First-opinion Practice Research Articles

Differential diagnosis and management of haematochezia in dogs and cats

Haematochezia is defined as the passing of fresh blood in the stools, and is a commonly encountered problem in dogs and, more rarely, in cats seen in first-opinion veterinary practice....

One Health

Not only are certain parasites endemic to the UK expanding their demographic range, but as a result of increasing numbers of animals travelling abroad and many being imported into the UK, more exotic parasites are gaining a foothold. Ian Wright of Mount Vets and Head of ESCCAP UK & Ireland, offers advice on what to look out for in first-opinion practice to try and arrest this parasitic spread.

Practitioner-led research

Abstract RCVS Knowledge provides a solution for turning clinical queries arising from first-opinion practice into answerable questions for relevant research.

A longitudinal study of fractures in 1488 Thoroughbred racehorses receiving intrasynovial medication: 2006-2011.

There is a need for investigation of associations between intrasynovial medication and fracture risk in racehorses. To document the proportion and type of fracture occurring following intrasynovial medication. Retrospective longitudinal study. Review of clinical records from all Thoroughbred flat racehorses receiving intrasynovial medication under the care of a first-opinion veterinary practice between 2006 and 2011. Fractures pre- and post-medication were categorised by location, type, and severity; analysis of fractures sustained within 56-days of medication was undertaken. Survival analyses using Cox proportional hazards models were conducted for associations between medication used (corticosteroid vs. non-corticosteroid), age at first medication, sex and total number of medications and fracture. A total of 1488 horses received intrasynovial medication during the period of study; 8692 synovial spaces were medicated in 3925 sessions. There were 96 fractures that occurred within 56-days of medication, of which 44 were classified as 'serious' (44/1488; 3.0% total population, 95% CI 2.1, 3.8%) and 11 (11/1488, 0.7%, 95% CI 0.3, 1.2%) were euthanased due to severity of injury. Fifty-four of 96 cases (56.4%, 95% CI 46.3, 66.2%) returned to racing. Targeted imaging of the subsequent injury site was undertaken prior to injury in only 7 (7/96, 7.3%) horses that injured post-medication. Horses that had received ≥3 previous intrasynovial medication sessions had an increased hazard of sustaining a fracture within 56 days (HR 2.31, 95% CI 1.51, 3.54, P<0.001) compared with those receiving ≤3 medication sessions, adjusted for each increasing year of age (HR 0.67, 95% CI 0.53, 0.86, P = 0.001). Absence of an unexposed cohort of nonmedicated racehorses. Serious musculoskeletal injury following intrasynovial medication occurred in 3% (44/1488) horses. Reduction in injury rates may be possible through greater use of premedication diagnostic imaging.

Diabetes mellitus in dogs

Canine diabetes mellitus is commonly diagnosed in first-opinion practice. Some cases are more challenging to manage than others, particularly when concurrent conditions such as pancreatitis are present. This article describes...

Brachycephalic Obstructive Airway Syndrome – an update

With the increasing popularity of the brachycephalic breeds more and more first-opinion practices are being presented with patients suffering from hereditary diseases. Even though the primary message is to persuade potential puppy owners to choose longer nosed breeds, there are many patients requiring help to alleviate these debilitating conditions for a better quality of life. Jane Ladlow and the BOAS Research Group at the University of Cambridge provide guidance on how to diagnose and treat these patients.

BSAVA congress 2018

The prestigious BSAVA Bourgelat award (2018) for outstanding international contributions to the field of small animal practice will be awarded at this year’s Congress to Clarence Rawlings, one of the pioneers of keyhole surgery. Clarence is emeritus professor of surgery at the University of Georgia veterinary school and here he discusses the benefits the introduction of minimal invasive surgery can offer first-opinion practices.

Clinical Reasoning by Veterinary Students in the First-Opinion Setting: Is It Encouraged? Is It Practiced?

A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students.

Epidemiological study of feline idiopathic cystitis in Seoul, South Korea.

Objectives The objective of this study was to investigate potential risk factors for the diagnosis of feline idiopathic cystitis (FIC) in cats living in a primarily indoor environment. Methods A case-control study focusing on a cohort of cats attending a first-opinion veterinary practice in Seoul, South Korea, from 2012-2016, was undertaken. Data were collected from cats' owners by questionnaire and analysed using a multivariable logistic regression analysis. Results Fifty-eight cases of FIC and 281 randomly selected controls were surveyed. Over 90% of the cases and controls had no access to the outside, and 100% and 91% of the cases and controls, respectively, were neutered. The estimated prevalence of an FIC diagnosis was 1.77% (95% confidence interval [CI] 1.36-2.18). The final logistic regression model included five variables associated with an FIC diagnosis. Males had 2.34 times the odds of being diagnosed with FIC compared with females (95% CI 1.18-4.62; P = 0.015). Cats reported as not having vantage points had 4.64 times the odds of an FIC diagnosis compared with those reported as having vantage points (95% CI 2.05-10.49; P <0.001). Cats living in an apartment had 2.53 times the odds of an FIC diagnosis compared with those living in a house (95% CI 1.30-4.93; P = 0.006). Cats cohabiting with other cats were more likely to be diagnosed with FIC than those living alone (odds ratio 3.16, 95% CI 1.61-6.22; P = 0.001). Cats using non-clumping litter had 2.62 times the odds of an FIC diagnosis compared with those using clumping litter (95% CI 1.38-4.96; P = 0.003). Conclusions and relevance This study was conducted in a different epidemiological context from previous studies in that the overwhelming majority of the cats studied were housed entirely indoors. This study identified several significant associations related to a cat's indoor environment. These findings suggest that the cat's physical and social environment may play a role in the development of FIC.

