In Practice Last 6 Issues

Surgical diseases of the genital tract in male dogs 1. Scrotum, testes and epididymides

de la Puerta, B., Baines, S. — 2012-02-13T06:11:40-08:00

While castration is the most common surgery carried out on the genitals of male dogs in first-opinion practice, there are several other, less common, surgical procedures that are performed to treat various conditions affecting the male reproductive tract. This article discusses the surgical diseases and treatment of the scrotum, testes and epididymides of dogs. A second article, to be published in the March issue of In Practice, will cover the surgical techniques used to manage disorders of the penis and prepuce.

Abdominal ultrasonography as an adjunct to clinical examination 2. Cattle

Scott, P. — 2012-02-13T06:11:40-08:00

This article, the second of two discussing the use of abdominal ultrasonography as an adjunct to a thorough clinical examination in farm animal practice, describes ultrasonographic findings that might be visualised in the abdomen of cattle, with particular focus on the common problems encountered in the species. Part 1, published in the January issue of In Practice (volume 34, pages 12–21), considered ultrasonography of the abdomen in small ruminants.

Muscle and tendon disorders in small animals 2. Conditions affecting the hindlimb and digital flexor tendons

Moores, A. — 2012-02-13T06:11:40-08:00

A wide range of muscle and tendon conditions are seen in small animals. An article in the January issue of In Practice (volume 34, pages 22–26) reviewed some general aspects of managing tendon and muscle disorders together with conditions affecting the forelimb. This article describes conditions affecting the hindlimb as well as digital flexor tendon injuries that affect both the fore- and hindlimbs.

A modern approach to equine dentistry 2. Identifying lesions

Tremaine, H., Casey, M. — 2012-02-13T06:11:40-08:00

This article, the second in a series of four to review recent developments equine dentistry, describes the common dental and oral lesions that may be seen during a routine dental examination in horses, the procedure for which was published in the January issue of In Practice (volume 34, pages 2 to 10). Part 3, to be published in the March issue, will consider how these lesions may be investigated further using appropriate imaging techniques, while Part 4, to be published in the April issue, will consider the techniques available for the prevention and treatment of equine dental disease.

Gastrointestinal disease in rabbits 1. Gastric diseases

Lord, B. — 2012-02-13T06:11:40-08:00

Gastrointestinal diseases in rabbits are being recognised with increasing frequency. A pet rabbit presented with anorexia, weight loss, changes in defecation and depression can present a diagnostic and therapeutic challenge for the clinician. Diet- and stress-related problems predominate, and preventive treatment plays a large role in managing these conditions. However, gastric ulceration and bacterial, viral, parasitic, idiopathic and neoplastic diseases are also seen frequently in pet rabbits. This article provides an overview of the common gastric conditions seen in rabbits, including their diagnosis and the options for treatment. The common causes, diagnosis and approach to the management of intestinal diseases will be discussed in an article to be published in the March issue of In Practice.

Laying your cards on the consulting table

Everitt, S. — 2012-02-13T06:11:41-08:00

Consultations are central to veterinary practice. They allow the veterinary surgeon to discuss options with the client to establish what is in the best interests of the animal patient. This requires effective communication through openness, transparency and an evidence-based approach. In this article, Sally Everitt describes some of the techniques that can be used during consultations to achieve the best results for all involved.

Trouble with snow: preparing your vehicle for winter conditions

Richards, I. — 2012-02-13T06:11:41-08:00

Snow may be an opportunity for many people to have some fun, but it represents quite a different prospect for anyone who has to work in it. Practice managers have a duty to ensure that their staff remain safe when they are on farm visits or house calls. In this article, Iain Richards describes the hazards associated with bad weather and recommends some useful equipment to keep in the boot of your vehicle in case problems arise.

Branching out: a guide to practice expansion

Terry, J. — 2012-02-13T06:11:41-08:00

The extension of practice services through the development of a branch network can boost practice profits significantly. Conversely, it can also be a considerable drain on the resources of an otherwise profitable business. Getting it right requires a strategic approach that is planned and executed carefully to minimise loss and to optimise profitability. Jane Terry describes some factors to consider.

Shortcomings in locum practice procedures

Green, R. — 2012-02-13T06:11:41-08:00

While working as a short-term locum, a client asks for a repeat prescription for acepromazine tablets for a dog in the run up to bonfire night. You know that it is not the ideal treatment from a behavioural point of view, but other clients' records show that acepromazine is widely prescribed by the practice for firework phobias. It would be difficult to refuse the repeat prescription without upsetting the client and the practice, and it seems unfair to cause problems for this particular client when she could come in a week later and be given the tablets without any hassle. As a short-term locum, you feel that it is important to fit in with normal practice procedures as much as possible, and the RCVS requires you not to criticise colleagues. However, your client is likely to know other clients who are being prescribed acepromazine tablets by the practice at the same time as you are refusing to prescribe them. With this in mind, if you refuse to prescribe the tablets, how should you explain to the client that they're not an appropriate treatment?

Comments on the dilemma in the January issue: 'Promoting personal views in practice'

Mullan, S. — 2012-02-13T06:11:41-08:00

The dilemma in the January issue questioned whether it was ethical for a practice owner to provide literature in the practice waiting room sympathetic to their own personal views on farm animal welfare issues (In Practice, January 2012, volume 34, page 54). While promoting animal welfare was admirable, the question of whether it was morally or professionally acceptable to promote personal views to clients on which animal-derived products to reject was less clear. Paul Roger commented that it was fine for practice owners to promote what they saw as beneficial practices as long as no negative pressure was put on the alternative view. In fact, they had a duty to publicise their stance, while ensuring that the information they provided was accurate and reviewed regularly. This would help to maintain the focus of the public on important animal welfare issues, leading to an improvement in standards. A possible way forward was to consider using an ethical framework to help inform views on different farming methods and to evaluate each method based on how well they applied the Five Freedoms concept.

