Three-dimensional printed guides for screw placement in equine navicular bones.

OBJECTIVE: To determine the influence of a custom 3D-printed guide for placement of cortical bone screws in the equine navicular bone. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Eight pairs of normal adult equine forelimbs. METHODS: A 3.5 × 55 mm cortical screw was placed in the longitudinal axis of each intact navicular bone. Screws were placed with a 3D-printed guide (3D) in one bone and with a traditional aiming device (AD) in the contralateral bone within each pair. Duration of surgery and the number of fluoroscopy images were compared between techniques. Screw placement was subjectively evaluated by gross examination and scored by three boarded veterinary surgeons. RESULTS: The use of a 3D-printed guide reduced the duration of surgery by 6.6 min (±1.5 min) compared to traditional screw placement (20.7 min ± 4.8 min, p < .01). Fewer peri-operative fluoroscopic images were obtained when the 3D guide was used (18 images ± 2.6 images vs. 40 images ± 5.1, p < .01). No difference was detected in navicular screw placement. CONCLUSION: The use of a 3D guide decreased the time required to place screws and the number of intraoperative images taken without affecting screw placement in intact navicular bones. CLINICAL RELEVANCE: 3D-printed guides can aid in the study, practice, and execution of surgical procedures reducing surgical time and radiation exposure throughout the operative period achieving similar results to those obtained with a conventional approach.

Influence of instructor-to-student ratio for teaching suturing skills with models.

OBJECTIVE: To evaluate the influence of instructor to student ratio on the effectiveness and efficiency of teaching suturing skills to veterinary students. STUDY DESIGN: Prospective randomized study. SAMPLE POPULATION: Second-year veterinary students (N = 121). METHODS: Students were randomly divided into three groups to participate in four 2-hour skills laboratory sessions in which suturing of the subcutaneous tissue was taught by using a simple continuous pattern, suturing of the skin was taught by using continuous patterns, suturing of the skin was taught by using interrupted patterns, and suturing of hollow organs was taught by using inverting patterns. For each laboratory, the groups were taught by using instructor-to-student ratios of 1:6, 1:8, and 1:10 on a rotating basis. Students were surveyed at the end of each laboratory, and underwent individual performance assessments at the end of each laboratory session and again at the end of the semester in an objective structured clinical examination (OSCE). RESULTS: For each of the four in-laboratory assessments and the OSCE, no difference in performance was detected between groups. When they were surveyed, students in all groups reported that there was an adequate number of instructors in the laboratory and that they received help in a timely fashion when help was requested (median for all groups = agree). CONCLUSION: For students with prior surgical skills education and with the use of prelaboratory instructional videos, teaching at the 1:10 instructor-to-student ratio was efficient and effective. CLINICAL SIGNIFICANCE: Good educational outcomes may be reached with a 1:10 instructor-to-student ratio or, potentially, fewer instructors, depending on the educational aids present in the laboratory and students' prior level of experience.

Use of a surgical safety checklist after implementation in an academic veterinary hospital.

OBJECTIVE: To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN: Voluntary online survey and retrospective study. SAMPLE POPULATION: All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS: Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS: Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. CONCLUSION: The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). CLINICAL SIGNIFICANCE: The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.

How do veterinary students engage when reflecting on their development towards being veterinary surgeons?

BACKGROUND: Reflection has been widely acknowledged to contribute to professional development, the ability to manage tension and enhanced resilience. However, many practitioners struggle to reflect productively due to a lack of clarity of what constitutes effective reflection. METHODS: To help develop reflective competence among future professionals, 30 veterinary students' reflective assignments were analysed by thematic text analysis. Theoretical frameworks were based on published criteria for critical and core reflection. RESULTS: Reflection was described through resources (the tools used), practices (the ways of using these tools) and outcomes (what was achieved). This helped to distinguish simple skills based reflection from higher-level core reflection. Simple skills-based reflection was associated with an identity of expert learner: students perceive that their task is to identify a knowledge deficit that can be easily rectified through new learning. Core reflection was associated with students articulating an identity of adaptable professionals: rather than veterinary challenges being resolved simply through application of a body of knowledge, wider complexities of professional practice are recognised, including a need to resolve tension between their own and other stakeholders' priorities, values and beliefs. CONCLUSION: Scaffolding an iterative, cyclical reflection process may support outcomes oriented towards resilience and the management of tension.

