Educational Research Report Development of International Learning Outcomes for Shelter Medicine in Veterinary Education: A Delphi Approach.

Shelter medicine is a veterinary discipline of growing importance. Formally accepted as a clinical specialty in the US in 2014, the practice of shelter medicine worldwide is expanding. As a topic in veterinary pre-registration (undergraduate) education, it is frequently used as an opportunity to teach primary care skills, but increasingly recognized as a subject worthy of teaching in its own right. The aim of this study was to use a Delphi consensus methodology to identify learning outcomes relevant to shelter medicine education. Shelter medicine educators worldwide in a variety of settings, including universities, non-governmental organizations and shelters were invited to participate. Participants were initially invited to share shelter medicine teaching materials. These were synthesized and formatted into Learning Outcomes (LOs) based on Bloom's taxonomy and organized into five subject-specific domains. Participants were then asked to develop and evaluate the identified LOs in two rounds of online surveys. Consensus was determined at > 80% of panelists selecting "agree" or "strongly agree" in response to the statement "please indicate whether you would advise that it should be included in a shelter medicine education program" for each LO. In the second survey, where re-wording of accepted LOs was suggested, preference was determined at > 50% agreement. Through this method, 102 agreed LOs have been identified and refined. These LOs, as well as those which did not reach consensus, are presented here. These are intended for use by shelter medicine educators worldwide, to enable and encourage the further development of this important veterinary discipline.

Development of International Learning Outcomes for Shelter Medicine in Veterinary Education: A Delphi Approach.

Shelter medicine is a veterinary discipline of growing importance. Formally accepted as a clinical specialty in the US in 2014, the practice of shelter medicine worldwide is expanding. As a topic in veterinary pre-registration (undergraduate) education, it is frequently used as an opportunity to teach primary care skills, but increasingly recognized as a subject worthy of teaching in its own right. The aim of this study was to use a Delphi consensus methodology to identify learning outcomes relevant to shelter medicine education. Shelter medicine educators worldwide in a variety of settings, including universities, non-governmental organizations and shelters were invited to participate. Participants were initially invited to share shelter medicine teaching materials. These were synthesized and formatted into Learning Outcomes (LOs) based on Bloom's taxonomy and organized into five subject-specific domains. Participants were then asked to develop and evaluate the identified LOs in two rounds of online surveys. Consensus was determined at > 80% of panelists selecting "agree" or "strongly agree" in response to the statement "please indicate whether you would advise that it should be included in a shelter medicine education program" for each LO. In the second survey, where re-wording of accepted LOs was suggested, preference was determined at > 50% agreement. Through this method, 102 agreed LOs have been identified and refined. These LOs, as well as those which did not reach consensus, are presented here. These are intended for use by shelter medicine educators worldwide, to enable and encourage the further development of this important veterinary discipline.

A novel approach to welfare interventions in problem multi-cat households.

BACKGROUND: Thousands of injured, stray and relinquished cats are received at the RSPCA Greater Manchester Animal Hospital each year. A significant and challenging proportion of these cats are confiscated from multicat households by RSPCA Inspectors, due to the owners' inability to care for them. These households share many characteristics of animal hoarding, including poor owner compliance with suggested welfare improvements and recidivism. The relatively poor adoption potential of animals from such households are a perennial problem for the charity. The aim of this study was to determine if offering female cat neutering assistance to multi-cat owners significantly improved colony welfare. RESULTS: Ten multicat households with a history of public complaint to the RSPCA were recruited. An RSPCA veterinary surgeon (VS) initially assessed the overall welfare of each household's cat population, individual cat welfare and the living environment. All entire female cats aged over 8 weeks were neutered and basic animal care education provided. Follow up visits were completed two and 12 months later to reassess welfare parameters and population numbers. The total number of cats was 176 across ten households (range 7-33, median 16). All owners consented to having all entire female cats spayed. At the first visit, mean individual cat welfare scores ranged from 5.4-8.7/ 16 across the 10 households, where 16 represented best possible welfare. Overall household mean welfare scores were significantly improved at both the 2 month and 12 month revisits (p = 0.011 and p = 0.01 respectively) when compared to the initial visits. By the end of the study period, three out of the ten households had voluntarily relinquished all of their cats, and overall there was a 40% reduction in the number of cats. CONCLUSIONS: Animal hoarding has previously been an intractable welfare concern with little evidence informing intervention techniques. These results show that positive veterinary engagement on site, focused on preventative care and population control, can yield significant improvement in welfare scoring systems in relatively short timescales. Promptly collecting and neutering all female cats at a site, combined with advice and support, show promise in improving welfare.

