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Background Mechanical ventilation is frequently performed in small animal critical care medicine with well‐documented survival data; quality of life in these patients following discharge from hospital is unknown. Key findings Owners of patients surviving to discharge following mechanical ventilation were surveyed with an open ended and ranking score questionnaire. Response rate was 57% (27/47). All respondents rated their pet's quality of life prior to the illness necessitating ventilation as good to excellent (8/10–10/10). Perceived recovery periods ranged from 0 days to 6 months (the most common response being 2–3 weeks). Fourteen owners stated that their pets’ quality of life was as good or better than previously. Patients with persistent quality of life concerns (n = 3) had been ventilated for neurological disease. Four owners reported changed behaviors such as startling easily or being excessively responsive to noise. One cat became deaf and at time of survey had not regained hearing. Commonly reported problems included decreased exercise tolerance (n = 3). All respondents stated that they would ventilate their pet again. Significance Cats and dogs that are mechanically ventilated appear to recover with minimal adverse effect on their quality of life. Patients ventilated for neurological conditions may be more likely to experience quality of life limitations.

BACKGROUND Cardiac auscultation is an important part of the physical examination. This study evaluated cardiac auscultation skills in veterinary students and compared their abilities to recent veterinary graduates, referral hospital veterinary surgeons and veterinary cardiologists or cardiology residents. In addition it compared their self-predicted quiz scores to their actual scores, evaluating if they could accurately predict their own performance level. METHODS A digital recording device was used to record auscultation sounds from 12 different patients with a diagnosis confirmed by a board-certified veterinary cardiologist. The sound files and associated phonocardiograms were uploaded to a video sharing website. A cloud-based online multiple-choice quiz was generated and shared with final year veterinary students, recent veterinary graduates, referral hospital veterinary surgeons and veterinary cardiologists or cardiology residents. RESULTS There were 128 participants: 51 final year veterinary students, 62 recent veterinary graduates, and 10 referral hospital veterinary surgeons and five veterinary cardiologists or cardiology residents. No difference was found between the cardiac auscultation skills of recent veterinary graduates and final year veterinary students. Veterinary students' self-predicted scores were lower than actual scores. CONCLUSIONS Recent veterinary graduates did not perform better than final year veterinary students in this study, suggesting that auscultation skills do not continue to improve in the first few years after graduation. Efforts should be made to maximise students' learning in cardiac auscultation skills. Veterinary students show a lack of confidence in cardiac auscultation skills.

In December, the RCVS informed us once again that veterinary surgeons are among the most trusted professionals in the UK.1 Those of us with ‘glass half full’ mindset might have nodded to ourselves with a smile as we balanced Christmas clinical activities and family life to some degree. However, in the current sociopolitical climate, the more cynical of us might have wondered whether this makes us feel any better if we are being compared with politicians, bankers and journalists. Without questioning how the survey was run, it does appear that veterinary surgeons are trusted. This trust is paramount for patient treatment, safety and care – the public need to trust the vets looking after their animals, and the veterinary team must trust each other. When teaching undergraduates in the clinical environment, supervisors entrust students to assume clinical responsibilities. This is not far removed from William Osler’s clerkship system, which was introduced at the Johns Hopkins University in Baltimore in 1889. Osler moved medical teaching from the lecture theatre to the bedside, enabling students to model themselves on more experienced colleagues and gain tacit knowledge in actual workplace settings.2 That model, combined with a variety of different educational theories, still dominates medical education today, and, by proxy, veterinary education. More recently, there is a trend in veterinary education to move away from solely knowledge-based assessment and to include assessment of clinical competence. This usually involves a structured assessment either in the workplace (eg, direct observation of a practical skill, such as placing an intravenous catheter) or in an assessment centre where an aspect of a clinical scenario is examined using a structured assessment tool (eg, objective structured clinical examination [OSCE]). #### What you need to know

An 11-month-old Border collie presented collapsed and continued to deteriorate rapidly despite supportive treatment. The dog had a history of failure to thrive and recurring respiratory infection. Laboratory abnormalities included neutrophilic leucocytosis, Heinz body anaemia, hyperammonaemia, hyperbilirubinaemia, proteinuria and hypocobalaminaemia. Post-mortem examination revealed multi-focal necrosis within the heart, kidneys, pancreas, liver, meninges and cerebral cortex. Fungal hyphae in lesions were identified as Scedosporium prolificans following culture. Subsequent genotyping confirmed that the dog carried the CUBN:c.8392delC mutation in a homozygous state, verifying hereditary cobalamin deficiency (a.k.a. Imerslund-Grasbeck syndrome). Cobalamin deficiency may have been a predisposing factor for the development of systemic fungal infection in this dog.

