Posted Sept. 30, 2015
The past 100 years have seen a marked shift in the role of animals in society, with most Americans now regarding their pets as family members. Client expectations have evolved, and pet owners are increasingly demanding the same sophisticated treatment options for their animals as they expect for themselves. One example of this trend is the growing interest in minimally invasive procedures in veterinary medicine, reflected in the publication during this decade of numerous single and multicenter case series and clinical reports describing a variety of promising laparoscopic, thoracoscopic, and endoscopic interventional procedures, particularly in small animal patients. Examples include reports describing the outcome for cats with benign ureteral obstructions treated with endoscopic ureteral stenting by Dr. Allyson Berent et al, the results of endovascular treatment of intrahepatic portosystemic shunts in dogs by Dr. Chick Weisse et al, and the results of thoracoscopic-assisted lung lobectomy in dogs by Dr. Chloe Wormser et al, all published in 2014.
||Drs. Boel Fransson and Claude Ragle work in the Veterinary Applied Laparoscopic Training
Laboratory at Washington State University. JAVMA published multiple articles on
laparoscopic simulation training from 2005-2015 as veterinarians worked to acquire new
skills. (Photo courtesy of Henry Moore/Washington State University College of Veterinary
Nonetheless, definitive benefits of minimally invasive procedures described for human patients, such as decreased signs of pain and rapid return to usual activities, are not yet evident for veterinary patients, and challenges remain in efforts to accumulate robust evidence in support of these newer procedures. As such, JAVMA has also published studies comparing laparoscopic or laparoscopic-assisted techniques with more traditional open techniques, such as for adrenalectomy in dogs, cystotomy in dogs, and cryptorchidectomy in horses, with mixed results to date. Dr. Richard Hartman et al updated a 1978 JAVMA article on cryptorchidectomy, including laparoscopic cases, providing an important historical perspective, with the two articles now comprising the largest series of cases published for this common procedure in horses. As clinicians continually refine their technical skills, specific training in minimally invasive techniques and procedures has been an essential foundation, and JAVMA has published articles evaluating various aspects of this training. Notable papers by Dr. Boel Fransson et al were published in 2010 and 2012 evaluating how various aspects of physician laparoscopic simulation training may contribute to the acquisition of laparoscopic skills by veterinarians. Dr. Heather Towle-Millard et al evaluated the relationship between video gaming proficiency and laparoscopic skills, while Dr. Jeffrey Runge et al evaluated the surgical learning curve for laparoendoscopic ovariectomy with a skill acquisition model.
We did not evaluate the success of treatment of tendonitis, but rather the effect of injury and treatment on the horse’s ability to perform. … In our clinical practice, this is the information the owner wants to know when assessing prognosis prior to treatment.”
“Racing performance of Thoroughbreds with superficial digital flexor tendonitis treated with desmotomy of the accessory ligament of the superficial digital flexor tendon: 332 cases (1989–2003)” in the June 15, 2014, issue
In 2006, the catastrophic breakdown injury suffered by the Thoroughbred colt Barbaro during the Preakness Stakes captured international attention. The care and treatment of this patient was an exemplary illustration of a multidisciplinary approach to the management of complex cases in the current era. Clinicians in comparable treatment settings continue to work to measure outcomes for similar patients, with studies published in JAVMA in 2013 and 2014 evaluating the long-term prognosis for neonatal foals treated at a referral center for colic and the ability of Thoroughbreds to return to racing after colic surgery. Dr. Ashley Hill et al evaluated risk factors for and outcome of noncatastrophic suspensory apparatus injuries in Thoroughbred racehorses in a 2001 study, with additional articles in 2012 by Dr. Tiffany Sarrafian et al and in 2014 by Dr. Scott McClure et al evaluating characteristics of fatal musculoskeletal injuries in Quarter Horse racehorses. A 2014 study by Drs. Alaine Hu and Larry Bramlage examined medical and performance records to evaluate the likelihood of return to racing and career longevity for 332 Thoroughbreds with superficial digital flexor tendinitis treated with superior check ligament desmotomy. Reports of biologic treatments such as the use of platelet-rich plasma for soft tissue injuries in horses were also published, as treatment interventions progressed beyond traditional surgery.
||Dr. Larry Bramlage performs desmotomy of the accessory ligament of the superficial digital flexor tendon (superior
check ligament desmotomy). In the June 15, 2014, issue, Drs. Alaine Hu and Bramlage reported that for 332
Thoroughbred racehorses treated with check ligament desmotomy over a 15-year period, 69 percent successfully
returned to racing when outcome was evaluated with objective, third-party racing data. (Photo courtesy of Rood &
Riddle Equine Hospital)
The financial crisis of the late 2000s particularly affected food animal practice. Although JAVMA continued to regularly publish high-quality articles covering all aspects of food animal medicine, commentaries and special reports highlighted important issues and challenges in terms of attracting veterinary students interested in food animal practice as well the challenges of adapting to meet changing needs.
Reflecting the increasing emphasis in biomedical research on quality and transparency of reporting, JAVMA published several important articles addressing the design of published veterinary clinical trials. Dr. Dorothy Brown evaluated control of selection bias in 2006, and Dr. Michelle Giuffrida et al evaluated the use of blinding terminology in 2012 and type II error and statistical power in 2014. Several commentaries also addressed evidence-based medicine and clinical decision making.
As we look toward the next decade, our ability to accumulate high-quality evidence and effectively evaluate outcomes remains an ongoing challenge. Nonetheless, JAVMA will continue to serve as a vehicle for the veterinary profession’s collective efforts toward improving patient care.