Objective:To report the changes in veterinary surgeon schedules, workflow, and job satisfaction associated with the COVID-19 pandemic from 2020 through 2021. Methods:A voluntary, nonincentivized, anonymized 40-question internet survey was deployed from November 2021 through February 2022. Veterinary surgeons were surveyed regarding schedule alterations and support implemented by their employers during the pandemic as well as changes in their job satisfaction. Associations between demographics and responses were analyzed. Results:333 respondents, including veterinary surgeons and residents, participated. Most respondents worked in private clinical practice (211 of 320 [65.9%]), followed by academia (95 of 313 [30.3%]). The pandemic significantly affected the work schedule of 245 of 333 respondents (77%), especially those in private practice and influenced by employment position, such as staff surgeon versus owner. 185 of 245 surgeons (76%) reported a stressful work environment, and 244 of 320 (78%) reported an increased caseload. 244 of 320 respondents (76%) felt management responses were supportive of employees; however, only 195 of 314 surgeons (62%) believed their safety was prioritized. While overall job satisfaction decreased from prepandemic levels, 147 of 247 respondents (60%) reported that at least 1 positive change in their work environment occurred due to coronavirus disease 2019 protocols, including the introduction of curbside care and remote meetings. Conclusions:The pandemic affected the working conditions of veterinary surgeons, increasing caseloads and stress. Respondents generally felt supported by their employers who implemented positive changes. Clinical Relevance:Work environment strategies identified as positive should be embraced as workplace stress and higher caseloads have impacted job satisfaction in veterinary surgery.

OBJECTIVE:To determine adverse effects of intraperitoneally (IP) or subcutaneously (SC) delivered silver nanoparticles (AgNP) in poloxamer 407 (P407; AgNP-P407) and local retention and systemic uptake in rats. STUDY DESIGN:Controlled randomized trial. ANIMALS:A total of 25 rats. METHODS:A total of 10 rats were randomly assigned in Phase 1 to a SC or IP surgical delivery group (5 rats/group) to receive 0.01 mg AgNP/rat in P407 (1:2 volume ratio). A total of 15 rats (5/group) were used in Phase 2 to receive IP: gel only (1.0 mL), AgNP-P407 (0.01 mg AgNP in 1.0 mL P407) or AgNP (0.01 mg in aqueous buffer). Incisions were assessed daily. Euthanasia was performed on day 7. The SC surgery sites and organs were harvested and evaluated histologically with scores reported. Plasma was obtained and batch analyzed together with organs for Ag content using mass spectroscopy. RESULTS:All rats survived the duration of the study. Minimal local histologic toxicity was seen after SC delivery. Plasma Ag peaked earlier for IP than SC delivery (p = .08) and for Ag delivered IP without gel (p = .04). Organ Ag uptake was minimal; macrophage aggregation was identified in the spleen and lymph node consistently. Rats that received P407 had increased cholesterol, whereas changes in total protein, albumin, glucose, amylase and lipase were seen for all groups. CONCLUSION:No adverse events were noted after use of AgNP-P407, while Ag uptake was delayed. CLINICAL RELEVANCE:Use of AgNP-P407 may be possible without systemic effects and prolonged local presence, but further testing is needed.

OBJECTIVE:To report the incidence, management, and outcomes of gossypibomas encountered in veterinary specialty hospitals. STUDY DESIGN:Multi-institutional, retrospective study. ANIMALS:A total of 21 client-owned animals (18 dogs, 3 cats). METHODS:A spreadsheet was generated and distributed to veterinary specialty institutions for case recruitment and evaluation of animals with histopathologic diagnosis of a gossypiboma. RESULTS:A total of 15 of 21 animals were female, and 11/15 females had ovariohysterectomies resulting in their gossypiboma. Median time to representation after initial surgery was 13.5 days (IQR: 4-90). Duration of clinical signs prior to representation was a median time of 5 days (IQR: 1.5-11), and the clinical signs included pyrexia (10), abdominal discomfort (8), lethargy (7), and anorexia (7). The secondary surgery was performed on an urgent basis in 10/21 animals. Animals were hospitalized for a median time of 5 days (IQR: 1.5-11) postoperatively. Postoperative complications occurred in 4/21 animals and included sepsis (1), urinary and fecal incontinence (1), persistent anorexia (1), and aspiration pneumonia (1). A total of 19 of 21 animals survived to discharge. CONCLUSION:Majority of animals had intraabdominal gossypibomas and frequently presented for non-specific clinical signs. Surgical treatment was commonly performed within 1 month prior to re-presentation. Surgical management yielded a good long-term prognosis but may need to be performed urgently. Postoperative complications may be associated with the gossypiboma or the additional surgical intervention required for removal. CLINICAL SIGNIFICANCE:Gossypibomas are preventable postoperative complications that can result in high morbidity and mortality but carry a favorable long-term prognosis following surgical excision.

