Suffolk-based Dr Horia Elefterescu has been struck off by the RCVS Disciplinary Committee for dishonesty, clinical failings and poor record keeping.

The Committee heard seven charges against Dr Elefterescu. The charges were:

1. In September 2015, in relation to a male cat called Kitty Brown, he failed to undertake an adequate examination prior to surgery and that he undertook an unnecessary laparotomy.

2. In February 2016, in relation to a male cat called Storm Page, he failed to undertake an adequate clinical examination prior to anaesthesia and made dishonest or misleading entries in the clinical records stating that he had undertaken a full clinical examination.

3. In February 2016, in relation to a male cat called Sampson Page, he failed to undertake an adequate clinical examination prior to anaesthesia and made dishonest or misleading entries to the effect that he had undertaken a full clinical examination.

4. In February 2016, in relation to Tibial Plateau Levelling Osteotomy (TPLO) surgery performed on a female Bichon Frise called Lucy Allen, he failed to undertake adequate examinations into the possibility of a cranial cruciate ligament rupture or failed to record the same; performed the TPLO surgery with insufficient clinical justification; performed the surgery inadequately; failed to take steps to rectify inadequate surgery having obtained post-operative radiographs; made dishonest/ misleading entries into clinical records; and, in a letter to the RCVS on 7 August 2016, made dishonest and misleading comments.

5. In February 2016, in relation to a male cat called Kipper Morley, he failed to take and record a sufficiently detailed history; failed to undertake an adequate clinical examination; that, having noted the possibility that Kipper might have anaemia, he failed to make arrangements for urgent investigations to be undertaken; that, having decided to administer intravenous fluids to Kipper, failed to make arrangements urgently; and failed to keep clear, accurate and detailed clinical records.

6. Between September 2015 and February 2016, he failed to keep clear, accurate clinical records in relation to seven cases.

7. In February 2016, in relation to a male cat named Chino Biggs, he failed to undertake adequate clinical examination and dishonestly made entries in the clinical records saying that he had undertaken aspects of an examination when he had not done so.

Having heard evidence from complainants, witnesses (including expert witnesses) and the respondent himself the Committee determined that the facts of all the charges were proven – with the exception of part of Charge 6 regarding his keeping inadequate clinical records in relation to a male cat called Dax Parham.

The Committee then went on to consider whether the proven charges, both individually and cumulatively, amounted to serious professional misconduct. In relation to the first and fifth charges the Committee found that, while Dr Elefterescu’s conduct fell below what was expected of a professional veterinary surgeon – they did not constitute serious professional conduct.

In relation to the parts of the second, third, fourth, sixth and seventh charges that were found proven, the Committee determined that each constituted serious professional misconduct. 

In relation to these determinations, Ian Arundale, chairing the Committee and speaking on its behalf, said: "The respondent’s clinical failures… are very serious, amounting as they do to failures in the basics of animal care and resulting in suffering to the animal. They involve widespread breaches of the Code, including not only the obligation in relation to animal health and welfare… but also the specific obligations of the Code in relation to record keeping. 

"In addition to his clinical and record keeping failures the respondent has been found to have acted dishonestly. This dishonesty would have impacted upon professional colleagues and any owner who viewed the records. It has the potential to undermine public confidence in the profession. The respondent was also dishonest in a letter written in August 2017 to his regulator."

In considering Dr Elefterescu’s sanction, the Committee took into account a number of aggravating and mitigating factors.

Aggravating factors included actual and risk of injury to animals, dishonesty, recklessness, breach of client trust, repeated misconduct and limited insight into his failings.

In mitigation the Committee considered that, at the time of the misconduct, the respondent was new to the UK, he had language difficulties which resulted in communication problems, that he was unfamiliar with UK veterinary computer systems and procedures, that he is of good character, that he has taken steps to avoid a repetition of his misconduct and that there have been no subsequent complaints since the dates of the matters in the charges.

