Assessment of owner perceptions of caregiver burden, veterinarian-client relationship and satisfaction with the provider in canine pruritus: An experimental vignette study.

BACKGROUND: Complicated treatments for skin disease are linked to owner-caregiver burden and poorer perception of the veterinarian-client relationship, regardless of disease severity. HYPOTHESES/OBJECTIVES: Using experimental vignettes, we explored the impact on owner perception of the interaction of treatment complexity and skin disease outcomes. We hypothesised that: (i) vignette conditions involving injection therapy would result in lower burden, better veterinary-client relationship and greater satisfaction relative to multimodal therapy conditions; (ii) the vignette condition of injection therapy with a completely effective outcome would be superior to all other conditions; (iii) ineffective vignette conditions would be inferior to all other conditions; and (iv) the vignette condition injection with a mostly effective outcome would be similar or superior to the multimodal therapy with a completely effective outcome condition. PARTICIPANTS: Three hundred and nine owners of pruritic dogs recruited from a general veterinary practice, pet-related podcast, or social media dog allergy group. MATERIALS AND METHODS: Participants were presented with six counterbalanced online vignettes representing three levels of treatment effectiveness (Completely Effective, Mostly Effective, Ineffective) and two treatment regimens (Multimodal, Injection). Measurements of participant perceptions of caregiver burden, veterinarian-client relationship and satisfaction were recorded. RESULTS: Injection with perfect outcome was superior to other conditions (p < 0.001). Conditions with poor effectiveness were inferior (p < 0.001). Comparison of Injection with a mostly effective outcome to Multimodal treatment with perfect outcome yielded small-to-medium effects of preference for the latter in veterinarian-client relationship and satisfaction (p < 0.01); no difference was observed for caregiver burden. When good effectiveness was assured, injection was preferred (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: Owners preferred a Completely Effective outcome and were prepared to select the Injection regimen or Multimodal therapy to achieve this; Injection was preferred when effectiveness was assured.

Integrative echocardiographic assessment of post-operative obstruction severity and restenosis after balloon valvuloplasty in 81 dogs with pulmonary stenosis.

INTRODUCTION/OBJECTIVES: Pulmonary stenosis (PS) is a congenital defect in the dog that is managed with balloon valvuloplasty (BV). Obstruction severity is routinely assessed using transthoracic echocardiography. The objectives of this study were to describe the short-term changes and long-term restenosis by retrospectively evaluating flow-dependent and flow-independent echocardiographic variables for dogs with PS after BV. ANIMALS, MATERIALS, AND METHODS: Medical records and stored echocardiographic images were reviewed from dogs that received BV for PS. The following echocardiographic variables were measured or calculated: maximum systolic ejection velocity (VmaxPV) and velocity-derived maximal pressure gradient (PV maxPG) across the pulmonary valve; ratio of aortic to pulmonary velocity time integral (VTIAV/VTIPV); ratio of aortic to pulmonary maximal velocity. RESULTS: Eighty-one dogs with PS that had a BV were included. Each of these dogs had pulmonary obstruction severity assessed in at least three timepoints. Forty-nine dogs had at least one additional examination performed, the last of which occurred a median of 504 days after the BV. Echocardiographic variables at the first follow-up had increased by a clinically relevant quantity in 20-34% of the dogs when comparing to the immediate post-BV examination. The last follow-up examination identified valve restenosis in 18-38% of the dogs in this study. Valve type and pre-BV obstruction severity did not have a significant effect (P > 0.1). CONCLUSIONS: For the assessment of BV efficacy, the immediate post-BV echocardiogram may not be as useful as the first follow-up examination several months later. Pulmonary restenosis after BV may be more prevalent than previously reported.

Home-cooked diets cost more than commercially prepared dry kibble diets for dogs with chronic enteropathies.

