Development of a questionnaire assessing health-related quality-of-life in dogs and cats with cancer

Health-related quality-of-life (HRQoL) has been studied extensively in human medicine. There is currently no standard HRQoL evaluation for veterinary oncology patients. The aim of this study was to assess the practicality, usefulness and robustness, from a pet owner and clinician perspective, of a questionnaire for the assessment of HRQoL in canine and feline cancer patients. A HRQoL assessment entitled 'Cancer Treatment Form' and two questionnaires entitled 'Owner Minitest' and 'Clinician Minitest' were designed. The first and second were completed by owners of patients presenting to a veterinary oncology referral service and the third by attending clinicians. The 'Cancer Treatment Form' was well received by owners and clinicians and provided a valuable assessment of HRQoL with 98% (82/84) of owners reporting an accurate reflection of their pet's quality-of-life. Following this, minor improvements to the form could be suggested prior to regular use in evaluation of clinical oncology patients.     

Assessment and management of acute pain in cats

Abstract: Cats are popular pets, but until recently, their peri-operative and traumatic pain had been seriously underestimated and under-treated. The lack of treatment stems from difficulty in recognizing pain, lack of licensed analgesic drugs, fear of toxic side effects, and lack of information specific to cats. Fortunately, in the last decade, many advances have been made in feline analgesia. It is now obvious that because of the cat's unique metabolism, species-specific studies are essential. Opioids are the mainstay of any analgesic protocol for acute pain and can be used with few side effects. Other drugs that can be utilized include the α₂-agonists, local anesthetics, and non-steroidal anti-inflammatory drugs. Pain assessment in cats is challenging and developing, and validating pain scoring systems remains an important goal. The information in this article will help the critical care and emergency clinician formulate a safe and effective analgesic plan for feline patients.     

Alfaxalone or ketamine‐medetomidine in cats undergoing ovariohysterectomy: a comparison of intra‐operative parameters and post‐operative pain

ObjectiveTo compare post-operative pain in cats after alfaxalone or ketamine- medetomidine anaesthesia for ovariohysterectomy (OHE) and physiologic parameters during and after surgery.Study designProspective ‘blinded’ randomized clinical study.AnimalsTwenty-one healthy cats.MethodsCats were assigned randomly into two groups: Group A, anaesthesia was induced and maintained with alfaxalone [5 mg kg^?1 intravenously (IV) followed by boli (2 mg kg^?1 IV); Group MK, induction with ketamine (5 mg kg^?1 IV) after medetomidine (30 μg kg^?1 intramuscularly (IM)], and maintenance with ketamine (2 mg kg^?1 IV). Meloxicam (0.2 mg kg^?1 IV) was administered after surgery. Basic physiological data were collected. At time T = -2, 0, 0.5, 1, 2, 4, 6, 8, 12, 16, 20, and 24 hours post-operatively pain was assessed by three methods, a composite pain scale (CPS; 0–24 points), a visual analogue scale (VAS 0–100 mm), and a mechanical wound threshold (MWT) device. Butorphanol (0.2 mg kg^?1 IM) was administered if CPS was scored =13. Data were analyzed using a general linear model, Kruskal–Wallis analyses, Bonferroni-Dunn test, unpaired t-test and Fisher's exact test as relevant. Significance was set at p < 0.05.ResultsVASs were significantly higher at 0.5, 1, 2, 4, and 20 hours in group A; MWT values were significantly higher at 8 and 12 hours in group MK. Post-operative MWT decreased significantly compared to baseline in both groups. There was no difference in CPS at any time point. Five cats required rescue analgesia (four in A; one in MK).Conclusion and clinical relevanceAnaesthesia with ketamine-medetomidine was found to provide better post-surgical analgesia than alfaxalone in cats undergoing OHE; however, primary hyperalgesia developed in both groups. Alfaxalone is suitable for induction and maintenance of anaesthesia in cats undergoing OHE, but administration of additional sedative and analgesic drugs is highly recommended.     

Preliminary validation of a point‐of‐care ethylene glycol test for cats

Objective – To evaluate the sensitivity and specificity of a newly available, semi‐quantitative, cage‐side test for the detection of ethylene glycol (EG) toxicosis in cats. Design – Prospective, laboratory study. Setting – University teaching hospital. Animals – This study utilized samples from 57 cats, whose blood had been anticoagulated with EDTA and submitted to the hospital's laboratory for a complete blood count. Samples were centrifuged, and the plasma separated, aliquoted, and immediately frozen at ?30 °C. Interventions – Samples were randomly divided into 2 primary groups (Group 1: no EG added, Group 2: EG added). Twenty microliters of plasma from each of the Group 1 samples was applied directly to the test strip. Plasma samples from Group 2 had EG added at different concentrations to achieve approximate final concentrations of 20, 60, or 80 mg/dL. These samples were then applied to the test strip. Measurements – Two readers who were blinded to the sample preparation procedure and isolated from each other were asked to categorically interpret the colorimetric reaction on the randomly presented test strips. Main Results – The agreement of the 2 reviewers at the 3 different levels of EG concentrations (20, 60, 80 mg/dL) were 0.7, 0.7, and 0.5, respectively. Thus, the readers demonstrated substantial agreement while reading the 2 lower concentrations, while at 80 mg/dL the level of agreement was moderate. Overall, the sensitivity of the assay increased as the concentration of EG increased (reviewer 1: 67%, 67%, 86%; reviewer 2: 56%, 89%, 100%), while the specificity of the assay decreased with increasing concentrations of EG (reviewer 1: 77%, 45%, 50%; reviewer 2: 77%, 53%, 25%). Conclusions: Because of the likelihood for false negatives and false positives, results from this test must be viewed in light of clinical data and should not be relied upon as a lone diagnostic test.     

