2021 AAHA Nutrition and Weight Management Guidelines for Dogs and Cats.

The guidelines discuss the components of a systematic approach to nutritional management of dogs and cats. A nutritional assessment, including a body condition score and muscle condition score, is a screening evaluation that should ideally be performed at every examination. Individualized nutritional recommendations, based on the nutritional assessment, should be designed to achieve and maintain an appropriate body weight and meet nutritional requirements. Communicating nutritional recommendations to clients is a challenging aspect of nutritional management because pet owners may interpret the practice team's guidance as advocacy for a particular pet food brand or a judgment of the client's ability to properly care for the pet or of the owner's own nutritional status. The guidelines discuss approaches for effective, nonjudgmental communication of dietary recommendations to clients and strategies to increase acceptance of and adherence to veterinary nutrition recommendations. Other pet nutrition topics of current interest include recommendations for particular pet life stages, breeds, and disease conditions; risk factors for nutritional deficiencies and obesity; and considerations for home-prepared diets.

Non-controlled, open-label clinical trial to assess the effectiveness of a dietetic food on pruritus and dermatologic scoring in atopic dogs.

BACKGROUND: Canine atopic dermatitis (AD) is a common skin disease. The goal of this study was to evaluate food designed to improve skin barrier function and lower inflammation to reduce pruritus and clinical severity in client-owned atopic dogs. The food contained an antioxidant blend to reduce oxidative stress, plant polyphenols to stabilize mast cells, and polyunsaturated fatty acids to improve skin health and reduce inflammation. RESULTS: Seventeen dogs were included in the analysis. Initially 48 adult atopic dogs were enrolled and exclusively fed a dermatologic food for 8 weeks in a non-controlled, open-label study. Thirty-one dogs were excluded for the following reasons: oral and topical medication changes (n = 17), missing data (n = 4), fatty acid supplementation (n = 3), food refusal (n = 3), dropped out (n = 3), and owner concerns (n = 1). Using a scale from 0 (normal) - 4 (severe), veterinarians evaluated the presence and severity of clinical signs of atopy at weeks 0, 4, and 8. Pet owners also rated their pet's clinical signs of atopy on a scale from 0 (not present) - 10 (present continuously) at weeks 0, 4, and 8. Compared with initial baseline scores (median 19, range 3-69), the total veterinarian scores were significantly lower at weeks 4 (median 11, range 1-15) and 8 (median 7, range 3-46) (p < 0.05). Similarly, owner assessments showed significant improvements in the least squares mean (LSM) from baseline to 4 weeks (itching, redness, licking, and scratching) continuing to 8 weeks (itching, redness, and scratching) (p < 0.05). CONCLUSIONS: In this open, non-controlled study evaluating a dermatologic diet in seventeen client-owned dogs, owner and veterinarian assessments showed statistically significant reductions in clinical scores designed to measure severity of atopic dermatitis. While these results show promise for the management of canine atopic dermatitis, controlled clinical trials are also needed to affirm our findings.

The extent to which core nursing textbooks inform holistic spiritual care.

National and international professional health and nursing guidelines recommend that attention should be given to the spiritual and religious needs of patients. This suggests that spiritual care is an important aspect of holistic patient care that needs to be considered and supported, if relevant, in a healthcare context. However, many nurses lack knowledge and awareness of the subject, and it is unclear to what extent core textbooks provide the information they need. This article reports on a study that explored the extent to which contemporary core nursing textbooks support and advocate the provision of spiritual care by nurses. Its findings suggest there is a lack of consistency in the inclusion of spirituality in these texts, and few refer specifically to the need for spiritual assessment tools or referral to chaplains. As more attention is given to patients' spiritual needs, the guidance given by nursing textbooks needs to be more substantive and consistent.

Safety of white adipose tissue activator cyclophilin A intracellular peptide (Pep19™) in healthy dogs.