OBJECTIVE: Nutrition plays a fundamental role in the management of canine chronic enteropathies (CCEs). Dog owners may elect to feed home-cooked diets (HCDs) rather than veterinary commercially prepared diets (CPDs) because of perceived lower costs. There is a paucity of data comparing costs of these options. We hypothesize there will be differences in costs between complete and balanced HCDs and nutritionally comparable CPDs. SAMPLE: 6 Home-cooked diets. PROCEDURES: Six HCD recipes (2 highly digestible, 2 limited antigen, 2 low-fat) were formulated by 2 board-certified veterinary nutritionists to mimic the nutritional and ingredient profiles of veterinary CPDs for management of CCEs. The cost (in US$ on a per 100 kilocalorie [kcal] basis) of each recipe was determined via collection of ingredient prices from 3 grocery stores combined with supplement prices from online retailers. Prices of CPDs were obtained from a national online retailer. Maintenance energy requirements of 1.6 X (70 X BWkg0.75), where BWkg represents body weight in kilograms, were calculated for 3 dog sizes (5, 20, and 40 kg), and costs of feeding maintenance energy requirements with HCDs versus dry and canned CPDs were compared with a Kruskal-Wallis test and post hoc testing. RESULTS: The median costs of all dry and canned CPDs and HCDs were $0.29 (range, $0.18 to $0.46), $1.01 (range, $0.77 to $1.20), and $0.55 (range, $0.35 to $1.14), respectively. Feeding complete and balanced HCDs cost more than feeding dry CPDs (P < .001), but not canned CPDs (P > .99). CLINICAL RELEVANCE: Dry CPDs cost the least for nutritional management of CCEs. There is a wide range of costs for both CPDs and HCDs.

The impact of COVID-19 on access to canine integrative medical care in Michigan, USA, and Ontario and British Columbia, Canada.

OBJECTIVE: To determine the effects of the COVID-19 associated restrictions on the ability of owners in Michigan (MI), USA versus Ontario (ON) and British Columbia (BC), Canada, to obtain care for their chronically painful dogs. STUDY DESIGN: Cross-sectional survey. POPULATION: A total of 90 owners met the inclusion criteria for the study. METHODS: An anonymous electronic survey was distributed to owners at four veterinary integrative medicine (IM) clinics during July and August 2020. Two clinics in MI and one each in ON and BC were recruited. Owners were asked about availability of IM care preceding and during COVID-19 restrictions and their opinions of the impact of COVID-19 on their dog's health. The survey asked where owners sought care for their dogs, types of chronic conditions treated, therapeutic modalities used, and if owners had a medical background. Comparisons were made within and between groups. Thematic analysis, Fisher's exact test, chi-square analyses, McNemar's and Wilcoxon signed-rank tests for paired comparisons were performed (p < 0.05). RESULTS: During COVID-19 restrictions, access to IM care was better for dogs in ON and BC than in MI (p < 0.001). The negative effect of the pandemic restrictions to IM care on quality of life was perceived greater by owners in MI than those in ON and BC (p < 0.001). The owners' medical backgrounds had no effect on attempts to access care during this time (p = 0.76). CONCLUSIONS AND CLINICAL RELEVANCE: The results suggest that a widespread disease in humans had an adverse impact on animal welfare. Providers of veterinary care should use this experience to establish protocols to ensure continuity of care for chronically painful animals in the event of a similar situation in the future.

Assessment of prehospital care in canine trauma patients presented to Veterinary Trauma Centers: A VetCOT registry study.

OBJECTIVE: To analyze the epidemiology of veterinary care in canine trauma patients prior to presentation to a Veterinary Trauma Center (VTC). DESIGN: Retrospective observational cross-sectional study. METHODS:  Retrospective descriptive analysis from 22,998 canine case records from the Veterinary Trauma Registry from September 2013 through April 2018. Analysis was focused on the type of injury, care provider, and care provided prior presentation to a VTC (pre-VTC care). A log-likelihood ratio test was used to test for association of outcome and pre-VTC care. Mann-Whitney U tests were used to compare modified Glasgow Coma Scale and Animal Trauma Triage (ATT) scores between pre-VTC and non-pre-VTC care groups. MEASUREMENTS AND MAIN RESULTS: Pre-VTC care was provided in 5636 out of 22,998 dogs (24.5%) by veterinarians (81%), owners (19.6%), and first responders (0.03%). The most common nonveterinary interventions included wound care and bandaging in 42% and 39% of the patients, respectively. Mortality was higher in the pre-VTC care group (8.7% vs 7.5%); dogs receiving pre-VTC care were 1.5 times (95% confidence interval [CI], 1.15-1.88) more likely to die and 1.2 times (95% CI, 1.07-1.37) more likely to be euthanized. The ATT scores were significantly higher in dogs receiving pre-VTC care (mean = 2.53 vs 1.78; p < 0.0001). CONCLUSION: Our data demonstrate that the majority of more severely injured dogs receiving pre-VTC care obtained care by a veterinarian. Dogs receiving pre-VTC care possessed a greater mortality rate but also a greater ATT score; therefore, mortality rate is more likely related to severity of trauma rather than reception of pre-VTC care. We propose that these data should prompt further research and education about prehospital care in veterinary medicine.

