Development and validation of a questionnaire to assess health-related quality-of-life in cats with hyperthyroidism.

BACKGROUND: Health-related quality-of-life (HRQoL) assessment tools are becoming increasingly important for the assessment of diseases in veterinary medicine. OBJECTIVES: To develop a tool to assess the HRQoL of hyperthyroid cats and their owners. ANIMALS: Cats with hyperthyroidism (n = 229) and without hyperthyroidism (n = 322). METHODS: Cross-sectional study design. A preliminary list of 28 questions relating to the HRQoL of hyperthyroid cats and the influence their cat's disease might have on owners was created. Each question consisted of 2 subquestions: (1) "how often does the item apply"; (2) "how strongly does the item affect HRQoL." The questionnaire was refined based on statistical analysis, including Mann-Whitney-U tests on each item, comparing the results from cats with and without hyperthyroidism. Internal consistency and reliability of the questions were measured by Cronbach's alpha (α). P < .05 was considered significant. RESULTS: Overall, 25/28 questions were retained within the final HRQoL tool, which had an excellent internal consistency (α = .92). The tool produced a score between 0 and 382 (lower scores meaning better HRQoL). The median HRQoL score was 87.5 (range, 2-348) for cats with hyperthyroidism, and 27 (range, 0-249) for cats without (P < .001), suggesting the HRQoL was poorer in hyperthyroid cats. CONCLUSIONS AND CLINICAL IMPORTANCE: This validated HRQoL tool is useful to reliably quantify the influence of hyperthyroidism on the quality-of-life of affected cats and their owners. In the future, it could be considered of assistance in the clinical assessment of cats with hyperthyroidism.

Pulmonary interstitial emphysema and spontaneous pneumomediastinum are more prevalent in sighthounds than other dog breeds undergoing thoracic CT.

Spontaneous pneumomediastinum is an uncommon condition described in veterinary medicine with concurrent respiratory disease. It can be caused by the Macklin effect, which is when gas leaks from the alveoli into the surrounding interstitial lung tissue. Pulmonary interstitial emphysema (PIE) is the presence of gas within the pulmonary vascular sheaths and indicates the presence of the Macklin effect. In the authors' experience, spontaneous pneumomediastinum and PIE are more prevalent in sighthound dogs than in other breeds and are often considered incidental findings. This retrospective, observational, cross-sectional study compared the prevalence of PIE and subsequent pneumomediastinum in sighthound with other purebred dogs. It characterized the appearance of PIE in CT and analyzed a possible association with concomitant pulmonary pathologies or with the use of general anesthesia. Medical records and thoracic CTs of sighthounds and nonsighthound dogs from two institutions were reviewed. A total of 256 dogs, comprising 127 sighthounds and 129 other purebred dogs, were included. The prevalence of PIE and pneumomediastinum was statistically higher in sighthound (14.2%) compared with other nonsighthound dogs (2.2%). There was no statistical association between the presence of PIE and pneumomediastinum with different age and weight groups or with sex. There was no statistical difference in the prevalence of PIE and pneumomediastinum between dogs with and without pulmonary pathology or in dogs undergoing CT with sedation or general anesthesia. Spontaneous pneumomediastinum in sighthounds is more prevalent than in other breeds, and its prevalence is not associated with the presence of pulmonary pathology or the use of general anesthesia.

Diagnostic and predictive ability of hyperbilirubinemia severity in cats: A multicenter retrospective study.