Oral consumption of Pep19™, a 10 amino acid intracellular peptide, has been associated with weight loss in rodents and humans via induction of nonshivering thermogenesis. This study aimed to test its safety and tolerance in dogs. Eight healthy adult neutered university owned beagles (4 female and 4 male) were individually housed in runs and fed an extruded kibble in a quantity historically associated with weight stability. They were administered Pep19™ (5 mg/dog/day, 0.32 - 0.49 mg/kg/day) as a once daily oral dose for 28 days. Health screening, including physical examination, body weight, body condition score (BCS), complete blood count, chemistry, total thyroxine, thyroid stimulating hormone, and urinalysis were collected at baseline, day 14, and day 28. Faecal score, appetite, and overall animal temperament and condition were assessed daily. At baseline, average age, weight, and BCS were 3.8 ± 0.3 years, 12.68 ± 2.11 kg, and 6.4 ± 0.7/9, respectively. There were no adverse effects and all blood and urine analyses remained normal. At study termination, average weight, and body condition score (BCS) were 12.53 ± 2.01 kg, and 5.6 ± 0.7/9, respectively. Despite no changes in diet or calorie intake, seven of the dogs lost between 0.7% and 3.8% of their body weight (p<0.01); this was associated with a reduction in body condition score (p<0.05). This initial study shows that Pep19™ is safe for dogs. Future clinical research should investigate its utility as a new approach to reduce excess body fat in dogs.

A survey of nurses' practices and perceptions of family-centered care in Ireland.

Family-centered care (FCC) is a philosophy of care that recognizes the family's central role in the child's life and in the delivery of care. We used a survey design to investigate the practices and perceptions of nurses toward FCC in Ireland. Data were obtained from 250 nurses in seven hospitals using the Family-Centered Care Questionnaire-Revised (FCCQ-R). Findings indicated that nurses' practices were significantly different from their perceptions of FCC. Nurses with dual registration (children and adult) had significantly lower mean scores on the total current (practice) scale than the other registration subgroups. Nurses with a baccalaureate or a higher academic qualification had higher mean scores than nurses who held a certificate-level qualification on the total necessary (perception) scale, which assessed the activities perceived to be necessary for FCC. Findings showed that nurses support FCC but perceive the design of the health care system and parent-professional collaboration as barriers to FCC practice.

Impact of fatty acid composition on markers of exocrine pancreatic stimulation in dogs.

Chronic pancreatitis in dogs is typically managed with a low-fat diet. Human research suggests that consumption of medium-chain triglycerides (MCT) may lessen pancreatic enzyme release compared to consumption of long-chain fatty acids (LCFA). Twelve healthy adult colony dogs were fed a meal of cod and rice with either 3% metabolizable energy (ME) fat (control), high MCT (25% ME MCT oil, 25% ME butter), high saturated LCFA (50% ME butter), or high unsaturated LCFA (50% ME canola oil) in a 4-period by 4-treatment crossover design. Serum concentrations of canine pancreatic lipase immunoreactivity, gastrin, cholesterol, triglycerides, and serum activities of amylase and DGGR lipase (1,2-o-dilauryl-rac-glycero-3-glutaric acid-(69-methylresorufin) ester lipase) were measured at times 0 (fasted), 30, 120 and 180 minutes post-prandially. Following a 3-or 4-day wash-out period, each dog was assigned a new diet and the process was repeated for all treatments. Data were analyzed as a repeated-measures mixed model ANOVA. Post-hoc pairwise comparisons were run using Tukey-Kramer adjusted p-values. Shapiro-Wilk tests were used to evaluate residual normality. All statistical assumptions were sufficiently met. Statistical significance was defined as P<0.05. Of the markers tested, only serum triglyceride concentrations were affected by treatment, with consumption of high MCT resulting in lower triglycerides than both LCFA groups at times 120 and 180 minutes (P<0.0001). As expected, the high MCT group had higher triglycerides compared to the control group (P<0.0001). The type of dietary fat consumed had little acute impact on most markers of exocrine pancreatic stimulation in healthy dogs.

Medication administration practices among children's nurses: a survey.

AIM AND OBJECTIVES: The overall aim of this study was to investigate the medication administration practices of children's nurses. The specific objective was to identify practices that may improve the medication administration process, where necessary. DESIGN: Using a non-experimental survey design, a 'Medication Administration Practices Survey' was developed for use in this study. The survey was designed to include questions based on medication administration practices and not solely on medication errors. Ethical approval was obtained from the local research ethics committee where data were collected. All clinical staff working in all areas in a children's hospital were included. RESULTS: Interruptions in the medication process, a heavy workload and fatigue were some of the findings that emerged from this study. Inadequate knowledge and skills and a failure to comply with hospital policy were also identified. CONCLUSION: A lack of adherence to hospital policy and the frequency of interruptions in the medication administration process are important practices that require change as indicated by this study. Several recommendations are made, directed toward preventing or reducing medication errors and supporting children's nurses in providing best practice.

