Assessment of companion animal quality of life in veterinary practice and research

O bjectives : Quality-of-life (QOL) assessment is a novel field in veterinary medicine. It shares similarities with the more established fields of human QOL assessment and animal welfare science and could prove similarly useful.
M ethods : This paper draws on existing literature on human QOL assessment, animal welfare, philosophy and animal QOL assessment.
R esults : It provides practical recommendations for QOL assessment in veterinary practice and in veterinary research on what should be assessed, how it should be assessed and who should assess it.
C linical S ignificance : These should assist veterinarians intending to develop their use QOL assessment.     

Development of a discriminative questionnaire to assess nonphysical aspects of quality of life of dogs

OBJECTIVE: To develop a preliminary discriminative questionnaire for assessment of nonphysical aspects of the quality of life (QOL) of pet dogs and evaluate the questionnaire's content validity, test-retest reliability, and internal consistency. STUDY POPULATION: Owners of 120 dogs. PROCEDURE: Each QOL question had 4 response options, representing descending levels of QOL that were equally weighted. A maximum of 38 items contributed to the QOL score. The questionnaire was administered by telephone to owners of dogs with appointments at a veterinary teaching hospital before the appointment. After the appointment, each dog was classified as sick or healthy by use of defined criteria; owners of healthy dogs had a second interview 3 to 4 weeks later. Test-retest reliability (kappa), internal consistency (Cronbach alpha), and respondents' comprehension were used as criteria for excluding an item. RESULTS: There were 77 sick and 43 healthy dogs. Twenty-two QOL questions had significant kappa values (0.11 to 0.91). The Cronbach alpha values for 5 domains of QOL ranged from 0.45 to 0.61, indicating that the domains had moderate internal consistency (homogeneity). The initial pool of 38 items was reduced to 27. CONCLUSIONS AND CLINICAL RELEVANCE: The questionnaire was designed to complement veterinary assessment of dogs' physical health. The questionnaire may be a useful tool in making decisions regarding dogs' QOL.     

Equine Nutrition in the United States: A Review of Perceptions and Practices of Horse Owners and Veterinarians

Nutrition plays a critical role in equine health. The horse owner and/or manager has a multitude of equine nutrition sources available to them, with preferences for how, and from whom, this information is delivered. Despite this, poor feeding practices continue to negatively affect the health, wellness, and welfare of equids and have a detrimental impact on the environment. The veterinarian is the primary expected source of equine nutrition information; yet, little is known about their recognition and acceptance of such a role. Doubt has arisen concerning the quality and provision of nutrition education within the veterinary curriculum and subsequent continuing education. Moreover, the value equine nutrition education plays in the veterinarian's practice philosophy, and the resulting provision of such in clinical practice, remains under evaluated. This review examines the present state of equine nutrition and how horses are being fed in practice, in the United States. It considers feeding horses from the horse owner's perspective and the expected role the veterinarian plays in such. Last, it goes on to evaluate this expected role from the veterinarian's perspective, examining how current nutrition education and practices may be falling short and offering recommendations for future research.     

Why measuring outcomes is important in health care

A new strategy has been introduced in human health care, namely, achieving the best outcomes for the lowest cost and thus maximizing value for patients. In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care. Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.     

Understanding veterinary practitioners' decision-making process: implications for veterinary medical education

Understanding how veterinary practitioners make clinical decisions, and how they use scientific information to inform their decisions, is important to optimize animal care, client satisfaction, and veterinary education. We aimed to develop an understanding of private practitioners' process of decision making. On the basis of a grounded-theory qualitative approach, we conducted a telephone survey and semi-structured face-to-face interviews. We identified a decision-making framework consisting of two possible processes to make decisions, five steps in the management of a clinical case, and three influencing factors. To inform their decision, veterinary surgeons rarely take the evidence-based medicine (EBM) approach. They consult first-opinion colleagues, specialists, laboratories, and the Internet rather than scientific databases and peer-reviewed literature, mainly because of limited time. Most interviewees suggested the development of educational interventions to better develop decision-making skills in veterinary schools. Adequate information and EBM tools are needed to optimize the time spent in query and assessment of scientific information, and practitioners need to be trained in their use.     

