Evaluation of normal findings using a detailed and focused technique for transcutaneous abdominal ultrasonography in the horse

Background Ultrasonography is an important diagnostic tool in the investigation of abdominal disease in the horse. Several factors may affect the ability to image different structures within the abdomen. The aim of the study was to describe the repeatability of identification of abdominal structures in normal horses using a detailed ultrasonographic examination technique and using a focused, limited preparation technique. Methods A detailed abdominal ultrasound examination was performed in five normal horses, repeated on five occasions (total of 25 examinations). The abdomen was divided into ten different imaging sites, and structures identified in each site were recorded. Five imaging sites were then selected for a single focused ultrasound examination in 20 normal horses. Limited patient preparation was performed. Structures were recorded as ‘identified’ if ultrasonographic features could be distinguished. The location of organs and their frequency of identification were recorded. Data from both phases were analysed to determine repeatability of identification of structures in each examination (irrespective of imaging site), and for each imaging site. Results Caecum, colon, spleen, liver and right kidney were repeatably identified using the detailed technique, and had defined locations. Large colon and right kidney were identified in 100% of examinations with both techniques. Liver, spleen, caecum, duodenum and other small intestine were identified more frequently with the detailed examination. Small intestine was most frequently identified in the ventral abdomen, its identification varied markedly within and between horses, and required repeated examinations in some horses. Left kidney could not be identified in every horse using either technique. Sacculated colon was identified in all ventral sites, and was infrequently identified in dorsal sites. Conclusions Caecum, sacculated large intestine, spleen, liver and right kidney were consistently identified with both techniques. There were some normal variations which should be considered when interpreting ultrasonographic findings in clinical cases: left kidney was not always identified, sacculated colon was occasionally identified in dorsal flank sites. Multiple imaging sites and repeated examinations may be required to identify small intestine. A focused examination identified most key structures, but has some limitations compared to a detailed examination

Prospective survey of veterinary practitioners’ primary assessment of equine colic: clinical features, diagnoses, and treatment of 120 cases of large colon impaction

Background Large colon impactions are a common cause of colic in the horse. There are no scientific reports on the clinical presentation, diagnostic tests and treatments used in first opinion practice for large colon impaction cases. The aim of this study was to describe the presentation, diagnostic approach and treatment at the primary assessment of horses with large colon impactions. Methods Data were collected prospectively from veterinary practitioners on the primary assessment of equine colic cases over a 12 month period. Inclusion criteria were a diagnosis of primary large colon impaction and positive findings on rectal examination. Data recorded for each case included history, signalment, clinical and diagnostic findings, treatment on primary assessment and final case outcome. Case outcomes were categorised into three groups: simple medical (resolved with single treatment), complicated medical (resolved with multiple medical treatments) and critical (required surgery, were euthanased or died). Univariable analysis using one-way ANOVA and Tukey’s post-hoc test, Kruskal Wallis with Dunn’s post-hoc test and Chi squared analysis were used to compare between different outcome categories. Results 1032 colic cases were submitted by veterinary practitioners: 120 cases met the inclusion criteria for large colon impaction. Fifty three percent of cases were categorised as simple medical, 36.6% as complicated medical, and 9.2% as critical. Most cases (42.1%) occurred during the winter. Fifty nine percent of horses had had a recent change in management, 43% of horses were not ridden, and 12.5% had a recent / current musculoskeletal injury. Mean heart rate was 43bpm (range 26-88) and most cases showed mild signs of pain (67.5%) and reduced gut sounds (76%). Heart rate was significantly increased and gut sounds significantly decreased in critical compared to simple medical cases (p<0.05). Fifty different treatment combinations were used, with NSAIDs (93%) and oral fluids (71%) being administered most often. Conclusions Large colon impactions typically presented with mild signs of colic; heart rate and gut sounds were the most useful parameters to distinguish between simple and critical cases at the primary assessment. The findings of seasonal incidence and associated management factors are consistent with other studies. Veterinary practitioners currently use a wide range of different treatment combinations for large colon impactions

Uncorrected Tetralogy of Fallot in a 25-Year Old Nigerian African

Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. Survival after the age of 12 years without corrective surgery is rare. We present the case of a 25 year-old man with uncorrected tetralogy of Fallot. Possible reasons for the longetivity in this patient are left ventricular hypertrophy and systemic to pulmonary shunting through internal mammary arteries

