Lessons Learned from a Pilot Study Implementing a Team-Based Messaging Application (Slack) to Improve Communication and Teamwork in Veterinary Medical Education.

Communication skills are paramount for a successful veterinary curriculum. Technological advances have improved communication processes, and the way instruction is delivered. Yet, with these advances come challenges such as email overload, increased interruptions, and miscommunications. Time is a valuable commodity at any high caseload veterinary teaching hospital. When increasingly more time is spent sending and receiving emails, text messages, pages, and calls in lieu of more focused clinical teaching, then the modes of communication and traditional learning theories need to be evaluated. An effective mode of communication is needed to reduce information overload and miscommunication. This article describes lessons learned from a pilot study to determine if a team-based messaging application could improve a surgical team's communication by having all forms of transmitted media directly related to their scope of work accessible to everyone on the team in one real-time digital platform (Slack). Fifteen members of a university-based surgical team were enrolled into the study and provided with surveys at specific time points to evaluate the efficacy of an internet-based team communication tool during a 3-month period. Results of our study showed an overall perception of improved communication among team members when using a team-based communication platform. Recommendations are provided to address team member's underutilization of the platform, which resulted in duplicate messages and miscommunication. We conclude an initial adoption by staff members is essential when implementing significant shifts in communication platforms.

Bacterial recovery using sonication versus swabbing of titanium and stainless steel implants inoculated with Staphylococcus pseudintermedius or Pseudomonas aeruginosa.

OBJECTIVE: To evaluate the use of sonication to improve recovery of bacteria from metal discs infected with bacteria commonly associated with implant infections in veterinary medicine. METHODS: In vitro study in which sterile titanium (Ti6Al4V) and stainless steel (AIS1316-L) discs were incubated with either Staphylococcus pseudintermedius or Pseudomonas aeruginosa for 24 hours. The following three groups were compared: 1) the sonication group involved immersing the discs in sterile saline and sonicating for five minutes; 2) the sham group was considered a negative control in which the discs were immersed in saline for five minutes without sonication; and 3) the swab group involved systematically swabbing the implant with a sterile culturette. All samples were plated on blood agar and incubated for 24 hours. Colonies were then counted and compared. RESULTS: For both species of bacteria, there was a significant increase in bacterial colonies isolated using sonication compared to the other two study groups (p = 0.0001). No differences in bacterial growth were found between the two types of metal implants. There was a significant increase in bacterial colony counts for S. pseudintermedius when comparing the swab group versus the sham group, but this was not significant for P. aeruginosa. CLINICAL SIGNIFICANCE: Sonication significantly improves recovery of bacteria commonly associated with veterinary implant-associated surgical site infections compared to swabbing of implants in vitro. A prospective clinical evaluation is indicated to determine the in vivo efficacy of sonication in veterinary patients.

Can ultraviolet light C decrease the environmental burden of antimicrobial-resistant and -sensitive bacteria on textiles?

BACKGROUND: The environment is important in transmission of bacteria. Textiles are difficult and time consuming to clean; ultraviolet light C (UVC) is germicidal and may be an effective disinfection method for textile surfaces. OBJECTIVE: This study evaluated the efficacy of UVC, a commercial quaternary ammonium compound antimicrobial spray (FAS) and UVC+FAS combined for reducing bacterial colonization on experimentally contaminated textiles. METHODS: Microfibre, cotton and polyester were inoculated with meticillin-sensitive and -resistant Staphylococcus aureus (MSSA and MRSA), Staphylococcus pseudintermedius (MSSP and MRSP), Pseudomonas aeruginosa or Escherichia coli. ATCC® strains were used except for MRSP, for which ten canine clinical isolates were collected. Textiles were treated with three doses of UVC (13 mJ/cm2 , 54 mJ/cm2 or 270 mJ/cm2 ), FAS or both (FAS and UVC at 270 mJ/cm2 ). UVC was delivered using a modified mercury-based lamp. Bleach (8.25%) was used as a positive control. Negative controls received no treatment. Surface bacterial counts were determined 24 h post-treatment. RESULTS: The lower dosages (13 mJ/cm2 and 54 mJ/cm2 ) of UVC had >90% colony forming unit (CFU) reduction, 270 mJ/cm2 had >99% CFU reduction and combined UVC+FAS had 100% CFU reduction against all bacterial strains on all surfaces (P < 0.05). Ten experiments showed that treatment with UVC had a greater CFU reduction when compared to FAS alone (P < 0.05). A majority of those experiments (seven of 10) involved Gram-negative species (P. aeruginosa or E. coli). CONCLUSION: UVC quickly reduced the bacterial burden on textiles to greater than 90%; UVC may be a better disinfecting agent than FAS for Gram-negative species.

Evaluation of Low-Dose Ultraviolet Light C for Reduction of Select ESKAPE Pathogens in a Canine Skin and Muscle Model.

