Prospective evaluation of venous access difficulty and a near-infrared vein visualizer at four French haemophilia treatment centres.

Although a serious impediment in haemophilia patients, difficulty accessing peripheral veins has received little attention in clinical studies. New peripheral vein visualization devices could potentially ameliorate difficult venous access (DVA), but their utility remains unproved. The study aim was to survey the frequency, causes and clinical manifestations of DVA and evaluate the clinical utility of a near-infrared (NIR) vein visualizer. In this multicentre prospective study, methods, difficulties and outcomes of venous access were assessed for a single venipuncture in consecutive patients. The impact of an NIR vein visualizer on vein localization, the number of venipuncture attempts and patient stress and pain was determined. Among 450 total patients enrolled, venous access was judged to be difficult in 165 (36.7%), most often because of poor vein condition, young patient age, overweight and difficulty in finding veins. Of the patients with DVA, difficulty in locating veins was encountered in 82.4%, and more than one venipuncture attempt was required in 24.8%. Veins were difficult to locate in significantly fewer DVA patients (P = 0.002) when the NIR vein visualizer was used (76.0%) than not used (92.3%). Pain during venipuncture in DVA patients was also significantly less common (P = 0.019) with use of the NIR vein visualizer (34.0% vs. 55.4%). No effect was observed on venipuncture attempts. DVA affects more than one-third of patients at haemophilia treatment centres. An NIR vein visualizer showed significant promise for facilitating vein location and mitigating patient pain in those patients.

Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry: rapid identification of bacteria isolated from patients with cystic fibrosis.

Despite extensive research into the diagnosis and management of cystic fibrosis (CF) over the past decades, sufferers still have a median life expectancy of less than 37 years. Respiratory tract infections have a significant role in increasing the morbidity and mortality of patients with CF via a progressive decline in lung function. Rapid identification of organisms recovered from CF sputum is necessary for effective management of respiratory tract infections; however, standard techniques of identification are slow, technically demanding and expensive. The aim of this study is to asses the suitability of matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS) in identifying bacteria isolated from the respiratory tract of patients with CF, and is assessed by testing the accuracy of MALDI-TOF MS in identifying samples from a reference collection of rare CF strains in conjunction with comparing MALDI-TOF MS and standard techniques in identifying clinical isolates from sputum samples of CF patients. MALDI-TOF MS accurately identified 100% of isolates from the reference collection of rare CF pathogens (EuroCare CF collection). The isolate identification given by MALDI-TOF MS agreed with that given by standard techniques for 479/481 (99.6%) clinical isolates obtained from respiratory samples provided by patients with CE In two (0.4%) of 481 samples there was a discrepancy in identification between MALDI-TOF MS and standard techniques. One organism was identified as Pseudomonas aeruginosa by MALDI-TOF but could only be identified by the laboratory's standard methods as of the Pseudomonas genus. The second organism was identified as P. beteli by MALDI-TOF MS and Stenotrophomonas maltophilia by standard methods. This study shows that MALDI-TOF MS is superior to standard techniques in providing cheap, rapid and accurate identification of CF sputum isolates.

Relationship between in feed drugs, antibiotics and organic enrichment in marine sediments at Canadian Atlantic salmon aquaculture sites.

The presence of in-feed anti-sea lice drugs and their relationship with organic enrichment is poorly understood in sediment surrounding salmon farms. Using data from an aquaculture monitoring program (2018-2020), we describe this relationship at ten sites in four Canadian provinces. Three anti-sea lice pesticides (lufenuron, teflubenzuron, emamectin benzoate and metabolite desmethyl emamectin benzoate), and one antibiotic (oxytetracycline) were detected. Concentrations were often below limits of quantification. Values are also lower than those reported in other aquaculture salmon-producing countries. Highest concentrations, along with organic enrichment, were observed ~200 m of cages with lower concentrations detected up to 1.5 km away. Most samples had at least two drugs present: 75.2 % (British Columbia), 91.4 % (Newfoundland), and 54.8 % (New Brunswick/Nova Scotia) highlighting the potential for cumulative effects. Emamectin benzoate and oxytetracycline were detected four and three years respectively after last known treatments, demonstrating the need for research on overall persistence of compounds.

