The current landscape of nutrition care in oesophageal and gastric cancer - insights from the national oesophagogastric nutrition audit (NONA) survey.

BACKGROUND AND AIMS: Specialist nutritional support is important during treatment for oesophagogastric (OG) cancer yet current practice remains unstandardised across the UK. The National Oesophagogastric Nutrition Audit (NONA) aimed to describe the current landscape of OG dietetic services in the UK and Ireland, with a specific focus on resource allocation, barriers to dietetic support, and the provision of support throughout the cancer pathway. METHODS: Tertiary cancer units, secondary care, and community services across the UK and Ireland were invited to complete a 28-point electronic questionnaire. Team leaders and senior specialist OG dietitians were the target respondents. All data points were peer-reviewed, piloted, and revised by the NONA steering committee before distribution. Data points covered a range of areas related to resources, skill mix, provision of support throughout the cancer pathway, and involvement with national audit and research. RESULTS: Complete responses were received from 50 individual units (tertiary surgical units, n = 35 and tertiary oncology units, n = 10). Secondary care and community services were underrepresented (n = 5). Of the units proving tertiary cancer care, the majority (77%) agreed or strongly agreed they were able to provide adequate nutritional care in the post-operative period. However, confidence dropped significantly in the early diagnostic phase and in the neoadjuvant period, with 52% and 67% of tertiary units disagreeing that they could provide adequate dietetic support during these parts of the cancer pathway, respectively. Inadequate funding, understaffing, and the prioritisation of inpatients were commonly reported barriers. There was significant variation in practice regarding nutritional assessment, service structure, and staffing resource allocation across specialist units. CONCLUSION: The NONA survey provides a 'real-world' landscape of nutritional care for patients with OG cancer. Lack of funding, resource, and evidence-base may explain the variation seen in services provided across the UK. Further research and consensus is required to help standardise nutritional care, guide service specification, and improve nutritional outcomes for patients with OG cancer.

Mental Experiences in Wild Animals: Scientifically Validating Measurable Welfare Indicators in Free-Roaming Horses.

The mental experiences of animals are what characterises their welfare status. The Five Domains Model for assessing welfare aligns with the understanding that physical and mental states are linked. Following measurement of indicators within each of the four physical/functional Domains (1. Nutrition; 2. Physical environment; 3. Health; and 4. Behavioural interactions), the anticipated negative or positive affective consequences (mental experiences) are cautiously inferred and assigned to Domain 5. Those inferences derive credibility from validated knowledge of the underlying systems of physiology, neurophysiology, neuroethology and affective neuroscience. Any indicators used for assessing welfare need to be scientifically validated. This requires, firstly, evidence of the links between a measurable/observable indicator and the physical/functional impact (in Domains 1 to 4), and secondly, a demonstrable relationship between the physical/functional impact and the mental experience it is inferred the indicators reflect (in Domain five). This review refers to indicators of physical/functional states in Domains 1 to 4, which have been shown to be measurable in free-roaming wild horses, and then evaluates the scientific evidence linking them to inferred mental experiences in Domain 5. This is the first time that the scientific evidence validating a comprehensive range of welfare indicators has been synthesised in this way. Inserting these indicators into the Five Domains Model enables transparently justifiable assessment and grading of welfare status in free-roaming horses.

Review of the Foundational Knowledge Required for Assessing Horse Welfare.

A detailed understanding of what is usual for a species under optimal conditions is critical for identifying and interpreting different features of body function that have known impacts on animal welfare and its assessment. When applying the Five Domains Model to assess animal welfare, the key starting point is therefore to acquire extensive species-specific knowledge relevant to each of the four physical/functional Domains of the Model. These Domains, 1 to 4, address areas where objective information is evaluated and collated. They are: (1) Nutrition; (2) Physical environment; (3) Health; and (4) Behavioural interactions. It is on the basis of this detailed knowledge that cautious inferences can then be made about welfare-relevant mental experiences animals may have, aligned with Domain 5, Mental State. However, this review is focused entirely on the first four Domains in order to provide a novel holistic framework to collate the multidisciplinary knowledge of horses required for undertaking comprehensive welfare assessments. Thus, inferring the potential mental experiences aligned with Domain 5, the final step in model-based welfare assessments, is not considered here. Finally, providing extensive information on free-roaming horses enables a better understanding of the impacts of human interventions on the welfare of horses in both free-roaming and domestic situations.

Ethical Treatment of Invasive and Native Fauna in Australia: Perspectives through the One Welfare Lens.

