Information about life expectancy related to obesity is most important to cat owners when deciding whether to act on a veterinarian's weight loss recommendation.

OBJECTIVE: To determine the relative importance of information communicated to cat owners during veterinarian-client obesity-related conversations. SAMPLE: Cat owner participants recruited via snowball sampling. METHODS: A cross-sectional online questionnaire was distributed to cat owners who owned cats of any weight status. A discrete choice experiment design was used to determine the relative importance of obesity-related attributes to cat owners when receiving information from a veterinarian. RESULTS: A total of 1,095 questionnaires were analyzed. Participating cat owners resided primarily in Canada and the US. Impact on life expectancy was the most important attribute that would encourage participants to pursue weight management for a cat with obesity (relative importance, 32.66%), followed by change to cost of food (20.40%), future quality of life (20.38%), future mobility (14.40%), and risk of developing diabetes (12.15%). CLINICAL RELEVANCE: Findings suggest that cat owners consider the impact on life expectancy to be most important when considering whether to follow a veterinarian's recommendation for their cat to lose weight. When veterinary professionals are communicating about obesity in practice, there is the potential to increase owner engagement in weight management efforts for cats by emphasizing the obesity-related information owners prefer to receive.

Impact on life expectancy was the most important information to clients when considering whether to take action for an overweight or obese dog.

OBJECTIVE: To determine dog owner preferences for information communicated during veterinarian-client obesity-related conversations within companion animal practice. SAMPLE: Dog owners recruited using snowball sampling. METHODS: A cross-sectional online questionnaire was distributed to dog owners. A discrete choice experiment was used to determine the relative importance, to participating dog owners, of information about selected weight-related attributes that would encourage them to pursue weight management for a dog when diagnosed as overweight by a veterinarian. RESULTS: A total of 1,108 surveys were analyzed, with most participating dog owners residing in Canada. The most important weight-related attribute was life expectancy (relative importance, 28.56%), followed by the timeline for developing arthritis (19.24%), future quality of life (18.91%), change to cost of food (18.90%), and future mobility (14.34%). CLINICAL RELEVANCE: Results suggest that dog owners may consider information relating to an extension of their dog's life as the most important aspect of an obesity-related veterinary recommendation. By integrating dog owner preferences into discussions between clients and veterinary professionals about obesity, there is the potential to encourage more clients to engage in weight management efforts for their overweight or obese dog.

Qualitative analysis of small animal veterinarian-perceived barriers to nutrition communication.

OBJECTIVE: Nutrition is important in preventing and managing disease. Veterinarians are an important source of nutrition information; however, nutrition communication between veterinarians and pet owners is relatively infrequent. The purpose of this study was to conduct a qualitative review of barriers to nutrition communication and possible solutions, reported by small animal veterinarians. SAMPLE: 18 veterinarians from Maryland, Michigan, Virginia, Washington DC, and West Virginia. METHODS: In a qualitative focus group study, 5 virtual focus groups using the Zoom platform were conducted from February 3, 2021, to April 2, 2021. Each focus group was audio recorded, and transcripts were created using Otter.ai software. Transcripts were analyzed in Atlas.ti qualitative data analysis software using a hybrid of inductive and deductive thematic analysis. RESULTS: The 4 barriers to nutrition communication identified by veterinarians were as follows: (1) time, (2) misinformation and information overload, (3) pet owners' apprehension toward new information, and (4) veterinarians' confidence in nutrition knowledge and communication skills. Potential solutions include (1) improving communication and nutrition education, (2) improving and increasing access to client-friendly resources, and (3) empowering credentialed veterinary technicians and support staff to discuss nutrition. CLINICAL RELEVANCE: This study provides guidance for how to focus efforts to break down barriers to nutrition communication in small animal veterinary practice.

Anticoagulation Regimens in Pregnancy.

This article explores current recommendations for anticoagulation therapy in pregnancy, including antepartum, intrapartum, and postpartum guidelines. The authors review various screening strategies used to assess whether a patient is an appropriate candidate for anticoagulation during pregnancy and the postpartum period. The article includes dosing regimens, optimal surveillance, and medication reversal. The authors also address the challenges of transitioning between low-molecular-weight heparin and unfractionated heparin. Finally, there is a discussion of intrapartum anticoagulation management, especially as it relates to the administration of regional anesthesia, and the indications for and timing of thromboprophylaxis following delivery.

