Keel bone fractures in broiler breeders: is palpation a reliable diagnostic method?

The aim of this study was to estimate the sensitivity and specificity of palpation relative to necropsy for detection of keel bone fractures (KBF) in broiler breeders. In addition, the study investigated observer reliability of palpation. Four commercial breeder flocks (Ross 308 n = 2, Ranger Gold n = 1, Hubbard JA 757, n = 1) were included in the study. A total of 400 hens and 60 roosters were examined after culling or slaughter, at end of lay (63 weeks). Keel bones were first palpated independently by two raters with a varying degree of experience in palpation of keel bones in laying hens. After palpation, a necropsy with investigation of the keel bone was conducted. The prevalence of KBF at end of lay for hens, as diagnosed by necropsy, varied from 14-58%, while only one in 60 assessed roosters had KBF. Palpation had poor sensitivity, with differences between raters ranging from 56% to 36% when hybrid is not considered. The specificity of palpation for all hybrids together was 85% and 88%, for the two raters, respectively. The two raters had moderate agreement, Gwet's agreement coefficient (95% confidence interval): 0.60 (0.52-0.69). In conclusion, palpation has poor diagnostic accuracy for detection of KBF in broiler breeders, and other methods, like necropsy, must be applied for reliable assessments. KBF appears to be a prevalent condition in different hybrids of broiler breeder hens, but not in roosters.RESEARCH HIGHLIGHTS This is the first study to investigate palpation as a diagnostic method for detection of KBF in broiler breeders.Palpation has poor diagnostic accuracy for detection of KBF in broiler breeder hens with differences between raters.KBF can be a prevalent problem in broiler breeder hens of several hybrids, but not in roosters.

An investigation into the detection of the pulse in conscious and anaesthetized dogs.

OBJECTIVES: To record the success rate of veterinary professionals and students at identifying the pulse in conscious and anaesthetized dogs. To explore the influence of clinical experience, pulse location, anaesthesia and likely confounding variables on the success of pulse palpation. STUDY DESIGN: Prospective, observational, randomized study. ANIMALS: A total of 54 client-owned dogs scheduled for general anaesthesia. METHODS: For each dog, three participants (senior anaesthetist, anaesthesia resident/nurse, veterinary student/animal care assistant) attempted pulse palpation at three locations (femoral, radial and dorsal pedal pulse) in conscious and anaesthetized dogs. The time to pulse palpation was measured with a stopwatch for each attempt and data were modelled using a multivariate Cox regression survival analysis (significance p < 0.05). RESULTS: The overall success rate of pulse palpation was 77%, with a median time of 10.91 seconds (interquartile range 9.09 seconds). Success rate was lower in conscious dogs (67%) than in anaesthetized dogs (87%). There was a 77% lower likelihood of success at the radial than at the femoral pulse [hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.38-0.69, p < 0.001]. Veterinary students/animal care assistants had a 71% lower likelihood of success than senior anaesthetists (HR 0.29, 95% CI 0.22-0.39, p < 0.001). Age, weight and American Society of Anesthesiologists physical status had no significant influence. Premedication/anaesthetic drugs, heart rate or mean arterial pressure had no significant influence on the time to pulse palpation in anaesthetized dogs. The median time to palpation was less than 10 seconds for all experience groups at the femoral location. CONCLUSIONS: Palpation of the femoral location had the greatest likelihood of success with the least amount of time. Monitoring the femoral pulse during induction of anaesthesia is suggested as a method for confirming spontaneous circulation. Pulse palpation improves with clinical experience.

Variables Affecting Veterinary Students' Ability to Accurately Interpret Ovulation in Live Mare Palpation.