The One Welfare concept is proposed to guide humans in the ethical treatment of non-human animals, each other and the environment. One Welfare was conceptualized for veterinarians but could be a foundational concept through which to promote the ethical treatment of animals that are outside of direct human care and responsibility. However, wild-living animals raise additional ethical conundrums because of their multifarious values and roles, and relationships that humans have with them. At an open facilitated forum, the 2018 Robert Dixon Memorial Animal Welfare Symposium, a panel of five experts from different fields shared their perspectives on "loving and hating animals in the wild" and responded to unscripted questions from the audience. The Symposium's objectives were to elucidate views on the ethical treatment of the native and invasive animals of Australia and to identify some of the resultant dilemmas facing conservationists, educators, veterinarians and society. Here, we document the presented views and case studies and synthesize common themes in a One Welfare framework. Additionally, we identified points of contention that can guide further discourse. With this guide in place, the identification and discussion of those disparate views was a first step toward practical resolutions on how to manage wild-living Australian fauna ethically. We concluded that there was great utility in the One Welfare approach for any discourse about wild animal welfare. It requires attention to each element of the triple bottom line and ensures that advocacy for one party does not vanquish the voices from other sectors. We argue that, by facilitating a focus on the ecology in the context of wild animal issues, One Welfare is more useful in this context than the veterinary context for which it was originally developed.

Use of Remote Camera Traps to Evaluate Animal-Based Welfare Indicators in Individual Free-Roaming Wild Horses.

We previously developed a Ten-Stage Protocol for scientifically assessing the welfare of individual free-roaming wild animals using the Five Domains Model. The protocol includes developing methods for measuring or observing welfare indices. In this study, we assessed the use of remote camera traps to evaluate an extensive range of welfare indicators in individual free-roaming wild horses. Still images and videos were collected and analysed to assess whether horses could be detected and identified individually, which welfare indicators could be reliably evaluated, and whether behaviour could be quantitatively assessed. Remote camera trapping was successful in detecting and identifying horses (75% on still images and 72% on video observation events), across a range of habitats including woodlands where horses could not be directly observed. Twelve indicators of welfare across the Five Domains were assessed with equal frequency on both still images and video, with those most frequently assessable being body condition score (73% and 79% of observation events, respectively), body posture (76% for both), coat condition (42% and 52%, respectively), and whether or not the horse was sweating excessively (42% and 45%, respectively). An additional five indicators could only be assessed on video; those most frequently observable being presence or absence of weakness (66%), qualitative behavioural assessment (60%), presence or absence of shivering (51%), and gait at walk (50%). Specific behaviours were identified in 93% of still images and 84% of video events, and proportions of time different behaviours were captured could be calculated. Most social behaviours were rarely observed, but close spatial proximity to other horses, as an indicator of social bonds, was recorded in 36% of still images, and 29% of video observation events. This is the first study that describes detailed methodology for these purposes. The results of this study can also form the basis of application to other species, which could contribute significantly to advancing the field of wild animal welfare.

The WISHED Randomized Controlled Trial: Impact of an Interactive Health Communication Application on Home Dialysis Use in People With Chronic Kidney Disease.

BACKGROUND: While home dialysis therapies are more cost effective and may offer improved health-related quality of life, uptake compared to in-center hemodialysis remains low. OBJECTIVE: To test whether a web-based interactive health communication application (IHCA) compared to usual care would increase home dialysis use. DESIGN: Randomized control trial. SETTING: Patients were recruited from 3 multidisciplinary kidney clinics across Ontario, Canada (Hamilton, Kingston, London). PATIENTS: We included adults with advanced chronic kidney disease (CKD) followed in multidisciplinary kidney clinics. Patients who had not completed dialysis modality education, who did not have access to a home computer or the internet, who had significant hearing or vision impairment, who could not read/write/speak English, who had a medical contraindication for home dialysis, or who had selected conservative kidney care were excluded. MEASUREMENTS: The primary outcome was any use of home dialysis (peritoneal dialysis or home hemodialysis) within 90 days of dialysis initiation. Secondary outcomes were social support, decision conflict and dialysis knowledge measured at baseline, 6 months and 1 year. METHODS: Eligible patients were randomized to either usual care or the IHCA in addition to usual care in a 1:1 ratio. As part of usual care, all patients received education about dialysis modalities and kidney transplantation delivered by clinic nurses according to local practices. Randomization was performed using a computer-generated sequence in randomly permuted block sizes, stratified by site, and allocation occurred using sequentially numbered sealed, opaque envelopes. Participants, care providers, and outcome assessors were not blinded to the intervention. All analyses were performed blinded using an intention to treat approach. We estimated the effect of the ICHA on the odds of the primary outcome using unadjusted logistic regression models. Linear mixed models for repeated measures over time were used to analyze the impact of the IHCA on the secondary outcomes of interest. RESULTS: We randomized 140 (usual care, n = 71; IHCA, n = 69) out of a planned 264 patients (mean [SD] age 61 [14.5] years, 65% men). Among patients randomized to the IHCA group that completed 6-month and 1-year follow-up visits, 56.8% and 71.4%, respectively, had not accessed the IHCA website within the past month. There were 23 (32.4%) and 26 (37.7%) patients in the usual care and IHCA groups who received a home dialysis therapy within 90 days of dialysis initiation (odds ratio, OR = 1.3, 95% CI = [0.6-2.5], P = .5). Among the 78 patients who initiated dialysis (n = 38 usual care, n = 40 IHCA), 60.5% and 65% in the usual care and IHCA groups received a home therapy within 90 days of dialysis initiation (OR = 1.2, 95% CI = [0.5-3.0], P = .7). Secondary outcomes did not differ by intervention group over time. LIMITATIONS: The trial was underpowered due to poor recruitment and use of the IHCA was low. CONCLUSIONS: We did not find evidence of a difference in home dialysis uptake with IHCA use, but our analyses were notably underpowered. The incorporation of greater patient engagement, qualitative research and design research, and pilot implementation may help future evaluations of strategies to improve home dialysis uptake. TRIAL REGISTRATION: ClinicalTrials.gov #NCT01403454, registration date: Jul 21, 2011.