Fighting the obesity pandemic during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic created delays in surgical care. The population with obesity has a high risk of death from COVID-19. Prior literature shows the most effective way to combat obesity is by weight loss surgery. At different times throughout the COVID-19 pandemic, elective inpatient surgeries have been halted due to bed availability. Recognizing that major complications following bariatric surgery are extremely low (bleeding 0-4%, anastomotic leaks 0.8%), we felt outpatient bariatric surgery would be safe for low-risk patients. Complications such as DVT, PE, infection, and anastomotic leaks typically present after 7 days postoperatively, well outside the usual length of stay. Bleeding events, severe postoperative nausea, and dehydration typically occur in the first few days postoperatively. We designed a pathway focused on detecting and preventing these early post-op complications to allow safe outpatient bariatric surgery. METHODS: We used a preoperative evaluation tool to risk stratify bariatric patients. During a 16-month period, 89 patients were identified as low risk for outpatient surgery. We designed a postoperative protocol that included IV hydration and PO intake goals to meet a safe discharge. We sent patients home with a pulse oximeter and had them self-monitor their pulse and oxygen saturation. We called all patients at 10 pm for a postoperative assessment and report of their vitals. Patients returned to clinic the following day and were seen by a provider, received IV hydration, and labs were drawn. RESULTS: 80 of 89 patients (89.8%) were successfully discharged on POD 0. 3 patients were readmitted within 30 days. We had zero deaths in our study cohort and no morbidity that would have been prevented with postoperative admission. CONCLUSION: We demonstrate that by identifying low-risk patients for outpatient bariatric surgery and by implementing remote monitoring of vitals early outpatient follow-up, we were able to safely perform outpatient bariatric surgery.

Case Report: Metastatic renal cell carcinoma to the thyroid- A rare encounter.

Background: Renal cell carcinoma (RCC) accounts for approximately 4% of new adult cancers. By fine needle aspiration, identification of metastatic RCC to thyroid is challenging; therefore, surgical resection is indicated for definitive characterization. Our report surveys metastatic RCC to thyroid in our hospital. Methods: Twenty years retrospective review of electronic records in our institution identified five patients with metastatic renal cell carcinoma to the thyroid. We analyzed patient charts and pathology reports to evaluate clinical parameters and therapy. Results: In all cases, the original RCC was of clear cell type. Pathologic tumor stage ranged from pT1a to pT3a, Fuhrman nuclear grade varied from 2 to 4 and angiolymphatic invasion was noted in one case. In three patients, RCC in the thyroid occurred as an oligometastasis with no evidence of disease in the nephrectomy bed or other parts of the body. In two patients, concomitant recurrent RCC and metastases to liver, lung, brain and chest wall were documented. The thyroid metastases were found approximately 10 years after completion of nephrectomy with a range of 0-21 years. Three thyroid fine needle aspirations correctly identified the disease, one was negative, and one was classified as atypical cells present, suspicious for RCC. Conclusion: The thyroid gland is an uncommon location for RCC metastasis and can appear across a wide range of initial stages and grades of the disease. Thyroid metastases occurred as late as 21 years from the initial tumor resection. Increased awareness and a high index of suspicion are needed to detect metastasis, as they can be found in atypical locations and mimic primary disease.

Home-cooked diets cost more than commercially prepared dry kibble diets for dogs with chronic enteropathies.

OBJECTIVE: Nutrition plays a fundamental role in the management of canine chronic enteropathies (CCEs). Dog owners may elect to feed home-cooked diets (HCDs) rather than veterinary commercially prepared diets (CPDs) because of perceived lower costs. There is a paucity of data comparing costs of these options. We hypothesize there will be differences in costs between complete and balanced HCDs and nutritionally comparable CPDs. SAMPLE: 6 Home-cooked diets. PROCEDURES: Six HCD recipes (2 highly digestible, 2 limited antigen, 2 low-fat) were formulated by 2 board-certified veterinary nutritionists to mimic the nutritional and ingredient profiles of veterinary CPDs for management of CCEs. The cost (in US$ on a per 100 kilocalorie [kcal] basis) of each recipe was determined via collection of ingredient prices from 3 grocery stores combined with supplement prices from online retailers. Prices of CPDs were obtained from a national online retailer. Maintenance energy requirements of 1.6 X (70 X BWkg0.75), where BWkg represents body weight in kilograms, were calculated for 3 dog sizes (5, 20, and 40 kg), and costs of feeding maintenance energy requirements with HCDs versus dry and canned CPDs were compared with a Kruskal-Wallis test and post hoc testing. RESULTS: The median costs of all dry and canned CPDs and HCDs were $0.29 (range, $0.18 to $0.46), $1.01 (range, $0.77 to $1.20), and $0.55 (range, $0.35 to $1.14), respectively. Feeding complete and balanced HCDs cost more than feeding dry CPDs (P < .001), but not canned CPDs (P > .99). CLINICAL RELEVANCE: Dry CPDs cost the least for nutritional management of CCEs. There is a wide range of costs for both CPDs and HCDs.

