Assessment of quality of life in equine patients

Reasons for performing study: Assessing patients' quality of life (QOL) is a core part of clinical decision making. Various methodologies for assessing patients' QOL have been developed in human medicine and small animal veterinary disciplines. In contrast, the lack of aids for QOL assessment in equine veterinary practice leaves practitioners reliant on subjective assessments of QOL, which may be prone to avoidable errors. Objectives: This paper suggests pragmatic ways in which QOL may be enhanced, while remaining appropriate for the time, financial and owner‐based constraints within equine practice. Methods: Through interdisciplinary research, this paper identifies, adapts and applies insights from several areas of research and practical experience in order to develop an overarching approach to making QOL‐based decisions in clinical cases. Results: The paper identifies 6 steps involved in QOL‐based decision making and provides examples of how these steps may be practically applied. These include deciding what each clinician feels is important; deciding how to evaluate it, including taking owners' views into consideration; making decisions about each case and achieving the desired clinical outcomes. Conclusions: Practitioners can draw their own conclusions on how they may improve QOL assessment in practice and may usefully share these with colleagues. Reporting cases and sharing practical examples of QOL tools used on the ground are vital to the development of this field and appropriate methodologies. Potential relevance: Improvements in QOL assessment are relevant to all areas of equine veterinary practice, and several areas of research. Further research may develop QOL assessment in practice, but more important are the personal improvements that each practitioner may achieve. See also correspondence by Grove     

Interpretation of canine and feline blood smears by emergency room personnel

Background: Interpretation of blood smears is commonly used to provide rapid laboratory evaluation of animals in veterinary emergency practice, but the accuracy of results of blood smear interpretation by emergency room personnel (ERP) compared with evaluation by trained veterinary clinical pathology personnel is unknown. Objective: The goal of this study was to compare blood smear evaluation by ERP with that of clinical pathology personnel. Methods: All animals that had a CBC determined by a diagnostic laboratory and had blood smears evaluated by personnel at the Foster Hospital for Small Animals Emergency Room between September 2008 and July 2009 were eligible for study inclusion. ERP who evaluated blood smears completed standardized forms with estimates of the WBC and platelet counts and evaluation of RBC and WBC morphology. Results from point‐of‐care assessment were compared with automated or manual results reported by the veterinary diagnostic laboratory. Results: One hundred and fifty‐five blood smears were evaluated. There was moderate agreement (κ value, 0.63; 95% confidence interval [CI]: 0.52, 0.74) between estimated platelet counts by ERP and automated counts. Poor agreement was found between estimated WBC counts by ERP and automated counts (κ value, 0.48; 95% CI: 0.37, 0.60). Specific abnormalities with a high likelihood of clinical significance, eg, toxic change, nucleated RBCs, spherocytes, hemoparasites, and lymphoblasts, were not predictably identified by ERP. Conclusions: ERP interpretation of canine and feline blood smears should be used cautiously and should not replace evaluation by a veterinary diagnostic laboratory.     

Canine obesity: is there a difference between veterinarian and owner perception?

Objectives : The overall aim of this study was to examine the nature of the relationship between dog‐ownership and canine obesity, explored in two cohorts of overweight/obese or non‐overweight dogs (n=125). This paper concentrates on the owners’ perception of dog weight. Methods : A researcher‐mediated questionnaire was used to collect data from dog owners attending a small veterinary practice. Interviewees (n=121) were asked qualitative and quantitative questions, designed to examine the owners’ views of their relationship with their dogs. Results : Although a high proportion of owners claimed to have discussed the dog's weight with their veterinarian, some discrepancies were apparent between owner perception of animal weight and the veterinarian's evaluation of body condition score. Owner disagreement was significantly greater for the veterinarian‐defined overweight dogs (P=0·005). Owners often provide personal narratives to account for their dog's weight status. Clinical Significance : This study confirms the important role of the vet in providing information about the issue of dog weight but also suggests that providing verbal information is sometimes insufficient. The study also indicates the potential value of qualitative research methods to further understand client perception of complex animal care issues and highlights the need for further in‐depth research.     

Comparison of owner-reported health problems with veterinary assessment of geriatric horses in the United Kingdom

Reasons for performing study: Previous studies suggest that owners underestimate or incorrectly recognise or report health problems in geriatric horses. However, few studies have directly compared owner‐reported and veterinary assessed disease. Objectives: To compare the findings of veterinary clinical examination of geriatric horses with owner‐reported clinical signs and disease. Methods: A total of 200 horses aged ≥15 years were randomly selected to receive a veterinary examination, from responses to a cross‐sectional postal questionnaire survey. Veterinary examinations were performed within 2 months of questionnaire return, and agreement between owner‐reported data and veterinary clinical findings was assessed. Results: Owners under‐reported many clinical signs and disease conditions detected on veterinary clinical examination. For example, dental abnormalities (detected in 95.4% of horses, reported by 24.5% of owners); cardiac murmurs (detected in 20% of horses, reported by 0.5% of owners); lameness (present in 50% of horses, reported by 23% of owners) and hoof abnormalities (detected in 80% of horses, reported by 27% of owners). Agreement between owner‐reported and veterinary assessed respiratory disease (Kappa 0.02–0.2), body condition score (Kappa 0.24) and coat abnormalities (Kappa 0.42) was poor, fair and moderate, respectively. Range of motion (ROM) of the tarsal and metacarpophalangeal joints was lower in horses with owner‐reported osteoarthritis (P = 0.005 and <0.001, respectively). Conclusions and potential relevance: The low prevalence and relatively poor agreement of owner‐reported disease compared to that detected on veterinary examination suggests inaccurate or under‐recognition, or inaccurate reporting of health problems by owners of geriatric horses, which could lead to a delay in presentation for veterinary treatment. Increased veterinary involvement and improved owner education in the care of geriatric horses should facilitate earlier identification of disease, particularly that which is not readily detectable by owners, and aid management of health and welfare problems.     