Efficacy assessment of PEV2 phage on Galleria mellonella larvae infected with a Pseudomonas aeruginosa dog otitis isolate.

Pseudomonas (P.) aeruginosa is the most frequently isolated Gram-negative bacteria in dog otitis. Antimicrobial resistance is particularly prevalent in P. aeruginosa and phage therapy represents a promising alternative therapeutic strategy. The aim of this study was to assess the efficacy of the PEV2 phage against a clinical P. aeruginosa isolate from a canine otitis using a Galleria (G.) mellonella larvae model. The genomic DNA of PAV237 P. aeruginosa isolate was sequenced and analysed. In a first main experiment, the efficacy of PEV2 phage against PAV237 was assessed at different multiplicities of infection (MOI) (50,000, 5000, 500, 50) by analyzing the larvae survival rate during 4 days. In a second experiment, the bacterial and phage titer evolutions were assessed depending on two MOIs (50,000, 5000). No significant survival increase was observed with PEV2 therapy in the infected larvae groups. The generated Kaplan-Meier curves showed that the rate of alive larvae was significantly higher in the non-infected larvae compared to the infected-treated ones irrespective of phage MOIs. An increase of the phage titer was observed at 24 and 48 h post-inoculation (HPI) with both MOIs and the P. aeruginosa titers were lower with MOI 50,000 and 5000 compared to the infectivity control at 24 and 48 HPI. Even if an ineffectiveness of the PEV2 phage was observed on the larvae survival, PEV2 is active against P. aeruginosa in this model and PEV2 replication is correlated with a lower bacterial proliferation in the phage treated larvae.

Non-neoplastic anal sac disorders in UK dogs: Epidemiology and management aspects of a research-neglected syndrome.

BACKGROUND: Non-neoplastic anal sac disorders (ASD) are frequent presentations for dogs in primary-care practice but evidence-based information on disease occurrence and risk is sparse. This study estimates prevalence, breed associations and other risk factors as well as reporting on clinical management. METHODS: A cohort study of dogs attending VetCompass practices between 1 January 2013 and 31 December 2013. Risk factor analysis used multivariable logistic regression methods. RESULTS: Of 104,212 dogs attending 110 UK practices, the 1-year period prevalence of ASD was 4.40% (95% CI: 4.22-4.57). Compared to crossbreds, six breeds showed increased odds of ASD (Cavalier King Charles spaniel, King Charles spaniel, Cockapoo, Shih-tzu, Bichon Frise and Cocker spaniel), and six breeds showed reduced odds (Labrador Retriever, Border collie, Staffordshire Bull Terrier, Lurcher, German Shepherd Dog and Boxer). Brachycephalic types had 2.6 times the odds for ASD compared to dolichocephalic types. Medication prescribed for ASD included antimicrobials (n = 480, 20.24%) and analgesics (n = 284, 11.97%). Anal sacculectomy was performed in under 1% of cases. CONCLUSIONS: High prevalence, strong breed predispositions and evidence of severity suggested from the antimicrobial and analgesic therapies combined with current substantial knowledge gaps identify ASD as a key research-neglected syndrome in dogs.

Assessment of biomarkers influencing treatment success on small intestinal lymphoma in dogs.

This study aimed to determine a reliable therapeutic biomarker for localized small intestinal lymphoma (SIL) in dogs based on clinical and histopathological features. We retrospectively investigated 84 dogs with localized SIL, including 36 dogs receiving surgery and 48 dogs receiving chemotherapy. The dogs receiving surgery were divided into two subgroups: 18 dogs (group 1) with overall survival (OS) <120 days (median OS) and 18 dogs (group 2) with OS ≥120 days. Correspondingly, the dogs receiving chemotherapy were divided into 24 dogs (group 3) with OS <98 days (median OS) and 24 dogs (group 4) with OS ≥98 days. Clinical, haematological, histopathological and immunohistochemical analyses were comparatively evaluated among the four subgroups. There was no significant difference in OS between the surgery and chemotherapy groups. In dogs receiving surgery, the rate of Ki67-positive cells was significantly increased in group 1 compared to group 2 and showed no significant difference between groups 3 and 4. In dogs receiving chemotherapy, the rate of O6-methylguanine-DNA methyltransferase (MGMT) was significantly higher in group 3 than in group 4 and showed no significant difference between groups 1 and 2. Additionally, our data showed that OS in dogs with higher Ki67 expression might be significantly increased by chemotherapy than by surgery, that of those with higher MGMT expression might be significantly increased by surgery than by chemotherapy, and Ki67 and MGMT were independent of each other. Indices of Ki67 and MGMT are suggested therapeutic biomarkers to determine the optimal first-line treatment for localized SIL in dogs.