A critically appraised topic (CAT) to compare the effects of single and multi-cat housing on physiological and behavioural measures of stress in domestic cats in confined environments.

BACKGROUND: Domestic cats have evolved from solitary, asocial predators and whilst they may display social behaviours, they can still exist as solitary survivors. Over-population and relinquishment of pet cats are ubiquitous problems worldwide, and rehoming centres (also known as rescues/ shelters) aim to ameliorate this by holding cats in confinement for a variable period until a new home is found. The provision of optimal housing for large numbers of cats in close confinement, such as in rehoming centres, is therefore inherently difficult. Under these conditions there is the potential for individuals to develop signs of physical and psychological ill health, and thus experience compromised welfare. Available information regarding housing practices that maximise welfare currently provides conflicting results, and as a consequence there are no unanimous housing recommendations. The aim of this study was therefore to review the evidence on the impact of single housing compared to multi-cat housing on stress in confined cats, as measured by physiological and/or behavioural outcomes. The review was conducted using a Critically Appraised Topic (CAT) format. A systematic search of electronic databases (CAB Abstracts, Zoological Records and Medline) was carried out to identify peer-reviewed literature comparing single and multi-cat housing in confined environments. RESULTS: A total of 959 papers were initially identified, six of which met sufficient criteria based on their relevance to be included within this review. All of the studies had significant limitations in design and methodology, including a lack of information on how groups were assigned, inconsistent handling and enrichment provision between groups, and lack of information on the socialisation status of cats. CONCLUSIONS: Whilst some studies suggested that single housing may be less stressful for cats, others suggested group housing was less stressful. Several other important factors were however identified as potential mediators of stress within the different housing systems, and recommendations based upon these findings are presented.

How do different members of the on-farm mobility team perceive lameness, and what factors influence their NSAID use?

BACKGROUND: Lameness affects approximately one-third of the national dairy herd, impacting welfare and production. Non-steroidal anti-inflammatory drugs (NSAIDs) are the main analgesic available, but use is variable. The aims of this study were to describe how members of the mobility team perceive pain and use NSAIDs for conditions causing lameness in dairy cows. METHODS: A questionnaire was distributed online to UK farmers, veterinarians, veterinary technicians (VTs) and foot trimmers (FTs). Respondents were asked to describe factors affecting their NSAID use and to score pain associated with 16 scenarios, including diagnoses, conditions and procedures associated with lameness in cows. RESULTS: Of 210 respondents, 81 (38.6%) were farmers, 80 (38.1%) were veterinarians, 34 (16.2%) were FTs and 15 (7.1%) were VTs. For most conditions, farmers scored pain lower than veterinarians and VTs and were less likely to use or recommend NSAIDs than veterinarians, VTs and FTs. Farmers rated cow comfort as more important (p < 0.001) and the cost of drugs as less important (p < 0.001) in using NSAIDs than veterinarians predicted. LIMITATIONS: There were fewer VTs and FTs than farmers and veterinarians, limiting generalisation. Response and social acceptability biases may have affected the findings. CONCLUSION: All members of the mobility team have different perceptions and areas of expertise around lameness. Increasing collaboration and harnessing of skills and knowledge within the team could improve detection and treatment of lameness, with consequent benefits to cow welfare and production.

Horse owner perceptions of equine veterinary nursing roles in the United Kingdom.

