“I always feel like I have to rush…”: pet owner and small animal veterinary surgeons’ reflections on time during preventative healthcare consultations in the United Kingdom

Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK). Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare

Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation

Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations. Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation. A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n = 1168; 64.6%) followed by cats (n = 510; 28.2%), rabbits (n = 86; 4.8%) and patients of other species (n = 43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model. Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and acted upon during all types of consultations. Dental and behavioural non-presenting problems were discussed more frequently during preventive-medicine consultations compared with specific health-problem consultations. Preventive-medicine consultations represent an opportunity for veterinary surgeons to discuss other aspects of preventive medicine, and to detect and manage new and ongoing health problems. A greater evidence base is needed to understand whether detecting and managing underlying disease during the preventive-medicine consultation has a positive impact on lifelong patient health and welfare

Diagnostic testing in first opinion small animal consultations

DIAGNOSTIC testing is a vital part of the decision-making process, which aims to increase diagnostic certainty, assist management and treatment decisions and provide a prognosis (Radostits and others 2000). A wide range of tests are available, with variable accuracy, expense and risk to the patient, but it is currently unclear how veterinary surgeons are making decisions about which tests to carry out. Understanding the decision-making process is vital in order to ensure that the decisions made during the consultation are based on the best relevant evidence. However, before decision-making around diagnostic testing can be understood, it is neccessary to know which tests are performed most frequently. This may be useful for veterinary practices, for example, when making business decisions surrounding diagnostic equipment and in-house training, and could also help direct veterinary curricula and research. The aim of this study was to describe the diagnostic tests commonly performed in a convenience sample of first opinion small animal consultations. Data collection took place over 16 weeks (two weeks each in eight different practices) as part of data gathered for a larger project (Robinson and others 2014a). A previously developed data collection tool (Robinson and others 2014a) was used to record consultation data by direct observation. Data were recorded on all health problems discussed, including the reason for presentation (the presenting problem) and all additional problems discussed (non-presenting problems). For each health problem discussed, the type of diagnostic test(s) was recorded by selecting one option from: None; In-consultation; Post-consultation; Both. Clinical examination, as defined by Robinson and others (2014b), was not considered to be a diagnostic

Measuring the success of canine and feline preventative healthcare consultations: a systematic review

Preventative healthcare consultations account for a large proportion of the veterinary caseload. This novel study is the first to methodically review all literature on canine and feline preventative healthcare consultations. Previous research has found these consultations to be different from health problem consultations in terms of communication style and content. Identifying relevant evidence and previously validated methods of measuring the success of these consultations will be useful when implementing strategies for optimisation. The aim of this study was to identify and assess the quality of existing literature which describes and/or measures the success of preventative healthcare consultations.Database searches of CAB Abstracts and Medline were conducted to identify published literature. Google searches were then conducted to identify any additional published or grey literature. Results were systematically screened to determine whether the returned sources were about cats and/or dogs, whether they related to preventative healthcare, and whether they described and/or measured the success of preventative healthcare consultations. For primary research citations which only described preventative healthcare consultations, data were extracted on the aspects of the consultations described. For citations which additionally measured the success of the consultations, the measures used, sampling technique, key results and key weaknesses were also extracted. Of 17538 citations identified in total during the database searches, a total of seven relevant primary research citations were identified. All of these citations described aspects of the preventative healthcare consultation, such as consultation length, health problems discussed, actions taken and communication style. Only one primary research citation measured success of the consultation, using veterinarian satisfaction to determine success. In addition, 30 narrative citations, including expert opinion pieces, textbooks, guidelines without transparent methodology and conference presentations were identified. Google searches identified 224 relevant narrative citations, and five of the seven primary research citations identified by the database searches, but did not identify any additional relevant primary research citations. The results suggest that, despite accounting for around a third of all consultations, there is relatively little evidence describing preventative healthcare consultations and only one measure of success has been described for these consultations. This presents potential challenges when implementing strategies to optimise these consultations, as measures which are useful and relevant to veterinary practice should first be identified. Identifying useful measures of success will allow future strategies designed to maximise the benefits of these consultations to be meaningfully assessed for efficacy

Veterinary services during the COVID pandemic: less stressful for cats and their carers?

