Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk.

INTRODUCTION AND HYPOTHESIS: Recent publications show an association between exposure to anticholinergic medications and the risk of developing dementia. We hypothesized that urogynecology providers have changed their overactive bladder syndrome treatment as a result of this literature. METHODS: This was an anonymous, cross-sectional, web-based survey of American Urogynecologic Society members. Survey questions queried awareness of the referenced literature, prescribing practices, the impact of insurance on treatment plans, and demographics. Our primary outcome measured the change in prescribing practice in response to literature linking anticholinergic medications with the risk of dementia. Descriptive statistics were used. RESULTS: A total of 222 urogynecology providers completed the survey. Nearly all respondents (99.1%) were aware of the recent literature, and, as a result, 90.5% reported changing their practice. Prior to the publication of recent literature, a "non-CNS-sparing" anticholinergic (e.g., oxybutynin) was most commonly prescribed (64.4%), whereas after the literature was published, this shifted to ß3-adrenoceptor agonists (58.5%, p < 0.001). A majority of respondents (96.6%) reported that insurance restrictions led to a change in treatment for some patients, with 73.5% describing the prior-authorization process as difficult. Many providers (61.8%) reported that a trial of anticholinergics was required by insurance companies prior to authorizing mirabegron. CONCLUSIONS: The recent literature associating anticholinergic medications with the development of dementia has changed practice patterns among survey respondents, with a shift away from anticholinergic medications and toward ß3-adrenoceptor agonists. The majority of respondents report insurance barriers to non-anticholinergic therapies, resulting in alteration of their preferred practices.

Variability in gynecologic case volume of obstetrician-gynecologist residents graduating from 2009 to 2017.

BACKGROUND: Residency training in obstetrics-gynecology has changed significantly over time, with residents expected to master an increasing number of surgical procedures. Residency operative case logs are tracked by the Accreditation Council for Graduate Medical Education, which sets case minimums for all procedures. In 2018, the Accreditation Council for Graduate Medical Education created a combined minimally invasive hysterectomy category and now requires graduating residents to complete a minimum of 70 minimally invasive hysterectomies. OBJECTIVES: The objectiges of the study were to evaluate the range of operative gynecological experience across graduating obstetrician-gynecologist residents in the United States and to estimate the number of residents able to meet new Accreditation Council for Graduate Medical Education minimum hysterectomy cases. STUDY DESIGN: Accreditation Council for Graduate Medical Education surgical case logs of graduating obstetrician-gynecologist residents from 2009 to 2017 were analyzed for case volume trends. RESULTS: The average total number of gynecological cases per resident decreased from 438.2 to 431.5 (P < .0001). Minimally invasive hysterectomy averages increased from 43.6 to 69.3 (P < .0001), a trend driven principally by an increase in total laparoscopic hysterectomies. Mean case log decreases were noted in invasive cancer (70.7 to 54.3), incontinence and pelvic floor (85.6 to 56.7), and total abdominal hysterectomies (74.4 to 42.9); (P < .0001 for all). Mean increases were seen in total laparoscopic (118.8 to 146.3) and operative hysteroscopy (68.6 to 77.1) cases (P < .0001 for all). The ratio of the 90th percentile to the 10th percentile of resident case logs showed substantial variation in surgical volume for all procedures, although this ratio decreased over time. Graduates who logged 70 minimally invasive hysterectomy cases were estimated to fall at the 51st percentile in 2017; this was down from the 91st percentile in 2009. CONCLUSION: Nationwide, graduates of obstetrician-gynecologist residency experience significant variability in their surgical training. Based on our extrapolation of Accreditation Council for Graduate Medical Education data, approximately half of residency graduates fell below the 70 case minimally invasive hysterectomy minimum in 2017. Meeting the new Accreditation Council for Graduate Medical Education hysterectomy minimums may be challenging for a significant proportion of residency programs. Understanding the scope and variability of gynecology training is needed to continue to improve and address gaps in resident education.

A low-cost approach to salpingectomy at cesarean delivery.