OBJECTIVE:The aim of this study was to report the effects of the COVID-19 pandemic on childcare responsibilities, mental health, and professional relationships of small animal surgeons. STUDY DESIGN:Voluntary, non-incentivized, anonymized 40-question internet survey deployed November 2021-February 2022. SAMPLE POPULATION:A total of 333 completed surveys from veterinary surgeons and residents in the USA. METHODS:Respondents provided information regarding demographics, family composition, effects of the COVID-19 pandemic on childcare, impact of work-life balance changes on mental health, and interpersonal work relationships. The influence of variables such as age and gender on these data was analyzed. Associations between demographics and responses were analyzed (p < .05). RESULTS:Families were most commonly categorized as "children and a partner" (139/312, 44.6%), followed by "partner and no children" (100/312, 32%). A total of 46.5% (67/145) of respondents reported disruptions in school schedules affected their work schedule. Female respondents were most likely affected (OR = 2.2, p = .047). Respondents experiencing stress due to disruptions in work-life balance reported three or more feelings of mental distress and were more likely to be female (p < .001). Female gender was associated with a delay in promotion, adverse effects on relationships with colleagues, and negative effects on relationships with administration (p = .016, p < .001, p = .01). CONCLUSION:The COVID-19 pandemic affected childcare responsibilities, professional standing, and the mental health of veterinary surgeons. Female gender was the most common variable associated with dysregulation of work-life balance. CLINICAL IMPACT:Identifying variables assists in creating strategies that improve job satisfaction and serve as a foundation for enhancing the profession's preparedness for future disruptions.

Objective:Thymoma-associated paraneoplastic syndromes in dogs and cats include myasthenia gravis, hypercalcemia, exfoliative dermatitis, erythema multiforme, T-cell lymphocytosis, myocarditis, anemia, and polymyositis. Paraneoplastic myasthenia gravis (MG) is the most commonly reported paraneoplastic syndrome in dogs with thymic epithelial tumors. The objective of this study was to examine cases of canine thymic-associated MG treated surgically, with the specific objective of providing an updated clinical picture of the preoperative management, postoperative complications, and outcomes of these cases. Animals:Nine dogs with paraneoplastic MG underwent surgical removal of a thymic epithelial tumor. Procedure:Medical records of dogs with MG that received surgical treatment of a thymic epithelial tumor between January 1, 2012 and October 1, 2022 were obtained from 4 veterinary teaching hospitals. Descriptions of perioperative MG management, complications, and outcomes were reported. Results:Six of the 9 dogs received medical therapy for MG, with either a cholinesterase inhibitor (4 dogs) or a cholinesterase inhibitor and immunosuppressive agent (2 dogs), before surgery. The median duration of medical therapy for MG before surgery was 7.5 d (range: 2 to 60 d). Three of 9 dogs experienced immediate postoperative complications and were euthanized. Six of 9 dogs (66.6%) survived to discharge and 3 of 6 dogs that survived to discharge were alive at the time of writing. At the time of writing, 3 of 6 dogs had complete resolution of clinical signs attributable to MG and 2 of 6 had partial resolution. The median time from surgery to resolution of clinical signs of MG in these dogs was 63 d (range: 2 to 515 d). Conclusion:Dogs with thymic epithelial tumors and paraneoplastic MG are at a high risk for perioperative complications. Clinical relevance:The findings of this study corroborate previous literature stating that paraneoplastic MG is a poor prognostic indicator for dogs with thymic epithelial tumors, while also highlighting the variation in approaches to clinical management of thymic-associated MG in veterinary medicine and the lack of established protocols guiding perioperative management.