Septic Shock and Cardiac Arrest in Obstetrics: A Practical Simplified Clinical View.

Septic shock and cardiac arrest during pregnancy, despite being uncommon, carry a high mortality rate among pregnant individuals. Basic initial management strategies are fundamental to improve clinical outcomes; obstetricians and maternal-fetal medicine specialists need to be familiar with such interventions.

Accommodations to cognitive assessment for a child with dyskinetic cerebral palsy: case study.

PURPOSE: Despite the importance of having knowledge about a child's cognitive functioning, less than one-third of children with cerebral palsy (CP) are formally assessed. Consequently, the cognitive strengths of many children with severe CP may be underestimated or go overlooked. This case study aimed to test accommodations to cognitive assessment administration procedures to enable switch access. METHODS: A 9-year-old boy with dyskinetic CP tested a suite of cognitive assessments with accommodations for single switch access and measures of user experience. The cognitive assessment included: receptive vocabulary; non-verbal reasoning; sustained attention; executive functions of problem solving and shifting; and visual perception skills. RESULTS: The participant's ability to independently undertake assessment on the receptive vocabulary, non-verbal reasoning and the sustained attention measures indicates that accommodations made for single switch access were appropriate. Assessment took 1-2 h longer than expected for a typically developing child via standardised administration procedures, but was considerably faster than expected if undertaken via low-tech partner assisted scanning. Accessibility barriers continued to be present for the executive function and visual perception measures. Overall, the user experience was positive, both in regards to usability and cognitive load. CONCLUSIONS: This case study provides emerging data for usability and accessibility of accommodations to a battery of cognitive assessment tasks. Further research is needed to devise appropriate accommodations for executive function and visual perception measures and to determine whether the accommodations are accessible more generally for children with motor and/or speech impairments. Implications for rehabilitationAccommodations can be successfully made to receptive vocabulary, non-verbal reasoning and sustained attention assessment administration procedures for switch technologies.Cognitive assessment with switch accommodations takes considerably longer to complete than standardised administration estimates for a typically developing child. Assessment may need to be scheduled over more than one session.User experience, including usability and cognitive load, of accommodations was positive.

Extracellular vesicles from maternal uterine cells exposed to risk factors cause fetal inflammatory response.

BACKGROUND: Fetal cell-derived exosomes (extracellular vesicles, 40-160 nm) are communication channels that can signal parturition by inducing inflammatory changes in maternal decidua and myometrium. Little is known about maternal cell-derived exosomes and their functional roles on the fetal side. This study isolated and characterized exosomes from decidual and myometrial cells grown under normal and inflammatory/oxidative stress conditions and determined their impact on fetal membrane cells. METHODS: Decidual and myometrial cells were grown under standard culture conditions (control) or exposed for 48 h to cigarette smoke extract or tumor necrosis factor-α, as proxies for oxidative stress and inflammation, respectively. Exosomes were isolated from media (differential ultra-centrifugation followed by size exclusion chromatography), quantified (nano particle tracking analysis), and characterized in terms of their size and morphology (cryo-electron microscopy), markers (dot blot), and cargo contents (proteomics followed by bioinformatics analysis). Maternal exosomes (109/mL) were used to treat amnion epithelial cells and chorion trophoblast cells for 24 h. The exosome uptake by fetal cells (confocal microscopy) and the cytokine response (enzyme-linked immunosorbent assays for IL-6, IL-10, and TNF-α) was determined. RESULTS: Exosomes from both decidual and myometrial cells were round and expressed tetraspanins and endosomal sorting complexes required for transport (ESCRT) protein markers. The size and quantity was not different between control and treated cell exosomes. Proteomic analysis identified several common proteins in exosomes, as well as unique proteins based on cell type and treatment. Compared to control exosomes, pro-inflammatory cytokine release was higher in both amnion epithelial cell and chorion trophoblast cell media when the cells had been exposed to exosomes from decidual or myometrial cells treated with either cigarette smoke extract or tumor necrosis factor-α. In chorion trophoblast cells, anti-inflammatory IL-10 was increased by exosomes from both decidual and myometrial cells. CONCLUSION: Various pathophysiological conditions cause maternal exosomes to carry inflammatory mediators that can result in cell type dependent fetal inflammatory response. Video Abstract.