Protein characterization using electrophoresis and immunofixation; a case‐based review of dogs and cats

Protein electrophoresis and immunotyping can be a useful adjunct to the standard biochemical techniques for characterizing serum and urine proteins. This paper reviews currently available and commonly used methods for diagnostic protein electrophoresis, including both agarose gel and capillary zone electrophoretic techniques and total protein assessments. Immunofixation and immunosubtraction methods for identification of immunoglobulin location and class are also presented. Practical application of quality assurance and quality control strategies in compliance with American Society of Veterinary Clinical Pathology (ASVCP) best practices are discussed. Commonly encountered serum and urine electrophoretic diagnostic patterns, including electrophoretically normal, acute‐phase protein responses, polyclonal gammopathies, restricted polyclonal/oligoclonal gammopathies, paraproteinemias (monoclonal or biclonal gammopathies), and Bence‐Jones proteinurias are also reviewed using relevant case material. Cases in which immunofixation electrophoresis are particularly useful are highlighted, and methodologies to more accurately quantify serum monoclonal proteins (M‐proteins), monitoring tests commonly used in human medicine, are discussed.     

Development of a behaviour-based scale to measure acute pain in dogs

A composite scale for assessing pain in dogs in a hospital setting has been developed on the basis of observations of their behaviour. Initially, 279 words and expressions suggested by 69 veterinary surgeons were reduced into 47 words and expressions which were allocated into seven behaviour categories: demeanour and response to people, posture, mobility, activity, response to touch, attention to painful area and vocalisation. Three statistical methods, hierarchical agglomerative cluster analysis, Cronbach's alpha coefficient, and analysis of variance with multiple comparisons and empirical cumulative distributions, were used to validate these procedures, and a questionnaire accompanied by a list of definitions was designed around the expressions. The new composite scale is more detailed than previously reported scales for assessing pain in dogs on the basis of their behaviour, and the methods used in its development are based on sound scientific principles.     

Development of a severity scoring system for acute haemorrhage in anaesthetized domestic cats: the CABSS score

ObjectiveTo determine whether physiological, haematological, biochemical or electrolyte variables can predict severe haemorrhage in cats.Study designRandomized crossover study whereby each cat underwent mild and severe haemorrhage, with a 2 month period between events.AnimalsA group of six domestic cats aged 21 ± 1 months and weighing 4.9 ± 1.2 kg, mean ± standard deviation.MethodsCats were anaesthetized (buprenorphine, alfaxalone, isoflurane in oxygen at a fixed end-tidal concentration of 1.7%) before the haemorrhage event. In total, 34 variables were measured twice (prehaemorrhage and posthaemorrhage). The difference and percent change for each variable were compared between haemorrhage events (paired t test). Significant variables were placed into 13 different ratios (posthaemorrhage value of one variable divided by a posthaemorrhage value of a second variable) and compared (paired t test), and Cohen’s d (d) was calculated. Receiver operating characteristic curves were plotted and cut-off values for weak, moderate and strong indicators of severe haemorrhage were obtained.ResultsThe blood loss was 4.5 ± 1.1 mL kg^–1 and 26.8 ± 5.5 mL kg^–1 for mild and severe haemorrhage events, respectively. The most significant variables with large effect sizes were heart rate (HR), systolic arterial blood pressure (SAP), end-tidal carbon dioxide (Pe′CO₂), serum albumin, haematocrit and actual bicarbonate ion concentration [HCO₃⁻(act)]. The most robust ratios were: 1) shock index (d = –2.8; HR:SAP); 2) HR:Pe′CO₂ (d = –2.9); 3) serum albumin: haematocrit (d = 1.5); and 4) HR:HCO₃⁻(act) (d = –1.6). These ratios were included in the final proposed Cat Acute Bleeding Scoring System (CABSS).Conclusionsand clinical relevance Cats subjected to mild and severe haemorrhage demonstrated statistically and clinically relevant changes whereby four ratios could be created to make up the CABSS. The ratios detected and quantified the presence of severe haemorrhage in anaesthetized cats.     

Characterization of a PCR‐based lymphocyte clonality assay as a complementary tool for the diagnosis of feline lymphoma

Differentiation between resident mature lymphocyte populations and small cell lymphoma cannot be made by cytological review alone and remains challenging in histopathological review. These cases warrant application of complementary tools like PCR‐based immunoglobulin (IG) and T‐cell receptor (TCR) clonality testing for confirmation. In this prospective study, diagnostic sensitivity and specificity of different primer sets for routine diagnosis of feline TCR gamma (TCRG) and complete IG heavy chain (IGH) gene rearrangements were assessed. Fine needle aspirates from 20 feline lymphoma cases and lymph node material from 10 cats without hematopoietic neoplasia were subjected to clonality testing. Feline lymphoma cell lines and previously confirmed patient material served as positive control. Detection limits for clonal populations within a polyclonal background was 90% for B‐cells and 50% for T‐cells. Diagnostic sensitivity and specificity of the clonality assay were 70% and 90%. Overall diagnostic accuracy was 77%, positive predictive value 93% and negative predictive value 60%.