There is increasing adoption of opportunistic salpingectomy for ovarian cancer prevention at the time of gynecologic surgery, which includes the postpartum period. However, there is no consensus on an ideal surgical approach for the parturient vasculature. We describe a safe, low-cost, and accessible approach for bilateral salpingectomy during cesarean delivery that we call the "Mesosalpinx Isolation Salpingectomy Technique" (MIST) that can guide institutions to standardize their postpartum salpingectomy procedures when advanced vessel-sealing devices are not available. In the MIST technique, avascular windows are created within the mesosalpinx close to the tubal vessels. The vasculature is thus fully skeletonized and isolated from the adjacent mesosalpinx before suture ligation, which ensures security of the free-tie to the individual vessels and avoids sharp injury to the mesosalpinx. Not using vessel-sealing devices also eliminates the risk of thermal injury to the adjacent ovarian tissue and vasculature and potentially achieves a cost-savings for the hospital and patient. MIST has been performed in 141 cesarean deliveries in the past 4 years. There were no noted bleeding complications during the salpingectomy procedure, blood transfusions, or instances of postoperative surgical reexploration. In our experience, a surgeon who is new to the procedure takes approximately 15 minutes to complete a bilateral salpingectomy. Those surgeons who are experienced in MIST need only 5 minutes. A video is included that demonstrates the technique.

Development of a vision impairment score for the assessment of functional vision in dogs: Initial evidence of validity, reliability, and responsiveness.

AIM: To describe the development and initial validation of a questionnaire measuring functional vision in dogs. METHODS: A 17-item survey was designed to quantify functional vision in dogs. The Vision Impairment Score (VIS) was determined by summing responses to each question. Questions were assigned to one of five subcategories: overall vision, daily activities, peripheral vision, near vision, and distance vision. Content validity was established during development phases, and construct validity via comparing results of known groups (blind vs sighted; normal vs impaired vision; surgery to improve vision vs nonrestorative surgery), and through factor analysis. Concurrent criterion validity was determined with use of a validated health-related quality-of-life (HRQL) assessment tool. Reliability and responsiveness assessments were investigated using intraclass correlation coefficient (ICC) and effect size (ES), respectively. RESULTS: Responses (221) from 201 dog owners were included. Compared to sighted dogs (n = 153), blind dogs (n = 48) had a higher VIS and greater impairment in all subcategories. Among sighted dogs, a higher VIS was obtained in dogs with low vision compared to those with normal vision (P < 0.001). A higher VIS was associated with poorer HRQL (P < 0.001). Perfect reliability was obtained for 6/17 questions, and excellent reliability for 11/17 questions (intraclass correlation 1.0 and >0.9, respectively), and the VIS was highly responsive to therapeutic intervention (effect size 1.46). CONCLUSION: Results suggest the VIS may be clinically useful in assessing and obtaining a quantifiable measure of functional vision in dogs. Ongoing validation of the tool for clinical use is needed.

Early postoperative results of Descemet's stripping endothelial keratoplasty in six dogs with corneal endothelial dystrophy.

OBJECTIVE: To describe and assess the clinical outcome and intraoperative and postoperative complications of Descemet's stripping endothelial keratoplasty (DSEK) in the treatment of canine corneal endothelial dystrophy. ANIMALS STUDIED: Six dogs (six eyes) diagnosed with progressive corneal edema resulting from abnormal dystrophic endothelial cells underwent Descemet's stripping endothelial keratoplasty. PROCEDURES: Six patients underwent Descemet's stripping endothelial keratoplasty (DSEK). The patients were examined preoperatively and postoperatively at 24 hours, 7 days, 1, 2, and 3 months after surgery. Corneal edema and ultrasonic pachymetry were evaluated preoperatively and postoperatively. The positions of DSEK grafts were evaluated 3 months after surgery using optical coherence tomography. Intraoperative and postoperative complications were noted. RESULTS: The degree of corneal edema and corneal thickness improved postoperatively in all the patients (n = 6). Fibrin was encountered intraoperatively in one out of the six eyes (1/6) and postoperatively in two out of the six eyes (2/6). One out of the six DSEK grafts was partially scrolled (1/6). Secondary ocular hypertension was observed in one out of the six eyes (1/6). Corneal vascularization was encountered in four out of six patients (4/6). CONCLUSIONS: Descemet's stripping endothelial keratoplasty is an effective surgical treatment option for corneal endothelial dystrophy in dogs. Corneal edema resolved and corneal thickness reduced significantly. The early postoperative results are encouraging. Further investigation is warranted to document any long-term complications and to study the longevity of the transplanted grafts.

