Javma-journal of The American Veterinary Medical Association最新文献

Objective: The goal of this study was to describe clinical and hospital-related factors associated with time to feeding tube placement in hospitalized dogs and cats.

Methods: This was a retrospective study from January 2014 through December 2023. Medical records at an academic veterinary teaching hospital were reviewed for small animal patients in the ICU with nasogastric or esophageal feeding tube placement for enteral nutrition due to inadequate food intake during hospitalization. Patients with feeding tubes placed prophylactically at hospital admission for surgery or physical inability to eat were excluded. Factors associated with placement including species, disease, inappetence, nutritional plans, and medical record recording of caloric intake were reviewed.

Results: 295 patients (89 cats and 206 dogs) were included. Median duration of hospitalization prior to feeding tube placement was 2 days (0 to 17 days) and was shorter in cats. Weekend admission and initial placement of an esophageal tube were associated with increased time to placement. Adequate feeding instructions were provided for only 53 of 295 patients (18%) and associated with both higher likelihood of having caloric intake recorded (OR, 10.30) and earlier feeding tube placement.

Conclusions: Provision of enteral nutrition occurred later than recommended by nutritional guidelines in many hospitalized patients. Clinician inclusion of specific diet instructions, weekday admission, and initial nasogastric tube placement reduced this duration.

Clinical relevance: Multiple factors may impact timely provision of nutrition in hospitalized dogs and cats. Close attention to energy requirements and exact food intake should be considered to optimize patient nutritional care.

Rabies is a fatal encephalitic disease affecting all mammals. This report describes identification of raccoon rabies virus variant isolated from a stray kitten in an urban Midwestern city that is nonendemic for this virus variant. The kitten originally presented with nonspecific neurologic abnormalities. Astute veterinary, wildlife, and public health professionals played a critical role in the identification of this fatal zoonotic disease and the extensive public health and wildlife management response that ensued. This case serves as an important reminder of the risk of rabies in unvaccinated animals or those without known vaccination status, including stray animals.

Objective: The objective of this study was to estimate the price elasticity of demand for 3 common equine veterinary services: vaccinations (a routine service), lameness examinations (an elective service), and emergency colic surgery (an urgent service).

Methods: Data were collected via a nationwide online survey of horse owners from August 15 to September 11, 2023, eliciting their willingness to pay for each service. The link to the online survey was distributed through participating organizations' social media and email lists to the target audience of US residents aged ≥ 18 years who were financially responsible for at least 1 horse, pony, mule, or donkey. Statistical software was used to estimate the demand models.

Results: The survey received a total of 4,915 usable responses, with at least one response from every state in the US. Results revealed elastic demand for all 3 services and subsample analyses provided reassurance as to the robustness of the results, suggesting that quantity demanded of these services would decrease more in a relative sense as compared to the increase in price.

Conclusions: Understanding the current and future trends of equine veterinary service demand is vital in ensuring the long-term financial sustainability of equine veterinary practices. Moreover, due to vast differences in the pricing structure of small animal and equine practice procedures, business models for these types of practices should be treated separately.

Clinical relevance: Although it may seem counterintuitive for practice growth, the estimated price elasticity of demand suggests that strategic price increases could enhance profitability. While higher prices may reduce service volume, they could also lead to lower costs, potentially offsetting any revenue reduction. Moreover, the findings on elastic demand can also inform decisions regarding discounts, service bundles, and the development of tiered service offerings.

Objective: Gain a better understanding of dog owners' knowledge and interest level for 13 preventative healthcare (PHC) topics. Examine the potential predictive value of owners' satisfaction with how their veterinarian communicates about PHC topics and perceived veterinarian-related trust and empathy and frequency of PHC veterinary visits.

Methods: An electronic survey was created in Qualtrics and distributed to dog owners within the US via a link offered in Prolific, an open online marketplace whereby respondents receive small monetary compensation for completing surveys.

Results: A total of 738 participants completed the survey, all of whom were dog owners living in the US. Owners reported knowing the most about the importance of mental engagement, how to assess their dog's everyday quality of life, vaccines, and parasites. Owners were most interested in learning more about how to assess their dog's everyday quality of life, importance of mental enrichment, diseases related to their dog's breed, and senior care. Veterinarians were the primary source of information for 13 of 14 topics. Owners' satisfaction with how PHC information is discussed was a significant predictor for perceived veterinarian empathy and trustworthiness, as well as frequency of PHC visits.

Conclusions: Dog owners understand the value of PHC and look to their veterinarian for this information. Satisfaction with PHC dissemination predicts owners' views of their veterinarian's trustworthiness and empathy.

Clinical relevance: Dissemination of PHC information can improve animal health and well-being not only directly but also indirectly through its impact on owners' perceptions of their veterinarian.

Objective: The purpose of this study was to develop random forest classifier models (a type of supervised machine learning algorithm) that could (1) predict students who will or will not complete the DVM degree requirements and (2) identify the top predictors for academic success and completion of the DVM degree.

Methods: The study utilized Ross University School of Veterinary Medicine student records from 2013 to 2022. Twenty-four variables encompassing demographic (eg, age, race), academic (eg, grade point average), and financial aid (eg, outstanding balances) data were assessed in 11 cross-validated random forest machine learning models. One model was built assessing all years of data and 10 individual models were developed for each enrollment year to compare how the top predictors of success varied among the years.