CONTEXTE: La dialyse à domicile est une modalité plus économique qui améliore la qualité de vie liée à la santé des patients. Malgré cela, son adoption demeure faible par rapport à l'hémodialyse en centre hospitalier. OBJECTIF: Vérifier si l'utilization d'une application interactive de communication en santé (AICS) accessible en ligne augmente l'adoption de la dialyse à domicile comparativement aux soins habituels. TYPE D'ÉTUDE: Essai contrôlé à répartition aléatoire. CADRE: Les patients ont été recrutés dans trois cliniques multidisciplinaires de néphrologie en Ontario, au Canada (Hamilton, Kingston, London). SUJETS: Nous avons inclus des adultes atteints d'insuffisance rénale chronique (IRC) de stade avancé suivis en clinique multidisciplinaire de néphrologie. Ont été exclus les patients n'ayant pas terminé la formation sur les modalités de dialyse, n'ayant pas accès à un ordinateur ou à Internet à domicile, ayant une déficience auditive ou visuelle importante, ne sachant pas lire, écrire ou parler en anglais, présentant une contre-indication médicale à la dialyse à domicile ou ayant choisi un traitement conservateur. MESURES: Le principal résultat était utilisation de la dialyse à domicile (dialyse péritonéale ou hémodialyse) dans les 90 jours suivant l'amorce du traitement. Les critères d'évaluation secondaires étaient le soutien social, les conflits décisionnels et les connaissances en matière de dialyse mesurés à l'inclusion, après six mois et après un an. MÉTHODOLOGIE: Les patients admissibles ont été répartis aléatoirement dans un rapport 1:1 pour recevoir les soins habituels ou l'AICS en plus des soins habituels. Dans le cadre des soins habituels, tous les patients ont reçu une formation sur les modalités de dialyse et la transplantation rénale donnée par le personnel infirmier de la clinique, conformément aux pratiques locales. La répartition aléatoire a été effectuée à l'aide d'une séquence générée par ordinateur dans des blocs de taille permutée au hasard, stratifiés par site. L'attribution s'est faite par enveloppes scellées et opaques, numérotées de façon séquentielle. L'intervention ne s'est pas faite à l'insu des participants, des fournisseurs de soins et des évaluateurs. Toutes les analyses ont été effectuées en aveugle avec une approche en intention de traiter. Nous avons estimé l'effet de l'AICS sur les probabilités du résultat principal en utilisant des modèles de régression logistique non corrigés. Des modèles mixtes linéaires pour des mesures répétées dans le temps ont été employés pour analyser l'impact de l'AICS sur les critères secondaires d'intérêt. RÉSULTATS: Des 264 patients prévus au départ (âge moyen [ÉT]: 61 [14,5] ans; 65 % d'hommes), 140 ont été répartis aléatoirement (71 en soins habituels; 69 avec l'AICS). Dans le groupe AICS, 56,8 % des patients ayant eu une visite de suivi après six mois et 71,4 % après un an n'avaient pas accédé au site Web de l'AICS au cours du mois précédent. Le nombre de patients ayant adopté la dialyse à domicile dans les 90 jours s'élevait à 23 (32,4 %) dans le groupe des soins habituels et à 26 (37,7 %) dans le groupe AICS (risque relatif [RR]: 1,3; IC 95 %: 0,6-2,5; p=0,5). Des 78 patients ayant amorcé des traitements de dialyse (38 en soins habituels; 40 avec l'AICS), la proportion de patients ayant reçu la dialyse à domicile dans les 90 suivants s'élevait à 60,5 % dans le groupe des soins habituels et à 65 % dans le groupe AICS (RR: 1,2; IC 95 %: 0,5-3,0; p=0,7). Les critères d'évaluation secondaires n'ont pas différé au fil du temps selon le groupe d'intervention. LIMITES: L'essai manque de robustesse en raison du faible recrutement et de la faible utilisation de l'AICS. CONCLUSION: Nous n'avons trouvé aucune preuve supportant une plus grande adoption de la dialyse à domicile avec l'AICS, mais nos analyses manquaient nettement de robustesse. Éventuellement, une plus grande participation des patients, une recherche qualificative et une recherche conceptuelle et une mise en œuvre pilote pourraient faciliter l'évaluation des stratégies visant à augmenter l'adoption de la dialyse à domicile.