A practitioner ponders

2012-02-13T06:11:41-08:00

It's time for me to get a new wallet. Not, regretfully, because the old one is so full of money that it can hold no more, but rather because the current one is crammed with all sorts of detritus and is basically worn out. It's stuffed full of faded till receipts, long-forgotten shopping lists, dog-eared business cards, and the all-essential credit and debit cards, with the odd wrinkled five-pound note hidden among it all. It's done the job but can do no more. On closer inspection, I realise that it bulges for one reason more than any other – because I have so many so-called loyalty cards in it.

Are these a curse or a blessing of the 21st century? I have loyalty cards for hotels, coffee bars, supermarkets, petrol stations and clothing shops, and not just one but several for each type of business. If I stop for...

A modern approach to equine dentistry 1. Oral examination

Tremaine, H., Casey, M. — 2012-01-11T08:21:53-08:00

Recent developments in our understanding of dental anatomy, pathology and the effects of specific dental techniques have advanced the current status of equine dental care. This article, the first in a series of four to review these developments, describes how to carry out a thorough oral examination in horses. Subsequent articles, to be published in consecutive issues of In Practice from February to April, will describe the different lesions that might be seen in equine patients (Part 2) and how these might be investigated further using appropriate imaging techniques (Part 3). Part 4 will consider the techniques available for the prevention and treatment of equine dental disease.

Abdominal ultrasonography as an adjunct to clinical examination 1. Small ruminants

Scott, P. — 2012-01-11T08:21:53-08:00

Abdominal ultrasonography is a diagnostic technique that can be used in farm animal practice as a complementary adjunct to a thorough clinical examination. This article describes the ultrasonographic findings that can be visualised in the abdomen of small ruminants and outlines some of the common indications for ultrasonography. It illustrates how this modality can be readily incorporated into a clinical examination on farm to provide an accurate demonstration of underlying pathology. A second article, to be published in the February issue of In Practice, will discuss the use of abdominal ultrasonography in cattle.

Muscle and tendon disorders in small animals 1. General management and conditions affecting the forelimb

Moores, A. — 2012-01-11T08:21:53-08:00

Muscle and tendon injuries and diseases are common causes of lameness in dogs and occasional causes of lameness in cats. This article reviews the general management of these disorders and provides an overview of specific conditions affecting the forelimb (thoracic limb). A second article, to be published in the February issue of In Practice, will consider conditions affecting the hindlimb (pelvic limb) and digital flexor tendon injuries.

Management of tail pull injuries in cats

Davies, E., Walmsley, G. — 2012-01-11T08:21:53-08:00

Feline tail pull injury is a challenging condition that is commonly encountered in first-opinion practice. This article discusses the key factors in the diagnosis, prognosis and management of tail pull injuries, including the use of radiography to confirm sacrocaudal luxation, and the identification and appropriate treatment of associated urinary and faecal dysfunction. It also highlights the importance of good owner communication, as currently the best prognostic indicators at the time of presentation for the return of continence (the conscious perception of noxious stimuli applied to the perineum or tail base) are not infallible and recovery can take weeks.

Anaesthesia and analgesia in chinchillas

Saunders, R., Harvey, L. — 2012-01-11T08:21:53-08:00

Chinchillas are becoming increasingly popular as pets, and so are being presented more often for veterinary care. The most common indications for anaesthesia of chinchillas include the diagnosis and treatment of dental disease, neutering, caesarean section, fracture repair and the collection of diagnostic samples. For successful anaesthesia of chinchillas, an understanding of their particular anatomy and physiology, and a sound knowledge of anaesthesia, is important. This article discusses the perianaesthetic and anaesthetic management of these animals.

Minimum monitoring for financial health

Gripper, P. — 2012-01-11T08:21:53-08:00

Maintaining financial success is important for every business, and a good manager should track its performance at a number of levels. These parameters may be interlinked and complex, so it is vital to be able to interpret the data collected. In this article, Peter Gripper describes some useful measures of financial performance and explains the importance of internal and external benchmarks.

Embracing the social media revolution

Samuel, S. — 2012-01-11T08:21:53-08:00

Over recent years, the use of social media has increased dramatically. If your veterinary practice chooses not to engage itself with the online community, it is missing a valuable opportunity to encourage recommendations, increase footfall and cement bonds with existing clients. Here, Susie Samuel describes how to set up profiles with some of the most popular social media platforms to facilitate practice marketing.

Keeping it legal: delegation to veterinary nurses

Branscombe, L. — 2012-01-11T08:21:53-08:00

Last year marked the 50th anniversary of veterinary nursing and, with non-statutory regulation of the profession being sought by the majority of its members, it is timely to consider the veterinary nurse's role. In this article, Liz Branscombe explains the procedures that can legally be delegated to veterinary nurses within the veterinary practice, as covered by Schedule 3 of the Veterinary Surgeons Act 1966.

Promoting personal views in practice

Roger, P. — 2012-01-11T08:21:53-08:00

You own a successful small animal practice and have a good relationship with your clients. You are also keen to do what you can to promote all aspects of animal welfare. Your knowledge of farm animal welfare issues leads you to reject certain animal-derived products when buying for yourself. Is it morally or professionally ethical for you to provide literature sympathetic to your viewpoint about farm animal welfare issues in your waiting room?

