Epidemiology of heat-related illness in dogs under UK emergency veterinary care in 2022.

BACKGROUND: Dogs are exposed to increasing environmental risk for developing heat-related illness (HRI), with 2022 recorded as the hottest year to date in the UK and most of Europe. METHODS: This study used VetCompass data to report the incidence risk, event fatality rate and canine risk factors for HRI in dogs presenting to Vets Now emergency care practices in the UK during 2022. RESULTS: From the clinical records of 167,751 dogs under care at Vets Now emergency clinics in 2022, 384 HRI events were identified. The 2022 incidence risk of HRI within the Vets Now caseload was 0.23% (95% confidence interval [CI]: 0.21%‒0.25%), with an event fatality rate of 26.56% (95% CI: 21.66%-32.25%). Multivariable analysis identified breed, age and sex/neuter status as risk factors for HRI. Brachycephalic dogs had 4.21 times the odds of HRI compared to mesocephalic dogs (95% CI: 3.22‒5.49, p < 0.001). LIMITATIONS: The clinical data used in this study were not primarily recorded for research and had some substantial levels of missing data (especially patient bodyweight). CONCLUSION: In order to protect canine welfare, improved long-term mitigation strategies are urgently needed to minimise HRI risk and associated fatality in UK dogs.

Post-exercise management of exertional hyperthermia in dogs participating in dog sport (canicross) events in the UK.

Exercise is a common trigger of heat-related illness (HRI) events in dogs, accounting for 74% of canine HRI cases treated under primary veterinary care in the United Kingdom. However, few empirical studies have evaluated the effectiveness of differing cooling methods for dogs with exertional hyperthermia or HRI. This study aimed to prospectively evaluate effects of ambient conditions and post-exercise management practices (cooling methods and vehicular confinement) on the post-exercise temperature change of dogs participating in UK canicross events. Canine temperature was recorded at three intervals post-exercise: as close as possible to 0- (immediately post-exercise), 5-, and 15-min post-exercise. Ambient conditions and post-exercise management were recorded for 115 cooling profiles from 52 dogs. In 28/115 (24.4%) profiles, the dog's temperature increased during the first 5-min post-exercise. Overall, 68/115 (59.1%) profiles included passive cooling (stood or walked outside), 35 (30.4%) active cooling (cold-water immersion or application of a cooling coat), and 12 (10.4%) involved no cooling and were immediately housed in vehicles. No dogs developed hypothermia during the study and no adverse effects were observed from any cooling method. In hyperthermic dogs, overall post-exercise body temperature change was significantly negatively associated (i.e. the dogs cooled more) with 0-min post-exercise body temperature (ß = -0.93, p < 0.001), and not being housed in a vehicle (ß = -0.43, p = 0.013). This study provides evidence cold-water immersion (in water at 0.1-15.0 °C) can be used to effectively and safely cool dogs with exertional hyperthermia. Progressive temperature increases in many dogs - even after exercise has terminated - supports the message to "cool first, transport second" when managing dogs with HRI. When transporting dogs post-exercise or with HRI even after active cooling, care should be taken to cool the vehicle before entry and promote air movement around the dog during transport to facilitate ongoing cooling and prevent worsening of hyperthermia during travel.

Cooling Methods Used to Manage Heat-Related Illness in Dogs Presented to Primary Care Veterinary Practices during 2016-2018 in the UK.

The management of heat-related illness (HRI) in dogs has received limited attention in the veterinary literature, especially regarding effective cooling methods. Guidelines published in 2016 for prehospital management of dogs with HRI advised "cool first, transport second", and recommended using cold-water immersion and evaporative cooling (water application with air movement) as the optimal approaches to reduce the patient's temperature. The current retrospective cross-sectional observation study analysed electronic patient records from the VetCompass programme to describe the cooling methods used in dogs with HRI presented to primary care veterinary practices during 2016-2018. Of 623 HRI events identified, 341 (54.74%, 95% CI 50.81-58.60%) included information on cooling in their clinical record. Of these, 74/341 (21.70%, 95% CI 17.65-26.38%) were cooled prior to transport for veterinary care. Overall, 23.97% (95% CI 19.24-29.44%) were cooled using one of the two recommended cooling methods, whilst the most common cooling method recorded was the application of wet towels (51.31%, 95% CI 45.34-57.24%). Canine cooling guidance and messaging in both the public and veterinary sectors requires urgent review to ensure that the most effective cooling methods are promoted because delays to canine temperature reduction worsen patient outcomes.

