Addressing the unique needs and quality of life issues for adults receiving long-term home enteral nutrition.

Individuals who require home enteral nutrition (EN)-and, subsequently, their families-undergo major changes in family dynamics. They would benefit from an approach that provides ongoing nutrition, hydration, enteral access, and quality of life assessments from knowledgeable clinicians. Most individuals and families will be new to the enteral access device, handling and administration of the nutrition formula, medication delivery through feeding tubes, and troubleshooting associated complications. Educational sessions are typically given but may not be comprehensive enough to meet all needs, especially in the first weeks to months of home EN therapy. Quality of life assessments obtained in the early stages of EN support would help clinicians identify and focus on areas that need special attention for that individual and family. Ongoing clinical care is essential because over time, the nutrition prescription, delivery methods and schedules typically require alterations and feeding tubes need to be assessed and replaced. In addition to these important physical dimensions of care, attention should be placed on the psychological, cognitive, social, and ethical aspects of life for these individuals and their families.

Fluid Needs in the Older Adult Receiving Tube Feedings.

Fluid imbalance can occur quickly in older adults and in others who cannot express thirst or are in a setting where fluid status is not closely monitored. In tube-fed individuals receiving inadequate calories, severe malnutrition may occur in weeks to months, but improper water intake may lead to critical fluid imbalances in a matter of days. Simplistic equations frequently used to determine fluid needs in adults include milliliters per kilogram of body weight and milliliters per energy (kilocalories) consumed or per energy (kilocalories) need and variations of the Holliday-Segar formula. None of these fluid-requirement equations have been validated through evidenced-based science, and research investigations have revealed that they can grossly overestimate or underestimate fluid needs in the older adult. Clinicians need guidance to better estimate initial fluid needs for the older adult receiving tube feedings and to provide proper close monitoring afterward to avert preventable fluid imbalance-related hospital readmissions, morbidities, and mortalities in this patient population.

Variability of first morning urine specific gravity in 103 healthy dogs.

BACKGROUND: Urine specific gravity (USG) is an integral part of the urinalysis and a key component of many clinical decisions, and fluctuations in USG have the potential to impact case management. OBJECTIVES: To determine the intraindividual variability of first morning USG results in healthy dogs. ANIMALS: One hundred three healthy client-owned dogs. METHODS: Dogs were deemed healthy based on clinical history and physical examination findings. Repeated USG measurements were performed over the course of 2 weeks. Three urine samples were collected each week for a total of 6 samples per dog. Sample collection was distributed evenly throughout the week. Urine samples were acquired immediately upon waking and before any ingestion of liquids, food, or exertion of physical activity in the dogs. All measurements were made using the same Misco digital refractometer. RESULTS: Intraindividual USG was variable over the course of the study. The mean difference between the minimum and maximum USG for each dog was 0.015 (SD, 0.007). The within-week difference between the minimum and maximum USG was less than over the complete 2-week study (0.009 [SD 0.006] for week 1 and 0.010 [SD 0.007] for week 2). The mean coefficient of variance across all 6 time points was 15.4% (SD 8.97%). CONCLUSIONS AND CLINICAL IMPORTANCE: Clinically important variation occurs in USG in healthy animals and might impact clinical decision-making when diagnostic cutoff points are utilized. Clinicians should be aware of inherent variability in this clinical variable when analyzing results.

Knowledge and Opinions of Third Year Veterinary Students Relevant to Animal Welfare Before and After Implementation of a Core Welfare Course.

Although leading veterinary organizations emphasize the importance of animal welfare knowledge, there exists a gap in current veterinary student animal welfare education and training. A survey instrument was created to assess third-year Doctor of Veterinary Medicine (DVM) student knowledge of key animal welfare topics, opinions regarding the inclusion of welfare education in the veterinary curriculum, and views on veterinarian responsibilities as advocates. In Spring 2018, Colorado State University added a required animal welfare course to the DVM curriculum. Pre- and post-course paper surveys were distributed to the third-year students enrolled in the animal welfare course. One hundred thirty one completed pre-course surveys were collected and 125 completed post-course surveys were collected. Of the pre and post-course surveys collected, 61 were paired with identification codes and utilized for statistical comparison. Results indicated that the course led students to view the inclusion of an animal welfare course in the veterinary curriculum more favorably (p = 0.009) and improved their confidence in conducting research on animal welfare topics (p < 0.001). The course did not change students' sense of responsibility toward welfare advocacy. Associations were not found between attitudes toward these issues and demographic variables of home community, respondent gender, and track selection (p > 0.06). Veterinarians were consistently ranked by students as the most influential member of a community in matters of animal welfare. Future research on the lack of veterinary student knowledge of animal welfare should be done on a national scale to facilitate strategic development of mandatory animal welfare courses in veterinary curricula. Future research should be designed to gain knowledge regarding DVM students' opinions and attitudes regarding effective methods of incorporating animal welfare education into their professional training.

