The case studies were developed by the RCVS Standards Committee and use a variety of examples of where miscommunication between a client and the veterinary practice can lead to an inadequate level of consent being gained for procedures and treatment, including euthanasia.
Examples include damaged teeth being removed during a clean and polish dental procedure without the owner’s express permission and not giving the full range of options available in the case of a dog with an osteosarcoma.
The case studies follow the Standards Committee approving changes to chapter 11 (‘Communication and consent’) of the supporting guidance to the RCVS Code of Professional Conduct in January 2018 to give further advice on how to discuss informed consent with clients, who can be responsible for gaining consent for a procedure and additional guidance on consent forms.
Dr Kate Richards MRCVS, Chair of the RCVS Standards Committee, said: "We hope these case studies will prove useful to practitioners who are having to deal with the complexities around making sure that procedures are fully explained to ensure informed consent is gained.
"We understand the difficulties that are encountered and so these case studies, based on real-life scenarios, highlight where things may go wrong and how these incidents can be avoided by being thorough and ensuring that good communication is at the heart of all we do."
To view the case studies, visit www.rcvs.org.uk/informed-consent.
Chapter 11 of the RCVS supporting guidance on communication and consent is available to view at www.rcvs.org.uk/consent
The VCMS, which is administered by Nockolds Solicitors, was formally launched by the RCVS as an alternative dispute resolution service in October 2017 following a year-long trial.
The aim of the service is to resolve, by mediation, disputes between clients and veterinary practices that do not meet the threshold of serious professional misconduct that is needed for the RCVS to investigate a concern through its formal processes.
Since the service’s trial, which started in October 2016, the VCMS has given preliminary mediation advice on how to resolve a case in more than 1,700 instances with over 580 cases having gone to full mediation of which 89% have concluded with a resolution.
Eleanor Ferguson, RCVS Registrar and Director of Legal Services, said: "From the perspective of both the public and the profession, the establishment of the VCMS has been a "win-win" situation. For the public it has provided them with an additional route to solve those complaints which wouldn’t cross the threshold to progress in the concerns investigation process.
"For the profession it has provided a more appropriate format for resolving a client dispute that doesn’t involve the time, effort and formal process of an RCVS investigation for those cases that will never amount to serious professional misconduct. I think this has been demonstrated by the fact that the vast majority of the profession are willing to engage with the VCMS process, even though it is entirely voluntary.
"The VCMS has also had a positive impact on the College and its concerns investigation process, allowing us to focus greater resources on those cases that do meet our threshold of serious professional misconduct. This has had a very clear impact on the speed with which we either close cases or move them on to the next stage of consideration by the Preliminary Investigation Committee (PIC), which, again, is important to both the public and the profession."
The College says that around 90% of cases investigated at Stage 1 of the process are now either closed or referred to PIC within four months – the College’s key performance indicator at this stage. This compares to around 50% of these cases being closed or referred within four months at Stage 1 in 2016.
The College also says that in total (including both preliminary and full mediation cases), 86% of the cases dealt with by VCMS were successfully mediated and feedback from both clients and veterinary practices has been largely positive. In client feedback from the third quarter of 2018, 93% said they would use the VCMS again and 79% considered it to be fair, while the equivalent figure amongst veterinary practices was 94% and 87% respectively.
Jennie Jones, a partner at Nockolds Solicitors who heads up the VCMS, said: "It is a good sign that mediation is largely working as it should when both parties are reporting similar satisfaction rates and we pride ourselves on negotiating resolutions that are acceptable and beneficial for both the clients and the practices.
"It is great to see that our efforts are also having an impact on the RCVS concerns investigation system by allowing it to concentrate on more serious cases."
More information about the RCVS concerns investigation process, including the different stages of an investigation, can be found at www.rcvs.org.uk/concerns
Further information about the VCMS can be found on its website at www.vetmediation.co.uk or by calling 0345 040 5834.
The course will be led by Dr Jon Hall, a European Specialist in Small Animal Surgery and Dr Danielle Gunn-Moore, an RCVS-recognised Specialist in Feline Medicine, supported by RVN Ms Claire Dorey-Phillips. It will take place at Improve’s new practical training facility in Sheffield in January 2019.
Improve says the programme will equip delegates with a full understanding of the causes of FLUTD and help them to advise owners with cats suffering from the condition in order to improve long-term outcomes. It will also provide a comprehensive overview of the nursing and medical options to treat feline idiopathic cystitis (FIC) and other causes of FLUTD including infection, calculi and neoplasia. The range of appropriate surgical methods to treat ureteral obstructions will also be covered, along with the post-operative nursing care, to ensure that delegates feel ready to perform a variety of bladder surgeries with confidence.
Juliet Pope MRCVS, Veterinary Operations Manager at Improve International (pictured right), said: "Treating patients with FLUTD is a team effort so we’re offering a special rate for a vet and nurse attending from the same practice though both vets and nurses can still, of course, book independently. The cutting-edge programme will be highly interactive and we aim to send delegates back to their practices with a revitalised approach to these tricky cat cases."
For further information visit www.improveinternational.com or email enquiries@improveinternational.com or call 01793 759159.
EthyCalm is sprayed directly on the skin, or, for more fractious patients, can be applied with a swab.
Invicta says that unlike other products the effect is instant and EthyCalm leaves no residue on the skin surface.
The improved product, EthyCalm Plus, contains 50% more product (good for over 100 applications) and incorporates a new 'on-off' switch for easier application. It is also now packed in a 'no-roll' case to protect from damage.
Rob Watkins, Managing Director of Invicta, said: "EthyCalm has been an incredibly popular product with nurses and vets. As a small company we always listen to our customers and have taken the opportunity to incorporate suggestions for improvement. The result is EthyCalm Plus which offers significant enhancement over the original product".
EthyCalm Plus is available from veterinary wholesalers and for a limited time the price has been held at £25 each.
One £1000 bursary will be made available to the student or qualified veterinary nurse in the UK, with the best research project application. There will be a further opportunity to win additional prizes at the MSD Animal Health Research Bursary Day.