OBJECTIVE To establish the lowest effective dose of commercially available nanoparticulate silver (AgNP) for antibacterial activity against Escherichia coli (E coli) and methicillin-resistant Staphylococcus pseudintermedius (MRSP), in vitro, and to establish the effect of incorporating AgNP into carriers for sustained release on this antibacterial activity. SAMPLES Silver nanoparticle dispersion (0.02 mg/mL) composed of citrate-stabilized, spherical, 10 nm diameter nanoparticles in aqueous buffer. PROCEDURES E coli and MRSP were treated with 0.01 mg/mL AgNP. The highest concentration of bacteria where growth was inhibited by AgNP was selected for treatment with 0.01 mg/mL AgNP incorporated 3 carriers for sustained release: calcium sulfate hemihydrate (CSH) beads, poloxamer 407 gel, and gelatin sponge, respectively. The antibacterial activity of AgNP and AgNP incorporated into carriers for sustained release was compared with a mixed linear effects model. RESULTS AgNP inhibited bacterial growth at a concentration of 10 1 for MRSP and 10 3 for E coli. For MRSP, the treatment group was associated with bacterial growth ( P < .001) while the concentration of bacteria and time were not ( P = .292 and P = .289, respectively). For E coli, the treatment group and concentration of bacteria were associated with bacterial growth ( P < .001 and = .029, respectively) while time was not ( P = .095). Poloxamer 407 gel exerted standalone antibacterial activity against both species of bacteria; sponge and CSH beads did not. CLINICAL RELEVANCE AgNP has antibacterial activity against E coli and MRSP, which can be reduced when incorporated into carriers for sustained release. Poloxamer 407 gel alone and combined with AgNP exerts antibacterial activity against E coli and MRSP.

OBJECTIVE To report the clinical use, adverse events, and outcomes after using amikacin in 30% poloxamer 407 (amikacin-P407) during open wound management or in a closed wound application in dogs. ANIMALS 29 client-owned dogs. METHODS Medical records from January 2017 to August 2023 from a single hospital were reviewed for dogs that received amikacin-P407 in an open or closed wound application. Information reviewed included signalment, nature of wound and/or surgical site infection (SSI), bacterial cultures, amikacin dose, gel volume, route of administration, estimated wound surface area, biochemistry parameters, urine casts, wound progression, and general clinical outcome. RESULTS Amikacin-P407 was applied during open wound care (10 dogs), via injection (5 dogs), and at time of wound closure (13 dogs) and was used both in open and closed wound management (1 dog). Wounds were associated with SSIs in 18 of 30 sites. Multidrug resistance was noted in 21 of 30 preapplication cultures. Median amikacin dose was 14.5 mg/ kg (range, 3 to 59.5 mg/kg), median total volume was 5.0 mL (range, 1 to 12 mL), and median tissue surface area was 6.6 cm2 (range, 1.6 to 36 cm2), for a local wound dose of 62.5 mg/cm2 (range, 6.9 to 214.3 mg/cm2). No short-term adverse local or systemic effects were noted in any wounds or dogs. No dehiscence was seen in 17 of 19 closed sites. CLINICAL RELEVANCE The results of this case series suggested that Amikacin-P407 can be applied in a variety of ways with no adverse effects. Amikacin-P407 may be considered in open wound management or in a closed setting for infected wounds and SSIs.

Locally sustained release antimicrobials such as silver nanoparticles (AgNPs) might prove useful in combating local infections. Their elution has been investigated in Phosphate Buffered Saline (PBS) including from poloxamer 407 (P407). No information exists on possible interactions with proteins, nor have ultrafiltration (UF) probes been evaluated to measure Ag. These investigations would provide helpful data prior to investigating the sustained release after subcutaneous implantation in vivo over time. We compared (1) the influence of elution fluid on AgNP elution, and (2) UF probe and direct sampling in vitro. Six AgNP-P407 specimens in a dialysis tube were placed in Dulbecco’s PPBS (DPBS) (n = 3) or canine plasma (n = 3) for 96 h on a stirred hot plate (37 °C and 600 rpm) and sampled 20 times. A 0.001 mg/mL AgNP solution was prepared in DPBS or plasma. Six pipette and UF probe samples were taken of each. Inductively coupled plasma mass spectrometry was used to analyze Ag. Stock plasma contained Ag. At 96 h, 5/6 dialysis tubes had not fully released AgNP. One peak in hourly Ag increase was present in DPBS (10–13 h), and two peaks in plasma (6–8 and 10–13 h). The hourly Ag increase in plasma decreased earlier than in DPBS. Ultrafiltration probe sampling was possible in both DPBS and plasma and resulted in higher Ag concentrations but with more variation. While in vitro use of DPBS might be more cost effective, plasma should be considered due to difference in elution and recovery. Ultrafiltration probes can be used to sample Ag, but results will have a greater degree of variation, and multiple samples and increased time points should be considered.

