Veterinarians' attitudes and practices regarding opioid-related vet shopping practices in tri-state Appalachian counties: an exploratory study.

BACKGROUND: The opioid crisis continues to grow in the United States with 46,700 drug overdose deaths due to opioids in 2017 alone. Vet shopping, the practice of soliciting veterinarians for prescription medications, has been receiving national media attention in recent years. A 2014 review of Prescription Monitoring Drug Programs found less than 10 veterinary shoppers nationwide. Still much is unknown about the role of vet shopping and the opioid crisis. This study sought to understand the practice of vet shopping through the eyes of veterinarians practicing in Appalachian counties within the states of Kentucky, Tennessee, and Virginia, United States. RESULTS: Fourteen veterinarians were asked a set of 13 questions related to vet shopping. Results indicated that 13 veterinarians in the study had heard of the phenomenon of vet shopping and eight veterinarians had personally encountered vet shopping in their practices. Qualitative analysis of the interviews identified six key themes including a need for interprofessional communication and how important a valid veterinary-client-patient-relationship is within the profession. CONCLUSIONS: The study hopefully sheds some light on the how often vet shopping is encountered in practice, concerns of veterinarians regarding vet shopping, and potential areas for improvement.

A systematic review of digital badges in health care education.

OBJECTIVES: A challenge to competency-based medical education is the verification of skill acquisition. Digital badges represent an innovative instruction strategy involving the credentialing of competencies to provide evidence for achievement. Despite increasing interest in digital badges, there has been no synthesis of the health care education literature regarding this credentialing strategy. The present authors proposed to address this gap by conducting the first systematic review of digital badges in health care education, to reveal pedagogical and research limitations, and to provide an evidence-based foundation for the design and implementation of digital badges. METHODS: A systematic search of the medical education literature from January 2008 to March 2019 was conducted using MEDLINE, Web of Science, CAB Abstracts and ScienceDirect. Included studies described digital badges in academic or professional medical education programmes in any health care profession. Included studies were appraised and quality assessment, methodological scoring, quantitative analysis and thematic extraction were conducted. RESULTS: A total of 1050 relevant records were screened for inclusion; 201 full text articles were then assessed for eligibility, which resulted in the identification of 30 independent papers for analysis. All records had been published since 2013; 77% were journal articles, and 83% involved academic health care education programmes. Scores for quality were relatively moderate. Thematic analyses revealed implications for the design and implementation of digital badges: learner characteristics may moderate student outcomes; the novelty effect can negate the value of digital badges, and educators may overcome instruction-related challenges with digital badges using design and implementation strategies such as the creation of badging ecosystems. CONCLUSIONS: The results indicate a growing momentum for the use of digital badges as an innovative instruction and credentialing strategy within higher education and provide evidence for outcomes within a learner-centred, competency-based model of medical education. There is a paucity of research to support the design and implementation of this credentialing system in health care education. The potential benefits necessitate future high-quality analyses reporting institutional, patient and workplace-based outcomes to evaluate the effectiveness and moderating conditions of digital badges.

A survey of knowledge and use of telehealth among veterinarians.

BACKGROUND: As usage of digital information and communication technologies continues to grow, the incorporation of telehealth and telemedicine has become a topic of interest in the veterinary industry. Veterinary telemedicine presents the opportunity to expand veterinary medicine by increasing access to healthcare services for clients and patients and improving medical quality. The objective of this study was to assess veterinarians' knowledge and utilization of telehealth and telemedicine. RESULTS: Seventy-six veterinarians participated in the study and both qualitative and quantitative analyses were performed on the data collected. Several key themes emerged from the qualitative analysis of open-ended questions, including telecommunication, Doctor of Veterinary Medicine (DVM)-patient services, and remote interaction, among others. Through coding and qualitative analysis, researchers identified a lack of knowledge of the American Veterinary Medical Association (AVMA) definitions of telehealth and telemedicine. Specifically, a notable amount of participants were unaware of the distinction between the two practices per AVMA guidelines. Quantitative analyses revealed that the largest group of respondents reported sometimes utilizing telehealth and telemedicine in practice, with no distinct difference in utilization among the different age demographics of participants. CONCLUSIONS: These observations indicate a need for interventions both in veterinary school and continuing education programs with the purpose of increasing both knowledge and utilization of telehealth and telemedicine among veterinarians. While these recommendations serve as a starting point, future studies are needed to further enhance the understanding of veterinary telehealth and telemedicine in practice.

