Measuring clinical outcomes of animal-assisted therapy: impact on resident medication usage

Exploring the benefits of full-time hospital facility dogs working with nurse handlers in a children's hospital

OBJECTIVE

To examine the benefits of full-time hospital facility dogs (HFDs) working with qualified nurse handlers for inpatients in a pediatric medical facility.

METHODS

A questionnaire survey on the evaluation of HFD activities was conducted in a hospital that had introduced HFDs for the first time in Japan and has been using them for 9 years. Of the 626 full-time medical staff, 431 responded, of which 270 who observed HFD activities were included in the analysis. The Questionnaire contained 20 questions, and nine questions were selected for presentation in this paper because they focused on the situations in which HFD activities were thought to have a strong impact on inpatients. A comparison of the respondents' evaluations for each question was made, and differences in the respondents' attributes (such as profession, length of clinical experience and experience of dog ownership) for those items were examined.

RESULTS

The impact of HFDs in terminal care was ranked highest among the respondents. Similarly, HFDs increased patient cooperation for clinical procedures. The responses to these two items did not differ statistically depending on the respondents' attributes. The results imply that patients were more cooperative even for highly invasive examinations and procedures with the support of HFD activities.

CONCLUSIONS

Healthcare providers considered that HFDs were useful, especially for providing support during the terminal phase and for gaining patients' cooperation for procedures. The fact that the handler was a nurse and the HFD team worked full-time may have enhanced the effectiveness of the program.

Psychophysiological mechanisms underlying the potential health benefits of human-dog interactions: A systematic literature review

While the symbiotic nature of human-dog relationships and perceived benefits to human health have attracted much scientific interest, the mechanisms through which human-dog interactions may confer health benefits to humans are still poorly understood. The aim of this systematic literature review was to synthesize evidence of physiological changes associated with human-dog interactions with relevance to human health. Electronic databases were systematically searched (PubMed, MEDLINE with full text, Scopus, PsycINFO, CINAHL Plus with Full Text, and Web of Science Core Collection) for relevant studies. Of the 13,072 studies identified, 129 met the inclusion criteria, with approximately half being randomized trials (Level 2) based on the Oxford Centre for Evidence Based Medicine level system. Measures employed to study human physiological changes associated with human-dog interactions most commonly involved cardiac parameters and hormones, with negligible research of brain activity. The main positive findings were increases in heart rate variability and oxytocin, and decreases in cortisol with human-dog interactions. These physiological indicators are consistent with activation of the parasympathetic nervous system (PNS) and oxytocinergic system (OTS), and down-regulation of hypothalamic-pituitary-adrenal (HPA) axis activity. These results provide evidence of specific pathways through which human-dog contact may confer health benefits, likely through relaxation, bonding, and stress reduction. However, these findings should be interpreted contextually due to limitations and methodological differences. Previous research using other biological variables was limited in quantity and quality, thus impeding firm conclusions on other possible mechanisms. Further research is needed in some psychophysiological domains, particularly electroencephalography, to better understand central nervous system (CNS) effects. The findings of this review have implications for human-dog interactions to positively affect several stress-sensitive physiological pathways and thus confer health benefits. This supports their incorporation in various clinical, non-clinical, and research settings to develop evidence-based interventions and practices for cost-effective and efficacious ways to improve human health.

Use of animal-assisted interventions in relieving pain in healthcare settings: A systematic review

BACKGROUND AND OBJECTIVE

Therapeutic interaction with animals for patients coping with physical and mental health conditions is a growing interest among healthcare providers and researchers. We aimed to comprehensively summarize and evaluate the current state of evidence examining the use of animal-assisted interventions [AAI] for pain relief in healthcare settings.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

METHODS

Two researchers independently assessed publications dated before February 5, 2021 in OVID Medline, CINAHL, and PsychINFO databases, and used the Delphi list to evaluate the quality of the evidence.

RESULTS

Of the 109 studies screened, a total of 24 studies totaling 1,950 participants were ultimately included. Studies varied in design, including single group trials (8), controlled trials with at least two groups (6), and randomized controlled trials (10). The most common form of pain measurement was the visual or numeric rating scale. For the 18 studies that reported data on changes in pain severity from pre-to-post-test, 13 reported a significant reduction; using the converted common metric we created, these reductions ranged from 0.20 to 3.33 points on a 10-point numeric rating scale.