We compared 1) the influence of elution fluid on rate, pattern, and completeness of silver nanoparticle (AgNP) elution, and 2) ultrafiltration (UF) probe and direct sampling in vitro . Six specimens (2.5ml of 0.02mg/ml 10nm AgNP and 5.0ml of 30% poloxamer 407) contained in a dialysis tube (12-14kDa pores) were placed in 100ml Dulbecco’s Phosphate Buffered Saline (DPBS) (n=3) or canine plasma (n=3) for 96h on a stirred hot plate (37°C and 600rpm) and sampled 20 times. Six pipette and UF probe samples were taken of a 0.001mg AgNP/ml DPBS or plasma solution. Inductively coupled plasma mass spectrometry was used to analyze Ag. Stock plasma contained Ag. At 96h, 5/6 dialysis tubes had not fully released AgNP. One peak in hourly Ag increase was present in DPBS (10-13h), and two peaks in plasma (6-8h and 10-13h). The hourly Ag increase in plasma decreased earlier than in DPBS. UF probe sampling was possible in both DPBS and plasma and resulted in higher Ag concentrations but with more variation than pipette samples. While in vitro use of DPBS might be more cost effective, plasma should be considered due to difference in elution and recovery.### Competing Interest StatementThe authors have declared no competing interest.

OBJECTIVETo compare antimicrobial activity as demonstrated by the zone of inhibition (ZOI) produced by antibiotic-impregnated calcium sulfate (CaSO4 ) beads after storage for 0, 3, 6, 9, and 12 months.STUDY DESIGNControlled laboratory study.SAMPLE POPULATIONThree-millimeter diameter CaSO4 beads impregnated with vancomycin (125 mg/mL), or amikacin (250 mg/mL), or without antibiotic (control).METHODSCalcium sulfate beads were created at the onset of the study. Individual beads were separated in sterile containers and stored in a closed cabinet at room temperature and humidity for 0, 3, 6, 9, or 12 months until testing. The ZOI against methicillin-resistant Staphylococcus pseudintermedius, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa was recorded with serial replating on a fresh lawn of bacteria every 24 h until beads failed to produce a ZOI. The ZOIs and their changes were compared with mixed-effects linear models. Eluted concentrations of vancomycin measured with high-performance liquid chromatography were reported.RESULTSAt 24 h, ZOIs were comparable regardless of time since formulation, except vancomycin against P. aeruginosa, which failed to generate a ZOI. The daily changes of ZOI and duration of activity of antibiotics did not vary between storage length (p > .05). There was no consistent change in eluted drug concentration between storage length of beads.CONCLUSIONLight protected storage at room temperature for up to 12 months did not impair the in vitro activity of antibiotic-impregnated CaSO4 beads, as demonstrated through ZOIs.CLINICAL SIGNIFICANCEWhen stored correctly, antibiotic-impregnated CaSO4 beads can be used at least up to 12 months after formulation.

OBJECTIVE The objectives were to (1) compare the impact of preoperative fluid resuscitation on anesthetic parameters and in- terventions and (2) assess the impact of preoperative resuscitation duration on the integrity of intestinal tissue and postoperative complications in dogs with gastrointestinal foreign body obstruction. METHODS Medical records from 1 academic hospital were reviewed for 297 client-owned dogs that underwent gastrointestinal foreign body obstruction surgery between May 2017 and August 2022. Data collected included the following: signalment, preoperative fluid resuscitation, surgical findings, anesthetic parameters and interventions, postoperative complications, and timing of the first meal. Variables for preoperative length of fluid resuscitation (hours), total preoperative fluid bolus (mL/kg), and preoperative fluid rate (mL/kg/d) were changed to categorical variables. As- sociations between anesthetic interventions, postoperative outcomes, preoperative fluid resuscitation length, and total fluid bolus were assessed with ordered logistic regression. RESULTS Shorter preoperative fluid resuscitation length was associated with higher anesthetic fluid rates (P = .033) and fluid boluses performed (P = .023). Increased total volume of preoperative fluid boluses was associated with anesthetic synthetic colloid use (P = .028). There was insufficient evidence to claim an association between the impact of preopera- tive fluid resuscitation length and intestinal wall compromise (perforation, P = .912; enterectomy performed, P = .711). CONCLUSIONS Shorter preoperative fluid resuscitation was associated with increased anesthetic fluid interventions but not the need for more complex surgeries. CLINICAL RELEVANCE Longer fluid resuscitation periods are associated with fewer anesthetic interventions in dogs.