Veterinary decision making in relation to metritis - a qualitative approach to understand the background for variation and bias in veterinary medical records

Background

Results of analyses based on veterinary records of animal disease may be prone to variation and bias, because data collection for these registers relies on different observers in different settings as well as different treatment criteria. Understanding the human influence on data collection and the decisions related to this process may help veterinary and agricultural scientists motivate observers (veterinarians and farmers) to work more systematically, which may improve data quality. This study investigates qualitative relations between two types of records: 1) ''diagnostic data'' as recordings of metritis scores and 2) ''intervention data'' as recordings of medical treatment for metritis and the potential influence on quality of the data.

Methods

The study is based on observations in veterinary dairy practice combined with semi-structured research interviews of veterinarians working within a herd health concept where metritis diagnosis was described in detail. The observations and interviews were analysed by qualitative research methods to describe differences in the veterinarians'' perceptions of metritis diagnosis (scores) and their own decisions related to diagnosis, treatment, and recording.

Results

The analysis demonstrates how data quality can be affected during the diagnostic procedures, as interaction occurs between diagnostics and decisions about medical treatments. Important findings were when scores lacked consistency within and between observers (variation) and when scores were adjusted to the treatment decision already made by the veterinarian (bias). The study further demonstrates that veterinarians made their decisions at 3 different levels of focus (cow, farm, population). Data quality was influenced by the veterinarians'' perceptions of collection procedures, decision making and their different motivations to collect data systematically.

Conclusion

Both variation and bias were introduced into the data because of veterinarians'' different perceptions of and motivations for decision making. Acknowledgement of these findings by researchers, educational institutions and veterinarians in practice may stimulate an effort to improve the quality of field data, as well as raise awareness about the importance of including knowledge about human perceptions when interpreting studies based on field data. Both recognitions may increase the usefulness of both within-herd and between-herd epidemiological analyses.     

Perioperative pain management in horses

The inability to talk does not diminish an animal's ability to experience pain, although it may hinder its recognition and therefore lead to the under-treatment of pain. Pain assessment and treatment in horses has advanced considerably with the recent publication of numerous research papers in this area. This review will summarise these research findings and suggest how advances in knowledge of perioperative pain management can be implemented in equine clinical practice.     

Oesophageal disorders in horses: Retrospective study of 39 cases

Oesophageal diseases are less frequently reported in equine veterinary practice in comparison with other alimentary pathologies. This paper describes the prevalence, age, breed and sex distribution, the duration of clinical presentation before admission, the diagnosis, aetiology, treatment course, complications, length of hospitalisation, and the short‐term and long‐term survival of 39 cases with equine oesophageal disorders at a referral clinic. Prevalence of oesophageal disorders was significantly higher in the group of horses up to 4 years of age in comparison with other age groups. The most common oesophageal disorder was simple obstruction represented by 22/39 cases (56.41%). The common complications of the oesophageal disorder were oesophagitis (16/39, 41.02%) and aspiration pneumonia (11/39, 28.20%); 31/39 (79.49%) of all oesophageal cases survived up to clinical discharge. Long‐term survival was 65.78% in this group of cases.     

