Evidence-Based Veterinary Medicine Matters: Our Commitment to the Future represents the first time that such a broad and influential group has united in support of a single issue in the veterinary profession.
The publication contains a number of case studies which illustrate the impact that evidence can have – and has had – on animal health and welfare. It also provides a rationale for veterinary professionals to contribute to the evidence base and put evidence into practice, to the benefit of animals, owners and veterinary teams themselves.
The signatories to the commitment are:
Animal and Plant Health Agency
British Cattle Veterinary Association
British Equine Veterinary Association
British Small Animal Veterinary Association
British Veterinary Association
British Veterinary Nursing Association
RCVS Knowledge
Royal College of Veterinary Surgeons (RCVS)
Royal Veterinary College
University of Bristol
University of Cambridge
University of Liverpool
University of Nottingham
University of Surrey
Veterinary Policy Research Foundation
No sign of the BAHVS, I see.
Jacqui Molyneux, Chair of the Board of Trustees of RCVS Knowledge, said: "Evidence-Based Veterinary Medicine Matters is a milestone publication for the professions, representing the first time the majority of the key institutions have aligned under the same EBVM banner.
"A celebration of decades of incredible discoveries, achievements and improvements in animal health, it also serves to remind us that even the earliest forms of veterinary medicine were underpinned by evidence."
UK Chief Vet Christine Middlemiss said: "What’s the evidence? An evidence-based approach is vital in all areas of our profession, whatever is keeping you awake at night. For me, it is the threat of African swine fever and avian flu. The evidence I rely on comes from our specialist surveillance monitoring and testing, veterinary epidemiologists and disease modellers. It enables me to make timely, proportionate risk-based decisions that stand up to scrutiny.
"If you are managing veterinary care in practice, the evidence you rely on to underpin your standards of clinical care comes from multiple sources too. Evidence-based veterinary medicine allows us to refine and tailor strategies to be effective and efficient, making full use of existing and new technologies.
"The profession has taken great strides towards embracing evidence-based veterinary medicine and building on this will strengthen the links between clinical decision-making, policy development and future research."
Chris Gush, Executive Director of RCVS Knowledge, added: "We are impressed by the contributions from our co-signatories, which clearly demonstrate the phenomenal impact on patient outcomes that conducting research and using evidence can have. We are also delighted that Sense about Science, a flagbearer for evidence, transparency and rational thinking, has joined with us to highlight the many benefits EBVM can bring.
"The publication also makes a strong case for much-needed funding for research to grow the evidence base, which would put powerful, robust data into the hands of veterinary professionals as they make critical decisions that can affect patient outcomes.
"It is our hope that the calibre, diversity and sheer number of the organisations putting their name to this commitment will galvanise all vets and their teams to expand their use of evidence in practice."
Rebecca Asher, Deputy Director at Sense about Science, said: "This is a showcase of game changers in veterinary care and we hope it will inspire and motivate everyone in the profession.
"We were delighted that RCVS Knowledge approached us to collaborate with them and other leading institutions in the veterinary research community to affirm their commitment to an evidence-based approach to veterinary medicine.
"Everyone expects treatment for humans to be underpinned by evidence. We now expect the same of the whole veterinary community when it comes to the treatment of animals."
The full commitment and portfolio of case studies can be read in Evidence-Based Veterinary Medicine Matters, available for free online: bit.ly/EBVMMatters.
Through the new service, which is designed to save clients' time and improve compliance, practices can arrange for owners to receive Bravecto for 12 week flea and tick control, together with the wormer of the vet's choice for six months to a year.
To use the new service, practices need to register clients on a portal provided by Easy Direct Debit (EDD) during the appointment. The first prescription is then dispensed at the practice with subsequent prescriptions sent direct to the owner in the post.
Amanda Melvin, Marketing Manager at MSD Animal Health said: "We launched VetsDeliver at the London Vet Show and had an extremely positive response.
"It is designed to build on the trust pet owners already have with their veterinary practices and adds convenient delivery to their door that is now familiar to most consumers. All branding and packaging has been designed to be eye-catching while communicating a high quality, professional service that reflects the quality of the veterinary practice.
"Furthermore, VetsDeliver will be the first service to offer 12-week flea and tick protection and provide the practice with the ability to add its wormer of choice. It’s easy for vets to sign-up clients and by offering Bravecto we reduce the number of deliveries and packaging required compared to monthly treatments."
Amanda added: "Vet practices remain an important source of reminders for owners to apply respective parasite treatment, however, it is mostly owners themselves (65%1) who try to remember the treatment.
"VetsDeliver builds on the advantage of the well-established bond between veterinary practices and owners to improve the reminding system. The service will ensure these reminders coincide with the delivery of the product so veterinary practices play an even bigger role in aligning the service to the personal needs of owners."
For further information contact your MSD Animal Health account manager or visit: www.msd-animal-health-hub.co.uk/vetsdeliver .
Reference
Lecture topics will include interesting cases, the importance of systematic abdominal technique, the challenge of becoming ultrasound competent within a primary referral setting, basic anaesthetic nerve blocks, using ultrasound for appropriate medical management, how CASE can support competency based veterinary ultrasound training and more.
The session will end with a debate on whether it is time for a formal / stand alone Veterinary Ultrasound training programme and who should accredit such courses.
Speakers include Natasha Dickinson from Cave Veterinary Specialists, Niamh Casey from Village Vets, Miguel Martinez from Northwest Veterinary Specialists, Will Humphreys from the University of Liverpool and Nuala Summerfield from Virtual Veterinary Specialists.
The day costs £75 (sounds like a steal, if you ask me), and you can register here: https://www.bmus.org/meeting-booking/ultrasound-2019/
There's a complimentary counter top unit and pillow packs to help veterinary surgeons and nurses communicate the benefits of probiotics to clients. The unit can hold a cat and dog 30 sachet box of Purina Pro Plan FortiFlora from practice stock and the pillow packs can be used to dispense single sachets, so the client can trial the product with their pet at home.
