The audit1 was led by Paragon Veterinary Referrals’ head of cardiology, Chris Linney (pictured), to review treatment for patent ductus arteriosus.
He set up the study whilst working at Willows Veterinary Centre and Referral Service, and the other centres collaborating on the study were Anicura Oslo Animal Hospital, Heart Vets; Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, University Hospital of Companion Animals, Copenhagen and Veterinary Cardiology Consultancy.
Other clinicians taking part included Brigite Pedro, Mike Martin and João Neves, formerly of Willows, along with Jo Harris and Dave Dickson, of HeartVets.
Chris, an RCVS and EBVS specialist in cardiology, said: “This published multicentre prospective clinical audit was a first of its kind in the cardiology world.
“This type of audit acts as a quality control to improve patient outcomes through systematic review of care, comparing to predefined criteria and then implementing change, and so the process repeats.
“Improving patient outcomes and benchmarking against existing standards is essential for elevating patient outcomes.
In the centres in this study, we are already delivering excellent patient outcomes but with room for improvements, however small, this audit will help future patients but also colleagues across the cardiology world.”
Reference
David, who was assisted by Dan Kenny and Kat Grzywa MsRCVS, said: “Penny presented with suspected ascites, given a large volume of peritoneal effusion. Her abdomen was very swollen and taut
“We performed a contrast-enhanced CT scan with an iodine-based contrast to help highlight the areas of the body we needed to examine and the results were startling.
“The mass was enormous. It almost completely filled the abdomen.”
CT images showed that the mass had originated in the right kidney, which had been displaced into the left side of the abdomen, and also compressed the rest of Penny’s internal organs.
There was no evidence of metastatic disease.
David added: “A right ureteronephrectomy was performed and the large cystic parts of the tumour were dissected free from the omentum, the peritoneum and the retroperitoneal vasculature.
“The surgery was really difficult because the mass was so large and heavy, and it required extra surgeons to hold and manipulate the mass, while its vasculature was dissected and ligated.
“The weight of the mass on the diaphragm also made the anaesthesia challenging but surgery went very well.
"Once the surgery was over, the weight of the mass was confirmed at nearly 5kg.
“Penny made a good recovery from the anaesthesia, her blood renal parameters remained normal throughout her recovery, and she was discharged 48 hours later. Histopathology later confirmed the mass to be renal carcinoma.”
Chris, who is moving from Willows, will develop both the medical cardiology service and deliver a new interventional cardiology service to complement the existing surgical offering at Paragon, which is investing around £145,000 in ultrasound equipment and operating facilities to support the service.
Chris said: “I’ve had a great time at Willows and couldn’t think of a better place than Paragon to continue my passion for all things cardiology.
“It’s an exciting time to be joining Paragon, which is growing phenomenally to service the region whilst it cements itself as one of the leading referral centres in the north of England.
“The investment and expansion which is taking place at Paragon will allow us to develop another globally-recognised cardiology centre within Linnaeus.”
For more information, visit: www.paragonreferrals.co.uk
Paragon’s head of neurology, Massimo Mariscoli, says it will deliver better results for pets, improve the health and well-being of the surgeons using it, and improve the hospital’s ability to deal with complex spinal and brain surgeries.
Massimo, an EBVS and RCVS specialist in veterinary neurology said: “The operative microscope is an essential piece of equipment in the modern neurosurgical theatre.
“It delivers good magnification, good illumination without significant aberration or production of excessive heat and has a great internal stability which allows operational flexibility.
“There is also direct visual control of the instrumentation with the possibility to have magnifications up to 10 times with a good depth of field allowing a more natural three-dimensional vision.
“In addition, surgical microscopes allow multiple different magnifications while maintaining constant working distances which leads to excellent flexibility and versatility during surgical procedures.
“For example, low magnification is used during the drilling of the vertebral laminar or the skull and to ensure that the whole surgical field is clean before suturing the muscle layers.
“Higher magnification is used while dealing with delicate structures such as the spinal cord or brain.
“The higher magnification coupled with a good depth of view and stable three-dimensional vision also increases the security and safety when manipulating micro-surgical instruments near the nervous tissue.”
Massimo says that while the microscopes are not common in veterinary practices, he strongly believes they are an essential piece of equipment when dissecting close to the brain or spinal cord in small animals.
