Treatment complexity and caregiver burden are linked in owners of dogs with allergic/atopic dermatitis

Long term use of lokivetmab (Cytopoint®) in atopic dogs

Lokivetmab (Cytopoint®, Zoetis) has been shown to be effective for the short-term treatment of dogs with allergic and atopic dermatitis but there are no studies at US label dosing (at least 2 mg/kg every 4-8 weeks as necessary) which evaluate long-term usage. The objective of this study was to follow a cohort of dogs receiving lokivetmab to treat their canine atopic dermatitis (CAD) over 12 months. The initial phase of this interventional cohort study evaluated a dog's pruritus following monthly injections (up to 3 injections) of lokivetmab. Dogs who achieved pruritus < 36 mm using a Pet Owner Pruritus Visual Analogue Scale (PVAS) scoring system during the initial phase, were included in this study. Dogs received lokivetmab injections per the US label every 4-8 weeks and returned on days 180 and 365 (± 7 days) after their initial Day 0 for examination by investigators. Pet owners were asked to complete an electronic PVAS assessment every 2 weeks. At each visit, investigators completed a Canine Atopic Dermatitis Extent and Severity Index (CADESI-4) score and VetVAS to measure skin lesion scores. There were 87% (64/75) of dogs who maintained a PVAS below their baseline PVAS on Day 0. Over the course of the study, 88% (65/75) of dogs obtained a mean PVAS below 36 mm. Of those dogs, 31% (23/75) achieved a biweekly PVAS that was below 36 for the entirety of the study with 11% (8/75) having a biweekly PVAS score that stayed below 20 (considered normal dog level of pruritus) for the entire study. Most owners (93%; 64/49) were satisfied with lokivetmab with 88% planning to continue lokivetmab usage. The majority (80%; 55/69) of pet owners reported they were able to reduce the use of other products while their dog was using lokivetmab, and 87% (60/69) of owners found caring for their dog's atopic dermatitis was easier with lokivetmab compared to prior treatments.

Possible relationship between long-term post neutering complications in dogs and caregiver burden in the owners

Gonadectomy, commonly known as neutering, is widely used to address dog overpopulation and reduce reproductive disease risks, such as mammary cancer and pyometra. It is also advocated for behavior modification. However, neutering is associated with an increased risk of certain musculoskeletal disorders, obesity, several types of cancer, immune-mediated diseases, and cognitive dysfunction. These conditions may necessitate ongoing care and treatment, that require special care that the caregiver must provide furthermore burdens the caregiver with daily tasks, which encompasses the emotional, physical, social, and financial impact on pet owners caring for chronically ill animals. This burden can result in burnout, health issues, depression, social isolation, and financial stress. The potential benefits and risk of gonadectomy can affect the quality of life of both humans and pets. Relevant research findings should therefore be incorporated into each pet's and owner's particular situation. The purpose of this review is to address the long-term neutering risks and the potential caregiver burden that arises from these risks.

In vitro evaluation of bactericidal effects of fluorescent light energy on Staphylococcus pseudintermedius and S. aureus

BACKGROUND

Staphylococcus pseudintermedius and S. aureus are bacterial species of importance in veterinary medicine. The increasing incidence of antibiotic resistance necessitates the implementation of novel treatment modalities. Fluorescent light energy (FLE) is used as an adjunctive and primary treatment for canine pyoderma. However, no in vitro studies exist investigating its bactericidal effects against S. pseudintermedius or S. aureus.

OBJECTIVES

To determine the bactericidal effects of FLE on S. pseudintermedius and S. aureus isolates.

MATERIALS AND METHODS

Two meticillin-susceptible S. pseudintermedius (MSSP) isolates, three meticillin-resistant S. pseudintermedius (MRSP) isolates and one meticillin-resistant S. aureus (MRSA) isolate were studied. A commercially available blue light-emitting diode (bLED) lamp and photoconverting hydrogel FLE system was used. All bacteria were exposed to five conditions following inoculation: (i) no treatment (control); (ii) blue light (bLED) once; (iii) bLED twice consecutively; (iv) FLE (bLED and photoconverting hydrogel) once; and (v) FLE (bLED and photoconverting hydrogel) twice consecutively. Each individual exposure was 2 min long.

RESULTS

No statistically significant differences (p < 0.05) were found for any treatment group when each bacterial isolate was evaluated individually, MSSP isolates were grouped, MRSP isolates were grouped, when all S. pseudintermedius isolates were combined, or when all isolates of both Staphylococcus species were combined.

CONCLUSIONS AND CLINICAL RELEVANCE

While clinical success is reported when using FLE to treat Staphylococcus infections in animals, no in vitro antibacterial efficacy was identified for S. pseudintermedius or S. aureus under experimental conditions. The clinical success observed with FLE may be the result of a more complex in vivo response.

