Evaluating validity evidence for 2 instruments developed to assess students' surgical skills in a simulated environment.

OBJECTIVE: To gather and evaluate validity evidence in the form of content and reliability of scores produced by 2 surgical skills assessment instruments, 1) a checklist, and 2) a modified form of the Objective Structured Assessment of Technical Skills (OSATS) global rating scale (GRS). STUDY DESIGN: Prospective randomized blinded study. SAMPLE POPULATION: Veterinary surgical skills educators (n =10) evaluated content validity. Scores from students in their third preclinical year of veterinary school (n = 16) were used to assess reliability. METHODS: Content validity was assessed using Lawshe's method to calculate the Content Validity Index (CVI) for the checklist and modified OSATS GRS. The importance and relevance of each item was determined in relation to skills needed to successfully perform supervised surgical procedures. The reliability of scores produced by both instruments was determined using generalizability (G) theory. RESULTS: Based on the results of the content validation, 39 of 40 checklist items were included. The 39-item checklist CVI was 0.81. One of the 6 OSATS GRS items was included. The 1-item GRS CVI was 0.80. The G-coefficients for the 40-item checklist and 6-item GRS were 0.85 and 0.79, respectively. CONCLUSION: Content validity was very good for the 39-item checklist and good for the 1-item OSATS GRS. The reliability of scores from both instruments was acceptable for a moderate stakes examination. IMPACT: These results provide evidence to support the use of the checklist described and a modified 1-item OSAT GRS in moderate stakes examinations when evaluating preclinical third-year veterinary students' technical surgical skills on low-fidelity models.

Effects of chronic nitric oxide synthase inhibition on responses to acute exercise in swine.

Nitric oxide (NO) is potentially involved in several responses to acute exercise. We tested the hypotheses that inhibition of NO formation reduces maximal O(2) delivery to muscle, but does not affect O(2) utilization by muscle, therefore lowering maximal O(2) consumption. To test these hypotheses, swine (approximately 30 kg) drank either tap water (Con, n = 25) or water with N(G)-nitro-l-arginine methyl ester (8.0 +/- 0.4 mg x kg(-1) x day(-1) for >or=4 wk; LN, n = 24). Treatment efficacy was reflected by higher mean arterial pressure and lower plasma NO metabolite concentration in LN than Con (both P < 0.05). Swine completed two graded treadmill running tests to maximum. In the first test, O(2) consumption was determined at rest through maximal exercise intensity. O(2) consumption did not differ between groups at rest or at most exercise intensities, including maximum (Con, 40.8 +/- 1.8 ml x min(-1) x kg(-1); LN, 40.4 +/- 2.9; not significant). In the second test, tissue-specific blood flows were determined using the radiolabeled-microsphere technique. At rest, blood flows were lower (P < 0.05) in LN compared with Con for a number of tissues, including kidney, adrenal, lung, and several skeletal muscles. During both submaximal and maximal exercise, however, blood flows were similar between Con and LN for all 16 muscles examined; only blood flows to kidney (Con, 99 +/- 16 ml x min(-1) x 100 g; LN, 55 +/- 15; P < 0.05) and pancreas (Con, 25 +/- 7; LN, 6 +/- 2; P < 0.05) were lower in LN at maximum. Endothelium-dependent, but not -independent, relaxation of renal arterial segments was reduced (P < 0.05) in vitro. These data indicate that exercise-induced increases in muscle blood flows are maintained with chronic inhibition of NO formation and that maximal O(2) consumption is therefore preserved. Redundant vasodilatory pathways and/or upregulation of these pathways may underlie these findings.

Head and facial wounds in dogs and cats.

Injuries to the head and facial area are common in small animal surgery. Although many of the injuries at first may seem formidable, most can be repaired using basic reconstructive surgery procedures. The excel-lent blood supply in this area and the availability of local tissues provide many options for repairing most wounds. This article describes the indications and techniques for reconstructing wounds in this area.

Dacryocystomaxillorhinostomy for chronic dacryocystitis in a dog.

A 10-year-old female spayed Vizsla had intermittent mucoid ocular discharge from the right eye for 7 years. History, clinical findings, imaging studies, and culture and histopathology results confirmed chronic dacryocystitis with granuloma. A dacryocystomaxillorhinostomy was performed to preserve the functional portions of the nasolacrimal system remaining in this patient, as well as to promote healing of the lacrimal sac granuloma and secondary infection. Complete resolution of the clinical abnormalities was achieved, and the dog remains healthy 3 years postoperatively.

A comparison of thiopental, propofol, and diazepam-ketamine anesthesia for evaluation of laryngeal function in dogs premedicated with butorphanol-glycopyrrolate.

Thiopental, propofol, and diazepam-ketamine were compared for evaluation of laryngeal function in dogs. There was no significant difference among the three protocols in time to observation of normal function after drug administration or in the occurrence of swallowing, laryngospasm, or breathing. Jaw tone was significantly greater with diazepam-ketamine. Exposure of the larynx was excellent in five dogs and moderate in three dogs, each receiving thiopental or propofol. Exposure was excellent in one dog, moderate in six dogs, and poor in one dog receiving diazepam-ketamine. Exposure of the larynx for laryngeal function evaluation is more readily accomplished with thiopental or propofol than with diazepam-ketamine.

The use of porcine small intestinal submucosa as a biomaterial for perineal herniorrhaphy in the dog.

OBJECTIVES: To develop an in vivo perineal hernia model, to develop a technique for using small intestinal submucosa (SIS) in perineal hernia repair, to further elucidate the biological behavior of SIS, and to compare SIS herniorrhaphy with the internal obturator muscle transposition (IOT) technique. STUDY DESIGN: Prospective evaluation comparing SIS herniorrhaphy with IOT. ANIMALS: Twelve adult castrated male, large-breed dogs. METHODS: All dogs had bilateral pelvic diaphragm defects created by complete excision of the levator ani muscle. Each dog had one side repaired using SIS and the other by IOT. Pain and inflammation were subjectively scored. Dogs were killed 2 weeks (n = 4), 12 weeks (n = 4), or 16 weeks (n = 4) after surgery. Each pelvic diaphragm was biomechanically tested to failure. The pelvic diaphragms from 2 normal dogs (n = 4 sides) were also biomechanically tested. Failure site, maximum pressure, displacement at failure, and initial linear stiffness values were determined. Histologic assessment was performed. Statistical analysis was performed with significance set at P <.05 RESULTS: No significant postoperative complications were noted. There were no significant differences in maximum pressure to failure, displacement, or stiffness when comparing normal, SIS, and IOT at any time point. The SIS group had significantly less displacement (P =.004) at 2 weeks than at weeks 12 or 16. For all herniorrhaphy techniques, the failure site was central (n = 22) or at the suture line (n = 2). At 2 weeks, histologic evaluation of tissues from the IOT group showed inflammation, mineralization, and necrosis, which were not present in tissues from the SIS group. Histologic examination at 12 and 16 weeks showed no microscopic differences in cell population or tissue characteristics between the IOT and SIS groups. CONCLUSIONS: SIS herniorrhaphy was successfully performed in this in vivo model of perineal hernia in the dog. CLINICAL RELEVANCE: This study suggests that SIS can be used as a primary means of repair, as augmentation when the internal obturator muscle is thin and friable, or as a salvage procedure in cases of recurrence in dogs with perineal hernia.