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation.

OBJECTIVE: To compare mechanisms of and pressures at failure of 4 methods of securing 2 types of cellophane bands around a vein. STUDY DESIGN: Ex vivo mechanical evaluation. METHODS: Cellophane bands composed of 3 or 4 layers were applied around a cadaveric external jugular vein (EJV) to create 25% or 50% attenuation. These bands were secured with a medium or medium-large polymer locking ligation clip (PLLC), or a medium or medium-large titanium ligation clip (TLC). Sterile saline 0.9% was instilled into the lumen of the EJV until a pressure of 100 mm Hg was reached. Failure mechanism and luminal pressure at failure were compared between groups. RESULTS: Medium clips failed less often than medium-large clips (P < .001) and consistently sustained 100 mm Hg without failing. Three-layer cellophane bands were 4.1 times more likely to fail than 4-layer bands (P = .003, CI 1.6-10.2) and failed at lower pressures (28.32 ± 3.59 mm Hg and 44.81 ± 6.51 mm Hg, respectively, P = .027). Failure rates of the cellophane band constructs did not differ whether secured with PLLC or with TLC (P = .635) or with 25% vs 50% attenuation (P = .780). CONCLUSION: A single medium clip withstood physiological forces and secured a cellophane band at up to 50% attenuation. A 3-layer cellophane band was more likely to fail compared with a 4-layer cellophane band. CLINICAL SIGNIFICANCE: These ex vivo results provide evidence to support the application of a 4-layer cellophane band secured with a single medium PLLC or TLC for portosystemic shunt attenuation. A single medium PLLC should be used to eliminate computed tomography artifacts during postoperative evaluation of shunt closure.

Pelvic floor disorders in women with gynecologic malignancy.

PURPOSE OF REVIEW: This article serves as an update on issues relating to the intersection of pelvic floor disorders and gynecology oncology. RECENT FINDINGS: Gynecologic cancer survivors experience pelvic floor disorders (PFDs) at a higher rate than their age-matched peers, often because of shared risk factors and as sequelae of cancer treatment. Concomitant pelvic floor and oncologic surgery can serve as a method to promote quality of life. Studies have demonstrated concomitant surgery to be well tolerated in appropriately selected patients, but only about 2% of oncologic surgeries are coordinated to include the treatment of PFDs. Conversely, women undergoing surgery for PFD have a low, but real risk of occult malignancy. Therefore, preoperative counseling is warranted in select populations. This article will discuss the management of concurrent PFDs and gynecologic malignancies. SUMMARY: Healthcare providers should be familiar with screening, management and referral of women with pelvic floor disorders in the gynecologic oncology population.

Cystoscopy at the time of incontinence and prolapse surgery.

PURPOSE OF REVIEW: This article provides an update on the use of cystoscopy at the time of prolapse and incontinence surgery. RECENT FINDINGS: Iatrogenic lower urinary tract injury is a known complication of antiincontinence procedures and surgical repair of pelvic organ prolapse. Intraoperative cystoscopy improves detection of lower urinary tract injuries in women undergoing pelvic floor surgery. The pelvic surgeon has a number of agents available to aid in the cystoscopic visualization of ureteral efflux. When injuries of the urinary tract are identified and treated intraoperatively, there is decreased morbidity, lower healthcare costs, and a lower risk of litigation than when detection is delayed. Therefore, many organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American Urogynecologic Society (AUGS), and the American Urological Association (AUA) recommend cystoscopy at the time of pelvic floor surgery. SUMMARY: Cystoscopy should be universally employed at the time of prolapse and incontinence surgery, except in instances of isolated repair of the posterior compartment.

Comparison of diode laser trans-scleral cyclophotocoagulation versus implantation of a 350-mm2 Baerveldt glaucoma drainage device for the treatment of glaucoma in dogs (a retrospective study: 2010-2016).