In a veterinary medicine curriculum, students' hands-on practice is essential but is still considered one of the major deficiencies in veterinary schools in Europe. After theoretical and basic practical training, students, under the control of experienced veterinarians (supervisors), monitored the reproductive cycle of embryo recipients by transrectal palpation and ultrasound. To evaluate the skills of students, the question "Has she ovulated?" was posed when a dominant follicle ≥ 35 mm was recorded in the previous day's examination and a score of 1 or 0 was assigned in the case of a correct or incorrect answer (test palpation), respectively. Study 1 involved the retrospective evaluation of 3,509 test palpation records of 43 students (31 females, 12 males) and showed a statistically significant positive correlation between the number of test palpations performed and the proportion of correct answers. There was a statistically significant effect of the number of test palpations performed by each student, their gender, and the season on the correct answers. When performing > 50 test palpations, a statistical difference between gender was observed (p < .05). Study 2 involved the prospective evaluation of 687 records on 52 standardbred or thoroughbred recipient mares collected from nine right-handed female students. The different mares, breed, occurrence of ovulation on the left or right ovary, and the presence of one or more large follicle(s) per ovary had no effect on the correct answers (p > .05). Individual students' performances were statistically different (p < .05), ranging from 60% to 92%.

Electromyographic Analysis of Muscle Activation Patterns During Bovine Transrectal Palpation and the Development of the Bovine Pregnancy Diagnosis Improvement Exercise Program.

The unusual and tiring physical activity of bovine transrectal palpation (TRP) requires a novel approach to improve students' TRP and pregnancy diagnosis (PD) skills. It has been shown that students who participated in an exercise program and students who had a grip strength (GS) of more than 30 kilograms performed better in bovine PDs. Participation in the exercise program increased students' sensitivity (ability to identify pregnant cows) but did not increase total arm muscle strength. To identify which muscles are used during TRPs and to improve the exercise program, an electromyographic (EMG) analysis was used to identify muscle activation patterns and muscle activity levels during bovine TRPs. Eight subject matter experts (SMEs) each palpated two live cows and one Breed'n Betsy® rectal examination simulator while an EMG Triggered Stimulator recorded muscle activity. Muscle activation was higher for forearm muscles compared with all other examined muscle groups (p < .001); was higher during retraction of the uterus and palpation of left and right uterine horn, compared with palpation of cervix, uterine body, left ovary, and right ovary (p < .001); and showed an endurance pattern. Findings have been used to modify the previously developed exercise program in effort to improve students' TRP and PD skills. The Bovine PD Improvement Exercise Program is available to students through an online application (http://icarus.up.ac.za/vetmlp/) and aims to not only improve GS and TRP accuracy but also stamina and well-being while adding fun to busy study schedules.

Effect of a high-intensity one-week training programme and student-level variables on the bovine transrectal palpation and pregnancy diagnosis skills of final-year veterinary students.

BACKGROUND: To improve bovine transrectal palpation (TRP) and pregnancy diagnosis (PD) training, the effect of a high-intensity one-week training programme for veterinary elective students (N=59) with an interest in production animal practice was evaluated. METHODS: Training consisted of exposure to rectal examination simulators, abattoir organs, theory materials and live cow PDs supervised by experienced large animal practitioners. Palpation skills were assessed before and after training using a validated TRP Objective Structured Clinical Examination (OSCE) in non-pregnant cows. Each student then performed PDs (n=12) on cows of known pregnancy status. Students' PD accuracy was measured as sensitivity and specificity, being respectively defined as the proportion of pregnant and non-pregnant cows correctly identified. RESULTS: Students' scores improved from the first to the second OSCE (P=0.03), mostly as a result of improved ability to identify uterine symmetry/asymmetry and the presence/absence of a corpus luteum on the right ovary (P<0.01 and P=0.03, respectively). Overall student sensitivity and specificity of PD were 89.1 per cent (95 per cent CI 78.1-92.2 per cent) and 67.7 per cent (95 per cent CI 60.1-74.5 per cent), respectively. CONCLUSION: This prospective cohort study describes a strategy to improve students' TRP skills with the potential to reduce training time and animal use at teaching institutions by outsourcing student training to private practitioners.

Improving intra- and inter-observer repeatability and accuracy of keel bone assessment by training with radiographs.

