Antimicrobial Prescription Behavior in Equine Asthma Cases: An International Survey

Equine asthma is considered a non-infectious respiratory disease characterized by inflammation and hypersensitivity. Given the importance of antimicrobial stewardship, an international survey was designed to investigate the use of antimicrobials in asthmatic horses and the factors influencing prescription behavior. An online survey was distributed in six languages by international mailing lists and social media from December 2020 to January 2022. Of the 434 responses recorded, 249 veterinarians working in 25 countries finished the survey. These included 79 ECEIM/ACVIM diplomats. A total of 204 respondents confirmed national regulations concerning antimicrobial use in their country. Knowledge of the asthma definitions as presented in the revised ACVIM consensus statement was greater in veterinarians treating over 95% of equine patients compared to veterinarians treating more species, based on 10 questions (answers consistent with the consensus statement in 7 (IQR 5–9) and 4 (IQR 3–6) questions, respectively, (p < 0.001)). A total of 131 respondents stated to use antimicrobials (at least ‘sometimes’) in at least one of the three presented cases consistent with equine asthma. Trimethoprim-Sulfa combinations, penicillin(s), and tetracyclines were prescribed most (by 105, 53 and 38 veterinarians, respectively). Aminoglycosides, cephalosporins and fluoroquinolones were also selected (22, 15, 9 veterinarians respectively). Tetracyclines and cephalosporins are prescribed more often by veterinarians working without national regulations (p 0.019 and p 0.035, respectively). The most selected factors influencing prescription behavior were: ‘tracheal wash culture’ (62% of 131 veterinarians using antimicrobials in these cases), ‘whether other horses in the barn have similar complaints’ (60%), and ‘response to other forms of therapy’ (53%). In conclusion, insight into prescription behavior is the first step towards minimizing and optimizing antimicrobial use

Effect of Lavage Solution Type on Bronchoalveolar Lavage Fluid Cytology in Clinically Healthy Horses

Equine bronchoalveolar lavage (BAL) is usually performed with 250–500 mL of isotonic saline at pH 5.5. The acidic pH of saline may cause an increase in airway neutrophil count 48 h after BAL. Other isotonic solutions such as Ringer’s solution, phosphate-buffered saline (PBS) or Plasma-Lyte 148® have a neutral pH of 7.4 and might be a better choice for BAL by not provoking inflammation and the influx of neutrophils into airways. BAL was performed in four healthy horses in four different lung lobes using four different solutions in a randomized crossover design. In each lobe, BAL was performed twice with a 48 h interval using 250 mL of solution. Automated total nucleated cell counts (TNCs) were recorded, and differential cell counts in lavage fluid were determined by two investigators blinded to treatments. The mean volume of BAL fluid retrieved was 51 ± 14%. The mean neutrophil percentage (%N) increased from 1.5 ± 0.9% to 14.7 ± 9.6% at 48 h (p < 0.001) but was not significantly affected by the solution used or the lung lobe sampled. In conclusion, in this study, the influx of neutrophils into airways after BAL was independent of the type of isotonic solution used and the lung lobe sampled. Saline remains an appropriate solution for BAL in horses

Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study

Background The alignment of student and workplace supervisors’ perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences. Methods A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests. Results ‘Honesty, integrity and dependability’ was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students’ awareness of their own and others’ mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher). Limitations Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution. Conclusion There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning

Rating and ranking preparedness characteristics important for veterinary workplace clinical training: a novel application of pairwise comparisons and the Elo algorithm

Quantitatively eliciting perspectives about a large number of similar entities (such as a list of competences) is a challenge for researchers in health professions education (HPE). Traditional survey methods may include using Likert items. However, a Likert item approach that generates absolute ratings of the entities may suffer from the "ceiling effect," as ratings cluster at one end of the scale. This impacts on researchers' ability to detect differences in ratings between the entities themselves and between respondent groups. This paper describes the use of pairwise comparison (this or that?) questions and a novel application of the Elo algorithm to generate relative ratings and rankings of a large number of entities, on a unidimensional scale. A study assessing the relative importance of 91 student "preparedness characteristics" for veterinary workplace clinical training (WCT) is presented as an example of this method in action. The Elo algorithm uses pairwise comparison responses to generate an importance rating for each preparedness characteristic on a scale from zero to one. This is continuous data with measurement variability which, by definition, spans an entire spectrum and is not susceptible to the ceiling effect. The output should allow for the detection of differences in perspectives between groups of survey respondents (such as students and workplace supervisors) which Likert ratings may be insensitive to. Additional advantages of the pairwise comparisons are their low susceptibility to systematic bias and measurement error, they can be quicker and arguably more engaging to complete than Likert items, and they should carry a low cognitive load for respondents. Methods for evaluating the validity and reliability of this survey design are also described. This paper presents a method that holds great potential for a diverse range of applications in HPE research. In the pursuit quantifying perspectives on survey items which are measured on a relative basis and a unidimensional scale (e.g., importance, priority, probability), this method is likely to be a valuable option