OBJECTIVE: To compare outcomes following trans-scleral cyclophotocoagulation (TSCP) and 350-mm2 Baerveldt implantation in the treatment of canine refractory glaucoma. DESIGN: Retrospective case study. CASE SELECTION: Client owned dogs undergoing surgical treatment of glaucoma within a veterinary referral hospital. PROCEDURES: Eighty-six glaucoma surgeries were performed on 83 eyes (69 dogs) diagnosed with primary or secondary glaucoma. Medical records were retrieved, and baseline data, surgery, medications, intraocular pressures (IOPs), vision, and complications were extracted. RESULTS: Fifty-four eyes (44 dogs) were treated with TSCP and placement of an anterior chamber suture shunt; 28 eyes (24 dogs) were implanted with a Baerveldt glaucoma drainage device (GDD); and four eyes (4 dogs) underwent GDD implantation after failure of TSCP to manage IOP. Following TSCP, IOP control (<20 mmHg) and vision retention occurred in 81.5% and 42.6%, respectively, for 16.1 ± 1.36 months. Following GDD implantation, 71.4% maintained IOP <20 mmHg and 69.6% maintained vision for 11.0 ± 0.94 months. IOP control without loss of vision was more likely following Baerveldt implantation (17/28; 60.7%) than TSCP (19/54; 35.2%) (P = 0.027). One eye had functional vision restored following GDD placement. IOP control without adjunctive medications was more likely following Baerveldt implantation (P = 0.02). CONCLUSIONS: In this study, eyes treated with Baerveldt GDD implantation were more likely to maintain IOP control and retain vision compared to eyes treated with TSCP and placement of an anterior chamber suture shunt. Lack of formal randomization, inconsistencies in surgical techniques and TSCP protocols, and potential unmeasured confounders must be considered when extrapolating from this retrospective study.

Topical vapocoolant spray reduces nociceptive response to ear notching in neonatal piglets.

OBJECTIVE: To evaluate the efficacy of a vapocoolant spray (VS) to provide local anaesthesia for piglets during ear notching. STUDY DESIGN: Randomized study. ANIMALS: Eleven 10 day old and forty 3-5 day old Large White piglets. METHODS: Temperature validation studies using thermocouples and a temperature data logger were conducted on dead and live tissue to determine optimal spray distance and duration to reduce tissue temperature to below 10 °C. A behavioural trial was conducted to assess efficacy for ear notching. Piglets were randomly assigned to one of four treatment groups: positive control (POS; n = 10), VS (n = 10), lignocaine (LIG; n = 10) and negative control (NEG; n = 10). Spray was administered to the margin of each ear, from a distance of 10 cm, and for a duration of 2 seconds immediately prior to ear notching. Behavioural observation was used to assess movement and vocal response, with responses categorized as no response (0) and response (1). RESULTS: Temperature and tissue validation studies indicated that a 2 second spray from 10 cm reduced tissue temperature to below 10 °C, and reduced response to stimulation of the skin with an 18 gauge needle (p < 0.001). There was a significant effect of treatment on response to ear notching (p < 0.001). The probability of a piglet to respond to ear notching was 98.7% for NEG piglets, compared with those treated with VS (5.3%), LIG (1.1%) and sham-notched piglets (0.9%). CONCLUSIONS AND CLINICAL RELEVANCE: This study contributes new data on the pain of ear notching in piglets. The application of a topical VS prior to ear notching reduced the antinociceptive response of piglets to the procedure, similar to that of a local anaesthetic. Cryoanaesthesia presents a simple and effective option for reducing the pain response to this simple husbandry procedure.

EFFECTS OF TWO CONTRAST INJECTION PROTOCOLS ON FELINE AORTIC AND HEPATIC ENHANCEMENT USING DYNAMIC COMPUTED TOMOGRAPHY.