He also says that veterinary surgeons benefit from the technology: "The operative neurosurgical microscope is fixed to a self-levelling tripod, allowing multiple spatial configuration to ensure a perfect vision of the surgical field.
“This has a positive outcome on the health and well-being of the surgeons, with a 2013 study showing that, for nearly 85% of the time spent operating, surgeons have symmetrical, non-neutral, head-neck posture.”
For more information, visit www.paragonreferrals.co.uk.
The operation of the equipment is being overseen by Dr Rodney Ayl, a specialist in both medical and radiation oncology. He said: "The need for protection of personnel during preparation of cytotoxic drugs presents the most significant obstacle to the safe provision of chemotherapy, as most practices are not equipped with an appropriate biosafety cabinet. This is especially true when there is a high case-load of chemotherapy patients."
Dr Ayl says the dangers of repeatedly handling and administering cancer drugs can be severe. He added: “The likelihood of drug exposure must be taken into account when considering the safety of personnel who handle cytotoxic drugs.
"The cumulative toxicity to personnel that arises from repeated contact with these drugs can cause health problems in the nursing staff that are beyond those expected in the patient.
"The main routes of personnel exposure to cytotoxic drugs are by aerosolisation or by absorption through skin.
"Both types of exposure can occur when preparing drugs for administration. The act of withdrawing cytotoxic drug from the vial into a syringe is generally the step that presents personnel with the greatest potential for exposure to a high concentration of drug.
"Ideally, personnel are optimally protected from drug exposure, and patients are protected from contamination of the product, by the use of a laminar flow biosafety cabinet (BCS) during drug preparation, regardless of whether a closed delivery system is used.
"The Envair CytoFAST BSC has been designed to guarantee the product, personnel and environmental protection.
"It belongs to the latest generation of laminar airflow systems and is built to the highest quality to guarantee the strictest safety standards - and the safety of our people is paramount at Paragon."
The traditional approach is to use anatomical knowledge to inject pain relief in the area of the nerves to be blocked.
Liz is leading a move away from this approach to a more precise method which uses ultrasound guidance to visualise the nerves, allowing the local anaesthetic to be placed directly around the nerve itself.
For some nerve blocks, it is possible to block just the sensory branches of nerves, which means pets can walk better immediately after surgery while not feeling any pain.
Liz, a past president of the Association of Veterinary Anaesthetists, said: “Local analgesia is now at the forefront of our post-operative care and reliably improves the quality of a pet’s recovery and reduces the need for opioid pain relief, which can cause side effects.
“We’re using the latest techniques to deliver the nerve-blocking anaesthetics to exactly where they’re needed.
“For many of the nerve blocks, the use of ultrasound guidance allows more precise delivery and a complete blockade of the sensory nerves, which is why, here at Paragon, we’ve invested in state-of-the art ultrasound machine designed specifically for superficial and deep nerve blocks.
“This means we can provide more effective immediate post-operative analgesia for our patients and minimise the need for further pain killers.
“The nerves can be directly visualised and local anaesthetic directly placed around the nerve bundles.”
Liz is keen to highlight the advantages of the increased use of local anaesthesia in the treatment of animals. She added: “We’re hoping we’ll soon be able to publish some clinical research on the use of some of the blocking techniques used to demonstrate our clinical impression of their effectiveness in patient management.”
The programme is comprised of one "Coffee with our Clinicians" session and two "Clinical Club evenings", both delivered using Microsoft Teams.
Paragon’s clinical director, Sophie Adamantos, said: "Coffee with our Clinicians is an opportunity to listen to two or more specialists discussing, and taking questions, on clinical cases and conundrums.
“Clinical Club will feature longer, more in-depth presentations by our clinicians from different disciplines discussing specific themes, treatments and developments."
The events are as follows:
To sign up for any of the CPD sessions, visit www.paragonreferrals.co.uk/veterinary-professionals/cpd
The RCVS assessor’s report said: "The premises are genuinely state of the art, with all the space and equipment needed to provide a full multi-discipline referral service.
"The outstanding feature of this visit was the level of inpatient care, which is impressive with dedicated team leaders and thorough handovers for continuity of care, and the depth of knowledge of the clinical and nursing teams.
"Special mention must be made of infection control and inpatient modules in which all the award points available were obtained."
The assessor's report added: "You have all produced a centre to be proud of, and the feeling of pride and commitment of the team, came across very clearly. I wish you every success as your reputation grows."