What are pre-registration nurses taught about caring for children?

Nurse education curricula have to be continually reviewed to ensure that content remains applicable to contemporary healthcare developments. In this article, the authors report the findings of a research study that investigated the children's nursing component taught in all non-children's BSc Nursing degree programmes in Irish colleges. The aim of the study was to identify how European Union directives and national curriculum guidelines are interpreted in colleges, and to clarify the preparation that non-children's pre-registration nursing students receive with respect to caring for children. The authors explored aspects related to children's nursing in all non-children's undergraduate pre-registration programmes, including curriculum content and its delivery, assessments and practice experiences. Data were collected by a specifically designed questionnaire based on the Requirements and Standards for Nurse Education Programmes (An Bord Altranais, 2005a; b). A university ethics committee provided ethical approval. The response rate was 54% (n=7), and data were analysed using SPSS 16 and content analysis. The authors' findings illustrated that the requirements and standards of all nursing programmes are interpreted in a variety of ways regarding children's nursing. Nationally, nursing content related to children needs to be reviewed in all nursing programmes to ensure consistency among providers. Healthcare requirements for children and families need to be heightened within curricula for all disciplines.

Evaluation of a pet-separating automatic feeder and high-frequency meal feeding for weight loss in multi-cat households.

OBJECTIVES: The objectives of this study were two-fold: (1) to determine if a feeder system providing individualized food access and automatic dispensing of meals makes weight-loss programs in multi-cat homes easier for cat owners; and (2) to assess if feeding six meals daily reduces food-seeking behavior and increases calorie requirements vs two meals per day. METHODS: Adult cats with body condition scores (BCSs) of 7/9 or greater underwent a weight-loss plan for up to 6 months using a traditional feeding bowl with two meals per day (B2) or an automatic feeder with two meals (A2) or six meals (A6) per day. Cats were weighed at weeks 0, 2, 4, 6, 10, 14, 18, 22 and 26 and food intake was adjusted to maintain weight-loss rates between 0.5% and 1.5% body weight per week. Owner questionnaires were completed at each study visit. RESULTS: Twenty-three cats were included in the study. Cats fed from the automatic feeders were more likely to reach ideal body condition (P = 0.006), with 83.2% of cats in A6, 40% of cats in A2 and no cats in B2 achieving a BCS of ⩽6/9. Owners of cats fed from automatic feeders reported the weight-loss plan was easier vs owners of cats fed from bowls (P = 0.01). Owners using the automatic feeders also reported fewer incidences of certain food-seeking behaviors. Neither percent body weight lost per week nor calorie intake per kg differed between groups. CONCLUSIONS AND RELEVANCE: Feeding six instead of two meals daily did not result in faster rates of weight loss or the need to increase calorie intake to maintain appropriate rates of weight loss. However, use of an automatic feeder that provided separated, portioned meal feeding made the weight-loss program easier, reduced food-seeking behaviors and improved the overall success of the weight-loss plan.

What does family-centred care mean to nurses and how do they think it could be enhanced in practice.

AIM: This paper is a report of the qualitative findings of a multisite survey in seven children's units in Ireland. In this survey, nurses caring for children identified their practice and perception of family-centred care. BACKGROUND: International research has identified inconsistencies with the provision and application of family-centred care in practice. Existing research studies illustrate barriers to family-centred care including nurses' attitudes to families and a lack of support and resources for the philosophy. METHOD: A descriptive survey design was employed to collect data in 2008-2009. Questionnaires were distributed to nurses (n = 750) which yielded a response rate of 33% (n = 250). The nurses completed a 47-item questionnaire which examined nurses' perceptions and practices of family-centred care, the quantitative findings of this study will be reported in another publication. The questionnaire contained two open-ended questions and the data from these questions are reported here. FINDINGS: While nurses accept family-centred care as an ideal philosophy for the care of children and their families, the implementation of family-centred care in practice would seem to present challenges for nurses. The majority in this study indicated that they required further organizational and managerial support to fully implement family-centred care practices. Two interrelated themes were identified 'the components of family-centred care' and 'enhancing family-centred care'. CONCLUSION: To provide good quality family-centred care nurses need adequate resources, appropriate education, support for managers and support from other healthcare disciplines.

Respite Care for Children with Complex Care Needs: A Literature Review.

