Reliability in performance assessment creates a potential application of artificial intelligence in veterinary education: evaluation of suturing skills at a single institution.

OBJECTIVES: To evaluate suturing skills of veterinary students using 3 common performance assessments (PAs) and to compare findings to data obtained by an electromyographic armband. SAMPLE: 16 second-year veterinary students. PROCEDURES: Students performed 4 suturing tasks on synthetic tissue models 1, 3, and 5 weeks after a surgical skills course. Digital videos were scored by 4 expert surgeons using 3 PAs (an Objective Structured Clinical Examination [OSCE]- style surgical binary checklist, an Objective Structured Assessment of Technical Skill [OSATS] checklist, and a surgical Global Rating Scale [GRS]). Surface electromyography (sEMG) data collected from the dominant forearm were input to machine learning algorithms. Performance assessment scores were compared between experts and correlated to task completion times and sEMG data. Inter-rater reliability was calculated using the intraclass correlation coefficient (ICC). Inter-rater agreement was calculated using percent agreement with varying levels of tolerance. RESULTS: Reliability was moderate for the OSCE and OSATS checklists and poor for the GRS. Agreement was achieved for the checklists when moderate tolerance was applied but remained poor for the GRS. sEMG signals did not correlate well with checklist scores or task times, but features extracted from signals permitted task differentiation by routine statistical comparison and correct task classification using machine learning algorithms. CLINICAL RELEVANCE: Reliability and agreement of an OSCE-style checklist, OSATS checklist, and surgical GRS assessment were insufficient to characterize suturing skills of veterinary students. To avoid subjectivity associated with PA by raters, further study of kinematics and EMG data is warranted in the surgical skills evaluation of veterinary students.

Presumed pituitary apoplexy in 26 dogs: Clinical findings, treatments, and outcomes.

BACKGROUND: Pituitary apoplexy refers to hemorrhage or infarction within the pituitary gland resulting in acute neurological abnormalities. This condition is poorly described in dogs. OBJECTIVES: To document presenting complaints, examination findings, endocrinopathies, magnetic resonance imaging (MRI), treatments, and outcomes of dogs with pituitary apoplexy. ANIMALS: Twenty-six client-owned dogs with acute onset of neurological dysfunction. METHODS: Retrospective case series. Dogs were diagnosed with pituitary apoplexy if MRI or histopathology documented an intrasellar or suprasellar mass with evidence of hemorrhage or infarction in conjunction with acute neurological dysfunction. Clinical information was obtained from medical records and imaging reports. RESULTS: Common presenting complaints included altered mentation (16/26, 62%) and gastrointestinal dysfunction (14/26, 54%). Gait or posture changes (22/26, 85%), mentation changes (18/26, 69%), cranial neuropathies (17/26, 65%), cervical or head hyperpathia (12/26, 46%), and hyperthermia (8/26, 31%) were the most frequent exam findings. Ten dogs (38%) lacked evidence of an endocrinopathy before presentation. Common MRI findings included T1-weighted hypo- to isointensity of the hemorrhagic lesion (21/25, 84%), peripheral enhancement of the pituitary mass lesion (15/25, 60%), brain herniation (14/25, 56%), and obstructive hydrocephalus (13/25, 52%). Fifteen dogs (58%) survived to hospital discharge. Seven of these dogs received medical management alone (median survival 143 days; range, 7-641 days) and 8 received medications and radiation therapy (median survival 973 days; range, 41-1719 days). CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with pituitary apoplexy present with a variety of acute signs of neurological disease and inconsistent endocrine dysfunction. Dogs that survive to discharge can have a favorable outcome.

Metastatic thyroid carcinoma in the appendicular skeleton and tibial plateau leveling osteotomy site of a dog.

A 13-year-old spayed female Labrador retriever cross dog was referred to the Foster Hospital for Small Animals at Tufts University for evaluation of a metastatic carcinoma discovered at the site of a previous tibial plateau leveling osteotomy (TPLO). The dog was previously evaluated at the primary care veterinarian for a complaint of lameness, and radiographs of the previous TPLO site revealed bony lysis associated with the TPLO plate. Surgical exploration of the site by the primary veterinarian provided evidence of osteolysis. The lytic area of the proximal tibia was biopsied, and a metastatic carcinoma was confirmed. The patient was referred for further evaluation. Following consultation and examination, a full body computed tomography (CT) scan was performed to determine the source of the carcinoma. A well-defined soft tissue attenuating mass effacing the right thyroid gland was located, along with 3, well-defined soft tissue attenuating nodules within the pulmonary parenchyma, consistent with metastatic disease. The previously diagnosed osteolytic, aggressive bone lesion of the proximal left tibia was visualized. Following the CT scan, palliative left hind-limb amputation via coxofemoral disarticulation was performed. Histological examination of the hind limb revealed neoplastic epithelial cells admixed with reactive bone. Neoplastic cells were arranged in packets with rare colloid-filled microfollicles consistent with a diagnosis of metastatic thyroid carcinoma. To the authors' knowledge, this is the first clinical report of metastatic thyroid carcinoma in the appendicular skeleton and TPLO site of a dog. Key clinical message: Our findings emphasized that thyroid carcinoma may metastasize to the appendicular skeleton, and causes other than osteomyelitis or implant-associated osteosarcoma should be considered when evaluating osteolytic lesions at a TPLO site.

