Mild-moderate equine asthma: A scoping review of evidence supporting the consensus definition.

Current consensus defines mild-moderate equine asthma (mEA; previously inflammatory airway disease) by a hierarchy of indicators of lung pathology: cough, poor performance, increased tracheobronchial mucus, inflammatory bronchoalveolar lavage (BAL) cytology and pulmonary dysfunction. Exclusion criteria include fever, systemic disease, or increased resting respiratory effort. The aim of this review was to inform future research by identifying gaps, strengths and weaknesses in the current body of evidence supporting this consensus-proposed definition. Objectives were to critique evidence supporting the inclusion of each diagnostic indicator in the case definition, by summarising and evaluating evidence for its association with higher-level indicators of lung inflammation. Searches of three databases identified 2275 articles relating to mEA or its diagnostic indicators, from which 298 full-text articles were screened and 45 reviewed in full. Studies (n = 44) had been performed worldwide in clinics, hospitals, racetracks, yards or research herds, in 6092 horses. Studies were predominantly opportunistic observational (n = 13/44: 29.5%) or cross-sectional (n = 11/44; 25%). The median number of horses per study was 74. Where breed and use were reported most were Thoroughbreds (58.2%; 2730/4688) and racehorses (72.8%; n = 3960/5439). Domains rated as high risk of bias in almost 50% of articles were 'study power' and 'masking'. Heterogeneity in clinical and laboratory measures precluded meta-analysis. Evidence was more consistent for certain pairwise relationships (e.g., between cough and tracheobronchial mucus) than others (e.g., BAL cytology and lung function). Findings highlight the need for increased standardisation of diagnostic methods and reporting to facilitate future systematic review and meta-analysis.

Veterinary team interactions, part 2: the personal effect.

Modern veterinary practices consist of multiple professions/occupations, often spread over multiple branches. Within these teams are identifiable 'key people' who are central to information and resource flow. Key people are frequently the appointed leaders, such as practice managers, but also include emergent leaders. Veterinary surgeons are commonly involved in the flow of higher order interactions such as problem solving, while administrators are often involved in information interactions. These key people are repeatedly boundary spanners, sharing resources across physical boundaries such as branches. Their marginal status (belonging to multiple groups) also allows them to interact across professional boundaries. Lower order interactions including asking for information and advice are often interprofessional; however, higher order interactions tend to be intraprofessional. Analysis of interaction reciprocity between professions demonstrated the prevalence of a profession based hierarchy, with veterinary surgeons at the top. Being social outside of work with a colleague is also linked to work based interactions. The results of this paper demonstrate the need for practices to consider key people and support them appropriately. Further to this, they suggest that, to promote an effective team, interactions should be based on experience as much as professional status, and that social interactions should be encouraged.

Errors in veterinary practice: preliminary lessons for building better veterinary teams.

Case studies in two typical UK veterinary practices were undertaken to explore teamwork, including interprofessional working. Each study involved one week of whole team observation based on practice locations (reception, operating theatre), one week of shadowing six focus individuals (veterinary surgeons, veterinary nurses and administrators) and a final week consisting of semistructured interviews regarding teamwork. Errors emerged as a finding of the study. The definition of errors was inclusive, pertaining to inputs or omitted actions with potential adverse outcomes for patients, clients or the practice. The 40 identified instances could be grouped into clinical errors (dosing/drugs, surgical preparation, lack of follow-up), lost item errors, and most frequently, communication errors (records, procedures, missing face-to-face communication, mistakes within face-to-face communication). The qualitative nature of the study allowed the underlying cause of the errors to be explored. In addition to some individual mistakes, system faults were identified as a major cause of errors. Observed examples and interviews demonstrated several challenges to interprofessional teamworking which may cause errors, including: lack of time, part-time staff leading to frequent handovers, branch differences and individual veterinary surgeon work preferences. Lessons are drawn for building better veterinary teams and implications for Disciplinary Proceedings considered.

Veterinary team interactions, part one: the practice effect.

Veterinary practices have evolved since the era of solo practitioners working on one site. Today veterinary practices tend to include veterinary surgeons, veterinary nurses, receptionists and business managers, leading to the notion of the veterinary team and the rise of interprofessional working. In addition, practices have grown in size and frequently include several branches, creating a distributed team. Research regarding veterinary teamwork is lacking. This paper uses Social Network Analysis (SNA) to address this issue. SNA measures interactions between members of a network. The types of interactions in practice and the effects of practice size and location (branches) are considered. Information sharing and asking for advice are straightforward, lower order interactions. Problem solving and being influenced by another are complex, higher order interactions. Smaller practices have higher densities of interactions, implying a more cohesive team. However, individuals in smaller practices still do not interact with everyone and therefore actively choose with whom to interact. Practices with little staff rotation across branches experience limited interactions across locations. The results of this study have implications for practices aiming to expand their team, either in a single site or by acquiring more branches. Suggestions for ways to maintain and improve interactions are made.

Continuing professional development: learning that leads to change in individual and collective clinical practice.