Enteral Access Devices: Types, Function, Care, and Challenges.

Enteral access feeding devices are placed in patients who have a functional and accessible gastrointestinal (GI) tract but are not able to consume or absorb enough nutrients to sustain adequate nutrition and hydration. For many individuals, enteral nutrition support is a lifesaving modality to prevent or treat a depleted nutrient state that can lead to tissue breakdown, compromised immune function, and poor wound healing. Psychological well-being is also affected with malnutrition and dehydration, triggering feelings of apathy, depression, fatigue, and loss of morale, negatively impacting a patient's ability for self-care. A variety of existing devices can be placed through the nares, mouth, stomach or small intestine to provide liquid nutrition, fluids, and medications directly to the GI tract. If indicated, some of the larger-bore devices may be used for gastric decompression and drainage. These enteral access devices need to be cared for properly to avert patient discomfort, mechanical device-related complications, and interruptions in the delivery of needed nutrients, hydration, and medications. Clinicians who seek knowledge about enteral access devices and actively participate in the selection and care of these devices will be an invaluable resource to any healthcare team. This article will review the types, care, proper positioning, and replacement schedules of the various enteral access devices, along with the prevention and troubleshooting of potential problems.

Adverse Childhood Experiences among Veterinary Medical Students: A Multi-Site Study.

This research explores Adverse Childhood Experiences (ACEs) among veterinary medical students across six academic institutions of veterinary medicine, and their relationship with depression, stress, and desire to become a veterinarian. Between April 1, 2016, and May 23, 2016, 1,118 veterinary medical students in all 4 years of the curriculum (39% response rate) completed an anonymous web-based questionnaire about ACEs, depression using the Center for Epidemiological Studies Depression scale (CESD), stress using the Perceived Stress Scale (PSS), and the age at which they wanted to become a veterinarian. Sixty-one percent (677) of respondents reported having at least one ACE. The most prevalent ACE reported was living with a household member with a mental illness (31%). Students who had experienced four or more ACEs had an approximately threefold increase in signs of clinical depression and higher than average stress when compared to students who had experienced no ACEs. The number of ACEs showed an overall graded relationship to signs of clinical depression and higher than average stress. There was no statistically significant relationship between age at which a student wanted to become a veterinarian and exposure to ACEs. Veterinary students report being exposed to ACEs before age 18 at a rate similar to that of other population-based studies. These findings do not suggest that veterinary students enter the veterinary medical education system more at risk for poor mental health due to ACEs than the general population.

Escape rates and biting histories of dogs confined to their owner's property through the use of various containment methods.

OBJECTIVE To determine escape rates for dogs confined to their owner's property by various containment methods and determine whether biting history was associated with containment method. DESIGN Cross-sectional survey. SAMPLE 974 owners of 1,053 dogs. PROCEDURES Individuals patronizing pet stores in Columbus, Ohio, were recruited to complete a survey on the method they used to confine their dogs to their property and their dogs' behavior history. RESULTS Dogs were confined to their owner's property by a physical fence (821/1,053 [78.0%]), electronic fence (150/1,053 [14.2%]), or tether system (82/1,053 [7.8%]). Dogs confined by an electronic fence were more likely to have escaped (66/150 [44.0%]) than were dogs confined by a see-through fence (153/658 [23.3%]), privacy fence (38/163 [23.3%]), or tether (22/82 [26.8%]). Forty-eight (4.6%) dogs had reportedly bitten a person in the past, and 81 (7.7%) had reportedly bitten another dog, but containment method was not significantly associated with whether dogs had ever bitten a person or another dog. Greeting behavior (growling, snarling, or trying to bite) was significantly associated with a history of biting a person or another dog. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that escape rate, but not biting history, was associated with the method owners used to confine dogs to their properties. Greeting behavior was associated with biting history, suggesting that owners of dogs that growl, snarl, or attempt to bite when meeting an unfamiliar person or dog should seek assistance to prevent future bites.

ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text].

Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

Improvement in Bilateral Carpal Valgus Deviation in 9 Foals After Unilateral Distolateral Radial Periosteal Transection and Elevation.