Inhibition of advanced glycation end product formation and serum protein infiltration in bioprosthetic heart valve leaflets: Investigations of anti-glycation agents and anticalcification interactions with ethanol pretreatment.

Bioprosthetic heart valves (BHV) fabricated from heterograft tissue, such as glutaraldehyde pretreated bovine pericardium (BP), are the most frequently used heart valve replacements. BHV durability is limited by structural valve degeneration (SVD), mechanistically associated with calcification, advanced glycation end products (AGE), and serum protein infiltration. We investigated the hypothesis that anti-AGE agents, Aminoguanidine, Pyridoxamine [PYR], and N-Acetylcysteine could mitigate AGE-serum protein SVD mechanisms in vitro and in vivo, and that these agents could mitigate calcification or demonstrate anti-calcification interactions with BP pretreatment with ethanol. In vitro, each of these agents significantly inhibited AGE-serum protein infiltration in BP. However, in 28-day rat subdermal BP implants only orally administered PYR demonstrated significant inhibition of AGE and serum protein uptake. Furthermore, BP PYR preincubation of BP mitigated AGE-serum protein SVD mechanisms in vitro, and demonstrated mitigation of both AGE-serum protein uptake and reduced calcification in vivo in 28-day rat subdermal BP explants. Inhibition of BP calcification as well as inhibition of AGE-serum protein infiltration was observed in 28-day rat subdermal BP explants pretreated with ethanol followed by PYR preincubation. In conclusion, AGE-serum protein and calcification SVD pathophysiology are significantly mitigated by both PYR oral therapy and PYR and ethanol pretreatment of BP.

Risk Factors for Severe and Fatal Heat-Related Illness in UK Dogs-A VetCompass Study.

Heat-related illness (HRI) is predicted to increase in dogs due to rising global temperatures. This study evaluated retrospective VetCompass veterinary clinical records to explore geographical variability and ambient conditions associated with HRI events in UK dogs, and report the intrinsic (canine) and extrinsic (location, trigger, ambient weather) risk factors for severe disease and fatal outcome in dogs affected by HRI. Dogs living in London had the greatest odds for developing HRI compared with dogs living in the North West (OR 1.9, 95% CI 1.31-2.74). The median ambient temperature on days of HRI events was 16.9 °C. For dogs with HRI, age, bodyweight and trigger were risk factors associated with severe disease. Age, skull shape and clinical grade of HRI presentation were associated with a fatal outcome. Whilst the majority of HRI events overall were triggered by exertion, the risk of severe disease was greater in situations where dogs could not escape the heat source (vehicular confinement), and the risk of death in HRI cases was greater for those dogs with reduced capacity to thermoregulate (older and brachycephalic dogs). These results highlight the need for better owner awareness of the factors that increase the risk of severe and fatal HRI, as a first stage in protecting canine welfare in the face of rising global temperatures.

Practical Tips for Setting Up and Running OSCEs.

Objective structured clinical examinations (OSCEs) are used to assess students' skills on a variety of tasks using live animals, models, cadaver tissue, and simulated clients. OSCEs can be used to provide formative feedback, or they can be summative, impacting progression decisions. OSCEs can also drive student motivation to engage with clinical skill development and mastery in preparation for clinical placements and rotations. This teaching tip discusses top tips for running an OSCE for veterinary and veterinary nursing/technician students as written by an international group of authors experienced with running OSCEs at a diverse set of institutions. These tips include tasks to perform prior to the OSCE, on the day of the examination, and after the examination and provide a comprehensive review of the requirements that OSCEs place on faculty, staff, students, facilities, and animals. These tips are meant to assist those who are already running OSCEs and wish to reassess their existing OSCE processes or intend to increase the number of OSCEs used across the curriculum, and for those who are planning to start using OSCEs at their institution. Incorporating OSCEs into a curriculum involves a significant commitment of resources, and this teaching tip aims to assist those responsible for delivering these assessments with improving their implementation and delivery.