BACKGROUND: Registered (equine) veterinary nurses (R(E)VNs) typically provide few client-facing services. Better utilising R(E)VN skills could help address workforce shortages, improve morale and benefit patient health. The aim of this study was to explore horse owner perceptions of R(E)VN roles. METHODS: An online cross-sectional survey of horse owners gathered data on their understanding of R(E)VN roles, their experiences of R(E)VNs their openness to further R(E)VN services and perceived facilitators of and barriers to such services. Participants were recruited via practices, social media and snowball sampling. Descriptive analysis of the quantitative data and manifest content analysis of the qualitative data were conducted. RESULTS: Three hundred and forty-seven useable responses were received. Eighty-one percent (282/347) had heard the term R(E)VN. Most talked positively about their experiences with R(E)VNs. Eighty-seven percent (285/326) were open to an R(E)VN visiting their horse under the direction of a veterinary surgeon, with more than 90% being extremely or somewhat comfortable with R(E)VN visits for bandaging and suture removal. LIMITATIONS: It is unclear how closely respondents' perceptions reflect those of the wider UK horse owner population. CONCLUSIONS: Horse owners appear to be open to further nursing services, with key procedures such as bandaging being a potential starting point. Understanding the career goals of the individual nurses and the needs of the practice will be key to the successful implementation of these services.

Methods used to estimate the size of the owned cat and dog population: a systematic review.

BACKGROUND: There are a number of different methods that can be used when estimating the size of the owned cat and dog population in a region, leading to varying population estimates. The aim of this study was to conduct a systematic review to evaluate the methods that have been used for estimating the sizes of owned cat and dog populations and to assess the biases associated with those methods.A comprehensive, systematic search of seven electronic bibliographic databases and the Google search engine was carried out using a range of different search terms for cats, dogs and population. The inclusion criteria were that the studies had involved owned or pet domestic dogs and/or cats, provided an estimate of the size of the owned dog or cat population, collected raw data on dog and cat ownership, and analysed primary data. Data relating to study methodology were extracted and assessed for biases. RESULTS: Seven papers were included in the final analysis. Collection methods used to select participants in the included studies were: mailed surveys using a commercial list of contacts, door to door surveys, random digit dialled telephone surveys, and randomised telephone surveys using a commercial list of numbers. Analytical and statistical methods used to estimate the pet population size were: mean number of dogs/cats per household multiplied by the number of households in an area, human density multiplied by number of dogs per human, and calculations using predictors of pet ownership. CONCLUSION: The main biases of the studies included selection bias, non-response bias, measurement bias and biases associated with length of sampling time. Careful design and planning of studies is a necessity before executing a study to estimate pet populations.

Demographics and economic burden of un-owned cats and dogs in the UK: results of a 2010 census.

BACKGROUND: The population of dogs and cats passing through rescue shelters may be subject to compromised welfare and increased susceptibility to disease. Little information exists to describe this population, its dynamics and associated management practices. The aim of this study was to carry out a census of un-owned cats and dogs in the UK in 2010, and to document the origins, destinations, husbandry and costs associated with the care of these animals. RESULTS: A sampling frame was constructed by searching the databases of publicly registered charities for England, Scotland and Wales, registers of breed rescues, and by internet searches of animal welfare websites. Overall, 2,352 contacts for 1,380 organisations were identified. All were sent a postal questionnaire asking for data on the number of dogs and cats housed, their origins and eventual outcomes, and details of husbandry between January 1st and December 31st 2010. For those which were registered charities (595), financial records were also obtained.A response rate of 38.8% was obtained. Overall, in 2010, 89,571 dogs and 156,826 cats entered the care of the participating organisations. Approximately half of these animals were relinquished by their owners. Other origins included being found as strays or confiscated for welfare purposes. Seventy-five per cent of dogs and 77.1% of cats were rehomed. The next most common outcome was euthanasia, accounting for 10.4% of dogs and 13.2% cats. For dogs and cats, 44.3% and 62% of participants respectively reported having a waiting list, which frequently exceeded the actual capacity of the facility. Over 19,000 people were involved in the care of these animals, on a paid or voluntary basis. Financial records were available for 519/595 (87.2%) of the registered charities, and their total expenditure in 2010 was £340 million. CONCLUSIONS: This study showed that a large number of animals become un-owned each year, which could have considerable implications for their welfare. Despite the resources expended, demand still exceeds capacity for many organisations, and a substantial number of both cats and dogs are euthanased, suggesting that further understanding of how and why these animals become un-owned is essential in order to target interventions.

Assessment of health and welfare in a small sample of dogs owned by people who are homeless.