ASVCP guidelines: allowable total error guidelines for biochemistry

As all laboratory equipment ages and contains components that may degrade with time, initial and periodically scheduled performance assessment is required to verify accurate and precise results over the life of the instrument. As veterinary patients may present to general practitioners and then to referral hospitals (both of which may each perform in‐clinic laboratory analyses using different instruments), and given that general practitioners may send samples to reference laboratories, there is a need for comparability of results across instruments and methods. Allowable total error (TE_a) is a simple comparative quality concept used to define acceptable analytical performance. These guidelines are recommendations for determination and interpretation of TE_a for commonly measured biochemical analytes in cats, dogs, and horses for equipment commonly used in veterinary diagnostic medicine. TE_a values recommended herein are aimed at all veterinary settings, both private in‐clinic laboratories using point‐of‐care analyzers and larger reference laboratories using more complex equipment. They represent the largest TEa possible without generating laboratory variation that would impact clinical decision making. TE_a can be used for (1) assessment of an individual instrument's analytical performance, which is of benefit if one uses this information during instrument selection or assessment of in‐clinic instrument performance, (2) Quality Control validation, and (3) as a measure of agreement or comparability of results from different laboratories (eg, between the in‐clinic analyzer and the reference laboratory). These guidelines define a straightforward approach to assessment of instrument analytical performance.     

Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks

To obtain information on euthanasia decisions from practising veterinary surgeons, respondents were asked to estimate how often during their time in practice they had refused to euthanase a dog and how often they had wanted to refuse to euthanase a dog but not done so because of other pressures. For each, respondents were then asked to state their most common reasons for refusing/not refusing in free text. The responses of clinicians were considered in the light of established ethical concepts to produce an evidence-based ethical framework for decision making. In total, 58 practitioners responded. Common reasons given for decisions on whether to refuse euthanasia referred to the patient's interests, such as the possibility of treatment or rehoming, and the fear of other unacceptable outcomes for the dog. Other reasons were based on concern for owners' interests. Some respondents reported being pressured into euthanasia by clients and other veterinary surgeons. This gives insight into the ethical principles that explicitly underlie veterinary surgeons' euthanasia decisions and the resultant framework may be useful for discussing and teaching euthanasia.     

Dynamic respiratory endoscopy without treadmill in 68 performance Standardbred,Thoroughbred and saddle horses under natural training conditions

Reasons for performing study: High speed treadmill endoscopy provides a true assessment and diagnosis of the dynamic obstructions of the upper equine respiratory tract (DO‐URT). However, treadmills do not always allow reproduction of the exact conditions of dynamic collapse of the URT. The availability of on‐board endoscopes, which could be used without a treadmill, would make exercising endoscopy readily available to more equine practices. Objectives: To develop and validate an innovative endoscope which could be used for the examination of the URT at exercise in ridden and harnessed sport horses performing in natural conditions. Methods: Authors worked closely with engineers of a company manufacturing veterinary endoscopes. Over a 2‐year period several prototypes were tested on more than 20 cooperative horses performing either in trot, gallop, jumping or endurance. The final Dynamic Respiratory Scope (DRS) allows real‐time visualisation of the URT and video recordings for post test reviewing and archiving. The DRS was then tested in 2 equine livery yards. Performance horses presented for investigation of abnormal respiratory noises at exercise and/or poor performance were subjected to exercising endoscopy. Endoscopic images of the URT were recorded and video recordings of the URT were reviewed post test. Results: A total of 68 horses were examined: 39 harnessed Standardbred and 29 mounted horses (16 Thoroughbred and 13 saddle horses). Of these, 44 were diagnosed with a URT abnormality. Good quality videos were obtained even at maximum speed in all cases. The innovative insertion tube provided very stable images compared to those obtained with flexible video endoscopes on treadmills. Conclusions: This study validates the safety and the reliability of the DRS for imaging the equine URT during natural exercising conditions. Potential relevance: Most common causes of DO‐URT can be diagnosed easily during any type of performance without a treadmill and the DRS offers a great potential for further URT clinical research.     