Objectives To describe clinical and imaging findings in dogs with confirmed gastrointestinal ulceration, to compare findings in dogs with perforated and non-perforated ulcers and to estimate the sensitivities of radiography, ultrasonography and computed tomography (CT) for gastrointestinal ulceration and perforation. Methods Retrospective review of medical records of 82 dogs that had a macroscopic ulcer in the gastric or intestinal mucosa diagnosed directly at endoscopy, surgery or necropsy and had survey radiography, ultrasonography or a CT scan of the abdomen during the same period of hospitalisation. Results The most frequent clinical signs were vomiting in 88% dogs, haematemesis in 32%, melaena in 31% and weight loss in 7%. The most frequent imaging findings in dogs with non-perforated ulcers were gastrointestinal mural lesion in 56%, mucosal defect compatible with an ulcer in 44% and peritoneal fluid in 21%. In dogs with perforated ulcers the most frequent imaging findings were peritoneal fluid in 83%, gastrointestinal mural lesion in 48%, peritoneal gas in 31% and mucosal defect compatible with an ulcer in 29%. Sensitivities of radiography, ultrasonography and CT were 30, 65 and 67% in dogs with non-perforated ulcers and 79, 86 and 93% in dogs with perforated ulcers, respectively. Clinical significance In dogs with non-perforated ulcers, survey radiography was usually negative whereas ultrasonography and CT frequently enabled detection of the site of the ulcer; in dogs with perforated ulcers, radiography was frequently positive for peritoneal gas and CT was a sensitive modality for both the ulcer and signs of perforation.

In emergency situations it should be paramount to alleviate pain by the most reliable and safe method. This chapter discussesuse and benefits of full mu agonist opioids, when to start an additional analgesic and what drugs to avoid. Case examples: Gastric dilatation-volvulus; Caesarean section; Septic abdomen; Road traffic accident.

Objective To describe the clinical characteristics of recurrent septic peritonitis in dogs. Design Multicenter retrospective observational study. Animals Client-owned dogs with recurrent septic peritonitis. Setting Three university emergency and referral hospitals. Interventions None. Measurements and Main Results Medical records from 3 veterinary university teaching hospitals were reviewed and data were collected using a standardized data collection sheet for all cases of septic peritonitis during the study period (2000–2011). Forty one dogs met the inclusion criteria for recurrent peritonitis. All dogs underwent relaparotomy. The original cause of septic peritonitis in these cases included previous surgery for gastrointestinal foreign body removal (n = 26), gastrointestinal neoplasia (n = 3), gastric or duodenal ulceration (n = 3), bilary tract leakage (n = 2), and single instance for each of the following: penetrating foreign body, hernia strangulation, intussusception, mesenteric volvulus, infection of the laparotomy incision, prostatic abscess, and trauma. Eighteen animals survived to discharge. There was no difference detected between survivors and nonsurvivors with recurrent peritonitis in terms of inciting cause, serum albumin concentration, surgical management, or provision of appropriate initial antimicrobials. The survival rate for dogs having recurrent peritonitis was 43.9% (18/41 dogs). Conclusions This retrospective study did not identify any significant prognostic indicators for dogs with recurrent peritonitis and that the mortality rate for dogs having more than one surgery for septic peritonitis is similar to that reported for a single surgery for septic peritonitis.

