To compare the clinical interview process, content of the medical dialog, and emotional tone of the veterinarian-client-patient interaction during wellness appointments and appointments related to a ...health problem in companion animal practice.
Cross-sectional descriptive study.
A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets.
For each practitioner, 6 clinical appointments (3 wellness appointments and 3 problem appointments) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes.
Wellness appointments were characterized by a broad discussion of topics, with 50% of data-gathering statements and 27% of client education statements related to the pet's lifestyle activities and social interactions. Wellness appointments included twice as much verbal interaction with the pet as did problem appointments, and the emotional atmosphere of wellness appointments was generally relaxed. There were more social talk, laughter, statements of reassurance, and compliments directed toward the client and pet. In contrast, during problem appointments, 90% of the data gathering and client education focused on biomedical topics. Coders rated veterinarians as hurried during 30 of the 150 (20%) problem appointments; they rated clients as anxious during 39 (26%) problem appointments and as emotionally distressed during 21 (14%).
Results suggested that veterinarian-client-patient communication differed between wellness and problem appointments. Owing to the emphasis on biomedical content during problem appointments, veterinarians may neglect lifestyle and social concerns that could impact patient management and outcomes, such as client satisfaction and adherence to veterinarian recommendations.
Undertaking peripheral intravenous (IV) cannulations and the management of cannulae are associated with the risk of blood leakage or spillage and blood exposure. Open cannulae are the most common ...type of peripheral IV cannulae used in the UK. However, closed cannulae, also known as blood-control cannulae, have the potential to reduce the risk of needlestick injury, blood leakage and blood exposure during cannulation, as well as to increase dwell time and patient comfort. Closed cannulae may also reduce the time taken to perform cannulation. This article explains the differences between open cannulae and closed cannulae. It reviews the current use of open cannulae and the risks of blood exposure and how these can be reduced. The benefits of using closed cannulae are also described.
Clinical empathy is a multi-dimensional concept characterized by four dimensions: (1) affective-the ability to experience patients' or clients' emotions and perspectives, (2) moral-the internal ...motivation to empathize, (3) cognitive-the intellectual ability to identify and comprehend others' perspective and emotions, and (4) behavioral-the ability to convey understanding of those emotions and perspectives back to the patient or client. The Davis Interpersonal Reactivity Index (IRI) was used to examine the affective and cognitive facets of empathy in veterinary practitioners. The IRI consists of four subscales that measure cognitive (perspective taking and fantasy) and affective (emphatic concern and personal distress) components of empathy. Data from a cross-sectional sample of practicing veterinarians (n=434) were collected. Veterinarians' fantasy scores were lowest for those with the most clinical experience. Personal distress scores were highest among new veterinarians and lowest for those with 26 or more years in practice. High levels of personal distress in the early years of practice are concerning for the professional wellness of veterinarians. To combat this trend, the implementation of resilience-building interventions should be considered to support veterinary practitioners.
Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical ...obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.
ObjectivesTo describe the design, development and pilot of a multicomponent intervention aimed at supporting withdrawal of opioids for people with chronic non-malignant pain for future evaluation in ...the Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial.DesignThe I-WOTCH intervention draws on previous literature and collaboration with stakeholders (patient and public involvement). Intervention mapping and development activities of Behaviour Change Taxonomy are described.SettingThe intervention development was conducted by a multidisciplinary team with clinical, academic and service user perspectives. The team had expertise in the development and testing of complex health behaviour interventions, opioid tapering and pain management in primary and secondary care, I.T programming, and software development—to develop an opioid tapering App.ParticipantsThe I-WOTCH trial participants are adults (18 years and over) with chronic non-malignant pain using strong opioids for at least 3 months and on most days in the preceding month.OutcomesA multicomponent self-management support package to help people using opioids for chronic non-malignant pain reduce opioid use.Interventions and resultsReceiving information on the impact of long-term opioid use, and potential adverse effects were highlighted as important facilitators in making the decision to reduce opioids. Case studies of those who have successfully stopped taking opioids were also favoured as a facilitator to reduce opioid use. Barriers included the need for a ‘trade-off to fill the deficit of the effect of the drug’. The final I-WOTCH intervention consists of an 8–10 week programme incorporating: education; problem-solving; motivation; group and one to one tailored planning; reflection and monitoring. A detailed facilitator manual was developed to promote consistent delivery of the intervention across the UK.ConclusionsWe describe the development of an opioid reduction intervention package suitable for testing in the I-WOTCH randomised controlled trial.Trial registration numberISRCTN49470934.