The use of sedatives,analgesic and anaesthetic drugs in the horse: An electronic survey of members of the American Association of Equine Practitioners (AAEP)

Reasons for performing study: To determine the sedative, analgesic and anaesthetic drugs and techniques that are used by equine veterinarians. Hypothesis or objectives: To provide equine veterinarians with information concerning veterinary use of anaesthetic techniques, a reflection of the collective experiences of the profession. Methods: A survey was conducted of those members of the American Association of Equine Practitioners (AAEP) with an electronic mail address on file with the organisation using proprietary, web‐based software. The survey was comprised of 30 questions divided into 8 sections: nonsteroidal anti‐inflammatory drugs; local anaesthesia; alternative techniques; standing chemical restraint; epidural anaesthesia; short‐term anaesthesia; long‐term anaesthesia; and a place for the respondent to make comments. Results: The response rate was 13.8% (952/6911) AAEP member veterinarians primarily use phenylbutazone and flunixin as anti‐inflammatory drugs, and lidocaine and mepivacaine for local anaesthesia. Combinations of drugs are preferred for standing chemical restraint. While many veterinarians frequently utilise short‐term anaesthesia, longer anaesthesia is less frequently performed. Conclusions: Most AAEP member veterinarians use sedatives in combination to provide standing chemical restraint. Extra‐label use of drugs is a core component of current equine sedation and anaesthetic practice. Potential relevance: Equine veterinarians can compare their choices of anaesthetic drugs with others practising equine medicine and surgery and may be stimulated to investigate alternative methods of providing comfort to horses.     

A cross-sectional study of geriatric horses in the United Kingdom. Part 1: Demographics and management practices

Reasons for performing study: With growing numbers of aged horses, geriatric medicine is becoming increasingly important in equine veterinary practice; however, there is a paucity of information on the UK equine geriatric population. Objectives: To describe the demographic characteristics of the equine geriatric population and to assess management practices undertaken by owners of geriatric horses (aged ≥15 years). Methods: A cross‐sectional study was conducted, surveying a randomly selected sample of veterinary registered owners with horses aged ≥15 years, using a self‐administered postal questionnaire. Results: Horses aged ≥15 years represented 29% of the equine population in the study area. The response rate to the questionnaire survey was 80.2%. Management practices were similar to those previously described for the general equine population. However, the level of exercise and feeding practices changed significantly with increasing age. A summary of the demographic characteristics, feeding and management of horses in a sample of the geriatric equine population is presented. Conclusions and potential relevance: The management of geriatric horses has a direct effect on their health and welfare and this study has provided valuable information on the demographics and management of geriatric horses and ponies in the UK. The information can be used to form targeted owner education programmes for geriatric health and should aid in the investigation and prevention of disease.     

Antibacterial drug resistance and equine practice

The equine practitioner is in a position to make day‐to‐day decisions regarding antimicrobial drug (AMD) use for their patients as well as to educate their clients regarding judicious use. General guidelines regarding judicious use of AMDs in equine patients have been developed by the American Association of Equine Practitioners. Detailed guidelines for AMD use in specific equine diseases supported by clinical trials and results of surveillance studies focused on resistance among equine bacterial pathogens are lacking. Studies that could lead to detailed and justifiable use recommendations would allow the equine practitioner to make more informed decisions regarding when to use AMDs, which drugs should be used and how they should be used (e.g. dose, route and duration).     

Evaluation of a Veterinary Glucometer for Use in Horses

Background: Glucose assessment and regulation are important factors in the treatment of hospitalized horses and foals. Hypothesis/Objectives: The purpose of this study was to compare glucose measurement by a veterinary glucometer, adjusted by code for use in horses and foals, to a reference chemistry analyzer. It was hypothesized that the veterinary glucometer and reference analyzer would yield similar results and that interpretation of glucose values obtained from a veterinary glucometer would result in clinically appropriate decisions. Animals: Fifty blood samples from adult horses and 50 blood samples from neonatal foals admitted to the Colorado State University Veterinary Hospital or Equine Reproduction Laboratory for evaluation. Methods: Glucose concentrations from fresh whole blood samples were evaluated in duplicate with a veterinary glucometer and these values were compared with those obtained with a reference plasma chemistry analyzer. The accuracy of glucometer measurement was evaluated with a Clarke error grid. Results: The veterinary glucometer accurately measured whole blood glucose concentrations in both horses and foals when compared with a reference plasma chemistry analyzer. Nearly 97% of the glucometer values obtained in this study would have resulted in appropriate clinical decisions based on the Clarke error grid analysis. Conclusions and Clinical Importance: The veterinary glucometer evaluated has potential utility for point‐of‐care whole blood glucose evaluation in both horses and foals.     