An investigation into the clinical reasoning development of veterinary students

Clinical reasoning is a fundamental skill for veterinary clinicians and a competency required of graduates by the Royal College of Veterinary Surgeons. However, it is unknown how veterinary students develop reasoning skills and where strengths and shortcomings of curricula lie. This research aimed to use the University of Nottingham School of Veterinary Medicine and Science (SVMS) as a case study to investigate the development of clinical reasoning among veterinary students. The analysis was framed in consideration of the taught, learned, and declared curricula. Sixteen staff and sixteen students from the SVMS participated separately in a total of four focus groups. In addition, five interviews were conducted with recent SVMS graduates. Audio transcriptions were used to conduct a thematic analysis. A content analysis was performed on all curriculum documentation. It was found that SVMS graduates feel they have a good level of reasoning ability, but they still experience a deficit in their reasoning capabilities when starting their first job. Overarching themes arising from the data suggest that a lack of responsibility for clinical decisions during the program and the embedded nature of the clinical reasoning skill within the curriculum could be restricting development. In addition, SVMS students would benefit from clinical reasoning training where factors influencing ‘‘real life’’ decisions (e.g., finances) are explored in more depth. Integrating these factors into the curriculum could lead to improved decision-making ability among SVMS graduates and better prepare students for the stressful transition to practice. These findings are likely to have implications for other veterinary curricula

Ultrasonographic-based predictive factors influencing successful return to racing after superficial digital flexor tendon injuries in flat racehorses: a retrospective cohort study in 469 Thoroughbred racehorses in Hong Kong

Background: Superficial digital flexor tendon (SDFT) injury is an important health and welfare concern in racehorses. It is generally diagnosed with ultrasonography, predictive ultrasonographic features have not been reported. Objectives: To determine ultrasonographic features of forelimb SDFT injury at initial presentation in Thoroughbred racehorses, that could predict a successful return to racing (completing > or = 5 races). Study Design: Retrospective cohort study. Methods: Digitised ultrasonographic images of 469 horses with forelimb SDFT injuries from the Hong Kong Jockey Club (2003-2014) were evaluated, using a previously validated ultrasonographic scoring system. Six ultrasonographic parameters were evaluated (type and extent of the injury, location, echogenicity, cross-sectional area and longitudinal fiber pattern of the maximal injury zone (MIZ)), as well as horse signalment, retirement date and number of races before and after injury. Data was analysed by generalized linear regression with significance at P<0.05. Results: Cases were divided in two groups: 1) For cases of SDFT tendonitis with core lesions, cross-sectional area at the MIZ was the most significant factor determining a successful return to racing (p=0.03). If the lesion was or > or = 50% this decreased to 11-16%. 2) For cases of SDFT tendonitis without a core lesion, longitudinal fiber pattern at the MIZ best predicted a successful return to racing (P=0.002); if the affected longitudinal fiber pattern was or = 75% this decreased to 14%. Main Limitations: Prognostic information may not be applicable to other breeds/disciplines. Conclusions: This is the first study to describe ultrasonographic features of forelimb SDFT injuries at initial presentation that were predictive of successful return to racing. The outcomes will assist with early, evidence-based decisions on prognosis in Thoroughbred racehorses

Emergency Conditions in Horses: Opinions and Decision Making of Livery Yard Owners

Objective: The aim of this study was to evaluate equine livery yard owners’ opinions of emergency conditions, and to identify factors influencing emergency decision making in the horse.Background: There is limited data on horse owners’ opinions and decision making in emergency conditions.Evidentiary value: An online questionnaire was distributed to UK livery yard owners accredited with the British Horse Society. There were 104 survey participants, who represented experienced owners with responsibility for care of a number of horses.Methods: The questionnaire consisted of open and closed questions on participants’ demographics, their experiences and opinions of the most common equine emergency conditions, and emergency decision making. Descriptive data analysis included frequency ranking and categorisation of free text responses.Results: The majority of respondents had kept horses for more than 10 years (97%), and reported previous experience of emergency conditions (99%), predominantly colic (96%) and wounds (92%). Participants considered that the most common emergency conditions were colic (98%), wounds (49%) and fractures (22%), and the most concerning conditions were colic (94%), lameness (36%) and wounds (21%). Factors believed to be important in emergency decision making were: degree of pain, likelihood of condition resolving, and severity of disease.Conclusion: This study highlights the importance of colic and wounds as emergency conditions in the horse, and describes factors considered important in emergency decision making.Application: The outcomes identify where research and clinical resources should be targeted to improve emergency care for horses. The results were used to inform a survey of the wider horse population

Cross-sectional study of horse owners’ knowledge, and opinions on recognising colic in the horse

BackgroundColic is the most common emergency problem in the horse. An owner’s ability to recognise colic and seek assistance is a critical first step in determining case outcome.ObjectivesThe aim of this study was to assess horse owners’ knowledge and opinions on recognising colic.Study designCross‐sectional study.MethodsAn online questionnaire was distributed to horse owners with open and closed questions on their knowledge of normal clinical parameters in the horse, confidence and approach to recognising colic (including assessment through case scenarios), and their demographics. Descriptive and chi squared statistical analyses were performed.ResultsThere were 1564 participants. Many respondents either did not know or provided incorrect estimates for their horse’s normal clinical parameters: only 45% (n = 693/1540) gave correct normal values for heart rate, 45% (n = 694/1541) for respiratory rate and 67% (n = 1028/1534) for rectal temperature. Knowledge of normal values was statistically associated with participants’ educational qualifications (