However, the Committee found that, in light of the seriousness of the charges found against him, the only sufficient sanction was to direct the Registrar to remove Dr Elefterescu’s name from the Register. 

Mr Arundale, commenting on the sanction, said: "The respondent’s misconduct involved very serious departures from the professional standards set out in the RCVS Code…. In particular, the unnecessary surgery (both the initial and revision) carried out on Lucy Allen constituted very serious harm to an animal. The Committee considers that the respondent’s lack of insight into his failings, and his wholly unjustified confidence in his abilities constitute an ongoing risk to animal welfare. In these circumstances, the Committee has determined that the only sanction which is appropriate and proportionate, in order to ensure the welfare of animals, the public interest and the reputation of the profession, is to direct the respondent’s removal from the Register."

Dr Elefterescu has 28 days in which he can lodge an appeal with the Privy Council regarding the Disciplinary Committee’s decision.

Mark Bush and Martin Owen, both RCVS Recognised Specialists in Small Animal Orthopaedic Surgery have joined forces to open East of England Veterinary Specialists, a new orthopaedic referral practice in Wimpole, Cambridgeshire.

The new practice was created by refurbishing the premises of what was a purpose-built human hospital, turning it into a referral clinic with two operating theatres, separate accommodation and waiting rooms for cats and dogs, offices and a seminar room. 

Funding for the refurbishment came from NatWest, with further funds for things like digital radiography and a CT scanner coming from Lombard Asset Finance.

Martin said: "We decided to open East of England Veterinary Specialists to offer a more personal, yet professional service for pet owners in the local community. Thanks to the funding from NatWest and Lombard, we have been able to create a well-equipped surgery where we can offer the highest level of veterinary orthopaedic expertise.

"We have enjoyed welcoming our first customers over the past month and look forward to continuing to establish ourselves as an expert orthopaedic veterinary clinic, where 100% of referred cases will be managed by a Recognised Specialist."

For more information, visit: https://eoevets.com or telephone 01223 795023

Photo: L-R Karl Simper, relationship manager at NatWest, Martin Owen, co- founder of East of England Veterinary Specialists, Mat Parkhouse relationship manager at NatWest and Mark Bush, co- founder of East of England Veterinary Specialists.

The High Court has dismissed a legal challenge by the British Homeopathic Association over a decision by NHS England to stop funding the discredited treatment.

The case came after the NHS issued new guidelines for Clinical Commissioning Groups (CCG) in November 2017 which listed homeopathy alongside herbal medicine and glucosamine/chondroitin as treatments which should not now be prescribed to new patients and which CCGs should assist in de-prescribing in all patients, on the grounds that they are "products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns."

The British Homeopathic Association challenged the decision on the grounds that the public consultation which preceded the guidelines was, amongst other things, conducted unfairly and biased/predetermined.

The judge, however, ruled otherwise, saying in his ruling that the consultation was "fair and balanced" and there was "no evidence of bias or predetermination on NHSE's part".

NHS chief Simon Stevens welcomed the decision, saying: "There is no robust evidence to support homeopathy which is at best a placebo and a misuse of scarce NHS funds.

"So we strongly welcome the High Court’s clear cut decision to kick out this costly and spurious legal challenge."

Photo: Multicolored homeopathy tubes isolated on a white background. Lush. Shutterstock.

In the first known procedure of its kind, a 3D printed titanium implant created using additive manufacturing (AM) has been used to replace hard tissue lost during tumour removal from the maxilla in a seven-year-old Bernese Mountain Dog.

The procedure was performed in Canada through an international collaboration between partners from Germany, Canada and the UK, who say that this was a case where the placement of the tumour made it impossible to operate without severely impacting the dog’s quality of life. The most suitable treatment was a total excision of the growth and reconstruction with an implant. 

The implant was designed with medical CAD tools by German company, Voxelmed, using 3D imaging from the affected area. The dog's veterinary surgeon, Julius Liptak, contributed to the design to ensure it met specifications and allowing him to plan the procedure in advance.