At the same time, the company is encouraging vets and nurses to look at the evidence behind the probiotics they recommend. Although carried out a while ago now (2003 and 2011), two studies have shown that other diets claiming to contain probiotics generally did not meet the label claim when evaluated1,2.
Libby Sheridan, MVB MRCVS, Purina Veterinary Technical Affairs Manager, UK & Ireland says the efficacy of probiotics is thought to be strain-specific3 and recommends that clinicians critically assess the evidence for the particular strain and preparation of probiotics stocked or used.
Libby said: "The quality and efficacy of probiotics can vary and while in some cases there is strong evidence for efficacy in the targeted species, for others, the evidence is scant. Having experienced it myself, I know it's not always easy when working in a busy practice to take the time to ensure the evidence is there, but the studies back up that we should assess these things carefully before making a robust recommendation to our clients."
Most of the probiotics commercially available to veterinary professionals use the lactic acid bacterium Enterococcus faecium.
The particular strain and preparation of any probiotic will affect its ability to reach the large intestine, the expected site of action, intact. The evidence for the SF68 strain of Enterococcus faecium has been validated in a number of studies4-11 over recent years. Proven benefits of the SF68 strain include those focused on the gastrointestinal system where it supports canine and feline intestinal health and microflora balance and those with wider implications, such as support for a healthy immune system.
To obtain a unit or discuss the science, contact your Purina Veterinary Nutrition Partner or telephone the Purina Veterinary Nutrition Team on 0800 212161 quoting code VETPRESS.
References
The grant has been awarded to Dr Carri Westgarth, a Lecturer in Human-Animal Interaction at the University of Liverpool, for her project entitled Using citizen science to develop a ‘Canine Ageing and Wellbeing’ tool for use in veterinary practice.
Dr Westgarth’s initiative aims to determine what senior dog preventative healthcare and treatment advice is currently offered in UK veterinary practices and then take steps to build a practical tool to facilitate knowledge-sharing between owners and veterinary professionals.
Carri said: "Dogs are living up to twice as long as they did 40 years ago and there are implications for senior dogs’ healthcare and wellbeing.
"As life expectancy increases, so does the amount of time spent in poor health. Many dog owners may not be aware of the signs of serious age-related diseases as they attribute them to normal age-related changes."
The Citizen Science project will investigate owner expectations, experiences and attitudes to ageing in dogs, including preventative care and general understanding of normal and abnormal changes during ageing.
A number of in-depth interviews and questionnaire surveys with veterinary professionals and dog owners will be conducted, and pet owners will be invited to submit diaries, photographs or videos to share their experiences of living with an older dog. The study will also examine electronic health records of senior dogs reported in the Small Animal Veterinary Surveillance Network.
The findings will be used to develop the Petsavers Canine Ageing and Wellbeing tool, to guide on best practice discussions in consultations with senior dogs.
In next year's election, there are three places on Council for elected veterinary surgeons, with successful candidates serving four-year terms.
The nomination period runs until 5pm on Friday 31 January 2020. In order to stand, candidates need to complete a nomination form, submit a short biography and personal statement and supply a high resolution digital photo.
Each candidate also needs to have two nominators who need to be veterinary surgeons who are on the RCVS Register but are not current RCVS Council members.
Eleanor Ferguson, RCVS Registrar and Returning Officer said: "As always, we would encourage those who are interested in having their say in some of the key debates in the regulatory sphere, such as our under care review, our policies around the impact of Brexit and our vision for new veterinary legislation, to become a candidate.
"RCVS Council is at its best when it encompasses a broad range of perspectives, experiences and knowledge, and so we encourage people from all areas of veterinary life and all levels of experience to put themselves forward and share their expertise and insight."
Nomination forms, guidance notes and frequently asked questions for prospective RCVS Council candidates can be found at www.rcvs.org.uk/rcvscouncil20.
Prospective candidates for RCVS Council are welcome to contact the Registrar, Eleanor Ferguson (e.ferguson@rcvs.org.uk) and the RCVS CEO, Lizzie Lockett (l.lockett@rcvs.org.uk) for more information about the role of the College and/or RCVS Council.
RCVS Council will also be holding its next public meeting on Thursday 23 January 2020, prior to the closure date for Council candidate nominations. Prospective candidates are welcome to attend the Council meeting as an observer. Contact Dawn Wiggins, RCVS Council Secretary, on d.wiggins@rcvs.org.uk if you wish to attend.
The new editorial team of Ed Hall, David Williams and Aarti Kathrani says the manual has been completely rewritten and reorganised to provide a current, well-structured overview of the main gastrointestinal diseases that challenge both clinical practitioners and academics.
The Manual is divided into four sections:
Diagnostic procedures and techniques: history taking, physical examination, clinical pathology, imaging and biopsy.
Diagnostic approaches to problems: diagnostic approach to complaints/problems affecting the GI tract, pancreas and liver.
Patient management: treatments available for GI, pancreatic and liver disease, including a chapter on fluid and nutritional therapy.
Diseases of specific systems/organs: conditions of organs of the GI tract, including pathophysiology, clinical signs, diagnosis, treatment and prognosis.
Ed Hall said: "The busy small animal practitioner is likely to see a dog or cat with GI signs most days and having this Manual as a resource should give them greater insight into the conditions they are treating and hopefully make their job more satisfying."
The BSAVA Manual of Canine and Feline Gastroenterology is available in a printed edition (£90; £60 to BSAVA members) and an online edition (£75 +VAT; £50 +VAT to BSAVA members).
The Pitpat was designed in Cambridge, launched in 2016 and is now the leading dog activity monitor on the market, with over 50,000 sold.