Michelle Townley, Veterinary Advisor at MSD Animal Health said: "We are very excited to be extending our bursary scheme to student and qualified veterinary nurses. They play a vital role in the welfare of animals and the future of the veterinary profession. Our new research bursary, supported by the BVNA, recognises and celebrates the value of veterinary nurses and our commitment to the science of healthier animals. We view our investment in research, and the pursuit of new knowledge, as the lifeblood of the veterinary profession and would ask veterinary practices and colleges to encourage their nurses to apply."
Wendy Nevins, BVNA President added: "This is a great opportunity for student and qualified veterinary nurses to develop their research skills and contribute to new research in the industry. We would encourage students and qualified veterinary nurses to consider applying and seek support from their lecturers or practices to complete an entry; helping raise the profile of the profession."
The Veterinary Nurse Research Bursary is open for applications from Monday 15th October 2018 and has a deadline for entries of Friday 10th May 2019.
For more information, visit: www.msdahresearchbursary.co.uk.
The study, which was carried out by the VetCompass programme at the RVC, in partnership with Vets Now, also found that cats are most likely to be involved in a traffic accident in the autumn.
1,407 cat road traffic accident cases that attended Vets Now clinics across the UK between December 2011 and February 2014 were analysed, with researchers finding:
Younger cats, aged six months to six years, are at the greatest risk of road traffic accidents.
Male cats are 1.3 times more at risk of road traffic accidents than female cats.
Crossbred cats are 1.9 times more at risk of road traffic accidents compared to purebred cats.
Cats are more likely to be involved in a road traffic accident in the autumn. However, they are less at risk in winter as compared to spring.
Those cats that present with abdominal or spinal injuries are more likely to die, as are those that present with an increasing count of injuries.
RVC veterinary epidemiologist and VetCompass researcher Dr Dan O’Neill said: "One of the scariest times for any cat-owner is when they first start to let their cat go outside unattended. Owners of younger, and especially male, cats need to be especially vigilant. These results help owners to understand the true risks and therefore assist these owners to make the best decisions about if and how they let their cats go outside."
Dr Amanda Boag, Clinical Director of Vets Now, said: "We are very proud to have worked with VetCompass to ensure this important information about risks to our pet cats is made available to vets and the public. Working with our partners such as the RVC, we are committed to ensuring our large clinical database is used to help advance veterinary knowledge and understanding of emergency and critical care practice."
The full paper entitled 'Epidemiology of Road Traffic Accidents in Cats attending emergency-care practices in the UK' is published in the Journal of Small Animal Practice.
A total of 8,234 votes were cast in this year’s election, a turnout of 25.5%. The College says the previous highest turnout recorded this century was 22.8%, and it thinks this year's result may even be an all-time record.
The full results, in order of number of votes, are:
Niall Connell – 3,766 votes (re-elected)
Linda Belton – 3,581 votes (elected)
Jo Dyer – 3,146 votes (re-elected)
John Innes – 2,716 votes
Kate Richards – 2,283 votes
Tim Greet – 2,280 votes
Peter Robinson – 1,791 votes
John Davies – 507 votes
Tom Lonsdale – 422 votes
Eleanor Ferguson, RCVS Registrar and Returning Officer for the election, said: "Congratulations to Niall and Jo for being re-elected to Council and congratulations also to Linda who we look forward to welcoming to Council at this year’s Royal College Day on Friday 12 July. I would also like to thank Kate, Tim and Peter for their contributions during their time on Council and give my commiserations to them and the other candidates who were unsuccessful this year.
"I was delighted to see that, this year, we had over a quarter of those eligible to vote doing so which means both a record number of votes and a record turnout – it seems this was assisted by our email reminders which, each time they were sent out, lead to a significant boost in uptake.
"However, we will not rest on our laurels and will continue to think about how we can further improve engagement in the election process and turnout for subsequent years."
The results of the election will be declared formally at this year’s Royal College Day – the College’s Annual General Meeting and awards ceremony – which takes place at the Royal Institute of British Architects on Friday 12 July 2019 where the successful candidates will also start their new four-year terms.
No election to Veterinary Nursing Council was held this year due to the fact that there were only two candidates – Liz Cox and Jane Davidson – standing for the two elected places. Both Liz and Jane will take up their three-year terms at Royal College Day.
The research, carried out by the Royal Veterinary College’s (RVC) VetCompass programme, involved analysing data from 333,910 bitches who presented at veterinary practices participating in the programme between 2014 and 2017.
The study also indicated that the females of certain breeds are more prone to UI than others, with Hungarian Vizslas, Doberman, Weimaraners and Boxers most at risk.
UI affects around 3% of bitches in primary veterinary care in England.
The researchers say that a connection between neutering and UI in bitches has long been suspected but this study provides stronger evidence on the extent of the relationship.
The data also showed that age and bodyweight are major contributory factors to bitches developing UI as well as neutering and breed. Other key findings include:
Bitches over nine years old are 1.7 times more likely to develop UI compared to those younger than three years.
Bitches weighing over 10kg are 1.9 more likely to develop UI than those weighing less than 10kg, while bitches over 30kg are three times more likely.
Camilla Pegram, VetCompass epidemiologist and lead researcher on the study, said: "First opinion vets discuss and perform neuters on a daily basis but, until now, evidence on the link between neutering and urinary incontinence has been tenuous.
"This study provides stronger evidence of an important association between neutering and urinary incontinence. The decision to neuter a bitch is based on many factors, not just incontinence risk alone. However, these results suggest that the component of the decision driven by urinary incontinence could be emphasised for the high-risk breeds and bitches of larger bodyweight.”
It is hoped that the results will aid owners and vets in making evidence-based decisions when it comes to neutering female dogs.
Reference
The Strategic Plan was developed throughout the course of 2016 with input from a number of stakeholders including RCVS Council and Veterinary Nurses Council, key committees and College staff. Most importantly, the evidence for change came from the wide and deep consultations that took place within Vet Futures, the joint RCVS and British Veterinary Association project that aims to help the veterinary profession prepare for and shape its future.