The content and quality of veterinary internships varies, for example, regarding the balance of teaching to work.1 Recent guidelines outline how this could be better balanced.2 3 Despite the fact there is no uniformity or quality assurance of the training delivered during an internship, all European and American Specialist Veterinary Colleges require a yearlong rotating internship or an undefined equivalent clinical experience prior to starting a residency. The aim of this study is to gain an understanding of what postgraduate veterinary surgeons look for, expect and currently achieve in university programmes. Following ethical approval, 23 interns in the 2015–2016 cohort of programmes at Langford Vets and The Royal Veterinary College were surveyed. Two questionnaires (online supplementary appendix 1) were designed and trialled and delivered on an online platform (SurveyMonkey), accessed via an email link. Each respondent could only complete the survey once. Questionnaire 1 was used within one month of starting the internship programme to explore the expectations of veterinary surgeons entering internships Questionnaire 2 was used at the end of the internship. All answers were collected anonymously. ### Supplementary file 1 [vetrec-2017-104761-SP1.docx] Questions were asked about the importance of various factors to selecting the internship, levels of agreement with statements defining success in an internship, skills they expected to and did achieve, attributes associated with being a good intern and …

A dog presenting with scleral haemorrhage and neck pain was diagnosed with Angiostrongylus vasorum on direct faecal smear. Thromboelastography (with the addition of tissue plasminogen activator) revealed evidence of hypocoagulability and hyperfibrinolysis. The administration of fresh frozen plasma and tranexamic acid was associated with the resolution of a hypocoagulable and a hyperfibrinolytic state, as well as clinical improvement.

We thank you for reaching out to us with your comments on our paper and we are sorry that you were upset by it. This was certainly not our intention. We have no argument that creating happy working environments will lead to happy employees and the best quality veterinary care for animals under our care. As outlined in our short communication,1 Grit is a marker that has been used in some areas to identify whether there are objective measures that can be used to determine success within some fields. As the majority of university-based interns intend to apply for residency programmes at the end of their programme we used attainment of one of these as success in the context of this paper. In a previous paper we asked interns for their definition of a successful internship and the answer was overwhelmingly ‘obtaining a residency’.2 Neither of us share this opinion of success, nor is it the stated aim of the internship programmes at either of the institutions we were …

Gastric dilatation and volvulus (GDV) is a surgical emergency in dogs which has been extensively studied, with virtually all aspects of patient management reviewed and examined. Breed predisposition,1 risk factors for development of the condition2, 3 including specific allele genetic analysis,4 the association between lactate and other biomarkers and outcome,5-9 diagnostic imaging findings,10 the use of different drug and fluid therapies alongside surgery11, 12 and even analysis of the composition of the gas within the stomach of the GDV patient,13 are just some of the topics that have been researched. Canine food engorgement, also often referred to as food bloat, causes gastric dilatation and has fairly similar presenting clinical signs to GDV. However, it is much less well described in the veterinary literature despite being, anecdotally, a fairly common presentation to first-opinion veterinary practitioners. In a study by Brockman and others,14 gastric dilation alone was considered alongside GDV and the mortality of the gastric dilation patients was found to be 0.9 per cent compared to 15 per cent for the GDV patients (although the gastric dilation group did include …

Objectives Pure red cell aplasia (PRCA) and non-regenerative immune-mediated haemolytic anaemia (NRIMHA) are uncommon causes of non-regenerative anaemia affecting the bone marrow in the cat. This retrospective study aimed to describe the clinical features, treatment and outcome (remission and survival) of cats with these disorders. Methods Cases of PRCA and NRIMHA presenting between 2009 and 2013 were retrieved. Clinical features including signalment, history, clinical signs and diagnostic investigations were recorded, as well as treatment(s) used and outcome (remission and survival). Outcome was compared for PRCA and NRIMHA. Results Fifteen cats met inclusion criteria: seven with PRCA and eight with NRIMHA. The majority (12/15) were younger than 3 years of age. Volume overload was common (8/11). Treatment with whole blood transfusions with or without Oxyglobin was necessary in most cats (14/15) and resulted in congestive heart failure in one cat. Most cats (11/15) achieved remission 12–42 days after starting immunosuppressive treatment. Treatment protocols associated with remission were glucocorticoids alone (remission in 6/7 cats), glucocorticoids and chlorambucil (remission in 3/6 treated cats), glucocorticoids and ciclosporin (one cat only) and ciclosporin alone (one cat only). Relapse was observed in 3/11 cats, and 8/11 cats were still receiving treatment at the time of follow-up. Outcome (remission and survival) did not differ between PRCA and NRIMHA. Conclusions and relevance PRCA and NRIMHA are uncommon causes of anaemia in predominantly young cats. The prognosis is reasonable, with a mortality rate of 27%, and it can take at least 6 weeks before remission is observed. Following clinical remission, gradual withdrawal of immunosuppressive treatments should be attempted, with close monitoring for relapse; some cats may require long-term treatment. This study is the first to report the use of chlorambucil as an adjunctive immunosuppressant in these cases. Outcome did not differ for PRCA and NRIMHA.