Transatlantic spread of highly pathogenic avian influenza H5N1 by wild birds from Europe to North America in 2021.

Highly pathogenic avian influenza (HPAI) viruses of the A/Goose/Guangdong/1/1996 lineage (GsGd), which threaten the health of poultry, wildlife and humans, are spreading across Asia, Europe, Africa and North America but are currently absent from South America and Oceania. In December 2021, H5N1 HPAI viruses were detected in poultry and a free-living gull in St. John's, Newfoundland and Labrador, Canada. Our phylogenetic analysis showed that these viruses were most closely related to HPAI GsGd viruses circulating in northwestern Europe in spring 2021. Our analysis of wild bird migration suggested that these viruses may have been carried across the Atlantic via Iceland, Greenland/Arctic or pelagic routes. The here documented incursion of HPAI GsGd viruses into North America raises concern for further virus spread across the Americas by wild bird migration.

Diversity, distribution and biogeographical origins of Plasmodium parasites from the New Zealand bellbird (Anthornis melanura).

Understanding the origin of invasive parasites and ecological transmission barriers on the distribution of mosquito-borne pathogens is enriched by molecular phylogenetic approaches now that large databases are becoming available. Here we assess the biogeographical relationships among haemosporidian blood parasites and an avian host, the New Zealand bellbird (Meliphagidae, Anthornis melanura). Four Plasmodium haplotypes were identified among 93 infected bellbirds (693 screened) using nested PCR of a mitochondrial DNA cytochrome b gene fragment. The most common lineage, LIN1 (11%), is confined to northern New Zealand and falls within a known clade of Plasmodium (subgenus Novyella) sp. infecting Australian meliphagids. LIN1 differs within that clade by 4 9% sequence divergence suggestive of an endemic lineage to New Zealand. The most widespread lineage, LIN2 (2%), is an exact match with a global cosmopolitan (P. elongatum GRW06). Two rare lineages, LIN3 and LIN4 are less abundant, geographically restricted within New Zealand and have <1% sequence divergence with P. (Novyella) sp. (AFTRU08) and P. relictum (LINOLI01) documented from Africa. For the first time, we provide invaluable information on possible rates of entry of invading parasites in New Zealand and their distribution from temperate to cold environments.

Triclosan - an update.

The discovery in 1998 that triclosan has a site-specific action in the bacterial cell as an inhibitor of NADH- or NADPH-dependent enoyl-acyl carrier protein reductase led to a lively debate in the scientific press. The thesis of this debate was that such a mode of action may allow triclosan to induce resistance and cross-resistance in bacterial cells. The debate last saw review in 2004, and this paper aims at updating our knowledge in this area, given recent research on the topic.

Assessing trace-elements as indicators of marine finfish aquaculture across three distinct Canadian coastal regions.

Several trace-elements have been identified as indicators of finfish aquaculture organic enrichment. In this study, sediment sampling at finfish farms was completed as part of an Aquaculture Monitoring Program in three distinct Canadian regions. Despite diverse datasets, multivariate analyses show a consistent clustering of known direct (Cu and Zn) and indirect (Cd, Mo and U) tracers of aquaculture activities with sediment organic matter (OM) and/or total dissolved sulfides concentrations. OM content was also a predictor of Cu, Zn, Mo and U concentrations according to decision tree analyses. Distance from cages did not emerge as a strong driver of differences among sampling points; however, a tendency towards negative associations is clear especially for Zn. Enriched stations as determined after geochemical normalization were mostly localized within 150 m of net-pens. Selected trace-elements (in particular Zn) can be useful indicators of aquaculture organic enrichment in different ecosystems and valuable tools for monitoring programs.

The challenge of teaching undergraduates evidence-based veterinary medicine.

The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met.

Retaining vets in farm animal practice: a cross-sectional study.

