2023 AAHA Senior Care Guidelines for Dogs and Cats.

Veterinary professionals are taught to recognize that "old age is not a disease." However, clients may have the perception that older dogs and cats undergo an unavoidable physical, mental, and behavioral decline attributable simply to old age. The veterinary team's role includes providing medical care and support to senior pets to maintain their quality of life, as well as supporting and educating clients on proper senior animal care and addressing any misconceptions about the aging process. These Guidelines describe a systematic approach to the healthcare of the senior pet that is based on an evidence-guided assessment of both healthy and unhealthy canine and feline patients. By using evidence-guided medicine, which may include conventional and integrative approaches as well as environmental management for the senior pet, the patient's quality of life can be enhanced and potentially extended during this vulnerable life stage. Developing a senior program for the veterinary practice requires appropriate training of the entire healthcare team and includes a robust client education program that focuses on the wellbeing of the senior pet. Palliative and hospice care should be included in the education and information provided for both the veterinary team and the families of senior pets.

Implementing Rounding Checklists in a Pediatric Oncologic Intensive Care Unit.

Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a four-stage Plan-Do-Study-Act (PDSA) model to standardize MDR in our PICU over 3 months, from January 2020 to March 2020. We distributed surveys to PICU RNs to assess their understanding regarding communication during MDR. We created a standardized rounding checklist that addressed key elements during MDR. Safety event reports before and after implementation of our initiative were retrospectively reviewed to assess our initiative's impact on safety events. Our intervention increased standardization of PICU MDR from 0% to 70% over three months, from January 2020 to March 2020. We sustained a rate of zero for CLABSI, CAUTI, and VAP during the 12-month period prior to, during, and post-intervention. Implementation of a standardized rounding checklist may improve closed-loop communication amongst the healthcare team, facilitate dialogue between patients' families and the healthcare team, and reduce safety events. Additional staffing for resource RNs, who assist with high acuity patients, has also facilitated bedside RN participation in MDR, without interruptions in clinical care.

Retrospective Review of Flexible Bronchoscopy in Pediatric Cancer Patients.

The use of flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) to diagnose and manage pulmonary complications has been shown to be safe in adult cancer patients, but whether its use is safe in pediatric cancer patients remains unclear. Thus, to describe the landscape of FB outcomes in pediatric cancer patients and to help define the populations most likely to benefit from the procedure, we undertook a retrospective review of FBs performed in patients younger than 21 years treated at our institution from 2002 to 2017. We found that a greater volume of total fluid instilled during BAL was significantly associated with increased probabilities of positive BAL culture (p=0.042), positive bacterial BAL culture (p=0.037), and positive viral BAL culture (p=0.0496). In more than half of the FB cases, findings resulted in alterations in antimicrobial treatment. Our study suggests that for pediatric cancer patients, FB is safe, likely provides diagnostic and/or therapeutic benefits, and has implications for treatment decisions.

Euthanasia from the Veterinary Client's Perspective: Psychosocial Contributors to Euthanasia Decision Making .

End-of-life decision making for a companion animal relies on the veterinarian acting as educator and counselor. However, little research has been conducted to understand client variables in this context. The current study examined potential client-related contributors to steps taken toward a euthanasia decision. Caregiver burden, anticipatory grief, depression, stress, and income all correlated positively with this outcome. However, when client factors were examined in a regression model controlling for animal quality of life, only caregiver burden and income emerged as significant predictors. All 3 caregiver burden factors: general strain, affective/relational discomfort, and guilt/uncertainty were significantly related to consideration of euthanasia.

Feasibility of implementing a recovery education center in a Veterans Affairs medical center.