BACKGROUND: Total serum bilirubin concentration (TBIL) can provide useful information on several pathophysiological conditions in cats. Nevertheless, whether the variable severity classification of hyperbilirubinemia can reliably indicate certain disease processes or predict a biliary obstruction (BO) has not been investigated. HYPOTHESIS/OBJECTIVE: Determine if hyperbilirubinemia of variable severity can assist clinicians to identify BO, which often is considered a surgical emergency. ANIMALS: Two-hundred sixteen client-owned cats. METHODS: Data were retrospectively collected from all cats (January 2015-August 2022) with an increased TBIL (>0.58 mg/dL [>10 µmol/L]) presented to 3 referral centers in the United Kingdom (UK). Presenting clinical features and diagnostic outcomes were collected. The predictive ability of TBIL to indicate BO was evaluated by multivariable binary logistic regression modeling and receiver operating characteristic (ROC) curves. RESULTS: Median TBIL was 1.73 mg/dL (range, 0.59-26.15; 29.5 µmol/L; range, 10.1-447.1) with severity classification of hyperbilirubinemia categorized as mild (>0.58-2.92 mg/dL; >10-50 µmol/L; 68.1%), moderate (>2.92-5.85 mg/dL; >50-100 µmol/L; 17.6%), severe (>5.85-11.70 mg/dL; >100-200 µmol/L; 9.7%) and very severe (>11.70 mg/dL; >200 µmol/L; 4.6%). Biliary obstruction was present in 17 (7.9%) cats, all of which received recommendation for emergency surgery. Median TBIL in cats with BO (9.69 mg/dL; 165.7 µmol/L) differed significantly from those without obstruction (1.51 mg/dL; 25.8 µmol/L; P < .01). The optimal TBIL cut-off to discriminate between cats with and without BO was ≥3.86 mg/dL (≥66 µmol/L) with a sensitivity of 94.1% and specificity of 82.4%. Using multivariable logistic regression, as age increased, the odds of BO increased significantly (odds ratio, 1.20; 95% confidence interval, 1.01-1.42; P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE: As part of a thorough clinical assessment, the severity classification of hyperbilirubinemia has the potential to predict the likelihood of a BO and to discriminate between cats that may or may not require surgery for BO at a suggested cut-off of ≥3.86 mg/dL (≥66 µmol/L). Alongside TBIL, age is also useful when assessing for the likelihood of BO in a cat presented with hyperbilirubinemia.

Humeral Condylar Fractures in French Bulldogs-Inciting Cause and Factors Influencing Complications of Internal Fixation in 136 Dogs.

OBJECTIVE: To report the inciting cause and configuration of humeral condylar fractures in French Bulldogs, and to identify risk factors for complications associated with their surgical stabilization, as well as their occurrence. STUDY DESIGN: Retrospective multicenter clinical cohort study. ANIMALS: French bulldogs (n = 136) with humeral condylar fracture. METHODS: Records from eight United Kingdom referral centers were reviewed for French bulldogs that underwent surgery for humeral condylar fracture between January 2017 and January 2021. RESULTS: Lateral fractures of the humeral condyle represented two-thirds of condylar fractures in this study (95 elbows; 69.8%); medial fractures of the humeral condyle and intracondylar Y or T fractures affected 22 (16.2%) and 19 (14%), respectively. A fall was the inciting cause for 60 elbows (45.6%), with stairs implicated in 27 (20.45%) elbows. Skeletal immaturity was significantly correlated with fracture. Complications affected 30 out of 132 dogs (136 elbows) (22%), of which 10 (33%) were major, and 20 (66%) were minor. Fixation method did not significantly impact complication rate for medial or lateral fractures of the humeral condyle (p = 0.87). Comminution increased the risk of complication for all humeral condylar fracture types (p = 0.02). CLINICAL RELEVANCE: Fixation method was not found to significantly impact the complication rate of surgically managed fractures of the humeral condyle in French bulldogs. Stair use, falling from low heights, and skeletal immaturity were common inciting reasons for humeral condylar fractures.

TTA-Rapid for treating the canine cruciate deficient stifle: Medium to long-term outcome and analysis of risk factors.