This prospective study compared aortic and hepatic enhancement achieved using a contrast injection protocol with a fixed rate of 5 ml/s vs. that achieved using a protocol with fixed injection duration of 20 s in eight cats. Cats were assigned into two groups (Group 1, rate 5 ml/s; Group 2, duration 20 s). The dose of contrast was the same in both groups (740 mgI/kg). Regions of interest (ROI) were drawn in the aorta and liver for transverse scans acquired at the hepatic hilus. Time to peak aortic enhancement occurred significantly earlier in Group 1 (M = 11s, SD = 1.63) than in Group 2 (M = 25.5 s, SD = 2.51). Peak aortic enhancement was significantly higher in Group 1 (M = 1906.51 HU, SD = 368.64) than in Group 2 (M = 745.08 HU, SD = 201.84). Duration of aortic enhancement equal to or above 300 HU was statistically longer in Group 2 (M = 24.5 s, SD = 8.39) than in Group 1 (M = 10 s, SD = 1.63). There were no significant differences in time to peak liver enhancement, peak liver enhancement, or duration of hepatic arterial phase between groups. Findings supported the hypothesis that longer injection duration results in a broader bolus geometry with a longer time to peak and a lower peak aortic enhancement in cat. This strong influence of injection duration on timing of aortic enhancement may help future users optimize protocols for CT angiography of the aorta and multiphasic evaluation of the liver, pancreas, and small intestine.

Effects of stifle flexion angle and scan plane on visibility of the normal canine cranial cruciate ligament using low-field magnetic resonance imaging.

Low-field magnetic resonance imaging (MRI) is commonly used to evaluate dogs with suspected cranial cruciate ligament injury; however, effects of stifle positioning and scan plane on visualization of the ligament are incompletely understood. Six stifle joints (one pilot, five test) were collected from dogs that were scheduled for euthanasia due to reasons unrelated to the stifle joint. Each stifle joint was scanned in three angles of flexion (90°, 135°, 145°) and eight scan planes (three dorsal, three axial, two sagittal), using the same low-field MRI scanner and T2-weighted fast spin echo scan protocol. Two experienced observers who were unaware of scan technique independently scored visualization of the cranial cruciate ligament in each scan using a scale of 0-3. Visualization score rank sums were higher when the stifle was flexed at 90° compared to 145°, regardless of the scan plane. Visualization scores for the cranial cruciate ligament in the dorsal (H (2) = 19.620, P = 0.000), axial (H (2) = 14.633, P = 0.001), and sagittal (H (2) = 8.143, P = 0.017) planes were significantly affected by the angle of stifle flexion. Post hoc analysis showed that the ligament was best visualized at 90° compared to 145° in the dorsal (Z = -3.906, P = 0.000), axial (Z = -3.398, P = 0.001), and sagittal (Z = -2.530, P = 0.011) planes. Findings supported the use of a 90° flexed stifle position for maximizing visualization of the cranial cruciate ligament using low-field MRI in dogs.

Australian Alpaca Demographics and Management: A National Survey.

The Australian alpaca industry has continued to grow since the introduction of alpacas in the 1980s. Little is known about the geographical distribution of alpacas or on-farm management practices. This study aimed to address this and identify key producer knowledge through an online survey. The survey consisted of 25 questions grouped into 3 areas: demographics, farm production and alpaca nutrition. The highest concentration of alpaca producers was along the east coast of Australia, primarily in high-rainfall zones, which could be attributed to more consistent year-round pasture availability and market access opportunities. The Huacaya breed accounted for 93% of the animal numbers reported in this survey. Respondents identified 12 key pasture species being grazed, with Kikuyu being the most common, followed by Subterranean Clover and Phalaris, likely due to the majority of respondents being located in suitable high-rainfall environments. Pasture species were not identified by 25% of respondents. There are no registered anthelmintics or vaccinations for alpacas, resulting in a variation in dosage rates and administration frequency, raising concerns for effective disease and parasite management. This survey has identified key knowledge gaps in alpaca management practices in Australia that will be further investigated to provide industry recommendations to improve alpaca production.

An Investigation of Parturient Ocular Appearance in Sows.