Short-and long-term outcomes of sustained low efficiency dialysis vs continuous renal replacement therapy in critically ill patients with acute kidney injury.

BACKGROUND: Sustained low efficiency dialysis (SLED) has emerged as an alternative to continuous renal replacement therapy (CRRT) for the treatment of acute kidney injury (AKI) in critically ill patients. However, there is limited information on the short- and long-term outcomes of SLED compared to CRRT. METHODS: We conducted a retrospective cohort study of patients with AKI who commenced either SLED or CRRT in ICUs at a tertiary care hospital in Toronto, Canada. The primary outcome was 90-day all-cause mortality. Secondary outcomes included mortality at one year, and dialysis dependence at 90 days and one year. All outcomes were ascertained by linkage to provincial datasets. RESULTS: We identified 284 patients, of whom 95 and 189 commenced SLED and CRRT, respectively. Compared to SLED recipients, more CRRT recipients were mechanically ventilated (96% vs 86%, p = 0.002) and receiving vasopressors (94% vs 84%, p = 0.01) at the time of RRT initiation. At 90 days following RRT initiation, 52 (55%) and 126 (67%) SLED and CRRT recipients, respectively, died (adjusted risk ratio (RR) 0.91, 95% CI 0.75-1.11). There was no inter-modality difference in time to death through 90 days (adjusted hazard ratio 0.90, 95% CI 0.64-1.27). Among patients surviving to Day 90, a higher proportion of SLED recipients remained RRT dependent (10 (23%) vs 6 (10%) CRRT recipients, adjusted RR 2.82, 95% CI 1.02-7.81). At one year, there was no difference in mortality or dialysis dependence. CONCLUSIONS: Among critically ill patients with acute kidney injury, mortality at 90 days and one year was not different among patients initiating SLED as compared to CRRT.

Predicting mortality among critically ill patients with acute kidney injury treated with renal replacement therapy: Development and validation of new prediction models.

PURPOSE: Severe acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically ill patients with AKI. METHODS: All patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study. RESULTS: The development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76-0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54-0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year. CONCLUSIONS: Routinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically ill patients with AKI who commence RRT.

A Ten-Stage Protocol for Assessing the Welfare of Individual Non-Captive Wild Animals: Free-Roaming Horses (Equus Ferus Caballus) as an Example.

Knowledge of the welfare status of wild animals is vital for informing debates about the ways in which we interact with wild animals and their habitats. Currently, there is no published information about how to scientifically assess the welfare of free-roaming wild animals during their normal day-to-day lives. Using free-roaming horses as an example, we describe a ten-stage protocol for systematically and scientifically assessing the welfare of individual non-captive wild animals. The protocol starts by emphasising the importance of readers having an understanding of animal welfare in a conservation context and also of the Five Domains Model for assessing welfare. It goes on to detail what species-specific information is required to assess welfare, how to identify measurable and observable indicators of animals' physical states and how to identify which individuals are being assessed. Further, it addresses how to select appropriate methods for measuring/observing physical indicators of welfare, the scientific validation of these indicators and then the grading of animals' welfare states, along with assigning a confidence score. Finally, grading future welfare risks and how these can guide management decisions is discussed. Applying this ten-stage protocol will enable biologists to scientifically assess the welfare of wild animals and should lead to significant advances in the field of wild animal welfare.

Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study.

Background: Patients with AKI may require interhospital transfer to receive RRT. Interhospital transfer may lead to delays in therapy, resulting in poor patient outcomes. There is minimal data comparing outcomes among patients undergoing transfer for RRT versus those who receive RRT at the hospital to which they first present. Methods: We conducted a population-based cohort study of all adult patients (≥19 years) who received acute dialysis within 14 days of admission to an acute-care hospital between April 1, 2004 and March 31, 2015. The transferred group included all patients who presented to a hospital without a dialysis program and underwent interhospital transfer (with the start of dialysis ≤3 days of transfer and within 14 days of initial admission). All other patients were considered nontransferred. The primary outcome was time to 90-day all-cause mortality, adjusting for demographics, comorbidities, and measures of acute illness severity. We also assessed chronic dialysis dependence as a secondary outcome, using the Fine and Gray proportional hazards model to account for the competing risks of death. In a secondary post hoc analysis, we assessed these outcomes in a propensity score-matched cohort, matching on age, sex, and prior CKD status. Results: We identified 27,270 individuals initiating acute RRT within 14 days of a hospital admission, of whom 2113 underwent interhospital transfer. Interhospital transfer was associated with lower rate of mortality (adjusted hazard ratio [aHR], 0.90; 95% CI, 0.84 to 0.97). Chronic dialysis dependence was not significantly different between groups (aHR, 0.98; 95% CI, 0.91 to 1.06). In the propensity score-matched analysis, interhospital transfer remained associated with a lower risk of death (HR, 0.88; 95% CI, 0.80 to 0.96). Conclusions: Interhospital transfer for receipt of RRT does not confer higher mortality or worse kidney outcomes.