I was invited to review the Pitpat by one of the company's non-executive directors, Myra Forster-van Hijfte FRCVS, a European and RCVS Specialist in Small Animal Medicine who was also one of the angel investors.
I wasn't convinced that this was something every dog owner would want to use regularly. You'd have to be a bit obsessed to be routinely reviewing the activity levels of a perfectly fit young dog. But I think there is real potential for it to add value to veterinary nurses' obesity clinics and also to measure a response to treatment for things like osteoarthritis (OA). As such, it is perhaps something for practices to consider buying for themselves, and then loaning it out to the owners of dogs on a weight loss programme or which are getting treatment for OA.
Myra said: "PitPat gives an objective measurement of the actual activity the dog has done and the app gives the owner tailored advice (based on breed, age and sex of the dog) on how much exercise their dog should be doing and an estimate of daily calories their dog has burnt. This will help owners keep their dogs fit and healthy and in the correct body condition.
"PitPat is useful in weight management clinics by improving owner engagement through the associated weight app. Encouraging exercise also provides the owner with a positive contribution towards weight management.
"Monitoring activity pre- and post treatment, for instance dogs with osteoarthritis on NSAID's, provides vet and owner with an objective measure of whether treatment is effective or not."
You can watch the full review here. If you're interested in technology that is designed to make life easier, do subscribe to the channel!
For more information about Pitpat, visit: https://www.pitpat.com/. Veterinary practices that want to buy a Pitpat for use with their clients will get a trade discount. Contact the company for more details.
Animal Friends is launching a pilot programme through which its customers will be able to check their pets' symptoms, get advice on treatment or find out if they need to visit a vet clinic on Joii.
Paul Hallett, co-founder of Vet-AI said: "Animal Friends is a perfect partner for Vet-AI, not only do we share common goals around animal welfare and the profession as a whole, but strategically we are both laser focused on the customer. In the coming few years we will support their customers by providing them with 24 hour expert-led care, at the click of a button. This will drive our business forward, helping us reach more pet owners and improve the care their pets receive."
Wes Pearson, Managing Director of Animal Friends said: "This partnership demonstrates our commitment to provide our pet parents with innovative options to ensure their pet receives the best care. Being able to access professional advice from the comfort of their own home and at a time that suits them can dramatically reduce stress for both the pet and the pet parent. We are excited to be working with Vet-AI and believe that the Joii app will bring expert knowledge and extra peace of mind to our customers."
Oh no, not another company talking about 'pet parents'. Is it just me, or is it not rather patronising?
The new maternity policy will offer enhancement at 100% of full pay for 10 weeks, and 50% of full pay for a further 10 weeks, without any clawback provision should mothers decide not to return to CVS after their leave.
As part of the Time To Change Pledge, CVS will submit a plan for introducing evidence-based interventions and policy to help its employees work in ways that promote positive mental wellbeing.
CVS's plan includes the appointment of 250 Wellbeing Champions who will be trained in first aid for mental health. The company also plans to roll out further training on managing stress and mental health issues for line managers in 2020.
Richard, pictured right, said: "We are proud to be the first major veterinary employer to sign the Time to Change Pledge. The CVS wellbeing working party have made much progress in the last 12 months delivering our plan which has been formalised through participating in the Time to Change pledge.
"We recognise that the pressures in our industry are significant and unique, and that there’s more work to do. We remain committed as a company and wellbeing working party to changing the way we all think and act about mental health in the workplace for the better."
It is not the first time Roundhouse Referrals has innovated in this area. Last year, it launched the first 'Fixed Price TPLO' - a guarantee that pet owners will have no additional costs, should complications arise and further treatment be required following surgery.
Ross Allan, RCVS Advanced Practitioner in Small Animal Surgery and Surgical Lead at Roundhouse Referrals, said: "We loved the idea of providing price certainty for referral clients, allowing those with no or lower levels of insurance to access our services and plan their finances. We also realised that in putting 'Fixed Price Fix' first and foremost we are also immediately highlight the possibility of complications and we felt the very best way to provide context for owners and referring vets would be to be open about our outcomes."
Following on from this Roundhouse Referrals has published the first of what it says will be a series of reports on TPLO+ clinical outcomes and customer satisfaction.
Ross said: "I think we're the first in Scotland to publish this kind of information outside scientific journals in a way that is easily accessible for pet owners, maybe in the whole of the UK."
The clinical outcome data was collected using a previously published questionnaire which enabled clients to give feedback on their pet’s recovery and status following their TPLO+ surgery.
According to Roundhouse, the results show that over 97% of dog owners rated their pets’ outcome as either excellent (85.29%) or good (11.76%) based on the first 70 TPLO+ surgeries performed. A figure which Ross says compares favourably with studies that have been previously published.
Additionally, 94.1% of pet owners agreed that if faced with having to make a similar decision again, they would choose to have the TPLO+ surgery done at Roundhouse Referrals, compared to 84.6% of owners in the previous study.
The results from the Customer Satisfaction Questionnaire showed that 100% of Roundhouse Referrals’ clients felt supported throughout the referral process, 96.97% of clients felt that the TPLO+ surgery was adequately explained and 100% would recommend Roundhouse Referrals to a friend or colleague.
Ross said: "Pet owners whose dogs’ had been through TPLO+ surgery and rehabilitation completed this questionnaire, enabling us to start measuring the outcome of the surgery, our aim being to ensure the surgery is optimal for the pet, and that owners feel supported throughout the entire surgical journey.
"We are delighted with these results, and will continue to monitor our outcomes and commit to publish our TPLO+ clinical outcome and customer satisfaction questionnaire results in the months and years ahead".
The winners and runners up will be honoured at a ceremony taking place on the eve of BSAVA Congress on 1st April 2020.