Comments on the dilemma in the November/December issue: 'Owner access to isolation facility webcam images'

Hopper, D. — 2012-01-11T08:21:53-08:00

The dilemma in the November/December issue concerned a practice that had recently installed webcams to monitor its patients in an isolation facility where human and animal contact had to be kept to a minimum (In Practice, November/December 2011, volume 33, pages 558–559). Susana Silva discussed the issue of whether or not owners should be allowed access to such images. She argued that the relationship between humans and their animals had changed greatly over the past few decades and that, now, they were usually regarded as family members. As such, people tended to be very concerned about the welfare and quality of life of their pet when it was in an isolation facility. It was good practice to discuss with the owners what type of care was going to be provided so as not to give them false expectations, and to allow them to visit the facility before their pet was admitted. Allowing owners to view video footage of their pet in isolation could have variable outcomes. Some would feel reassured while others might become anxious about their pet's altered behaviour or about protocols that might be in place to keep human contact with the animal to a minimum. A compromise might be to allow the owner to see a short video of a couple of minutes per day, rather than a live stream, thus allowing the vet to decide which footage was most appropriate for which client. Although partial access had the potential for the owner to accuse the vet of censoring, vets were not currently legally obliged to allow access to such images.

A practitioner ponders

2012-01-11T08:21:53-08:00

I've been thinking lately about customer service.

I'll give a couple of examples. There is a very small Italian restaurant in London that I go to three or four times a year. The food is perfectly good though nothing outstanding, but the patron always recognises me and greets me like a long-lost cousin. Nearby, in a London club, a young maître d’ used to insult his guests with such cheerfulness as to charm them and never troubled them for their room number for the bill; instead, he memorised their faces and kept print outs showing who was staying in which room. In both instances, the chef might think that customers are buying his food, but we are actually buying customer service – the atmosphere created by the front-of-house people. What can we learn from this and apply in our surgeries?

Complaint handling is another area that we all know...

Diagnostic testing for the detection of feline retroviruses

Adam, F., Dandrieux, J. — 2011-12-21T04:02:10-08:00

Since the discovery of feline leukaemia virus (FeLV) in 1964 and feline immunodeficiency virus (FIV) in 1986, knowledge of viral epidemiology and disease pathogenesis has developed greatly. Diagnostic tests demonstrating antigen, whole virus and the presence of virus-specific antibody titres have allowed the identification of retrovirus-infected cats. More recently, molecular testing methods have been developed for use in the diagnosis of FIV and FeLV. This article discusses the commercial diagnostic tests available for the detection of these viruses and outlines how such tests may be applied in clinical practice.

Welfare assessment in sheep

Goddard, P. — 2011-12-21T04:02:10-08:00

Protocols for the assessment of welfare in sheep are not as well developed or validated as in other livestock species. However, it is possible to use a number of animal- and resource-based measures to indicate the standard of animal welfare in sheep flocks. This article considers the potential indices that can be implemented when assessing welfare in sheep, and reflects on what difference this might make to the animals themselves. In addition, it highlights how these might be tailored to individual production units in order to make them more relevant and, hence, maximise welfare.

Investigation of pelvic problems in horses

Powell, S. — 2011-12-21T04:02:10-08:00

Despite the advanced diagnostic techniques that are currently available, diagnosing equine pelvic injuries and pain can be challenging for even the most experienced equine diagnostician. Due in part to its size and complexity, the equine pelvis is rather daunting to investigate as a site of pain. Localising diagnostic anaesthesia – required for the assessment of pelvic and thoracic limbs in horses – is restricted in the back and pelvis, leading to a degree of subjective assessment, which is obviously not ideal. The introduction of scintigraphic imaging has revolutionised the diagnostic potential of bone injuries of the pelvis but has contributed to a far lesser degree to the understanding of soft tissue pain. This article describes an approach to the investigation of pelvic pain in horses and outlines a number of pathological conditions that can be encountered.

Pleural effusions in dogs and cats 2. Placement of tubes and treatment

Murphy, K., Papasouliotis, K. — 2011-12-21T04:02:10-08:00

It is not uncommon for dogs and cats to present with a pleural effusion, which often requires emergency management involving the placement of a thoracic drain. This article describes a step-by-step guide to placing traditional wide-bore tubes and small-bore drains in practice. It also focuses on the general management of specific conditions that can cause pleural effusions. The diagnostic investigation of dogs and cats with pleural effusions was discussed in an article published in the October issue of In Practice (volume 33, pp 462–469).

Veterinary care of snakes

Rowland, M. — 2011-12-21T04:02:10-08:00

Snakes are becoming increasingly popular pets and are hence seen more frequently in general veterinary practice. It is therefore important that clinicians have a working understanding of the species presented, as well as the steps required to accurately diagnose and manage health issues. This article reviews the commonly presented species and outlines the husbandry requirements of each. In addition, it discusses the unique anatomy and physiology of snakes and highlights commonly seen conditions, their diagnosis and treatment.

Oestrus detection in dairy cattle

Gordon, P. — 2011-12-21T04:02:10-08:00

Achieving reproductive targets in artificially inseminated cattle herds relies on oestrus (heat) detection, which can be identified directly and indirectly from behavioural changes in cows. Increased herd size and reduced oestrus expression have been linked to suboptimal detection. This article reviews current knowledge of oestrus detection and highlights the opportunities for veterinary surgeons to become further involved in its management through training, monitoring and the identification of appropriate aids for oestrus detection.

Back to black: a five-point plan to boost practice profits

Wright, M. — 2011-12-21T04:02:10-08:00

With rising costs, reducing client numbers and increasing competition, the current economic climate is making it more and more difficult for veterinary practices to stay in the black. In this article, Malcolm Wright describes a five-point plan to improve practice performance and management, and help boost practice profits.

Media training for vets in the limelight

Walter, D. — 2011-12-21T04:02:10-08:00

The phrase ‘prevention is better than cure’ crops up frequently in the veterinary world and, when it comes to media appearances, it is far better to be prepared in advance than to have to repair the damage caused by a bad interview. In this article, David Walter explains how a short course in media training could prepare vets for defending the profession against criticism and might even present an opportunity for them to promote it proactively.

