Final day to register for the AVPH webinar on Biosecurity and Smallholders

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As I am on a hiatus from social media (well, Facebook to be more precise), it’s hard to get notices out of events that may be of interest.

However, it can’t help to give a final push via the Veterinary Careers news section

On the 18th of May, the AVPH are hosting a 1hr webinar on smallholders and biosecurity.

As a veterinarian who has a thing or two to say about surveillance and biosecurity, there are some genuine concerns about how we can engage with such producers/farmers/enthusiasts.

This webinar is part of a bigger planned output from AVPH and the AVA.

On the 9th of June, the AVPH will be hosting a 1-day workshop at the University of Melbourne that is designed for private practitioners who want to upskill their technical skills and knowledge of notifiable diseases with regards to smallholder farmers. This is a collaboration with DPI NSW, Agriculture Victoria, The Mackinnon Project (University of Melbourne), Charles Sturt University and 3M. Further details can be found on the AVA website.

DPI NSW have also launched a 2 hour, free e-learning webinar to provide Australian veterinarians with the foundational know-how of how biosecurity works within Australia as well as valuable resources. Further details are in the link below and requires registration on the DPI’s EMTrain website

Lots going on, but a fun time to get involved.

See you all tomorrow at the webinar!

Cheers

Guy

1 hour challenge: Antimicrobial stewardship in companion animal practice

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As part of my ACVPM training, I am required to pump out a number of essays (at a rate of 1 per hour). To try and facilitate this, I am going to adhere to getting a frequent blog on various subjects on veterinary careers to get into the zone. Feel free to comment on our Facebook page or whatever pathways you can reach me. At some point, we’ll open up the comments section in this website. The main aim is to pump out a one-pager that is concise and engaging. So what better way than to start than something that is quite close to my heart (at least in clinical practice). I’ll be setting these challenges myself, but if anyone has any requests, I’ll be happy to take them up. 

Challenge: Antimicrobial stewardship is quickly being adopted within human hospitals to encourage judicious use of antibiotics. Veterinary hospitals and clinics have been a little slower in the uptake. The Journal of Internal Veterinary Medicine has recently released its guidelines on Antimicrobial use for the treatment of respiratory tract disease in dogs and cats. The has been produced by the International Society for Companion Animal Infectious Diseases. 

The Australian Veterinary Association has a selection of antimicrobial resources including the Australasian Infectious Diseases Advisory Panel (AIDAP), safe handling of antimicrobials and animals, a list of antimicrobials for veterinary use that prioritises according to human health and guidelines for personal biosecurity. The Australian Department of Agriculture and Water Resources has collaborated with the Department of Health to establish a One Health National Antimicrobial Resistance Strategy (2015-2019).

Your assignment is to write a letter to the editor targeting small animal veterinarians to encourage them to review their use of antimicrobials, with a focus on the treatment of respiratory disease as well as encourage the establishment of antimicrobial stewardship in companion animal hospitals and clinics. 

Antimicrobial Stewardship in companion animal practice – no sneezing matter

In early 2017, the Journal of Internal Veterinary Medicine released its latest guidelines for antimicrobial use in the treatment of respiratory tract diseases in dogs and cats. This was a collaborative effort from the Antimicrobial working group from the International Society for Companion Animal Infectious Diseases. Whilst each medical case seen by a veterinarian should be approached in a first principles manner, using all diagnostic tools available including culture and sensitivity tests, guidelines are critical for veterinarians to be up to date with recommended empirical therapies.

I would recommend every companion animal veterinarian as well as mixed practitioners to review these latest guidelines and assess whether the recommendations match with the prescribing habits of your clinic. Do your habits or the habits of your associate veterinarians match with these guidelines?

Antimicrobial resistance is a critical issue for the health of not only our patients but also human health as well.