The environmental needs of many Australian pet cats are not being met.

OBJECTIVES: The aim of this study was to investigate whether Australian cat owners are effectively meeting their cats' environmental needs and to identify areas of deficiency that may have an impact on the cats' health and welfare. METHODS: An online survey investigating lifestyle factors and provision of environmental resources was distributed to Australian cat owners. RESULTS: In total, 12,010 respondents, representing cat-owning households, completed the survey. Altogether, 45.5% were single-cat households and 54.5% were multi-cat households, with a mean number of two cats per household. In total, 46.3% of households contained indoor cats, 51.8% contained indoor-outdoor cats and 1.8% had mostly outdoor cats. Dry food was the predominant food type in 59% of households and few respondents fed their cats in a manner that stimulates natural predatory behaviours. Altogether, 17.1% of households reported cats with urinary problems such as haematuria or urethral obstruction, and 19.8% reported inappropriate urination outside of the litter tray. The incidence of urinary problems was found to be significantly increased in multi-cat households, those with a low number of litter trays, less frequent cleaning of the trays of faeces and the use of crystal type litter. The veterinary clinic was the most common place to obtain advice about feeding and toileting management. CONCLUSIONS AND RELEVANCE: An increased number of Australian households now contain multiple cats that live restricted or indoor lifestyles. Despite the majority of respondents claiming to have a lot of knowledge about cats and obtaining veterinary advice, deficiencies were identified in toileting facilities and feeding practices, which raises significant welfare concerns. Urinary tract disorders are an important cause of morbidity, mortality and relinquishment and its presence was associated with inadequate toileting facilities. Ongoing education of cat owners and an increased effort by veterinarians to include basic husbandry in preventative care consultations is critical to improving the welfare of pet cats.

Comparing immunochromatography with latex antigen agglutination testing for the diagnosis of cryptococcosis in cats, dogs and koalas.

Although the point-of-care cryptococcal antigen lateral flow assay (LFA) has revolutionized the diagnosis of cryptococcosis in human patients, to date there has been no large-scale examination of this test in animals. We therefore assessed the LFA in cats, dogs and koalas suspected of having cryptococcosis. In sum, 528 serum specimens (129 from cats, 108 from dogs, 291 from koalas) were tested using the LFA and one of two commercially available latex cryptococcal antigen agglutination test (LCAT) kits. The LCAT is a proven and well-accepted method in veterinary patients and therefore taken as the "gold standard" against which the LFA was compared. The LFA achieved a sensitivity of 92%, 100%, and 98% in cats, dogs, and koalas, respectively, with corresponding negative predictive values of 94%, 100%, and 98%. The specificity of the LFA was 81%, 84%, and 62% for cats, dogs, and koalas, respectively, with corresponding positive predictive values of 76%, 48%, and 69%. These findings suggest the most appropriate role for the LFA is as a screening test to rule out a diagnosis of cryptococcosis in cats, dogs, and koalas. Point-of-care accessibility makes it equally suited for use in the field and as a cage-side test in veterinary hospitals. The suboptimal specificity of the LFA makes it less suited to definitive confirmation of cryptococcosis in animals; therefore, all LFA-positive test results should be confirmed by LCAT testing. The discrepancy between these observations and the high specificity of the LFA in humans may reflect differences in the host-pathogen interactions amongst the species.

Evaluation of benazepril in cats with heart disease in a prospective, randomized, blinded, placebo-controlled clinical trial.

BACKGROUND: Heart disease is an important cause of morbidity and mortality in cats, but there is limited evidence of the benefit of any medication. HYPOTHESIS: The angiotensin-converting enzyme inhibitor benazepril would delay the time to treatment failure in cats with heart disease of various etiologies. ANIMALS: One hundred fifty-one client-owned cats. METHODS: Cats with heart disease, confirmed by echocardiography, with or without clinical signs of congestive heart failure, were recruited between 2002 and 2005 and randomized to benazepril or placebo in a prospective, multicenter, parallel-group, blinded clinical trial. Benazepril (0.5-1.0 mg/kg) or placebo was administered PO once daily for up to 2 years. The primary endpoint was treatment failure. Analyses were conducted separately for all-cause treatment failure (main analysis) and heart disease-related treatment failure (supportive analysis). RESULTS: No benefit of benazepril versus placebo was detected for time to all-cause treatment failure (P = .42) or time to treatment failure related to heart disease (P = .21). Hazard ratios (95% confidence interval [CI]) from multivariate analysis for benazepril compared with placebo were 1.00 (0.57-1.74) for all-cause failure, and 0.99 (0.50-1.94) for forward selection and 0.93 (0.48-1.81) for bidirectional selection models for heart disease-related failure. There were no significant differences between groups over time after administration of the test articles in left atrium diameter, left ventricle wall thickness, quality of life scores, adverse events, or plasma biochemistry or hematology variables. CONCLUSIONS AND CLINICAL RELEVANCE: Benazepril was tolerated well in cats with heart disease, but no evidence of benefit was detected.

