Supervisor descriptions of veterinary student performance in the clinical workplace: a qualitative interview study.

This qualitative study investigated the qualities of veterinary student performance that inform a supervisor's impression of their competency. Semi-structured interviews were conducted with a purposive sample of 15 supervisors from different veterinary subdisciplines, to elicit descriptions of excellent, weak and marginal students. Thematic analysis of transcriptions revealed 12 themes, of which engagement was frequently discussed and of stated importance, and trustworthiness was a differentiator of weak and marginal students from excellent students. Other themes were knowledge, application of knowledge, technical and animal handling skills, communication, social interaction, personal functioning, caring for animals, impact, prospects and the difficulty in judging competency. Patterns of association of themes were found, however themes were also used independently in unique combinations for most students described. The findings show the range of abilities, behaviours, attitudes and personal characteristics of students that are considered by supervisors and how these are weighted and balanced. The key contribution of engagement and trustworthiness to the overall impression aligns with research indicating their importance for success in clinical practice, as both contributors to competency and indicators of it. The findings may inform future design and investigation of workplace-based learning and in-training evaluation, as well as conceptions of veterinary competency.

Curettage and diathermy: a treatment for feline nasal planum actinic dysplasia and superficial squamous cell carcinoma.

OBJECTIVE: To evaluate curettage and diathermy as a treatment for actinic dysplasia and superficial squamous cell carcinoma of the feline nasal planum. METHODS: Thirty-four cats clinically assessed to have actinic dysplasia and superficial squamous cell carcinoma involving less than 50% of the nasal planum were treated with a three-cycle curettage and diathermy procedure. Degree of dysplasia, response to treatment, adverse effects, owner perceptions, time to recurrence and proportion disease free at 1 year were evaluated. RESULTS: Lesions ranged from actinic keratoses to invasive squamous cell carcinoma. A complete response to treatment was obtained in all cats. The median follow-up time was 18 · 2 (IQR: 12 · 0-22 · 8) months. Two cats had a clinical recurrence of lesions at 161 and 192 days after treatment. The probability of remaining disease free after 12 months was 0 · 94 (95% CI: 0 · 85-1 · 0). Median time to recurrence was not reached. The procedure was well tolerated with a good cosmetic outcome and no significant post-operative complications. CLINICAL SIGNIFICANCE: This study suggests that curettage and diathermy is an effective treatment for feline actinic dysplasia and for superficial squamous cell carcinoma involving less than 50% of the nasal planum. Curettage and diathermy is an easily mastered technique, requiring minimal equipment.

Comparison of point-of-care analysis using Coaguchek XS and standard laboratory-measured prothrombin time in dogs.

AIMS: The Coaguchek XS is a hand-held coagulation monitor, which is widely available for human testing, and could have applications for canine samples. The aim of this study was a preliminary evaluation of the suitability of this point-of-care device to determine prothrombin time (PT) in dogs by measuring the clinical agreement between the results obtained using the device and standard laboratory testing. METHODS: The PT in 24 samples from 13 dogs with suspected coagulopathy and 40 samples from 40 healthy dogs was determined concurrently using the point-of-care device and standard laboratory analysis. The clinical agreement between methods was assessed using Bland-Altman analysis and error grid analysis. RESULTS: Four of the paired samples were not suitable for analysis. The point-of-care device showed a 1.29 fold positive systematic bias which, when corrected for, gave excellent clinical agreement. Differences in the results obtained would have influenced clinical decision making in only 3 of 60 (5.0%) samples where the point-of-care result suggested a more prolonged PT than laboratory testing. A measurement error occurred in two point-of-care samples which may have been due to the combination of severe anaemia and severely prolonged PT. CONCLUSIONS AND CLINICAL RELEVANCE: The point-of-care device can be used in dogs and would provide rapid analysis of PT to aid clinical decision making in dogs with suspected rodenticide toxicity. Development of a device-specific reference range for dogs would improve its value.