Effect of food toys on owner-perceived quality of life of cats during a prescribed weight loss plan.

OBJECTIVE: To determine the effect of a food toy on owner-perceived quality of life (QOL) of overweight cats during a weight loss plan. ANIMALS: 44 adult cats, 1 to 10 years of age with a body condition score (BCS) ≥ 7/9. PROCEDURES: Cats were randomly assigned to the food toy or food bowl group. Cat owners completed an initial questionnaire and received a prescribed weight loss plan, bag of dry veterinary therapeutic cat food formulated for weight loss, measuring cup, and food bowl or ball-type food toy. Body weight and BCS were checked monthly. Owners completed a monthly questionnaire to assess their cat's QOL. Low-calorie vegetables were offered to 32 cats whose owners reported disruptive food-seeking behavior. RESULTS: Of the 44 cats in the final analysis, 29 cats either lost ≥ 2 BCS points or achieved an ideal BCS. Owner-perceived QOL was higher at the final weigh-in, compared with that at the initial weigh-in. An effect of food toy versus food bowl on owner-perceived QOL was not detected. Of the cats offered vegetables, 28 cats would eat the vegetables with a palatability additive; 4 cats ate vegetables plain. CONCLUSIONS AND CLINICAL RELEVANCE: Owner-perceived QOL was higher at the end of the study. Feeding overweight cats by use of a ball-type food toy did not influence owner-perceived QOL. Low-calorie vegetables can successfully be added to the weight loss diet to promote satiety; albeit, a palatability additive is likely needed. Further studies regarding feeding management for cats during a weight loss plan should be explored.

What Would Be Good for All Veterinarians to Know About Equine Nutrition.

Nutrition and management have enabling and supporting roles to play in the health, welfare, and performance of equines. Poor or inappropriate nutrition may therefore impose limits on an animal's ability to perform and adversely affect health and welfare. Understanding the gastrointestinal tract from a nutrition perspective can help to reduce the risk of certain clinical problems. This article outlines key factors with respect to the equine digestive tract and discusses relevant aspects of ration formation. Forage is highlighted, because inappropriate forage provision is one of the key limitations in many horse diets.

Nutritional Considerations When Dealing with an Obese Adult Equine.

Equine obesity is common, reducing quality of life and requiring dietary energy restriction. Equine obesity is identified using subjective body condition scoring. Considerations are given for life stage and health status when managing obese equines. Every effort should be made to maximize feeding duration, and minimize time spent without feed while meeting all essential nutrient requirements. Limiting total daily dry matter intake to 2% of current bodyweight per day of a low caloric, forage-based diet may result in adequate body weight loss. Weight loss and weight management plans should be monitored for success and potential gastrointestinal, metabolic, and/or behavioral complications.

How to Perform a Nutritional Assessment in a First-Line/General Practice.

Inappropriate nutrition is a priority welfare challenge. Nutritional mistakes are common and can lead to adverse events, such as poor growth and performance, colic, laminitis, and obesity. A detailed nutritional assessment involving evaluating the equine patient, current diet/ration, and management is essential in creating an effective nutritional plan. Goal(s) should be established and used to inform the plan. Management or resource barriers should be considered. Effective communication and a team-based approach versus an authoritarian one are likely to enhance the success of the nutritional plan. Developing a plan should be an interactive process, adjusting as needed after intentional monitoring.

Canine and Feline Obesity Management.

Obesity and overweight have an impact on more than half of pet cats and dogs. Effective and team-based communication is essential for creating an effective weight loss plan. The diet should meet all essential nutrient requirements during energy/calorie restriction. There are several ways to initiate a weight loss plan, and regular monitoring is essential for determining if a plan is working or needs to be adjusted.

Measurement of preprandial and postprandial urine calcium to creatinine ratios in male Miniature Schnauzers with and without urolithiasis.