The television presenter Matt Baker will be hosting the Ceva Animal Welfare Awards for the third consecutive year, alongside head judge Chris Laurence MBE FRCVS, who puts his name to the Vet of the Year Award.
The award categories include:
Chris Laurence Vet of the Year – sponsored by Vet Record
Vet Nurse of the Year – sponsored by Agria Pet Insurance
Charity Team of the Year – sponsored by PDSA
Charitable Contribution of the Year – sponsored by Blue Cross
International Cat Care Welfare of the Year – sponsored by International Cat Care
Farmer of the Year – sponsored by R.A.B.I. and Farmers Guardian
Farm Educator of the Year – sponsored by NADIS and Farmers Guardian
Outstanding Contribution to Animal Welfare – sponsored by Your Dog and Your Cat magazines
To nominate someone, visit wwww.cevawelfare.com. They can come from all walks of life and will be assessed on the evidence provided in the original nomination.
Entries must be in by Tuesday 31 December 2019.
The centre was launched in February last year after an 8-month briefing and design period, followed by a 9-month construction and fit-out process.
Paragon and DesM also picked up the top prize in the Conversion category, awarded to practices which have made use of buildings previously used for other purposes.
John Marsh said: "Our aim was to build on our experience with two previous small animal hospitals for the RVC and Lower Langford Veterinary School, in designing a 'practitioners' answer' to veterinary care, but adapted to a more commercial facility, mindful of a practical but bright working environment for both the clinicians and owners, where it is a pleasure to work and a catalyst for enabling the best possible animal care."
Paragon managing director Ian Monteith said: "Every year, the BVHA seeks out and rewards the very best veterinary hospitals across the UK and we are delighted the high standards we set here at Paragon have been recognised.
"This is a terrific compliment to the very careful planning that went into designing the building and equipping it with the very latest equipment and technology."
In their report, the BVHA assessor said: "The premises are spectacular in design and appearance, creating an immediate impression of clinical excellence and quality patient care to both clients and visiting clinicians.
"The quality of the clinical work being undertaken was easy to see. There was a very positive attitude to training and induction routines, as well as mental health and team welfare."
There was one other category, for the best refurbishment, which was won by Vets Now’s hospital in Glasgow.
Neptra has been approved for the treatment of acute canine otitis externa or acute exacerbations of recurrent otitis caused by mixed infections of susceptible strains of bacteria sensitive to florfenicol (Staphylococcus pseudintermedius) and fungi sensitive to terbinafine (Malassezia pachydermatis), by the European Commission.
Mario Andreoli, Head of Marketing at Bayer Animal Health, said: "Otitis externa is a common disease in dogs and a leading cause why owners take their dog to a veterinarian.
"Neptra offers a key advantage, unlike competing products, it requires just one dose, administered by the veterinarian in the practice."
No at-home applications by the dog owner are required. The treatment stays in the hands of the vet who has full control over compliance.
Mario added: "With Neptra we provide a high-quality veterinary treatment that is convenient for the dog owner and ensures the well-being of dogs with a proper, effective application."
VetSurgeon understands the new product will be available in the UK in January 2020.
The research is being conducted by Sarah Mansell under the supervision of Dr. Malgorzata Behnke. They say this parasite hasn't been studied in depth in the UK since the 1970's, because the symptoms can be controlled by routine worming measures. However, as the industry moves away from routine worming as a measure of reducing the risk of parasites developing resistances to treatments, a condition such as this which is now considered to be quite rare in the UK can start to re-emerge.
Sarah is asking vets to fill out a short questionnaire to assess awareness of Onchocerca Cervicalis in veterinary practices. The survey includes specific questions about the parasite as well as questions about cases of unresponsive skin conditions because a similarity in symptoms can lead to misdiagnoses that could, in fact, turn out to be Onchocerca Cervicalis.
Sarah said: "Hopefully the findings will raise awareness of this problem and help shape future research in this area."
She added: "I want to get vets thinking about this issue much more than perhaps they are at the moment."
To take part in the survey, visit: https://harper-adams.onlinesurveys.ac.uk/assessing-the-awareness-of-onchocerca-cervicalis-amongst-e-2
Southfields Veterinary Specialists in Laindon, which is part of the Linnaeus Group, has recruited the highly-respected Dr Fabio Stabile to join its neurology and neurosurgery unit.
Fabio will start working at the practice's neurology and neurosurgery unit in January, with another specialist, Dr Ane Uriarte from Tufts University in the USA, joining in the spring.
Fabio said: "I am delighted to be joining Southfields Veterinary Specialists in the new year as a Consultant in neurology and neurosurgery.
"It is an extremely exciting time to be joining Southfields and their team of renowned and successful specialists, especially as this is a strong time of growth in their neurology/neurosurgery discipline.
"The imminent move of the Southfields team to a new, state-of-the-art hospital with the possibility of creating a new phenomenal environment and ‘family’ is really exciting!"
Fabio graduated from Padova University in 2003 before completing a three-year PhD in veterinary clinical sciences at the university supervised by Dr Marco Bernardini DVM, DECVN.
In 2009, he moved to the UK and started a Residency in Neurology and Neurosurgery at the Animal Health Trust under the supervision of Dr Luisa De Risio DVM, FRCVS, PhD, DECVN.
Fabio added: "My main area of interest in veterinary neurology and neurosurgery are epilepsies and the treatment of epilepsy and any neurosurgeries.
"Improving antiepileptic treatment for our patients has constituted my main focus of clinical research. It’s a subject I strongly care about."
Dr Stabile also enjoys passing on the benefits of his expertise and experience to the next generation of veterinary surgeons. He has presented several clinical research abstracts at international and European conferences and he is the author of multiple publications in peer reviewed journal Veterinary Services.
"I have always been extremely keen on teaching and I enjoy delivering lectures to young colleagues in training and to colleagues working in general practice."