OBJECTIVE: The purpose of this study was to determine the feasibility of implementing a recovery education program in a Veterans Affairs medical center. METHOD: This case study describes development and implementation of a mental health and wellness curriculum offered through a centralized location. Referral and utilization data (n = 781) from the first 18 months of implementation were used to evaluate feasibility. FINDINGS: Access to programming with zero exclusion was prioritized and average time from referral to enrollment was 9.6 days. Fifty-six percent of veterans admitted to mental health services during the 18-month evaluation period were referred to the program, and this level of utilization continued to be sustained. A broad range of classes was available. Opportunities to change classes as recovery goals evolved was encouraged and data indicate veterans actively tailored their individual recovery curriculum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Educational recovery programming was easily incorporated into a large integrated health facility, was well received, and offered greater opportunity for choice and individualization of recovery curriculum. (PsycINFO Database Record

Family-centered interventions for substance abuse in Hispanic communities.

Treatment programs geared toward Hispanic culture are extremely rare, and programs involving the entire Hispanic family are virtually nonexistent. Two prospective studies test the hypothesis that a family-centered intervention is as effective with Hispanic families as it is with non-Hispanic families. First, the program (Celebrating Families!) was presented in English to non-Hispanic and Hispanic families. Second, the program was translated into Spanish and adapted to Spanish culture (¡Celebrando Familias!). Hispanic families were compared with non-Hispanic families in both studies. These studies indicate that a family-centered treatment model can be an effective treatment intervention for Hispanic clients.

Current status of radioactive seed for localization of non palpable breast lesions.

BACKGROUND: Wire-localized breast biopsy (WLBB) remains the standard method for the surgical excision of nonpalpable breast lesions. Because of many of its shortcomings, most important a high microscopic positive margin rate, alternative approaches have been described, including radioactive seed localization (RSL). This review highlights the literature regarding RSL, including safety, the ease of the procedure, billing, and oncologic outcomes. METHODS: Medline and PubMed were searched using the terms "radioactive seed" and "breast." All peer-reviewed studies were included in this review. CONCLUSIONS: RSL is a promising approach for the resection of nonpalpable breast lesions. It is a reliable and safe alternative to WLBB. RSL is at least equivalent compared with WLBB in terms of the ease of the procedure, removing the target lesion, the volume of breast tissue excised, obtaining negative margins, avoiding a second operative intervention, and allowing for simultaneous axillary staging.

Scientists' and science writers' experiences reporting genetic discoveries: toward an ethic of trust in science journalism.

PURPOSE: To describe the relationship between scientists and science writers and their experiences with media reporting of genetic discoveries. METHODS: This study included individual interviews with 15 scientists who specialize in genetics and 22 science writers who have covered their stories and a qualitative analysis of the data. RESULTS: Scientists and science writers place an equally high priority on accuracy of media reports. They agree on what makes genetics stories newsworthy and the particular challenges in reporting genetic discoveries (i.e., poor public understanding of genetics, the association of genetics with eugenics, and the lack of immediately apparent applications of genetic discoveries to human health). The relationship between scientists and bona fide science writers is largely positive. Scientists tend to trust, respect, and be receptive to science writers. Both scientists and science writers acknowledge that trust is an essential component of a good interview. Science writers report a fair degree of autonomy with respect to the relationship they have with their editors. CONCLUSION: To the degree that trust facilitates the access that science writers have to scientists, as well as higher quality interviews between scientists and science writers, trust might also contribute to higher quality media reporting. Therefore, scientists and science writers have an ethical obligation to foster trusting relationships with each other. Future research should systematically explore ways to cultivate such relationships and assess their impact on the quality of science journalism.

Do GPs practice what they preach? A questionnaire study of GPs' treatments for themselves and their patients.

Anecdotal evidence indicates a difference between doctors' health seeking behaviours for their patients and for themselves. This difference remains untested. This study aimed to assess any differences between the first-line treatment options GPs would accept for themselves and those they would advise their patients. A postal questionnaire was completed by 286 GPs based in two west London Health Authorities (response rate 51.4%) asking them to score the treatment options of 6 common symptoms for both themselves and their patients in terms of over the counter (OTC) remedies, prescriptions, referrals and complementary therapies. The results showed that GPs differentiated between themselves and their patients in terms of OTC remedies for indigestion and depression, prescriptions for indigestion, hypertension, depression and 'tired all the time' (TATT); referrals for indigestion, hypertension, low back pain and TATT; and complementary therapy for depression. GPs may be prepared to cross the boundary be treated the same as their patients if the symptoms are relatively uncontroversial. Stigmatised problems and those with clinical guidelines, however, seem to result in a 'do as I say not as I do' approach to health care.