OBJECTIVES: To evaluate the effect of periosteal transection and elevation in foals with naturally occurring carpal valgus deviation. STUDY DESIGN: Prospective clinical study. ANIMALS: Foals (n = 9) with bilateral carpal valgus. METHODS: Foals with bilateral carpal valgus had distolateral radial periosteal transection and elevation (PE) including distal ulnar transection on 1 limb. Foals were stall confined until the skin incisions healed, and then allowed free exercise in a small paddock or round pen. Dorsopalmar carpal radiographs were obtained at 14 day intervals to determine the carpal valgus angle (CVA) until it was <5°. RESULTS: All limbs had a reduction in CVA and there was no significant difference in total carpal valgus angular correction or the rate at which the correction occurred between the surgical and control limb. CONCLUSIONS: Unilateral distolateral radial PE had no effect on carpal angulation in 9 foals with naturally occurring bilateral carpal valgus deviation when performed between 19 and 43 days.

Effects of environmental enrichment on the behavior of shelter dogs.

OBJECTIVE: To determine the effect of food-toy enrichment combined with cage-behavior training on desirable behaviors in shelter dogs and adoption rates. DESIGN: Randomized controlled clinical trial. ANIMALS: 107 dogs. PROCEDURES: Dogs placed up for adoption in a municipal shelter were randomly assigned to either an experimental group (n = 48) or control group (59). Experimental group subjects were exposed to an environmental enrichment and training protocol consisting of twice-daily cage-behavior training and daily provision of a food-filled toy. Cage-behavior training included operant conditioning via positive reinforcement of desirable behaviors, including approaching the front of the cage, sitting or lying, and remaining quiet when approached. Behavioral observations were performed by a blinded observer in a scan-sampling technique on day 0 (first day on adoption floor) and again on day 3 for experimental (n = 26) and control (32) dogs. Body posture, location in cage, and other behavioral parameters were recorded. Adoption information and behavioral observation data were compared between groups. RESULTS: Compared with the control group, the experimental group had a significantly greater percentage of dogs with an increase in desirable behaviors of sitting or lying down (17/26 [65%] vs 7/32 [22%]) and being quiet (9/26 [35%] vs 4/32 [13%]) and a significantly greater percentage of dogs with a decrease in the undesirable behavior of jumping (15/26 [57%] vs 3/32 [9%]). Location in cage, fearfulness, and eye contact were not significantly different between groups. Survival analysis revealed no significant difference in adoption rates between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that enrichment programs improve desirable behaviors and decrease undesirable behavior in shelter dogs, which may enhance welfare.

Identifying the needs of veterinary students and recent alumni in establishing a student service center.

Quality service for students has been identified as an important theme of higher education. In pursuing the aim of service quality, educational providers have long recognized that perceptions of service transcend the area of quality teaching and encompass the students' overall experience within the university. This article investigates the types of services that would be most beneficial to students, from the perspective of both current students and recent alumni. A cross-sectional survey of all students was conducted using an online survey. A separate survey was also conducted of alumni from the last five graduating classes. From these surveys, 94.0% of student respondents and 91.9% of alumni respondents strongly agreed with the statement "It is important for the OSU CVM (Ohio State University College of Veterinary Medicine) to provide on-site comprehensive student services." Both groups ranked job postings for post-graduation employment, fourth-year off-site rotation opportunities, and financial planning/budgeting among their top ranked preferred services. In addition, requests for continued or enhanced interviewing/communication skills training; individual mental, emotional, and spiritual counseling; and individual and group tutoring were predominant themes identified from the qualitative data as well as the Likert-scale questions. The findings from the study sheds light on the need for comprehensive services for veterinary students beyond those services traditionally provided in an academic setting, such as tutoring and course advising.

Use of and satisfaction of pet owners with a clinical behavior service in a companion animal specialty referral practice.

OBJECTIVE: To determine whether availability of a veterinary behavior service aids in the recruitment of clients to a referral practice who may not have chosen to visit a referral practice otherwise and to assess the priorities and satisfaction of first-time clients. DESIGN: Prospective survey study. SAMPLE: 87 questionnaires completed by pet owners. PROCEDURES: Owners of dogs and cats visiting the Behavior Medicine Clinic, a veterinary behavior service, at The Ohio State University Veterinary Medical Center for the first time were asked to participate in a 10-question survey at the end of their initial appointment. RESULTS: 59 of 87 (68%) new clients had never visited the Veterinary Medical Center for any other specialty service; in addition, 56 of 87 (64%) had never taken a pet to any specialty practice prior to their appointment with the Behavior Medicine Clinic. Seventy-four of 85 (87%) clients reported that they were likely to bring their pet to another specialty service on the basis of their experience with the Behavior Medicine Clinic. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of the survey findings, availability of veterinary behavior services may result in recruitment of first-time clients to a referral center. Clients' experience with a veterinary behavior service may increase their likelihood of visiting other specialty practices within the same hospital, potentially increasing revenue for the entire practice.