Concerns have been raised about a potential shortage of farm animal vets in the UK. There is no apparent lack of new graduates willing to work with farm animals, but practices report difficulties in recruiting and retaining experienced farm animal vets. Retention of vets in farm animal practice has been identified as a key issue for the sustainability of veterinary businesses and livestock health. A cross-sectional study design was used to identify factors associated with vets remaining in farm animal practice. Data were collected via an online questionnaire covering employment, education, personal background and future plans. The target population was vets with experience of farm animal work in the UK. 380 responses were included in the analysis. Working in a practice where accommodation was provided and an increasing number of years since graduation were associated with significantly lower odds of remaining in farm animal practice, while working in a practice where staff appraisals were carried out; coming from a family with a commercial farm; spending more time on farm work and being on call with an experienced vet in the first job after graduation increased the odds of remaining in farm work. Gender was not significantly associated with retention.

Maternity leave: existing policies in obstetrics and gynecology residency programs.

OBJECTIVE: To survey program directors in obstetrics and gynecology regarding maternity leave and to determine how programs are dealing with maternity leave coverage. METHODS: Questionnaires regarding impact and policy on maternity leave were mailed to accredited obstetrics and gynecology residency programs. RESULTS: A total of 188 of 274 (69%) questionnaires were returned completed. Respectively, 80% and 69% of respondents indicated that they have a formal maternity (maximum mean 8.7 weeks) and paternity (mean 5.27 days) leave policy. Approximately 75% of programs require residents to make up time if their leave exceeds 8 weeks during the first 3 years. Eighty-five percent of programs require residents to make up time if their leave exceeds 6 weeks during the fourth year. Ninety-three percent of programs require residents to make up time if their leave exceeds 20 weeks over the 4 years. Seventy-seven percent of respondents have other residents in their program cover for the absent resident. Thirty-seven percent of programs have schedules flexible enough to allow rearrangement so that some rotations go uncovered. Eighty-three percent of programs surveyed stated that maternity leave has a somewhat to very significant impact on the residents' schedules. CONCLUSION: Most residency programs have written maternity/paternity leave policies. A more flexible curriculum may help to accommodate the residents on leave without overburdening the residents who are left to cover.

Acute and long-term management of patients with vertebral fractures.

Symptomatic vertebral fractures are associated with significant morbidity, excess mortality and health and social service expenditure. Up to 20% of patients with an incident vertebral fracture experience a further vertebral fracture within one year. It is therefore important that vertebral fractures are detected early, and treatment considered as soon as possible. Only a third of vertebral fractures come to medical attention, where they typically present with acute back pain, but other presentations include loss of height and increasing kyphosis. Spine X-rays should then be performed to confirm the diagnosis and exclude other pathology. Bone density measurements are not essential before starting treatment for osteoporosis in patients with low-trauma vertebral fractures, but may be useful to confirm osteoporosis when there is uncertainty about previous trauma. They may also aid in selecting the most appropriate therapy and monitoring response to treatment. Up to 30% of women and 55% of men with symptomatic vertebral crush fractures have underlying secondary osteoporosis, where treatment may lead to large increases in bone density. These conditions should therefore be sought by medical history, physical examination and appropriate investigations. The management of patients with acute vertebral fractures should include measures to reduce pain and improve mobility, as well as starting treatment for osteoporosis. Treatments have now been shown in randomized controlled trials to improve bone density and reduce the incidence of vertebral and non-vertebral fractures in patients with osteoporosis. Choice of treatment will depend on the underlying causes of bone loss, efficacy in any particular situation, cost, patient preference and the potential non-skeletal advantages and disadvantages.

Case of the month: a case of forgetfulness?

An obese 24-year-old man was admitted following a road traffic accident, during which he crashed into several cars and a shop. He had not been drinking alcohol, yet did not recall the incident. The family had noticed recent odd behaviour, episodic aggression and a glazed look at times. Apart from a minor whiplash injury, he was uninjured and clinically normal. A computed tomography (CT) head scan and encephalo-electrography were both normal. Routine investigations were unremarkable apart from a fasting glucose 0.9 mmol l-1. In view of the presenting symptoms and fasting hypoglycaemia, a CT scan of the abdomen was performed (Figure 1). What does this show?

Stakeholder consultation on tracking in UK veterinary degrees: part 1.