Cross-sectional survey of owner knowledge and husbandry practices, tack and health issues affecting working horses in Lesotho

Reasons for performing study: To establish baseline parameters of equine health, owner knowledge and husbandry practices and tack against which benefits to local horses arising from an equine charity's training programme in Lesotho could be measured. Objectives: To describe and investigate associations between owner knowledge and equine husbandry practices, horse health and tack‐related parameters prior to the start of the training programme. Methods: A cross‐sectional survey was undertaken in the catchment area of students attending the first training course. Owners from randomly selected villages were interviewed about horse care using a standardised, structured questionnaire, administered face to face in local language. Horses were clinically examined and tack assessed according to standardised protocols. Results: Clinical examinations were performed on 312 horses and 287 owners were interviewed. Owners had variable knowledge of equine husbandry and limited understanding of appropriate primary and preventive healthcare. Equine health problems identified included ecto‐ and endoparasite infestation, mouth lesions, overgrown and unbalanced feet and tack‐associated wounds. The majority of tack was in poor condition, dirty and ill‐fitting. With the exception of below‐average body condition score, no associations were found between key adverse horse‐related clinical findings and owners reporting their horse as being ‘unhealthy’. Conclusions: Working horses in Lesotho have a range of physical problems, many of which could be ameliorated through targeted owner education. With limited access to veterinary advice and scarce resources, improved availability of affordable local equine trade skills is key to improving equine health. Potential relevance: Findings could be used to inform and direct training programmes to maximise benefits to equine health and to serve as a baseline against which to monitor effects of educational and other interventions.     

Intra‐abdominal hypertension in horses

Intra‐abdominal hypertension (IAH) may lead to a multiple organ dysfunction syndrome associated with significant dysfunction of the cardiovascular, respiratory, renal, gastrointestinal and central nervous systems of human patients. A recent prospective multicentre epidemiological investigation in man concluded that IAH was associated with an increased risk of mortality in critically ill patients. In this review, we present current information pertaining to the potential clinical importance of IAH in the context of equine clinical practice. In conclusion, consideration of intra‐abdominal pressure should be a part of the clinical assessment of patient well‐being in critically ill equine patients.     

Exploring lay perceptions of the causes of crib‐biting/windsucking behaviour in horses

Reasons for performing study: Crib‐biting/windsucking behaviour has important consequences for equine health and welfare. Lay perceptions of health and illness are of interest to medical sociologists, providing important information to medical practitioners, but have infrequently been applied in veterinary research. Objectives: To demonstrate how lay epidemiology can be applied within veterinary research by exploring the lay perceptions regarding the causes of crib‐biting/windsucking behaviour in horses. Methods: Informants were recruited from professional and amateur horse owners who had or had not owned/cared for a horse that exhibited crib‐biting/windsucking behaviour. In‐depth interviews were used to examine perceptions about the development of this behaviour within each group until a ‘saturation’ of themes emerged. Results: The main themes that emerged as causes of crib‐biting/windsucking behaviour were ‘boredom’, ‘stress’ and ‘habit/addiction’. In the group of owners/carers who did not have direct experience of this type of behaviour, ‘copying’ from other horses emerged as a strong theme and they stated that they would not wish to own a crib‐biting/windsucking horse. In contrast, those who had direct experience of horses demonstrating this behaviour did not believe copying was a cause based on their own observations and would not be put off purchasing or caring for another horse displaying this behaviour. Conclusions: Perceptions about what causes crib‐biting/windsucking was influenced by whether or not informants had personal experience of horses demonstrating this behaviour. The three main themes that emerged have some justification based on current research and highlight the need for further investigation into the underlying pathophysiology of crib‐biting/windsucking behaviour. Potential relevance: Qualitative approaches to health, disease and behaviour have an important role in the medical field and are applicable to veterinary research.