The lack of analgesic use (oligoanalgesia) in small animal practice

Oligoanalgesia is defined as failure to provide analgesia in patients with acute pain. Treatment of pain in emergencies, critical care and perioperatively may influence patient outcomes: the harmful practice of withholding analgesics occurs in teaching hospitals and private practices and results in severe physiological consequences. This article discusses the prevalence, primary causes, species and regional differences and ways to avoid oligoanalgesia in small animal practice. Oligoanalgesia may be addressed by improving education on pain management in the veterinary curriculum, providing continuing education to veterinarians and implementing pain scales.     

The use of low‐dose metronomic chemotherapy in dogs—insight into a modern cancer field

The era of chemotherapy, which started in the middle of the last century, has been ruled by the routine use of dose‐intense protocols, based on the “maximum‐tolerated dose” concept. By promoting a balance between patient's quality of life and the goal of rapidly killing as many tumour cells as possible, these protocols still play a prominent role in veterinary oncology. However, with the opening of a new millennium, metronomic chemotherapy (MC) started to be considered a possible alternative to traditional dose‐intense chemotherapy. Characterized by a long‐term daily administration of lower doses of cytotoxic drugs, this new modality stands out for its unique combination of effects, namely on neovascularization, immune response and tumour dormancy. This article reviews the rationale for treatment with MC, its mechanism of action and the main studies conducted in veterinary medicine, and discusses the key challenges yet to be solved.     

Faculty expectations of veterinary students in clinical rotations

Expectations of veterinary students during clinical rotations should be developed with the goal of bettering the veterinary profession as a whole. This article outlines five areas of expectations for the veterinary professional: treating colleagues with respect, providing excellent care for patients and clients, developing and maintaining skill sets to support intellectual curiosity and continued professional development, and improving upon and using self-care and life-balance skills.     

Surgical margins in the veterinary cancer patient

In veterinary oncologic specimens, histopathology is the gold standard for determining adequacy of excision. Despite limitations of this technique, the pathologist's interpretation of margin status significantly impacts patient management, including indications for adjuvant therapy. This article aims to summarize peer‐reviewed literature as it relates to histologic margin evaluation in veterinary cancer patients. The value of histologic tumour‐free margins and technical factors influencing histopathologic margin outcomes are also discussed. We review alternative strategies for determining excisional status, and discuss how an evolving understanding of tumour biology might inform clinical and research perspectives on surgical margins. In doing so, we aim to provide context and a stimulus for future investigations into this important yet incompletely understood topic.     

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.     

Evidence-based medicine concepts.

Today, the busy clinician benefits from a philosophy of practice that brings together the best applicable evidence and the experiences of clinical work in an effort to provide the best care for individual patients. EBM provides a structured approach that recognizes the contributions of evidence and clinical experience. An EBM practice is efficient and effective in meeting the goal of assuring optimum care. The concepts of EBM make sense for veterinary medicine (even if there are limited numbers of randomized, blinded studies), and clinicians in all types of practice can apply them.     

Neonatal respiratory distress and sepsis in the premature foal: Challenges with diagnosis and management

The presentation of a premature, neonatal foal affected with respiratory distress and seizures represents a difficult diagnostic and therapeutic challenge often best addressed by the provision of appropriate emergency care followed by prompt referral to a well‐equipped critical care facility. Veterinary management of the premature foal described in the accompanying report was complicated by the development of sepsis and pulmonary failure. The development of pulmonary emphysematous bullae was identified during the course of the foal's treatment and probably contributed to its clinical deterioration. Diagnostic imaging modalities that may be used for the diagnosis of respiratory distress in neonatal foals include thoracic radiography, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI require general anaesthesia. The likelihood of a successful outcome for the foal in this report might have been improved by the provision of urgent veterinary care and referral to the critical care facility earlier in the course of its management. Important early indicators of the need for urgent veterinary care in this case included the foal's prematurity, inability to stand, and the need to provide manual support to facilitate nursing from the mare's udder. Foals affected in this manner should warrant treatment with broad‐spectrum antimicrobials, circulating volume maintenance, immunoglobulin support, and the use of a nasogastric tube to facilitate nutritional support.     

