Preoperative anaemia management in patients undergoing vascular surgery.

CAVIAR is a multicentre prospective stepped observational study encompassing 160 patients undergoing vascular intervention. The aim was to identify whether it was feasible to establish a preoperative anaemia pathway and, if so, the efficacy of intravenous iron for treatment of preoperative anaemia. Large barriers prevented implementation of an intravenous iron pathway, with only ten patients receiving intravenous iron and a small increase in haemoglobin level (mean 5·7 (95 per cent c.i. 4·5 to 6·9) g/l). Preoperative anaemia was associated with a longer hospital stay and greater transfusion requirement. Anaemia common and dedicated pathway difficult to instigate.

Assessment of quality of life and chronic pain in dogs.

Assessment of chronic pain and quality of life (QOL) are integral to clinical veterinary research and practice, and recent years have seen an increase in the published tools available for the assessment of both. However, the relationship between chronic pain and QOL in veterinary patients has received insufficient attention. This narrative review for the first time explores similarities, differences and interactions between chronic pain and quality of life and identifies common challenges to their assessment in dogs. In the opinion of these authors, assessments of both chronic pain and quality of life should be pro-active, global, regular, applied to answer specific questions for researchers and decision makers, and transparent about what has, and has not, been assessed. Collaboration in this field between animal welfare scientists, veterinary researchers and clinicians appears rare, and should be prioritised.

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery.

BACKGROUND: A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking. METHODS: We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score. RESULTS: Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients. CONCLUSIONS: The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.

Ethical principles for novel therapies in veterinary practice.

OBJECTIVES: To present insights to aid decision-making about novel veterinary treatments from regulations concerning animal experimentation and human clinical medical trials. MATERIALS AND METHODS: EU Directive 2010/63/EU on the protection of animals used for scientific purposes and EU Regulation 536/2014 on clinical trials on medicinal products for human use were analysed, evaluated and "translated" into relevant principles for veterinary surgeons. RESULTS: A number of principles are relevant, relating to treatment expectations, thresholds and objectives; client consent; minimising harms; personnel; review committees; assessment and publication. CLINICAL SIGNIFICANCE: These principles should assist veterinary surgeons to make good ethical decisions about novel treatments.

Individualism and nonindividualism in the application of nonhuman animal welfare to policy.

Science-based policy making and assessments are individualistic insofar as they are sensitive to interindividual differences, intraindividual connectivity, or both. Several scientists and policymakers have argued that nonhuman animal welfare should relate to individual animals, but there are reasons for both individualistic and nonindividualistic approaches. Opportunities to develop more individualistic approaches include employing concepts such as "quality-of-life," "welfare opportunities," and greater stockperson flexibility.

Ethical and evidential considerations on the use of novel therapies in veterinary practice.

Novel therapies may be necessary both in the interests of the individual animal and in the advancement of veterinary science. However, special consideration is necessary to safeguard the welfare of the animals, ensure fully informed consent from the owner, determine the procedure's value in other cases and appropriately disseminate results. This article reviews ethical and evidential considerations raised when novel therapies are undertaken in veterinary practice, based on a series of committee meetings and intervening discussions held between members of the British Small Animal Veterinary Association Scientific Committee and Officers (2010-2011). The aim of this article is to encourage the advancement of novel veterinary therapies while safeguarding the welfare of animals.

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.

Promoting discussions and decisions about dogs' quality-of-life.

OBJECTIVE: The objective of this paper is to report the formulation and preliminary testing of a participatory tool in order to encourage discussions and decisions about dogs' quality-of-life. MATERIALS AND METHODS: A tool was designed in which owners rated aspects of their dog's quality-of-life. Two randomised controlled trials were conducted: one with a veterinary surgeon who was involved in the tool design, the second with other veterinary surgeons. In each, owners either were given the tool before a veterinary consultation or underwent normal consultations. After each consultation, owners were asked to report what they had discussed and what decisions they had made. RESULTS: The study involved a total of 170 consultations, of which 91 were randomly allocated to the tool group and 79 into the control group. In both trials, using the tool was associated with a significant increase in the frequency of discussions. In the first trial, using the tool was also associated with an increase in the number of decisions made, but this was not found in the second trial with practitioners who were not involved in the trial design. CLINICAL SIGNIFICANCE: These data suggest that the use of a participatory tool has the potential to enhance the effectiveness of consultations, especially if the practitioner is familiar with the tool design.

Veterinary surgeons' opinions on dog welfare issues.