UK company Renishaw then additively manufactured the patient specific implant (PSI) at the Additive Design In Surgical Solutions (ADEISS) Centre in London, Ontario, Canada.

Ed Littlewood, Marketing Manager at Renishaw’s Medical and Dental Products Division said: "Without the advancements in additive manufacturing technology, this dog would not have had such a long and happy future ahead of him.

"Prior to this case, many veterinary surgeons were unaware that the technology was available. Similar procedures are now being planned in Germany and further research is underway to see how animals can benefit from additively manufactured PSIs.

Jan Klasen, veterinary surgeon, 3D designer and CEO of Voxelmed said: "Without AM technology, it would have been almost impossible to reconstruct the dog’s maxilla after tumour removal, because the area was extremely complex in geometry. The implant had to have a similar shape and functionality as the dog’s existing bone structure. 

"Using additive manufacturing to maintain the original shape and function of the oral and nasal cavity ensures a high quality of life for the dog, just as a naturally shaped skull and maxilla helps the dog to breathe and eat easily."

To read the full case study, visit http://www.renishaw.com/en/additive-manufacturing-in-veterinary-surgery-saving-a-well-loved-member-of-the-family--42950. 

Vetsnet and VetLed have announced that the first WellVet Weekend, an event designed to offer veterinary nurses and surgeons a chance to recharge, refresh and re-energise, will take place at Girton College, Cambridge, on 24th-26th August 2018.

The WellVet Weekend will include a variety of sporting activities, yoga classes, wellbeing workshops and social times, all finished off with a gala dinner. Something for everyone. 

Speaking at the gala dinner on the Saturday evening will be Rob Pope. Rob, also known as the 'real-life Forrest Gump' is an emergency vet by night and a marathon runner by day. He's the first person ever to run across the USA four times in one year and he's currently running across the USA for the fifth time. This will be Rob’s first public event following his completion of this epic journey. 

Liz Barton, Founder of Vetsnet said: "I love sport and I love this profession, so it's fantastic to be able to organise a weekend dedicated to the physical and mental wellbeing of vets and vet nurses. It promises to be a brilliant weekend, and I’m excited to have Rob Pope join us to share his stories from the road."

Ru Clements, Founding Partner of VetLed said: "We’re excited to create a community which supports veterinary professionals to thrive. The WellVet Weekend is a very special concept with a core mission that we wholeheartedly believe in. We hope we can make a long-lasting positive difference to those who attend the first WellVet Weekend."

For more information and to buy your ticket, visit www.wellvet.co.uk 

Vets4Pets has opened it's 450th joint venture practice in Essex with Cheryl Lucas MRCVS and veterinary nurse Nick Briggs.

The Mayor of Loughton, Councillor Philip Abraham, officially opened the Vets4Pets Loughton veterinary surgery inside Pets at Home at the Epping Forest Shopping Park, before enjoying a guided tour of the bright and modern facility.

Cheryl, who stars in the BBC’s children’s TV show The Pet Factor, said: "It’s fantastic to be able to open the doors to Vets4Pets Loughton and reach a landmark number of practices for the group.

"The opening event gave us chance to meet new clients, and welcome them to the practice."

Cheryl qualified in 2009 and is also a joint venture partner at Vets4Pets Chadwell and Newbury Park in Ilford.

Nick, who qualified in 2008, is also joint venture partner at Newbury Park, Romford, Beckton and Dagenham.

Nick said: "I have always been interested in caring for pets and have several dogs and cats at home.

"I love being a veterinary nurse and I’m delighted to have another opportunity from Vets4Pets to open my fifth practice.

"Once again the process to open a practice has been easy and we’ve had brilliant support on all aspects from Vets4Pets.

"I’m now looking forward to welcoming pets and their owners to Vets4Pets Loughton and providing the highest standard of veterinary care to the area’s pets."