The building blocks in the professional education process that lead to best practices and quality medicine

It is time for the faculty of veterinary colleges to take responsibility for the veterinary curriculum, to move beyond the debate over teaching styles, and to understanding what a curriculum needs to accomplish. Our challenge is to engage students, faculty, and all veterinary professionals in evidence-based medicine and medical outcomes assessment and to identify best practices and continually improve the quality of veterinary health care. The education program of students must lay the foundation for this essential approach to veterinary practice.     

A cross-sectional study of geriatric horses in the United Kingdom. Part 2: Health care and disease

Reasons for performing study: Geriatric horses (aged ≥15 years) represent a substantial proportion of the equine population, yet very few studies have investigated the prevalence of diseases within the UK equine geriatric population. Objectives: To describe the provision of routine preventive health care measures, prevalence of clinical signs of disease and the prevalence of owner reported diseases. Additionally, the effect of increasing age on the provision of preventive health care and the presence or absence of clinical signs and disease was assessed. 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: As geriatric horses increased in age, there was a reduction in the provision of preventive health care measures, such as vaccination, farrier care and routine veterinary checks. Only 68.7% of horses had received a routine veterinary visit within the previous 12 months. Owners frequently observed clinical signs in their animals, with 77% reporting at least one clinical sign of disease. Increasing age was associated with increased reporting of many clinical signs of disease. Over half (58%) of horses had at least one episode of disease within the previous 12 months, yet only 31% of owners reported that their animal currently suffered from a known disease or disorder. Conclusions and potential relevance: Although owners frequently observed clinical signs in their aged horse, there may be incorrect or under recognition of many diseases and health problems. Reduced frequency of routine preventive health care measures, along with suboptimal owner recognition of health and welfare problems may lead to compromised welfare in the geriatric population.     

Farrier services at veterinary teaching hospitals in the USA

Horse health is best served when farriers and veterinarians collaborate in the care of their patients. Veterinary Teaching Hospitals (VTHs) provide an environment that can nurture that collaboration. While VTH veterinary services are well known, VTH farrier activities are undocumented. To characterise farrier services at VTHs in the USA, 27 VTH Diplomates of the American College of Veterinary Surgeons and/or VTH farriers completed a multiple choice questionnaire characterising VTH farrier details, training, certification, remuneration method, and clinical, teaching and research responsibilities; and farrier service prevalence, facilities and financial viability. Questionnaire response rate was 81%. Eighteen of 22 (82%) responding VTHs had in‐house farrier services. Twenty‐one of 22 (95%) VTH farriers were male. Farriers' ages ranged from <30 years (n = 1, 5%) to >50 years (n = 7, 32%). At 11 (61%) VTHs the farriers were paid by the client and at 7 (39%) by the VTH. Five farriers (23%) received a VTH salary. Eighteen of 22 (82%) farriers had a professional certification. At 5 (28%) VTHs the farrier service made a profit and operational costs were met at 13 (72%). Fifteen (83%) farrier services provided professional education in clinical settings and 13 (72%) in lecture settings. Nine (41%) VTH farriers participated in research activities. In the USA, VTH farrier services vary considerably in both nature and extent. The farriers' potential contributions to VTH operations are often recognised but not consistently exploited. VTH farriers are a valuable resource who can contribute effectively toward VTH patient care, veterinary education and research.     

Thromboelastography in equine medicine: Technique and use in clinical research

Thromboelastography (TEG) is a viscoelastic, whole blood‐based assay that integrates information from both the cellular and soluble components of coagulation, providing a global evaluation of the haemostatic system. This contrasts with the conventional coagulation assays (i.e. platelet count, prothrombin time [PT], activated partial thromboplastin time [aPTT] and fibrinogen concentration [FIB]), which only provide information about one component (e.g. clotting factors in the case of PT and aPTT) of the haemostatic process, requiring the combination of several assays for a complete evaluation of haemostasis. Thromboelastography is an old technology that has been used in human medicine for over 50 years. However, it is relatively new in veterinary medicine and has only been applied to horses in the last 5 years. Clinical applications in human medicine include diagnosis and monitoring of coagulopathies. Currently, extensive research is being carried out to expand the use of TEG in dogs and cats. Therefore, it is expected that the use of this technique will also further expand in horses in the near future. To date, the available studies in the equine species have evaluated TEG in healthy horses, horses with gastrointestinal disease, septic foals, horses with exercise‐induced pulmonary haemorrhage (EIPH) and a filly with Glanzmann's thrombasthenia. The main objective of this review is to introduce the TEG technique to equine clinicians, providing information on how the TEG functions, blood sample collection and processing, variables measured and their interpretations, normal reference values and areas of potential clinical application.     

Evidence-based veterinary medicine: evolution, revolution, or repackaging of veterinary practice?

Over time, evidence-based veterinary medicine (EBVM) should integrate with normal clinical practice. Also, clinical knowledge increases with EBVM, reducing the need for information in one area and allowing veterinarians to explore new areas of specialty or cutting-edge advances in the profession. Textbooks, journals, veterinary conferences, and web sites provide nearly unlimited information about EBVM for the practicing veterinarian to help with the transition to EBVM use in daily practice life. EBVM should continue to change and improve how we, as veterinarians, provide the best available care to our clients and patients.