Effect of Different Instructional Methods on Contamination and Personal Protective Equipment Protocol Adherence among Veterinary Students.

Proper use of personal protective equipment (PPE) is crucial to prevent disease spread. Recent studies in human medicine have shown disconcerting inconsistencies in the use of PPE in hospital wards. In this study, we compared the effect of three instructional methods for PPE use on contamination and protocol adherence among veterinary students. Students were divided into three groups according to the instructional method to which they had access (instructional video, wall chart, or both). They underwent an isolation exercise consisting of donning, patient examination (mock patient prepared with contamination marker), and doffing. Student contamination after the exercise was evaluated using UV light. Videos of student performance were reviewed for errors committed. Results showed that the number of students with contamination was higher in the group who only had access to video instruction than in the two other groups. The number of students with contamination on forearms, hands, and wrists was higher in the group who only had access to charts. Disinfecting gloves between doffing steps was the most frequently omitted step. The number of students who touched the environment with unprotected areas of their bodies was higher in the group who only had access to video instruction than in the other two groups. In conclusion, video instruction was less effective in achieving PPE protocol adherence among veterinary students than was instruction with a chart or chart-video combination. Incorporating video instruction as part of the instructions may be valuable to reinforce individual steps of donning and doffing.

Development and Validation of a Model for Training Equine Phlebotomy and Intramuscular Injection Skills.

Simulation in veterinary education offers a solution for bridging the gap between observation and performance of clinical skills. An equine neck model was created that allows repetitive practice of jugular phlebotomy, intramuscular (IM) injection, and intravenous catheterization. The aim of this study was to validate the model for jugular phlebotomy and IM injection. We surveyed experienced veterinarians on the model's realism and the comprehensiveness of its features. In a randomized experimental study, we compared the learning outcomes of first-year veterinary students trained on the model (n=48) and students trained on equine head-neck cadavers (n=45). There was no difference in post-training performance of phlebotomy on the live horse between cadaver-trained students and model-trained students when assessed by a checklist (cadaver 6.87±0.33; model 6.89±0.77; p=.99) or a global rating scale (cadaver 5.23±0.87; model 5.32±0.77; p=.78). No difference was found between post-training scores for IM injection when assessed by checklist (cadaver 6.87±0.34; model 6.89±0.31; p=.76) or global rating scale (cadaver 5.23±0.87; model 5.32±0.77; p=.75). Veterinarians (n=7) found this low-fidelity model acceptable and supported its use as a training tool for veterinary students. Students reported in a post-lab survey that they felt models were as helpful as cadavers for learning the procedures. These results support the use of the model as a component of first-year veterinary student curriculum.

Serosurvey for Brucella spp. and Coxiella burnetii in animals on Caribbean islands.

To determine the prevalence of antibodies to Brucella melitensis, Brucella abortus and Coxiella burnetii in animals on Caribbean islands we obtained sera from convenience samples of cattle (C), sheep (S), goats (G) and cats (F) from Dominica (C, S, G), Grenada (C, S, G), Montserrat (C, S, G), Puerto Rico (C), Nevis (C, S, G), St Kitts (C, S, G, F) and St Lucia (C, G). The sera were tested for antibodies against the Brucella spp. using commercial ELISA kits. Some sera were also tested at 1/80 for antibodies to C. burnetii using an indirect fluorescent antibody test. Positive sera were also tested at 1/640. None of 599 cattle, 462 sheep or 434 goats were positive in the Brucella ELISAs. None of 230 cattle had antibodies against C. burnetii, but one of 299 sheep was positive at 1/80 (Dominica - 1/54, 2%, 95% CI (0%-5.6%)), as were two of 314 goats, at 1/80 (Grenada - 1/53, 2%, 95% CI (0%-7.5%)) and 1/640 (St Kitts - 1/18, 5.6%, 95% CI (0%-16.7%)), and one of 34 cats, at 1/80 (St Kitts - 1/34; 3%, 95% CI (0%-8.8%)). Our data suggests that there is a very low prevalence or absence of B. melitensis and B. abortus on Caribbean islands. Coxiella burnetii, however, is present but it appears to be present on only some islands and then only at low levels. Overall, there appears to be a low threat to human and animal health from these organisms in the Caribbean.

Qualitative Case Study of Public Health Preparedness and Response to the Rabid Raccoon Discovered in Wise County, Virginia.