The Diagnosis of Feline Leukaemia Virus (FeLV) Infection in Owned and Group-Housed Rescue Cats in Australia.

A field study was undertaken to (i) measure the prevalence of feline leukaemia virus (FeLV) exposure and FeLV infection in a cross-section of healthy Australian pet cats; and (ii) investigate the outcomes following natural FeLV exposure in two Australian rescue facilities. Group 1 (n = 440) consisted of healthy client-owned cats with outdoor access, predominantly from eastern Australia. Groups 2 (n = 38) and 3 (n = 51) consisted of a mixture of healthy and sick cats, group-housed in two separate rescue facilities in Sydney, Australia, tested following identification of index cases of FeLV infection in cats sourced from these facilities. Diagnostic testing for FeLV exposure/infection included p27 antigen testing using three different point-of-care FeLV kits and a laboratory-based ELISA, real-time polymerase chain reaction (qPCR) testing to detect FeLV proviral DNA in leukocytes, real-time reverse-transcription PCR (qRT-PCR) testing to detect FeLV RNA in plasma, and neutralising antibody (NAb) testing. Cats were classified as FeLV-uninfected (FeLV-unexposed and presumptively FeLV-abortive infections) or FeLV-infected (presumptively regressive and presumptively progressive infections). In Group 1, 370 FeLV-unexposed cats (370/440, 84%), 47 abortive infections (47/440, 11%), nine regressive infections (9/440, 2%), and two progressive infections (2/440, 0.5%) were identified, and 12 FeLV-uninfected cats (12/440, 3%) were unclassifiable as FeLV-unexposed or abortive infections due to insufficient samples available for NAb testing. In Groups 2 and 3, 31 FeLV-unexposed cats (31/89, 35%), eight abortive infections (8/89, 9%), 22 regressive infections (22/89; 25%), and 19 progressive infections (19/89; 21%) were discovered, and nine FeLV-uninfected cats (9/89; 10%) were unclassifiable due to insufficient samples available for NAb testing. One of the presumptively progressively-infected cats in Group 3 was likely a focal FeLV infection. Two other presumptively progressively-infected cats in Group 3 may have been classified as regressive infections with repeated testing, highlighting the difficulties associated with FeLV diagnosis when sampling cats at a single time point, even with results from a panel of FeLV tests. These results serve as a reminder to Australian veterinarians that the threat of FeLV to the general pet cat population remains high, thus vigilant FeLV testing, separate housing for FeLV-infected cats, and FeLV vaccination of at-risk cats is important, particularly in group-housed cats in shelters and rescue facilities, where outbreaks of FeLV infection can occur.

Wild horse populations in south-east Australia have a high prevalence of Strongylus vulgaris and may act as a reservoir of infection for domestic horses.

Australia has over 400,000 wild horses, the largest wild equid population in the world, scattered across a range of different habitats. We hypothesised that wild horse populations unexposed to anthelmintics would have a high prevalence of Strongylus vulgaris infections. Verminous endarteritis and colic due to migrating S. vulgaris larvae is now absent or unreported in domestic horses in Australia, yet wild horses may pose a risk for its re-emergence. A total of 289 faecal egg counts (FECs) were performed across six remote wild horse populations in south-east Australia, of varying densities, herd sizes and habitats. Total strongyle egg counts ranged from 50 to 3740 eggs per gram (EPG, mean 1443) and 89% (257/289) of faecal samples had > 500 EPG, classifying them as 'high level shedders'. There were significant differences in mean total strongyle FECs between different locations, habitats and population densities. Occurrence of S. vulgaris was not predictable based on FECs of total strongyle eggs or small (<90 µm) strongyle eggs. A high prevalence of S. vulgaris DNA in faecal samples was demonstrated across all six populations, with an overall predicted prevalence of 96.7%. This finding is important, because of the ample opportunity for transmission to domestic horses. The high prevalence of S. vulgaris suggests vigilance is required when adopting wild horses, or when domestic horses graze in environments inhabited by wild horses. Appropriate veterinary advise is required to minimize disease risk due to S. vulgaris. Monitoring horses for S. vulgaris using larval culture or qPCR remains prudent. Gastrointestinal parasites in wild horse populations may also serve as parasite refugia, thus contributing to integrated parasite management when facing emerging anthelmintic resistance.

"Feelings and Fitness" Not "Feelings or Fitness"-The Raison d'être of Conservation Welfare, Which Aligns Conservation and Animal Welfare Objectives.

