The purpose of an individual care plan in pediatric palliative care according to healthcare professionals: a qualitative study.

BACKGROUND: To ensure high-quality pediatric palliative care (PPC) and enable healthcare professionals (HCPs) to provide person-centered care for the individual child with a life-limiting or life-threatening illness and their family, the Individual Care Plan (ICP) for PPC was developed. However, in practice, the ICP for PPC is not used for all children in need of PPC. Insight into why, for which problem and for which children HCPs wish to use an ICP in PPC is therefore necessary to assure that the ICP can be fully implemented in practice. METHODS: Two semi-structured focus group interviews were held with 15 experienced healthcare professionals in PPC. Data were thematically analyzed. RESULTS: Participants wish to use an ICP to collaboratively establish a plan with parents for the current and future care and treatment of the child. By doing so, they hope to achieve coordination and continuity of care, to achieve shared decision-making, and to support parents and other healthcare professionals in the care of the child. Participants think the ICP could also be used in the care for children with complex chronic conditions. CONCLUSION: The purposes for which healthcare professionals wish to use an ICP in PPC are broader than the purpose for which the ICP for PPC was developed. Future research should focus on whether the use of an ICP in PPC practice can achieve these purposes.

Right coronary artery to left ventricle coronary cameral fistula in a cat.

A six-month-old female intact domestic shorthair cat was presented for evaluation of a loud heart murmur. Transthoracic echocardiography revealed dilation of the left ventricle secondary to an abnormal vessel shunting blood into the left ventricular outflow tract at a high velocity during diastole. Multidetector computed tomography angiography revealed a coronary cameral fistula that originated at the right coronary artery, encircled the heart, and then terminated into the left ventricular outflow tract. This case report documents the first known case of a coronary cameral fistula in a cat. Multimodal imaging was an essential aspect to diagnosing the congenital lesion in this case.

Comparison of cardiac measurements by multi-detector computed tomography angiography and transthoracic echocardiography in English bulldogs.

INTRODUCTION: Transthoracic echocardiography (TTE) is the primary tool for the assessment of cardiac structure and function in dogs but is challenging in English bulldogs due to dorsoventral compression of the thorax, obesity, and narrow intercostal spaces. Multi-detector computed tomography angiography (CTA) may overcome the conformational obstacles of cardiac imaging in this breed. ANIMALS: Eleven client-owned English bulldogs. MATERIALS AND METHODS: Prospective clinical trial with paired analysis of TTE and CTA studies. RESULTS: Eight of the 25 linear cardiac dimensional measurements were significantly different between TTE and CTA (p<0.033). Intraobserver agreement was strong with average coefficients of variation (CV) of 5.34% for TTE and 2.50% for CTA. Interobserver agreement CV averaged 6.5% for TTE and 8.75% CTA. Ejection fraction, stroke volume, and end-systolic volume were significantly different between modalities (all p<0.002). No significant difference was present between end-diastolic volume for TTE compared with CTA. DISCUSSION: High-quality cardiac angiographic studies were accomplished using CTA without the use of general anesthesia in English bulldogs. Multi-detector computed tomography angiography and TTE are not interchangeable modalities in the clinical setting. CONCLUSION: Multi-detector-CT ECG-gated cardiac angiography is possible in sedated, non-intubated English bulldogs. Differences were found between some cardiac dimensions as measured by TTE in the awake dog and compared with sedated CTA, indicating the two methodologies are not equivalent. Sedated, non-intubated CTA yielded high-quality imaging with strong intraobserver and interobserver measurement repeatability in English bulldogs.

Kinematic Magnetic Resonance Imaging for Evaluation of Disc-Associated Cervical Spondylomyelopathy in Doberman Pinschers.

BACKGROUND: The dynamic component of disc-associated cervical spondylomyelopathy (DA-CSM) currently is evaluated using traction magnetic resonance imaging (MRI), which does not assess changes in flexion and extension of the cervical vertebral column. In humans with cervical spondylotic myelopathy, kinematic MRI is used to identify dynamic compressions. HYPOTHESIS/OBJECTIVES: To evaluate the feasibility and utility of kMRI in Doberman Pinschers with DA-CSM using a novel positioning device. We hypothesized that kMRI would identify compressive lesions not observed with neutral positioning and change the dimensions of the spinal cord and cervical vertebral canal. ANIMALS: Nine client-owned Doberman Pinschers with DA-CSM. METHODS: Prospective study. After standard MR imaging of the cervical spine confirmed DA-CSM, dogs were placed on a positioning device to allow imaging in flexion and extension. Morphologic and morphometric assessments were compared between neutral, flexion, and extension images. RESULTS: Flexion was associated with improvement or resolution of spinal cord compression in 4/9 patients, whereas extension caused worsening of compressions in 6/9 patients. Extension identified 6 new compressive lesions and was significantly associated with dorsal and ventral compression at C5-C6 (P = .021) and C6-C7 (P = .031). A significant decrease in spinal cord height occurred at C6-C7 from neutral to extension (P = .003) and in vertebral canal height at C5-C6 and C6-C7 from neutral to extension (P = .011 and .017, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Our results suggest that kMRI is feasible and provides additional information beyond what is observed with neutral imaging, primarily when using extension views, in dogs with DA-CSM.