The new practice will create five new jobs, with two vets, veterinary nurse, two pet care assistants and a receptionist.

Chief executive of the Pets at Home Vet Group, Andrei Balta, said: "Cheryl and Nick are two great advocates for the veterinary profession and we’re delighted they are part of the group.

"Wherever we have opened, pet owners have responded enthusiastically to our state-of-the-art practices and convenient opening hours.

"The joint venture model we operate across our practices provides the support vets and vet nurses need to run their businesses.

"It allows them to focus on what they really love, looking after the health of animals, while the support team helps with other areas including marketing, HR and business strategy."

The RCVS has updated its supporting guidance for veterinary surgeons and veterinary nurses on informed consent, with more advice on discussing informed consent with clients and who is responsible for seeking consent.

The Codes of Professional Conduct for both veterinary surgeons and veterinary nurses stress the need for effective communication with clients and ensuring that informed consent is obtained and documented before treatments or procedures are carried out.

At its January meeting RCVS Standards Committee approved changes to chapter 11 (‘Communication and consent’) of the supporting guidance to the Codes to provide further advice to the professions on matters that should be discussed with clients to ensure informed consent is gained, provide clarification on who can gain consent for a procedure and give some additional guidance on consent forms.

Nick Oldham, Standards and Advisory Manager at the RCVS, said: "We hope that this updated guidance is more accessible, readable and will aid members of the profession in developing a more comprehensive approach to gaining informed consent for treatments and procedures and therefore reduce the risk of miscommunication and misunderstanding which can lead to concerns being raised by clients. 

"For example, we have updated our guidance to encourage veterinary surgeons to consider discussing a number of additional factors with a client before obtaining consent. This includes the nature, purpose and benefits of any treatment or procedures, the likely outcomes including potential risks, financial estimates, informing the client when other treatments may have available and checking that the client understands what they are agreeing to rather than assuming the client understands both the potential financial outlay and possible side effects.

"Furthermore, there is now additional guidance for veterinary surgeons on who should be seeking consent. While ordinarily it is expected that the veterinary surgeon undertaking the procedure or providing treatment is responsible for obtaining the client’s consent we know that this is not always practical.

"Therefore we clarify that the responsibility of obtaining consent can be delegated to another veterinary surgeon and, failing that, a registered veterinary nurse or student veterinary nurse could obtain consent provided that they are suitably trained, have sufficient knowledge of the proposed procedure or treatment and understand the risks involved.

"The RCVS Standards and Advice Team is also in the process of producing a series of fictional case studies based on informed consent issues encountered by the College’s Preliminary Investigation Committee which we hope will further help the profession."

The updated supporting guidance can be found in full at www.rcvs.org.uk/consent

The Code of Professional Conduct and its supporting guidance can also be downloaded as an app for smartphones and tablets at www.rcvs.org.uk/codeapp

Members of the profession seeking confidential advice on matters relating to professional conduct can contact the Standards and Advice Team on 020 7202 0789 or advice@rcvs.org.uk

Researchers from Ghent University (UGhent), Austria Veterinary Medicine School (Austria VetMed) and the Royal Veterinary College (RVC) have published the first systematic review of the evidence for the efficacy and safety of all anti-epileptic drugs (AEDs) in feline epilepsy.

The aim of the study was to assess the efficacy and adverse effect profile of each individual AED by analysing all available data published and then evaluating how reliable it was.

The researchers gathered, screened and assessed all the information published in peer-reviewed journals and publications. The individual studies were then evaluated based on the quality of evidence, study design, study group sizes, subject enrolment quality and overall risk of bias, as well as the efficacy and safety outcome measures.

Lead-author, Marios Charalambous from Ghent University, said: "We recruited systematic methods to combine, compare and summarise the results of independent studies and, therefore, create more objective and reliable conclusions based on the current evidence. It was a time-consuming, demanding and challenging process, and we hope we provided the clinicians now with essential information which they can use for daily practice." 