Assessing keel bone damage reliably and accurately is a requirement for all research on this topic. Most commonly, assessment is done on live birds by palpation and is therefore prone to bias. A 2-day Training School of the COST Action "Identifying causes and solutions of keel bone damage in laying hens" with 16 participants of variable experience was held where palpation of live hens was followed by consulting corresponding radiographic images of keel bones. We hypothesized that the inter-observer and intra-observer repeatabilities as well as the agreement between palpation and assessment from the radiograph (considered as the accuracy) would increase from day 1 to 2. Repeatability estimates were calculated using the R-package rptR and the change in level of accuracy on day 1 and 2 was analyzed with generalized linear models. As predicted, the inter-observer repeatabilities of the assessments of the fractures and deviations were improved by training, but this improvement differed for fractures and deviations between the cranial, middle, and caudal parts of the keel bone. Intra-observer repeatabilities before training also differed between the different parts of the keel bone and were highest for fractures at the caudal part of the keel bone. The training affected the accuracy of palpation to different degrees for the different parts of the keel bone. A training effect was found for the caudal part of the keel bone in regard to fractures and deviations, but for fractures the training effect was missing for the cranial part and for deviations it was missing for the middle part of the keel bone. In conclusion, the training school involving radiographs improved inter-observer repeatabilities in the diagnosis of fractures and deviations of keel bones and thus had the potential to lead to more comparable results among research groups.

Ability of a bovine transrectal palpation objective structured clinical examination to predict veterinary students' pregnancy diagnosis accuracy.

Bovine pregnancy diagnosis (PD) by transrectal palpation (TRP) is one of the most frequently performed procedures in bovine practice, and an important competency for veterinary graduates. It is currently not known if pre-existing TRP skills on non-pregnant cows can be used to predict students' future PD accuracy. The study objective was to evaluate if TRP objective structured clinical examination (OSCE) scores can predict students' future PD accuracy.Fourth year (of a six-year programme) veterinary students (n=128) received TRP and PD training on Breed'n Betsy (BB) simulators and live cows. Students' TRP skills were assessed using a live cow TRP OSCE after completion of the fourth year training. The same students received additional TRP (BB and live cows) and PD (BB) training sessions in the first semester of their fifth year. PD accuracy was assessed after the additional TRP and PD training, five months after the TRP OSCE assessment and measured as sensitivity and specificity (the ability to correctly identify the presence and absence of pregnancy, respectively). Each student palpated six cows transrectally to diagnose pregnancy status and stage for the PD assessment. The TRP OSCE results were analysed as predictors for students' PD accuracy.Students with 'competent palpation skills' on the TRP OSCE had higher PD specificity. The individual OSCE components that were predictive of higher PD accuracy were students' ability to estimate ovarian size, identify uterine position and exclude intrauterine fluid. It was concluded that a TRP OSCE has the ability to predict students' future PD accuracy.

The CT dorsolateral subluxation index is a feasible method for quantifying laxity in the feline hip joint.

The dorsolateral subluxation index of the femoral head is a good proxy of hip dysplasia in dogs. An exploratory, prospective, descriptive study was carried out in order to assess whether the dorsolateral subluxation index may also be useful to improve diagnosis of hip dysplasia in cats. The dorsolateral subluxation index was determined by CT scans simulating the loading position, and compared with measurements of the Norberg-Olsson angle. A total of 82 cats were subjected to radiographic examination of the pelvis, in the standard ventro-dorsal projection, and to CT scans of the pelvis and hips. The Norberg-Olsson angle of each hip was calculated radiographically, while the dorsolateral subluxation index of the femur was calculated on CT images according to a technique recently developed for evaluation of hip dysplasia in dogs. Using the Norberg-Olsson angle a total of 52 hips (31,7%) were diagnosed as dysplastic, 74 (45,1%) as non-dysplastic, and 38 (23,1%) as borderline. Using the dorsolateral subluxation index, values ranged from a minimum of 34.6% to a maximum of 66.6% and four distribution classes were proposed. Findings indicated that the dorsolateral subluxation index previously described as method for quantifying hip dysplasia in dogs is also a feasible method for quantifying hip dysplasia in cats. Future studies are needed to more definitively determine the diagnostic sensitivity of this method.