Rominervin contains 10 mg/ml romifidine hydrochloride, equivalent to 8.76 mg romifidine, presented in a 20 ml vial.
It can be used as a sedative to facilitate handling, examination, minor surgical interventions and minor procedures or as a premedication prior to administration of injectable or inhalation anaesthetics.
Rominervin can also be used in combination with synthetic opiates such as butorphanol to provide deeper sedation or analgesia.
Dechra Brand Manager Emma Jennings said: "Rominervin is highly effective as it has a longer duration of action than other alpha-2 agonists1. It starts to work within one to two minutes with maximum sedation achieved between five and 10 minutes.
"It is yet another valuable addition in our equine anaesthesia and analgesia range that has been designed to provide vets with the therapies they need to operate successfully in day-to-day practice."
Rominervin can be used in conjunction with Dechra’s equine anaesthesia and analgesia app, designed to help veterinary professionals choose optimal anaesthetic protocols and calculate anaesthetic drug doses and administration rates.
For more information visit: www.dechra.co.uk/products/equine
The Disciplinary Committee considered a number of charges against Javier Salas Navarro MRCVS and Roman Kristin over 35 days.
The charges against Dr Navarro concerned his treatment of a kitten named Marnie. They included:
In August 2016, failing to read the anaesthesia consent form in relation to a surgical spay he performed;
When Marnie was readmitted for surgery, failing to read the anaesthesia consent form, failing to undertake adequate assessment of Marnie’s condition; performing surgery without adequately considering her condition; subjecting Marnie to anaesthesia without recognising the seriousness of her illness; failing to obtain informed consent from the owners; administering medication which was contra-indicated; and failure to make an adequate record of his involvement in Marnie’s care.
The charges against Dr Kristin also related to his treatment of Marnie. They included:
In August 2016, failing to undertake an adequate assessment of her condition; failure to recognise and record the fact that Marnie could not pass urine; failure to refer or offer her for specialist treatment; and failure to ensure Marnie received care and treatment overnight.
When admitting Marnie for surgery, that he made a number of clinical mistakes including failure to gain informed consent; and failure to recognise the seriousness of her illness;
that there were a number of failings in relation to Marnie’s care, including failure to arrange adequate overnight care, failure to monitor and record her condition, and failure to gain informed consent for the overnight care.
that he failed to advise Marnie’s owners that he suspected her uterers had been ligated during the spay, failed to advise Marnie’s owners that she required specialist veterinary treatment; and advised that Marnie undergo further surgery at the practice in spite of this meaning her having to undergo further anaesthesia in a week and with poor chances of survival;
that the above conduct was misleading and dishonest.
The Disciplinary Committee found a number of the facts in the charges against both Dr Navarro and Dr Kristin proven (the full details can be found in the documentation at www.rcvs.org.uk/disciplinary).
The Committee found that Dr Navarro breached a number of aspects of the Code of Professional Conduct for Veterinary Surgeons including: making animal health and welfare the first consideration when attending to animals; the provision of appropriate and adequate veterinary care; responsible prescription, supply and administration of medicines; communication with professional colleagues to ensure the health and welfare of the animal; being open and honest with clients and respecting their needs and requirements; effective communication with clients; keeping clear and accurate clinical records; and working with the veterinary team to coordinate the care of animals.
Of the proven charges, the Committee found that his initial failure to read Marnie’s anaesthesia consent form on 5 August did not amount to disgraceful conduct in a professional respect, but that the repetition of this failure on 9 August did amount to disgraceful conduct. It also found that Dr Navarro’s failure to undertake adequate assessment and perform surgery without this assessment amounted to serious professional misconduct. Furthermore, the Committee found that subjecting Marnie to anaesthesia in spite of her being unwell, failure to obtain informed consent and failure to keep adequate records also amounted to serious professional misconduct.
For Dr Kristin, in summary, the Committee found not proven the allegation that he had failed to respond on 5 August 2016 to concerns from Marnie’s owners about her condition while she was recovering from a surgical spay and also all the allegations relating to Dr Kristin’s admission of Marnie to the practice on 9 August on the basis that it was not satisfied so as to be sure that Dr Kristin had been the veterinary surgeon who admitted Marnie on that day.
The Committee found proven the remaining charges and found he breached the following parts of the Code of Professional Conduct for Veterinary Surgeons: making animal health and welfare the first consideration when attending to animals; keeping within area of competence and referring responsibly; providing appropriate and adequate veterinary care; responsible prescribing, supply and administration of medicines; communication with colleagues to ensure the health and welfare of the animal; being open and honest with clients and respecting their needs and requirements; communicating effectively with clients and obtaining informed consent; keeping clear and accurate clinical records; and working with the veterinary team to coordinate the care of animals.
Of the proven charges, the Committee determined that his failure to adequately assess Marnie’s health, to obtain a clinical history, to undertake blood tests and recognise that she was seriously ill, amounted to disgraceful conduct in a professional respect and led to “Marnie’s underlying condition going undetected and undoubtedly contributed to her eventual death two days later”.
The Committee also found that Dr Kristin’s decision to hospitalise Marnie without adequate overnight care, place her on IV fluids without monitoring the treatment or her condition, and failure to obtain adequate informed consent – among other things – amounted disgraceful conduct in a professional respect.
Stuart Drummond, chairing the Committee and speaking on its behalf, said: "As a direct result of Dr Kristin’s acts and omissions, Marnie was left alone overnight on fluids when those fluids had nowhere to go. Had he done his job properly he would have known that and Marnie could have avoided the prolonged suffering caused by the chosen course of treatment that did not address the underlying condition. Every element of Dr Kristin’s behaviour was catastrophic for Marnie, and yet he took no personal responsibility for her welfare and just went home.”
Following its findings on disgraceful conduct in a professional respect, the Committee then went on to consider its sanction for both Dr Navarro and Dr Kristin.