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.

Are images worth a thousand words? A preliminary study testing a video for owner education in canine atopic dermatitis

BACKGROUND

Successful management of canine atopic dermatitis (cAD) is challenging and effective pet owner education is crucial to successful outcomes. However, there are limited proven educational strategies in this area. Our goal was to create an effective and engaging educational tool for owners of dogs with cAD.

HYPOTHESIS

Video-based education efficacy would be comparable to traditional verbal delivery. Secondary objectives included assessing client perception of the intervention, and determining if there were clinical benefits for the dogs and improved client adherence to treatment.

SUBJECTS

Twenty-nine dogs with cAD and their owners were recruited from a teaching hospital of a European veterinary medicine faculty.

MATERIALS AND METHODS

In this 8 week, prospective, randomised controlled study, clients in the control group (CG, n = 13) received verbal education and those in the intervention group (IG, n = 16) watched a video. Client knowledge was assessed at Day (D)0 and D56. Treatment adherence and perceived utility and appeal ratings were measured at D56. Clinical progress was assessed at D0 and D56 using CADESI-04 and PVAS10.

RESULTS

The differences found in the means of cAD knowledge score, clinical outcomes, utility and appeal ratings and owners' adherence score between groups were not statistically significant. A significant association between the outcome and the intervention group concerning education success [CG, six of 13 (46.15%); IG, 15 of 16 (93.75%)] was found (p = 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Video-based instructions positively impacted owners' education and demonstrated their potential as a valuable tool. The authors believe that video-based education could be a time-efficient alternative for initial cAD education in veterinary clinics.

Caregiver Burden in Small Animal Clinics: A Comparative Analysis of Dermatological and Oncological Cases

Caregiver burden, a response to the challenges faced by those caring for sick loved ones, combines objective caregiving aspects with subjective experiences. This study aimed to describe the caregiver burden in guardians of ailing animals with dermatological and oncological pathologies. Additionally, this study aimed to correlate the degree of caregiver burden with the duration of the animal's treatment, disease stability, family income, owner's age, and the number of people living in the same household responsible for the animal's treatment. Using a cross-sectional approach, questionnaires were administered to guardians at a veterinary hospital. Out of 182 valid responses, 50.55% related to oncological patients and 49.45% to dermatological patients. Notably, 36.9% of oncological and 37.8% of dermatological guardians exhibited a clinically significant burden, with no statistical differences between the groups. Of the respondents, 84.6% were dog guardians, with 34.4% showing a significant burden. Feline guardians (15.4% of respondents) exhibited a higher burden (53.5%) compared to dog guardians (p = 0.02). Disease stability, time since diagnosis, and guardian age significantly influenced the burden, while household composition, income, and treatment duration showed no substantial impact. These findings underscore the psychosocial impact of caring for animals, emphasizing the need for a comprehensive understanding of the caregiver's perspective.

Response of pet owners to Whistle FIT® activity monitor digital alerts of increased pruritic activity in their dogs: a retrospective observational study

Pruritus is a common clinical sign in dogs and is often underrecognized by dog owners and veterinarians. The Whistle FIT®, a wearable accelerometer paired with analytics, can detect changes in pruritic activity in dogs, which can be reported to owners in a smartphone/tablet application. The objectives of this retrospective observational study were to investigate the impact of digital alerts for increased pruritic behaviors received by dog owners in a real-life setting, on (1) the initiation of veterinary clinic visits, and (2) if such visits resulted in initiation of therapy for pruritus. Whistle FIT® data and electronic health records from 1,042 Banfield veterinary clinics in the United States were obtained for a 20-month period and reviewed retrospectively. Data on times of increased pruritic behaviors was calculated retrospectively by the investigators by applying the same algorithms used in the Whistle system. Data from the first 10-month interval was compared to the second 10 months, when reports on pruritic behaviors and alerts for increased pruritic behaviors were viewable by pet owners. Signalment of dogs with clinic visits in the first (n = 7,191) and second (n = 6,684) 10-month groups was similar. The total number of pruritic alerts was 113,530 in the first 10 months and 93,217 in the second 10 months. The odds of an 'alert visit' (the first veterinary clinic visit that occurred within 4 weeks after the time of a pruritus alert) was statistically significantly more likely (odds ratio, 1.6264; 95% CI, 1.57-1.69; p < 0.0001) in the second 10-month period compared to the first 10-month period. The total number of medications administered was 10,829 in the first 10 months and 9,863 in the second 10 months. The percentage of medications prescribed within 4 weeks after a pruritus alert was higher in the second 10 month period (53.3%) compared to the first 10 month period (38.8%). This study suggests that pruritus alerts sent to dog owners may improve owner recognition of pruritic behaviors and increase the likelihood of a veterinary visit to treat canine pruritus.