OBJECTIVES: To begin to determine the significance of various dog welfare issues as perceived by veterinary practitioners. METHODS: Using an online questionnaire, respondents were asked how frequently they were made aware of 12 welfare issues and how important they felt each one was for each dog affected. Respondents were also asked how much they agreed with statements that the veterinary practitioners in their area, and the veterinary profession, should do more about each issue. RESULTS: Responses were received from 59 practitioners. The most frequently noted problems were "obesity", "chronic pain/poor mobility" and "breed-related conditions". The most important issues for each dog affected were "lack of treatment for suffering", "abuse or active cruelty" and "malnutrition". "Breed-related conditions", "obesity" and "behavioural problems" were the issues for which there was greatest agreement that veterinary practitioners should do more, both in their area and as a profession. CLINICAL SIGNIFICANCE: This pilot study suggests that the veterinary profession believes that obesity, breed-related conditions and behavioural problems are important concerns, and that more should be done about them. Although these results cannot be taken as definitive from a study of this size, it does provide a background for such further work involving companion dog welfare and the veterinary profession.

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.

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

OBJECTIVES: 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. METHODS: This paper draws on existing literature on human QOL assessment, animal welfare, philosophy and animal QOL assessment. RESULTS: 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. CLINICAL SIGNIFICANCE: These should assist veterinarians intending to develop their use QOL assessment.

Assessment of positive welfare: a review.

As a complement to the concentration on negative states in welfare science, scientists are increasingly considering the desirability of measuring positive outcomes. Since evaluation of an animal's mental state is a critical goal for welfare assessment, considerations of both positive feelings (what an animal "likes") and resources that an animal is motivated to obtain (what an animal "wants") appear to be important. However, since animals may make choices that are not in their long-term interests, an assessment of positive feelings and resources should include an evaluation of any associated actual or potential harms, such as fear, distress, pain, injury and disease. A review of current evidence suggests that positive welfare can be best assessed by evaluation of resources (i.e. inputs) that are valued by an animal and by positive outcomes such as behavioural responses, influences on cognitive processes and physiological markers. Since negative welfare is often inversely correlated with positive welfare measures, current welfare policy will have been achieving some positive welfare outcomes, however the explicit inclusion of positive welfare outcomes in the framework allows for analyses that are both deeper and more in tune with commonsense, which can hopefully yield more objective policies.

Respiratory syncytial virus infection in children hospitalised with acute lower respiratory tract infection.

BACKGROUND: Data are lacking on respiratory syncytial virus. (RSV) respiratory tract infections in children from developing countries. OBJECTIVE: To determine the importance of RSV as a cause of acute lower respiratory tract infection (ALRTI) in Cape Town children. METHODS: Children younger than 2 years of age admitted to hospital with ALRTI over a 15-month period from 1 June 1995 to 31 August 1996 were studied prospectively. Sociodemographic data, risk factors for severe RSV disease, clinical signs, diagnosis and hospital course were documented. A nasopharyngeal aspirate (NPA) for detection of RSV by enzyme immunoassay (EIA) was obtained in all cases. The NPA of every fifth child was sent for viral culture. RESULTS: A total of 1,288 patients (60% male, 40% female) with a median age (25th-75th percentile) of 6 months (2-11 months) was enrolled; 32.4 had one or more risk factors for severe RSV infection. Pneumonia was diagnosed in 62.2%, bronchiolitis in 20.6%, laryngotracheobronchitis (LTB) in 8% and other respiratory illnesses in 9.2%. Mild disease, requiring admission to an overnight ward, was documented in 38.1%, while 48.9% and 13% respectively had moderate and severe disease requiring admission to a general ward and intensive care unit (ICU). Supplemental oxygen and mechanical ventilation were required by 68.9% and 8.5% of patients, respectively. The median duration of hospital stay was 5 days (range 1-10 days). RSV EIA was positive in 16.4% of cases, and there was no difference in detection rates according to diagnosis. Viral culture performed in 162 of the 1,288 study patients (12.6%) grew RSV in 11.7% of cases, adenovirus in 3.7%, para-influenza virus type 3 in 2.5% and influenza B virus in 0.6%. Patients who tested RSV EIA-positive did not significantly differ from those who tested negative with regard to demographic variables, clinical diagnoses, risk factors for RSV or length of hospitalisation. The only significant difference noted was the presence of hyperinflation, which occurred in 70.1% of EIA-positive patients compared with 57.1% of those testing negative (P = 0.0005). The mortality rate (2%) was similar for both groups. CONCLUSION: This study indicates that RSV is an important cause of hospitalisation in infants and young children with ALRTI. Distinguishing RSV from other ALRTIs is difficult because of similarity in clinical presentation among children.

Training inspiratory resistance in Duchenne dystrophy using adapted computer games.

Computer games were modified to encourage respiratory effort by two groups of patients with Duchenne muscular dystrophy. One group trained during the first six months of the study, the other during the second six months. Inspiratory effort was increased by their having to breathe through a mask to both start and continue the games. Pulmonary function tests were done at the beginning of the trial and six, 12 and 18 months later, when forced vital capacity, respiratory muscle endurance and strength were measured. Although there were some individual improvements, over-all the results were not statistically significant.