In respect of Dr Navarro, the Committee considered the mitigating factors including previous good character, admissions to some of the facts of the case from the outset; genuine insight and remorse into the seriousness of the actions; his youth and inexperience; and relevant and good-quality testimonials from colleagues. The Committee noted that the testimonials were universally positive and demonstrated that Dr Navarro had reflected on his conduct, had become more mature and confident in his practice and made efforts to rectify the areas in which he had fallen below standards.
Stuart Drummond said: “Although the consequences for Marnie and her owners were clearly devastating, the Committee considered that Dr Navarro’s part in her demise has to be seen in the context of all the evidence. In light of the extensive mitigation, including significant evidence of insight and remediation, the Committee was able to conclude that Dr Navarro did not represent a future risk to animals or the public. In such circumstances, the Committee considered that it was not necessary to restrict Dr Navarro’s registration and that a reprimand was the appropriate and proportionate sanction in his case.”
In relation to Dr Kristin, the Committee took into account positive character evidence from Mr Karel Daniel, a semi-retired veterinary surgeon and Vice-President of the Czech Republic Veterinary Chamber, a similar body to the RCVS in that country, as well as other testimonials on his behalf. In mitigation, the Committee considered Dr Kristin’s previously unblemished career, the fact that it was a single case involving a single animal; some development of insight into his conduct; no evidence of repetition; expressions of remorse; the impact of a family bereavement during the course of proceedings; and his financial position.
However, the Committee also took into account aggravating factors including a lack of candour from Dr Kristin when he was giving evidence, demonstrated by a tendency to blame others rather than take responsibility, as well as his recklessness in suggesting a third operation on Marnie that was not in her interests, rather than referring her into specialist care.
The final decision of the Committee on the sanction for Dr Kristin was that, given the seriousness of the misconduct, it was satisfied that this warranted a six-month suspension period. However, given the mitigating factors, the Committee decided that four months was appropriate and proportionate.
Commenting on the sanction Stuart Drummond said: “The Committee determined that it was important a clear message be sent that this sort of behaviour is wholly inappropriate and not to be tolerated. It brings discredit upon the respondent and discredit upon the profession and, most importantly, caused harm to Marnie and great distress to her owners.
"The Committee did consider whether to remove Dr Kristin from the Register. However, in light of the mitigation in this case, the fact that this was a single case in an otherwise unblemished career, together with the unlikelihood he would repeat his disgraceful conduct, the Committee decided that, in all the circumstances, to remove him from the Register would be disproportionate.
"The Committee therefore decided to order that the Registrar suspend Dr Kristin’s registration…. The Committee was satisfied that a period of four months was appropriate and proportionate in all the circumstances."
The full facts and findings from the case can be found at www.rcvs.org.uk/disciplinary
Prior to the start of the hearing, the RCVS received correspondence from Mr Kombert confirming that he did not intend to attend the hearing, either in person or via a video-link, nor did he intend to send legal representation in his stead.
The Committee, chaired by Dr Martin Whiting, decided to proceed with the hearing in the absence of Mr Kombert and any legal representation, on the basis that it was in the public interest and the interests of justice to proceed and that Mr Kombert had been given the opportunity to attend or be represented.
The Committee heard that staff at the practice where Mr Kombert was working as a locum had undertaken a check of the medicines kept in the practice’s controlled drugs cabinet and discovered that 5.5ml of ketamine and 1.5ml of methadone was missing. After the code to the controlled drugs cabinet was changed, Mr Kombert was observed taking an additional 3ml of methadone, which he then administered to himself while on duty at the practice.
After Mr Kombert was confronted with the evidence, he was given the details of the Vetlife charity for support and asked not to return to the practice.
The police were contacted and, on 4 January 2019, Mr Kombert was arrested and interviewed. He received a police caution for theft, with conditions that he should attend and complete a drug-use awareness course, and engage in a restorative justice process, which involved attending the practice to discuss his offences. At this meeting, Mr Kombert admitted stealing the drugs and administering them to himself while on duty, which meant he was not in a fit state to see patients. He apologised for his actions and the matter was then also reported to the RCVS.
In relation to the fact that Mr Kombert had accepted the police caution, made the admissions at the restorative justice meeting and had emailed the RCVS apologising for his actions, the facts of the case were found proven.
The Committee then went on to consider if Mr Kombert’s actions amounted to disgraceful conduct in a professional respect (henceforth called ‘serious professional misconduct’), something which Mr Kombert had admitted to in correspondence with the RCVS.
The Committee found that Mr Kombert’s actions did amount to serious professional misconduct. Dr Martin Whiting, chairing the Committee and speaking on its behalf, said: "The respondent’s conduct was dishonest; it constituted both a breach of trust and an abuse of his position with regards to access to veterinary medicines; it risked animal welfare and jeopardised the reputation of colleagues. It fell far short of the conduct expected of a member of the profession and amounts to disgraceful conduct in a professional respect."
The Committee then considered what the appropriate sanction against Mr Kombert should be, taking into account both aggravating and mitigating factors.
In terms of aggravating factors, the Committee took into account the risk of harm to animals, his dishonesty, the premeditated nature of the misconduct, the breach of trust and the fact it was repeated.
It also took into account three previous matters recorded against Mr Kombert in the United States of America.
These were: a letter of admonition from the Colorado State Board of Veterinary Medicine for practising when his licence had expired; a stipulation order from the same body in which he agreed to relinquish his licence in that state following an allegation that he took controlled substances from a veterinary practice and self-administered them; and a criminal conviction in New York State for obtaining an opioid controlled drug by deception, for which he was sentenced to three years’ probation. The Committee was made aware of the New York State criminal conviction after Dianne Norris, a Probation Officer based in that state, had contacted the RCVS after hearing about the inquiry and informed the College that Mr Kombert was in breach of his probation conditions.