BACKGROUND: This study aimed to evaluate medium to long-term outcomes following treatment of lameness associated with cranial cruciate ligament insufficiency using the tibial tuberosity advancement (TTA)-Rapid technique and to investigate risk factors associated with outcome, including tibial plateau angle (TPA). METHODS: Patient records for cases treated over an 80-month period were examined retrospectively. An owner postal questionnaire using a clinical metrology instrument (Liverpool Osteoarthritis in Dogs) evaluated the outcome at least 6 months after surgery. RESULTS: A total of 149 procedures were carried out in 120 dogs. Questionnaires were received for 64 dogs (53.3%), with a median follow-up time of 37.5 months. Outcome was judged to be satisfactory, based on frequency of lameness, in 63 (98.4%), while satisfactory outcomes were achieved in 61 (95.3%) based on severity of lameness and in 50 (78.1%) based on mobility score. Statistical analysis showed that age, bodyweight, TPA, meniscal injury and concurrent patellar surgery did not influence outcome, but time to follow-up positively correlated with mobility score. LIMITATIONS: This study involved one surgeon in one centre with outcome data based on the completion of an owner questionnaire, although this used a validated clinical metrology instrument. CONCLUSION: TTA-Rapid offers a treatment option for cranial cruciate-deficient stifles with a good medium to long-term outcome, and no risk factors were identified to suggest any limitations to its use.

Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: A randomized clinical trial.

OBJECTIVE: To determine the influence of screw direction on complications following transcondylar screw placement for the treatment of canine humeral intracondylar fissures (HIFs). STUDY DESIGN: Equivalence, parallel group, randomized clinical trial. SAMPLE POPULATION: Fifty-two client owned dogs (73 elbows). METHODS: Transcondylar screw placement was randomized to either a medial or lateral approach. The primary outcome was the incidence of postoperative complications. RESULTS: There were 37 cases in the lateral approach group and 36 cases in the medial approach group. There was a significantly greater proportion of postoperative complications following placement of transcondylar screws from a lateral to medial direction (p = .001). There were seven cases with complications (19%) in the medial approach group versus 23 cases with complications (62%) in the lateral approach group. The majority of complications were seromas (n = 13) and surgical site infections (n = 16) with 4 complications requiring further surgery. Implant area moment of inertia (AMI), normalized to bodyweight, was lower in dogs with a major complication (p = .037). CONCLUSION: Transcondylar screws placed from lateral to medial for canine HIFs had a greater proportion of postoperative complications in this randomized clinical trial design. Implants with a lower AMI, relative to bodyweight, were more likely to lead to major complications. CLINICAL SIGNIFICANCE: We recommend placing transcondylar screws from medial to lateral for canine HIFs to reduce the risk of postoperative complications. Relatively small diameter implants had an increased risk of major complications.

Incidence and clinical characterisation of thoracolumbar intervertebral disc extrusions in Basset Hounds compared with Dachshunds.

BACKGROUND: The Basset Hound is the largest chondrodystrophic breed predisposed to thoracolumbar intervertebral disc extrusion (TL-IVDE). However, literature describing this particular breed in terms of incidence, signalment, anatomical location, clinical severity and short-term outcome of TL-IVDE is lacking. METHODS: The medical histories of Dachshunds and Basset Hounds presenting to three neurology departments were retrospectively assessed. Information collected for each dog included signalment, whether it had received a diagnosis of TL-IVDE, duration of clinical signs, affected discs and anatomical region and neurological grading at presentation and discharge. RESULTS: A total of 270 Dachshunds and 188 Basset Hounds were included for incidence analysis. Of these, 154 Dachshunds and 68 Basset Hounds with confirmed TL-IVDE were included for signalment, anatomical location, clinical severity and short-term outcome analysis. Statistical analysis indicated a significantly higher incidence of TL-IVDE in Dachshunds than in Basset Hounds (77.4% vs. 36.2%, p < 0.05). Basset Hounds presenting to a neurology department were older (median 87.5 months vs. 66.5 months), had a greater proportion of midlumbar IVDE (L2-L5) and were more frequently ambulatory at discharge than Dachshunds. Only one Basset Hound presented as paraplegic without nociception, compared with 16 Dachshunds (1.5% vs. 10.4%). LIMITATIONS: The study had a retrospective design and included multicentric non-standardised cases. CONCLUSION: TL-IVDE incidence was higher in Dachshunds than in Basset Hounds. Basset Hounds were older at presentation, frequently affected more caudally in the vertebral column and more frequently ambulatory at discharge than Dachshunds. The differences found in this study could aid in the development of preventive strategies.