Increasingly, human activities, including those aimed at conserving species and ecosystems (conservation activities) influence not only the survival and fitness but also the welfare of wild animals. Animal welfare relates to how an animal is experiencing its life and encompasses both its physical and mental states. While conservation biology and animal welfare science are both multi-disciplinary fields that use scientific methods to address concerns about animals, their focus and objectives sometimes appear to conflict. However, activities impacting detrimentally on the welfare of individual animals also hamper achievement of some conservation goals, and societal acceptance is imperative to the continuation of conservation activities. Thus, the best outcomes for both disciplines will be achieved through collaboration and knowledge-sharing. Despite this recognition, cross-disciplinary information-sharing and collaborative research and practice in conservation are still rare, with the exception of the zoo context. This paper summarizes key points developed by a group of conservation and animal welfare scientists discussing scientific assessment of wild animal welfare and barriers to progress. The dominant theme emerging was the need for a common language to facilitate cross-disciplinary progress in understanding and safeguarding the welfare of animals of wild species. Current conceptions of welfare implicit in conservation science, based mainly on "fitness" (physical states), need to be aligned with contemporary animal welfare science concepts which emphasize the dynamic integration of "fitness" and "feelings" (mental experiences) to holistically understand animals' welfare states. The way in which animal welfare is characterized influences the way it is evaluated and the emphasis put on different features of welfare, as well as, the importance placed on the outcomes of such evaluations and how that information is used, for example in policy development and decision-making. Salient examples from the New Zealand and Australian context are presented to illustrate. To genuinely progress our understanding and evaluation of wild animal welfare and optimize the aims of both scientific disciplines, conservation and animal welfare scientists should work together to evolve and apply a common understanding of welfare. To facilitate this, we propose the formal development of a new discipline, Conservation Welfare, integrating the expertise of scientists from both fields.

What insights do patients and caregivers have on acute kidney injury and posthospitalisation care? A single-centre qualitative study from Toronto, Canada.

OBJECTIVES: Hospitalisation with acute kidney injury (AKI) is associated with short-term and long-term adverse events, but patient and caregiver experiences with AKI are not well described. We sought to better understand patient and caregiver perspectives after a hospitalisation with AKI to inform discharge strategies that may improve outcomes for this high-risk population. DESIGN: Qualitative study with semistructured interviews. SETTING: Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS: Adult patients (n=15) who survived a hospitalisation with Kidney Disease Improving Global Outcomes stage 2 or 3 AKI from May to December 2016. We also interviewed five patient caregivers. We required patients to have no previous evidence of severe chronic kidney disease (ie, prior receipt of dialysis, previous kidney transplantation or pre-existing estimated glomerular filtration rate (eGFR) under 30 mL/min/1.73 m2). RESULTS: We identified three over-arching themes: (1) prioritisation of conditions other than AKI, reflected by the importance placed on other comorbidities and the omission of AKI as part of the ongoing medical history; (2) variability in comprehension of the significance of AKI, represented by minimal knowledge of the causes and symptoms associated with AKI, along with misinformation on the kidneys' ability to self-repair; and (3) anxiety from discharge planning and competing health demands, illustrated by complicated discharge plans involving multiple specialist appointments. CONCLUSIONS: Patients and caregivers view AKI as a short-term and reversible condition, giving it little thought during the postdischarge period. As a result, reliance on patients and caregivers to report an episode of AKI to their outpatient physicians is unlikely to be successful. Patient-centred tools and decision aids are needed to bridge the gap between a hospitalisation with AKI and the safe transition to the outpatient setting.

Metastatic pulmonary carcinomas in cats ('feline lung-digit syndrome'): further variations on a theme.

CASE SERIES SUMMARY: The aim of this retrospective case series was to describe seven cases where cats with primary lung tumours were presented because of metastases to extra-pulmonary sites ('feline lung-digit syndrome'). Specifically, we wanted to emphasise less typical case descriptions where tumour emboli resulted in lesions developing in the musculature (including the muscles of the head), skin or distal aorta. RELEVANCE AND NOVEL INFORMATION: The cases are presented to increase clinical awareness of this entity in feline practice, especially when characteristic combinations of clinical signs are present. When clinicians have a high index of suspicion for these presentations, radiology (thorax and digits) or ultrasound (distal aorta), combined with collection of fine needle aspirate specimens for cytology, are usually sufficient to secure a definitive diagnosis. Novel information in this series includes CT and MRI findings from some cases. Typically, needle aspiration or biopsy targeting the skin, digits and lesions in musculature is far easier compared with sampling the primary tumour site in the lungs. The differential diagnosis and investigation of multiple digital lesions is also considered.

Management and monitoring of hyperthyroid cats: a survey of Australian veterinarians.