Rebecca Lunn, operations co-ordinator at Paragon, said: "Pets always come first at Paragon so to receive four “outstanding” awards from the RCVS is a great compliment and achievement.
"Naturally we are delighted. It’s a real tribute to our entire team and our determination to deliver quality care, excellent service and a compassionate approach to ensure the best possible treatment for our animals.
"To achieve this, we have invested heavily, not only in the best, highly-experienced diplomates but also the most advanced specialist equipment within veterinary science.
"That level of commitment will continue on all fronts as we strive to be the very best we can be."
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.
The clinic is being run by Liz Leece, an RCVS and EBVS Specialist in veterinary anaesthesia and analgesia, to offer bespoke pain management plans for clients.
Liz has more than 20 years’ experience in specialist anaesthesia and analgesia and has extensive experience managing dogs and cats with complex problems causing chronic pain.
Liz said: "Our pets are similar to humans in the sense that the longer they live, the greater the chance they will develop conditions causing chronic pain.
"The clinic is available for any pet referred by their primary care vet for management of chronic pain, including osteoarthritis and other orthopaedic conditions, neurological and cancer pain.
"Animals will be assessed and advice given on how the pain can be managed, including monitoring a pet’s response to different treatments and what to expect."
Liz Leece, an RCVS and EBVS specialist in veterinary anaesthesia and analgesia (pictured right) and Massimo Mariscoli, an EBVS and RCVS specialist in veterinary neurology joined Paragon at the start of this month.
Liz is a past president of the Association of Veterinary Anaesthetists, is on the British Small Animal Veterinary Association’s congress organising committee and lectures to vets, nurses and occasionally human anaesthetists, all over the world.
She said: "I’m a keen supporter of the anaesthetist’s role in the referral hospital setting, safeguarding welfare and optimising the hospital experience for all our patients.
"One of my first tasks will be to establish a chronic pain management clinic at Paragon to aid any patients in need of such support.
"I also love teaching both inside and outside clinics and I’m currently involved in clinical research into brachycephalics, neuroanaesthesia and chronic pain."
Massimo grew up in Italy and graduated from the University of Bologna in 1990. He worked as head of small animal surgery and neurology at the Veterinary Teaching Hospital of the University of Teramo, before spells as lecturer and associate professor at the same centre.
The past president of the Italian Society of Veterinary Neurology (SINVet) moved to the UK in May 2017 to work as a neurology specialist and then head of neurology at a small animal hospital.
His main clinical interests are epilepsy, inflammatory disorders of the central nervous system and neurosurgery.
He said: "I was looking for a new challenge and was very pleased when I learned there was the possibility of setting up the neurology service at Paragon. I first visited the site in February and got a very good impression.
"Neurology has been split between internal medicine and surgery to date, so I will be looking to establish the service in its own right.
"Setting up a new service and new systems can be complex, so I will be taking my time and letting the service take shape naturally."
Paragon managing director Ian Monteith said: "Both Liz and Massimo are tremendous additions to our team and we’re delighted to be adding yet more high-calibre specialists to our ranks."
Andrea, who is also an EBVS Specialist in Small Animal Internal Medicine, is joining Paragon after returning from a spell in Australia. The transfer fee was not disclosed.
Andrea graduated from Bristol in 2011 and became a Specialist in 2017. She said: "I'm so pleased to be returning to my beautiful home county of Yorkshire and joining the brilliant team at Paragon.
"Internal medicine will be my key area and my main interests are infectious diseases and post graduate clinical teaching."
Andrea represented England youth at basketball between 2000 and 2002, starring in tournaments in Hungary and Italy, and her passion for sport is still high on her list of priorities.
She added: "Now I’m back home I’m looking to join a triathlon club and will attempt to master the ukulele, which I recently began playing."
Paragon managing director, Ian Monteith, said: "Andrea is the fifth high-calibre specialist addition we’ve made in the past six months which illustrates our dedication to delivering the highest level of care and treatment to our patients."
Rodney (pictured right) has spent the last 26 years practising in the USA, latterly at the California-based Advanced Veterinary Specialists & Animal Specialty Group.
After growing up in Zimbabwe and graduating from the University of Pretoria in South Africa in 1985, he moved to London, where he became an MRCVS, and thence to the USA.
He undertook a small animal internship at the Animal Medical Centre in Manhattan, before moving to the Ohio State University for his residency in medical oncology in 1989. He achieved Board Certification in medical oncology in 1994 and in radiation oncology in 2000.