The lack of effectiveness of traditional models of continuing professional development is increasingly recognised. While they can lead to increased knowledge of participants, research suggests that there is a general failure to produce meaningful and sustained changes in clinician behaviours. The aim of this study was to explore the effect of the Royal College of Veterinary Surgeons' (RCVS) new individual outcomes-focused approach to delivery of continuing professional development (CPD) through the reflective accounts of participant experiences. Content analysis of 12 summaries of their learning, produced by early pioneers of the Professional Key Skills (PKS) Module of the RCVS Certificate in Advanced Veterinary Practice, revealed that the benefits of the PKS-related professional development is best understood through 'a framework of 'stakeholder' dynamics', with impact and behavioural change at the individual participant level having an effect on practice team behaviours, leading to patient, owner and business benefits. It can be concluded that, at least for these early pioneers, this new model for CPD has resulted in changes that have gone beyond knowledge accumulation to changed practitioner behaviours and recognisable patient, owner and business benefits.

A survey of the opinions of recent veterinary graduates and employers regarding early career business skills.

A questionnaire was designed to assess recent veterinary graduates' proficiency in early career business skills, from the perspectives of graduates of 2006-2008 and employers of recent graduates in the UK. Recent graduates perceived themselves to be generally more competent in financial matters than employers considered them to be. However, when specific skills were assessed, graduates felt less prepared than employers considered them to be competent. Overall, graduates and employers rated recent graduates' preparedness/competence as poor to average for all skills, which were regarded as having average to high importance. Both groups commented on the difficulties faced by new graduates in terms of client communication (generally and financially), and having the confidence to charge clients appropriately for veterinary services. The results of this study indicate that veterinary schools need to take a more active role in the teaching of basic finance skills in order to equip graduates with essential early career competencies. It is anticipated that the information reported will help inform undergraduate curriculum development and highlight the need for increased training at the continuing education level.

Veterinary career ambitions correlate with gender and past experience, with current experience influencing curricular perspectives.

The Royal Veterinary College's 'Teaching Quality Survey' was completed by 261 recent graduates (six months after graduation) from 2005 to 2011 (26.8 per cent response rate). The results were used to compare veterinarians' background information with current position and career ambition, and to investigate perceptions of curriculum balance. There was a significant difference between males' and females' current positions and career ambitions with comparatively lower percentages of females in farm animal and farm and equine practices. There was also a significant difference between individuals from different childhood areas; individuals from urban areas preferred small animal practice, in comparison to those from rural areas who are more likely to choose farm animal practices. Compared with their peers, individuals engaged in a specific area of work tend to think that their area was under-represented in the professional curriculum. Taken alongside the feminisation and urbanisation of the profession, the results of this study indicate that food animal careers need to be promoted as an attractive option for new graduates and those going into mixed practice initially. Also, those involved in curriculum design using graduate surveys should take into account the current careers of the respondents in order to avoid biased results.

Care and Justice orientations to moral decision making in veterinary students.

An adapted version of the Moral Justification Scale was used to assess moral decision-making orientation in veterinary students, comparing sex and year of study. The Scale consists of vignettes and related statements, each of which was classified as Justice, Care for People or Care for Animals. The importance of each statement in the decision-making process was rated by 204 students on a 10-point Likert Scale. An average score of importance for Justice, Care for People and Care for Animals related statements were calculated for each individual. General inclination scores were calculated by subtracting an individual's average Care score from their average Justice score. Inclination scores suggested that two-thirds of students have a balanced approach, using Justice and Care almost equally in approaching ethical dilemmas. The majority of students, however, show an overall Justice orientation. The attitude towards the importance of Justice did not vary between students of different years or sexes. Students' attitudes towards the importance of Care for People in their decision making were, however, significantly lower for final-year students. Reasons hypothesised include the start of placements. Care for Animals scores were affected by sex, whereby females give more importance to such statements than males.

Attitudes to animal euthanasia do not correlate with acceptance of human euthanasia or suicide.

Several reasons have been suggested for the elevated risk of suicide experienced by those in the veterinary profession. The current study aimed to investigate possible links between veterinarians' attitudes to 'convenience' or non-justified animal euthanasia and attitudes towards human euthanasia and suicide. Veterinary students and graduates had a negative attitude towards convenience animal euthanasia, but their attitudes changed over time (pre-clinical studies, clinical studies and recently graduated). A greater tolerance to euthanasia was displayed in the later years of study and post qualification - primarily by males. Attitudes towards both human euthanasia and suicide, however, remained stable over time and indicated on average a neutral stance. No correlations were found between attitudes to convenience euthanasia and either human euthanasia or suicide, suggesting a tolerance to convenience euthanasia of animals does not lead to desensitisation in valuing human life and a changed attitude to human euthanasia or suicide, or vice versa. Attitudes to human euthanasia and suicide were predictably correlated, perhaps suggesting an overarching attitude towards control over human death. The results of the current study throw into question the argument that it is the changes in attitudes to animal life that affect veterinarian's attitudes to human life and contribute to the high suicide rate.

Web 2.0 and the veterinary profession: current trends and future implications for lifelong learning.

The NOVICE project is an EU initiative under the Lifelong Learning Programme, which aims to develop an online, professional network to promote informal, lifelong learning within the veterinary profession, using Web 2.0 tools. To inform the development of the network, a need analysis study was undertaken with relevant stakeholders. Focus group discussions were undertaken with veterinary students and veterinarians and a survey was administered to first-year students and recent graduates. The results indicate that use of computers and the internet is ubiquitous among junior members of the profession and that use of Web 2.0 tools is increasing. Concerns raised in relation to participation in online communities include verifying the quality of information and issues around professionalism. Compared with face-to-face communities, online communities were perceived to offer a number of advantages. These include convenient access to expert advice on an international scale, as well as helping to alleviate certain barriers to participation in formal, continuing education such as time, distance and cost.