Assessing keel bone damage in laying hens by palpation: effects of assessor experience on accuracy, inter-rater agreement and intra-rater consistency.

Accurate assessment is essential when evaluating keel bone damage. Palpation is commonly used to assess keel bone damage in living hens. However, there is little information on the accuracy of assessment of deviations and fractures on different parts of the keel, and on the consistency within, and agreement between, assessors. Crucially, although the importance of experience is commonly emphasized, knowledge on its effect is scarce. Ten assessors with or without prior experience palpated the same 50 75-wk-old hens for deviations, medial fractures, and caudal fractures (scored as present/absent). Accuracy, sensitivity, specificity, precision, and negative predictive value were determined by comparing palpation scores to post-dissection assessment, and then compared between experienced and inexperienced assessors. To determine the effect of the experience gained during the experiment, hens were subsequently re-assessed. Consistency within, and agreement between, assessors were also determined. Assessors with prior experience were more accurate (proportion of accurately assessed deviations: experienced 0.83 vs. inexperienced 0.79±0.01, P = 0.04; medial fractures: 0.82 vs. 0.68±0.03 in session 1 only, P = 0.04; caudal fractures: 0.41 vs. 0.29±0.03, P = 0.03), and inexperienced assessors classified medial fractures more accurately in session 2 (session 1: 0.68 vs. session 2: 0.77±0.04, P = 0.04). However, effect sizes were small for deviations and even experienced assessors lacked accuracy when assessing caudal fractures. Unexpectedly, deviations tended to be assessed more accurately in session 1 than in session 2, regardless of assessor status (1: 0.83 vs. 2: 0.79±0.01, P = 0.06), suggesting that prolonged assessment contributes to errors. Prior experience decreased specificity and precision of fracture assessment (more unfractured keels were classified as fractured) even though overall accuracy was greater. Intra-rater consistency was fair to good (0.55 to 0.67) for deviations and medial fractures, but poor to fair (0.36 to 0.44) for caudal fractures, and unaffected by prior experience (P = 0.49 to 0.89). In conclusion, experience improves accuracy to a limited extent but does not guarantee high accuracy for all types of damage. Future research should determine if other training methods (e.g., comparison to post-dissection scores or to radiographs) improve accuracy.

Keel bone damage assessment: consistency in enriched colony laying hens.

Damage to the keel bone is a major issue in the laying hen industry. The goal of this study was to compare palpation results of live laying hens to digital computed tomography (CT) images, to assess changes in palpation reliability as training and familiarity increased, and to examine keel bone morphology over time. The longitudinal study consisted of 2 trials of 3 observation periods using 40 different (n = 120) W-36 hens housed in enriched colony cages. The first trial began when hens were 52 to 58 wk of age repeating the trial when the same birds were 74 to 81 wk of age. At 52 wk of age, each hen's keel bone was palpated by a single individual for keel bone caudal tip fractures (Tip), sagittal deviations (Evenness), and transverse deviations (Straightness). After palpation, each hen was placed in a motion limiting restraint and scanned using CT. The hens spent the next 21 d in their cages and on day 21, the hens were collected, palpated, and CT scanned again. The CT scans were imported into Mimics analysis software, 3D models of each keel bone were constructed and evaluated. Each bone and 3D model was scored (0, 1, 2) on the measurement of transverse deviation based on <0.5 cm, 0.51 to 1.0 cm, and >1.0 cm total deviation, respectively. Analysis of data using Proc Freq and Means in SAS 9.3 revealed minimal to moderate kappa values and moderate agreement percentages between palpators and digital analysis. The computer generated 3D models of individual keel bones were compared to palpation scores for Tip, Evenness, and Straightness at the beginning and end of each trial. The visual observations of the 3D models were qualitative, performed by a single individual. Overall, we found CT scanning to be a useful tool in observing changes to the keel bone, we observed changes in palpation accuracy as training/familiarity increased, and examined changes in keel morphology, specifically in the tip, after 52 wk of age.

