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

Objective: To understand the salary, benefits, hours, and job duties of shelter medicine veterinarians.

Methods: Similar to a 2018 survey, an anonymous survey on compensation and duties of shelter medicine veterinarians was conducted via a commercial platform from January 4 to 31, 2024. The survey was distributed through social media, message boards, and specialty listservs. Participants were categorized into part-time clinical veterinarians, full-time clinical veterinarians, academic faculty, and leadership/consultants.

Results: 299 US shelter veterinarians responded: 258 were engaged in clinical work (198 working full time and 60 part time), 18 worked in academia, and 23 held leadership/consulting roles. Full-time clinical veterinarians reported a median salary of $122,500, reflecting a 25% increase since 2018. Part-time clinicians earned $85/h-a 77% increase-while working a median of 24 h/wk. Faculty had a median salary of $130,000, a 20% increase. Those in leadership or consulting roles earned a median of $168,000, a 40% increase.

Conclusions: Salaries increased across all categories, with the highest increase for leadership/consulting roles and the lowest for academic positions. Part-time veterinarians saw a large rise in hourly rates, while working fewer hours. Leadership positions yielded the highest incomes, followed by faculty. Clinical salaries were 5% lower than the AVMA-reported 2022 salaries for private practice veterinarians and 7% lower for companion animal veterinarians.

Clinical relevance: Understanding these compensation trends assists shelter veterinarians in making informed career decisions and negotiations. Despite salary increases, shelter veterinarians' earnings remain lower than those in private practice.

Objective: To evaluate the clinical benefit and adverse events following outpatient intravenous (IV) ketamine-lidocaine (KL) infusions for palliation of cancer pain in dogs and cats.

Methods: Medical records from 15 years (2008 to 2023) were searched and data reviewed retrospectively. Animals were prescribed ketamine (0.15 mg/kg/h) and lidocaine (3 mg/kg/h in dogs and 1.5 mg/kg/h in cats) diluted in 250 mL (cats or dogs < 15 kg) or 500 mL (dogs ≥ 15 kg) of 0.9% saline administered IV at 2.5 mL/kg/h for 4 to 6 hours.

Results: A total of 105 dogs and 9 cats (114 animals) were included. The most common tumor types treated were appendicular osteosarcoma in dogs (n = 45 [43%]) and oral squamous cell carcinoma in cats (4 [44%]). All animals received concomitant oral analgesic medications. Animals received a median of 2 KL infusions (range, 2 to 49 KL infusions). The overall clinical benefit rate was 76% following the first KL infusion, as defined by an improvement in at least 1 evaluated clinical sign. The likelihood of clinical response was improved with a ketamine infusion rate ≥ 2 µg/kg/min, total ketamine dose of ≥ 0.5 mg/kg, and lidocaine infusion rate ≥ 25 µg/kg/min.

Conclusions: Outpatient IV KL infusions were well-tolerated in dogs and cats with cancer and provided a high rate of clinical benefit when combined with standard anti-cancer and analgesic therapies.

Clinical relevance: Management of cancer pain often requires multimodal analgesia. Given the clinical benefit and minimal toxicity observed with outpatient KL infusions, KL infusions should be considered as an adjunctive treatment to use in combination with anticancer therapy, oral and topical analgesics, and interventional therapies in dogs and cats for palliation of refractory cancer pain from advanced disease.

Objective: Many hyperthyroid cats (15% to 50%) have concurrent chronic kidney disease (CKD) that is "masked" and will not become azotemic until after treatment. Previous studies reported that mild-to-moderate azotemic CKD after methimazole or thyroidectomy does not adversely affect survival. Our objective was to determine whether hyperthyroid cats with masked CKD rendered euthyroid with radioiodine (131I) have shorter survival than 131I-treated euthyroid cats that remain nonazotemic.

Methods: We treated 1,047 hyperthyroid cats with 131I from 2013 to 2020 to render them euthyroid, as defined by normal serum concentrations of thyroxine and thyroid-stimulating hormone. Cats were subsequently classified as azotemic or nonazotemic at 6 to 12 months after 131I treatment (median, 6.1 months). Cats were then monitored at 6- to 12-month intervals (ie, complete physical examination, routine laboratory testing, and serum thyroid hormone concentrations) until death or end of study period (January 2024). Survival time was defined as the period from the date of 131I treatment to the date of death or last follow-up.