BACKGROUND: We aimed to identify a simple test for excessive calciuresis and predict calcium oxalate (CaOx) disease in Miniature Schnauzers. We investigated the impact of postprandial time on the urine calcium to creatinine ratio (UCa/Cr) in male dogs of this breed, with the goal of improving the utility of the UCa/Cr. HYPOTHESES: (1) Significant differences will exist in preprandial and postprandial UCa/Cr between CaOx urolith-forming and control Schnauzers. (2) The UCa/Cr will increase significantly from the first morning baseline at ≥1 postprandial time point(s) in both control and CaOx urolith-forming dogs. (3) Biochemical abnormalities and other variables may be associated with urolith status. ANIMALS: Twenty-four male Miniature Schnauzer dogs, consisting of 9 with (urolith formers) and 15 without (controls) CaOx uroliths. METHODS: Urine was collected before and 1, 2, 4, and 8 hours after feeding a standardized diet. Receiver operator characteristic curve analysis was performed to identify the UCa/Cr cutoff that most accurately differentiates dogs based on urolith status. RESULTS: Urolith formers had significantly higher mean UCa/Cr over the course of 8 hours. The postprandial change in UCa/Cr was not significant at any time point between or within groups. The cutoff UCa/Cr value of 0.06 had a specificity of 93% (95% confidence interval [CI], 80%-100%) and a sensitivity of 56% (95% CI, 21%-86%) for identifying CaOx urolithiasis. CONCLUSIONS AND CLINICAL IMPORTANCE: Urolith-forming male Miniature Schnauzers have excessive calciuresis, and the postprandial sampling time up to 8 hours is not critical. This simple urine measurement has potential as a marker of CaOx disease.

Survey of owner motivations and veterinary input of owners feeding diets containing raw animal products.

BACKGROUND: The practice of feeding of diets containing raw animal products (RAP) to pets (dogs and cats) is discouraged by veterinary organizations and governmental public health organizations. Nevertheless, the practice of feeding RAP to pets is increasing in popularity. Pet owner motivations for feeding RAP diets to pets have not been explored and the benefits of RAP diets remain largely anecdotal. We hypothesized that pet owners feeding RAP diets would not rely on veterinary advice in choosing their pet's diet. We also hypothesized that these owners would have lower levels of trust in veterinary advice with respect to nutrition relative to pet owners not feeding RAP. METHODS: An anonymous web-based survey was developed to identify pet owner motivations for feeding RAP diets, and to characterize the veterinarian-client relationships of individuals feeding RAP diets. RESULTS: There were 2,337 respondents and 2,171 completed surveys. Of survey respondents, 804 reported feeding RAP at the time of the survey. While 20% of pet owners feeding RAP relied on online resources to determine what or how much RAP to feed, only 9% reported consulting with a veterinarian in making decisions about feeding RAP. Pet owners feeding RAP reported lower levels of trust in veterinary advice both 'in general' and 'with respect to nutrition' than pet owners not feeding RAP. Most pet owners reported that a discussion regarding their pet's nutrition does not occur at every veterinary appointment. DISCUSSION: Pet owners feeding a RAP diet have lower trust in veterinary advice than pet owners not feeding a RAP diet. Owners feeding RAP are more reliant on online resources than their own veterinarian in deciding what and how much RAP to feed. Pet owners perceive that nutrition is not discussed at most veterinary appointments. Therefore, there is room for improvement in the veterinarian-client communication with regards to nutrition.

Evaluation of a Pharmacist-Managed Heart Failure Education Project: Empowering Patients to Self-Manage Their Disease.

Background: Recent reimbursement cuts for hospitals with higher 30-day heart failure (HF)-related readmission rates call for means of reducing those readmissions. Objective: To determine if pharmacist-initiated education increases HF knowledge and assess if an increase in HF knowledge decreases HF readmission. Methods: This was a prospective interventional study. Participants were ≥18 years old admitted through the emergency department of a 322-bed community hospital with a diagnosis and/or past medical history of HF. Terminal/palliative care patients, patients residing in an assisted-living environment, or patients with a mental illness that deemed them incapable of participating were excluded. Forty-eight patients received pharmacist-initiated HF education on HF pathophysiology and its pharmacologic and nonpharmacologic treatment. Medication assistance and ancillary services were consulted when necessary. Patients' knowledge of HF was assessed using the same questionnaire prior to education and through a follow-up phone call within 7 days postdischarge. Results: Posteducation HF knowledge scores were 13.7 points higher than preeducation scores (P < .05). Twenty-five patients (52%) had HF as a primary discharge diagnosis. Of those patients, 9 (36%) were readmitted within 30 days for any cause. Only 3 patients (12%) had a HF-related diagnosis at readmission. There was a statistical difference in the level of knowledge but that was not translated into a statistical difference in readmission rates. Conclusion: Patients' HF knowledge scores increased after pharmacist education. Improvements in HF knowledge could not be correlated with readmission rates. However, the majority of HF patients in this study did not have a HF-related diagnosis at the time of readmission.