Ultrasonographic scoring system for superficial digital flexor tendon injuries in horses: intra- and inter-rater variability

Superficial digital flexor tendon (SDFT) tendinopathy is an important musculoskeletal problem in horses. The study objective was to validate an ultrasonographic scoring system for SDFT injuries. Ultrasonographic images from 14 Thoroughbred racehorses with SDFT lesions (seven core; seven diffuse) and two controls were blindly assessed by five clinicians on two occasions. Ultrasonographic parameters evaluated were: type and extent of the injury, location, echogenicity, cross-sectional area and longitudinal fibre pattern of the maximal injury zone (MIZ). Inter-rater variability and intra-rater reliability were assessed using Kendall’s coefficient of concordance (KC) and Lin’s concordance correlation coefficient (LC), respectively. Type of injury (core vs. diffuse) had perfect inter/intra-rater agreement. Cases with core lesions had very strong inter-rater agreement (KC ≥0.74, P<0.001) and intra-rater reliability (LC ≥0.73) for all parameters apart from echogenicity. Cases with diffuse lesions had strong inter-rater agreement (KC ≥0.62) for all parameters, but weak agreement for echogenicity (KC=0.22); intra-rater reliability was excellent for MIZ location and fibre pattern (LC ≥0.82), and moderate (LC ≥0.58) for cross-sectional area and number of zones affected. This scoring system was reliable and repeatable for all parameters, except for echogenicity. A validated scoring system will facilitate reliable recording of SDFT injuries and inter-study meta-analyses

Large-scale collective motion of RFGC galaxies in curved space-time

We consider large-scale collective motion of flat edge-on spiral galaxies from the Revised Flat Galaxy Catalogue (RFGC) taking into account the curvature of space-time in the Local Universe at the scale 100 Mpc/h. We analyse how the relativistic model of collective motion should be modified to provide the best possible values of parameters, the effects that impact these parameters and ways to mitigate them. Evolution of galactic diameters, selection effects, and difference between isophotal and angular diameter distances are inadequate to explain this impact. At the same time, measurement error in HI line widths and angular diameters can easily provide such an impact. This is illustrated in a toy model, which allows analytical consideration, and then in the full model using Monte Carlo simulations. The resulting velocity field is very close to that provided by the non-relativistic model of motion. The obtained bulk flow velocity is consistent with {\Lambda}CDM cosmology.Comment: 10 pages, 3 figures, 2 table

Evaluation of veterinarians’ views on the aetiology and treatment of retained fetal membranes in the mare

Reasons for performing study: Retained fetal membranes (RFM) is reported as the most common problem in the post-partum mare. As yet, there has been no research providing an insight into the veterinary clinician’s knowledge of RFM. Objectives: Evaluate and quantify views on the definition, aetiology and treatment of RFM. Study design: Survey of veterinary surgeons. Methods: Open-question interviews of three clinicians with considerable experience in equine reproduction were performed to guide the preparation of a mixed-method questionnaire prior to dissemination. The questionnaire investigated the demographic of respondents and their opinion of definition, aetiology and treatment of RFM using both general questions and case-based scenarios. The questionnaire was circulated online to equine practices identified from the RCVS database and to diplomats of the European College of Animal Reproduction. Results: In total, 287 responses were received from veterinary clinicians with 70.3% based in the UK. Less than half (46.6%) of respondents agreed with current literature that the time period to define RFM is 3 h. Dystocia and previous history of RFM were indicated as major risk factors for RFM by 62.6% and 64.5% of respondents, respectively. Over half of respondents (52.6%) selected hormonal imbalance affecting calcium or magnesium as a risk factor for RFM. Oxytocin was the treatment of choice for RFM for 95.0% of respondents. Manual removal was used by 63.0% of respondents in over half of the cases of RFM they saw in practice. A total of 44% of respondentsselected that they would use systemic antimicrobials in cases of RFM that had occurred for less than 3 h. Conclusions: The results showed that the approach to RFM by clinicians has changed little in recent years but that veterinary surgeons often disagree on the best treatment for RFM. Further research is required to support the evidence-based best practice approach to RFM. Ethical animal research: This study was completed under the approval of the Ethics Review Panel of the School of Veterinary Medicine and Science, The University of Nottingham. Source of funding: School of Veterinary Medicine and Science, The University of Nottingham. Competing interests: None declared