The Effect of an Ovariohysterectomy Model Practice on Surgical Times for Final-Year Veterinary Students' First Live-Animal Ovariohysterectomies.

This study evaluated whether one supervised simulated ovariohysterectomy (OVH) using a locally developed canine OVH model, decreased surgical time for final-year veterinary students' first live-animal OVH. We also investigated student perceptions of the model as a teaching aid. Final-year veterinary students were exposed to an OVH model (Group M, n = 48) and compared to students without the exposure (Group C, n = 58). Both groups were instructed similarly on performing an OVH using a lecture, student notes, a video, and a demonstration OVH performed by a veterinary surgeon. Students in Group M then performed an OVH on the model before performing a live-animal OVH. Students in Group C had no exposure to the OVH model before performing a live-animal OVH. Surgical time data were analyzed using linear regression. Students in Group M completed a questionnaire on the OVH model after performing their first live-animal OVH. The OVH model exposure reduced students' first canine live-animal OVH surgery time (p = .009) for students without prior OVH experience. All students (n = 48) enjoyed performing the procedure on the mode; students practicing an OVH on the model felt more confident (92%) and less stressed (73%) when performing their first live-animal OVH. Results suggest that the canine OVH model may be helpful as a clinical training tool and we concluded that the OVH model was effective at decreasing students' first OVH surgical time.

Feline onychectomy: Current practices and perceptions of veterinarians in Ontario, Canada.

The objective of the study was to determine the proportion of practitioners from Ontario, Canada who perform onychectomy, identify the techniques utilized, and obtain practitioners views on the procedure. An anonymous survey was distributed to Ontario Veterinary Medical Association members. Mann-Whitney U-tests were used to compare responses of opinion questions related to declawing between respondents who indicated they perform declawing procedures and those who do not. Of 500 respondents, 75.8% reported performing onychectomy, with 60.1% of those reporting performing the procedure less than monthly and 73.3% only performing the procedure after recommending alternatives. Statistically significant differences were found between those who do and those who do not perform onychectomy for perception of procedural pain, concept of mutilation, perception of procedural necessity for behavior modification or prevention of euthanasia, and support of province-wide procedural bans.

Onychectomie féline : pratiques et perceptions actuelles des vétérinaires en Ontario, Canada. L'objectif de l'étude consistait à déterminer la proportion de praticiens en Ontario, au Canada, qui réalisent l'onychectomie, d'identifier les techniques utilisées et d'obtenir le point de vue des praticiens sur l'intervention. Un sondage anonyme a été distribué aux membres de l'Ontario Veterinary Medical Association. Des tests U de Mann-Whitney ont été utilisés pour comparer les réponses aux questions d'opinion portant sur le dégriffage entre les répondants qui avaient indiqué qu'ils réalisaient des interventions de dégriffage et ceux qui n'en effectuaient pas. Parmi les 500 répondants, 75,8 % ont déclaré qu'ils réalisaient l'onychectomie : 60,1 % ont déclaré la réaliser moins d'une fois par mois et 73,3 % ont dit l'effectuer après avoir recommandé des solutions de remplacement. Des différences statistiquement significatives ont été constatées entre ceux qui réalisaient l'onychectomie et ceux qui ne la réalisaient pas, au niveau de la perception de la douleur associée à l'intervention, du concept de mutilation, de la nécessité de l'intervention pour la modification du comportement ou la prévention de l'euthanasie et de l'appui d'une interdiction à l'échelle de province.(Traduit par Isabelle Vallières).

Canine Ovariohysterectomy: A Survey of Surgeon Concerns and Surgical Complications Encountered by Newly Graduated Veterinarians.