Breast cancer in patients with prior augmentation: presentation, stage, and lymphatic mapping.

The purpose of this study was to determine whether breast cancer patients who had prior breast augmentation presented at a more advanced stage than nonaugmented breast cancer patients, and to determine the mode of presentation and effectiveness of lymphatic mapping and sentinel lymph node biopsy in this same group of patients. A total of 4186 breast cancer patients from 1987 to 2002 were reviewed. Patients who had augmentation before their diagnosis of breast cancer were compared with a control group of nonaugmented breast cancer patients. The Wilcoxon rank sum test was used to compare tumor size, node positivity, and stage. The patient's age at presentation was also compared by the two-sided pooled t test. Seventy-six patients who previously underwent augmentation were identified with 78 breast cancers. Seventy percent (48 of 69) were initially detected by palpation, whereas 30 percent (21 of 69) were initially identified mammographically. Fifty-three percent (n = 41) underwent mastectomy and 47 percent (n = 37) underwent a lumpectomy. This compares with a 63.6 percent (2615 of 4110) breast conservation rate in the nonaugmented population during the same time period. The two groups did not differ regarding (tumor) size (p = 0.77), nodal positivity (p = 0.32), or stage (p = 0.34). The mean time between implant placement and a diagnosis of breast cancer was 14 years. The average age of the patients who had previously undergone augmentation at breast cancer diagnosis was 49.5 years (SD, 9.0 years) versus 57.1 years (SD, 13.5 years) for the nonaugmented patients (p < 0.0001). Forty-nine of the patients underwent lymphatic mapping, with a 100 percent success rate in identifying the sentinel lymph node. There have been no clinically detected axillary recurrences in the patients who had a negative sentinel lymph node biopsy. Breast cancer patients who have undergone previous augmentation are more likely to present with a palpable mass. This initial mode of detection does not appear to translate into a larger tumor size or worse prognosis. Breast conservation and lymphatic mapping can be performed successfully in previously augmented patients.

The role of sentinel lymph node biopsy in patients with ductal carcinoma in situ or with locally advanced breast cancer receiving neoadjuvant chemotherapy.

BACKGROUND: A significant number of patients who are initially diagnosed with pure DCIS will harbor missed or occult invasive disease at their definitive surgery. To provide more accurate staging information and to avoid a second operation, some investigators believe that SLN mapping should be performed in DCIS patients. The role of SLN biopsy after neoadjuvant chemotherapy in patients with advanced breast cancer is controversial. METHODS: A review of the literature was performed to determine the role of SLN biopsy in patients with DCIS or advanced breast cancer receiving neoadjuvant chemotherapy. The success rate of SLN biopsy after neoadjuvant chemotherapy was investigated as well as the percentage of positive SLNs in patients with DCIS. RESULTS: Two consecutive studies revealed metastatic disease to the regional lymph nodes in up to 13% of DCIS patients. In addition, 10% of DCIS patients were upstaged to infiltrating ductal carcinoma at their definitive therapy. The ability of the SLN to predict the status of the remaining non-SLNs after neoadjuvant chemotherapy is unknown. False-negative rates range from 0% to 33%. The success rate for SLN identification for the combined series varies from 84% to 97%. CONCLUSIONS: SLN biopsy is a minimally invasive technique that can be used to evaluate the regional nodal status of DCIS patients. Performing a SLN biopsy during the initial surgical procedure may avoid a second operation in some DCIS patients who are diagnosed with invasive disease at their definitive operation. The success rate of sentinel node identification does not seem to be altered after neoadjuvant therapy. However, the ability of the SLN to predict the pathologic status of the adjacent non-SLNs remains unknown. Therefore, until further prospective randomized trials are conducted, it cannot be assumed that all the regional nodes have the same biologic response to chemotherapy as the SLN.