Relationship between total thyroxine, thyroid palpation and a clinical index in hyperthyroid and healthy cats and cats with other diseases.

OBJECTIVES: Present-day diagnosis of hyperthyroidism is often established in the early stages where clinical signs and physical examination findings typically associated with the disease may not yet be present. The purpose of this study was to investigate thyroid palpation score (TPS), total thyroxine (T4), body weight, body condition score and a clinical scoring index, which assesses severity of illness and quality of life, in untreated hyperthyroid cats, healthy cats and cats with non-thyroidal illness. METHODS: Fifty-five cats with hyperthyroidism, 45 healthy cats and 327 euthyroid cats with non-thyroidal disease were prospectively enrolled. A Kruskal-Wallis test was used to determine any differences between metric data. A χ2 test was applied to compare nominal data between the three subgroups. Correlation between two variables was analysed using Spearman's correlation coefficient. RESULTS: Almost 80% of the hyperthyroid cats and up to 20% of the healthy cats and cats with non-thyroidal illness had a palpable thyroid gland. Median TPS in hyperthyroid cats was 2, which was significantly higher compared with the other groups. Although there was a significant correlation between TPS and T4 when evaluating all cats, this could not be demonstrated in the three subgroups. Hyperthyroid cats with larger thyroid glands (TPS >3) did not have higher T4 levels. Hyperthyroid cats with lower clinical scores had significantly higher T4 levels compared with hyperthyroid cats with higher scores. Hyperthyroid cats were older and had lower body weights and body condition scores than other cats. CONCLUSIONS AND RELEVANCE: Hyperthyroid cats were commonly found to have palpable thyroid glands, but they were smaller than previously reported.

Assessment of Musculoskeletal Injuries Associated with Palpation, Infection Control Practices, and Zoonotic Disease Risks among Utah Clinical Veterinarians.

OBJECTIVES: Practicing veterinarians are exposed to unique occupational hazards and zoonotic diseases. National studies have highlighted an increase risk to injuries and a lack of veterinary awareness for these hazards. In Utah (and likely other states), reports of acquired zoonoses are sporadic, and underlying risk factors poorly understood. To better clarify occupational risk factors, the knowledge, attitudes, and behaviors of Utah veterinarians were examined. METHODS: A total sample of 809 Utah veterinarians were identified from the 2017 licensure listing provided by the Utah Division of Professional Licensing. These individuals were invited to participate in an internet-based survey to self-report musculoskeletal injuries associated with large animal palpation practices. The relationships between some variables and Precaution awareness (PA) score rankings were examined using logistic regression and odds ratios. RESULTS: Of 809 veterinarians, 223 (28%) responded, with 209 self-identifying as clinical veterinarians. Frequent palpation of large animals (equine or bovine) was performed by 43 (22%) of 197 responding veterinarians. Joint pain or injury was experienced by 29 (67%) of 43 responding veterinarians who frequently palpated large animals (equine or bovine). Animal bites, needle-sticks, and cuts were the most frequently reported injuries within the past year. There were 44 (22%) of 197 respondents who reported having contracted a zoonotic disease. Most of the respondents failed to use appropriate PPE when examining an ill animal or when handling potentially infectious specimens. Clinical veterinarians who have less than 10 years of experience and work in a practice providing clinic-based services were 2.3 and 3.8 times more likely to have low PA rankings, respectively. CONCLUSION: Our work underscores the importance for continued clinical veterinarian education on occupational risks associated with musculoskeletal injuries, animal bites, needle-sticks, and cuts. The fact that survey veterinarians reported a high level of zoonotic disease infection illustrates the need for education and training on proper PPE use. Further work is needed to understand why precaution awareness scores were low among this sample of participants in this study. Additional follow-up with veterinarians is recommended to assess availability of large animal handling facilities and safety practices to prevent musculoskeletal injuries.