The objective of this study was to document newly qualified veterinarians' concerns and surgical complications encountered during canine ovariohysterectomy (cOVH) during the first year of general practice. A questionnaire investigating concerns about cOVH procedures was sent to all final-year veterinary students (group 1) enrolled at five UK universities. Participants were later asked to complete a similar questionnaire 6 months (group 2) and 12 months (group 3) after graduation, which involved grading their concern about different aspects of the cOVH procedure and reporting surgical complications encountered after completing three cOVHs. Responses were compared between different time points. There were 196 respondents in group 1, 55 in group 2, and 36 in group 3. Between groups 1 and 2, there was a statistically significant reduction in the respondents' levels of concern in every aspect of cOVH (p<.05). Between groups 2 and 3, there was no statistically significant change in respondents' levels of concern in any aspect of cOVH (p≥.21). There was a significant reduction in the number of complications encountered by veterinarians in group 3 (39/102, 38.2%) compared to those in group 2 (117/206, 56.8%) (p=.002). Employers should anticipate high levels of concern regarding all aspects of cOVHs in new graduates, and supervision during the first 6 months may be particularly useful.

International online survey to assess current practice in equine anaesthesia.

REASONS FOR PERFORMING STUDY: Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years ago. OBJECTIVES: To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. STUDY DESIGN: Online questionnaire survey. METHODS: An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. RESULTS: A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the animal and training of the anaesthetist. CONCLUSIONS: Current practice in equine anaesthesia varies widely, and the study has highlighted important topics relevant for designing a future prospective multicentre cohort study (CEPEF-4). The Summary is available in Chinese - see Supporting information.

Bacterial contamination of gloves worn by small animal surgeons in a veterinary teaching hospital.

This prospective study investigated bacterial contamination of surgical gloves during small animal surgical procedures and factors associated with glove contamination. The outer surface of surgical gloves was sampled and cultured after completion of surgical procedures. Bacterial presence and numbers were recorded. Of 78 gloves sampled from 39 surgical procedures, bacterial contamination was noted in 16/78 (21%) gloves from 12/39 (31%) procedures. There was no difference in contamination of left or right hand glove [7/39 (18%) versus 9/39 (23%)], respectively (P = 0.78). There was no impact of glove type of left hand (P = 0.41), right hand (P = 0.44) or either hand (P = 0.26) contamination, or of surgical time (P = 0.71), dominant hand (P > 0.13), surgery type (orthopedic versus soft tissue versus neurological) (P > 0.42) or surgical wound classification (P > 0.11) on the incidence of contamination.

Contamination bactérienne des gants portés par des chirurgiens pour petits animaux dans un hôpital d'enseignement vétérinaire. Cette étude prospective a étudié la contamination bactérienne des gants chirurgicaux durant les interventions chirurgicales pour petits animaux et les facteurs associés à la contamination des gants. La surface extérieure des gants chirurgicaux a été échantillonnée et une culture a été effectuée après la réalisation des interventions chirurgicales. La présence et la numération bactériennes ont été consignées. Parmi les 78 gants provenant de 39 interventions chirurgicales, la contamination bactérienne a été signalée dans 16/78 (21 %) gants provenant de 12/39 (31 %) interventions. Il n'y avait aucune différence au niveau de la contamination du gant gauche ou droit [7/39 (18 %) contre 9/39 (23 %)], respectivement (P = 0,78). Il n'y a eu aucun impact au niveau de la contamination quant au type de gant de la main gauche (P = 0,41), de la main droite (P = 0,44) ou de l'une ou l'autre main (P = 0,26) ou à la durée de la chirurgie (P = 0,71), à la main dominante (P > 0,13), au type de chirurgie (orthopédique contre tissus mous contre neurologique) (P > 0,42) ou à la classification de la plaie chirurgicale (P > 0,11) sur l'incidence de la contamination.(Traduit par Isabelle Vallières).