External validation of a United Kingdom primary-care Cushing's prediction tool in a population of referred Dutch dogs.

BACKGROUND: A prediction tool was developed and internally validated to aid the diagnosis of Cushing's syndrome in dogs attending UK primary-care practices. External validation is an important part of model validation to assess model performance when used in different populations. OBJECTIVES: To assess the original prediction model's transportability, applicability, and diagnostic performance in a secondary-care practice in the Netherlands. ANIMALS: Two hundred thirty client-owned dogs. METHODS: Retrospective observational study. Medical records of dogs under investigation of Cushing's syndrome between 2011 and 2020 were reviewed. Dogs diagnosed with Cushing's syndrome by the attending internists and fulfilling ALIVE criteria were defined as cases, others as non-cases. All dogs were scored using the aforementioned prediction tool. Dog characteristics and predictor-outcome effects in development and validation data sets were compared to assess model transportability. Calibration and discrimination were examined to assess model performance. RESULTS: Eighty of 230 dogs were defined as cases. Significant differences in dog characteristics were found between UK primary-care and Dutch secondary-care populations. Not all predictors from the original model were confirmed to be significant predictors in the validation sample. The model systematically overestimated the probability of having Cushing's syndrome (a = -1.10, P < .001). Calibration slope was 1.35 and discrimination proved excellent (area under the receiver operating curve = 0.83). CONCLUSIONS AND CLINICAL IMPORTANCE: The prediction model had moderate transportability, excellent discriminatory ability, and overall overestimated probability of having Cushing's syndrome. This study confirms its utility, though emphasizes that ongoing validation efforts of disease prediction tools are a worthwhile effort.

Identifying factors associated with UK veterinary nurse resignations through examination of veterinary practice data.

BACKGROUND: This study aimed to identify demographic, practice and job-specific factors that are associated with veterinary nurses resigning from UK companion animal veterinary practices. METHODS: Employment data from nurses working across a group of practices at the end of 2020 were included. Nurses were categorised into those who remained at, or resigned from, their practice in 2021. Proposed risk factors for future resignations were analysed using multivariable binary logistic regression modelling. RESULTS: In total, 278 of 1642 (16.9%) nurses across 418 practices resigned in 2021. The most frequently recorded reasons for nurses resigning included 'career progression' (n = 102; 36.7%), 'personal reasons' (n = 36; 12.9%) and 'better pay or benefits' (n = 33; 11.9%). Factors associated with lower odds of future nurse resignations included longer tenure (p < 0.001), higher practice property and facilities rating (p = 0.049) and being a head or student nurse (p = 0.008). LIMITATIONS: Data were collected retrospectively and were not recorded for research purposes. CONCLUSIONS: This study highlights key factors that are predictive of veterinary nurse resignations. With known difficulties in staff retention within veterinary practices, analysis of these data is an important addition to the evidence base surrounding the complex issue of nurse retention and could help steer future retention strategies.

The value of routine radiographic follow up in the postoperative management of canine medial patellar luxation.

OBJECTIVE: To determine the influence of radiographic examination on the recommendations made at the time of planned re-evaluation of dogs after medial patellar luxation (MPL) surgery. STUDY DESIGN: Retrospective multi-institutional case series. ANIMALS: Client-owned dogs (N = 825) that underwent MPL surgery. METHODS: Records of 10 referral institutions were searched for dogs that had been treated surgically for unilateral MPL and underwent a planned follow-up visit, including radiographs. The frequency of, and reasons for, changes in further recovery recommendations were investigated. RESULTS: Follow up was performed at a median of 6 (range, 4-20) weeks postoperatively. Isolated radiographic abnormalities were identified in 3.3% (27/825) of dogs following MPL surgery and led to a change in recommendations in 3% (13/432) of dogs that were presented without owner or clinician concerns. Lameness, administration of analgesia at follow up, and history of unplanned visits prior to routine re-examination were associated with a change in postoperative plan (P < .001). In the absence of owner and clinician concerns, the odds of having a change in convalescence plans were not different, whether or not isolated radiographic abnormalities were present (P = .641). CONCLUSION: Routine radiographs at follow up did not influence postoperative management of most dogs after MPL surgery in the absence of abnormalities on clinical history or orthopedic examination. CLINICAL SIGNIFICANCE: Dogs that were presented for routine follow up after unilateral MPL surgery without owner concerns, lameness, analgesic treatment or a history of unplanned visits, and for which examination by a surgical specialist was unremarkable, were unlikely to benefit from radiographs.