Pathology of mucopolysaccharidosis IIIA in Huntaway dogs.

Dogs with mucopolysaccharidosis (MPS) IIIA were bred within an experimental colony. As part of characterizing them as a model for testing therapeutic strategies for the analogous disease of children, a pathologic study was undertaken. By histology, there were variably stained storage cytosomes within neurons, including many that stained for gangliosides. On ultrastructure examination, these cytosomes contained either moderately dense granular material, tentatively interpreted as precipitated glycosaminoglycan; a variety of multilaminar bodies, interpreted as being associated with secondary accumulation of gangliosides; or a mixture of both types. In the liver, storage vesicles also contained excess glycogen as a secondary storage product. In various tissues, there were large foamy macrophages. In the brain, many of these were in juxtaposition with neurons, and, on ultrastructure examination, they contained storage cytosomes similar to those in neurons. However, the neuron in association with such a macrophage frequently showed little such material.

Pregnancy-related diabetes mellitus in two dogs.

CASE SUMMARIES: Two cases of diabetes mellitus occurring in bitches in association with pregnancy are reported. In the first case, a bitch with suspected acromegaly developed diabetes mellitus within 2 weeks of the due date. Despite insulin therapy, euglycaemia was not achieved. Two live, small pups were delivered by elective Caesarean section but died within 2 days. Signs consistent with acromegaly resolved but diabetes mellitus was permanent in the bitch. In the second case, diabetic ketosis with severe gastrointestinal disease was diagnosed 2 days after Caesarean section was performed due to dystocia. The pups delivered all died within 5 days. The bitch recovered fully from diabetes mellitus within 2 weeks and has remained euglycaemic without insulin for a period of at least 18 months. CLINICAL RELEVANCE: These two cases demonstrate that diabetes mellitus can occur in association with pregnancy in dogs, that diabetic ketosis can occur during transient diabetes mellitus in dogs, and suggest that acromegaly may occur during pregnancy-related dioestrus in dogs. The scarcity of previous reports of this nature, however, suggests that such cases are unusual. Lack of prompt resolution of hyperglycaemia may result in secondary diabetes mellitus becoming permanent. Management should focus on immediate insulin therapy or ovariohysterectomy to minimise this risk. Even mild hyperglycaemia should not be ignored during pregnancy. The insulin antagonistic effects of pregnancy, stressful illness, surgery and dystocia can be enough to result in diabetic ketosis in the absence of permanent insulin deficiency. Maternal hyperglycaemia may contribute to adverse fetal outcomes in dogs but further study is required regarding the nature of the risk.

Diagnosis and management of diabetes mellitus in five cats with somatotrophic abnormalities.

The clinical findings and management of five cats with abnormalities consistent with acromegaly were examined retrospectively. Growth hormone (GH) concentrations were elevated in four cats. In one, a minimal elevation of GH was accompanied by a marked elevation in insulin-like growth factor-1 (IGF-1). Insulin-like growth factor-1 concentrations supported the diagnosis in three of four cats measured, but was not elevated initially in one cat, despite a markedly elevated GH concentration. These findings suggest that elevated IGF-1 concentrations are a reliable indicator of acromegaly, but that values within the reference range do not exclude such a diagnosis. Clinical signs of acromegaly were similar to those previously reported, although upper respiratory stridor occurred in one cat, and insulin-resistant diabetes mellitus was not a consistent feature. Despite the lack of a widely available definitive treatment for acromegaly, good control of the clinical signs of diabetes mellitus can be achieved for long periods despite high doses of insulin often being required.

Dynamic adrenal function testing in eight dogs with hyperadrenocorticism associated with adrenocortical neoplasia.