Protocols that enable prompt identification of sows in need of assistance during farrowing are important for optimal production outcomes. Change in the colour and appearance of the sclera of the eye can indicate increased stress. This warrants investigation into its use for the identification of sows in need of assistance at the time of parturition. To this end, a three-level ocular scoring system for the pig was devised and subsequently used in a preliminary investigation into the relationship between farrowing kinetics and visual changes in the sclera at farrowing. Data were collected and analysed from twenty randomly selected Large White × Landrace crossbred sows during farrowing. It was determined that sows with a severe ocular score were more likely to experience a prolonged farrowing duration (p = 0.013) and incur increased parturient straining of either total straining time (p = 0.011) or straining per piglet (p = 0.025). There was a significant association between ocular score and litter size (p = 0.043). Ocular score was not associated with sow parity (p = 0.728) and inter-piglet interval (p = 0.075). The proposed three-level scoring system successfully identified sows experiencing an abnormal parturition as defined by a prolonged farrowing duration and increased straining time. Findings from this study suggest the potential application of this simple ocular scoring tool for identifying sows experiencing an abnormal farrowing via in-person application or integration into remote monitoring systems in the future.

Correction: Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design.

[This corrects the article DOI: 10.2196/58551.].

Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design.

BACKGROUND: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women's access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. OBJECTIVE: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. METHODS: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. RESULTS: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. CONCLUSIONS: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 2: client-related, work-related, and personal burnout.

Burnout is reported to be common among veterinarians. However, there is limited research investigating the relationship between specific types of veterinary practice and burnout. A previous study found significant differences in work exposures between veterinary general practitioners (GPs) and emergency practitioners (EPs). The primary aim of this study was to investigate whether Australian veterinary EPs suffer from a higher level of burnout compared to veterinary GPs. The secondary aim of this study was to explore if the previously reported differences between GP and EP groups were positively associated with burnout. An anonymous, online survey incorporating the Copenhagen Burnout Inventory (CBI) was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 responses were analysed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Both groups suffered from moderate levels of burnout, but there were no significant differences in the severity of CBI burnout scores between the two groups. From the multivariable analysis four investigated factors were found to be significantly associated (p < 0.05) with the work-related CBI subscale: frequency of finishing work on time; adequate staffing; work satisfaction and seriously considering leaving their principal area of practice. Five factors were significantly associated (p < 0.05) with the client-related CBI subscale: position in practice; frequency of client adherence; work satisfaction; frequency of interacting with emotionally distressed clients and seriously considering leaving their principal area of practice. Four factors were significantly associated (p < 0.05) with the personal burnout CBI subscale: gender; seriously considering leaving their principal area of practice; frequency of interacting with emotionally distressed clients and the workplace environment. The total burnout score was also significantly associated (p < 0.05) with four factors: position in practice, workplace environment, appropriate staffing in the past week and client adherence. Future studies should focus on investigating effective strategies to mitigate these risk factors for both GPs and EPs, to reduce career attrition.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 1: demographic and work-related factors.

Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

Effect of Maternal Flavour Conditioning Combined with Organic and Inorganic Iron-Supplemented Creep Feed on Piglet Performance and Haemoglobin Status.

Iron injections are vital but imperfect against iron deficiency anaemia (IDA). This experiment explored the effects on piglets of maternal flavour conditioning and the voluntary intake of anise flavoured, iron-supplemented creep feed compared with iron injections. The experiment was a 2 × 2 factorial arrangement: ±maternal exposure to dietary anise flavour and ±intramuscular injections of piglets. Twenty-three sows and their litters (242 piglets) were randomly allocated to one of four treatments (n = 5 or 6 per treatment): no flavour plus no injection (NF + NI); no flavour plus iron injection (NF + I); flavour plus no injection (F + NI); and flavour plus iron injection (F + I). All piglets could access anise flavoured, iron-supplemented creep feed (organic and inorganic forms) from D2 of birth. Sow feed intake and milk anethole concentration, piglet body weight (BW) and average daily gain (ADG), creep feed disappearance, piglet behavioural time budgets, and piglet blood glucose and haemoglobin concentrations were determined. Over the four-week study, the only significant differences found were that iron-injected piglets had reduced blood glucose (p = 0.036) on D14 and that maternal flavour provision increased the frequency of piglet creep feed interaction (p = 0.023) and decreased the frequency of suckling events (p = 0.009). In summary, maternal flavour conditioning reduced piglet creep feed neophobia without influencing consumption. The supplementation of creep feed with iron and anise flavour to piglets under the conditions of this trial was effective in preventing IDA, regardless of exposure to maternal flavouring conditioning.