Vestibular disease in dogs under UK primary veterinary care: Epidemiology and clinical management.

BACKGROUND: Vestibular disease (VD), central or peripheral, can be a dramatic primary-care presentation. Current literature describes mostly dogs examined in referral centers. HYPOTHESIS/OBJECTIVES: Describe the prevalence, presentation, clinical management, and outcomes of VD in dogs under primary veterinary care at UK practices participating in VetCompass. ANIMALS: Seven hundred and fifty-nine vestibular cases identified out of 905 544 study dogs. METHODS: Retrospective cohort study. Potential VD cases clinically examined during 2016 were verified by reviewing clinical records for signalment, presenting clinical signs, treatments, and outcomes. Multivariable logistic regression was used to evaluate factors associated with VD. RESULTS: The overall prevalence of VD was 8 per 10 000 dogs (95% CI = 7-9). Median age at first diagnosis was 12.68 years (interquartile range [IQR], 11.28-14.64). Compared with crossbreeds, breeds with the highest odds of VD diagnosis included French Bulldogs (odds ratio [OR] = 9.25, 95% CI = 4.81-17.76, P < .001), Bulldogs (OR = 6.53, 95% CI = 2.66-16.15, P < .001), King Charles Spaniels (OR = 4.96, 95% CI = 2.52-9.78, P < .001), Cavalier King Charles Spaniels (OR = 3.56, 95% CI = 2.50-5.06, P < .001), and Springer Spaniels (OR = 3.37, 95% CI = 2.52-4.52, P < .001). The most common presenting signs were head tilt (69.8%), nystagmus (68.1%), and ataxia (64.5%). The most frequently used treatments were antiemetics (43.2%), systemic glucocorticoids (33.1%), antimicrobials (25%), and propentofylline (23.25%). There were 3.6% of cases referred. Improvement was recorded in 41.8% cases after a median of 4 days (IQR, 2-10.25). CONCLUSIONS: Our study identifies strong breed predispositions for VD. The low referral rates suggest that primary-care data sources offer more generalizable information for benchmarking to help clinicians review their own clinical activities.

Love, hope and charity: how low-cost veterinary clinics make a difference.

This month, an owner explains how a charitable clinic has been vital in supporting her and her dog, Piper.

Retrospective evaluation of outpatient canine parvovirus treatment in a shelter-based low-cost urban clinic.

OBJECTIVE: To evaluate survival and associated risk factors when utilizing an outpatient treatment protocol for treatment of canine parvovirus (CPV) performed in a shelter-based low-cost urban clinic. DESIGN: Retrospective study. SETTING: Pennsylvania Society for the Prevention of Cruelty to Animals. ANIMALS: Ninety-five CPV positive dogs presented between June 1 and July 31, 2016. Owners elected for outpatient care when inpatient care was not financially feasible and the dog was considered medically stable for outpatient care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 95 CPV positive dogs, 79 (83%) survived treatment. Logistic regression indicated that an increasing number of days with clinical signs prior to treatment and an increase in percent body weight during treatment were significantly associated with survival (odds ratio [OR], 3.15, P = 0.020; and OR, 1.29, P = 0.027, respectively). Hypothermia upon presentation (T < 37℃) was negatively associated with survival (OR, 0.002; P = 0.002). CONCLUSIONS AND CLINICAL RELEVANCE: The survival rate of this clinic suggests that an outpatient program may be a potential alternative treatment to inpatient care. Longer duration of clinical signs prior to treatment and an increase in percent body weight during treatment appear to be associated with increased survival outcomes, while hypothermia on presentation appears to be associated with decreased survival outcomes.

Prognostic markers and assessment of a previously published clinical severity index in 109 hospitalised dogs with acute presentation of pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is common in dogs. Nevertheless, validated clinical severity index (CSI) scoring systems to assess severity and guide treatment in current, large-scale studies are unavailable. METHODS: This is a retrospective study including 109 dogs. Pancreatitis was diagnosed based on clinical signs, abdominal sonographic evidence, positive pancreatic lipase assays and experts' assessment consensus. RESULTS: The survival rate was 75 per cent (82 dogs). Azotaemia and presence of local complications (ie, ascites) and secondary complications (ie, acute kidney injury and acute respiratory distress syndrome) were significantly associated with death. In agreement with the previously published CSI, respiratory anomalies were significantly associated with death. However, in disagreement with that study, high scores in the kidney and local abdominal complication categories and the sum of scores of all nine categories, but not high gastrointestinal category score, were also significantly associated with death. A final CSI score of at least 4 was associated with death. CONCLUSIONS: This study has validated a nine-category CSI, proven a useful assessment tool in dogs with AP. Several previously reported and novel prognostic markers were assessed.