The researchers found that much of the evidence for the medical treatment of feline epilepsy was based on below-par reporting of efficacy and adverse effect, worse than what was formerly reported in dogs.

The lack of good quality evidence led authors to conclude that it would be: "...rather inaccurate to make definite statements on which one [AED] should be considered as a first or second choice in terms of both efficacy and safety profile. However, if clinicians focus on AED’s efficacy, phenobarbital can be used as first-choice monotherapy and if they focus on AED’s safety, imepitoin or levetiracetam can be used." 

Holger Volk, Head of the Department Clinical Science and Services and Professor of Veterinary Neurology and Neurosurgery at the RVC, said: "Not only does this study offer a new perspective on the management of feline epilepsy, but also highlights the importance of the need for trials which provide high quality evidence in order to have more reliable and objective results about the efficacy and safety of the AEDs in feline epilepsy."

The study was published in BMC Veterinary Research (https://doi.org/10.1186/s12917-018-1386-3).

White Cross Vets, the 18-practice group headquartered in Leeds, has introduced 'peternity leave', through which all its 220 staff are entitled to two paid days off work when they get a cat, dog or rabbit, to help them settle the animal in its new home.

The initiative was the idea of one of the practice's client care co-ordinators, who suggested it whilst she was acting as the managing director for the day, as part of White Cross Vets' 80 year anniversary celebrations. 

Managing director Tim Harrison said: "We believe we are the first veterinary practice in the UK to offer two full days paid peternity leave. Our ethos is all about caring for pets, and the first few days at home with a new addition are so special. It’s therefore essential that quality time can be dedicated to a new pet, in order to make sure they feel comfortable and safe in their new environment.

"As all of our team are all pet owners already, this time off will give them the chance to introduce and socialise any new family members with existing pets, which must be done carefully and under supervision.

"Bringing a new pet into the family takes a lot of patience and perseverance, and certain breeds or older pets can be harder to train or take longer to bond. Also there is a lot of preparation work that needs to be done in the home and garden when a young pet dog, cat or rabbit arrives, so this time off will hopefully make it easier for our team to give their new pets a safe and welcoming start in their new homes."

Other perks that White Cross Vets offers include five fully paid donation days a year to volunteer with chosen charities, a health care scheme, days off and cakes for birthdays, as well as subsidised Fitbits and gym memberships.

A D. immitis cake prepared by veterinary students at the University of Nottingham’s Sutton Bonington campus has won the public vote in the university's annual cake off, helping raise £880 for Vets In The Community and the Terence Higgins Trust.

'Hany’s Heartbreak' was a gorily realistic representation of a dog’s heart infected with Dirofilaria Immitis, baked by vet students Anna Burrows, Caitlin Glover, Chloe Tredinnick and Liberty Daly.

It pulled in votes from all over the world including Australia and the US, Saudi Arabia, Germany, Italy and the Caribbean.

The winning bakers said: "We chose to bake this cake as we wanted to make something that we could make look as realistic as possible and as gruesome.

"Our parasitology lecturer, Hany, inspired us to use the D. Immitis parasite as our theme to promote the message of how detrimental and possibly fatal some animal parasites can be! We had a great time baking it and enjoyed the looks of disgust that people who saw it gave. We promise it tastes better than it looks! Our key message to everyone is to PLEASE WORM YOUR PETS!"

The categories for baking inspiration this year were Transport to Campus, Scrumptious Science, Blue Planet and a Showstopper section. Sir David Attenborough and Pixar characters Nemo and Dory were among the other stars of the show, with colourful cakes on an environmental theme also winning prizes.

One of this year’s judges was Dr Wendela Wapenaar, Associate Professor at the Nottingham Vet School. Wendela said: “It’s been another great year for the Sutton Bonington Bakeoff. It was impressive to see how some bakers took on the challenging topics for this year; winning cakes were covering topics such as global warming, environmental pollution in addition to the more gory aspects of veterinary medicine."