Clinical presentation, treatment and outcome of canine malignant mesothelioma: A retrospective study of 34 cases.

Canine malignant mesothelioma (CMM) is a rare and aggressive tumour associated with a poor prognosis. Limited information is available regarding effective treatment options and prognostic factors. The purpose of this retrospective case series was to describe the clinical presentation, treatment and survival in a cohort of dogs with this disease and to investigate possible prognostic factors. Thirty-four dogs were included. Tachypnoea and dyspnoea due to pleural effusion were the most common presenting clinical signs. Twenty-two dogs had a subcutaneous access port placed and 25 dogs were treated with intracavitary and/or intravenous chemotherapy. The main protocols used were single-agent 5-FU (n = 14) and carboplatin single-agent or alternated with mitoxantrone (n = 10). The overall response rate (defined as more than 25% reduction in effusion volume) to chemotherapy treatment was 37% after 3-weeks and 24% after 15-weeks. The median survival time (MST) for all dogs was 195 days (95% CI 53-324). MST was 234 days for dogs receiving chemotherapy and 29 days for dogs not receiving chemotherapy. The 1-year survival rate was 22% for all dogs. Treatment with chemotherapy was the only significant prognostic factor associated with survival (p = .001). Further studies are needed to determine the optimal treatment approach for malignant mesothelioma in dogs. Nevertheless, effusion recurrence should be expected and the prognosis for these patients in the long-term is poor.

Machine-learning based prediction of Cushing's syndrome in dogs attending UK primary-care veterinary practice.

Cushing's syndrome is an endocrine disease in dogs that negatively impacts upon the quality-of-life of affected animals. Cushing's syndrome can be a challenging diagnosis to confirm, therefore new methods to aid diagnosis are warranted. Four machine-learning algorithms were applied to predict a future diagnosis of Cushing's syndrome, using structured clinical data from the VetCompass programme in the UK. Dogs suspected of having Cushing's syndrome were included in the analysis and classified based on their final reported diagnosis within their clinical records. Demographic and clinical features available at the point of first suspicion by the attending veterinarian were included within the models. The machine-learning methods were able to classify the recorded Cushing's syndrome diagnoses, with good predictive performance. The LASSO penalised regression model indicated the best overall performance when applied to the test set with an AUROC = 0.85 (95% CI 0.80-0.89), sensitivity = 0.71, specificity = 0.82, PPV = 0.75 and NPV = 0.78. The findings of our study indicate that machine-learning methods could predict the future diagnosis of a practicing veterinarian. New approaches using these methods could support clinical decision-making and contribute to improved diagnosis of Cushing's syndrome in dogs.

Development and internal validation of a prediction tool to aid the diagnosis of Cushing's syndrome in dogs attending primary-care practice.