Just recently the WHO published a list of 12 bacterial species that were regarded as antibiotic-resistant “priority pathogens”:

The WHO list:

Priority 1: Critical

1. Acinetobacter baumannii, carbapenem-resistant
2. Pseudomonas aeruginosa, carbapenem-resistant
3. Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: High

4. Enterococcus faecium, vancomycin-resistant
5. Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
6. Helicobacter pylori, clarithromycin-resistant
7. Campylobacter spp., fluoroquinolone-resistant
8. Salmonellae, fluoroquinolone-resistant
9. Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: Medium

10. Streptococcus pneumoniae, penicillin-non-susceptible
11. Haemophilus influenzae, ampicillin-resistant
12. Shigella spp., fluoroquinolone-resistant

In clinical veterinary practice we may encounter a number of these bacterial species in our own patients – either as pathogens that may be explicitly affecting our patients, or as commensals that are existing as the natural flora. Yet how many of them are identified with the resistance profiles that are described by the WHO? There are a few papers out there, however they do carry a bias due to often being produced by specialist centres or universities. In day-to-day, companion animal general practice, the capacity for bacterial resistance surveillance is reliant on the finances of our clients. My personal preference is to always offer a culture and sensitivity profile on the majority of each suspect/confirmed bacterial infection. Yet, when presented with an estimate that often ranges between $100-200, a significant number of clients will baulk and request for empirical therapy. And this is the worth of the above-mentioned guidelines.

Moving to a clinic-wide approach, the release of the ISCAID guidelines on respiratory tract infections should serve as a talking point within the veterinary team to ensure that there is consistency with how empirical antibiotics are prescribed. Such discussions could serve as a perfect launching point to raise the subject of antimicrobial stewardship within the clinic/hospital.

Within the US human hospitals, antimicrobial stewardship seek to improve antibiotic use with goals to optimise appropriate antibiotic selection, dose and duration of therapy. Often the stewardship team is made up of the following individuals:

  • A lead physician
  • A pharmacist
  • Nurses
  • Infection prevention and control staff
  • Laboratory staff
  • and Information Technology representatives

Given the size of many veterinary clinics, what can be done by our practitioners?

  1. Encourage a culture of stewardship amongst the whole team – include the veterinarians, nurses, practice managers and reception staff.
  2. Establish a champion of stewardship within the clinic.
  3. Establish clinic policies and protocols – differentiate between the non-antibiotic diseases that can be managed with supportive therapy vs those that will require appropriate antibiotics. Various tools are available to do that including the in-clinic PROTECT poster
  4. Promote a culture of Infection, Prevention and Control (IPC). Place a veterinary nurse in charge of IPC and establish metrics to identify areas for improvement and success.
  5. Establish appropriate in-clinic surveillance, monitoring and feedback systems to ensure that the stewardship program is operating well. Some metrics that could be used may include clinic antibiograms (these can be sourced from your diagnostic laboratory), the frequency of culture and sensitivity submissions and clinician notes on the selection process.

Over the coming years, more formalised stewardship programs will be released. This is the way of the future for veterinary practice and it is critical that we prepare to play our role in preventing the rise of antibiotic-resistant bacteria.

Ok, that’s done… 1hr and 10min… Granted I was writing this whilst plugging in links and checking my work. Probably not something I can get away with in the exam. I think next time, I’ll write and then for the sake of the blog, I’ll populate it with links.  Reviewing this, I think I lost my way in the middle there, probably didn’t need the WHO list or a ramble about costs of culturing. Plus, I probably should have established a shorthand for some words, for example, C&S for culture and sensitivity. The inclusion of the hospital team make up was also superfluous unless I provided more details on the roles and how they operated together. 

For further details, and if you are an AVA member, feel free to log into the website and go to this link to watch a webinar the AVPH ran at the end of 2016.

The Marine Mammal Center : Domoic Acid Toxicity

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Study for my ACVPM boards takes me into interesting areas for veterinarians to step into – especially the world of ecosystem health. Today I learned about Domoic acid toxicity from the diatom plankton genus known as Pseudo-Nitzschia. I feel you should all learn about the impacts of this toxin too!

The link below has a ton of interesting videos and information about the condition in sea lions.

The Marine Mammal Center works to rescue and humanely treat ill, injured, or orphaned marine mammals and to advance knowledge about marine mammal health. Explore The Center’s website to find out how you can help support marine mammal conservation.