In the director's chair: understanding your responsibilities

Miller, J. — 2011-12-21T04:02:10-08:00

A director's responsibility is to manage a company's resources to deliver profitability. This requires specific personality traits, continuous learning and an understanding of the legislation governing employment and directorship. In this article, Julie Miller describes the role of limited company directors, including their responsibilities as both employers and employees.

Owner access to isolation facility webcam images

Silva, S. — 2011-12-21T04:02:11-08:00

You have recently installed webcams to monitor your patients in an isolation facility where human and animal contact must be kept to a minimum. It would be technically possible to allow owners to have access to the webcam images. Would this be a good thing to do?

Comments on the dilemma in the October issue: 'Mammary mass in an overweight dog'

Mullan, S. — 2011-12-21T04:02:11-08:00

The dilemma in the October issue concerned an overweight labrador with a mammary mass (In Practice, October 2011, volume 33, pages 493–494), which required biopsy and removal of the mass. However, when the client was advised that the dog would need to lose weight before surgery, they become aggressive, said ‘the dog is on a diet and the weight problem is under control’ and refused to discuss attending weight clinics or changing the animal's food. Practice records showed that the client had previously taken the dog to two weight loss clinics and, at the last visit, it had weighed 27 kg. It was now 33 kg. Rachel Casey commented that there were three options for dealing with this scenario: to ignore the problem until the client returned; to report the owner to the RSPCA; or to contact the owner and try to convince them to reconsider weight loss options. By not taking action, the weight issue would probably not be addressed by the owner and the mass would inevitably grow bigger over time, resulting in a decline in the dog's welfare, while reporting the client to the RSPCA might breach client confidentiality. Consideration also needed to be given to whether the welfare of the dog would be better in kennels or with its owner. She suggested that the best option was to contact the owner and to take the time to consider why the owner was reluctant to address the dog's weight problem. In addition, focusing on the mass and the requirement for surgery rather than the weight of the animal, or suggesting alternative weight-loss options, such as a balanced home-made diet, might achieve good welfare outcomes for the dog.

A practitioner ponders

2011-12-21T04:02:11-08:00

The current emphasis on evidence-based veterinary practice in veterinary schools and journals is very necessary, but an unacknowledged victim of this progress is the humble case report. I thought it was just my imagination, until a friend sent me an editorial from the recently launched Journal of Medical Case Reports, which stated that ‘case reports have become a casualty of the pursuit of the impact factor’ (Kidd and Hubbard 2007).

In other words, case reports have low citation value and may therefore negatively affect a journal's impact factor – so it is no surprise that the prevalence of case reports in high-impact journals is decreasing.

Don't get me wrong – large studies are critically important to the future of veterinary medicine. Systematic reviews and meta-analyses, particularly in human medicine but increasingly in the veterinary field, have demonstrated that some treatments that we have relied upon for decades...

Encephalitozoonosis in rabbits - what we do and don't know

Keeble, E. — 2011-10-21T02:21:18-07:00

Encephalitozoon cuniculi infection is commonly diagnosed in pet rabbits and has been recognised for some time in farm and laboratory rabbits. It is an opportunistic pathogen of humans causing disease in immunosuppressed HIV-positive patients and many other animal species, but the primary host is the rabbit where subclinical infections are common. While there is a wealth of literature on this disease in laboratory rabbits, much is still unknown about the disease in pet rabbits. Findings are often confusing and, in some instances, conflicting, making interpretation difficult, particularly with regard to the diagnosis and treatment of the disease. This article clarifies what we do and don't know about E cuniculi infection, focusing on diagnostic and treatment options. It also summarises recent developments and research into this disease, which may aid in the diagnosis of encephalitozoonosis in pet rabbits.

Postoperative management of gastrointestinal cases: 2. Ongoing requirements and monitoring

Charlesworth, T. — 2011-10-21T02:21:18-07:00

An article in the September issue of In Practice (volume 33, pp 374–378) reviewed the normal physiology and healing of the gastrointestinal tract in small animals after undergoing surgery, and discussed the options for providing analgesia and intravenous fluid support in these patients. This article discusses the nutritional requirements and use of antibiotics in animals recovering from gastrointestinal surgery, and explains how to monitor for and diagnose the most common postoperative complications to maximise the chances of a successful outcome.

DNA testing in companion animals - what is it and why do it?

Mellersh, C., Sargan, D. — 2011-10-21T02:21:18-07:00

Since the sequencing of the canine genome was completed in 2004, many mutations responsible for inherited disease in dogs have been identified. This, in turn, has led to the development of DNA tests for a wide range of inherited traits in dogs, and tests for genetic diseases in other companion species are also becoming available. With increasing emphasis being placed on improving the health of purebred dogs, DNA testing is likely to be an important tool for breeders to help them make the best breeding selections and, ultimately, eliminate inherited conditions. This article explains the principles of DNA testing and highlights the tests that are currently available commercially. While the article focuses on DNA testing in dogs, and provides an overview of the current situation in cats, the principles discussed are applicable to any species.

Diagnosis and investigation of fluorosis in livestock and horses

Livesey, C., Payne, J. — 2011-10-21T02:21:18-07:00

Fluorosis (fluoride ion poisoning) can affect all mammals and birds. Acute fluorosis is rare in the UK. Mild dental fluorosis is probably quite common but will not affect production. Severe dental fluorosis and skeletal fluorosis (which requires longer-term exposure than dental fluorosis) occur close to fluorine-emitting industries. Fluorosis should be included in the differential diagnosis of dental conditions, lameness and skeletal abnormalities. Background sources of fluorides include soil, feed crops, superphosphate fertilisers and phosphate feed supplements. UK environmental hot spots include natural mineral deposits and areas close to fluorine-emitting industries. Volcanic ash also contains fluorides and small quantities of volcanic ash grounded in the UK following recent eruptions in Iceland, but monitoring in the UK confirmed that fluoride levels in grass remained within the expected background range. This article describes acute and chronic fluorosis, and discusses how to assess and manage the associated risks.