Surveillance of heat-related illness in small animals presenting to veterinary practices in the UK between 2013 and 2018.

Background: Heat-related illness (HRI) can affect all companion animals and is likely to become more common as global temperatures rise. The misconception that HRI is primarily a result of dogs being trapped in hot cars, highlights a lack of awareness of HRI risk factors within the UK companion animal population. Aim: This project aimed to review all species of small animal presentations of HRI to UK veterinary practices participating in the Small Animal Veterinary Surveillance Network (SAVSNET), describe the inciting triggers and seasonality of HRI events, and review the clinical grade of canine patients presenting with HRI. Methods: Electronic consultation records were submitted by volunteer veterinary practices across the UK to SAVSNET. Cases were defined as animals presented for consultation with strong evidence of current, or recent heat induced illness during the study period (2013-2018). Results: The HRI cases included 146 dogs, 16 cats, 8 guinea pigs, 3 rabbits and 1 ferret. Of the 118 HRI cases with a recorded trigger, exercise was the primary trigger for dogs presenting (73.5%); 7 (6.9%) canine HRI events followed vehicular confinement. Environmental HRI was recorded as a trigger for the remaining dogs (19.6%), and for all cats, guinea pigs, rabbits and the ferret. Brachycephalic breeds comprised 21.2% of canine HRI cases, and all rabbits were brachycephalic breeds. Dogs with HRI were presented between April and October, with 42.5% during July, typically the UK's hottest month of the year. Cats with HRI were presented between May and September, with 75.0% during June and July. The smaller companion species-ferrets, rabbits and guinea pigs-were presented during the UK's summer months June to August. Conclusion: This study highlights the risk of HRI to all pet animals during the UK's warmer summer months (June to August). The findings support previous claims that exercise is the most common trigger of HRI in dogs, while environmental HRI (a hot ambient temperature) accounted for all HRI events in cats, rabbits, guinea pigs, and ferrets. Both brachycephalic dogs and rabbits were overrepresented, adding further evidence that owners of these animals should be particularly vigilant for HRI during hot weather.

Exploring Owner Perceptions of the Impacts of Seasonal Weather Variations on Canine Activity and Potential Consequences for Human-Canine Relationships.

Climate change is leading to more instances of seasonal weather variation. Studies have explored the impact of adverse winter weather on dog walking, but the impact on the dog's overall activity levels have not been previously considered. This study explored dog owner perceptions of the effects of both summer and winter weather on their dog's activity levels. An international online survey recruited 3153 respondents between May and December 2018, to explore the impact of summer and winter weather conditions on baseline activity levels. Owners reported their dogs were more impacted by cold (48.2% less likely to exercise their dog in the cold) and ice (64.0% less likely), than rain (25.3% were less likely). In hot weather, over 80% of owners reported reduced exercise duration and vigour for their dogs. Carrying water or walking near water to facilitate activity in the summer was the most popular mitigation strategy (90.8%). Participation in dog sports appeared to reduce the impact of winter weather on canine activity and increase owner awareness of cooling strategies to facilitate summer activity. Strategies to promote safe activity participation are needed to maintain canine activity levels amidst rising global temperatures, including better understanding of cooling strategies for exercising dogs.

Proposing the VetCompass clinical grading tool for heat-related illness in dogs.