Source: The Marine Mammal Center : Domoic Acid Toxicity

 

The ACVPM aka at the post graduation Year 5 mark, why not up the ante even more?

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So the next 6 months are going to be an interesting exercise in my efforts to blog whilst juggling life and work – I’ve been accepted to sit the ACVPM boards exam.

What’s the ACVPM?

It’s the American College of Veterinary Preventive Medicine. Think of it like big picture veterinary medicine. The stuff that probably doesn’t get associated with veterinarians as much on the media unless it involves puppies and kittens… (not that there’s anything wrong with that as our cat Glen Coco can vouch with his fine fez).

What is the exam made up of?

This exam is broken into 5 parts

  1. Infectious diseases
  2. Public Health administration and education
  3. Food Safety
  4. Environmental Health and toxicology
  5. Epidemiology and Biostatistics

The exam is run over 2 days – Day 1 will be a 6 hour block of short answer and essay questions broken into the 5 sections; Day 2 will be a 6 hour block of 300 questions evenly spread over the 5 sections.

Aren’t you doing your Masters?

Yes, I am currently completing my Masters in Veterinary Public Health. This should be completed within the next year.

So how are you preparing?

  1. I’ve been mainlining the ProMed posts for the past 3-4 years – it’s a good way to get a scope of what is current and topical – which is critical for the essay section which often pulls from the past few years of disease events.
  2. I’ve scared myself by looking at the reading list that is required for this exam… I’m still scared.
  3. I’ve enrolled into an online course run by the Centre for Food Security and Public Health at Iowa State University. There’s a ton of resources here and it’s a platform to interact with other candidates who are mostly based in the US.
  4. The word on the street is that I also have to have an intimate understanding of the compendia from the National Association of State Public Health Veterinarians
  5. The hope is also utilise much of the foundation knowledge I have picked up during my adventures through my Masters in Veterinary Public Health.
  6. I’ll be sitting this exam with 2 other friends who are similarly minded on this side of the world. Whilst we are separated geographically in the region, having allies who are going through the same challenges is important to me – it’s how I got through vet school.

WHY?????

I feel that I will be asking myself that frequently over the coming months. There’s some logic behind all this (buried amongst a ton of ego).

  1. I am now 5 years out from graduation. This is the time many of us veterinarians start to work out where we’d like to develop our skills or even specialize. As someone who has an interest in all things public health, surveillance, biosecurity and epidemiology, I would like to upskill in these areas. Here in Australia, we used to have a Veterinary Public Health chapter under the Australian and New Zealand College of Veterinary Scientists – the college that facilitates our structured further training towards becoming specialists. Sadly, in the 1990’s, the chapter folded due to a lack of applicants sitting the exam and the exam was run intermittently until 2003. Since then, we’ve not had any formal process to develop our skills in that area apart from doing a graduate degree such as a Masters or PhD. There is a Chapter for Epidemiology which facilitates the membership and fellowship exams for epidemiology. Whilst I do see myself sitting at least the membership exam for epi into the future, I do want to be recognised in the world of veterinary public health… Which is an odd thing to want right?
  2. The dream would be to pass this exam and be part of the team that is seeking to build up the chapter and specialty of veterinary public health within Australia.
  3. Some of the blogs on the ACVPM exam talk about pay rises with getting boarded. As this is a non-existent specialty here in Australia, there’s no chance of that.
  4. Yet, there is hope to carve a small niche in the world of preventive veterinary medicine (and veterinary public health), and be part of the movement to make it a recognisable discipline in Australasia.

So what does this mean for Veterinary Careers?

I’m going to be juggling this quite a bit, however I reckon there is a win-win here. For anyone who’s ever considered sitting the ACVPM board exams, there’s a well frequented blog out there by Dr Elliot Garber (he of the “Uncommon Veterinarian” fame) where he muses before and after taking the exam with some great tips scattered for any potential candidates. My hope is to replicate Dr Garber’s efforts by writing about the study experience – this way we can track my descent into crazy study land, I can practice my communication skills via the blogging experience, and I can use my quite-frequent procrasti-brainwaves in a more productive manner. I won’t be putting any material up here from the prep course or other study sources, but hope to take the core messages from each section and see how such principles and investigations apply in Australia.