Results: Consistently, only academic and financial factors were identified as being features of importance (predictors) in all models. Demographic factors such as race were not important for predicting student success. All models performed very well to excellently based on multiple performance metrics including accuracy, ranging from 96.1% to 99%, and the areas under the receiver operating characteristic curves, ranging from 98.1% to 99.9%.

Conclusions: The random forest algorithm is a powerful machine learning prediction model that performs well with veterinary student academic records and is customizable such that variables important to each veterinary school's student population can be assessed.

Clinical relevance: Identifying predictors of success as well as at-risk students is essential for providing targeted curricular interventions to increase retention and achieve timely completion of a DVM degree.

Objective: To evaluate the specificity/sensitivity and predictive values of urine spot metanephrines-to-creatinine ratios to diagnose canine pheochromocytomas and to determine whether there is a correlation between urine catecholamine levels and tumor volume.

Methods: In a retrospective study, 32 client-owned dogs with adrenal tumors were identified (13 nonpheochromocytoma and 19 pheochromocytoma). Medical records were evaluated for patients undergoing adrenalectomy between August 2020 and August 2023. Patients were divided into groupings of pheochromocytoma and other adrenal tumor diagnosis on the basis of histopathology.

Results: Urine spot normetanephrine concentrations were significantly elevated in dogs with pheochromocytomas compared to dogs with other adrenal tumors. Sensitivity was 78.9%, specificity 76.9%, positive predictive value 83.3%, and negative predictive value 71.4% for discriminating between pheochromocytoma and nonpheochromocytoma. Spot urine metanephrine concentrations were not significantly different between the 2 groups. Only 5 of 19 pheochromocytoma patients had urine normetanephrine concentrations > 4 times the upper reference limit, which is the previously established diagnostic cutoff. Median tumor volume did not correlate with normetanephrine values, nor did those values correlate to patients that experienced intraoperative complications. Twenty-one percent of cases were biochemically silent pheochromocytomas.

Conclusions: Urine normetanephrine-to-creatinine levels but not metanephrine-to-creatinine levels can potentially differentiate a pheochromocytoma from a nonpheochromocytoma.

Clinical relevance: Previously published guidelines of 4 times the upper reference limit in spot urine metanephrines testing used to diagnose pheochromocytomas will lead to a significant number of missed diagnoses.

Objective: To assess the impact of dietary fiber supplementation with cellulose on clinical course, fecal consistency, and intestinal microbiota composition in dogs with uncomplicated acute diarrhea (AD).

Methods: From September 2022 to November 2023, a total of 19 dogs presenting with uncomplicated AD were included in this prospective, randomized, and double-blinded clinical trial. The time to resolution of diarrhea was evaluated via owner surveys and a fecal scoring chart. The client-owned dogs were randomly assigned to a cellulose group (CG) or control group. The intestinal microbiota was analyzed via quantitative PCR.

Results: A marginally significant, faster improvement in stool consistency on day 1 was observed in the CG (P = .09). All dogs improved clinically, with a median recovery time of 3.0 days in the CG and 3.2 days in the control group (range, 1 to 6 days in both groups). There was no significant difference regarding the Canine Acute Diarrhea Severity index or composition of the intestinal microbiota during the study.

Conclusions: All dogs with uncomplicated AD exhibited rapid clinical improvement and recovery of the core intestinal microbiota within the first few days. Cellulose improved the fecal consistency in a subset of dogs, and intestinal dysbiosis was mild and self-limiting.

Clinical relevance: The administration of dietary cellulose has the potential to accelerate improvements of stool consistency. Mild changes in pathobionts, such as an increased amount of Clostridium perfringens, are self-limiting; thus, antibiotic intervention is not warranted.

Objective: To describe the outcome of common medical therapies, intraoral dental procedures, extraoral surgical interventions, and resulting complications of treatment in client-owned rabbits diagnosed with dental disease.

Methods: The medical records of 51 client-owned domestic rabbits presenting for veterinary care and management of dental disease from 2013 to 2023 at 2 veterinary teaching hospitals were reviewed.

Results: Of the patients managed with coronal reduction and occlusal adjustment, none developed significant complications. Of the patients that required intraoral dental extractions, 41% developed postprocedural complications, including incomplete tooth extraction. Following periapical infection and the formation of an odontogenic abscess for which surgical intervention was implemented, 25% of patients developed complications, including abscess recurrence and sepsis. Meloxicam was the most frequently prescribed analgesic medication for all procedures reviewed. Trimethoprim-sulfamethoxazole combination oral suspension was the most frequently prescribed antibiotic following coronal reduction, occlusal adjustment, and dental extractions, and parenteral penicillin G procaine was the most frequently prescribed antibiotic following periapical infection-related interventions. Seven patients had documentation of natural death or humane euthanasia secondary to progressive dental disease.

Conclusions: The risk of postprocedural complications during the management of dental disease must be considered and discussed given the high rate of potential complications.

Clinical relevance: With the increasing popularity of rabbits as companion animals, dental disease is considered one of the most common reasons for veterinary care in this species. Rabbits undergoing intraoral dental procedures and extraoral surgical interventions for the treatment of acquired and progressive dental disease are at risk of developing adverse postprocedural sequelae that must be considered before attempting intervention. This report adds to the growing body of scientific literature related to the management of this challenging disease process.