The results of adrenocorticotropin (ACTH) stimulation and low-dose dexamethasone suppression tests (LDDST) were evaluated retrospectively in eight dogs with clinical signs of hyperadrenocorticism arising from functional adrenocortical tumours, and compared with the results from 12 dogs with confirmed pituitary-dependent hyperadrenocorticism (PDH). The post-ACTH cortisol concentration in the dogs with adrenocortical tumours ranged from 61 to 345-6 nmol/litre (median 251.5 nmol/litre) and they were within the reference range (150 to 450 nmol/litre) in five and unexpectedly low (< 150 nmol/litre) in three dogs. Both the basal and post-ACTH cortisol concentrations were significantly lower in the dogs with adrenocortical neoplasia than in the dogs with PDH. Eight hours after the LDDST, only two of six dogs with adrenocortical tumours had a cortisol concentration above 30 nmol/litre, and the median resting, three, and eight-hour cortisol concentrations were 31.5, 23.0, and 22.7 nmol/litre respectively. There was no significant cortisol suppression during the LDDST, although interpretation was complicated by the low cortisol concentrations, but two dogs showed a pattern of apparent suppression. Two dogs with adrenal tumours showed a diagnostically significant increase in 17-OH-progesterone concentration in response to ACTH although their cortisol concentrations did not increase greatly. These results differ from previous reports of the response of functional adrenal tumours to dynamic endocrine tests.

Mitotane (o,p'-DDD) resistance in a dog with pituitary-dependent hyperadrenocorticism and phaeochromocytoma.

A dog was presented with a 2 year history of polyuria and polydipsia due to pituitary-dependent hyperadrenocorticism. A low-dose dexamethasone suppression test and measurement of plasma ACTH concentration confirmed the diagnosis. Treatment was instituted with mitotane at 44 mg/kg/day and then 88 mg/kg/d without complete resolution of signs. The dog collapsed with signs consistent with liver disease and was euthanased. Necropsy revealed a phaeochromocytoma of the left adrenal medulla with extensive metastases to the liver. A chromophobe adenoma of the pars intermedia of the pituitary was found.

Screening elderly populations for cobalamin (vitamin B12) deficiency using the urinary methylmalonic acid assay by gas chromatography mass spectrometry.

PURPOSE: This study assesses the value of the urinary methylmalonic acid (MMA) assay by gas chromatography mass spectrometry as a screening procedure for detection of cobalamin (Cbl) deficiency and estimates the prevalence of undetected Cbl deficiency in elderly populations. SUBJECTS AND METHODS: A total of 809 elderly individuals over age 65 were screened using random spot urine specimens from 4 different sites: a health fair, retirement apartments, a hospital-based elderly assessment center, and a nursing home. Follow-up tests included serum total Cbl, serum MMA, and normalization of urinary and serum MMA levels with Cbl intramuscular (IM) therapy. RESULTS: The prevalence of elevated urinary MMA varied across population groups, from 3.0% in elderly visiting a health fair to 5.1% in elderly residing in retirement apartments. Follow-up on 35 of 36 subjects with elevated urinary MMA levels showed that 18 had low serum total Cbl (less than 180 pg/mL at Hospital 1 or less than 200 pg/mL at Hospital 2), 12 had low-normal Cbl (180 or 200 pg/mL to 350 pg/mL), and 5 had normal Cbl. Of the 12 subjects with low-normal Cbl on retesting, further assessment was performed in 7, and all 7 of these subjects had evidence of Cbl deficiency. Cbl IM therapy was initiated for 23 subjects; 16 were seen for follow-up and all had normal urinary MMA. CONCLUSION: The relatively high prevalence of undetected Cbl deficiency identified in the seniors warrants additional studies of elderly populations. The sensitivity, convenience, and noninvasive nature of the urinary MMA assay by gas chromatography mass spectrometry make it a practical screening test.

Protein-induced hyperthermia for liver cancer treatment.

It is suggested that the thermic effect of protein be exploited as a means of hyperthermia therapy in the treatment of liver cancer. Oral ingestion of high amounts of protein or intravenous amino acid therapy could generate heat directly within the hepatocytes primarily through urea synthesis. This approach could enhance the effects of conventional hyperthermia or radiation therapy.