The other four ambitions described in the plan are:
Nick Stace, RCVS CEO, said: "The hallmark of our 2014 to 2016 Strategic Plan was getting the basics right by clarifying our identity, improving our core functions, setting out our service agenda and strengthening our foundations. The plan gave us a firm foundation to build upon and improved levels of confidence in the College from stakeholders which has allowed us to be more ambitious and outward-looking with this new plan.
"Within the new plan there are challenging ambitions and stretching objectives that address some of the big issues affecting the veterinary team, whether that’s playing a more global role post-Brexit, the importance of embracing new technology, or the pressing need to consider culture change within the profession to ensure it continues to grow and learn.
"I would ask each member of the profession to take a look at the Strategic Plan and I am very happy to receive comments and feedback on the plan by email at nick@rcvs.org.uk."
To download the Strategic Plan, visit www.rcvs.org.uk/publications
The report, which was developed in consultation with BVA members, devolved branches, BVA specialist divisions and other stakeholders, outlines the essential role that the UK veterinary workforce plays in not only caring for animals, but in enabling trade, ensuring food hygiene and safety, and undertaking cutting-edge research.
Non-British EU veterinary surgeons are critical to the UK veterinary workforce. Around 50% of veterinary surgeons registering to practise in the UK each year come from overseas, with the vast majority of these coming from the rest of the EU. Yet one-fifth of vets are already reporting that it has become harder to recruit since the EU Referendum.
To secure the best possible outcomes for animal health and welfare, public health, and the veterinary profession, Brexit and the veterinary profession sets out 52 recommendations for the short, medium and long term, including calling on the next Government to:
BVA President Gudrun Ravetz said: "Vets provide the foundation for the UK’s work on animal health and welfare. Veterinary teams up and down the country support the UK’s 11 million pet-owning households; not a penny of the UK’s £13 billion agri-food industry could be realised without vets; and we are an integral part of the international scientific community, annually bringing in over £50 million for research and development projects.
"The veterinary profession is in a unique position from which to offer the next Government evidence-based policy recommendations to ensure animal health and welfare, public health and other standards are at the very least maintained as we exit the EU.
"We believe Brexit also presents us with opportunities, for example, to develop a strong, competitive food industry with full consumer confidence at home and abroad as well as to position the UK as a world leader in high animal welfare - and a strong veterinary workforce is vital in achieving this."
Brexit and the veterinary profession was developed and written by the BVA Brexit Working Group, under the chairmanship of Alick Simmons, former UK deputy Chief Veterinary Officer, and was agreed by BVA Council in April.
The report builds on BVA’s Brexit Principles, agreed by Council in September 2016, and covers seven areas of public policy: veterinary workforce, animal health, animal welfare, food hygiene and safety, veterinary medicines, research and development, and trade.
Two further sections of the report consider issues relating to devolution and to Northern Ireland’s unique position as the only part of the UK to share a land border with an EU member state.
With a snap General Election due in five weeks’ time, BVA has produced a 20-point manifesto of key recommendations covering both Brexit and wider policy issues, which has been sent to the main political parties’ manifesto-writing teams and to BVA’s Honorary Associates.
Brexit and the veterinary profession and the manifesto for the 2017 General Election are available at: www.bva.co.uk/brexit.
The recommendation follows the analysis of data collected as part of the company's Talk About Laminitis disease awareness initiative, which has seen more than 47,000 horses tested for PPID since it was launched in 20121.
The data revealed that, regardless of presenting clinical signs, a horse aged 15-20 is three times more likely to have PPID compared to a horse under 10, and this risk increases with age. For example, a horse of 20-25 is six times more likely to have PPID compared to a horse under 10 and a horse that is 25-30 is 10 times more likely to have PPID.
Boehringer says that despite the high prevalence of PPID in the older horse population, the clinical signs of the disease are insidious in onset and owners may simply associate them with the ageing process.
One study demonstrated that in a single population of horses over the age of 15 only 1.6% of owners reported signs of PPID2. However, when the same group of horses were examined by a veterinary surgeon, 21% were found to have signs of the disease.
Dr Jo Ireland, veterinary surgeon at the University of Liverpool, said: "It is often difficult for owners to spot the signs of PPID as they frequently associate them with the ageing process. However, PPID is now the fifth most commonly diagnosed disease in horses in the UK3.
"We are therefore encouraging veterinary surgeons to routinely test horses over 15 years of age or those that are displaying signs of PPID with an ACTH test."
The 'Talk About Laminitis' disease awareness initiative runs from June until the end of October and aims to raise awareness of the underlying hormonal causes of laminitis – PPID and Equine Metabolic Syndrome (EMS). As part of the scheme, the laboratory fees for the blood test which detects PPID (the basal ACTH test) are free.
Redwings’ head of veterinary and care, senior veterinary surgeon Nicky Jarvis, said: "Any initiative that decreases the incidence of laminitis developing in an older equine is invaluable. Laminitis is an extremely distressing condition for both the horse and the owner and the long-term consequences can be devastating. Knowing the underlying cause is a huge help in tackling the disease and we would encourage anyone to take advantage of this offer and get their veteran checked out."
For further information about 'Talk About Laminitis', visit www.talkaboutlaminitis.co.uk or contact your local Boehringer Ingelheim account manager.
References
In 2014 ioLight co-founders, Oxford physicists Andrew Monk and Richard Williams, filed a patent application for a pocket-sized digital microscope with a performance that compares with expensive laboratory microscopes. They asked Cambridge Industrial Design to realise the product, briefing them that the device would need to deliver images with one micron resolution (required to view human or animal cells) onto a smartphone or tablet, be pocket-sized, easy to use, and economical to build in medium to high volumes.
One of the biggest challenges was in making the unit pocket-sized, which meant it had to be foldable, something which could have led to a loss in the rigidity needed to achieve high resolution images. This challenge was overcome with the use of a single hinge which the company says makes the ioLight both portable and robust.