Treatment of canine cranial cruciate ligament disease. A survey of ACVS Diplomates and primary care veterinarians.

OBJECTIVE: To describe veterinarians' treatment recommendations and decision-making factors for dogs with cranial cruciate ligament disease (CCLD). METHODS: An online survey of American College of Veterinary Surgeons (ACVS)-Diplomates (surgeon group) and primary care veterinarians (practitioner group) was performed. The survey included questions on treatment recommendations for common case scenarios (small or large breed dog with complete or partial CCLD), treatment decision factors, non-surgical treatment options, and actual treatment, if any, provided for a client-owned dog as well as one owned by their family or close friend. RESULTS: The response rate was 42% for the surgeon group (n = 305/723) and four percent for the practitioner group (n = 1145/ 27,771). Extracapsular stabilization (ES) was the most common treatment recommendation for CCLD in small (9.1 kg) breed dogs amongst surgeons and practitioners. Tibial plateau levelling osteotomy (TPLO) was the most common treatment recommendation for CCLD in large (27.2 kg) breed dogs amongst both groups. The two most important treatment decision factors were dog size (78% of practitioners, 69% of surgeons) and activity level (63% of practitioners, 52% of surgeons). The most common treatment provided for a dog of their own or close relation in the surgeon group was TPLO (64%) followed by ES (15%), whereas in the practitioner group it was ES (38%) followed by TPLO (30%). CLINICAL SIGNIFICANCE: Extracapsular stabilization and TPLO are the most commonly employed surgical procedures in the surveyed population; dog size and activity level (but not age) are the major factors influencing treatment decisions.

Prospective study to investigate the use of fine needle aspiration techniques in UK veterinary practice.

OBJECTIVES: To document the fine needle aspiration methods used by UK veterinary practitioners for the assessment of cutaneous masses and relate this to the achievement of a representative sample. METHODS: An internet-based questionnaire was designed and publicised in the UK national veterinary press, at a national surgical meeting, and in letters to veterinary surgeons. RESULTS: One hundred and seventy respondents replied to the questionnaire: 58 · 2% sampled cutaneous masses on the basis of appearance or behaviour; 41 · 3% sampled every cutaneous mass. Practitioners with a greater oncological caseload or who graduated more recently were more likely to recommend fine needle aspiration for every cutaneous mass (P = 0 · 019 and P = 0 · 0002 respectively); 66 · 5% of respondents applied suction during fine needle aspiration; 89% of all respondents used a 2 or 5 mL syringe in combination with a 21 or 23 G needle. There was no statistically significant association between achievement of a representative sample and syringe (P = 0 · 64) or needle size (P = 0 · 63). CLINICAL SIGNIFICANCE: Fine needle aspiration is widely used in UK practice, but may be underutilised in practices with lower oncological caseloads. Survey participants reported a high rate of representative samples obtained using all the commonly used techniques. Further work is required to confirm these observations.

Management of cranial cruciate ligament rupture in small dogs: a questionnaire study.

OBJECTIVES: To survey the current management of cranial cruciate ligament rupture in small dogs (<15 kg) by veterinarians. METHODS: A questionnaire was distributed to veterinarians attending the British Veterinary Orthopaedic Association Spring meeting and British Small Animal Veterinary Association Annual Congress which took place in April 2010. Respondents were surveyed on their management of small dogs with cranial cruciate ligament rupture. RESULTS: Immediate surgical management was chosen by 15.5% of the respondents. Following that, 77.6% of respondents suggested that case management would depend on severity of lameness (81%), age (72.6%), bodyweight (70.4%), degree of instability (64.8%), and duration of lameness (64.0%). Conservative management included non-steroidal anti-inflammatory drugs (91.1%), short leash walks (91.1%), weight loss (89.0%), hydrotherapy (53.6%), physiotherapy (41.9%), and cage rest (24.2%). Where surgical management was chosen, 71.4% would perform the procedure rather than refer it to another practice. Surgical techniques included extra-capsular stabilisation (63.4%), corrective osteotomies (32.9%), and intra-articular stabilisation (6.8%). The demographic characteristics of the responding veterinarians had no effect on their initial management of the case. General practice veterinarians were less likely to perform a corrective osteotomy than to refer the case, but were no less likely to perform an extracapsular technique. CLINICAL SIGNIFICANCE: Conservative management is still widely used for treatment of cranial cruciate ligament rupture in dogs weighing less than 15 kg; this is in agreement with previous publications on the management of this condition in small dogs.