Rodney specialises in the application of multi-modality therapy protocols for the treatment of cancer in animals, and has conducted research on the phenomenon of multi-drug resistance, mast cell tumour and oral melanoma.
He said: "Thirty-something years on, I have come back to the UK as a specialist, where I started as a GP. Living in the UK also brings me much closer to my family, which is very important to me.
"Over the years, veterinary practice in the USA has changed significantly, where it has become more corporate and less personal. I enjoy being part of a new group where typically it is much closer, friendlier and more like a family."
Rodney now plans to oversee the development of a comprehensive oncology department to include chemotherapy, surgery, radiation therapy, immune-therapy and molecular targeted therapy.
He said his work at Paragon will focus on educating referring vets and clients about what is possible in the oncology field.
He said: "My job will be about increasing the level of knowledge, both of owners and general practitioners, of how we treat cancer in animals.
"It can be a scary disease and the first door an owner needs to step through, is understanding that treating a pet is very different to treating a human.
"The intention in humans is usually to cure but with pets, it is more about providing a good quality of life for as long as possible.
"There can be a fear of cancer therapy but if you stick to the protocols, it is no different to treating any other chronic incurable diseases. We use the safest methods with an abundance of caution and try to make sure that the treatment is not worse than the disease.
"It’s about internal training too, from reception right up to nurses and interns, looking at what we do and how we do it, to optimize the quality of life of the pet and their owners.
"I would like to see an oncology department that considers the emotional, financial, time and patient concerns of the owners, so they feel their commitment to cancer treatment for their pet is not a commitment to putting their pet or themselves through a difficult time."
The 18,000 sq ft centre's facilities include a £1 million imaging suite with state-of-the-art MRI and CT scanners, five operating theatres and extensive kennelling facilities and cat wards. It is also equipped with fluoroscopy equipment with additional mobile C-arm, mobile digital radiography, a Phaco machine and Mindray WATO anaesthetic equipment.
A total of up to 80 staff will be employed at Paragon, including up to 18 referral veterinary surgeons and 32 nurses. Treatment will include ophthalmology, orthopaedics, soft tissue surgery, cardiology, neurology, medicine, oncology and dermatology.
The centre, which is part of Dewsbury-based Calder Vets, which has 12 practices across Yorkshire, is being led by managing director Ian Monteith and clinical director Adam Bell.
Adam said: "The opening of Paragon is the culmination of an 18-month project to bring the very best quality referral veterinary centre here to Wakefield.
"We’re delighted to open our doors and the team here at Paragon Veterinary Referrals are totally committed to, and looking forward to, providing excellent care for patients using the latest veterinary techniques."
For more information about the services Paragon will be offering, and for details of the vacancies on offer at the vet centre, as well as Continuing Professional Development (CPD) opportunities, visit www.paragonreferrals.co.uk.
Paragon is being built by the Linnaeus Group, which says the new centre will be one of the largest and best-equipped in the UK when it opens its doors early in the New Year.
The new centre follows the Linnaeus Group's acquisition of Dewsbury-based Calder Vets last year.
Calder Vets' existing referral teams, together with two ophthalmologists from its Mirfield branch, will be transferring to Paragon. Meanwhile, Calder Vets will move to solely first-opinion work.
Currently nearing the end of construction, the centre will have eight consulting rooms, five operating theatres, MRI and CT scanners, intensive care facilities along with an all-digital imaging department.
A total of up to 80 staff will be employed at Paragon, including up to 18 referral vets and 32 veterinary nurses.
Specialist services will include cardiology, neurology, ophthalmology and orthopaedic and soft tissue surgery.
Positions currently available include a diagnostic imager, internal medicine specialist, neurology specialist, oncology specialist and an ophthalmologist, as well as various nursing posts.
Ian Monteith, managing director of Paragon, said: "We are looking for the best possible people who not only have the right skills and experience, but who will also fit into the ethos we want to create at Paragon.
"It is a significant and exciting opportunity for motivated, high calibre people to help shape something that has a very bright future for both the industry and for their own careers.
"Our philosophy is very much one of friendly cooperation between all members of staff, creating a pleasant, supportive and good-humoured atmosphere."
For details of the vacancies currently on offer at Paragon, visit www.paragonreferrals.co.uk/en-GB/careers