Worldwide experience with lymphatic mapping for invasive breast cancer.

Lymphatic mapping and sentinel lymph node (SLN) biopsy have changed the standard of surgical care for women with invasive breast cancer. The rate of successful axillary SLN identification varies from 90% to 99%. Recurrence rates after a negative SLN biopsy have been remarkably low. Internal mammary node drainage has been noted in 8% to 22% of cases, but whether to harvest these extra-axillary sites of drainage remains controversial. Because of the low morbidity associated with the lymphatic mapping procedure, all women with invasive breast cancer should be considered as candidates for this more accurate staging technique.

Radioactive seed localization breast biopsy and lumpectomy: can specimen radiographs be eliminated?

BACKGROUND: Wire localization (WL) is the current standard for surgical diagnosis of nonpalpable breast lesions. Many disadvantages inherent to WL are solved with radioactive seed localization (RSL). This trial investigated the ability of RSL to reduce the need for specimen radiographs and operating room delays associated with WL. METHODS: A total of 134 women were entered onto an institutional review board-approved study. RSL was performed by placing a titanium seed containing.29 to 20 mCi of iodine-125 to within 1 cm of the suggestive breast lesion. The surgeon used a handheld gamma detector to locate and excise the iodine-125 seed and the lesion. RESULTS: Specimen radiographs were eliminated in 98 (79%) of 124 patients. Surgical seed retrieval was 100% in 124 patients. No seed migration occurred after correct radiographical placement. A total of 26 (21%) of 124 patients required a specimen radiograph; 22 (85%) of these 26 were performed for microcalcifications. CONCLUSIONS: After surgical removal, RSL can eliminate specimen radiographs when the radiologist accurately places the seed and the pathologist grossly identifies the lesion. If small microcalcifications are noted before surgery, then specimen radiographs may be necessary. RSL reduced requirements for specimen radiographs, decreased OR time, improved incision placement, and improved resections to clear margins.

Effect of 0.5 Tesla magnetic resonance imaging on the surgical management of breast cancer patients.

BACKGROUND: This trial examines the utility of breast magnetic resonance imaging (MRI) for detection of occult breast disease and its effect on surgical treatment. METHODS: Between October 2000 and March 2002, 76 of 1289 patients underwent bilateral breast MRI within 4 months of a mammogram. The MRI scan, mammogram, pathology reports, and physicians' notes were reviewed to determine impact of MRI on surgical treatment. RESULTS: Magnetic resonance imaging detected 23 additional lesions in 19 patients not detected by mammogram. Cancer occult to mammography was detected by MRI in 6 women, constituting 7.9%. Magnetic resonance imaging impacted surgical treatment plans in 10 of 76 (13.2%) patients. CONCLUSIONS: Magnetic resonance imaging is effective at identifying new subclinical breast disease not seen on mammography. Ten of 76 patients (13.2%) who underwent MRI had their surgical management altered due to MRI findings. Specific criteria should be studied to know which subgroups would benefit most from breast MRI.

Doctors expressions of uncertainty and patient confidence.