OBJECTIVES: The COVID-19 pandemic saw major changes to small animal veterinary practice, many of which may have had an impact on stress in cats presented to the clinic. The aim of this study was to examine the nature of feline outpatient visits before and during the pandemic, and examine signs of stress noted in cats before, during and after these visits. METHODS: A questionnaire was used to gather data on cat owner experiences of visits to the veterinary clinic. Data were gathered on the owner’s most recent experience of a consultation, with consultations occurring in February 2020 or earlier coded as a standard consultation, and consultations occurring in March 2020 or later coded as COVID-19 consultations. RESULTS: A total of 371 responses were received, with 210 coded as standard consultations and 161 coded as COVID-19 consultations. Consultation type varied significantly between standard and COVID-19 consultations (P <0.001), with emergency consultations more frequent and preventive healthcare consultations less frequent during the COVID-19 pandemic. The area in which the owner and their cat waited also varied significantly between standard and COVID-19 consultations (P <0.001), with standard consultations more likely to involve time in a waiting room while COVID-19 consultations were often called straight in or waited outside the practice. Most owners notedbehaviours associated with stress in their cats, regardless of consultation type, although trying to hide or escape were noted more frequently for cats seen prior to the COVID-19 pandemic. CONCLUSIONS AND RELEVANCE: The findings suggest that outpatient visits to the veterinary clinic were stressful for cats both prior to and during the COVID-19 pandemic, but some measures taken during the pandemic, for example less use of waiting rooms, could be used alongside existing cat friendly measures to help to reduce stress in feline patients

Assembly and function of AP-3 complexes in cells expressing mutant subunits

The mouse mutants mocha and pearl are deficient in the AP-3 δ and β3A subunits, respectively. We have used cells from these mice to investigate both the assembly of AP-3 complexes and AP-3 function. In mocha cells, the β3 and μ3 subunits coassemble into a heterodimer, whereas the σ3 subunit remains monomeric. In pearl cells, the δ and σ3 subunits coassemble into a heterodimer, whereas μ3 gets destroyed. The yeast two hybrid system was used to confirm these interactions, and also to demonstrate that the A (ubiquitous) and B (neuronal-specific) isoforms of β3 and μ3 can interact with each other. Pearl cell lines were generated that express β3A, β3B, a β3Aβ2 chimera, two β3A deletion mutants, and a β3A point mutant lacking a functional clathrin binding site. All six constructs assembled into complexes and were recruited onto membranes. However, only β3A, β3B, and the point mutant gave full functional rescue, as assayed by LAMP-1 sorting. The β3Aβ2 chimera and the β3A short deletion mutant gave partial functional rescue, whereas the β3A truncation mutant gave no functional rescue. These results indicate that the hinge and/or ear domains of β3 are important for function, but the clathrin binding site is not needed

Experiences and Attitudes of Genome Investigators Regarding Return of Individual Genetic Test Results

Purpose Whether and how to return individual genetic results to study participants is among the most contentious policy issues in contemporary genomic research. Methods: We surveyed corresponding authors of genome-wide association studies (GWAS), identified through the National Human Genome Research Institute's Catalog of Published GWAS, to describe the experiences and attitudes of these stakeholders. Results: Of 357 corresponding authors, 200 (56%) responded. One hundred twenty-six (63%) had been responsible for primary data and sample collection, whereas 74 (37%) had performed secondary analyses. Only 7 (4%) had returned individual results within their index GWAS. Most (69%) believed that return of results to individual participants was warranted under at least some circumstances. Most respondents identified a desire to benefit participants's health (63%) and respect for participants's; desires for information (57%) as major motivations for returning results. Most also identified uncertain clinical utility (76%), the possibility that participants will misunderstand results (74%), the potential for emotional harm (61%), the need to ensure access to trained clinicians (59%), and the potential for loss of confidentiality (51%) as major barriers to return. Conclusion: Investigators have limited experience returning individual results from genome-scale research, yet most are motivated to do so in at least some circumstances