Comparison of surgical duration of canine ovariectomy and ovariohysterectomy in a veterinary teaching hospital.

OBJECTIVE: To prospectively evaluate ovariectomy and ovariohysterectomy via midline coeliotomy when being employed by supervised final year veterinary students for the purpose of routine canine neutering. METHODS: One hundred and eight female dogs of various breeds, presented to a veterinary teaching hospital for neutering, were randomly allocated to one of two surgery groups, ovariectomy or ovariohysterectomy. The specified procedure was performed by a supervised final year veterinary student. If the duration of surgery exceeded 2 hours or if major surgical or anaesthetic complications occurred, the supervising surgeon intervened to complete the procedure. RESULTS: Data analysed included age, weight, time from first incision to start of closure, duration of closure, total surgical time and length of incision. Fifty-four dogs underwent each procedure. There was no significant difference between the two surgery groups for any of the measured variables. CLINICAL SIGNIFICANCE: Ovariectomy is not associated with shorter surgical times or smaller abdominal incisions than ovariohysterectomy when employed by inexperienced surgeons. As no major complications novel to ovariectomy occurred in this cohort of dogs, this study adds support to the existing literature indicating that ovariectomy is an acceptable alternative to ovariohysterectomy for canine neutering.

Cystotomy practices and complications among general small animal practitioners in Ontario, Canada.

Cystotomy is a common surgical procedure in small animal veterinary medicine, yet common pre-, intra-, and post-operative practices have not been described. This survey evaluated cystotomy practices of 106 veterinarians in Ontario. The majority of respondents reported practices consistent with standard recommendations, but some deficiencies in antimicrobial and analgesic use, as well as intra- and post-operative practices, were identified. Some factors associated with the likelihood that practitioners reported recurrent urolithiasis or urinary tract infection are contrary to typical recommendations, such as the association of the use of absorbable, multifilament suture or a dorsal (versus ventral) incision and a lesser likelihood of reporting post-operative urinary tract infections. While care must be taken interpreting these statistical associations, the results suggest that objective assessment of common cystotomy recommendations (use of monofilament, absorbable suture) is required. Re-assessment of certain peri-operative practices, such as analgesic and antimicrobial administration, and post-operative testing, is required for a minority of practitioners.

A survey of surgical draping practices in small-animal practice in the UK.

Veterinary practices in the United Kingdom were surveyed to compare their surgical draping practices with Royal College of Veterinary Surgeons (RCVS) accreditation tier and other surgery-related factors. Using descriptive statistics and logistic or ordinal regression analysis (where appropriate), the relationships between draping material and accreditation tier and other surgery-related factors were assessed. Procedures were categorised as short or long. Two hundred and sixty-nine surveys were completed. Reusable drapes were used in 66 per cent of practices. Antibiotics were administered routinely in 38 per cent of short and 93 per cent of long procedures. Practices accredited as a Veterinary Hospital (VH) were 6.3-7.2 (short and long surgeries, respectively) times more likely to use disposable drapes, when compared with non-accredited practices. Use of dedicated surgical attire, draping the whole animal/table, and routine antibiotic usage were also positively correlated with disposable drape usage. Fifty-one per cent of practices rated infection rate as most important when choosing drape material. 'Best practice' techniques are associated with lower importance given to infection rate, and higher importance given to financial cost, when choosing drape material. Disposable drape use correlates with RCVS accreditation and with other aspects of surgical technique. Importance ratings awarded correlate with best practice procedures. Clinical relevance 'Best practice' draping procedures, that are not governed by RCVS accreditation scheme, are also more frequently performed in accredited VHs.