Retrospective evaluation of the effectiveness of epsilon aminocaproic acid for the prevention of postamputation bleeding in retired racing Greyhounds with appendicular bone tumors: 46 cases (2003-2008).

OBJECTIVES: To determine the frequency of delayed postoperative bleeding in retired racing Greyhounds with appendicular bone tumors undergoing limb amputations. To identify if administration of epsilon-aminocaproic acid (EACA) was effective on the prevention of postoperative bleeding. DESIGN: Retrospective study from December 2003 to December 2008. SETTING: Veterinary university teaching hospital. ANIMALS: Forty-six retired racing Greyhounds (RRGs) diagnosed with primary appendicular bone tumors that underwent limb amputation were included in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirteen of 46 RRGs (28%) included in the study had delayed postoperative bleeding starting 48-72 h after surgery. Bleeding episodes included cutaneous, subcutaneous, and external bleeding that extended from the area of the surgical site that became widespread within hours, and that required administration of blood components. A paired t-test suggests that there was a significant decrease in PCV postoperatively for both dogs that bled and dogs that did not bleed (P < 0.0001). Forty of 46 RRGs (86%) received either fresh frozen plasma (FFP) or EACA or both, for the prevention of postoperative bleeding. A logistic regression model determined that dogs that did not receive EACA were 5.7 times more likely to bleed than dogs that did receive EACA, when controlling for whether or not they received FFP (95% CI: 1.02-32.15, P = 0.047). CONCLUSION: This retrospective study suggests that preemptive postoperative administration of EACA appears to be efficacious in decreasing the frequency of bleeding in RRGs undergoing limb amputation; however, a prospective study is warranted to corroborate its effectiveness.

Frequency of use and proficiency in performance of surgical skills expected of entry-level veterinarians by general practitioners.

OBJECTIVE: To identify a list of core surgical skills and determine the frequency of use and proficiency in performance of these skills expected of entry-level veterinarians by general practitioners. DESIGN: Mail-based survey. SAMPLE: 750 general practitioners randomly chosen from the AVMA membership database. PROCEDURES: Survey respondents rated the proficiency and frequency of use expected of entry-level veterinarians in regard to 26 surgical skills. Demographic information (gender; graduation year; practice type, geographic location, and setting; number of veterinarians in practice; number of surgical procedures performed per week; and number of new graduates mentored in the past 5 years) of respondents was obtained. RESULTS: 387 (52%) general practitioners responded to the survey. Greater than 60% of respondents expected new graduates to have high proficiency and require minimal supervision for 21 of 26 skills. Greater than 60% of respondents assigned 6 of the skills a low expected frequency of use rating. Orthopedic skills, creation of square knots by use of a 1-handed tie technique, and use of electrosurgical and laser instruments received some of the lowest ratings. CONCLUSIONS AND CLINICAL RELEVANCE: Core surgical skills were identified. Results indicated a broad consensus among general practitioners independent of demographic characteristics. Results may aid veterinary colleges in identification of the surgical skills that are most important to include in surgical curricula and for which new graduates should attain proficiency according to general practitioners.

Expected frequency of use and proficiency of core surgical skills in entry-level veterinary practice: 2009 ACVS core surgical skills diplomate survey results.

OBJECTIVES: ACVS Diplomates were surveyed to identify a complete list of core surgical skills, determine the expected frequency of use of these skills, and ascertain the level of skills proficiency expected of entry-level practicing veterinarians. STUDY DESIGN: Internet-based survey. SAMPLE POPULATION: Randomly chosen ACVS Diplomates (n = 750). METHODS: Rating scale items were used to construct the main portion of the survey with 26 skills that were scored by participants based on rankings of proficiency expected of entry-level veterinarians, as well as expected frequency of use of these skills. Additional demographic questions were included to gather information regarding gender, practice type, year of veterinary school, year of ACVS membership, job description, primary surgical discipline, practice location, average number of procedures performed on a weekly basis, and number of new graduates mentored in the last 5 years. RESULTS: Of 337 Diplomates (44.9%) who responded to the survey, >60% expected entry-level graduates to have good skills with minimal supervision or complete skills for 21 of the 26 skills categories listed. More than 60% of respondents ranked 7 skills with a lower frequency score (seldom or occasionally use). Orthopedic instrument handling and fixation skills as well as electrosurgical and laser skills received some of the lowest expected proficiency and frequency rankings. No additional skills categories were identified in the open-ended survey questions. CONCLUSIONS: A complete list of core surgical skills was identified. There was broad consensus between boarded surgeons irrespective of their practice type, experience, or discipline for ranked proficiency and frequency scores among the core surgical skills expected of entry-level veterinarians.