Following the launch of Pro Plan Liveclear, the Purina Institute is hosting a two-hour CPD symposium on managing cat allergens which will take place online on Wednesday, 8th July at 7:30pm. 

Speakers at the free event will include feline expert Dr Andy Sparkes, BVetMed, PhD, DipECVIM, MANZCVS, MRCVS and the immunologist who led the Purina research behind Liveclear, Dr Ebenezer Satyaraj, PhD.

Andy will address the consequences of feline allergy. He says that in majority of cases, cat-allergic owners will choose to tolerate ongoing symptoms of allergy, rather than relinquish their cats, even when they have severe symptoms.

Ebenezer will talk about the research behind Pro Plan Liveclear and how it will allow veterinary surgeons and nurses to help support these clients.

Libby Sheridan, MVB MRCVS, Purina Veterinary Technical Affairs Manager, UK & Ireland said: "This innovation is safe for cats who continue to produce the major cat allergen, Fel d 1, which is found mainly in the cat's saliva and sebaceous glands.

"Our researchers found that the Fel d 1 protein could be neutralised through feeding a nutritious cat food coated with an innovative egg product ingredient containing anti-Fel d 1 antibodies1 which helps reduce the active allergen transferred to hair and dander during grooming, and ultimately helps reduce active Fel d 1 in the environment.2

"Now the science has resulted in a commercially available product that could have a big impact on the quality of life of the cat and their owner. We'll be sharing the research behind this at the symposium so that clinicians can evaluate the potential benefits."

Any member of the practice team can register for the event at  www.veterinarywebinars.com/purina, and will be entered into a prize draw to win an iPad. There will also be a number of goody bags available as additional prizes.

More information about the science is available at www.purinainstitute.com.

References

1. Satyaraj E, Sun P and Sherrill S (2019). Fel d 1 blocking anti bodies against the major cat allergen Fel d 1. Presented at the annual meeting of the European Academy of Allergy and Clinical Immunology, Lisbon, Portugal.
2. Satyaraj E, Li Q, Sun P and Sherrill S (2019). Anti -Fel d 1 immunoglobulin Y anti body-containing egg ingredient lowers allergen levels in cat saliva, Journal of Feline Medicine and Surgery 21(10): 875-881. Doi:10.1177/1098612X19861218

Liz Leece, a European and RCVS Specialist in veterinary anaesthesia and analgesia at Paragon Veterinary Referrals in Yorkshire, is championing a new approach to post-operative pain management.

The traditional approach is to use anatomical knowledge to inject pain relief in the area of the nerves to be blocked.

Liz is leading a move away from this approach to a more precise method which uses ultrasound guidance to visualise the nerves, allowing the local anaesthetic to be placed directly around the nerve itself.

For some nerve blocks, it is possible to block just the sensory branches of nerves, which means pets can walk better immediately after surgery while not feeling any pain.

Liz, a past president of the Association of Veterinary Anaesthetists, said: “Local analgesia is now at the forefront of our post-operative care and reliably improves the quality of a pet’s recovery and reduces the need for opioid pain relief, which can cause side effects.

“We’re using the latest techniques to deliver the nerve-blocking anaesthetics to exactly where they’re needed.

“For many of the nerve blocks, the use of ultrasound guidance allows more precise delivery and a complete blockade of the sensory nerves, which is why, here at Paragon, we’ve invested in state-of-the art ultrasound machine designed specifically for superficial and deep nerve blocks.

“This means we can provide more effective immediate post-operative analgesia for our patients and minimise the need for further pain killers.

“The nerves can be directly visualised and local anaesthetic directly placed around the nerve bundles.”

Liz is keen to highlight the advantages of the increased use of local anaesthesia in the treatment of animals. She added: “We’re hoping we’ll soon be able to publish some clinical research on the use of some of the blocking techniques used to demonstrate our clinical impression of their effectiveness in patient management.”