Alcohol consumption among veterinary surgeons in the UK.

BACKGROUND: Alcohol consumption can have both medical and occupational implications and may affect fitness to practise among veterinary surgeons (vets). AIMS: To investigate alcohol consumption and the prevalence and associations of 'at-risk' drinking among vets in the UK. METHODS: Alcohol consumption was measured using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) embedded in a questionnaire which included measures of mental health and psychosocial working conditions, administered to a representative sample of 1796 vets. Scores of >or=4 for women and >or=5 for men were used as an indicator of 'at-risk' drinking. RESULTS: The response rate was 56%. Five per cent of respondents were non-drinkers, 32% low-risk drinkers and 63% at-risk drinkers. The estimated odds of at-risk drinking was not significantly different for men and women. A 1-year increase in age was associated with a 2% reduction in the odds of at-risk drinking (OR 0.98, 95% CI: 0.97-0.99, P < 0.01). There was no significant difference across hours worked or on call in a typical week. Lower psychological demands at work were associated with reduced odds of at-risk drinking (OR 0.75, 95% CI: 0.63-0.90, P < 0.01). CONCLUSIONS: It is estimated that vets drink more frequently than the general population, but consume less on a typical drinking day and have a prevalence of daily and weekly binge drinking that is similar to the general population. The level of alcohol consumption does not appear to be a negative influence on mental health within the profession as a whole.

A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession.

BACKGROUND: Veterinary surgeons are at elevated risk of suicide, with a proportional mortality ratio around four times that of the general population and approximately twice that of other healthcare professions. There has been much speculation regarding possible mechanisms underlying increased suicide risk in the profession but little empirical research. We aimed to assess the contribution of mental health and well-being to the elevated risk, through a postal questionnaire survey of a large stratified random sample of veterinary surgeons practising within the UK. METHODS: A questionnaire was mailed twice to 3,200 veterinary surgeons. Anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being, perceptions of psychosocial work characteristics, and work-home interaction were assessed using valid and reliable existing instruments and a series of bespoke questions previously developed through informal focus groups. RESULTS: Evaluable questionnaires were returned by 1,796 participants, a response rate of 56.1%. The demographic and occupational profile of respondents was representative of the UK veterinary profession. The prevalence of 'caseness' (i.e. HADS subscale score >/=8) for anxiety, depression, and co-morbid anxiety and depression was 26.3, 5.8 and 4.5%. 5.4% of respondents were non-drinkers, 32.0% low-risk drinkers, and 62.6% 'at-risk' drinkers (i.e. AUDIT-C score >/=4 for women, >/=5 for men). The 12-month prevalence of suicidal thoughts was 21.3%. CONCLUSIONS: Compared to the general population, the sample reported high levels of anxiety and depressive symptoms; higher 12-month prevalence of suicidal thoughts; less favourable psychosocial work characteristics, especially in regard to demands and managerial support; lower levels of positive mental well-being; and higher levels of negative work-home interaction. The levels of psychological distress reported suggest ready access to and knowledge of lethal means is probably not operating in isolation to increase suicide risk within the profession.

The creation of an international audit and database of equine colic surgery: survey of attitudes of surgeons.