Ultrasonography is more accurate than percutaneous palpation for identifying targeted thoracolumbar intervertebral disc spaces in dogs.

During minimally invasive spinal surgery, correct identification of the affected intervertebral disc space is critical. Percutaneous palpation is commonly used, but results may be unreliable. Fluoroscopy is the gold standard but can be cumbersome and exposes operators to ionizing radiation. Spinal ultrasound has been described in veterinary medicine and could be a feasible alternative. This prospective, methods comparison study mimicked a minimally invasive spinal surgery in 10 canine cadavers and compared the accuracy of ultrasound and percutaneous palpation for thoracolumbar intervertebral disc space identification, using fluoroscopy as the reference standard. For each experiment, a disc space was randomly chosen. Identification was then attempted using both percutaneous palpation and ultrasound. For ultrasound, a linear probe was used to guide the operator to the correct location. The time necessary to perform each method was recorded. Accuracies for each method were calculated and statistically compared. Effects of body condition score, location of the targeted thoracolumbar intervertebral disc space and learning curve for each method were also evaluated. Ultrasonographic identification was more accurate (96.7% vs. 76.7%; P < 0.03) but took longer (147 s vs. 29 s; P < 0.0001) than percutaneous palpation. Findings from this cadaver study indicated that percutaneous palpation alone had low accuracy for correctly identifying a targeted thoracolumbar intervertebral disc space and supported the use of ultrasound as a method for improving the accuracy. Future studies are needed to assess the method in clinical cases, especially in obese dogs and/or those in which the targeted site is distant from palpable anatomical landmarks.

Evaluation of the relationship between peripheral pulse palpation and Doppler systolic blood pressure in dogs presenting to an emergency service.

OBJECTIVE: To assess the association between peripheral pulse palpation and Doppler-derived systolic blood pressure (SBP) measurement in dogs presenting to an emergency service. DESIGN: Prospective observational study. SETTING: University veterinary teaching hospital. ANIMALS: Ninety-three dogs that were presented to the emergency service. Dogs were eligible for inclusion in the study if a physical examination and a SBP measurement were performed prior to any interventions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Both the femoral pulse quality and dorsal metatarsal pulse quality were digitally palpated and assessed as either strong, weak, or absent. The mean SBP in all dogs was 139 mm Hg (± 39 mm Hg). Seventeen (17/93; 18%) dogs were hypotensive with a SBP < 90 mm Hg (range, 40-88 mm Hg). The median SBP was not significantly different between dogs in the absent and present femoral pulse groups (P = 0.120) but the median SBP was significantly different between absent and present metatarsal pulse groups (P = 0.002). Dogs with absent metatarsal pulses were 7.6 times more likely to be hypotensive with a SBP < 90 mm Hg (OR, 7.6; 95% CI, 1.8-32) as compared to dogs with palpable metatarsal pulses. The sensitivity of absent metatarsal pulses to diagnose hypotension (SBP < 90 mm Hg) was 33% (95% CI, 10-65%) and the specificity was 94% (95% CI, 86-98%). CONCLUSIONS: Absent metatarsal pulses are highly specific in the diagnosis of hypotension. However, dogs with palpable metatarsal pulses can still be hypotensive. Dorsal metatarsal pulse palpation is useful during triage assessment of dogs presenting to an emergency service, though it should not be used as the only indicator of a dog's cardiovascular stability and should not replace an actual blood pressure measurement.

Pilot study utilizing Fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography for glycolytic phenotyping of canine mast cell tumors.