Dr Whiting said: “The Committee has considered the witness statement of Ms Dianne Norris, a probation officer employed by Putnam County Probation in New York, who was responsible for supervising the respondent as part of his probation. Ms Norris explained that the respondent breached his probation on numerous occasions, which took place from November 2017 to 2018…. As a result of the breaches, Ms Norris required the respondent to increase his attendance at support groups to an inpatient treatment program for 28 days from 13 July 2018. He failed to attend.
"Ms Norris explained that warrants were issued for the respondent’s arrest…. The Committee noted that the conduct of the respondent in relation to obtaining controlled drugs from his employers for his own use while in the United States of America was similar to his conduct … [described in] the charges."
In mitigation the Committee considered that Mr Kombert had consistently admitted the charges against him as well as accepting and agreeing with the evidence against him.
However, the Committee decided that in light of the seriousness of his misconduct, including dishonesty and risk of serious harm to animals, removal from the Register was the most appropriate and proportionate sanction.
Summing up, Dr Whiting said: "The respondent has failed to uphold the requisite standards to be expected of him on multiple occasions. The Committee considers that the only sanction that is sufficient to protect the welfare of animals, maintain public confidence in the profession and declare and uphold proper standards of conduct is one of erasure."
Mr Kombert has 28 days from being informed of the outcome of the hearing in which to make an appeal to the Privy Council.
Starting in the New Year, the benefits of vaccination will be communicated to both farmers and pet owners, initially focussing on farm use.
The aims of the campaign are to raise awareness of how and why vaccines work and the range of diseases they protect against, to review and improve how vaccines are stored and administered, and to encourage better uptake of existing vaccines.
Further information and tips on storing and using vaccines correctly will be shared, to help ensure that vaccines used will be effective.
NOAH says that research has shown that:
Dawn Howard, NOAH’s Chief Executive said: “It is encouraging that vaccination of the UK’s calves and sheep against livestock diseases has risen to one of the highest levels in seven years1. This increase is encouraging, however still more needs to be done in relation to uptake, storage and usage. We are asking the vet profession to support the #VaccinesWork campaign by spreading the messages with their clients and engaging on social media."
"We will be providing information for farmers e.g. if vaccines are not stored correctly, it will impact on their potency, meaning they could be less effective – not only will there be the potential for the vaccine to fail to protect animals against disease but also farmers may have wasted their efforts – and may be deterred from vaccinating again."
Whilst correct use by farmers is the initial focus, the campaign will include pets. Dawn said: "The topic of vaccine hesitancy is becoming increasingly important. Recognised by the WHO as one of the top 10 global health threats for people in 2019, this phenomenon is translating to the veterinary sector as well, especially in companion animals. The PDSA reports an ‘alarming’ drop in pet vaccinations: the proportion of pet dogs, cats and rabbits receiving a primary course when young has fallen by 18% over the past 3 years, down to 66%3.”
"This is bad news for the health and welfare of the nation’s pets, who are increasingly at risk of disease, and we need to work to address this."
https://ahdb.org.uk/knowledge-library/use-of-vaccines-in-cattle-and-sheep-2018-sales-update
https://www.noah.co.uk/wp-content/uploads/2019/10/NOAH-Vision-Paper-8pp-A4-Sep-19-vf.pdf
https://www.pdsa.org.uk/media/7420/2019-paw-report_downloadable.pdf
As a result, clients of LV=GI and Waggel will be able to book an online appointment with a veterinary surgeon within 30 minutes, without having to pay FirstVet's normal £20-30 charge.
Waggel is FirstVet's 26th insurance partner globally, and its third in the UK. The company now has 150 veterinary surgeons working on the platform.
Lucy Broadbridge, LV= GI Pet Product Manager, said: “At LV= GI we’re always looking for ways to help our customers protect what they love, so we’re very excited to be able to work with FirstVet to provide this service to our pet customers. With access to a vet from your smartphone or device, our pet customers will have peace of mind knowing that qualified veterinary advice is on hand 24/7, avoiding unnecessary time, cost and distress of visiting their vet if they don’t really need to."
Under current legislation, there is very little practical assistance that can be offered via an online consultation, other than recommending whether or not the animal needs to be seen by a veterinary surgeon in person. It may also be the case that the online consultation offers little more than a pet owner would get by ringing their normal vet. Nevertheless, online consultations will doubtless grow significantly in 2020, as the players line up to take advantage of any relaxation in the regulations that they hope will allow veterinary surgeons to prescribe medicines for animals they have not seen in person.
Regardless of whether that happens, there is a value in face-to-face communication between a veterinary surgeon or nurse and a client, whether it be for triage or follow up consultations. Independent practices might therefore be well advised to start implementing this kind of technology in practice sooner rather than later, in particular looking at ways that online appointments could be scheduled (perhaps between normal consultations) so as to compete with the short waiting times offered by companies like FirstVet.
The survey was conducted by Mo Gannon & Associates, which asked 2,000 UK adults about their satisfaction with the service they and their animals received from veterinary surgeons, levels of trust in the profession, and whether the service provided by vets represents value for money.
32% of the respondents felt that veterinary surgeons represented excellent (8%) or good (24%) value for money. 38% thought that veterinary fees are fair. However, 29% thought that veterinary surgeons and their services provided poor (21%) or very poor (8%) value for money. The results were very similar to the last time the survey was conducted, in 2015.
Nevertheless, veterinary surgeons continue to enjoy very high levels of trust amongst the public. 94% said they either completely trust (34%) or generally trust (60%) vets. This put veterinary surgeons in third place amongst the most trusted professions, below opticians and pharmacists but above GPs and and dentists.
Satisfaction with the profession was also high. 80% said they were either very satisfied (39%) or satisfied (41%), putting vets in fourth place below opticians, pharmacists and dentists, but above general practitioners and accountants.