BACKGROUND: Pet ownership is common among homeless people, with dogs the most frequently reported pets. However, homeless people receive considerable criticism for keeping pets due to public perception of poor care provision. MATERIALS AND METHODS: A convenience, cross-sectional sample of 19 homeless people, owning a total of 21 dogs were recruited, and their dogs' health and wellbeing assessed using the PDSA Petwise MOT (P-MOT). RESULTS: The dogs compared favourably with conventionally owned pets in most areas, including exercise and companionship. Problems included being overweight/obese (although at lower prevalence than the general population). Some owners had difficulty in accessing veterinary care. Behavioural concerns were reported for 61.9% of the dogs, most commonly separation-related distress. DISCUSSION: Being unable to safely leave their pets may impair owners' access to services. Provision of accessible veterinary care, behavioural support and pet-friendly services could improve the health of homeless owners and their pets.

Priorities for Research into the Impact of Canine Surgical Sterilisation Programmes for Free-Roaming Dogs: An International Priority Setting Partnership.

Surgical sterilisation is a core activity of free-roaming dog population management (DPM) programmes globally. However, there is limited published evidence on its impact at the population level. To support evidence-based decision making in this field, it is important that research conducted is relevant to those involved in working with free-roaming dogs and implementing such programmes. The aim of this study was to adapt the James Lind Alliance (JLA) user involvement approach to systematically identify the top 10 research priorities regarding the impact of canine sterilisation. International stakeholders with experience working in DPM were asked in an online survey what unanswered questions they had regarding the impact of sterilisation programmes. Thematic analysis of survey responses was used to develop a long list of collated indicative research questions (CIRQs). A literature review was performed to identify questions that were 'true uncertainties' (had not been answered by evidence review). These questions were reduced to a shortlist via an online interim prioritisation survey, and a Delphi consensus process determined the top 10 priorities. The top 10 questions related to dog population size and turnover, dog bite incidents, rabies control, implementation in the field and human behaviour change. These priorities were identified and shaped by people with direct experience of canine surgical sterilisation programmes, and as such are an essential resource for directing future funding and research. Addressing these priorities will generate evidence that is directly applicable to policy makers and practitioners who make decisions regarding the management of free-roaming dogs (FRDs) worldwide.

Detection of squirrel poxvirus by nested and real-time PCR from red (Sciurus vulgaris) and grey (Sciurus carolinensis) squirrels.

BACKGROUND: Squirrel poxvirus (SQPV) is highly pathogenic to red squirrels (Sciurus vulgaris), and is a significant contributing factor to the local extinction of the species in most parts of England and Wales, where infection is endemic in Eastern grey squirrel (Sciurus carolinensis) populations. Although a nested PCR assay has been used successfully to study the epidemiology of SQPV, samples have a long processing time and the assay is not quantifiable. RESULTS: This project describes the design and optimization of a real-time PCR for SQPV. Comparison with the nested PCR showed the real-time assay to be more sensitive by one log and able to detect approximately 144 genome copies per mg of tissue. CONCLUSIONS: The real-time PCR has been used to quantify viral genome load in tissues from diseased and apparently healthy red and grey squirrels, and suggests that the titre of virus in tissues from diseased red squirrels is considerably higher than that found even in a grey squirrel with cutaneous lesions.

Importing rescue dogs into the UK: reasons, methods and welfare considerations.

BACKGROUND: Rescuing dogs from overseas is increasing in popularity but has associated risks. This study is the first to investigate the reasons why people bring rescue dogs into the UK from overseas, the importation process, and potential welfare problems associated with this practice. METHODS: An online questionnaire was advertised on social media in 2017 and received 3080 responses. RESULTS: Participants primarily chose to adopt from abroad based on a desire for a particular dog they had seen advertised and on concern for its situation. However, some were motivated by previously having been refused dogs from UK rescues. Adopters reported that the EU Pet Travel Scheme was used to import 89 per cent of dogs, with only 1.2 per cent reportedly under the more stringent (and correct) Balai Directive. 14.8 per cent (79/533) of dogs reportedly tested for Leishmania infantum had positive results. Although sometimes severe, the prevalence of behavioural problems appeared comparable to that of other rescue dogs. CONCLUSION: It is important that vets consider testing for exotic diseases, and the provision of behavioural support, when seeing imported patients. Our findings emphasise the importance of clear guidelines on travel laws, and stricter checks on animals imported as rescues, to ensure protection against the importation of diseases that pose a risk to animal and human health in the UK.