CONCLUSIONS

AAI may be considered a promising approach in need of further, more rigorous research. Available evidence supporting AAI remains weak due to issues of study quality and design, thereby impeding our ability to draw reliable conclusions on the utility of AAI in relieving pain. Given the rapidly increasing availability of these interventions in hospitals, it is important to better understand its effectiveness.

Effects of Animal-Assisted Therapy on Hospitalized Children and Teenagers: A Systematic Review and Meta-Analysis

PROBLEM

Psychological and symptom disturbances seriously affect hospitalized children's subjective experiences of hospitalization and their prognosis. We systematically reviewed the effects of animal-assisted therapy (AAT) on pain, anxiety, depression, stress, blood pressure (BP), and heart rate (HR) in hospitalized children and teenagers.

ELIGIBILITY CRITERIA

A systematic review and meta-analysis were conducted using the English-language electronic databases PubMed, EMBASE, Web of Science, the Cochrane Library, Clinical Trials, Science Direct, EBSCOhost, Open Grey and Google Scholar, and the Chinese databases CNKI, Sinomed, Vip, and WanFang. These databases were searched through July 15, 2020.

SAMPLE

Eight studies, including four randomized controlled trials (RCTs) and four quasi-experimental studies were included, with a total of 348 participants.

RESULTS

Hospitalized children and teenagers with AAT had less pain (standardized mean difference = -0.49; 95% confidence interval [CI], -0.77 to -0.22; P < 0.001), lower systolic blood pressure (mean difference [MD] = -4.85; 95% CI, -9.50 to -0.21; P₌ 0.04), higher diastolic blood pressure (MD = 4.95; 95% CI, 1.90 to 8.00; P = 0.001) than controls, while there was no significant difference in depression, anxiety, stress, or HR.

CONCLUSION

As an adjuvant to traditional treatment, AAT was beneficial for controlling pain and BP in hospitalized children and teenagers.

IMPLICATION

AAT may be an effective strategy for relieving pain and controlling BP in hospitalized children and teenagers, especially those with cancer. High-quality RCTs conducted or supported by nurses on the effects of AAT are needed.

Animal-assisted therapy for dementia

BACKGROUND

Dementia is a chronic condition which progressively affects memory and other cognitive functions, social behaviour, and ability to carry out daily activities. To date, no treatment is clearly effective in preventing progression of the disease, and most treatments are symptomatic, often aiming to improve people's psychological symptoms or behaviours which are challenging for carers. A range of new therapeutic strategies has been evaluated in research, and the use of trained animals in therapy sessions, termed animal-assisted therapy (AAT), is receiving increasing attention.

OBJECTIVES

To evaluate the efficacy and safety of animal-assisted therapy for people with dementia.

SEARCH METHODS

We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialised Register on 5 September 2019. ALOIS contains records of clinical trials identified from monthly searches of major healthcare databases, trial registries, and grey literature sources. We also searched MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), ISI Web of Science, ClinicalTrials.gov, and the WHO's trial registry portal.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-randomised trials, and randomised cross-over trials that compared AAT versus no AAT, AAT using live animals versus alternatives such as robots or toys, or AAT versus any other active intervention.

DATA COLLECTION AND ANALYSIS

We extracted data using the standard methods of Cochrane Dementia. Two review authors independently assessed the eligibility and risk of bias of the retrieved records. We expressed our results using mean difference (MD), standardised mean difference (SMD), and risk ratio (RR) with their 95% confidence intervals (CIs) where appropriate.