The goal of this prospective pilot study was to use naturally occurring canine mast cell tumors of various grades and stages as a model for attempting to determine how glucose uptake and markers of biologic behavior are correlated. It was hypothesized that enhanced glucose uptake, as measured by 2-[fluorine-18]fluoro-d-glucose-positron emission tomography/computed tomography (F18 FDG PET-CT), would correlate with histologic grade. Dogs were recruited for this study from a population referred for treatment of cytologically or histologically confirmed mast cell tumors. Patients were staged utilizing standard of care methods (abdominal ultrasound and three view thoracic radiographs), followed by a whole body F18 FDG PET-CT. Results of the F18 FDG PET-CT were analyzed for possible metastasis and standard uptake value maximum (SUVmax ) of identified lesions. Incisional or excisional biopsies of the accessible mast cell tumors were obtained and histology performed. Results were then analyzed to look for a possible correlation between the grade of mast cell tumors and SUVmax . A total of nine animals were included in the sample. Findings indicated that there was a correlation between grade of mast cell tumors and SUVmax as determined by F18 FDG PET-CT (p-value = 0.073, significance ≤ 0.1). Based on the limited power of this study, it is felt that further research to examine the relationship between glucose utilization and biologic aggressiveness in canine mast cell tumors is warranted. This study was unable to show that F18 FDG PET-CT was a better staging tool than standard of care methods.

[Effects of different training methods for palpation per rectum of internal genital organs on learning success and self-evaluation of students]. / Untersuchungen zur Effektivität verschiedener Unterrichtsmethoden der transrektalen gynäkologischen Untersuchung beim Rind auf Lernerfolg und Selbstevaluierung von Studierenden.

Large animal veterinary practice is more and more emphasizing herd-health-management. Processes to ensure and optimize economic viability of dairy farming are becoming more important in comparison to treatment of single ill animals. Amongst others, rectal palpation skills are crucial for proper fertility management, rapid and correct diagnosis of early pregnancies, and recognition of cycle or fertility problems. The aim of this study was first to objectively analyse the effectiveness of prevailing teaching methods for rectal palpation of the reproductive tract during the students' "agricultural internship." Simultaneously, the effectiveness of the use of two teaching simulators prior to the first hands-on experience with live animals was compared with proving just theoretical instruction. The results showed that students acted with more confidence when they were trained in groups of three to five. In particular, the subjective as well as the objective training success was greater for those students, who trained with a simulator (Haptic Cow®, Breed'n Betsy®) than for those who only had theoretical training. Furthermore simulator training resulted in a more realistic student assessment of performance, as well as in a better understanding of where reproductive structures were located (cervix, uterus) in live animals. No significant difference in effect of training was found between the different simulators used here. The results of this study suggest that it is in the interest, not only of students but also of the animals, that simulator training occurs before exercises are performed on living animals.

Prediction of systolic blood pressure using peripheral pulse palpation in cats.

OBJECTIVE: To evaluate the ability of peripheral pulse palpation to predict systolic blood pressure (SBP) in cats presenting as emergencies. DESIGN: Prospective observational study performed over an 8-month period. SETTING: University veterinary teaching hospital. ANIMALS: One hundred two cats presenting to the emergency service. Eligibility for inclusion in the study included a physical examination and a SBP via Doppler technique performed prior to treatment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Femoral and metatarsal pulses were digitally palpated and the quality of the pulses was assessed as either strong, moderate, poor, or absent. A concurrent SBP was also recorded. The median SBP for all cats was 92.5 mm Hg (range, 30-240 mm Hg). Femoral pulse quality was found to strongly correlate with the admission SBP (P < 0.001, rho = 0.6755). The median SBP for each femoral pulse quality category (strong, moderate, poor, or absent) was significantly different (P < 0.05). For metatarsal pulses, the median SBP for cats with either absent or strong pulses was significantly different (P < 0.001). Cats with absent metatarsal and femoral pulses had a median SBP of 30 mm Hg (range, 30-105 mm Hg), whereas cats with strong metatarsal pulses had a median SBP of 135 mm Hg (range, 58-210 mm Hg). Absent metatarsal pulses correctly identified cats with a blood pressure of 75 mm Hg or less 84% the time (area under the curve: 0.89, confidence interval 0.81, 0.97). CONCLUSIONS: In cats, peripheral pulse quality assessment by emergency room veterinarians correlates with SBP. With progressive decreases in blood pressure, metatarsal pulses will disappear and it is only with severe hypotension that femoral pulses are absent. An assessment of both dorsal metatarsal pulse and femoral pulse quality during triage may be useful in identifying abnormalities in blood pressure.