Heat-related illness is a potentially fatal condition in dogs. Rapid and accurate recognition of the severity can improve clinical management in affected dogs and lead to better outcomes. This study explored retrospective VetCompass veterinary clinical records to investigate the clinical signs recorded for dogs presenting with heat-related illness to primary-care veterinary practice from 2016 to 2018. The relative risk of death associated with these clinical signs was reported and used to develop a novel clinical grading tool. From the clinical records of 856 heat-related illness events, the most frequently recorded clinical signs were respiratory changes (68.73%) and lethargy (47.79%). The clinical signs with the highest relative risk of death were neurological dysfunction, gastrointestinal haemorrhage and bleeding disorders. The novel VetCompass Clinical Grading Tool for Heat-Related Illness in dogs defines three grades: mild (altered respiration, lethargy), moderate (gastrointestinal signs, a single seizure, episodic collapse) and severe (neurological dysfunction, gastrointestinal haemorrhage, bleeding disorders). This novel grading tool offers a simple, evidence-based device to improve recognition of heat-related illness in dogs and promote improved decision-making for earlier interventions such as cooling and hospitalisation. This could improve outcomes and protect the welfare of dogs in the face of rising global temperatures.

An Exploration of the Value of Elective Health Checks in UK Zoo-Housed Gibbons.

Elective health checks form an important part of the preventative healthcare of many zoo-housed animals. These procedures are not without risk or financial expenditure, meaning careful cost-benefit analysis is required when determining the frequency and intensity with which they are implemented. This study evaluated the value of elective health checks (n = 74) carried out on 33 gibbons at a single UK zoological collection from 2011 to 2018. Data were categorised by health check type, animal age, clinical findings and outcome. Univariable binary logistic regression and multivariable modelling were used to identify factors associated with the likelihood of actionable (clinically significant) outcomes. In total, 51.35% of all elective health checks resulted in an actionable outcome. Elderly heath checks had 13.64 times greater odds of an actionable outcome and 34 times greater odds of a significant radiographic finding, when compared to routine (non-elderly) health checks. Our findings suggest that 75% wild longevity is a suitable threshold for identifying elderly captive gibbons and increasing health check frequency. Whilst further work is needed to ascertain whether these findings can be extrapolated to other collections and/or species, this study demonstrates how the analysis of clinical data can aid in the implementation of an effective and evidence-based preventative healthcare plan.

Drugs, dogs, and driving: the potential for year-round thermal stress in UK vehicles.

Background: Dogs are regularly transported or housed in vehicles, with guidelines for housing dogs suggesting that the ambient temperature should be maintained between 15°C and 24°C. Veterinary drugs are routinely stored and carried in vehicles providing ambulatory veterinary care. Non-refrigerated medications typically require storage between 8°C and 25°C. Aim: This study aims to investigate the potential for thermal stress associated with vehicular storage and transportation of drugs and dogs in a temperate climate, such as the United Kingdom. Methods: The study used data loggers to continuously record internal temperatures of four vehicles at 15-minute intervals over a two-year period, to investigate the effect of seasonality and time of day on the internal car temperature. Results: The internal car temperature ranged from -7.4°C to 54.5°C during the study period. Temperatures fell below 8°C every month, except June and July. The internal car temperature exceeded typical drug storage recommendations (>25°C) during every month, and exceeded the canine thermoneutral zone (>35°C) from April to September. Peak temperatures occurred between 14:00 and 17:00 hours. Conclusion: The results demonstrate the year-round potential for thermal stress of both dogs and drugs left in cars. Public awareness campaigns highlighting the risks of leaving dogs in hot cars are typically launched in late spring, but should consider launching earlier in light of these findings. Veterinary surgeons transporting drugs should take measures to ensure that drugs are stored within the manufacturer's temperature range year-round. This will limit the potential for drug degradation and decreased efficacy.

Dogs Don't Die Just in Hot Cars-Exertional Heat-Related Illness (Heatstroke) Is a Greater Threat to UK Dogs.