Children with complex care needs form a diverse population with a variety of health and social care requisites in the presence of a range of complex symptoms and diagnoses. An exploratory literature review with a systematic search of the current qualitative literature was undertaken to explore parents' perceptions and evaluation of respite care services for children with complex needs. A systematic search was undertaken using a pre-defined search strategy in six databases; CINAHL, EMBASE, PsycINFO, Applied Social Sciences Index & abstracts and Web of Science. Studies were screened using inclusion criteria and eight studies were included in the review. These were analyzed using thematic analysis based on Braun and Clarke framework. Findings identified that there was a limited availability of respite care services for children with complex needs. Parents' perceived that respite was beneficial for themselves, their child and other siblings in the family. Barriers to accessing respite were also identified. It is recommended that respite services should be flexible and appropriate to the family's needs. A combination of in home and out of home services that are responsive to families' needs and are flexible would be optimal. Qualitative research is considered most suitable to obtain the views of parents of children with complex needs. Further research is recommended in this area, particularly in determining how services may improve and what the views of children using the respite services and their siblings are regarding respite.

Enhancing care of children with complex healthcare needs: an improvement project in a community health organisation in Ireland.

BACKGROUND: Integration of care for children with complex care needs is developing slowly internationally. There remains wide variation in the governance of, and access to, care for these children and their families. LOCAL PROBLEM: There was a need to develop a service that would have a specific remit for organising the overall management and governance of the care of these children in the community. METHOD: A bespoke model was established specifically to support the needs of children with complex healthcare needs (CHNs). The sole focus of the team is to provide the highest standard of care to these children and their families, and to enable families to remain central to decision-making. INTERVENTION: The service for children with CHNs was established in August 2017 with the appointment of a service manager and case managers. A comprehensive training and education programme was put in place to support care to the children and their families. RESULTS: The service is viewed as delivering high-quality care. Parents and stakeholders highlighted the value placed within the service on individualised care, specialist knowledge and the importance of advocacy. CONCLUSIONS: The model recognises the exceptional lives these children and families live, given the complexities and challenges they have to overcome on a daily basis. The team have built a specialist knowledge and skill set in supporting families and others involved in the care of the child, as they are solely employed and dedicated to the provision of care to children with CHNs. The corporate governance structures seem strong and stand up to scrutiny very well in terms of parents' and stakeholders' perspectives and in the context of published international best practice.

Assessing Nutritional Requirements and Current Intake.

To provide the best dietary recommendations to maintain optimal patient health, veterinarians must be able to assess a patient's nutritional status and offer necessary diet adjustment recommendations. Because obtaining accurate diet histories and answering owner questions about specific diet options can be time-consuming, this article summarizes efficient methods to complete this process. Short case illustrations of common nutrition calculation equations and an example diet history form are included. Members of the entire veterinary team can be involved with the assessment process to reduce the veterinarian's workload, while improving the quality of information obtained and the recommendations made for the pet.

Effect of a Leucine/Pyridoxine Nutraceutical on Caloric Intake and Body Composition of Obese Dogs Losing Weight.

The aim of this 29-week randomized, positively and negatively controlled study was to investigate whether a nutraceutical containing 1 g leucine and 13 mg pyridoxine can enhance weight loss while maintaining lean muscle mass in obese dogs. Twenty-four healthy, 2-year-old beagles were initially divided into obesification (n = 18) or ideal body weight groups (n = 6). After obesification, the 18 dogs were divided into three weight loss groups and fed one of the following over 12 weeks: nutraceutical with canned adult diet (CAD; ObN), placebo with CAD (ObP), or a canned therapeutic weight loss diet (WLD). Dogs in the ideal body weight (IBW) group were fed maintenance calorie requirements with CAD over 12 weeks. Based on MANOVA, ObN and WLD lost similar amounts of total weight (3.6 ± 0.9 vs. 4.4 ± 1.1 kg, respectively) and fat mass (3.1 ± 0.6 vs. 3.9 ± 0.8 kg, respectively) after 12 weeks of treatment, and more than ObP (1.1 ± 1.2 kg weight; 0.9 ± 1.0 kg fat; p < 0.0001). These data show the nutraceutical is a promising option for successful weight loss in dogs. Maintenance levels of CAD were able to induce weight loss without risk of hypo- or anorexia, or the need to switch diets or restrict energy intake.

Nutritional assessment in the cat: Practical recommendations for better medical care.