Objective: To describe fluid dispersal and retrieval patterns in an infusion-retrieval system across various configurations and locations in a cadaveric canine model. Study design: Cadaveric study. Animals: Four large breed canines. Methods: Four full-thickness wounds (10 x 10 cm) were created bilaterally in four canine cadavers (shoulder, thorax, flank, and thigh). A wound infusion catheter and active suction drain were placed in four configurations (diagonal, opposite, parallel, and perpendicular) and the incisions were closed. Diluted methylene blue was instilled, allowed to dwell for 10 min, and quantified after retrieval. A 14 x 14 cm full-thickness skin segment, including the initial 10 x 10 cm wound, was removed. Images of the removed skin and cadaver wound bed were taken to calculate surface area (SA) and to evaluate fluid dispersion. A mixed-effects linear regression model was used for statistical analysis. Results: Fluid retrieval did not differ by configuration (p = .92) or location (p = .32), although the perpendicular configuration resulted in the highest retrieval (11.35 +/- 6.1 mL) (56.8 +/- 30% volume instilled) and the flank location resulted in the lowest (7.2 +/- 6.4 mL) (35.9 +/- 32% volume instilled). Configuration influenced SA coverage of the wound bed (p < .01), whereas location did not (p = .10). The parallel configuration had the greatest SA coverage (83.4 +/- 11.6%). No difference existed for leakage of methylene blue (MB) beyond the borders for configuration (p = .74) or location (p = .10). Conclusion: The parallel configuration maximized the fluid dispersion within the cadaveric wound bed in comparison with other configurations (p < .01). Clinical significance: An infusion-retrieval system could be considered during wound closure to administer topical solutions and remove excess free fluid.

Objective evaluate 1) if targeting of platinum magnetic nanoclusters will promote uptake in osteosarcoma cells in vitro , 2) targeting will improve uptake and delivery in murine OSA in vivo compared to free carboplatin, 3) incorporation into a sustained release carrier (SRC) will prolong local retention in vivo . Methods Complex stability and peptide loading was assessed. Drug release was tested at pH 7.4 and 5.5 and cellular uptake and cytotoxity determined for canine, human and mouse osteosarcoma. Subcutaneous murine osteosarcoma was induced and optimal dose and time until tumor growth were established. Tumor bearing mice were equally distributed between 8 treatment (0.5mg carboplatin/mouse) and 1 control group and sacrificed at 8 predetermined time points between 1 hour and 8 days. Blood, tumor site and organs were harvested for tissue ferron and platinum content analysis (ICP-MS). Results Carboplatin was preferentially released at pH5.5. Targeting increased cellular uptake for carboplatin 15.2-fold, and decreased IC50 at 24h and 48h. At 2 weeks, a SC injection of 1-1.56 live cells/mouse reliably resulted in a palpable tumor. Plasma platinum peaked prior to 6 hours while plasma ferron peaked at 24-48 hours. Intratumoral delivery did not lead to a sustained local presence while local delivery in a SRC after surgery did. Conclusions Targeting of MNC-carboplatin is possible with an increased osteosarcoma cell uptake in vitro . In vivo metastatic uptake could not be assessed due to lack of metastases, but local delivery in a SRC yielded high local, and low systemic platinum concentrations in mice. ### Competing Interest Statement The authors have declared no competing interest.