In 1919, in the wake of the upheaval of World War I, a remarkable group of English women came up with their own solution to the world's grief: a new religion. At the heart of the Panacea Society was ...a charismatic and autocratic leader, a vicar's widow named Mabel Bartlrop. Her followers called her Octavia, and they believed that she was the daughter of God, sent to build the New Jerusalem in Bedford.When the last living members of the Panacea Society revealed to historian Jane Shaw their immense and painstakingly preserved archives, she began to reconstruct the story of a close-knit utopian community that grew to include seventy residents, thousands of followers, and an international healing ministry reaching 130,000 people. Shaw offers a detailed portrait of Octavia and describes the faith of her devoted followers who believed they would never die. Vividly told, by turns funny and tragic, Octavia, Daughter of God is about a moment at the advent of modernity, when a generation of newly empowered women tried to re-make Christianity in their own image, offering a fascinating window into the anxieties and hopes of the interwar years.
Abstract Objective To provide communication skills education to veterinary professionals in the practice setting and evaluate the training by measuring veterinarian communication pre- and ...post-intervention. Methods This is a case-based pre-test/post-test intervention study of a veterinary practice in Denver, CO. Four veterinarians from a single practice and 48 clients (selected to represent wellness and problem visits) were recruited to the study. The veterinarians took part in a training intervention consisting of a year-long curriculum, including interactive communication modules, individual coaching and communication laboratories. Six visit interactions were measured for each of the 4 veterinarians pre- and post-skill training. The Roter interaction analysis system (RIAS) was used to analyze the study's 48 videotapes. Results Compared to the pre-training visits, veterinarians gathered twice as much lifestyle-social data ( p < 0.02), and used 1.5 times more partnership building ( p < 0.03) and positive rapport-building ( p < 0.01) communication. Clients provided 1.4 times more lifestyle/social information ( p < 0.02) and expressed 1.7 times more emotional statements ( p < 0.01) in post-training visits. Conclusion The training intervention promoted a more client-centered approach to veterinarian–client communication. Practice implications Practice-based communication training is novel to veterinary practice. As a case study, generalization of the findings are limited, however the findings support the efficacy of the communication intervention and enhanced utilization of veterinarian–client communication skills by these veterinarians.
A diverse range of plant proteases are implicated in pathogen perception and in subsequent signalling and execution of disease resistance. We demonstrate, using protease inhibitors and virus-induced ...gene silencing (VIGS), that the plant papain cysteine protease cathepsin B is required for the disease resistance hypersensitive response (HR). VIGS of cathepsin B prevented programmed cell death (PCD) and compromised disease resistance induced by two distinct non-host bacterial pathogens. It also suppressed the HR triggered by transient co-expression of potato R3a and Phytophthora infestans Avr3a genes. However, VIGS of cathepsin B did not compromise HR following recognition of Cladosporium fulvum AVR4 by tomato Cf-4, indicating that plant PCD can be independent of cathepsin B. The non-host HR to Erwinia amylovora was accompanied by a transient increase in cathepsin B transcript level and enzymatic activity and induction of the HR marker gene Hsr203. VIGS of cathepsin B significantly reduced the induction of Hsr203 following E. amylovora challenge, further demonstrating a role for this protease in PCD. Whereas cathepsin B is often relocalized from the lysosome to the cytosol during animal PCD, plant cathepsin B is secreted into the apoplast, and is activated upon secretion in the absence of pathogen challenge.
It is common knowledge that South Africa (SA) has a particularly high burden of tuberculosis (TB).1 This is reflected not only in the overall high incidence rate of TB, but also in the discrepancy ...between reported global and local rates of extrapulmonary TB (EPTB). Local data report that up to 42% of TB cases are EPTB, compared with the global rate of 15%.1,2 The local rate of pleural TB alone has been reported to be as high as 30%.3 While this is unsurprising in light of our high incidence of HIV coinfection, it does mean that we have to deal with a far higher burden of pleural TB than our colleagues in low-incidence regions. In fact, using international best estimates of TB burden, at a rate of 30%, SA would have had 96 600 cases of pleural TB in 2017. Yet the diagnosis of this common condition often still proves elusive. By its very nature, the TB pleural effusion is unlikely to have a high load of organisms.
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