Evaluation of proton pump inhibitor administration in hospitalized dogs in a tertiary referral hospital

BACKGROUND

Although proton pump inhibitors (PPIs) are commonly administered to hospitalized dogs, prescribing patterns and appropriateness of use require continued investigation.

HYPOTHESIS/OBJECTIVE

Describe prescription patterns and appropriateness of use associated with PPIs in hospitalized dogs at a single tertiary care facility. We hypothesized that the majority of prescriptions would not comply with current guidelines for the rational use of acid suppressants.

ANIMALS

Two hundred randomly selected hospitalized dogs.

METHODS

Retrospective evaluation of the medical records associated with a randomly selected sample of hospitalized dogs that received PPIs between January 2013 and December 2018.

RESULTS

A total of 12 610 dogs were admitted for first-time hospitalization between January 2013 and December 2018. Forty percent of these dogs (5062/12610) were prescribed a PPI PO or IV. Of the 200 randomly selected records, an adequate indication for use was identified in 27% of dogs (54/200). Of the dogs surviving to discharge, 54% (95/175) were discharged with a PPI and 51.6% (49/95) of those were prescribed an inadequate dose.

CONCLUSIONS AND IMPORTANCE

Our findings support other studies in which the majority of PPI prescriptions for hospitalized dogs at a tertiary care hospital lacked an appropriate indication. Furthermore, analysis of the prescribing patterns of dispensed PPIs identified a frequent occurrence of dosages considered inadequate, raising concern for ineffective treatment even with appropriate indications of use. With growing concern of adverse effects associated with PPI and other acid suppressant administration in human and veterinary medicine, rational use of these medications following consensus guidelines should be emphasized and treatment should be reserved for dogs with historical, physical examination, clinicopathologic, and imaging findings supportive of an appropriate indication for use.

Relationships among owner consideration of euthanasia, caregiver burden, and treatment satisfaction in canine osteoarthritis

Although diagnosis of osteoarthritis (OA) has been recently linked to euthanasia in dogs, no prior work has examined the roles of caregiver burden or treatment satisfaction in this relationship. We expected that there would be an indirect effect of caregiver burden on the association between consideration of euthanasia and clinical signs of OA, but that this effect would be influenced by owner satisfaction. Cross-sectional online evaluations were completed by 277 owners of dogs with OA recruited through social media. Canine OA-related pain and functional impairment, owner consideration of euthanasia, caregiver burden, and satisfaction were examined. Relationships among OA-related pain and functional impairment, owner consideration of euthanasia, caregiver burden, and satisfaction were statistically significant (P 0.01 for all). Cross-sectional mediation analysis demonstrated a statistically significant indirect effect of caregiver burden on the relationship between consideration of euthanasia and OA-related clinical signs (bias-corrected 95% confidence interval [BC 95% CI], 0.001-0.009), which was significantly moderated by owner satisfaction (BC 95% CI, -0.003 to -0.0002). Findings align with prior work connecting canine OA to euthanasia. The current study extends past research to demonstrate that caregiver burden in the owner may be partially responsible for this relationship. The moderating role of owner satisfaction suggests that optimizing owner impressions of treatment and the veterinary team could attenuate these relationships, potentially decreasing the likelihood of premature euthanasia for dogs with OA.

Caregiver burden, treatment complexity, and the veterinarian-client relationship in owners of dog with skin disease

BACKGROUND

Increasing complexity of treatment plans is associated with higher levels of caregiver burden in owners of dogs with skin disease. It is possible that elevated caregiver burden resulting from treatment complexity could, in turn, affect the veterinarian-client relationship.

HYPOTHESES/OBJECTIVES

We expected that treatment complexity, caregiver burden, and the client's perception of the veterinarian-client relationship would be related to each other. We also expected an indirect effect of caregiver burden on the cross-sectional association between treatment complexity and the veterinarian-client relationship, and that this effect would be robust to adjustment for the dog's skin disease course and severity.

PARTICIPANTS

Participants were 349 owners of dogs with skin disease recruited through online consumer panels.

MATERIALS AND METHODS

Cross-sectional online assessments were completed for caregiver burden, treatment plan complexity, veterinarian-client relationship, and skin disease course and severity. Demographic information also was collected.

RESULTS

The indirect effect of caregiver burden on the relationship between treatment complexity and veterinarian-client relationship was statistically significant, accounting for 42.76% of the variance in the model. After controlling for disease severity and course, that effect remained statistically significant, accounting for 37.76% of the variance.

CONCLUSIONS AND CLINICAL IMPORTANCE

Findings support the notion that greater treatment complexity is related to the owner's perception of the veterinarian-client relationship via caregiver burden. Efforts to reduce caregiver burden by using the simplest effective treatment may benefit the veterinarian-client relationship.