RCVS President Dr Niall Connell, pictured right (would you trust this man?) said: "These results clearly demonstrate that there is a great deal of good will towards the veterinary profession and the work they do in treating the nation’s animals and serving their communities. The basis of all good relationships is trust, and it is fantastic to see that our clients continue overwhelmingly to trust our knowledge and expertise and remain very happy with the service we provide them.
"The picture on value for money is clearly a bit more mixed, although clearly 70% of the respondents recognise that we at least charge fair fees in terms of our time and expertise. There is, of course, always more work that we can do in order to help the public understand veterinary costs and fees and promote the value of veterinary care, as demonstrated by last year’s joint Pets Need Vets social media campaign with BVA, in which we highlighted the benefits to pet owners of being registered with a vet."
PBD Biotech says the Actiphage test offers the potential to revolutionise control of bovine TB by allowing detection of the disease within hours from a blood or milk sample.
Last November, the Welsh Government announced a new policy that allowed the use of non-validated tests such as Actiphage in herds affected by a TB breakdown. It followed a similar protocol to one authorised by the UK Government last year for cattle herds in England after the test was used as part of a successful private eradication plan on a Devon dairy farm.
Mossman Farming, in Ceredigion, is located in an area of chronic breakdown. It is a spring-calving milking herd with a total stock of 529, to date 312 dairy cows have been slaughtered. Farmer Chris Mossman agreed to trial Actiphage after hearing about the Gatcombe pilot.
Chris said: "TB is a massive problem in Ceredigion, so when I heard about Actiphage’s use at Gatacombe, helping to clear that dairy herd for the first time in six years, I wanted to try and replicate those findings here. Me – and many other farmers – are losing large numbers of animals. I’m trying to do all I can to get rid of this disease from my herd."
In Spring 2019, The Office of the Chief Veterinary Officer for Wales granted permission for Robert Price-Jones MRCVS to use Actiphage to screen high-risk cattle for M. bovis.
Robert, who has been leading the trial, said: "Actiphage is able to identify the presence of relatively low numbers of M. bovis in the blood stream of infected cattle. It is not dependent upon an immune system response to the pathogen - in contrast to current validated tests - and so has greater sensitivity than such as the official Tuberculin SICCT skin test.
"The benefit of using Actiphage is that it offers the potential for eradicating the disease from the farm; as early identification of animals at risk of bovine TB enables heightened disease management and control."
Under the terms of the Welsh Government’s protocol, cattle not condemned for slaughter can be tested with Actiphage. Those that give a positive result are identified with a ‘management’ marker, monitored and milked separately.
To prevent further contamination of the environment and to minimise risk to uninfected cattle, animals found to be ‘shedders’ are removed from the farm.
Although a decision to remove cattle based on a non-validated test will be at the farmers’ own expense, the APHA (Animal and Plant Health Agency) has confirmed that during the trial, where a positive result is confirmed with statutory tests, the animals will be removed with compensation as normal.
So far, 100 animals from Mossman Farming have been tested with Actiphage and Robert Price-Jones is preparing a paper to publish the findings in early 2020.
PBD Biotech is now seeking more farms to trial Actiphage in order to gain the World Organisation for Animal Health (OIE) validation. The company is offering reduced cost testing to support trials where the findings are made available to support validation of the test.
Vetlife is independent of all other veterinary organisations and is managed by a Board of 11 elected Trustees, all of whom are veterinary surgeons.
The charity employs a small number of staff, so trustees are often asked to undertake operational as well as strategic work and the role demands a substantial time commitment, including attendance at four board meetings in London each year. Trustees also act as ambassadors for Vetlife and to represent the charity within the UK Veterinary community.
Danny Chambers MRCVS is a trustee. He said: "Given the unique challenges facing veterinary professionals it is vital that the mental health support is delivered by people who understand the specific issues facing those working within the veterinary industry.
"This is why Vetlife is so important. We are a mental health charity run by the veterinary community, for the veterinary community. Being a trustee of this charity is a very hands-on role, where you get to influence all aspects of the charity’s work. If you want to help support your friends and colleagues, this is a great and fulfilling way to give back to the profession."
Vetlife President Geoff Little said: "Being a Vetlife trustee allows you to work with other members of a team dedicated to the welfare of others in the veterinary community."
The charity is currently seeking to co-opt a twelfth trustee to sit on the board until the next AGM in September 2020. Their appointment for the following three years would then need to be ratified by the membership. Any veterinary surgeon wishing to stand who is not an existing Vetlife member will be required to become one before applying. If you do not know any current members to propose you, contact the Vetlife office for assistance.
Submissions must be received by 20th January 2020. Interviews will be held in London on 3rd February 2020.
Further information, including an application form is available on the Vetlife website: vetlife.org.uk/support-us/volunteer/ or via the Vetlife office, 020 7908 6382 or info@vetlife.org.uk.
The deadline for nominations for Practice of the Year, Vet of the Year, Vet Nurse of the Year, Practice Manager of the Year and Practice Support Staff of the Year, is 16th January.
The award ceremony will take place on 2nd April 2020 in Birmingham.
James Barnes, Head of Sales & Partnerships at Petplan, said: "We’ve been recognising the brilliant work of the UK’s veterinary professionals through the Petplan Veterinary Awards for 21 years now and every year the standard of entries just gets higher.
"The nominations are a testament to the hard work of all of those involved at practices who care for animals and clients all year round.
"The awards are a perfect opportunity for you to showcase your practice and your colleagues. Being acknowledged is great for team morale and a wonderful opportunity to raise the profile of the practice to new and existing clients alike. If you haven’t already I’d invite you to nominate someone today!"
You can nominate a colleague or your own practice at petplanvet.co.uk/vetawards, before nominations close on 16th January 2020.