In the UK, the majority of veterinary surgeons undertaking small animal rotating internships in university teaching hospitals do so with an intention to progress to clinical specialist training.1 However, not all those interns wanting to pursue specialist training achieve their goal. The achievement of difficult goals entails talent and a continued focused application of that talent over time.2 Veterinary degrees are highly competitive (approximately 8.3 applicants per university admission in the UK).3 Those who are successful in obtaining a degree in the UK are likely to work in small animal practice with approximately 10 per cent of recent veterinary graduates pursuing an internship.3 Selection procedures for interns applying for university-based programmes use a number of methods which include academic grades throughout their degree, examination of curricula vitae and interviews. Success is defined by interns in academic programmes as progressing to clinical specialist training.1 Currently, there are no studies investigating what academic and personal characteristics are associated with this success. The Grit score provides a numerical value to an individual’s personality trait of perseverance of effort and consistency of interest for long-term goals.2 The aim of this study is to examine the grit value for small animal veterinary interns completing university programmes and to see if that value has any correlation with progression to further clinical training or research. A web-based questionnaire was sent to small animal interns from the University of Bristol and the Royal Veterinary …

THE UK is fortunate to have a Veterinary Poisons Information Service (VPIS). A paper summarised on p 229 of this issue of Veterinary Record by Bates and Edwards (2014) concerning benzalkonium chloride (BAC) exposure in cats is testament to the excellent database analyses VPIS conducts as part of its mission. It is pertinent that during the period studied, only one case of feline BAC intoxication was reported in the adverse drug reaction database of the Center for Veterinary Medicines in the USA, with another single case recorded by the Australian Pesticides and Veterinary Medicines Authority, while the VPIS recorded 245 cases. Although the paper is retrospective, the data is sufficiently robust to paint an evidence-based clinical picture for both owners and the veterinary team confronted with the management of such patients. The number of cases Bates and Edwards reviewed is huge, reflecting the commonness and importance of this toxicosis, and the excellent record-keeping of this group. The first question that springs from the paper is ‘Why cats?’ (or, ‘Why not dogs?’). The answer is straightforward, at least in part. The intoxication reflects the behavioural predisposition of cats to groom any abnormal material from their coat or pads. This often gets them into trouble when they share the environment with people who use different chemical agents to clean surfaces on which cats may walk or roll. It is the same reason why cats are at risk of lead intoxication from flaky paint (they groom it off their coat and ingest it) (Knight and Kumar 2003), why flea allergens in the coat can trigger severe secondary eosinophilic granuloma lesions on the lingual surface (Malik 2007), and why cats come to ingest illicit substances that mysteriously find their way onto their coat or paws (Barfield and others …

Case summary A cat with a chronic diaphragmatic rupture presented with neurological signs, including twitching and focal seizures. Blood ammonia level was markedly elevated and therefore neurological signs were thought to be related to hepatic encephalopathy. Exploratory laparotomy revealed that the left lateral and medial liver lobes were herniated into the thorax and multiple acquired portosystemic shunts (MAPSS) were present. The hernia was reduced and the diaphragm repaired. Neurological signs gradually resolved following surgery and 1 year postoperatively the cat was clinically normal, was not on any medication and had no evidence of hepatic dysfunction. Relevance and novel information This is the first report of a chronic diaphragmatic rupture leading to MAPSS in a cat.

