasma concentrations of NAC after oral administration at 100 mg/kg may be effective in the treatment of chronic diseases.

Relationships between admissions requirements and pre-clinical and clinical performance in a distributed veterinary curriculum.

The purpose of this study was twofold: first, to assess the relationships between knowledge-based admission requirements and pre-clinical and clinical performance in a distributed model of veterinary education that uses problem-based learning as the main instruction method in the first two years of the curriculum; second, to compare pre-clinical and clinical performance with performance on the Program for the Assessment of Veterinary Education Equivalence (PAVE) exam. Admissions data including overall GPA, prerequisite GPA, Graduate Record Examination (GRE) score on the Analytical, Analytical Writing, Quantitative, and Verbal sections), veterinary school performance data (GPA for pre-clinical and clinical years), and performance PAVE (taken at the end of second year) were analyzed for two classes (N = 155, 85.8% women and 14.2% men). Overall GPA, prerequisite GPA, and GRE Quantitative and Analytical scores were the best predictors for pre-clinical (years 1 and 2) performance (R = 0.49, 23.5% of the variance), GRE Analytical score was the best predictor for year 3 (pre-clinical and clinical) performance (R = 0.25, 6.3% of the variance), GRE Quantitative score was the best predictor for PAVE performance (R = 0.27, 7.5% of the variance), and GRE Analytical score was the best predictor for clinical performance (year 4; R = 0.21, 4.4% of the variance). PAVE scores correlated with GRE Quantitative scores (r = 0.27, p <.01) and veterinary school performance, with higher correlations in the pre-clinical years (rs = 0.67-0.36, p < .01), providing evidence of convergent validity for the PAVE exam.

Influence of age, sex, and production class on liver zinc concentration in calves.

Determination of zinc concentrations in the liver of calves and young stock is commonly requested by practitioners and nutritionists to assess whether they receive an appropriate amount of zinc in their diet. However, interpretation of liver zinc concentrations is currently based on information reported for adult cattle for which the health status was unknown and irrespective of production class, sex, and age. A retrospective study of necropsy reports was undertaken to assess the relationships between liver zinc concentrations and age, sex, and production class for calves that did not have a history compatible with zinc toxicosis or zinc deficiency. Results of a generalized least squares, polynomial regression analysis of 474 records found that zinc concentration was not affected by sex (P = 0.29) or production class (P = 0.50). Zinc concentration was significantly associated with linear (P < 0.00001) and nonlinear (quadratic, P = 0.0039) functions of age (r2 = 0.1503), where the concentration decreased from 93 mg/kg wet weight at 30 days of age to 57 mg/kg wet weight at 9 months of age, after which it began to increase. The age-specific 95% confidence limits of the mean concentration for a group of calves and the 95% prediction limits of a single concentration value for an individual animal estimated in this study suggest reconsideration of the recommended limits for liver zinc concentration in calves. As a consequence of the significant influence of age on liver zinc concentration of calves presumably not experiencing zinc toxicosis or deficiency, diagnosis of zinc imbalances based on liver zinc concentration needs to consider age as a diagnostic covariate.

Cyanide toxicosis in goats after ingestion of California Holly (Heteromeles arbutifolia).

Cyanogenic glycosides are found in many native and naturalized plants throughout North America. The glycosides themselves are not toxic, but they yield hydrogen cyanide (hydrocyanic or prussic acid) when they are hydrolyzed by beta-glycosidases, either as a result of injury to the plant cells or by microbial action in the rumen. Hydrogen cyanide is readily absorbed from the gastrointestinal tract. Cyanide ion binds with iron in cytochrome oxidase, interfering with cellular respiration. The clinical effects are peracute, often resulting in death less than 1 hour after ingestion. This study describes a case that resulted in significant morbidity and mortality in a herd of goats after exposure to California holly (Heteromeles arbutifolia).

Toxic mushrooms.

Poisonous mushrooms contain toxins that are as diverse as the mushrooms themselves. Clinical syndromes often involve multiple organ systems, and progression of clinical signs is often directly related to the quantity eaten. Diagnostic detection of the toxins is rarely an option; rather, diagnosis is based on a history of possible exposure and identification of mushroom species in the stomach contents and environment. Treatments are usually based on clinical signs, as most mushroom toxins are without an antidote. There are exceptions, however, and prompt identification of mushroom species involved is vital whenever possible. Collection of the toxicologic minimum database and gastrointestinal decontamination are important in all cases where mushroom ingestion is suspected.

Amanita mushroom poisoning: efficacy of aggressive treatment of two dogs.

Amatoxins, the primary toxins found in mushrooms of the genus Amanita, are very toxic to dogs. Acute fulminant liver failure and death can occur within a few days of ingestion. By their curious nature, dogs, especially young dogs, are prone to ingest mushrooms. Early identification of suspect mushrooms, and prompt emergency measures aimed at decreasing absorption of the toxins can improve the chance of survival. Knowing the major clinical syndromes associated with Amanita mushroom toxicosis can help direct the treatment and supportive care of affected animals and improve survival rates. We describe 2 cases in dogs with confirmed ingestion of Amanita phalloides and Amanita ocreata resulting in fulminant liver failure. Death occurred in 1 dog despite aggressive treatment measures including hemoperfusion, while aggressive measures resulted in a favorable outcome in the other dog.

Coma and apnea in a dog with hydroxyzine toxicosis.

Hydroxyzine is a commonly prescribed H1-receptor antagonist in small animal practice. The most common adverse effect reported after therapeutic dosing is mild sedation; severe reactions resulting in coma have occasionally been reported in children. We present a case of large po hydroxyzine exposure causing in coma and apnea in a dog. Exposure was confirmed with gas chromatography/mass spectrometry analysis of urine. Extensive therapeutic measures to enhance drug elimination and assist ventilation were required for 11 d. The positive outcome justifies critical care of similarly exposed animals. Veterinarians should be aware of the potential for coma and apnea secondary to hydroxyzine exposure.