Alex Jones, Managing director of Cambridge Industrial Design said: "We recognised immediately this was a great idea but the design brief was certainly a challenge. Fortunately, challenges can sometimes bring out the best in designers. The final design is a real success both aesthetically and ergonomically, and this award is a fantastic acknowledgement for the design process and the final product that we have created together with ioLight."
ioLight is also celebrating another success: closing its second round of equity funding after raising £320k from 335 investors on the Crowdcube platform (128% of the initial target).
The company says the new funding will allow it to promote the microscope to a wide range of target markets including veterinary surgeons, education, laboratory and field research, museums and public engagement as well as to international markets.
Andrew Monk, ioLight’s co-founder said: "The product is so simple to use that it is the ideal communication tool for explaining science to the public, students and customers. The microscope lets everyone see the same image so the discussion is about the picture not the tools. It’s a perfect fit for government public engagement campaigns, which are well funded at the moment. We are absolutely delighted that this funding provides us with the opportunity for both product development and to reach out and make microscopy available to so many more people."
The company says that until now, veterinary surgeons wanting to protect pets against both lungworm and ticks have had to prescribe multiple products, often with different methods of administration and/or treatment frequencies, leading to potential client confusion and issues with compliance. Being able to use one beef-flavoured chew will, it says, make things much simpler.
NexGard Spectra contains afoxolaner, an isoxazoline effective against ectoparasites, and milbemycin oxime for lungworm prevention and the treatment of GI roundworms, such as Toxocara.
Merial highlights data which indicates an ever-increasing threat to dogs in the UK from lungworm and ticks: Angiostrongylus vasorum is spreading across the UK, with prevalence in foxes rising from 7% in 2005 to 18% in 20141,2. The risk of exposure to ticks has increased, with a recent study showing that nearly 1 in 3 dogs were found to host ticks3, compared to around 1 in 7 dogs in a previous study4. Cases of the potentially fatal tick-borne disease Babesiosis (carried by the tick vector Dermacentor reticulatus) are also being diagnosed in un-travelled UK dogs5.
Lynda Maris, NexGard Spectra Product Manager, says that the changing patterns mean both parasites have become higher priority risks in many practices: "Until now vets have had to recommend combinations of products, or make a choice about which parasite represents the greatest risk in their area – ticks or lungworm. But as both parasites have changed their behavior, the risk of exposure has increased across the country.
"Now just one tasty chew will address both lungworm and ticks, meaning that pet owners don’t have to concern themselves with administering different products and vets know that in the face of a rapidly changing situation there is a simple way to make sure their patients are protected."
The company also highlights a recent vet practice sampling campaign5, in which 79% of dogs took NexGard Spectra readily or like a treat. More than 90% of respondents to the survey said they would be likely or very likely to recommend it to their clients.
NexGard Spectra can be used from 8 weeks of age in puppies weighing more than 2 kgs, and is very well tolerated, including by MDR-1 mutant collies, where studies showed no treatment-related changes even at five times the maximum dose. It is available in packs of three chews, with five different presentations to ensure accurate dosing according to bodyweight (2-3.5 kgs, 3.5-7.5 kgs, 7.5-15 kgs, 15-30 kgs and 30-60 kgs).
For more information, contact your Merial Territory Manager, call Merial on 0870 6000 123, or visit www.nexgardspectra.co.uk.
References:
The traditional method for detecting equine lameness is subjective, using expert visual evaluation of gait to identify the presence or absence and degree of asymmetries. The lame horse is described as having a disorder, defect or loss of function and this clinical diagnosis has associated welfare implications if the horse is still asked to perform.
The article explains how advanced computer technology is starting to change all this. Optic motion capture or the use of inertial measurement units (IMUs) is now enabling the detailed study and quantification of the horse’s gait; objective assessment against preset thresholds. The paper points out that while these digital systems can overcome the temporal and spatial limitations of the human eye they simply rely on one or a number of set gait parameters to decide about lameness and this can present obstacles.
Thresholds are forcibly based on a limited reference population, which doesn’t adequately reflect the millions of horses in the world. The individual environmental and mental conditions for each horse and its day-to-day gait variations are also not accounted for. On this basis to use the term ‘lame’ because a horse demonstrates a subtle gait alteration, causing it to fall below the threshold, could be inappropriate, particularly as it may not affect the horse’s welfare in any way.
Professor Celia Marr, Editor of the Equine Veterinary Journal said: "An important first step is for researchers and clinicians to start to discriminate clearly between 'asymmetry' and 'lameness' and not to use these as interchangeable terms when interpreting gait analysis data. Asymmetry is often, but not always, a hallmark of lameness, but is not a clinical term, whereas lameness is."
Professor Van Weeren said: "Digital equine gait analysis is sure to become an indispensable additional tool for clinical decision-making. At this early stage we must define the use of terminology in order to avoid confusion and to prevent the formation of wrong perceptions. Using the term 'lame' for any horse falling beyond thresholds set for quantitative gait analysis or not showing the ideal motion pattern when assessed clinically is inadvisable. We should reserve the use of that term for horses deemed unfit to compete based on a comprehensive assessment of the animal that includes, but does not rely entirely on, the appreciation of the degree of gait asymmetry."
The paper is available free online at: http://onlinelibrary.wiley.com/doi/10.1111/evj.12715/full
The first part of the charge was that, between 3 November 2014 and 10 December 2016 he did not provide CPD records to the RCVS requested in four separate letters dated November 2014, September 2015, November 2015 and November 2016. The second part of the charge was that, between 11 December 2016 and 26 July 2017, he did not provide the RCVS with his CPD records despite requests.
Dr Zukauskas admitted to the charge against him at the outset of the hearing.
The Committee considered whether Mr Zukauskas’ failure to respond to requests for his CPD records constituted serious professional misconduct.