A thermophilic Bacillus spp. capable of transforming aliphatic nitriles, cyclic nitriles and dinitriles was used as a free cell suspension and immobilized in alginate beads to study the utilization of acetonitrile and acrylonitrile in a buffered biotransformation medium. The cells grew optimally at 65°C and contained a nitrile hydratase–amidase enzyme system that transformed nitrile compounds stoichiometrically to the corresponding carboxylic acids. In the presence of urea or chloroacetone, amidase activity was inhibited and the amide intermediate was accumulated. Mass transfer limitation of nitrile utilization rates was observed with immobilized cells, but the alginate afforded the cells some degree of additional thermal stability and potential advantage in re-use. In vitro inhibition of the partially purified amidase was confirmed and the use of whole cells of this organism in a continuous bioreactor to generate amide products from nitrile substrates was demonstrated.

Practical relevance Blood transfusions are a potentially life-saving procedure that are within the reach of most small animal practitioners. Only minimal equipment is required. Patient group Any cat with clinical signs attributable to a reduced red blood cell mass that is affecting oxygen transport (as a result of reduced packed cell volume or acute blood loss) is a potential candidate for a transfusion. Clinical challenges Although the principles of transfusion medicine are not complicated, there can be fatal consequences if certain steps are omitted. Diagnostics Blood typing kits and blood filters are readily available from veterinary wholesalers, laboratories and blood banking services. Evidence base Over the past three decades, a substantial body of clinical research and reports has built up covering feline blood types and transfusion medicine. This article draws on that research to provide clinical guidance aimed at all veterinarians in feline or small animal practice who either currently practise transfusion medicine or plan to do so.

Case Description—2 English Pointers were suspected of having consumed toxic doses of methotrexate, a dihydrofolate reductase inhibitor frequently used in human and veterinary chemotherapeutic protocols. Clinical Findings—Potentially toxic plasma concentrations of methotrexate were detected in both dogs. Results of physical examination, a CBC, blood gas analysis, and serum biochemical analysis were predominantly unremarkable, although 1 dog had mild hyponatremia (1372 mmol/L; reference range, 140 to 153 mmol/L) and mild hypocalcemia (1.03 mmol of ionized calcium/L; reference range, 1.13 to 1.33 mmol of ionized calcium/L). Treatment and Outcome—Point-of-care determination of plasma methotrexate concentrations was not available; thus, palliative care was provided. Emesis was induced in both dogs by SC administration of apomorphine, and 3 doses of a suspension of activated charcoal with sorbitol were administered orally over a 6-hour period. Fluid diuresis was initiated in both dogs by administration of a compound sodium lactate solution, and N-acetylcysteine was administered IV to both dogs as a hepatoprotectant. A solution of calcium folinate (also known as leucovorin) was administered IV to both dogs to mitigate the effects of ingested methotrexate. No adverse effects associated with calcium folinate administration were identified, and no clinical or pathological evidence of methotrexate intoxication was detected. Clinical Relevance—IV administration of calcium folinate appeared to prevent the pathological sequelae of methotrexate intoxication without adverse effects. Administration of calcium folinate is recommended for the treatment of dogs with suspected or confirmed methotrexate overdose.

IN a paper summarised on p 352 of this issue, Juvet and others (2011) describe the blood types of 176 cats in and around the Dublin area of Ireland as well as the prevalence of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV). The blood types of cats is a subject that has attracted significant study since Holmes first described two types in the Manchester area of the UK in the 1950s (Holmes 1950). The information gleaned from these studies is of great importance to the veterinary practitioner. The importance of blood typing feline patients for AB blood grouping before transfusion cannot be stressed enough due to the risk of fatal transfusion reactions that can occur in type B cats due to the presence of preformed anti-A antibodies. Previous studies have identified not only geographical variation, but also breed variation and have demonstrated a lack of predictability of feline blood types. Interestingly, recent studies have also identified an increased incidence of type B cats compared with older studies. Geographically, it is thought that the basis of different blood types in the AB group system is most likely to be related to the blood type of cats introduced to a certain area as a result of ‘the founder effect’. This is clearly demonstrated with the introduction of certain breeds from a single blood type to different regions, for example, Siamese and Bengal cats in the UK (Gunn-Moore and others 2009). This is possibly the …