Am I going to pass?

Maybe, maybe not – but it certainly is worth a stab.

 

Guy is a Director for Veterinary Careers – he secretly works in clinical veterinary practice (and his opinions are reflective of his own and not of his place of work), whilst completing his Masters in Veterinary Public Health. He enjoys the interface of clinical practice and case management whilst unleashing his VPH-nerdiness onto the unsuspecting public. 

Choose Science. Choose a job. Choose a career. Choose epidemiology. Choose a quality-designed study, peer-reviewed journals, replicable studies, critical thinking and meta-analyses. Choose veterinary public health. Choose viruses, bacteria, fungi and prions. Choose zoonoses, transboundary diseases, food safety and one health. Choose multi-disciplinary collaborations. Choose vaccination programs and disease eradication. Choose developing country work. Choose research. Choose communication and explaining concepts that are digestible to the public. Choose to take on the tough challenges, the snake oil peddlers and the pits of mistruth. Choose a world which appreciates science- and evidence-based approaches to issues. Choose to give a sh!t. 

Choose your future

Choose science. (*)

(*) With full apologies to fans of John Hodge, Renton and Trainspotting.

 

Antimicrobial resistance in veterinary practice

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“Ruin is the destination toward which all men rush, each pursuing his own best interest in a society that believes in the freedom of the commons. Freedom in a commons brings ruin to all.”
― Garrett Hardin, The Tragedy of the Commons

“If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality universal healthcare coverage more difficult if not impossible…It will undermine sustainable food production. And it will put the sustainable development goals in jeopardy.” – Ban Ki-moon, outgoing UN Secretary General

 

its-complicated

 

Antimicrobial resistance is a critical issue for both human and animal health. As practitioners who are able to prescribe and dispense antibiotics, we (veterinarians) need to ensure that our practices are up to date and we are doing our best to limit the risk of antimicrobial resistance – not only for the sake of our patients, but also our clients and our staff. For too long have we put our use of antimicrobials as a side thought, reflecting that it would not be an issue in our realm of practice – a true tragedy of the commons.

In light of that, I feel the need to highlight that next week is Antibiotic awareness week – a week to raise awareness about the problem at hand, get up to speed on what our respective countries are doing, address our respective knowledge gaps and to develop solutions collectively. You might say it is a “One Health” issue (yes, cross-linking to earlier blogs is the “new black”).

The Australian Veterinarians in Public Health (a special interest group under the Australian Veterinary Association), a group I am proud to be a committee member of, is hosting its next webinar during Antibiotic Awareness Week on the 16th of November. The webinar will feature Dr. Laura Hardefeldt, a large animal internal medicine specialist, who is currently working on her PhD with the National Centre for Antimicrobial Stewardship and The University of Melbourne. The aim of this webinar is to update veterinary practitioners about the mechanisms of resistance in bacteria, discuss how stewardship programs are being implemented internationally in veterinary practices and in agriculture, and some ideas of how stewardship could look within Australian veterinary practices.

This is a critical webinar for all veterinarians from all fields of practice. One hopes that such a webinar will inspire some veterinarians (if not all) to have an open discussion about the judicious use of antimicrobials in their respective clinics and help develop their own stewardship programs (1). Go on, sign up and bring on the new wave of awesome in Antimicrobial stewardship.

Register here: Australian Veterinary Association

Guy is a Director for Veterinary Careers – he secretly works in clinical veterinary practice (and his opinions are reflective of his own and not of his place of work), whilst completing his Masters in Veterinary Public Health. He enjoys the interface of clinical practice and case management whilst unleashing his VPH-nerdiness onto the unsuspecting public. 

1 – I fully appreciate that it’s not just veterinarians who need to be part of the solution and that there are other drivers that push resistance in microbes – and that will be the subject of a future 1 hour blog in due time. Needless to say, “it’s complicated”.