The Committee found that he had breached the RCVS Code of Professional Conduct for Veterinary Surgeons by not responding to the repeated requests for information from the College, although the Committee noted that there had not been total silence. Mr Zukauskas had made email contact on at least two occasions in response to RCVS letters and gave evidence that he had attempted to phone the authors of the letters. The Committee also noted that in early February 2017 Mr Zukauskas had made repeated attempts to give the RCVS access to his online CPD account, which he had been updating to reflect CPD work that he had undertaken.
Mr Zukauskas’ explanation for his failure was that he had not fully appreciated the importance of the letters, that his English was poor, and that he failed to obtain appropriate advice about the content of the letters until recently. It was only in a witness statement dated 27 July 2017 that he finally disclosed his full CPD records.
The Committee noted Mr Zukauskas' admission in his evidence that his English was not good, particularly in light of the obligation, brought into the Code in February 2016, for veterinary surgeons to be able to communicate effectively in written and spoken English.
Chitra Karve, chairing the Committee and speaking on its behalf, said: "From that date, if not earlier, the respondent should have been concerned to understand English sufficiently well to address the correspondence from the College. Whilst the Committee did not consider that his conduct in this respect amounted to disrespect, it did consider that he had shown a disregard of his obligations.
"At all times he could and should have made appropriate efforts to respond to the correspondence from the College and obtain appropriate advice. In effect he put off dealing with these matters and put his head in the sand."
Regarding his failure to respond to requests between December 2016 and July 2017, Ms Karve added: "This caused the College a considerable amount of concern and extra work. Had he done so much earlier, much of this matter would have been avoided. The respondent was once again in breach of his obligations."
Having found Mr Zukauskas guilty of serious professional misconduct in relation to both parts of the charge the Committee then considered its sanction against Mr Zukauskas, taking into account the fact that the Veterinary Nurse Disciplinary Committee had recently suspended a veterinary nurse from the Register for a period of two months having found her guilty of similar charges.
In mitigation the Committee considered a number of testimonials from colleagues and clients, his hitherto long and unblemished career in the United Kingdom, and his open and frank admissions and subsequent efforts to avoid repetition of his behaviour. Language problems were also considered as an explanation for why the situation had occurred. However, it also considered the aggravating factor that the misconduct was sustained over a period of time and that there was unacceptable disregard for the obligations he had to the College as a veterinary surgeon.
In summing up Ms Karve said: "The Committee has determined to impose a reprimand. In doing so it acknowledged that the respondent has shown considerable insight into his behaviour. He had acknowledged that he has needed help in communicating with the College. It noted that he is a good and proficient veterinary surgeon in the work which he undertakes. He expressed remorse for his behaviour. He has carried out sufficient CPD and since December 2016 has been communicating with the College. The Committee considers it unlikely that he will transgress again.
"The Committee has decided that it is appropriate in this case to add a warning to the decision to impose a reprimand. It is mindful of the fact that other veterinary surgeons registered with the College have a duty to discharge their CPD obligations and they honour those obligations. Moreover, the conduct of the respondent has involved a considerable amount of work and expense for the College."
The warning was that in future Mr Zukauskas must respond in a timely and appropriate manner to any communications from the RCVS.
In addition to enhancing current standards of veterinary dentistry, the WSAVA says it hopes that the guidelines will help to bridge what it perceives as a significant gap in veterinary education globally and to encourage a greater emphasis on dentistry in the veterinary curriculum.
The WSAVA’s Global Dental Guidelines include information and images of oral anatomy and common pathology, as well as best practice recommendations for oral examinations and an easily implementable dental health scoring system.
Evidence-based guidance on periodontal therapy, radiology and dental extractions is also included, together with details of minimum equipment recommendations.
A key theme is the WSAVA’s rejection of anesthesia-free dentistry (AFD), which it describes as ineffective and a cause of unnecessary stress and suffering to patients.
The guidelines have been developed by the WSAVA’s Global Dental Guidelines Committee (DGC) whose members include veterinary dentists from five continents, together with representatives from the WSAVA’s Global Pain Council, Global Nutrition and Animal Wellness and Welfare Committees. They are based on the WSAVA’s three-tier continuing education system to ensure that they are relevant for all veterinary surgeons, whether they are working in an advanced hospital setting or in a clinic in a country in which companion animal practice is still developing.
Dr Brook Niemiec, a Board-Certified Specialist in Veterinary Dentistry of the American and European Veterinary Dental Colleges and a Fellow of the Academy of Veterinary Dentistry, is Co-chair of the WSAVA DGC.
He said: "Dental, oral and maxillofacial diseases are, by far, the most common medical conditions in small animal veterinary medicine. They cause significant pain, as well as localized and potentially systemic infection but, because pets rarely show outward signs of disease, treatment is often delayed or not performed with a corresponding impact on the welfare of the patient. In developing the Global Dental Guidelines, we felt that the lack of perception of patient pain was a key issue.
"Our Committee members were also unanimous in their opposition to AFD. We believe that anesthesia is essential for the execution of any useful dental procedure and this is a central recommendation of the Guidelines. To support it, we have provided a detailed analysis of anesthesia and pain management approaches."
He added: "Our patients are not well served by the current variation in standards of care, level of equipment and procedural knowledge of dentistry. Misinformation which clouds the sector is a further hindrance. As clinicians, we cannot allow a fear of the unknown, the discomfort of client pushback or ignorance of current techniques to keep us from doing our best to relieve pain and suffering in our patients.
“We are delighted to launch the WSAVA’s Global Dental Guidelines, which are free to download at http://www.wsava.org/guidelines/global-dental-guidelines. We are equally delighted to announce that 22 of our member associations have already endorsed them. It is our firm intent that they will be the first step in changing the way that dental disease is perceived in the veterinary profession and in improving dental treatment in companion animals worldwide. We are grateful to our sponsors, Addison Biological Laboratory, Boehringer Ingelheim, Hill’s Pet Nutrition, KRUUSE and Virbac for supporting this important project."
The new guidelines strongly recommend an overall reduction in the use of all classes of medically important antibiotics in food-producing animals, including complete restriction of these antibiotics for growth promotion and disease prevention without diagnosis. Healthy animals should only receive antibiotics to prevent disease if it has been diagnosed in other animals in the same flock, herd, or fish population.