PRACTICAL RELEVANCE: Pet owners want dietary recommendations from their veterinarian. Providing a brief nutritional assessment for every cat at every visit will result in better medical care and build trust with clients. CLINICAL CHALLENGES: Examination time is limited, and it can be challenging to ensure appointments are efficient, yet thorough. A range of practical assessment tools is available that can assist with this process. PATIENT GROUP: Every cat can benefit from a screening nutritional evaluation as the fifth vital assessment (after temperature, pulse, respiration and pain assessment). Identifying patients with nutritional risk factors or nutrition-responsive diseases should prompt a more in-depth review of dietary needs. AUDIENCE: This article is aimed at all veterinary health professionals and is accompanied by videos demonstrating the body condition scoring process for a series of cats ranging from ideal body weight through to obese. EVIDENCE BASE: Information in the review is drawn from the current scientific literature, as well as the clinical experience of the authors.

Education of children's nurses in Ireland: an update.

The first teaching hospital for sick children in Great Britain and Ireland opened in Dublin in 1821. From then, the development of sick children's nursing in Ireland followed a similar path to that in many other countries until a national report in 2000 recognised that post-registration pathways alone were unlikely to meet future health service needs for suitably qualified and flexible children's nurses. In 2006, a four-and-a-half-year integrated children's and general nursing pre-registration degree programme started on four sites. At the same time, the existing 18-month post-registration course was replaced with an accelerated one-year diploma programme. The full integration of children's nursing into third level at both pre- and post-registration level was a welcome development in Ireland. Further work is under way to address the remaining educational challenges: post-graduate and doctoral programmes, preparation of advanced nurse practitioners and continuing professional education for qualified children's nurses.

The Role of the Healthcare Chaplain: A Literature Review.

Healthcare chaplains operate in many healthcare sites internationally and yet their contribution is not always clearly understood by medical and healthcare staff. This review aims to explore the chaplains' role in healthcare, with a view to informing best practice in future healthcare chaplaincy. Overall the extent of the provision and staffing of chaplaincy service internationally is unclear. From this review, several key spiritual and pastoral roles in healthcare emerge including a potential contribution to ethical decision making at the end of life. Healthcare chaplains are key personnel, already employed in many healthcare organizations, who are in a pivotal position to contribute to future developments of faith-based care, faith-sensitive pastoral, and spiritual care provision. They also have a new and evolving role in ethical support of patient, families and healthcare teams.

An Exploration of Current Approaches to and Facilities for Spiritual Care Provision in the Republic of Ireland.

This study aimed to explore current approaches to and facilities for spiritual care provision in the Republic of Ireland. The findings identify that providing spiritual care to patients is a key component of hospital policy. Spiritual support is identified as the responsibility of the whole healthcare team with specific responsibility being attributed to the healthcare chaplain. Most sites provided a sacred space or quiet place for clients, visitors and staff to contemplate.

Obesity Treatment: Environment and Behavior Modification.

Obesity is commonly encountered in veterinary patients. Although there are various published dietary approaches to achieving weight loss, successful long-term prevention of weight regain has proven elusive. Adding environmental and behavioral treatment strategies to a weight loss plan may help the veterinary team, the pet, and the pet owner maximize the effectiveness of the program. Because the owner directly affects the environment and behavior of the pet undergoing a weight loss plan, treatment strategies with an emphasis on owner involvement is the focus of this review. Veterinary use of the 5 A's behavioral counseling approach with the pet owner is discussed.

Spiritual care competence for contemporary nursing practice: A quantitative exploration of the guidance provided by fundamental nursing textbooks.

Spirituality is receiving unprecedented attention in the nursing literature. Both the volume and scope of literature on the topic is expanding, and it is clear that this topic is of interest to nurses. There is consensus that the spiritual required by clients receiving health ought to be an integrated effort across the health care team. Although undergraduate nurses receive some education on the topic, this is ad hoc and inconsistent across universities. Textbooks are clearly a key resource in this area however the extent to which they form a comprehensive guide for nursing students and nurses is unclear. This study provides a hitherto unperformed analysis of core nursing textbooks to ascertain spirituality related content. 543 books were examined and this provides a range of useful information about inclusions and omissions in this field. Findings revealed that spirituality is not strongly portrayed as a component of holistic care and specific direction for the provision of spiritual care is lacking. Fundamental textbooks used by nurses and nursing students ought to inform and guide integrated spiritual care and reflect a more holistic approach to nursing care. The religious and/or spiritual needs of an increasingly diverse community need to be taken seriously within scholarly texts so that this commitment to individual clients' needs can be mirrored in practice.