There is on-going debate regarding whether veterinary students should focus on one (or a small number of) species during their undergraduate training (ie, track). The aims of this study were to: evaluate UK stakeholders' opinion on partial tracking (whereby students continue to qualify able to practise in all species) and full tracking (students qualify in a limited number of species necessitating restricted registration); and evaluate students' career aspirations in relation to the UK veterinary profession's employment profile. This paper presents the quantitative results of surveys completed by practitioners, students and university staff. The majority of respondents (69.4 per cent) disagreed or strongly disagreed with full tracking, however, there was widespread support for partial tracking (79.0 per cent agreed or strongly agreed). Students favoured partial tracking more so than practitioners (P<0.001). Univariate analysis of demographic factors did not identify differences in opinion regarding tracking within stakeholder groups. Students' knowledge of the UK veterinary employment profile appeared accurate. However, their career aspiration changed with year of the course, and only final year students' intentions were aligned with the profession's current profile. Qualitative data from these surveys are presented in a second paper and include the advantages, disadvantages and implications of partial and full tracking.

Stakeholder consultation on tracking in UK veterinary degrees: part 2.

There is ongoing debate in the profession as to whether veterinary students should focus on one (or a small number of) species during their undergraduate training (ie, track). This paper presents the qualitative data from surveys evaluating UK stakeholder opinion on introducing partial tracking (whereby students continue to qualify able to practise in all species) and full tracking (students qualify in a limited number of species with restricted registration). Surveys were distributed to practitioners, students and university staff; 1061 responses were completed. Thematic framework analysis was conducted on the free-text responses; responses were coded to a hierarchical framework developed inductively from the data. Six major themes were identified: choice, flexibility, competency and knowledge, stakeholder implications, specialisation and 'what is a vet?'. The majority of the themes related to both full and partial tracking, usually being more pronounced in full tracking. The theme 'choice' is particularly important in light of the study's quantitative findings on students' awareness of the profession and their career aspirations (presented in a previous paper); should tracking be implemented, veterinary schools will need to take a proactive role in educating and assisting students while making career choices.

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.

A cross-sectional study of mental health in UK veterinary undergraduates.

Wellbeing (positive mental health) and mental ill-health of veterinary students from a single UK school were quantified using validated psychological scales. Attitudes towards mental ill-health and suicide were also assessed. Results were compared with published data from the UK general population and veterinary profession. Of the total student population (N=1068), 509 (48 per cent) completed a questionnaire. Just over half (54 per cent) of the respondents had ever experienced mental ill-health, with the majority reporting a first occurrence before veterinary school. Student wellbeing was significantly poorer (p<0.0001) than general population estimates, but not significantly different (p=0.2) from veterinary profession estimates. Degree of mental distress in students was significantly higher than in the general population (p<0.0001). Despite the majority (94 per cent) agreeing that 'Anyone can suffer from mental health problems', students were significantly more likely than members of the general population to agree that 'If I were suffering from mental health problems, I wouldn't want people knowing about it' (p<0.0001). Students were more likely to have thought about suicide, but less likely to have made an attempt (p<0.001; p=0.005), than members of the general population. The possibility of non-response bias must be considered when interpreting findings. However, strong similarities between results from this study population and the UK veterinary profession, as well as other veterinary student populations internationally, suggest no substantial school-level bias.

A Comparative Study of Haptic Stiffness Identification by Veterinarians and Students.

Palpation is an important clinical skill in both veterinary and medical health professions. The present study compares the ability of practicing veterinarians and veterinary students to identify the stiffness of virtual surfaces through palpation. An absolute identification paradigm was used where a force-feedback haptic device rendered virtual surfaces with five levels of stiffness within a "clinically relevant" range (0.2-0.5 N/mm). The mean information transfer was 0.97 bits (almost two perfectly identifiable stiffness levels) for 12 veterinarians and 0.58 bits (one correctly identified level) for 14 veterinary students. Although the difference between the two groups was significant (p <; 0.001), neither group was able to reliably identify more than two levels of stiffness, indicating that the success of veterinarians in clinical practice probably relies on additional properties such as size, shape, and texture. Analyses of force versus time and displacement versus time recordings suggest that the superior performance of the veterinarians may be partially attributable to motor strategy. Specifically, veterinarians used a greater mean maximum force (2.0 N) compared to students (1.6 N) (p <; 0.05). However, further studies are required to investigate motor strategy in more detail. The implications of our findings for veterinary education and quantitative skill assessment are discussed.

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.