An empirical assessment of research practices across 163 clinical trials of tumor-bearing companion dogs.

Comparative clinical trials of domestic dogs with spontaneously-occurring cancers are increasingly common. Canine cancers are likely more representative of human cancers than induced murine tumors. These trials could bridge murine models and human trials and better prioritize drug candidates. Such investigations also benefit veterinary patients. We aimed to evaluate the design and reporting practices of clinical trials containing ≥2 arms and involving tumor-bearing dogs. 163 trials containing 8552 animals were systematically retrieved from PubMed (searched 1/18/18). Data extracted included sample sizes, response criteria, study design, and outcome reporting. Low sample sizes were prevalent (median n = 33). The median detectable hazard ratio was 0.3 for overall survival and 0.06 for disease progression. Progressive disease thresholds for studies that did not adopt VCOG-RECIST guidelines varied in stringency. Additionally, there was significant underreporting across all Cochrane risk of bias categories. The proportion of studies with unclear reporting ranged from 44% (randomization) to 94% (selective reporting). 72% of studies also failed to define a primary outcome. The present study confirms previous findings that clinical trials in dogs need to be improved, particularly regarding low statistical power and underreporting of design and outcomes.

Gastrointestinal Tract Dysfunction With Critical Illness: Clinical Assessment and Management.

The gut is the site of digestion and absorption as well as serving as an endocrine and immune organ. All of these functions may be affected by critical illness. This review will discuss secondary effects of critical illness on the gut in terms of gastrointestinal function that is clinically observable and discuss consequences of gut dysfunction with critical illness to patient outcome. Because there is little evidence-based medicine in the veterinary field, much of our understanding of gut dysfunction with critical illness comes from animal models or from the human medical field. We can extrapolate some of these conclusions and recommendations to companion animals, particularly in dogs, who have similar gastrointestinal physiology to people. Additionally, the evidence regarding gut dysfunction in veterinary patients will be explored. By recognizing signs of dysfunction early and taking preventative measures, we may be able to increase success with treatment of critical illnesses.

Evaluation of a structured individualised protocol as a potential cost-effective diagnostic and therapeutic approach to chronic diarrhoea in the dog.

Diagnostic investigation and management of chronic diarrhoea in dogs can be cost-prohibitive to many owners. The objectives of this study were to evaluate evidence-based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget-limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty-two client-owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget-limited step-wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence-based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget-limited protocol were then enrolled for complete, referral-level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow-up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget-limited approach (success rate 72.2%, confidence intervals 46.5-90.3%) and five dogs were moved on to a referral-level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget-limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7-99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.

Dendritic cell vaccination plus low-dose doxorubicin for the treatment of spontaneous canine hemangiosarcoma.

Angiosarcoma is a deadly neoplasm of the vascular endothelium. Metastatic disease is often present at diagnosis, and 5-year survival is only 10-35%. Although there exist no immunocompetent mouse models of angiosarcoma with which to study immune-based approaches to therapy, angiosarcoma is a major killer of companion dogs, responsible for up to 2% of all canine deaths in some susceptible breeds or an estimated 120,000 per year in the US. The canine disease (HSA) often presents in the spleen as acute hemoabdomen secondary to splenic rupture. Even if life-saving splenectomy is performed, median overall survival (OS) is only 48 days, and 1-year survival is negligible. Here we report the analysis of a pilot phase I open-label trial of chemo-immunotherapy performed on consecutively presenting splenectomized canines with histologically verified HSA. Subjects received an abbreviated course of low-dose doxorubicin plus alpha interferon and an autologous dendritic cell-therapy reported to enhance durable CD8+ memory. Disease was monitored monthly by abdominal ultrasound, chest X-ray, and echocardiogram. Median OS in the per protocol population was 109 days including one of five animals that died cancer-free at 16 months after documented resolution of relapsed disease. These results indicate that therapeutic administration of chemo-immunotherapy is both feasible and safe, substantiating the rationale for additional veterinary and human clinical studies.

Assessment of caregiver burden and associations with psychosocial function, veterinary service use, and factors related to treatment plan adherence among owners of dogs and cats.