Clinical reasoning in canine spinal disease: what combination of clinical information is useful?

Spinal disease in dogs is commonly encountered in veterinary practice. Numerous diseases may cause similar clinical signs and presenting histories. The study objective was to use statistical models to identify combinations of discrete parameters from the patient signalment, history and neurological examination that could suggest the most likely diagnoses with statistical significance. A retrospective study of 500 dogs referred to the Queen Mother Hospital for Animals before June 2012 for the investigation of spinal disease was performed. Details regarding signalment, history, physical and neurological examinations, neuroanatomical localisation and imaging data were obtained. Univariate analyses of variables (breed, age, weight, onset, deterioration, pain, asymmetry, neuroanatomical localisation) were performed, and variables were retained in a multivariate logistic regression model if P<0.05. Leading diagnoses were intervertebral disc extrusion (IVDE, n=149), intervertebral disc protrusion (n=149), ischaemic myelopathy (IM, n=48) and neoplasms (n=44). Multivariate logistic regression characterised IM and acute non-compressive nucleus pulposus extrusions as the only peracute onset, non-progressive, non-painful and asymmetrical T3-L3 myelopathies. IVDE was most commonly characterised as acute onset, often deteriorating, painful and largely symmetrical T3-L3 myelopathy. This study suggests that most spinal diseases cause distinctive combinations of presenting clinical parameters (signalment, onset, deterioration, pain, asymmetry, neuroanatomical localisation). Taking particular account of these parameters may aid decision making in a clinical setting.

Development and validation of a feline abdominal palpation model and scoring rubric.

Simulation in veterinary education enables clinical skills practice without animal use. A feline abdominal palpation model was created that allows practice in this fractious species. This study assessed the model and rubric using a validation framework of content evidence, internal structure and relationship with level of training. Content Evidence: Veterinarians accepted this model as a helpful training tool for students (median=4 on five-point Likert scale). Internal Structure Evidence: G-coefficients were low for first- and second-year students (0.28 and 0.23), but were acceptable for veterinarians (0.61). Internal consistency values (0.24, 0.42 and 0.67) followed a similar pattern. Thus, scores were more reliable for veterinarians than for the students. Evidence of Relationship with Level of Training: Although level of training impacted reliability, its effect on performance scores was inconsistent. Analysis of variance (ANOVA) identified no differences among the groups of students and veterinarians. However, effect size between first- and third-year students was medium to large (0.62). Effect sizes between the veterinarians and student groups were small. Although the model and rubric appeared valid for experts, modifications would be necessary to generate reliable scores for students. These results allow greater understanding of the needs of students utilising a low-fidelity model.

Canine Prostate Palpation Simulator as a Teaching Tool in Veterinary Education.

Adult dogs, especially elderly ones, are commonly affected by prostate diseases. Performing rectal palpation during physical examination in dogs is important in small animal clinical diagnosis. Prostate palpation training allows students to learn how to correctly introduce the finger into the rectum and identify the location, size, symmetry, and consistency of the prostate. Alternative methods are needed to teach this technique without using live dogs. Thus, our aim was to develop a canine prostate palpation simulator to provide students with the opportunity to learn the prostate palpation technique in dogs and to assess their opinion of this simulator as a teaching tool. The inner part of the canine mannequin contains a rotation system with three types of prostates that can be exchanged during the exam. Of the 64 participating students, 81% had never used alternative methods and 92.2% had never performed any prostatic palpation. According to the students' opinions, performing a clinical examination on a simulator allowed them to be prepared and familiarized with the palpation technique. They felt satisfied learning a practical method in a harmless way. Both the 3R (replacement, reduction, and refinement) and dog welfare principles were present in most of the students' concerns. We conclude that the simulator can help students to develop clinical skills for prostate palpation in dogs.