OBJECTIVE: This study aimed at comparing the ability of low-dose UVC, 0.05% chlorhexidine, and combined UVC with 0.05% chlorhexidine to reduce colony-forming units (CFUs) on select ESKAPE pathogens (Staphylococcus aureus, Klebsiella pneumoniae, and Enterococcus faecium) in a canine skin and muscle model. BACKGROUND DATA: Surgical site infections (SSIs) result in increased morbidity and cost. UVC damages DNA, rendering bacteria nonviable and does not discriminate between drug-sensitive and multi-drug-resistant organisms. MATERIALS AND METHODS: Specimens were inoculated with one of three pathogens. Samples were treated with a 254 nm UVC mercury lamp or a 270 nm UVC LED light at 0.015, 0.03, or 0.04 J/cm(2) doses; 0.05% and 2% chlorhexidine were used as positive controls. To evaluate synergism, 0.05% chlorhexidine was used with 0.015 J/cm(2) of UVC. CFUs were counted and compared against the negative control. RESULTS: There were no significant differences in CFU counts between samples of the same tissue type treated with different light sources of the same UVC dose. UVC significantly decreased CFUs when compared against all negative controls in both skin and muscle. There was no consistently superior bactericidal UVC dose identified for individual bacteria or for tissue type. The bactericidal activity of UVC at 0.015 J/cm(2) versus 0.05% chlorhexidine was not different in muscle for any bacteria. The bactericidal activity of UVC at 0.015 J/cm(2) was superior to 0.05% chlorhexidine in skin for S. aureus and K. pneumonia, but not E. faecium. Combination of UVC and 0.05% chlorhexidine showed synergy against E. faecium when evaluated on skin. CONCLUSIONS: Low-dose UVC shows promise as a rapid, effective, and synergistic means of reducing bacterial burdens, which may decrease the incidence of SSIs. It should be further evaluated for use when 2% chlorhexidine would be contraindicated or impractical, such as open wounds or surgical sites.

Injection of the diaphragmatic crus with methylene blue for coloration of the canine thoracic duct.

OBJECTIVE: To describe and compare onset and intensity of thoracic duct (TD) coloration after injection of methylene blue into the diaphragmatic crus and mesenteric lymph node. STUDY DESIGN: Experimental study. ANIMALS: Adult dogs (n = 18). METHODS: Methylene blue (≤0.5 mg/kg 1% solution) was injected into the left (n = 9) or right (n = 9) diaphragmatic crus via right 10th intercostal thoracotomy. TD coloration was graded over 10 minutes. A right paracostal laparotomy was then performed in all dogs, and an equal volume of methylene blue injected into a mesenteric lymph node (n = 18). TD color grading was repeated. Statistical analysis was performed on subject weight, volume of contrast agent injected between left and right crus, and number of successful outcomes between diaphragmatic crus injection and mesenteric lymph node injection. RESULTS: TD coloration occurred in 6 dogs with left crus injection and 4 dogs with right crus injection with obvious staining present in 2 and 3 dogs, respectively. Successful outcome was noted in all dogs with mesenteric lymph node injection. The number of successful outcomes was significantly greater after mesenteric lymph node injection compared with diaphragmatic crus injection (P < .001). CONCLUSIONS: Methylene blue injected into the diaphragmatic crura and mesenteric lymph node was successful in coloring the TD; however, mean thoracic duct color grade and number of successful outcomes were significantly higher after mesenteric injection.

Diaphragmatic support of a thoracic wall defect in a dog.

A large, caudal thoracic mass was removed along with ribs 11 and 12, resulting in an approximate 16 x 14-cm, caudal thoracic wall defect in a dog. The diaphragmatic musculature was mobilized and used to support the thoracic wall defect. To our knowledge, this method of thoracic wall repair has not been previously reported. This procedure allowed for airtight closure of the thoracic cavity, provided physical support, eliminated the need for muscle flaps or commercially available meshes, and provided a good cosmetic appearance without negatively affecting the dog's athletic performance.

Evaluation of short- and long-term complications after endoscopically assisted gastropexy in dogs.

OBJECTIVE: To determine short- and long-term complications in clinically normal dogs after endoscopically assisted gastropexy. DESIGN: Prospective case series. ANIMALS: 24 dogs. PROCEDURES: Endoscopically assisted gastropexy was performed on each dog. Dogs were evaluated laparoscopically at 1 or 6 months after surgery to assess integrity of the gastropexy. Long-term outcome was determined via telephone conversations conducted with owners > or = 1 year after surgery. RESULTS: Mean +/- SD gastropexy length was 4.5 +/- 0.9 cm, and mean duration of surgery was 22 +/- 5 minutes. One dog had a partially rotated stomach at the time of insufflation, which was corrected by untwisting the stomach with Babcock forceps. Two dogs vomited within 4 weeks after surgery, but the vomiting resolved in both dogs. Four dogs had diarrhea within 4 weeks after surgery, which resolved without medical intervention. In all dogs, the gastropexy site was firmly adhered to the abdominal wall at the level of the pyloric antrum. Long-term follow-up information was available for 23 dogs, none of which had any episodes of gastric dilatation-volvulus a mean of 1.4 years after gastropexy. CONCLUSIONS AND CLINICAL RELEVANCE: Endoscopically assisted gastropexy can be a simple, fast, safe, and reliable method for performing prophylactic gastropexy in dogs. At 1 and 6 months after gastropexy, adequate placement and adhesion of the gastropexy site to the body wall was confirmed. Such a procedure could maximize the benefits of minimally invasive surgery, such as decreases in morbidity rate and anesthetic time. This technique appeared to be suitable as an alternative to laparoscopic-assisted gastropexy.