OBJECTIVE To investigate caregiver burden and its potential associations with psychosocial function and veterinary service use among dog and cat owners and with factors related to treatment plan adherence among owners of animals with chronic or terminal disease. DESIGN Cross-sectional, observational study. SAMPLE 124 clients of a small animal hospital. PROCEDURES Study participants were recruited by email. Owners of sick animals were blindly matched with owners of healthy animals (62/group) by age, gender, and companion animal species. Respondents completed electronic questionnaires related to demographics and previously described measures of caregiver burden, psychosocial function, and treatment plan adherence. Veterinary medical records were reviewed to verify animal health status and assess veterinary service use (billable and nonbillable contacts with veterinary staff) in the 12 months prior to study enrollment. Variables were tested for association by statistical methods. RESULTS Questionnaire scores reflected greater caregiver burden; greater symptoms of depression, anxiety, and stress; and poorer quality of life for respondents with sick animals than for respondents with healthy animals. Greater caregiver burden was associated with scores reflecting poorer psychosocial function and with greater veterinary service use. The number of nonbillable, but not billable, contacts was greater for respondents with high caregiver burden than for those without this finding. Treatment plan factors associated with greater caregiver burden included changes in routine because of the animal's condition and perception that following new rules and routines for management of the condition was challenging. CONCLUSIONS AND CLINICAL RELEVANCE Awareness of potential caregiver burden and psychosocial distress in clients with sick companion animals may help veterinarians identify opportunities for an empathic response. Future research should assess directionality of the relationship between these factors.

Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior.

OBJECTIVE To develop and validate a Burden Transfer Inventory (BTI) of stressful client behaviors and to evaluate whether those behaviors are associated with client caregiver burden and contribute to veterinarian stress and burnout. DESIGN 3-stage cross-sectional psychometric validation study. SAMPLE 1,151 small animal veterinarians and 372 dog and cat owners. PROCEDURES During stage 1, a pool of 34 items representing stressful client behaviors was created through open-ended surveys of practicing veterinarians and 3 phases of pilot testing. During stage 2, 1,151 veterinarians recruited through the Veterinary Information Network completed a survey including those behavior items and validated measures of stress and burnout. Completed surveys were randomly assigned to either a measure development or validation database for factor and item analyses. Data were then combined to determine whether the BTI was correlated with measures of stress and burnout. During stage 3, owners of dogs and cats with a serious illness completed an online survey to assess how frequently they engaged in each BTI item as well as a validated measure of caregiver burden. RESULTS For dog and cat owners, there was a significant positive correlation between caregiver burden and the frequency that those owners reported engaging in BTI items. The frequency that veterinarians reported encountering BTI items was positively correlated with measures of stress and burnout, which suggested burden transfer from owners to veterinarians. The extent to which veterinarians reported being bothered by BTI items was a more robust predictor of stress and burnout than the frequency with which those items occurred. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated the BTI can be used to understand how client behaviors associated with caregiver burden affect veterinarian stress and burnout. The BTI may be useful to identify specific stressors affecting individual veterinarians and how they react to those stressors.

Assessment of a novel nanoparticle hyperthermia therapy in a murine model of osteosarcoma.

OBJECTIVE: To evaluate the effects of nanoparticle hyperthermia therapy on monocyte function and tumor-derived factors associated with macrophage polarization in a murine osteosarcoma model. STUDY DESIGN: Experimental study. ANIMALS: Female C3H mice. METHODS: Peripheral blood monocyte cell surface phenotype, monocyte chemotaxis, tumor messenger RNA expression, and survival were compared among osteosarcoma (OS)-bearing mice treated with nanoparticle hyperthermia therapy, OS-bearing mice with osteomyelitis, OS-bearing mice, vehicle control mice, and normal control mice. RESULTS: OS-bearing mice with osteomyelitis had a higher proportion of "nonclassical" monocytes (Ly6Clo ) compared with all other experimental groups. There were alterations in monocyte expression of multiple chemokine receptors among experimental groups including CXCR2, CCR2, and CXCR4. Monocytes from OS-bearing mice treated with hyperthermia therapy exhibited greater chemotaxis compared with monocytes from OS-bearing mice with osteomyelitis. CONCLUSION: OS likely induced alterations in monocyte phenotype and function. Nanoparticle hyperthermia therapy increased in vitro monocyte chemotaxis. CLINICAL IMPACT: Enhancing monocyte/macrophage function in dogs with OS may enhance antitumor immunity.