Pleural effusions in dogs and cats: 1. Diagnostic investigation

Murphy, K., Papasouliotis, K. — 2011-10-21T02:21:18-07:00

Pleural effusions in dogs and cats can be caused by various diseases, but the basic approach to diagnosis and management is similar in all patients. Affected animals can be very fragile, so careful handling and confidence in the emergency management of such cases is vital. This article, the first of two discussing pleural effusions in small animals, describes the diagnostic approach to animals presenting with respiratory distress due to a pleural effusion. Part 2, to be published in the November/December issue of In Practice, will discuss the placement of thoracic drains/thoracostomy tubes and the management of specific types of pleural effusion.

Diagnosis, treatment and control of left displaced abomasum in cattle

Mueller, K. — 2011-10-21T02:21:19-07:00

Left displaced abomasum remains an important disease in dairy cows during the early postpartum period. The condition is multifactorial in nature, so it is important to carry out a thorough clinical examination and consider the influence of concurrent disease on management. This article outlines the clinical findings that aid diagnosis, and describes the treatment options available and the relative merits of each. In addition, it reviews the potential risk factors that might be involved and highlights some predictive indicators cited in the literature that may find practical application in the future.

Legal considerations for limited companies

Openshaw, N. — 2011-10-21T02:21:19-07:00

A limited company is one in which its members invest. Should the business fail, its officers and shareholders have limited liability, in contrast with sole traders or other non-limited businesses, where their owners risk losing personal assets. Before 1998, the Royal College of Veterinary Surgeons (RCVS) did not permit the ownership or running of veterinary practices by limited companies and almost all practices operated as sole traders or partnerships. Since the RCVS modified its position, a considerable number of practices have ‘converted’ to limited company status or new practices have been set up as companies, and others have been taken over by ‘corporate’ owners. In this article, Nick Openshaw explains the legal relationships between the owners of veterinary practices run by a limited company compared with those run by a partnership. In particular, he looks at the role of the Shareholders Agreement in regulating matters relating to the running of limited businesses.

Good website design - not just a pretty face

Taylor, A. — 2011-10-21T02:21:19-07:00

As internet use increases and clients become accustomed to visiting increasingly impressive websites, it is now more important than ever that the practice website boasts an excellent design. Here, Angela Taylor suggests ways to ensure that the practice website is effective at meeting the needs of clients.

The balanced scorecard - a tool for improving practice performance

Coates, C. — 2011-10-21T02:21:19-07:00

The balanced scorecard (BSC) is a management tool designed to improve the productivity of businesses. Developed in 1992 by Kaplan and Norton, it involves setting measurable objectives relating to customers, finances, internal processes, and innovation and learning. As these four areas are interlinked, improvements in one perspective should have a positive effect on the rest, as well as contributing to the achievement of the overall vision of the business. The BSC has proved popular with the large commercial organisations for which it was originally developed and has been used widely within diverse industry sectors. However, its application in small and medium enterprises has been limited, and there is little documented evidence to demonstrate its effectiveness in smaller businesses, and none for its application in veterinary practice. Here, Catherine Coates describes the concept of the BSC and uses a hypothetical veterinary practice to illustrate how it might be applied in veterinary practice.

Mammary mass in an overweight dog

Casey, R. — 2011-10-21T02:21:19-07:00

A client brings in a nine-year-old female neutered labrador to ask your advice about a mammary mass. The mass is relatively small and well defined, and you consider it of value to biopsy and/or remove it. However, the dog is 33 kg (ideal weight 15 to 16 kg), struggles to walk and pants after coming from the car park to the waiting room. Looking at previous records, you see that the owner has not visited the practice for several months. At the last visit, they had been to two weight loss clinics and the dog's weight was 27 kg. A note on the record suggests that the owner was reluctant to follow the advice given or to change the dog's food from the working dog diet it was on, and could not afford a prescription diet. When you mention the weight problem and the need for the dog to lose weight before surgery is considered, the client becomes aggressive, tells you ‘the dog is on a diet and the weight problem is under control’ and refuses to discuss attending weight clinics again or changing food. You feel that the welfare of the dog is compromised, and mention this to the client, who becomes angrier and storms out of the practice.

Comments on the dilemma in the September issue: 'Irresponsible dog ownership'

Stevenson, M. — 2011-10-21T02:21:19-07:00

The dilemma in the September issue concerned neighbours who owned two beagles and housed them in a purpose-built compound (In Practice, September 2011, volume 33, page 422). The owners worked long days and were often away at weekends. A paid dog walker exercised the dogs for 50 minutes a day during the week, but after being walked the dogs bayed periodically throughout the day. The dogs were not walked at the weekend but were allowed to run around a terraced garage roof. Paul Roger commented that this problem exemplified the lack of forethought and planning taken by many people when they decided to become dog owners. Rather than choosing a dog based on aesthetics, potential owners needed to think about breed characteristics and whether they would be able to provide the five freedoms in their home environment. In this case, the dogs had limited exercise and might also have experienced fear and discomfort when confined within the compound. These conditions contravened guidelines published by the Companion Animal Welfare Council in its Code of Practice for the Welfare of Dogs. While a breach in these provisions was not a legal offence in itself, it could be used to demonstrate failure to comply with the current regulations listed under Section 9 of the Animal Welfare Act 2006. Complaints made to the appropriate authorities could result in an investigation by the police or an appropriately appointed inspector, who might choose to involve a local veterinary surgeon. The RSPCA might also investigate complaints in a private capacity. A person suspected of failing to comply with the Act would be handed an improvement notice; failure to comply with this would result in prosecution and could lead to seizure and rehoming of the animals.