Objectives This study sought to evaluate how Australian veterinarians approach management and monitoring of feline hyperthyroidism and compare these results with a similar survey recently performed in the UK. Methods An invitation to complete an online survey was sent to veterinarians in all states and territories of Australia. The survey comprised questions relating to management of hyperthyroidism, use of antithyroid drugs vs radioiodine treatment vs surgical thyroidectomy, in addition to demographic information for respondents. Results A total of 546 clinicians completed the survey. The most commonly preferred treatments for long-term management of feline hyperthyroidism were antithyroid medications (305/546; 56%) and radioiodine (210/546; 38%), with substantially more respondents selecting radioiodine when cost was removed as a consideration (425/546; 78%). However, most respondents had treated or referred few cases for radioiodine (median 2). Most veterinarians (500/546; 92%) used antithyroid medications either long term or prior to definitive treatment of hyperthyroidism. For medical management, 45% (244/546) of veterinarians used twice-daily carbimazole. Half of respondents (274/546) aimed to maintain the total thyroxine concentration anywhere within the laboratory reference interval in hyperthyroid cats without chronic kidney disease. Blood pressure monitoring was uncommon. Surgical thyroidectomy was rarely performed. Conclusions and relevance Radioiodine was more frequently preferred by Australian veterinarians compared with those in the UK, likely associated with greater availability, reduced cost and shorter hospitalisation times in this jurisdiction, although antithyroid medications were the most frequently used treatment modality. Barriers remain to its utilisation, however, including perceived cost, misconceptions with regard to expected success rate and accessibility. Recent changes to recommendations on the management and monitoring of hyperthyroid cats do not appear to have been widely adopted by veterinarians at this time.

The WISHED Trial: implementation of an interactive health communication application for patients with chronic kidney disease.

BACKGROUND: Despite many advantages over facility-based therapies, less than 25 % of prevalent dialysis patients in Ontario are on a home therapy. Interactive health communication applications, web-based packages for patients, have been shown to have a beneficial effect on knowledge, social support, self-efficacy, and behavioral and clinical outcomes but have not been evaluated in patients with chronic kidney disease (CKD). Web-based tools designed for patients with CKD exist but to our knowledge have not been assessed in their ability to influence dialysis modality decision-making. OBJECTIVE: To determine if a web-based tool increases utilization of a home-based therapy in patients with CKD starting dialysis. DESIGN: This is a multi-centered randomized controlled study. SETTING: Participants will be recruited from sites in Canada. PARTICIPANTS: Two hundred and sixty-four consenting patients with an estimated glomerular filtration rate (eGFR) less than 20 ml/min/1.73 m(2) who have received modality education will be enrolled in the study. MEASUREMENTS: The primary outcome will be the proportion of participants who are on dialysis using a home-based therapy within 3 months of dialysis initiation. Secondary outcomes will include the proportion of patients intending to perform a home-based modality and measures of dialysis knowledge, decision conflict, and social support. METHODS: The between-group differences in frequencies will be expressed as either absolute risk differences and/or by calculating the odds ratio and its associated 95 % confidence interval. CONCLUSIONS: This study will assess whether access to a website dedicated to supporting and promoting home-based dialysis therapies will increase the proportion of patients with CKD who initiate a home-based dialysis therapy. TRIAL REGISTRATION: ClinicalTrials.gov #NCT01403454, registration date: July 21, 2011.

MISE EN CONTEXTE: L'administration de traitements d'hémodialyse à domicile présente plusieurs avantages par rapport aux traitements offerts en centre hospitalier. Pourtant, moins de 25 % des patients Ontariens suivent leurs traitements de dialyse à domicile. Bien que l'accès à des outils interactifs de communication en santé (OICS) ait des effets bénéfiques sur le niveau de connaissances, le soutien social, le niveau d'autonomie ainsi que sur les résultats cliniques et comportementaux des patients qui les utilisent, ces outils n'ont jamais fait l'objet d'études chez les patients atteints d'insuffisance rénale chronique (IRC). Des OICS existent pour cette population, mais on ne connaît pas leur part d'influence au moment où le patient doit faire le choix d'une technique de dialyse. OBJECTIFS DE L'ÉTUDE: Par cette étude, on entend vérifier si l'accès à des outils sur le web augmentera le nombre de patients atteints d'IRC en amorce d'une dialyse qui choisiront d'effectuer leurs traitements à domicile. CADRE ET TYPE D'ÉTUDE: Il s'agit d'un essai contrôlé, randomisé, qui se tiendra dans plusieurs centres hospitaliers à travers le Canada. PARTICIPANTS: La cohorte sera constituée de 264 patients atteints d'IRC dont le taux de filtration glomérulaire se situe à moins de 20 ml/min/1, 73 m2. Les participants auront suivi une séance d'orientation pour les aider à naviguer dans les différents outils mis à leur disposition sur le web. MESURES: À titre de résultat principal, on établira la proportion de patients qui auront adhéré à la technique de dialyse à domicile au cours des trois mois suivant l'initiation du traitement. On cherchera ensuite à connaître la proportion de patients ayant l'intention de le faire au courant de la première année de traitement. De plus, on procèdera à l'évaluation des connaissances et de la capacité des patients de prendre des décisions concernant leur traitement, ainsi que du soutien social qu'ils reçoivent. MÉTHODOLOGIE: Les différences entre les groupes d'étude seront exprimées soit sur le plan du risque absolu ou en calculant les rapports de cotes et les intervalles de confiance à 95 % correspondants. CONCLUSION: Cette étude évaluera si l'accès à un site web consacré au soutien social des patients et à la promotion des traitements de dialyse à domicile augmentera la proportion de patients souffrant d'IRC qui choisiront cette option pour l'amorce de leur traitement.