Evaluation of an endoscopically assisted gastropexy technique in dogs.

OBJECTIVE: To evaluate the use of endoscopy in conjunction with a gastropexy technique in dogs as a potential means to aid prevention of gastric dilatation-volvulus. ANIMALS: 12 healthy adult medium- and large-breed dogs. PROCEDURES: 12 adult research dogs that had no abnormal physical examination findings each underwent an endoscopically assisted gastropexy procedure. On completion of the procedure, the dogs were euthanized and exploratory laparotomies were performed to evaluate the surgical site. Data recorded included anatomic location of the gastropexy, gastropexy length, and duration of procedure as well as any complications. RESULTS: Mean+/-SD gastropexy length was 3.3+/-0.25 cm, and mean duration of surgery was 18+/-7 minutes. In each dog, the stomach was located in its normal anatomic position and all gastropexies were sutured to the abdominal wall at the level of the pyloric antrum. The only complications during the procedure were needle bending and breakage at the time of stay suture placement. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of these findings, it appears that endoscopically assisted gastropexy is a simple, fast, safe, and reliable method of performing a prophylactic gastropexy in dogs when undertaken by a person who is skilled in endoscopy. Such a procedure maximizes the benefits of decreased morbidity and shorter duration of anesthesia associated with minimally invasive surgery. Further clinical studies are warranted to evaluate the long-term efficacy of this procedure in dogs at risk for development of gastric dilatation-volvulus.

Molecular characterization of Clostridium difficile isolates from horses in an intensive care unit and association of disease severity with strain type.

OBJECTIVE: To determine molecular characteristics, antimicrobial susceptibility, and toxigenicity of Clostridium difficile isolates from horses in an intensive care unit and evaluate associations among severity of clinical disease with specific strains of C difficile. DESIGN: Prospective study. ANIMALS: 130 horses. PROCEDURES: Feces were collected from horses admitted for acute gastrointestinal tract disease with loose feces and submitted for microbial culture and immunoassay for toxin production. Polymerase chain reaction assays were performed on isolates for toxins A and B genes and strain identification. RESULTS: Isolates were grouped into 3 strains (A, B, and C) on the basis of molecular banding patterns. Toxins A and B gene sequences were detected in 93%, 95%, and 73% of isolates of strains A, B, and C, respectively. Results of fecal immunoassays for toxin A were positive in 40%, 63%, and 16% of horses with strains A, B, and C, respectively. Isolates in strain B were resistant to metronidazole. Horses infected with strain B were 10 times as likely to have been treated with metronidazole prior to the onset of diarrhea as horses infected with other strains. Duration from onset of diarrhea to discharge (among survivors) was longer, systemic inflammatory response syndromes were more pronounced, and mortality rate was higher in horses infected with strain B than those infected with strains A and C combined. CONCLUSIONS AND CLINICAL RELEVANCE: Horses may be infected with a number of heterogeneous isolates of C difficile. Results indicated that toxigenicity and antimicrobial susceptibility of isolates vary and that metronidazole-resistant strains may be associated with severe disease.

Hematologic and biochemical reference ranges for captive California condors (Gymnogyps californianus).

To provide proper medical evaluation and care for the endangered California condor (Gymnogyps californianus), veterinarians need accurate hematologic and biochemical reference ranges. A retrospective study of blood samples from captive California condors housed at the San Diego Wild Animal Park assessed the samples by sex and age of condor to determine serum biochemical and hematologic reference ranges, including lead and zinc levels. Condors were grouped by age as follows: group 1 included birds less than 30 days of age; group 2 included birds between 30 days and 6 mo of age; group 3 included birds between 6 mo and 5 yr of age; group 4 included all birds greater than 5 yr of age. Significant differences between sexes included higher chloride, cholesterol, and total plasma protein concentration in males as compared to females (P < 0.05). Significant differences between age groups were identified in glucose, potassium, phosphorus, calcium, albumin, total plasma protein, globulin, cholesterol, bile acid, and zinc concentrations, as well as aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase, and creatine phosphokinase activities (P < 0.05). Additionally, significant differences between age groups were noted in white blood cell count, hematocrit, heterophils, lymphocytes, and eosinophils (P < 0.05). A steady increase in glucose and a decrease in alkaline phosphatase and lactate dehydrogenase activities, as well as cholesterol, bile acid, calcium, and phosphorus concentrations, were correlated with age (P < 0.05). Following application of statistical analysis, condors less than 6 mo of age were identified as unique compared to older cohorts; therefore, two reference ranges are proposed by calculating a 90% confidence interval. Reference ranges obtained from other published avian data, including those for psittaciformes, ratites, galliformes, anseriformes, and raptors, were similar to condors in this study.