REASONS FOR PERFORMING STUDY: Currently, there is a lack of available evidence-based data concerning the optimum treatments for horses affected by different types of colic and this precludes the application of clinical audit in this area. In order to accumulate such data, a large-scale, multicentre database of the outcomes of colic surgery is proposed. The attitudes of surgeons is an important consideration in determining the feasibility of developing this database. OBJECTIVES: To assess attitudes and opinions of equine surgeons concerning clinical audit and to assess the perceived advantages and problems of setting up a large-scale international audit/database of colic surgery. METHODS: Interviews were conducted with 30 equine surgeons (large animal/equine surgeons who are diplomates of either the American College of Veterinary Surgeons or the European College of Veterinary Surgeons). Questionnaires were sent by e-mail to 98 equine surgeons. RESULTS: Face to face interviews were conducted (n = 30) and 43/98 completed questionnaires received (44%). The results of the 2 techniques were very similar. There was generally a high level of interest in the development of a large scale database of colic surgery, but perceived problems included time to collect and submit data, and confidentiality issues. A minority of surgeons reported that they were undertaking any form of specific monitoring of the results of colic surgery within their hospitals. CONCLUSIONS: There is a good level of interest among equine surgeons to develop a large scale database of colic surgery and most would be willing to contribute data from their own hospitals provided that data collection is quick and easy, and that confidentiality is maintained.

Survey of diplomates of the American College of Veterinary Surgeons regarding postoperative intra-abdominal adhesion formation in horses undergoing abdominal surgery.

OBJECTIVE: To obtain information from specialists in equine surgery as to prevalence of, predisposing factors for, and methods to prevent postoperative adhesion formation in horses undergoing abdominal surgery. DESIGN: Survey. PROCEDURE: Surveys were mailed to 196 diplomates of the American College of Veterinary Surgeons involved in equine practice. RESULTS: 60 (31%) surveys were returned. Most respondents (55/60) routinely informed clients of the risk of postoperative adhesion formation in horses with small intestinal lesions. When asked after which procedures they routinely used measures to prevent adhesions, 56 of 60 (93%) indicated that they did after small intestinal resection and anastomosis and 56 of 60 (93%) indicated that they did after any abdominal surgery in foals. The 4 methods most frequently listed when respondents were asked which methods were effective at preventing adhesion formation were meticulous surgical technique, administration of antibiotics and nonsteroidal anti-inflammatory drugs, intraoperative peritoneal lavage, and methods that prevent abdominal contamination. Most respondents (50/60) thought that at least some horses with colic secondary to adhesion formation could be managed medically. Fifty-four (90%) respondents indicated that they were successful less than half of the time when treating horses with adhesions severe enough to require additional surgery. CONCLUSION: In general, respondents thought that less than 15% of horses undergoing abdominal surgery would develop adhesions, but that horses with small intestinal disease and foals were most prone to develop adhesions. Meticulous surgical technique was thought to be the most important factor in preventing adhesions, and many prevention regimens reported to be effective in the literature were not commonly used in practice.

Confidential enquiry of perioperative equine fatalities (CEPEF-1): preliminary results.

The Confidential Enquiry into Perioperative Equine Fatalities (CEPEF-1) is an observational multi-institutional prospective study of recovery outcome at 7 days post operatively, as called for by Steffey (1991). Data from 6,255 general anaesthetics (February 91-March 93) were submitted confidentially by 62 clinics. The outcomes of 333 cases which were subjected to euthanasia and which were not classified 'alive' or 'died' at 7 days, were excluded from the analysis. The remaining 5922 cases were analysed to identify risk ratios (RR) between survivors and nonsurvivors for a variety of factors. These preliminary results indicate an overall death rate, for equine patients dying or being subjected to euthanasia within 7 days of a general anaesthetic because of perioperative complications, of 102/6255 (1.6%). This mortality rate decreased to 46/5220 (0.9%) when all colic surgery and delivery of foals under general anaesthesia were excluded. There was an increased risk for mares in the last trimester of pregnancy (RR = 6.4). Patients undergoing emergency abdominal procedures (colic patients and pregnant mares undergoing controlled or caesarean section delivery of foals) under general anaesthesia were at increased risk (RR = 12.9) compared to ear, nose and throat surgery. Within orthopaedic surgery, patients requiring internal fixation were at increased risk (RR = 3.2) compared to those undergoing miscellaneous orthopaedic surgery. There was no difference in risk between breeds. Patients not placed in dorsal recumbency were at reduced risk (RR = 0.3-0.5) compared to those which were in dorsal recumbency.(ABSTRACT TRUNCATED AT 250 WORDS)