Epidemiology and clinical outcomes of feline immunodeficiency virus and feline leukaemia virus in client-owned cats in New Zealand.

ObjectivesThe objectives were to collect baseline data on the occurrence, testing and vaccination practices, and clinical outcomes of feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) in New ZealandMethodsA cross-sectional survey of 423 veterinary practices in New Zealand was performed to collect data on FeLV and FIV testing and vaccination during the 2015 calendar year. Clinical records from 572 cats tested using a point-of-care ELISA at a first-opinion veterinary practice between 7 April 2010 and 23 June 2016 were also obtained and multivariable logistic regression models were constructed to identify risk factors for test positivity. Survival times were estimated using Kaplan–Meier methods.ResultsThe survey was completed by 112 clinics (26.4%) of which 72 performed in-house testing. Of the 2125 tests performed, 56 (2.6%) were positive for FeLV and 393 (18.5%) were positive for FIV. Fewer than 1% of cats were vaccinated for FeLV, with veterinarians citing low perceived prevalence as the primary reason for not vaccinating. Being male compared with being female and having clinical evidence of immunosuppression were significant risk factors for both FeLV and FIV test positivity. The median survival times of FeLV and FIV test-positive cats were 10 days (95% confidence interval [CI] 0–16) and 650 days (95% CI 431–993), respectively.Conclusions and relevanceTesting and vaccination for FeLV and FIV in New Zealand appears targeted towards high-risk animals, which may bias prevalence estimates. Baseline data should be monitored for changes in FeLV epidemiology now commercial vaccines are no longer available.

Canine pyometra: assessment to optimise outcomes in first-opinion practice

Four cases of canine pyometra presented to a first-opinion small animal practice in Greater London by owners with financial and personal concerns about treatment options are described. The management decisions are discussed based on the use of diagnostic protocols; reference to clinical and laboratory prognostic markers; and open communication with the owners.

Phenobarbital – a beneficial eight-hourly dosing option?

IDIOPATHIC epilepsy is the most common neurological medical condition in dogs with an estimated prevalence of 0.6 per cent presenting to first-opinion practice in the UK (Kearsley-Fleet and others 2013)....

Use of ultrasonographic examination in sheep veterinary practice

This review describes the current, emerging and potential applications of ultrasonography in the field of first-opinion sheep veterinary practice. The most widespread application is pregnancy diagnosis, where both transrectal and transabdominal ultrasonography offer a highly sensitive tool for, among others, detection of pregnancy, identification of foetal number and diagnosis of uterine abnormalities, e.g., metritis. The diagnostic applications of ultrasonography for imaging the lungs, heart, male genitourinary system and superficial swellings are also described. Through review of recent research in sheep and by analogy from applications in other animal species, the potential role of ultrasonography in screening programmes for cystic echinococcosis or ovine pulmonary adenocarcinoma, diagnosis of ocular and laryngeal disease and localisation of Coenurus cysts is explored.

Mapping discussion of canine obesity between veterinary surgeons and dog owners: a provisional study

This study maps communication between veterinary surgeons and dog owners on obesity management in four first-opinion practices in the UK. A total of 74 dog owners who met the study's...

Common decisions made and actions taken during small-animal consultations at eight first-opinion practices in the United Kingdom

In order for veterinary surgeons to undertake an evidence-based approach to making decisions about their patients, it is important that new evidence is generated to support the clinical decision-making process. Many of the decisions are likely to be around the actions taken to treat or manage health problems discussed during the consultation, and little is currently known about the factors which affect the type of action taken. The aim of this study was to determine the decisions made and actions taken for health problems discussed during first-opinion small-animal consultations, as well as identifying factors which may affect the decision-making process.Data were gathered during direct observation of small-animal consultations conducted by 62 veterinary surgeons in eight first-opinion practices in the United Kingdom. For each patient presented, data were gathered on all health problems discussed during the consultation. The decision made (whether an action was taken or not) and the action taken where applicable (e.g. therapeutic treatment with antibiotics) was also recorded. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3), and a binary outcome variable of action versus no action.At least one action was taken for 69% (n=2203/3192) of all problems discussed. Therapeutic treatment was the most common action taken (n=1286/3192 problems; 40.3%), followed by management advice (n=1040/3192; 32.6%) and diagnostic work-up (n=323/3192; 10.1%). The most common therapeutic treatment was antibiotics (n=386/1286; 30%), while the most common management advice given was dietary advice (n=509/1040; 48.9%). The three explanatory variables remaining in the final model were whether the problem was a presenting or non-presenting problem, the type of diagnosis made, and the body system affected. Explanatory variables which did not remain in the final model were patient signalment, problem history, consultation type, clinical examination type, and who raised the problem (veterinary surgeon or owner).For over two-thirds of problems discussed, an action was taken which suggests these problems may be seen as important by the veterinary surgeon and/or pet owner. No action was taken for almost a third of cases which could represent ‘watchful waiting’, which has been highlighted as important in human healthcare. Future research should focus on the common actions taken, further exploring the complex decision-making process, and examining the effect of the decisions made on long-term patient outcomes.