Heat-related illness will affect increasing numbers of dogs as global temperatures rise unless effective mitigation strategies are implemented. This study aimed to identify the key triggers of heat-related illness in dogs and investigate canine risk factors for the most common triggers in UK dogs. Using the VetCompassTM programme, de-identified electronic patient records of 905,543 dogs under primary veterinary care in 2016 were reviewed to identify 1259 heat-related illness events from 1222 dogs. Exertional heat-related illness was the predominant trigger (74.2% of events), followed by environmental (12.9%) and vehicular confinement (5.2%). Canine and human risk factors appear similar; young male dogs had greater odds of exertional heat-related illness, older dogs and dogs with respiratory compromise had the greatest odds of environmental heat-related illness. Brachycephalic dogs had greater odds of all three types of heat-related illness compared with mesocephalic dogs. The odds of death following vehicular heat-related illness (OR 1.47, p = 0.492) was similar to that of exertional heat-related illness. In the UK, exertional heat-related illness affects more dogs, and kills more dogs, than confinement in a hot vehicle. Campaigns to raise public awareness about heat-related illness in dogs need to highlight that dogs don't die just in hot cars.

Incidence and risk factors for heat-related illness (heatstroke) in UK dogs under primary veterinary care in 2016.

As climate change causes global temperatures to rise, heat-related illness, a potentially fatal condition in dogs, will become an ever-greater threat. This study aimed to report the incidence, fatality and canine risk factors of heat-related illness in UK dogs under primary veterinary care in 2016. The VetCompassTM programme collects de-identified electronic patient records from UK veterinary practices for research. From the clinical records of 905,543 dogs under veterinary care in 2016, 395 confirmed heat-related illness events were identified. The estimated 2016 incidence of heat-related illness was 0.04% (95% CI 0.04-0.05%), with an event fatality rate of 14.18% (95% CI 11.08 - 17.96%). Multivariable analysis identified significant risk factors including breed (e.g. Chow Chow, Bulldog and French Bulldog), higher bodyweight relative to the breed/sex mean and being over two years of age. Dogs with a brachycephalic skull shape and dogs weighing over 50 kg were also at greater risk. As we move into an ever-warmer world, veterinary professionals may need to include resistance to heat-related illness amongst their rationales when advising owners on breed selection. Breeding for good respiratory function and maintaining a healthy bodyweight should be considered key welfare priorities for all dogs to limit the risk of heat-related illness.

Investigating factors affecting the body temperature of dogs competing in cross country (canicross) races in the UK.

Increasing numbers of people are running with their dogs, particularly in harness through the sport canicross. Whilst canicross races are typically held in the winter months, some human centred events are encouraging running with dogs in summer months, potentially putting dogs at risk of heat related injuries, including heatstroke. The aim of this project was to investigate the effects of ambient conditions and running speed on post-race temperature of canicross dogs in the UK, and investigate the potential risk of heatstroke to canicross racing dogs. The effects of canine characteristics (e.g. gender, coat colour) were explored in order to identify factors that could increase the risk of exercise-induced hyperthermia (defined as body temperature exceeding the upper normal limit of 38.8°C).108 dogs were recruited from 10 race days, where ambient conditions ranged from - 5 to 11°C measured as universal thermal comfort index (UTCI). 281 post race tympanic membrane temperatures were recorded, ranging from 37.0-42.5°C. There was a weak correlation between speed and post-race temperature (r = 0.269, P < 0.001). Whilst no correlation between any single environmental factor or UTCI and post-race temperature was found, the proportion of dogs developing exercise-induced hyperthermia during the race increased with UTCI (r = 0.688, P = 0.028). Male dogs (χ(1) = 18.286, P < 0.001), and dark coated dogs (χ(2) = 8.234, P = 0.014), were significantly more likely to finish the race with a temperature exceeding 40.6°C. Prolonged elevati°n of body temperature above this temperature is likely to cause heatstroke. At every race dogs exceeded this critical temperature, with 10.7% (n = 30) of the overall study population exceeding this temperature throughout the study period. The results suggest male dogs, dark coloured dogs, and increased speed of running all increase the risk of heatstroke in racing canicross dogs. Further research is required to investigate the impact of environmental conditions on post-race cooling, to better understand safe running conditions for dogs.