MAIN RESULTS

We included nine RCTs from 10 reports. All nine studies were conducted in Europe and the US. Six studies were parallel-group, individually randomised RCTs; one was a randomised cross-over trial; and two were cluster-RCTs that were possibly related where randomisation took place at the level of the day care and nursing home. We identified two ongoing trials from trial registries. There were three comparisons: AAT versus no AAT (standard care or various non-animal-related activities), AAT using live animals versus robotic animals, and AAT using live animals versus the use of a soft animal toy. The studies evaluated 305 participants with dementia. One study used horses and the remainder used dogs as the therapy animal. The duration of the intervention ranged from six weeks to six months, and the therapy sessions lasted between 10 and 90 minutes each, with a frequency ranging from one session every two weeks to two sessions per week. There was a wide variety of instruments used to measure the outcomes. All studies were at high risk of performance bias and unclear risk of selection bias. Our certainty about the results for all major outcomes was very low to moderate. Comparing AAT versus no AAT, participants who received AAT may be slightly less depressed after the intervention (MD -2.87, 95% CI -5.24 to -0.50; 2 studies, 83 participants; low-certainty evidence), but they did not appear to have improved quality of life (MD 0.45, 95% CI -1.28 to 2.18; 3 studies, 164 participants; moderate-certainty evidence). There were no clear differences in all other major outcomes, including social functioning (MD -0.40, 95% CI -3.41 to 2.61; 1 study, 58 participants; low-certainty evidence), problematic behaviour (SMD -0.34, 95% CI -0.98 to 0.30; 3 studies, 142 participants; very-low-certainty evidence), agitation (SMD -0.39, 95% CI -0.89 to 0.10; 3 studies, 143 participants; very-low-certainty evidence), activities of daily living (MD 4.65, 95% CI -16.05 to 25.35; 1 study, 37 participants; low-certainty evidence), and self-care ability (MD 2.20, 95% CI -1.23 to 5.63; 1 study, 58 participants; low-certainty evidence). There were no data on adverse events. Comparing AAT using live animals versus robotic animals, one study (68 participants) found mixed effects on social function, with longer duration of physical contact but shorter duration of talking in participants who received AAT using live animals versus robotic animals (median: 93 seconds with live versus 28 seconds with robotic for physical contact; 164 seconds with live versus 206 seconds with robotic for talk directed at a person; 263 seconds with live versus 307 seconds with robotic for talk in total). Another study showed no clear differences between groups in behaviour measured using the Neuropsychiatric Inventory (MD -6.96, 95% CI -14.58 to 0.66; 78 participants; low-certainty evidence) or quality of life (MD -2.42, 95% CI -5.71 to 0.87; 78 participants; low-certainty evidence). There were no data on the other outcomes. Comparing AAT using live animals versus a soft toy cat, one study (64 participants) evaluated only social functioning, in the form of duration of contact and talking. The data were expressed as median and interquartile ranges. Duration of contact was slightly longer in participants in the AAT group and duration of talking slightly longer in those exposed to the toy cat. This was low-certainty evidence.

AUTHORS' CONCLUSIONS

We found low-certainty evidence that AAT may slightly reduce depressive symptoms in people with dementia. We found no clear evidence that AAT affects other outcomes in this population, with our certainty in the evidence ranging from very-low to moderate depending on the outcome. We found no evidence on safety or effects on the animals. Therefore, clear conclusions cannot yet be drawn about the overall benefits and risks of AAT in people with dementia. Further well-conducted RCTs are needed to improve the certainty of the evidence. In view of the difficulty in achieving blinding of participants and personnel in such trials, future RCTs should work on blinding outcome assessors, document allocation methods clearly, and include major patient-important outcomes such as affect, emotional and social functioning, quality of life, adverse events, and outcomes for animals.

Animal-Assisted Intervention Improves Pain Perception in Polymedicated Geriatric Patients with Chronic Joint Pain: A Clinical Trial

Chronic joint pain is associated to an increase in the consumption of medication and decrease in life quality in elderly people, which requires developing non-pharmacological treatments. The aim of this study was to evaluate the effectivity of a group intervention, based on animal-assisted therapy and applied to elderly people with chronic joint pain and polymedication, regarding the decrease of chronic pain, use of analgesics and improvement of life quality. A randomized controlled trial, two arms and open-label was conducted in a Primary Health Center. Twelve weekly sessions of kinesitherapy; in the EG, these exercises were performed with the additional assistance of the therapy dog. A total of 52 participants (22 Control Group (CG), 30 EG), average age 77.50 (±7.3), women 90.4%. A significant reduction on post-intervention values of pain β = −0.67(−1.27, −0.08), p = 0.03 and pain induced insomnia β = −0.53(−1.01, −0.05), p = 0.03 was found in EG for increasing baseline values. Animal-assisted therapy leads to an additional reduction in the perception of pain and pain induced insomnia in individuals with higher baseline severity. The presence of the dog improves the attachment to intervention and the satisfaction of the participants.

Prevention of transmitted infections in a pet therapy program: An exemplar

The focus of the patient experience in health care delivery has afforded the opportunity to integrate pet therapy as a part of patient care. The purpose of this article is to present the implementation of a pet therapy program that includes guidelines for the prevention of transmitted infections. Consideration of infection prevention strategies has resulted in a 16-year program with no documented incidences of transmitted infections, averaging 20,000 pet therapy interactions per year.