Chronic kidney disease in cats

![Graphic][1] Martha Cannon is an RCVS Specialist in Feline Medicine and co-director of the Oxford Cat Clinic, a first-opinion and referral cat-only veterinary practice. She is a trustee-director of International Cat Care and its veterinary division, the International Society of Feline Medicine (ISFM). Martha is a frequent speaker at international and national meetings providing feline-focused CPD for veterinary surgeons and nurses. She is also involved in developing the … [1]: /embed/inline-graphic-1.gif

Use of cefovecin in a UK population of cats attending first-opinion practices as recorded in electronic health records.

Objectives The objective was to use electronic health records to describe the use of cefovecin (Convenia; Zoetis UK), a third-generation long-acting injectable antimicrobial, in a UK population of cats attending first-opinion practices, and to compare the use of Convenia with the licensed uses described on the UK Convenia datasheet. Methods Data were obtained as an Excel database from the Small Animal Veterinary Surveillance Network for all feline consultations containing the word Convenia and/or cefovecin from 1 September 2012 to 23 September 2013 inclusive. Entries were classified according to body system treated, confirmation or suspicion of an abscess, evidence of microbiological evaluation being performed, any concurrent therapies given and whether any reason was given for use of Convenia over alternative antimicrobials. Data were exported to IBM SPSS Statistics and descriptive analysis performed. Results In total, 1148 entries were analysed. The most common body system treated was skin in 553 (48.2%) entries, then urinary (n = 157; 13.7%) and respiratory (n = 112; 9.8%). Microbiological evaluation was recorded in 193 (16.8%) entries, with visible purulent material most commonly cited (in 147 [12.8%] entries). A reason for prescribing Convenia over alternative antimicrobials was given in 138 (12.0%) entries; the most cited was an inability to orally medicate the cat in 77 (55.8%) of these entries. Excluding 131 entries where no body system or multiple body systems were described, the use of Convenia complied with a licensed use in the UK datasheet in 710 (69.8%) of 1017 entries. Conclusions and relevance Most administrations were licensed uses; however, most entries did not describe any microbiological evaluation, or a reason for prescribing Convenia over alternative antimicrobials. Further education of the public and the veterinary profession is needed to promote antimicrobial stewardship in the UK. Health records provide a valuable tool with which to monitor, both locally and at scale, the use of important therapeutics like antimicrobials. Information relevant to decision-making should be recorded in individual animal health records.

Ten top tips to make the most of your practice laboratory

ABSTRACTThe majority of first-opinion practices have an in-house laboratory and RVNs are well placed to become adept at maximising the diagnostic information that can be obtained. Refreshing skills learnt during VN training, in addition to learning a few new techniques, can provide greater diagnostic yield from samples being examined externally and more information from samples examined in-house. Laboratory work is interesting and enjoyable and providing our veterinary surgeons with the best information with which to treat patients is the ultimate reward.

Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation

Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations.Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation.A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n=1168; 64.6%) followed by cats (n=510; 28.2%), rabbits (n=86; 4.8%) and patients of other species (n=43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model.Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and acted upon during all types of consultations. Dental and behavioural non-presenting problems were discussed more frequently during preventive-medicine consultations compared with specific health-problem consultations.Preventive-medicine consultations represent an opportunity for veterinary surgeons to discuss other aspects of preventive medicine, and to detect and manage new and ongoing health problems. A greater evidence base is needed to understand whether detecting and managing underlying disease during the preventive-medicine consultation has a positive impact on lifelong patient health and welfare.

Abdominal ultrasonography — what can be achieved in first-opinion practice?

Improvements in image quality, and relative decreases in equipment cost, make ultrasonography an imaging modality that should be widely used in first opinion small animal practice. This article briefly describes the transducers that are commonly used for small animal abdominal ultrasonography, outlining the advantages, limitations and main applications of each. As ultrasound is a ‘real time’ modality, ways are described in which the operator can maximise image quality during a scan. The utility of ultrasound for evaluating the main abdominal organ systems is summarised, together with clinical examples where an ultrasound examination can be of significant value in the diagnostic work-up of a case.