Intrathoracis pressure measurement in horses during exercise: Validation of the wireless equivent 300 device

Low-grade respiratory disease is a potential cause for reduced athletic performance. Increased intrathoracic pressure amplitude (IP) indicates impaired respiratory function but measurements at rest are insensitive diagnostics to abnormally elevated respiratory effort during exercise. A purpose-designed device (Equivent 300) for continuous telemetric measurement of IP during exercise was validated and reference ranges of exercising IP in warmblood horses were established. Twenty healthy Dutch warmblood mares underwent resting IP measurements using a standard method and the Equivent. With the device in place, horses underwent a standardized lunging exercise test (four minutes trot, four minutes canter, five minutes trot, five minutes walk) on four consecutive days. Heart rate and mean IP for each stage and ambient temperature and humidity for each session were recorded. All data were checked for normality and a mixed linear model was used to determine mean IP for each stage and the intraclass correlation coefficient (ICC) of IP for each stage with horse, SET stage, and session as explanatory variables. Reference values were calculated as mean IP±2SD. The device was well tolerated by the horses. There was no significant effect of session day; the ICC for ‘horses was 0.11 and the ICC for ‘stage’ was 0.77. Mean IP was 21.1±4.9 (ref 11.4-30.9), 33.9±7.9 (ref 18.2-49.7), 24.3±5.6 (ref 13.1-35.6) and 10.5±3.1 (ref 4.3-16.6) cm H2O for trot-1, canter, trot-2 and walk respectively. Reliable telemetric exercising IP measurement is possible but swallowing, coughing, head- and neck position, location of the esophageal balloon, G-force associated with locomotion were possible artefact-causing factors

Effect of ionization, bedding, and feeding on air quality in a horse stable

BACKGROUND: Organic dust is associated with Equine asthma. Ionization should reduce airborne dust levels. OBJECTIVES: To determine the effect of ionization of air, type of bedding, and feed on the levels of airborne dust, endotoxin, and fungal colonies in horse stables. ANIMALS: 24 healthy University-owned horses occupied the stables. METHODS: A randomized controlled cross-over study. Four units with 6 stables were equipped with an ionization installation (25 VA, 5000 Volt Direct Current). Horses were kept either on wood shavings and fed haylage (2 units), or on straw and fed dry hay (2 units). Measurements were performed with and without activated ionization, during daytime and nighttime, repeatedly over the course of a week and repeatedly during 4-6 weeks. Statistical analysis was performed using a mixed effect model with Akaike's Information Criterion for model reduction and 95% profile (log) likelihood confidence intervals (CI). RESULTS: Ionization did not alter concentrations of dust, endotoxin, or fungi, fewer. In the units with straw and hay, the concentration of dust, endotoxin, and fungi (difference in logarithmic mean 1.92 (95%CI 1.71-2.12); 2.86 (95%CI 2.59-3.14); 1.75 (95%CI 1.13-2.36)) were significantly higher compared to wood shavings and haylage. CONCLUSIONS AND CLINICAL IMPORTANCE: The installation of a negative air-ionizer in the horse stable did not reduce concentrations of dust, endotoxin, and viable fungal spores. The substantial effect of low dust bedding and feed is confirmed

Intrathoracis pressure measurement in horses during exercise: Validation of the wireless equivent 300 device

Low-grade respiratory disease is a potential cause for reduced athletic performance. Increased intrathoracic pressure amplitude (IP) indicates impaired respiratory function but measurements at rest are insensitive diagnostics to abnormally elevated respiratory effort during exercise. A purpose-designed device (Equivent 300) for continuous telemetric measurement of IP during exercise was validated and reference ranges of exercising IP in warmblood horses were established. Twenty healthy Dutch warmblood mares underwent resting IP measurements using a standard method and the Equivent. With the device in place, horses underwent a standardized lunging exercise test (four minutes trot, four minutes canter, five minutes trot, five minutes walk) on four consecutive days. Heart rate and mean IP for each stage and ambient temperature and humidity for each session were recorded. All data were checked for normality and a mixed linear model was used to determine mean IP for each stage and the intraclass correlation coefficient (ICC) of IP for each stage with horse, SET stage, and session as explanatory variables. Reference values were calculated as mean IP±2SD. The device was well tolerated by the horses. There was no significant effect of session day; the ICC for ‘horses was 0.11 and the ICC for ‘stage’ was 0.77. Mean IP was 21.1±4.9 (ref 11.4-30.9), 33.9±7.9 (ref 18.2-49.7), 24.3±5.6 (ref 13.1-35.6) and 10.5±3.1 (ref 4.3-16.6) cm H2O for trot-1, canter, trot-2 and walk respectively. Reliable telemetric exercising IP measurement is possible but swallowing, coughing, head- and neck position, location of the esophageal balloon, G-force associated with locomotion were possible artefact-causing factors