Further comment on the dilemma in the July/August issue: 'Regulation breach on farm'

Hall, S. — 2011-10-21T02:21:19-07:00

The dilemma in the July/August issue, discussed by Mike Steele, concerned a pregnant suckler cow with an infected, ulcerated growth on its third eyelid that was provisionally diagnosed as squamous cell carcinoma. The farmer client insisted on palliative treatment despite the vet recommending removal of the mass as the best course of action. In addition, several untagged dead calves and two dead sheep were observed in a ditch at the entrance to the farmer's land (In Practice, July/August 2011, volume 33, page 362).

A practitioner ponders

2011-10-21T02:21:19-07:00

I look forward to the day when I can tell my grandchildren that I was present at a moment of veterinary history in the making: the very first graduation from Nottingham Veterinary School on July 22 this year. My offspring will doubtless sit spellbound as I recount the significance of that day in the annals of veterinary history and the juxtaposition of so many anniversaries of veterinary significance. On the very same date 25 years previously, the justifiably proud first dean of the Nottingham school had himself graduated from the Royal Veterinary College. This year also marks the 50th anniversary of the opening of Cambridge Veterinary School and, as if two such prestigious anniversaries are not enough, 2011 marks the 250th anniversary of the opening of the very first European veterinary school in Lyon.

Many in the profession have watched the development of the new veterinary school with great...

Role of the veterinary surgeon in managing the impact of dairy farming on the environment

Green, M., Husband, J., Huxley, J., Statham, J. — 2011-08-31T06:33:06-07:00

With increasing concerns surrounding the causes and consequences of climate change, the impact of agriculture on the environment has come under intense scrutiny. For example, it is claimed that the livestock sector produces 18 per cent of all worldwide greenhouse gas emissions (measured in carbon dioxide equivalents), which, on a global basis, equates to more than all means of transport. It is therefore important to consider changes to farming systems and management methods that could reduce negative environmental effects. It is likely that pressure will mount on agriculture to proportionally reduce its emissions in line with other industries in order to meet government targets on greenhouse gas emissions. However, controversy remains over which farming methods result in the best environmental outcomes and there are also potential areas of conflict between environmental issues and animal health/welfare considerations or perceptions. This article considers the role of the veterinary surgeon in mitigating some of the potentially harmful effects of dairy farming on the environment.

Postoperative management of gastrointestinal cases: 1. Physiology and initial stabilisation

Charlesworth, T. — 2011-08-31T06:33:06-07:00

Small animals that have undergone surgery of the gastrointestinal tract can all too easily deteriorate and succumb to potentially devastating complications if their postoperative care is inadequate. Veterinary surgeons therefore need to pay just as much attention to the postoperative phase of patient management as to the preoperative and intraoperative phases. This article describes the normal physiology and healing of the gastrointestinal tract, and discusses the provision of analgesia and intravenous fluid support for patients following gastrointestinal surgery. A second article, to be published in the October issue of In Practice, will outline the nutritional requirements of these animals, and consider the appropriate use of antibiotics as well as the need for active monitoring for postoperative complications.

Diagnosis and management of osteoarthritis in cats

Godfrey, D. — 2011-08-31T06:33:06-07:00

Osteoarthritis is one of the most significant conditions affecting older cats and can be difficult to diagnose. Inactivity is a common sign but owners often do not recognise this as a clinical issue and many older cats have a sedentary lifestyle anyway. Treatment can be very effective in relieving the pain associated with this condition and improving an animal's quality of life. This article describes the general approach to osteoarthritis in cats and discusses some options for management.

Critical care of the rabbit

Hedley, J. — 2011-08-31T06:33:06-07:00

Although rabbits are an increasingly popular household pet, they still retain their wild instincts. From the veterinary surgeon's point of view, the most important of these is the tendency of rabbits to hide signs of illness – critical for the survival of a prey species, but unhelpful in a consulting room. Consequently, any rabbit noticed as being ‘sick’ by an owner is often a much more critical patient than a dog or cat with similar problems. This article describes the steps that must be taken when a critically ill rabbit is presented for treatment, and provides some examples of the type of emergency cases that might be seen.

Causes and management of complications in wound healing

Demetriou, J., Stein, S. — 2011-08-31T06:33:06-07:00

Although most wound complications are not life-threatening, they can involve prolonged periods of discomfort for the animal and extended veterinary care, as well as increased costs for owners. However, with the appropriate treatment, most wound complications can be managed successfully. This article describes what might be expected of a normal healing wound, and discusses the common causes of complications in small animals and how these can be managed.

Practical assessment of blood smears in dogs and cats

Wilson, R. — 2011-08-31T06:33:06-07:00

Complete blood count (CBC) or haematological analysis is an integral part of the diagnostic work-up in dogs and cats, and involves assessment of a freshly prepared blood smear (also known as a blood film). Despite the widespread availability of automated analysers, the value of a basic blood smear should not be forgotten and should be incorporated into routine blood testing in clinical practice. This article describes a step-by-step approach to blood smear evaluation, which is simple, inexpensive and quick to perform.

Ins and outs of implementing a pet health plan

Goulding, J. — 2011-08-31T06:33:06-07:00

The number of pet health plans delivered by veterinary surgeons has increased significantly over the past 10 years in both small animal and equine practice. They offer many benefits for both the client and the practice, but require careful planning if they are to be implemented successfully. In this article, John Goulding provides an overview of the benefits and difficulties associated with setting up and running a health plan, and describes some of the common models available.

Customer focus: understanding client needs and motivations

Lowndes, P. — 2011-08-31T06:33:06-07:00

Although it is difficult to second guess why people do things, it is possible to model why they do them and then use this to make sure that your practice is best placed to attract and retain clientele. In this article, Philip Lowndes describes a simple model comprising six motivations that are exhibited by people to differing degrees that can be used to attract customers to your practice.