Carcinome métastatique de la thyro ï de dans le squelette appendiculaire et site d'ostéotomie de n ivellement du plateau tibial d'un chien. Une chienne croisée Labrador retriever stérilisée âgée de 13 ans a été référée au Foster Hospital for Small Animals de l'Université Tufts pour l'évaluation d'un carcinome métastatique découvert sur le site d'une ostéotomie de nivellement du plateau tibial (TPLO) antérieure. Le chien a été précédemment évalué chez le vétérinaire de soins primaires pour une plainte de boiterie, et les radiographies du site TPLO précédent ont révélé une lyse osseuse associée à la plaque TPLO. L'exploration chirurgicale du site par le vétérinaire initial a mis en évidence une ostéolyse. La zone lytique du tibia proximal a été biopsiée et un carcinome métastatique a été confirmé. Le patient a été référé pour une évaluation plus approfondie. Après consultation et examen, une tomodensitométrie (CT) du corps entier a été réalisée pour déterminer la source du carcinome. Une masse d'atténuation des tissus mous bien définie effaçant la glande thyroïde droite a été localisée, ainsi que trois nodules d'atténuation des tissus mous bien définis dans le parenchyme pulmonaire, compatibles avec une maladie métastatique. La lésion osseuse ostéolytique et agressive du tibia gauche proximal précédemment diagnostiquée a été visualisée. Après la CT, une amputation palliative du membre postérieur gauche par désarticulation coxofémorale a été réalisée. L'examen histologique du membre postérieur a révélé des cellules épithéliales néoplasiques mélangées à de l'os réactif. Les cellules néoplasiques étaient disposées en paquets avec de rares microfollicules remplis de colloïdes compatibles avec un diagnostic de carcinome thyroïdien métastatique. À la connaissance des auteurs, il s'agit du premier rapport clinique de carcinome thyroïdien métastatique dans le squelette appendiculaire et le site TPLO d'un chien.Message clinique clé :Nos résultats ont montré que le carcinome thyroïdien peut métastaser au squelette appendiculaire et que des causes autres que l'ostéomyélite ou l'ostéosarcome associé à l'implant doivent être prises en compte lors de l'évaluation des lésions ostéolytiques sur un site TPLO.(Traduit par Dr Serge Messier).

Predicting the effect of fresh gas flow on tidal volume in volume-controlled mechanically ventilated dogs.

OBJECTIVES: To determine if the tidal volume (VT) delivered (VTDEL) to canine patients being mechanically ventilated by a volume-controlled ventilator differed from the volume set on the ventilator (VTSET) at three fresh gas flow (FGF) rates. To determine if VTDEL could be accurately predicted by an FGF-based mathematical model. STUDY DESIGN: Prospective proof-of-concept study. ANIMALS: A total of 23 adult client-owned dogs undergoing elective orthopedic surgery. METHODS: Dogs were anesthetized and ventilated with a volume-controlled mechanical ventilator with constant respiratory rate (fR) of 10 breaths minute-1, inspiratory-to-expiratory ratio of 1:2 [fraction of inspiratory time (TI) in one respiratory cycle (Ttot) 1:3], and VTSET as body weight (kg) × 15 (mL kg-1). VTDEL was measured in 20 dogs at three FGF (500, 1000 and 4000 mL minute-1). A mathematical model was used to calculate predicted volume (VTPRED) for each animal at each FGF: VTSET + {FGF × [(TI/Ttot)/fR]}. Linear repeated measures models were fit comparing VTDEL to VTSET and to VTPRED by FGF. RESULTS: VTDEL was significantly higher than VTSET at every FGF (p < 0.05), and differences were larger at higher FGF (p < 0.001). There were no statistically significant differences between VTDEL and VTPRED at FGF rates of 500 and 4000 mL minute-1 and, although the mean VTDEL was statistically significantly higher than VTPRED at FGF 1000 mL minute-1 (p = 0.017), the mean difference of 9 mL was not clinically significant. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs on volume-controlled ventilators may be ventilated at a higher VTDEL than intended depending on the FGF settings. Ventilation of small animals at high FGF could inadvertently induce pulmonary damage. A mathematical equation can be used to achieve a desired VTDEL by adjusting VTSET values based on FGF, fR and TI/Ttot.