Although recent work has encouraged doctors to express their uncertainty to patients as a means to improve communication the potential impact of this on patients remains unclear. The present study first explored the impact of the way in which uncertainty was expressed (behaviourally versus verbally) on doctor's and patient's beliefs about patient confidence. Second the study examined the role of the patient's personal characteristics and knowledge of their doctor as a means to address the broader context. Matched questionnaires were completed by GPs (n=66, response rate=92%) and patients (n=550, response rate=88%) from practices in the south-east of England. The results showed that the majority of GPs and patients viewed verbal expressions of uncertainty such as 'Let's see what happens' as the most potentially damaging to patient confidence and both GPs and patients believed that asking a nurse for advice would have a detrimental effect. In contrast, behaviours such as using a book or computer were seen as benign or even beneficial activities. When compared directly, GPs and patients agreed about behavioural expressions of uncertainty, but the patients rated the verbal expressions as more detrimental to their confidence than anticipated by the doctors. In terms of the context, patients who indicated that both verbal and behavioural expressions of uncertainty would have the most detrimental impact upon their confidence were younger, lower class and had known their GP for less time. To conclude, patients' reactions to uncertainty occur within the context of the patient's own background and experience, however, some consistent responses can be found. In particular, whilst behavioural expressions of uncertainty may have a positive impact upon patient confidence, verbal expressions have a consistently detrimental effect which is underestimated by GPs.

A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department.

OBJECTIVE: Dog bites account for a significant number of traumatic injuries in the pediatric population that often require medical treatment. Although agent, host, and environmental characteristics of dog bites have been well documented, no attempt has been made to compare these characteristics by patient age group. The purpose of this study is to determine if differences exist in agent, host, and environmental characteristics among younger (< or =6 y) and older (>7 y) patients treated in a pediatric emergency department (ED) for dog bites. Findings from our study could be used to develop age-specific strategies for dog bite prevention. THEORETICAL FRAMEWORK: The epidemiologic triad of agent/host/environment formed the theoretical framework. METHODS: The study setting was the ED at Children's Hospital of Pittsburgh. Patients were enrolled between 1999 and 2000 and were identified through a review of ED records (n = 386) of children sustaining dog bites. Records were abstracted with a researcher-designed and validated form for agent (eg, breed, number of biting dogs, owner, rabies status), host (eg, age, gender, number and location of bites, treatment), and environmental (eg, bite month and time, bite location, events leading to the bite, ZIP code) characteristics. Data were analyzed using descriptive and inferential statistical tests. RESULTS: Children younger than 6 years constituted 52.8% (n = 204) of the sample. As compared with older children, a higher proportion of younger children were bitten by their family dog (chi2 = 27.64, P = 0.001) whose rabies shots were up to date (chi2 = 12.08, P = 0.034). A higher proportion of younger children were bitten on the face (chi2 = 49.54, P = 0.000) and were bitten in their own homes (chi2 = 16.075, P = 0.013). IMPLICATIONS FOR NURSING PRACTICE: Young children frequently sustain dog bites from their family dog in their own homes. Injuries typically involve severe lacerations to the face. Prevention strategies for young children include close supervision of child-dog interactions.

Utility of radiographic hepatic injury grade in predicting outcome for children after blunt abdominal trauma.

BACKGROUND/PURPOSE: The American Association for the Surgery of Trauma (AAST) liver injury grading system has been adopted in the management of pediatric hepatic injuries. However, the usefulness of this grading system in children remains undefined. The authors, therefore, examined the validity of AAST grading in the management of pediatric blunt liver injury. METHODS: The authors identified 152 patients, ages 0 to 18 years, with blunt hepatic injury treated at our pediatric trauma center between 1995 and 2000. Radiographic AAST grade was assigned retrospectively by 2 radiologists. Variables analyzed included age, gender, Glasgow Coma Score (GCS), Injury Severity Score (ISS), and associated injuries. Outcome measures were mortality rate and length of stay (LOS). Statistical analysis was performed using analysis of variance or linear regression. RESULTS: Computed tomography (CT) scans were available for 95 patients. Radiographic injury grade did not correlate with mortality rate, hospital LOS or intensive care unit (ICU) LOS. ISS and associated injury, but not age, gender, or GCS, were predictive of LOS. Grade did not correlate with mortality rate, ICU LOS, or hospital LOS. CONCLUSIONS: Radiographic liver grading does not predict outcome reliably in children and should not be the main parameter utilized to guide clinical decision making. A role for scoring systems that utilize factors such as associated injuries and ISS is indicated.