WHO says that where possible, sick animals should be tested to determine the most effective and prudent antibiotic to treat their specific infection. Antibiotics used in animals should be selected from those WHO has listed as being "least important" to human health, and not from those classified as "highest priority critically important", as they are often the last line, or one of a limited number of treatments available to treat serious bacterial infections in humans.
The new guidelines were informed by a systematic review published in The Lancet Planetary Health which found that interventions that restrict antibiotic use in food-producing animals reduced antibiotic-resistant bacteria in these animals by up to 39%1.
Dr Kazuaki Miyagishima, Director of the Department of Food Safety and Zoonoses at WHO said: "Scientific evidence demonstrates that overuse of antibiotics in animals can contribute to the emergence of antibiotic resistance. The volume of antibiotics used in animals is continuing to increase worldwide, driven by a growing demand for foods of animal origin, often produced through intensive animal husbandry."
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO said: "A lack of effective antibiotics is as serious a security threat as a sudden and deadly disease outbreak. Strong, sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance and keep the world safe."
Responding to the announcement, BVA Senior Vice President Gudrun Ravetz said: "We welcome the WHO continuing to tackle this serious global health issue. Their guidelines echo the guidance BVA has long been issuing on the responsible use of antimicrobials.
"We agree that the prophylactic use of antimicrobials in healthy animals to prevent disease is never a substitute for good animal husbandry and management.
"Through cross-sector working, the UK is leading the way in significantly reducing antimicrobial usage, having already achieved the UK Government usage targets set for 2020.
"Critically Important Antimicrobials use is at a very low level in the UK, and, as recent Government data shows, is continuing to decrease. It is encouraging that WHO recognises that these vital medicines are sometimes needed, under veterinary judgment and prescription, as a last resort, to prevent the further spread of disease and to protect animal and human health."
The new guidelines can be downloaded here: http://www.who.int/foodsafety/areas_work/antimicrobial-resistance/cia_guidelines/en/
RSA has confirmed the initial 27 practices that have joined its new Preferred Referral Network, launching today.
The creation of the network means that whilst veterinary surgeons can continue to appoint referral practices as they do now, owners of animals needing a non-emergency referral outside the RSA network may need to pay £200 towards the cost of treatment.
The new rules currently apply to holders of policies issued by Tesco Bank and MORE TH>N, however RSA says it is in discussion with other insurance brands about adopting the new network.
RSA says the Preferred Referral Network will enable it to provide competitively priced products and deliver a range of benefits for customers including:
The company is highlighting the fact that its new network fields 178 RCVS, EBVS or AVMA recognised specialists, 49 Diploma holders and 71 Certificate holders or Advanced Practitioners, working at a mixture of large, multi-disciplinary centres (including five with links to university teaching hospitals), independents and corporates.
RSA says that over the last 12 months, vets have directed more than half of all RSA cases to the 27 practices in its network.
Bill Paton, Claims Director for UK and Western Europe said: “We are delighted to have twenty seven practices from around the UK join our preferred referral network. This is a huge step forward and will enable us to continue to provide competitively priced insurance cover with access to the highest standards of veterinary treatment and care.
"We expect further practices to join the Network in due course and we are actively engaged in discussions with a number of referral practices of varying size and scale, which have expressed an interest in joining."
The 27 referral practices are:
South East
South West
Midlands
North East
East
Scotland
* referral arrangements still being finalised
Biobest is highlighting the benefits of using its canine prostate specific arginine esterase (CPSE) test to differentiate between those dogs which have benign prostatic hyperplasia and those suffering more serious conditions, such as neoplasia.
Benign prostatic hyperplasia is a common condition of entire dogs with over 50% of dogs over 5 years of showing histological evidence of BPH.
Paul Burr MRCVS from Biobest said: "While the clinical stages of prostatic disease are not difficult to diagnose, differentiating BPH from other causes of prostatic disease such as prostatic cysts, prostatitis, prostatic abscesses or neoplasia is less simple. Traditionally further investigation would include bacteriology and cytology on a prostatic wash or final needle aspirate, and prostatic ultrasonography."
Although the CPSE test has been available for a couple of years now, Paul says the benefits of the test have not thus far been well-explained: "I think most vets probably think it's just a test for Prostatic Disease, something which is easy enough to diagnose without testing.
"While the test can be used as part of an annual check up to look for pre-clinical BPH in entire male dogs, it's real value is that it is a simple, convenient non-invasive blood test that helps determine whether a dog presenting with signs of prostatic disease is most likely to be suffering from BPH or a more serious condition that requires further investigation."
For more information about the CPSE test, contact Biobest on 0131 440 2628 or email enquiry@biobest.co.uk.
The RCVS and the BVNA have launched VN Futures, a companion project to Vet Futures, which aims to draw up a blueprint for the future of the veterinary nursing profession.
One of the recommendations of the Vet Futures report (Taking charge of our future: a vision for the veterinary profession for 2030), which was published in November 2015, was to “encourage veterinary nurse leaders to develop a report and recommendations which are directly relevant to veterinary nurses and their future...”.
Following a joint meeting between the RCVS VN Council and the Council of the BVNA in October 2015, it was decided that a ‘VN Futures’ project would provide the relevant leadership and engagement to achieve this.
An initial meeting with a broad range of stakeholders took place at the RCVS on 7 January 2016, and, following this, a VN Futures Action Group has now been established to take the project forward, with the aim of delivering an action plan at the Vet Futures Summit in the summer.
The Action Group includes a mix of individuals involved in the training, representation, regulation, employment and management of veterinary nurses. The biographies of the team are available at www.vetfutures.org.uk/vnfutures.
The timeframe under consideration for Vet Futures is until 2030, however, it was considered that a five-year timeline may be more appropriate for veterinary nursing, given that it’s a younger profession, the retention rate is lower, and the training cycle is shorter.