Results: After 131I treatment to restore euthyroidism, 128 of 1,047 (12%) cats developed azotemia, whereas 919 remained nonazotemic. Azotemic cats had a shorter median survival time than nonazotemic cats (2.8 vs 4.3 years).

Conclusions: In contrast to earlier studies that reported no shortening of survival in cats with mild-to-moderate azotemic CKD after treatment, our results show that euthyroid cats developing azotemia after 131I treatment have shorter survival, with median survival lessened by 1.5 years.

Clinical relevance: Recognizing concurrent CKD in hyperthyroid cats is crucial, as it shortens survival and enables clinicians to tailor treatment for affected hyperthyroid cats.

Objective: To assess the impact of clopidogrel or rivaroxaban administration on recurrence of arterial thromboembolism (ATE) in cats that have recovered from cardiogenic ATE.

Methods: This multicenter prospective double-masked protocol enrolled 45 cats that had recovered from cardiogenic ATE and were randomized to receive either clopidogrel (18.75 mg/cat, PO; n = 19) or rivaroxaban (2.5 mg/cat, PO; 26) as sole anticoagulant therapy for up to 2 years after the initial ATE. Primary outcome measures included recurrent ATE or death from any cause. In addition to bimonthly internet-based surveys of animal quality of life, echocardiograms were performed by veterinary cardiologists at 2, 6, 12, and 18 months after initial ATE.

Results: 17 cats experienced ATE recurrence: 7 of 19 (37%) in the clopidogrel group and 10 of 26 (39%) in the rivaroxaban group. Three cats in each group survived for the entire 2-year study without recurrence. In the clopidogrel group, median (95% CI) time to ATE recurrence was 663 days (150 to not calculable) and in the rivaroxaban group, 513 days (242 to not calculable). Median time from enrollment to death from cardiac or noncardiac causes was also not different between treatment groups.

Conclusions: Single-agent antithrombotic therapy with rivaroxaban in cats recovered from cardiogenic embolism delayed recurrence of ATE for a similar time period as single-agent therapy with clopidogrel.

Clinical relevance: In cats that have recovered from cardiogenic ATE, either rivaroxaban or clopidogrel may be used for single-agent thromboprophylaxis to delay ATE recurrence.

Objective: The objectives were to describe a distal teat amputation and determine the long-term outcomes in dairy cows.

Methods: This retrospective study examined medical records of 22 lactating dairy cows admitted to the Farm Animal Hospital from 2015 to 2021 for distal teat and papillary canal injuries that received a distal teat amputation as the sole surgical treatment. Long-term follow-up was obtained from the Canadian Dairy Network (CDN) and milk producers to determine whether the cows remained in the herd and identify whether any factors affected this outcome.

Results: The hindquarters were affected in 18 of the 22 distally amputated teats (82%; 95% CI, 66% to 98%). Mastitis was the most common postoperative complication. Of the 22 cows, CDN and follow-up information was available for 18 cows (82%). Of these 18 cows, 13 (72%; 95% CI, 51% to 93%) remained in the herd for at least the start of a subsequent lactation following surgery.

Conclusions: Lactating dairy cows had a favorable chance of remaining in the herd following a distal teat amputation.

Clinical relevance: Decreased milking efficiency caused by distal teat injuries can be a source of economic loss for the milk producer. Distal teat amputation to reestablish milk flow was a practical procedure that required attentive postoperative care.

Veterinary diagnostic laboratories provide a vast catalog of tests for infectious agents and often have multiple tests and testing modalities for individual pathogens. Understanding which test to select, which sample type is best, and which animal to sample in a population are critical factors for drawing appropriate conclusions and diagnosing a disease. Each diagnostic test has its inherent diagnostic sensitivity and specificity, and, in many situations, multiple tests may be required for proper interpretation. When multiple tests are needed in a large population (eg, animal shelters, farmed animals, and breeding colonies), the cost of diagnostic testing becomes an increasing concern, and knowing when and how to use aggregate or composite samples is critical. A clinical examination is the first and arguably most important diagnostic procedure providing the framework for laboratory test selection. This yields not only a differential diagnosis but an expected stage of disease, which is necessary for determining the most appropriate laboratory tests and how they should be interpreted. This review will discuss the diagnostic process, strengths and limitations of commonly requested tests at a diagnostic laboratory (eg, histopathology, microbial culture, PCR, and ELISA), common sources of error in interpretation, the impact of pooling samples on different tests, and ways to help strengthen conclusions made from diagnostic test data.