Introduction: Antibiotic-impregnated CaSO4 beads are commonly used for fracture related infections due to their biodegradable nature. Efficacy of clinician-formulated antibiotic impregnated CaSO4 beads after long term storage has not been objectively measured. Manufacturer guidelines recommend immediate use with disposal of unused beads, making these products costly, time-consuming and wasteful. The purpose of this project was to study elution characteristics and effectiveness after storage. We hypothesized that there would be therapeutic levels of antibiotics at every time point with no variation between antibiotic and bead age. With these data, clinicians could produce antibiotic beads for future use; reducing costs and providing valuable tools in combatting SSIs.

OBJECTIVE:This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management.STUDY DESIGN:Narrative review.METHODS:Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar.RESULTS:Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine.CONCLUSION:Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur.CLINICAL SIGNIFICANCE (OR IMPACT):A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

A 7-year-old male mixed intact breed dog was presented with a 6-day history of lethargy and anorexia. A linear foreign body was diagnosed and an exploratory laparotomy performed. The foreign body was pushed orad and removed via gastrotomy. Two mesenteric duodenal perforations were found: one at the level of the common bile duct and a second at the duodenal flexure. Both lesions were debrided and primarily closed in a simple interrupted appositional pattern. A gastrostomy tube and closed suction drain were placed routinely. The dog recovered without complications and ate voluntarily the first day postoperatively. The drain and gastrostomy tube were removed without incident at 4 and 15 days, respectively. Five months postoperatively the dog was reported to be clinically normal. Debridement and primary closure may represent an alternative to more extensive surgery with rerouting for duodenal perforations in select cases.

Background:Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor.Objectives and procedures:This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors.Results:Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians.Conclusion and clinical relevance:Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Background:Despite substantial ramifications of insufficient sleep on mental and physical health and general well-being, many individuals are unaware of what constitutes sufficient sleep, or of the short- and long-term extent of sleep deficiency effects, including those that may not be perceived as fatigue. Objectives and procedures:This review describes the physiology of sleep, defines healthy standards, reviews the pathophysiology and health hazards of acute and chronic sleep insufficiency, and offers concepts for improving individual sleep hygiene. Online databases were searched to extract literature pertaining to sleep, sleep insufficiency, fatigue, and health, with emphasis on literature published in the preceding 5 years. Results:The detrimental effects of acute and chronic sleep loss vary in their range and impact. Individuals often obtain a substandard quantity of sleep, a problem that is poorly recognized by individuals and society. This lack of recognition perpetuates a culture in which sleep insufficiency is accepted, resulting in serious and substantial negative impacts on mental and physical health. Conclusion and clinical relevance:Sleep management is one of the most fundamental and changeable aspects of personal health. Improving awareness of the important physiological roles of sleep, healthy sleep habits, and the consequence of insufficient sleep is essential in promoting general well-being and mental and physical health.

OBJECTIVE To describe and compare the pattern of fluid dispersal and retrieval in a novel instillation therapy system. STUDY DESIGN In vitro experimental study. METHODS A 10 cm2 square model was constructed using plastic sheeting secured to plexiglass, with a wound infusion catheter and Jackson-Pratt (JP) active suction drain positioned in 4 configurations: parallel, perpendicular, diagonal, and opposite. Fluid was instilled using the wound infusion catheter, allowed to dwell for 10 min, and retrieved using the JP drain. Two surface area calculations were made using imaging software: coloration with diluted methylene blue (MB) on photos, and filling with diluted contrast on fluoroscopic images. Fluid retrieval was recorded. Statistical analysis was performed using a mixed-effects linear model (p < .05). RESULTS Configuration influenced fluid dispersion within the model (p = .0001); the diagonal configuration had the greatest surface area coverage (mean ± SD; 94.5 ± 2.4%) and the parallel configuration had the lowest surface area coverage (60.2 ± 2.9%). A dwell period increased fluid dispersal by an average of 4.0 ± 0.8% (p < .0001). Fluid retrieval exceeded 16.7 ± 1.5 mL (83.5 ± 7.5% volume instilled) for all configurations and was 0.5 ± 0.1 mL (2.5 ± 0.5% volume instilled) greater for MB than contrast agent (p < .0001). CONCLUSION Perpendicular or diagonal configurations and low-viscosity fluid maximized fluid dispersion and retrieval. CLINICAL SIGNIFICANCE Wound instillation therapy involves delivering lavage fluid or medications to a closed wound space. This is feasible using a wound-infusion catheter and active suction drain. Configuration should be considered to optimize fluid dispersal and retrieval when planning instillation therapy.