The VN Futures project is running a series of evening meetings to engage with VNs and those involved in the profession, as follows:
The meetings are free to attend and will start at 6.30pm, with a buffet supper. For more information and to register, please visit: www.vnfutures.eventbrite.com
Liz Cox, Chair of the RCVS VN Council, said: “The VN Futures project aims to deliver an action plan that will help take the veterinary nursing profession into its next phase of development. With the new Charter now in place, and a willingness from Defra to review Schedule 3, the time is ripe for us to take control of what happens next.
“The key to VN Futures’ success will be collaboration – I am delighted that we are working with the BVNA on this, together with other representative bodies – and also engagement: we want to hear VNs’ aspirations for their profession to ensure our action plan is as relevant and far-reaching as possible. I look forward to seeing a good turn-out for our roadshow events.”
Sam Morgan, BVNA President, said: “BVNA is delighted to be working alongside RCVS VN Council on this project. We fully believe in the importance of the veterinary nurse within practice and think this project can help shape the future of the profession. Being involved in the Vet Futures project, via BVA, was an eye-opener, and that only just touched on our own profession; we now have the chance to look at veterinary nursing specifically, and it is an opportunity not to be missed. Knowing where we want to take the profession will make it so much easier to reach the goal.”
The Society for Practising Veterinary Surgeons (SPVS) has published its 2015 Fee Survey, which has revealed an increasing divergence between fees charged for routine and unroutine procedures in small animal practice.
SPVS says that small animal practices accounted for the largest proportion of responses to its survey, and that 75.9% of them had increased their fees during the last 12 months. When comparing a 'bundle' price comprising a kitten vaccination course, puppy vaccination course, cat spay, dog spay and consultation, the increase was 4.09%. However SPVS notes that this increase may be artificially low, as it relates to the sort of procedures that are regularly quoted and may therefore be constrained by the marketplace.
Perhaps more revealingly, whilst routine procedures such as vaccination had risen 3.3%, non routine procedures had risen by considerably more: pyometras were up 15.6%, cat dentals were up 17.5% and out-of-hours callouts were up 18.6%.
Equine fees showed an overall drop of 3.5% on the bundle price comprising initial routine examination, five-stage PPE, routine dental examination and float, a colic examination and the cost of sedation / waiting. Although many of the individual equine procedures showed a fee decrease, 79% of equine practices reported that they had increased fees over the past year. The largest decrease in equine fees was for sedating a horse and waiting while the horse was clipped or treated by an equine dental technician, with the fee charged being 12.5% less than last year and ranging from £12.50 to £93.82. Conversely, conducting an ultrasound scan of a mare for pregnancy had increased by 17.3% and ranged from £20 to £62.36.
For large animal vets, the fees are more tightly constrained by the commercial realities of farming and the range of fees quoted tends to be lower. This year, the overall price rise for the bundle of fees comprising routine calving, foot trimming, elective Caesarean and hourly rates for fertility work and herd health schemes was 4.1%. However, only 47.8% of large animal practices reported an increase in fees charged over the last twelve months. The largest increase reported was for paring the hind feet of a cow without sedation, which was up 24.4% and ranged in price from £19 to £70, while issuing a prescription to a farm animal client had decreased by 1.6% and ranged in price from 0 to £48.
Nick Stuart, SPVS president said: "We all know the industry is facing real challenges and this is reflected in the fee survey, with equine practices in particular decreasing many of their prices on last year. However the survey also shows that the fees vets charge vary widely, particularly in the small animal sector. While some of this can be accounted for by differing overheads, it does provide a fascinating insight into the various financial models that exist and challenges practice owners to review how they construct their fees. It also suggests that there is scope for practices to grow their profitability and understanding the market will help them with this.
"We have a new benchmarking service from Veterinary Insights that will help practices to set more accurate fee levels and we will be developing our fee survey further so that it dovetails with this service. I would urge practices to join SPVS and access the invaluable data we produce to help them grow their businesses."
For more information, a copy of the survey, or to join SPVS visit www.spvs.org.uk
Blue Cross has announced the results from its National Equine Health Survey (NEHS) which show that lameness is three times more likely to be caused by conditions such as osteoarthritis in the limb rather than problems in the foot.
Blue Cross runs NEHS in May each year, in partnership with the British Equine Veterinary Association (BEVA). It is sponsored by SPILLERS and Zoetis and supported by the UK’s leading equestrian organisations and charities. This year saw a 35% increase in participation compared to 2014, with survey records returned for almost 15,000 horses, ponies, donkeys and mules.
The charity says that whilst of course the horse’s foot is fundamental to soundness and performance, NEHS results have shown consistently that limb lameness, as opposed to foot lameness, is in fact the biggest syndrome affecting horses.
In the latest survey, conducted in May, a total of 18% were recorded as lame. 13.5% of these were recorded as suffering with lameness such as osteoarthritis, also known as degenerative joint disease (13.9% in 2014 and 14.8% in 2013).
Meanwhile foot lameness was recorded in 4.5% of returns, a similar figure to previous years.
Josh Slater from the Royal Veterinary College, who is member of BEVA’s Health & Medicines Committee and analysed the NEHS data, said: “NEHS is now producing important evidence that is replacing subjective opinion. While the lameness figures were initially surprising, given that the foot has been generally regarded as the main problem area, the fact that these figures have remained consistent over the past three years gives constructive credibility to the data. Our findings will help owner vigilance with day-to-day healthcare as well as help prioritise on areas for future veterinary education and research.”
The six most notable disease syndromes identified in the 2015 National Equine Health Survey were:
23.2% of horses were reported as being overweight with a Body Condition Score of 3.5-5, continuing the upward trend seen in previous years (16.9% in 2014 and 7.8% in 2013). Next year’s survey will explore links between obesity and the possible associated rise of obesity-related diseases such as equine metabolic syndrome (which was reported in 2.4% of 2015 returns) and laminitis.
The survey also enables participants to report on any health problems not covered in the survey questions, giving them a chance to shape future survey subjects.
