Outcome based veterinary medicine… (Day -278)

Outcome based veterinary medicine

In nature animal behaviour is driven by need. They balance their energy expenditure to the expected reward received. Yet it is proven psychologically that sometimes people do stuff just because the people before them did it. Check out the video here:

So yeah, all those people started to do that just because someone else did. When asked why they did it they didn’t know. Unfortunately this also happens in veterinary medicine as well as human medicine as well as other professions.

A good example is the air port on an infusion giving set – many people just open it even with collapsible plastic bags/bottles because they always have. This is something that is used with fixed volume glass bottles to let air in to replace the liquid that is lost.

It is often easy to do what you always have as you feel safe, yet it does not always reflect what is correct or best. The worst case is when you have been shown to do something, yet do not understand why you are doing it. The best case is when you understand why you are doing what you are doing.

Now yesterday I spoke about evidence based medicine and the problem with statistics in research papers. Today I want to talk about another type of medicine that I have read about recently – it is called outcome based medicine.

So instead of doing stuff because that is the way it is always you decide what you want the outcome to be, and you take the steps to get to that outcome. The perfect example is that of fluid therapy. There are loads of guidelines and refinements to fluid therapy are happening all the time. However it is always about the amount, the speed, and type of fluid.

Traditionally though there was guidelines on the quantity, some on the speed of administration. However the thing that was undefined was that of when to stop even though the measurement of fluid deficit is subjective.

Now with outcome based medicine you are looking at what you want to achieve in a measurable way. With fluid therapy we have things such as the heart rate, blood pressure, capillary refill time that we can use with well-defined normal ranges. So if you want to get to these normal parameters you can give smaller boluses of fluids over a shorter time. Reassess these clinical parameters; if it is normal then you can stop, if not then you repeat the bolus until it is normal.

This way you know what your outcome is, why you are doing something, and you know how to measure it. For me when I think about surgery this is logical, I always try to have a plan of what I will do when I operate. I will know what my expected outcome will be.  I will then have backup plans with their expected outcomes. And then I will have plans on what needs to be done post operatively as well.

So taking this approach of outcome based medicine and applying it within internal medicine takes some of the guesswork away. And in combination with properly reviewed articles from evidence based medicine will I think this will form a lot of the future of veterinary medicine. In surgery especially we are already looking at computer models to predict the outcome of surgery on a patient by patient basis.

My first cat cannulation… (Day 531)

Today’s Diary Entry is sponsored by Rabbit Feeds

So today started badly as because of the Norwegian program my Falconry and Wildlife Rehab lecture was cancelled leaving me with just patho physiology and parasitology lectures followed by my general surgery practical. Well so though I have seen plenty placed, I’ve never actually got to place a cannula into a cat before. Something about my first ever attempt being in front of a owner, on a sick (and very stressed) cat, with the associated pressure always kinda gave me pause. Not to mention the claws and teeth that cats possess!

Today’s general surgery class was all about how and where to give different injections using various techniques (on cadavers). A few of the group were then allowed to attempt cannulation – basically inserting a port into the vein which is then kept there as long as needed. Now someone in my group tried the vein lower down and failed, which caused a hematoma (bruise). So my attempt was a little higher than I would normally like – you are supposed to try to avoid joints etc – however as no one else jumped forward I decided to give it a go.

Now I found blood straight away (meaning I found the vein), however trying to get the cannula into place I lost it. Basically this part is really fiddly as a cannula is basically a silicone tube over a metal stylet, once you are in the vein you need to push the tube in further whilst taking out the stylet… This is a lot more difficult then it sounds one handed. So after going a little wonky beside the vein with some fiddling I managed to get it into the vein properly. Now this meant I then had to fix it in, so using the sticky tape I had prepared I attempted to do this, so I found that this is also more difficult than I expected – added to the fact I think I cut the tape strips too long – so it didn’t look as pretty as it could have, however it worked.