Digital signage for the practice waiting room

Barrand, K. — 2011-08-31T06:33:06-07:00

Digital signage is a form of dynamic communication that generally comprises replaying digital media as slideshows and short films on digital display screens such as TVs, touch screens or projectors in public venues. It can be used for advertising, education or to provide information and, nowadays, is seen everywhere – from estate agents' windows to doctors' surgeries to shopping centres. This has been driven primarily by the falling price of digital screens. In this article, Keith Barrand describes the practical aspects of setting up and running simple digital signage in the practice waiting room, and suggests how to make your content relevant, lively and interesting.

Irresponsible dog ownership

Roger, P. — 2011-08-31T06:33:06-07:00

Your neighbours buy two beagles and house them in a purpose-built compound. During the week, both occupants leave for work early and return in the evening, and they are often away at weekends. A paid dog walker exercises the dogs for about 50 minutes a day during the week and spends a further 10 minutes feeding them and cleaning up. Before and after being walked, the dogs bay periodically throughout the day, which is starting to get on your nerves. At weekends the dogs are not walked, but they are allowed to run around a terraced garage roof. How should you proceed?

Comments on the dilemma in the July/August issue: 'Regulation breach on farm'

Mullan, S. — 2011-08-31T06:33:06-07:00

The dilemma in the July/August issue concerned a farmer client requesting a veterinary examination of a pregnant suckler cow (In Practice, July/August 2011, volume 33, page 362). Examination revealed an infected, ulcerated growth on its third eyelid that was provisionally diagnosed as squamous cell carcinoma. The farmer was advised that removal of the mass under local anaesthetic was the best course of action, but that by the time the cow had calved and reared its calf, the growth would probably have returned and culling would then be recommended. The client insisted on palliative treatment with a time limit, without removal of the mass, but a courtesy visit one week later revealed that the cow was showing signs of pain as a result of the growth. In addition, several untagged dead calves and two dead sheep were observed in a ditch at the entrance to the farmer's land. Mike Steele commented that it was the vet's role to remind the farmer immediately of his responsibilities to both the cow's welfare and the dead animals. A solution for the suckler cow may have been to cull it only if early signs of regrowth revealed themselves after removal of the mass, potentially allowing the animal to live longer. The dead animals were ultimately the farmer's responsibility, irrespective of whether they belonged to him, because they were on his land. The fact that they were not tagged may have contravened the Rural Payment Agency's tagging rules, depending on the calves' ages, and dumping of carcases in watercourses would be treated very seriously by the authorities. However, the vet should question the farmer on why the animals were dumped, to identify potential underlying problems such as a lack of finances to send them to the knacker (implying an inability to care for the animals properly), or a disease outbreak that needed addressing.

A veterinary student ponders

2011-08-31T06:33:06-07:00

As fifth-year vet students, we've attended analgesia lectures. We've also acquired skills through practical classes, helped administer analgesics during clinical EMS, studied our course notes and even passed an exam. But do we know what we need to know to be good vets?

I experienced my first general anaesthetic a few months ago as I underwent a bilateral tonsillectomy. The anaesthetist gave me a pre-anaesthetic health check and, when he discovered that I was a vet student, started talking about the drugs he would use for anaesthesia and analgesia. I recognised the names – fentanyl, propofol and isoflurane, followed by tramadol, paracetamol and ibuprofen for postoperative pain relief – so I felt pretty confident that I knew what to expect. I was wrong.

The experience opened my eyes to an area of medicine that I had greatly underappreciated, and I feel, with no evidence to support my argument, that...

Understanding viruses

Erles, K. — 2011-07-28T03:28:33-07:00

Viruses are important pathogens that are frequently encountered in veterinary practice. The diagnosis of viral infections has become more readily available owing to the development of rapid molecular methods. This article explains the basic properties of viruses, how they interact with their host and how this knowledge aids the diagnosis and control of infection. It also briefly discusses different diagnostic techniques and the challenges posed by viral evolution.

Investigation and management of cervical swellings in dogs

Owen, L. — 2011-07-28T03:28:33-07:00

Cervical swellings in the dog comprise neoplastic masses, abscesses/granulomas, salivary mucoceles and congenital cysts. It is important to differentiate between these conditions because the investigative pathway, treatment and prognosis for each of them are very different. Accurate history taking, physical examination and cytology can all provide vital clues about the nature of the disease and, hence, often avoid the need for more invasive and expensive testing. Subsequent decision-making depends on patient, owner and disease factors as well as financial constraints. This article describes how to diagnose cervical swellings in dogs and highlights the management options for each type of condition.

Responsible use of anthelmintics for nematode control in sheep and cattle

Sargison, N. — 2011-07-28T03:28:34-07:00

Globally, nematode parasites are arguably the most important causes of suboptimal productivity in sheep and cattle, albeit that they often occur concurrently with other problems. The control of nematode parasites is therefore a prerequisite for economically efficient meat production. For many years, in the UK, this involved the frequent routine use of broad-spectrum anthelmintics to suppress contamination of pasture, but the consequent emergence of anthelmintic resistance has meant that the livestock industry has had to re-evaluate its approach to the management of these parasites. This article discusses how the use of certain nematode parasite control regimens has led to the evolution of species resistant to licensed anthelmintic drugs, and suggests some strategies for reducing the further development of anthelmintic resistance.

Problems associated with cattle welfare

Gregory, N. — 2011-07-28T03:28:34-07:00

Recent studies have highlighted six welfare issues affecting cattle: assessing prognosis in cows with uterine prolapse; methods for feeding calves colostrum; understanding the relationship between floor hygiene, slurry heel and mastitis; managing slippery floors; avoiding foot disorders caused by newly laid concrete; and genetic antagonisms between production performance and cow welfare. This article describes how these problems might be prevented and discusses the role of the veterinary surgeon in educating farmers on how to manage issues affecting cattle welfare appropriately.