BACKGROUND: Novel methods to aid identification of dogs with spontaneous Cushing's syndrome are warranted to optimize case selection for diagnostics, avoid unnecessary testing, and ultimately aid decision-making for veterinarians. HYPOTHESIS/OBJECTIVES: To develop and internally validate a prediction tool for dogs receiving a diagnosis of Cushing's syndrome using primary-care electronic health records. ANIMALS: Three hundred and ninety-eight dogs diagnosed with Cushing's syndrome and 541 noncase dogs, tested for but not diagnosed with Cushing's syndrome, from a cohort of 905 544 dogs attending VetCompass participating practices. METHODS: A cross-sectional study design was performed. A prediction model was developed using multivariable binary logistic regression taking the demography, presenting clinical signs and some routine laboratory results into consideration. Predictive performance of each model was assessed and internally validated through bootstrap resampling. A novel clinical prediction tool was developed from the final model. RESULTS: The final model included predictor variables sex, age, breed, polydipsia, vomiting, potbelly/hepatomegaly, alopecia, pruritus, alkaline phosphatase, and urine specific gravity. The model demonstrated good discrimination (area under the receiver operating curve [AUROC] = 0.78 [95% CI = 0.75-0.81]; optimism-adjusted AUROC = 0.76) and calibration (C-slope = 0.86). A tool was developed from the model which calculates the predicted likelihood of a dog having Cushing's syndrome from 0% (score = -13) to 96% (score = 10). CONCLUSIONS AND CLINICAL IMPORTANCE: A tool to predict a diagnosis of Cushing's syndrome at the point of first suspicion in dogs was developed, with good predictive performance. This tool can be used in practice to support decision-making and increase confidence in diagnosis.

Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England.

BACKGROUND: Hyperadrenocorticism is an endocrine disease routinely encountered within primary care practice; however, few studies evaluating survival beyond diagnosis have studied this population. METHODS: This retrospective cohort study analysed the electronic patient records of 219 cases of hyperadrenocorticism from a sample of dogs attending primary care practices in England. Kaplan-Meier plots examined the cumulative survival and Cox proportional hazard regression modelling identified factors associated with the hazard of all-cause mortality. RESULTS: In the analysis, 179/219 (81.7 per cent) hyperadrenocorticism cases died during the study period with a median survival time from first diagnosis of 510 days (95% CI 412 to 618 days). Trilostane was used in 94.1 per cent of cases and differentiation between pituitary-dependent and adrenal-dependent disease was made in 20.1 per cent of cases. In the multivariable analysis, dogs weighing greater than or equal to 15 kg (HR 1.51, 95% CI 1.06 to 2.15, P=0.023) and those diagnosed greater than or equal to 13 years of age (HR 3.74, 95% CI 2.29 to 6.09, P<0.001) had increased hazards of all-cause mortality. Dogs that had their initial trilostane dose increased had a favourable prognosis (HR 0.49, 95% CI 0.32 to 0.76, P=0.015). CONCLUSION: This study shows that survival from diagnosis of hyperadrenocorticism appears fair for many dogs and provides primary care practitioners with relatable benchmark prognostic figures.

Development and evaluation of a health-related quality-of-life tool for dogs with Cushing's syndrome.

BACKGROUND: Clinical signs and consequences of Cushing's syndrome are likely to impact upon a dog's life. Quantification of this impact on a dog's health-related quality-of-life (HRQoL) could contribute to optimized disease management. HYPOTHESIS/OBJECTIVES: To develop a novel HRQoL tool to aid assessment of dogs with Cushing's syndrome and to evaluate factors that impact upon dogs living with this disease. ANIMALS: Two hundred and ten dogs with Cushing's syndrome and 617 dogs without Cushing's syndrome. METHODS: Cross-sectional study design. Dog owners answered questions relating to the HRQoL of their dogs which were refined to develop the final tool. The tool was analyzed for reliability, validity, and interpretability, including Cronbach's alpha and principal components analysis. Factors impacting upon the HRQoL of dogs with Cushing's syndrome were assessed using appropriate nonparametric tests. RESULTS: The tool was refined from 32 questions to 19 and showed good internal consistency (α = .83). Owners rated questions related to "owner impact" as more important and those related to demeanor as less important. There was a positive correlation between the tool score of dogs with Cushing's syndrome and owner's assessment of their dog's quality-of-life (r = .41, P < .001). Dogs currently on treatment with trilostane had a statistically better HRQoL (.33, interquartile range [IQR] .23-.44) than those not receiving trilostane (.36, IQR .33-.54, P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE: The developed tool quantifies the HRQoL of dogs with Cushing's syndrome and could assist clinicians in the clinical assessment of dogs with Cushing's syndrome.