Rabies is a zoonotic lyssavirus of mammals that is a major public health threat due to the high mortality rate in humans who develop clinical symptoms. In the United States and other developed countries, the main reservoirs are wildlife species. In April 2017, a raccoon tested positive for rabies in Wise County, Virginia, with a second raccoon testing positive in May. Wise County, Virginia, is one of the few counties in western Virginia that is not endemic for raccoon rabies variant virus. Due to this fact, local, state, and federal agencies worked together to prevent and control the outbreak to stop the public health theat. The purpose of this study was to understand how professionals from these various agencies viewed the response efforts to the two rabid raccoons in 2017 and to determine what could be done to improve future responses. A list of responders from the different agencies involved in the outbreak in 2017 was created. Participants were recruited via email and those who agreed to be interviewed were contacted via telephone. Participants were asked a series of 13 questions pertaining to the 2017 outbreak to understand more about the strengths and weaknesses perceived during the outbreak. Of the 11 individuals contacted, six agreed to an interview. Data were analyzed utilizing a three-step qualitative analysis process which included the steps of open coding, audit trail, and axial coding. Staff and partnerships were identified as strengths of the response while funding, community, and region were identified as weaknesses of the response. It is hoped that by identifying different strengths and weaknesses through qualitative analysis this will aid in improving future responses.

The prevalence and demographic correlates of stress, anxiety, and depression among veterinary students in the Southeastern United States.

It is no secret that the rigors of professional medical programs are creating an immense strain on mental health, and studies show that students are coping poorly. It is becoming more widely known that this problem especially exists in veterinary medicine. Veterinary colleges are starting to make changes to address the mental health crisis among their student (and practitioner) population, however, in order to solve a problem you must first understand your audience. There are still questions regarding who is more often affected and why? In this study, the prevalence and correlates of stress, anxiety, and depression among veterinary students in the Southeastern US is the primary focus. Three hundred and forty two participants answered survey questions addressing socio-demographics, as well as, completed a perceived stress scale and patient health questionnaire (PHQ-4) to measure anxiety and depression. Chi-square, independent samples t-test, and ANOVA were conducted to assess demographic correlates of stress, anxiety, and depression. High levels of stress, anxiety, and depression were identified among veterinary students participating in the study. Stress level was significantly associated with sex and Grade Point Average (GPA): females and those with GPA <3.0 exhibited higher levels of stress. While it is good that veterinary colleges are already making changes, the question remains if these changes are significant enough. Based on this study's results, transitioning to a pass/fail grading system and implementing regular mindfulness practice are proposed changes that may aid in promoting a positive mental health culture for students and future veterinary professionals.

Tear Film Amphiphilic and Anti-Inflammatory Lipids in Bovine Pink Eye.

Background: Tear film fluid serves as a dynamic barrier that both lubricates the eye and protects against allergens and infectious agents. However, a detailed analysis of a bacteria-induced immune response on the tear film lipidome has not been undertaken. Methods: We undertook a high-resolution mass spectrometry lipidomics analysis of endogenous anti-inflammatory and structural tear film lipids in bovine pink eye. Results: Bovine pink eye resulted in dramatic elevations in tear fluid levels of the anti-inflammatory lipids resolvin E2, cyclic phosphatidic acid 16:0, and cyclic phosphatidic acid 18:0. In addition, there were elevated levels of the structural lipids (O-acyl)-ω-hydroxy-fatty acids, cholesterol sulfate, ethanolamine plasmalogens, and sphingomyelins. Lipid peroxidation also was augmented in pink eye as evidenced by the hydroperoxy derivatives of ethanolamine plasmalogens. Conclusions: Ocular infections with Moraxella bovis result in the induction of a number of endogenous anti-inflammatory lipids and augmentation of the levels of structural glycerophospholipids and sphingolipids. Increased levels of hydroperoxy glycerophospholipids also indicate that this bacterial infection results in lipid peroxidation.

Panola Mountain Ehrlichia in Amblyomma maculatum From the United States and Amblyomma variegatum (Acari: Ixodidae) From the Caribbean and Africa.

Panola Mountain Ehrlichia (PME) has been suggested as an emerging pathogen of humans and dogs. Domestic goats and white-tailed deer (Odocoileus virginianus) are also susceptible and likely serve as reservoirs. Experimentally, both the lone star tick (Amblyomma americanum (L.)) and the Gulf Coast tick (Amblyomma maculatum Koch) can transmit PME among deer and goats. In the current study, we detected PME in adult wild-caught A. maculatum from the United States and Amblyomma variegatum (F.) from the Caribbean and Africa. This significantly expands the range, potential tick vectors, and risk for exposure to PME.