Neural correlates for perception of companion animal photographs

Anthrozoological neuroscience, which we propose as the use of neuroscience techniques to study human-animal interaction, may help to elucidate mechanisms underlying the associated psychological, physiological, and other purported health effects. This preliminary study investigates the neural response to animal photographs in pet owners and non-pet owners, and both attraction and attachment to companion animals as modulators of human perception of companion animal photographs. Thirty male participants, 15 "Pet Owners" (PO) and 15 "Non-Pet Owners" (NPO), viewed photographs of companion animals during functional MRI (fMRI) scans at 3 T and provided ratings of attraction to the animal species represented in the photographs. Fourteen subjects additionally submitted and viewed personal pet photographs during fMRI scans, and completed the Lexington Attachment to Pets Scale (LAPS). PO exhibited greater activation than NPO during the viewing of animal photographs in areas of the insula, and frontal and occipital cortices. Moreover, ratings of attraction to animals correlated positively with neural activation in the cingulate gyrus, precentral gyrus, inferior parietal lobule, and superior temporal gyrus during the viewing of representative photographs. For subjects with household pets, scores on the LAPS correlated positively with neural activation during the viewing of owned pet photographs in the precuneus, cuneus, and superior parietal lobule. Our preliminary findings suggest that human perception of companion animals involve the visual attention network, which may be modulated at the neural level by subjective experiences of attraction or attachment to animals. Our understanding of human-animal interactions through anthrozoological neuroscience may better direct therapeutic applications, such as animal-assisted therapy.

Dog-assisted therapies and activities in rehabilitation of children with cerebral palsy and physical and mental disabilities

The aim of the present study was to evaluate dog-assisted therapies and activities in the rehabilitation of children with cerebral palsy and physical and mental disabilities who have difficulties in benefiting from well-being and health-improving services. This descriptive-explanatory study was conducted in disabled children of various ages between 2008 and 2011 by an experienced team in a private training and rehabilitation center in Antalya (Turkey). In this study, five study groups were formed among the children with physical and mental disabilities. During the therapy studies, three dogs were used. For each therapy group, the goals for the children and therapist were defined, and the activities were determined according to these goals. The entire study process was followed using audio-records and photographs of patients. The expected targets were reached in all study groups. The children who experienced fear, anxiety and difficulties due to their disabilities in daily life learned to cope with their anxieties and fears, set goals and make plans to achieve their aims. During this study, the children improved their abilities to use their bodies according to their capabilities. Accordingly, they improved their ability to develop empathy between themselves and a therapy dog, to receive and present help, and to communicate. The results of the present study revealed that dog-assisted therapies and activities can be a supportive method for routine treatment procedures in the rehabilitation of children with cerebral palsy and physical and mental disabilities.

Can therapy dogs improve pain and satisfaction after total joint arthroplasty? A randomized controlled trial

BACKGROUND

The use of animals to augment traditional medical therapies was reported as early as the 9th century but to our knowledge has not been studied in an orthopaedic patient population. The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA.

QUESTIONS/PURPOSES

We asked: (1) Do therapy dogs have an effect on patients' perception of pain after total joint arthroplasty as measured by the VAS? (3) Do therapy dogs have an effect on patients' satisfaction with their hospital stay after total joint arthroplasty as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)?

METHODS

A randomized controlled trial of 72 patients undergoing primary unilateral THA or TKA was conducted. Patients were randomized to a 15-minute visitation with a therapy dog before physical therapy or standard postoperative physical therapy regimens. Both groups had similar demographic characteristics. Reduction in pain was assessed using the VAS after each physical therapy session, beginning on postoperative Day 1 and continuing for three consecutive sessions. To ascertain patient satisfaction, the proportion of patients selecting top-category ratings in each subsection of the HCAHPS was compared.

RESULTS

Patients in the treatment group had lower VAS scores after each physical therapy session with a final VAS score difference of 2.4 units (animal-assisted therapy VAS, 1.7; SD, 0.97 [95% CI, 1.4-2.0] versus control VAS, 4.1; SD, 0.97 [95% CI, 3.8-4.4], p<0.001) after the third physical therapy session. Patients in the treatment group had a higher proportion of top-box HCAHPS scores in the following fields: nursing communication (33 of 36, 92% [95% CI, 78%-98%] versus 69%, 25 of 36 [95% CI, 52%-84%], p=0.035; risk ratio, 1.3 [95% CI of risk ratio, 1.0-1.7]; risk difference, 23% [95% CI of risk difference, 5%-40%]), pain management (34 of 36, 94% [95% CI, 81%-99%], versus 26 of 36, 72% [95% CI, 55%-86%], p=0.024; risk ratio, 1.3 [95% CI of risk ratio, 1.1-1.6]; risk difference, 18% [95% CI of risk difference, 5%-39%]). The overall hospital rating also was greater in the treatment group (0-10 scale) (9.6; SD, 0.7 [95% CI, 9.3-9.8] versus 8.6, SD, 0.9 [95% CI, 8.3-8.9], p<0.001).