Use of supplemental intravenous anaesthesia/analgesia in horses

Auckburally, A., Flaherty, D. — 2011-07-28T03:28:34-07:00

General anaesthesia in horses is associated with a significant risk of both morbidity and mortality. One major factor contributing to this is the marked cardiopulmonary depression that occurs in this species in association with the use of volatile anaesthetic agents. Attempts to minimise the required volatile concentration for the maintenance of unconsciousness by administering additional injectable agents may have beneficial effects on the outcome for the animal. This article describes the characteristics of the agents commonly used for supplemental intravenous anaesthesia/analgesia (SIVA), and highlights the key points that must be taken into consideration when undertaking the concurrent administration of these drugs.

Postmortem examination of cage and aviary birds

Gresham, A., Ainsworth, H. — 2011-07-28T03:28:34-07:00

Postmortem examination can often reveal significant findings in caged birds and, in many cases, can help to establish an accurate diagnosis about the cause of death. For good results, a comprehensive history and fresh specimens are required. Where mortality has occurred in a number of birds, it is best to examine all or a representative proportion of them. If carcases are unavailable, affected birds that are still alive and representative of the problem may be euthanased for postmortem examination. These birds should preferably be submitted to the laboratory alive if their welfare is not compromised; otherwise, they should be euthanased before submission. This article describes the human health and safety aspects that should be taken into consideration when performing an avian postmortem examination, the stages involved in the procedure and the possible causes of the lesions seen.

Practice ownership - past, present and future

Wright, M. — 2011-07-28T03:28:34-07:00

If you were reading the Veterinary Record in 1980, you would have found, on average, at least two adverts for practices for sale and three adverts offering jobs with partnership prospects or partnerships wanted in each issue. Read it today and you may find a practice for sale once a month and a partnership advert hardly ever. What has been behind this change? Almost certainly it relates to the changes in attitude and demands of graduates over the past 30 years. In this article, Malcolm Wright looks at the past, present and future of practice ownership to gain an insight into how these changes have evolved and their effects on the future.

Counting your losses: medicines audits in practice

Macfarlane, J., Robson, R. — 2011-07-28T03:28:34-07:00

It has been estimated that shrinkage of veterinary purchases – that is, the difference between what is bought and sold – is in the order of 5 to 10 per cent. XLVets' key performance indicator data suggest that medicines sales per vet by sector are £81,500 (small animal), £147,000 (farm animal) and £44,500 (equine); 10 or even 5 per cent of these amounts would create a significant loss to the bottom line of any business. The only way of revealing the true extent of these losses in your practice is to conduct a full medicines audit, and this must be adopted as a regular feature of stock management. In this article, John Macfarlane and Rachel Robson describe how to carry out a medicines audit.

Regulation breach on farm

Steele, M. — 2011-07-28T03:28:34-07:00

A farmer client, known to be sceptical of all things veterinary, requests a visit. Examination of a pregnant suckler cow reveals an infected, ulcerated growth on its third eyelid. You provisionally diagnose squamous cell carcinoma of the third eyelid, and suggest removal of the mass under local anaesthetic, with the caveat that by the time the cow had calved and reared its calf, the growth would probably have returned and culling would then be recommended. However, the client insists on palliative treatment with a time limit, without removal of the mass. A courtesy visit a week later reveals that the cow is showing signs of pain from the growth. On arrival at the farm, however, you notice several untagged dead calves and two dead sheep in a ditch on the farmer's land by the entrance. How do you approach the farmer to remind him of his responsibilities to both the cow's welfare and the dead animals?

Comments on the dilemma in the June issue: 'Financially strapped owner with a suffering cat'

Fountain, K. — 2011-07-28T03:28:34-07:00

The dilemma in the June issue concerned a client presenting a cat at a private clinic out of hours for depression and straining to urinate (In Practice, June 2011, volume 33, pages 297–298). Evaluation of the cat revealed a blocked bladder and the signalment, history and clinical presentation together suggested urolithiasis. Unfortunately, the owner did not have the funds required to stabilise, catheterise and hospitalise her pet. It was also a difficult situation for the vet who might have had to consider euthanasia as a possible way forward. Steven McCulloch commented that suffering could be defined as a profoundly negative mental state, the cause of which had overridden the individual's ordinary physiological and behavioural coping mechanism; therefore, if that suffering could not be alleviated, it was morally justified to perform euthanasia. Hence, an animal should be euthanased first because it was suffering and secondly because the suffering could not be resolved. The animal was assumed to be in pain and suffering so the criterion for morally justified euthanasia was satisfied. However, in a medical sense, the second criterion was not satisfied because the cat could be stabilised and unblocked without significant irreversible complications, but it was satisfied in a financial sense because the owner did not have enough money for therapy. Referral to a charity clinic with no prior treatment, referral to a charity clinic with conservative treatment or treatment at reduced cost at the clinic were all options that the vet could consider as possible ways forward. The last two were preferable from the cat's point of view. However, supererogatory acts such as the last option could be criticised for encouraging irresponsible behaviour (eg, unable to afford veterinary fees, no insurance) and might also be construed as unfair to those who paid the normal fee.

A practitioner ponders

2011-07-28T03:28:34-07:00

It's 3am – the insomniac hour for mulling over the previous day's successes and failures, the time for a mug of cocoa and a quick channel hop on the television before the soothed brain can be eased back to sleep.

It is not so long ago that there was nothing on television at this hour, not even an obscure lecture from a wing-collared former hippy (a guaranteed cure for insomnia); only the puppet and blackboard of the trusty test card. In essence, the BBC did nothing for several hours.

Nowadays, we have so much more and yet there is still nothing on; I can hop between a myriad programmes that hold no interest whatsoever. The only difference is that the TV channels appear to be trying to do something. Really rather like some therapies. How often do we feel the need to do something – to give a therapy...