OBJECTIVE To describe animal owners' experiences with palliative radiation therapy (PRT) of pets and identify factors influencing satisfaction with their pets' treatment. DESIGN Retrospective, cross-sectional study. SAMPLE 118 owners of dogs, cats, or rabbits. PROCEDURES Medical records were searched to identify animals that underwent PRT between 2004 and 2013. Signalment, tumor-related data, and outcome information were recorded. Owners completed an electronic survey assessing satisfaction with treatment (ie, satisfaction with the decision for their pet to undergo PRT and indication that they would choose PRT for their pet again), expectations regarding PRT, and perceptions of their pets' quality of life (QOL) and signs of discomfort from acute adverse radiation effects. Additional data regarding practical aspects of treatment, pet death, communications with veterinarians, and owner demographics were collected. Variables were tested for association with measures of owner satisfaction. RESULTS 92 of 116 (79%) owners were satisfied with the decision to have their pets undergo PRT. Most (92/118 [78%]) owners reported their pet's QOL improved after PRT; these owners were significantly more likely to be satisfied than those who did not report improved QOL. Owners who perceived their pets had discomfort from adverse radiation effects (38/116 [33%]) were significantly less likely to be satisfied than owners who did not report this observation. Measures of satisfaction were not associated with patient survival time. Twenty-one of 118 (18%) owners indicated they expected PRT would cure their pet's tumor. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that short life expectancy should not deter recommendation of PRT for pets. Protocols that minimize risk of acute adverse effects may be advantageous. Veterinarians should attempt to ensure that owners understand the goals of PRT.
The flipped classroom has been gaining momentum within medical education circles. Pre-class assignments are an important component of this pedagogical approach. In this study, a section of the introductory course to veterinary medical imaging was taught using a flipped classroom, and the effectiveness of two different pre-classroom assignments was evaluated. The pre-classroom assignments consisted of either short videos or readings. Both had similar content, which included basic information about pulmonary patterns of disease on chest radiographs. Learning outcomes were assessed by in-classroom and final examination questions. Student learning self-assessments and student satisfaction were also evaluated via an online survey. Students in the video group answered more of the in-classroom questions correctly (71% video vs. 63% reading group; p = .01) and had higher scores on the final examination (83% video vs. 75% reading group; p = .02). There was also a higher student satisfaction with the videos versus the reading assignment. However, we found no significant difference in the student self-assessments of learning or participation in class. An additional finding of this study related to the ongoing difficulties students were having with the learning objectives, including differentiating a pathological process from a normal, or normal variant, recognizing the different pulmonary patterns, and developing a differential diagnoses list, despite the pre-classroom assignments and large group learning sessions. This speaks to the difficulty in developing confidence in pulmonary pattern recognition on chest radiographs, a skill that requires considerable training and time investment.
Veterinary workers use lead shielding for protection against harm from ionizing radiation during diagnostic imaging. Surface lead on shielding has been reported as a potential exposure hazard. The purpose of this prospective, analytical, descriptive study was to measure surface lead on lead-containing shielding in the field service and small animal radiology areas of a veterinary teaching hospital, and to examine potential risk factors for surface lead. Surface lead on a convenience sample of 54 lead shielding items was measured in a commercial laboratory using inductively coupled plasma mass spectrometry. The median and range of surface lead for aprons, thyroid collars, and gloves were 3.6 µg/dm 2 (range, 1.3-22.4 µg/dm 2 ), 23.1 µg/dm 2 (range, 2.6-116 µg/dm 2 ), and 134 µg/dm 2 (range, 1.5-155 µg/dm 2 ), respectively. In the final multivariable analysis, the mean surface lead on thyroid collars and gloves was higher than on aprons (relative differences 4.8, 95% confidence interval [CI] 2.2, 10.5, P < 0.001; and 9.5, 95% CI 4.4, 20.6, P < 0.001, respectively). The mean surface lead on shielding in the worst condition was higher than on shielding in the intermediate and best conditions (P < 0.001). Lead shielding provides effective protection against the harmful effects of ionizing radiation, and shielding should always be worn during radiation exposure. Based on our findings and the common use of lead shielding in veterinary workplaces, we recommend that employers inform workers of this hazard and provide training on steps to mitigate exposure, including the use of disposable gloves when wearing lead shielding and handwashing after use.
Case summary A 5-month-old cat was evaluated for a 3 week history of cough, nasal discharge, decreased appetite and weight loss. Musculoskeletal examination was normal and serum creatine kinase (CK) activity was within the reference interval. The cat was treated during the next 10 months for chronic, persistent pneumonia. Weakness then became apparent, the cat developed dysphagia and was euthanized. Post-mortem evaluation revealed chronic aspiration pneumonia and muscular dystrophy associated with beta (β)-sarcoglycan deficiency. Relevance and novel information This is the first report of a cat with muscular dystrophy presenting for chronic pneumonia without obvious megaesophagus, dysphagia or prominent neuromuscular signs until late in the course of the disease. The absence of gait abnormalities, marked muscle atrophy or hypertrophy and normal serum CK activity delayed the diagnosis in this cat with β-sarcoglycan deficiency.
Staging and therapeutic planning for dogs with malignant disease in the popliteal lymph node are based on the expected patterns of lymphatic drainage from the lymph node. The medial iliac lymph nodes are known to receive efferent lymph from the popliteal lymph node; however, an accessory popliteal efferent pathway with direct connection to the sacral lymph nodes has also been less frequently reported. The primary objective of this prospective, anatomic study was to describe the frequency of various patterns of lymphatic drainage of the popliteal lymph node. With informed client consent, 50 adult dogs with no known disease of the lymphatic system underwent computed tomographic lymphography after ultrasound-guided, percutaneous injection of 350 mg/ml iohexol into a popliteal lymph node. In all 50 dogs, the popliteal lymph node drained directly to the ipsilateral medial iliac lymph node through multiple lymphatic vessels that coursed along the medial thigh. In 26% (13/50) of dogs, efferent vessels also drained from the popliteal lymph node directly to the internal iliac and/or sacral lymph nodes, coursing laterally through the gluteal region and passing over the dorsal aspect of the pelvis. Lymphatic connections between the right and left medial iliac and right and left internal iliac lymph nodes were found. Based on our findings, the internal iliac and sacral lymph nodes should be considered when staging or planning therapy for dogs with malignant disease in the popliteal lymph node.
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