CONCLUSIONS

The use of therapy dogs has a positive effect on patients' pain level and satisfaction with hospital stay after total joint replacement. Surgeons are encouraged to inquire about the status of volunteer-based animal-assisted therapy programs in their hospital as this may provide a means to improve the immediate postoperative recovery for a select group of patients having total joint arthroplasty.

LEVEL OF EVIDENCE

Level II, randomized controlled study. See Instructions for Authors for a complete description of levels of evidence.

Impact of animal-assisted intervention on rehabilitation of patients with spinal cord injury

Introduction: The animal-assisted programs represent an interdisciplinary approach. They can be integrated into preventive, therapeutic and rehabilitative processes as complementary methods. Aim: The aim of the study was to promote the psychological adaptation and social reintegration of patients who suffered spinal cord injury, as well as reducing depression and feelings of isolation caused by the long hospitalization. The hypothesis of the authors was that the animal-assisted intervention method can be effectively inserted into the rehabilitation process of individuals with spinal cord injury as complementary therapy. Methods: 15 adults with spinal cord injury participated in the five-week program, twice a week. Participants first filled out a questionnaire on socio-demographics, and after completion of the program they participated in a short, directed interview with open questions. During the field-work, after observing the participants, qualitative data analysis was performed. Results: The results suggest that the therapeutic animal induced a positive effect on the emotional state of the patients. Participants acquired new skills and knowledge, socialization and group cohesion had been improved. Conclusions: The authors conclude that the animal-assisted activity complemented by therapeutic elements can be beneficial in patients undergoing spinal cord injury rehabilitation and that knowledge obtained from the study can be helpful in the development of a future animal-assisted therapy program for spinal cord injury patients. Orv. Hetil., 2014, 155(39), 1549–1557.

Animal-assisted therapy at an outpatient pain management clinic

OBJECTIVE

The objective of this study was to evaluate the effects of brief therapy dog visits to an outpatient pain management facility compared with time spent in a waiting room.

DESIGN

The design of this study is open-label. Setting.  This study was conducted in a university tertiary care adult chronic pain outpatient clinic.

SUBJECTS

The subjects of this study include outpatients, adults accompanying outpatients to their appointments, and clinic staff. Intervention.  Participants were able to spend clinic waiting time with a certified therapy dog instead of waiting in the outpatient waiting area. When the therapy dog was not available, individuals remained in the waiting area.

OUTCOME MEASURES

Self-reported pain, fatigue, and emotional distress were recorded using 11-point numeric rating scales before and after the therapy dog visit or waiting room time.

RESULTS

Two hundred ninety-five therapy dog visits (235 with patients, 34 family/friends, and 26 staff) and 96 waiting room surveys (83 from patients, 6 family/friends, and 7 staff) were completed over a 2-month study period. Significant improvements were reported for pain, mood, and other measures of distress among patients after the therapy dog visit but not the waiting room control, with clinically meaningful pain relief (decrease ≥2 points) in 23% after the therapy dog visit and 4% in the waiting room control. Significant improvements were likewise seen after therapy dog visits for family/friends and staff.

CONCLUSIONS

Therapy dog visits in an outpatient setting can provide significant reduction in pain and emotional distress for chronic pain patients. Therapy dog visits can also significantly improve emotional distress and feelings of well-being in family and friends accompanying patients to appointments and clinic staff.