Gemma Taylor, Education Officer at Blue Cross explains: “This year 11% of our free text answers mentioned gastric ulcers giving a valuable insight into the prevalence gastric ulcer syndrome in the principally leisure horse NEHS population. As a result we will be adding new questions to the 2016 survey to help us find out more.”
The 2015 NEHS survey results are now available from http://www.bluecross.org.uk/nehs2015results. To register for next year’s survey, visit www.bluecross.org.uk/nehs
Davies Veterinary Specialists (DVS) has announced that it has completed development work on its premises in Higham Gobion, Hertfordshire, to improve capacity and workflow for diagnostic procedures including MRI, CT and endoscopy.
The new development includes the construction and outfitting of an anaesthesia induction room with two state-of-the art stations, a diagnostic imaging viewing room, a further ultrasound and procedures room and office space for the nurse supervisor team. The rooms were built inside the site’s central barn as the next phase of DVS’s ongoing expansion programme, which has recently seen the completion of a new staff room and upgraded kennels and cattery facilities.
Clive Elwood, Managing Director of DVS said: “We first acquired the barn space in 2004 and initial construction included MRI and CT rooms with the plan of completing further rooms as needs arose. This latest development has already had a big impact on workflow and allows us to optimise the use of our diagnostic equipment. It represents our continued commitment to growth and development so that we can serve our customers to the best of our ability. I am very grateful to all of those who contributed to the project and showed necessary patience during construction.”
DVS now employs more than 35 specialist clinicians, 60 nurses, many with an advanced nursing qualification, and 30 administrators and support staff.
For further information visit www.vetspecialists.co.uk. You can also follow DVS on Facebook at http://www.facebook.com/DVSvets.
Locum David John Porter has been struck off by the RCVS Disciplinary Committee for rude and aggressive behaviour, deficient clinical standards and obstructing the Committee's investigation into the complaints against him.
Three charges were found against Mr Porter.
The first charge (charge A) concerned failure to communicate courteously and respectfully with colleagues. This charge related to four incidents as follows:
In finding him guilty of this charge the Committee referred to his “wholly unacceptable exchanges with other veterinary surgeons and veterinary nurses and ancillary practice staff members with whom he was working on the dates in question.”
The second charge for which he was found guilty (charge C) concerned what the Committee called “his seriously deficient clinical standards when treating animals under his care”, in particular that:
Within charge C he was cleared of two further parts of the charge – first, that he failed to discuss euthanasia with a client in relation to a kitten and failed to provide the client with sufficient advice and instructions regarding after-care; and, second, that he prescribed steroids to treat a kitten for muscle strain at a time when it was recovering from surgery.
The third charge for which he was found guilty (charge D) relates to Mr Porter’s failure, between 7 February 2013 and 31 October 2014, to respond adequately to communications from the RCVS. In particular that:
As to the conduct found proved in relation to charge D, the Committee set out its findings of fact and declared: “What Mr Porter chose to do was to attempt to obstruct the College in its attempts to investigate the complaints laid against him and, thereafter, its attempts to bring him before the Committee to answer the charges preferred against him. In short, he has directly questioned, and then disregarded and thwarted, the legitimate role of his professional regulatory body.”
The Committee’s reasons for taking a serious view of such conduct were expressed in the following words: “Both the public and other members of the profession must be entitled to rely on the expectation that all veterinary surgeons, as responsible professional persons, will co-operate fully and promptly to all proper enquiries made of them by the College. This is the wider public interest factor which means that deliberate attempts to thwart the College’s enquiries into complaints must, in our judgment, come at the top end of the spectrum of gravity of disgraceful conduct in a professional respect.”
During the course of the hearing, which began in June 2015 and was adjourned three times, Mr Porter was cleared of charge B against him which concerned alleged refusal to undertake out-of-hours work for the Clent Hills Veterinary Group having previously indicated he would undertake such work.
In making the decision on the sanction in this case, Judith Webb, chairing the Disciplinary Committee and speaking on its behalf, said: “In reaching our conclusion as to the sanction which is merited in this case we have taken into account the totality of Mr Porter’s conduct and failings. We consider that the conduct pertaining to Charges D(i) and (ii), even when viewed separately, demand the imposition of a direction for the removal of Mr Porter’s name from the Register.
“When that conduct is considered in conjunction with the other misconduct found proved in relation to Charges C1 to C4, which identify his clinical failings, and Charges A1 to A4, which demonstrate unprofessional behaviour in the workplace, we unhesitatingly conclude that there is no other sanction that could be considered sufficient, other than that of erasure.”
Dr. Lauren Finka, a researcher at the University of Lincoln, has developed L-CAT, a new tool for assessing behaviour in cats at rehoming centres and help match them to the ideal new home.
During the course of her PhD studies, which were part funded by COAPE (Centre of Applied Pet Ethology), Lauren discovered inconsistencies in the current models and perceptions of behaviour traits used in re-homing cats.
For example, one of the most common behaviours associated with affection towards humans is the activity of rubbing. Initial results suggested that this is often very inconsistent, as are several other behaviours that were previously thought to to be important in assessing a cat's underlying temperament. Dr Finka’s studies showed that it all depends much more on the specifics of the physical and social context of interactions and that these may change on a daily basis. It was found that on one day a cat might rub against a person ten times, but the next day rub against the same person only once.
The Lincoln Cat Assessment Tool (L-CAT) was developed during this research. COAPE says it is the first of its kind to offer a suitably robust, reliable and easy-to-use way of assessing behaviour in cats at re-homing centres, as well in predicting new owner satisfaction based on those assessments.
The organisation goes on to say that the potential welfare implications of this research are substantial, enabling cats to be properly but rapidly assessed, optimally managed, and suitably matched with would-be owners and thus shortening the length of time cats might spend in the re-homing centre.
L-CAT was tested to establish the possibility of predicting the future behaviour of cats after they had been adopted, as well as gauging how satisfied owners were likely to be with their cats. COAPE says the results generally confirmed that these outcomes were indeed possible, meaning re-homing staff could also use L-CAT to help manage the expectations of owners and potentially improve their satisfaction.
For more information, visit: www.coape.org