Evaluating the role of surgical sterilisation in canine rabies control: A systematic review of impact and outcomes.

Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB Abstracts, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

Critically Appraised Topics (CATs) in Veterinary Medicine: Applying Evidence in Clinical Practice.

Critically appraised topics (CATs) are evidence syntheses that provide veterinary professionals with information to rapidly address clinical questions and support the practice of evidence-based veterinary medicine (EBVM). They also have an important role to play in both undergraduate and post-registration education of veterinary professionals, in research and knowledge gap identification, literature scoping, preparing research grants and informing policy. CATs are not without limitations, the primary one relating to the rapid approach used which may lead to selection bias or restrict information identified or retrieved. Furthermore, the narrow focus of CATs may limit applicability of the evidence findings beyond a specific clinical scenario, and infrequently updated CATs may become redundant. Despite these limitations, CATs are fundamental to EBVM in the veterinary profession. Using the example of a dog with osteoarthritis, the five steps involved in creating and applying a CAT to clinical practice are outlined, with an emphasis on clinical relevance and practicalities. Finally, potential future developments for CATs and their role in EBVM, and the education of veterinary professionals are discussed. This review is focused on critically appraised topics (CATs) as a form of evidence synthesis in veterinary medicine. It aims to be a primary guide for veterinarians, from students to clinicians, and for veterinary nurses and technicians (hereafter collectively called veterinary professionals). Additionally, this review provides further information for those with some experience of CATs who would like to better understand the historic context and process, including further detail on more advanced concepts. This more detailed information will appear in pop-out boxes with a double-lined surround to distinguish it from the information core to producing and interpreting CATs, and from the boxes with a single line surround which contain additional resources relevant to the different parts of the review.

Shelter housing for cats: Principles of design for health, welfare and rehoming.

Practical relevance: Shelters and rehoming centres are a valuable tool in the population management and rehoming of cats. However, housing large numbers of a relatively asocial species in close proximity poses significant challenges. Well-designed accommodation enables improved standards of husbandry, as well as a better working environment for staff. This can have a significant benefit in expediting rehoming, as cats are healthier, and more likely to display natural behaviors and have positive interactions with potential adopters. Global importance: As cat overpopulation is such a widespread issue, cat shelters are common in many countries. This review will be of interest to those involved in the design and construction of cat shelters, and to those caring for the cats within them. The principles discussed also apply to boarding, breeding, research and hospitalization facilities. Challenges: Shelter housing poses substantial challenges in terms of maintaining positive health and wellbeing while sustaining adoption at an optimum rate. Disease control and biosecurity are typically facilitated by having a relatively barren, easily cleanable environment. However, this must be weighed against the provision of opportunities for cats to perform natural behaviors such as hiding, perching and interacting if they wish. A more enriched environment has also been shown to expedite adoption. AIMS: This review, the first in a two-part series, discusses practical aspects of housing and shelter design for the health, welfare and adoption of shelter cats. Evidence base: There is a relatively small body of empirical evidence to inform shelter design recommendations. The recommendations in this article are based on a careful review of the available evidence, some of which has come from allied fields such as the care of experimental animals. Where evidence is not yet available, recommendations have been based on field experience and collective expert opinion.

Shelter housing for cats: Practical aspects of design and construction, and adaptation of existing accommodation.

Practical relevance: Not every cat shelter will have purpose-built accommodation but housing designed with the basic needs of cats in mind, whether purpose-built or adapted from existing housing, will improve the experience of cats passing through the facility. Challenges: Designing and building accommodation for cats in shelters should be a thoughtful process. There is a range of different housing types available. A variety of factors, such as expected length of stay, type of cat, cost and disease risk, will influence which design is most appropriate. AIMS: This review, the second in a two-part series, provides an overview of some of the essential requirements for housing shelter cats, either singly or in groups. Specific practical aspects of housing, including design, space allowances, cage furnishings and suitable construction materials, are discussed, and suggestions made for upgrading existing housing where extensive rebuilding is not feasible or realistic. Evidence base: There is a relatively small body of empirical evidence to inform shelter design recommendations. The recommendations in this article are based on a careful review of the available evidence, some of which has come from allied fields such as the care of experimental animals. Where evidence is not yet available, recommendations have been based on field experience and collective expert opinion.