The effects of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review

EXECUTIVE SUMMARY

Background: Animal-assisted interventions are classified as 'any therapeutic process that intentionally includes or involves animals as part of the process'. Providing these interventions within the long term care environment may potentially reduce or alleviate symptoms of disease and illness and increase quality of life. Many people suggest that the use of animal-assisted interventions produces beneficial effects, however an examination of the current evidence base reveals a lack of rigorous quantitative research in this area.Objective The aim of the review was to synthesise the best available evidence on the effects of canine-assisted interventions on the health and social care of the older population residing in long-term care.Data sources A comprehensive search was undertaken on 32 electronic databases from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered.Review methods Studies that examined canine-assisted interventions used for older people residing in long term care were considered. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of effectiveness.Results Eight randomised controlled trials were included in the review of which half were doctoral theses. Due to the presence of heterogeneity, meta-analyses were not appropriate and a narrative summary was provided.Based on the results of single studies, the evidence suggests that providing canine-assisted interventions in long term care facilities can provide some short term benefits to residents, both physically and emotionally, however they appear to be no more effective than other interventions such as visits from humans and providing opportunities to interact with inanimate objects. Providing sessions once a week seems to be just as effective as providing session three times a week in the short term and more research is needed to determine if providing interventions on an individual basis is actually more effective than group interactionsConclusion The current evidence base for the effects of canine-assisted interventions in long term care facilities is methodologically weak and is unable to be pooled. No solid recommendations can be made, however some preliminary conclusions based on the results of single studies are provided. Caution is advised when interpreting these results.Implications for practice Due to the poor quality of evidence located on this topic the use of canine-assisted interventions cannot currently be recommended nor refuted. If, however, a long term care facility is considering implementing canine-assisted interventions for older residents they should be aware that canine-assisted activities may produce some short term beneficial effects but they are similar to those seen from organising visits from people or arranging interactions with animal-like inanimate objects.Implications for research Due to the lack of well-designed trials further higher quality experimental studies that examine the effects of canine-assisted interventions on older long term care residents should be conducted. Trials need to be conducted following a standardised rigorous process.

The meaningfulness of Canine-Assisted Interventions (CAIs) on the health and social care of older people residing in long term care: a systematic review

BACKGROUND

Preliminary evidence suggests that canine-assisted interventions (any therapeutic process that intentionally involves dogs as part of the process ) may produce some short term beneficial effects on the health and social care of older people residing in long term care facilities; however there has been no formal qualitative synthesis on how these activities are experienced by those involved. Determining peoples' opinions and feelings towards this activity is crucial to its success.

OBJECTIVE

The aim of this systematic review was to synthesise the best available evidence on the meaningfulness of canine-assisted intervention on older people who reside in long term care.

DATA SOURCES

A comprehensive search was undertaken of 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies were considered.

REVIEW METHODS

Studies that examined the experience of older people residing in long term care that were involved in canine-assisted interventions were considered. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of meaningfulness.

RESULTS

Two studies met inclusion criteria and methodological quality requirements. Studies had some differences: one explored residents' experiences while the other focused on staff experiences, one was conducted in a 'Westernised' country and one included residents who had been involved in this activity for two years prior to the study being conducted. There were 41 findings extracted from both studies that were organised into 12 categories. A meta-synthesis was undertaken and two synthesised findings were developed; the first suggesting that providing residents of long term care facilities the opportunity to participate in canine-assisted interventions (more specifically canine-assisted activities) can provide a range of mental, emotional, physiological and social benefits and the other suggesting that undertaking a program in such a facility has both practical and safety considerations for staff, residents and animals.

CONCLUSIONS

The current evidence base for the meaningfulness of canine-assisted activities in long term care facilities is limited and methodologically weak. A qualitative meta-synthesis using the Joanna Briggs Institute Qualitative Assessment and Review Instrument software suggests that the experience of a resident being involved in a canine-assisted activity can be positive on an emotional, mental, physiological and social level but there are some practical issues to consider such as the personal preference of the resident and staff training. Caution is advised when interpreting these results due to the small number of studies included and their methodological limitations.

IMPLICATIONS FOR PRACTICE

Canine-assisted activities may provide a positive experience for residents however the following should be considered: IMPLICATIONS FOR RESEARCH: Due to the limited number of qualitative studies attempting to determine the experiences of older people involved in canine-assisted interventions within a long term care environment, further high quality studies should be undertaken. Studies should focus on the experiences of the different people involved (staff, family, animal handlers), and compare residents with different medical or psychological conditions to determine if involvement is experienced differently across populations.

Fatal embryo chondral damage associated with fluoroquinolones in eggs of threatened avian scavengers

Stabled livestock reared in housed conditions are often subjected to intensive treatments with veterinary drug, which residues may be present in livestock meat ingested by scavengers, but nothing is known about their presence in eggs of wild birds and their potential detrimental effects on breeding success. We searched for residues of veterinary drugs and other toxicants in infertile and embryonated unhatched eggs of griffon vultures (Gyps fulvus) and red kites (Milvus milvus), two threatened avian scavengers. Quinolones (ciprofloxacin and enrofloxacin) were found in most unhatched eggs of both scavenger species clearly associated with severe alterations in the development of embryo cartilage and bones that could preclude embryo movements and subsequently normal development, pre-hatch position and successful hatching. The detrimental effects on developing eggs of veterinary drugs from livestock operations may help to explain reduced breeding success of avian scavengers.