Slecht nieuws communiceren in de diergeneeskunde : wat is de goede aanpak? = Breaking bad news in veterinary medicine : what is the best approach?

Bad news can be defined as any news which negatively affects the client’s future perspective. Bad news conversations are frequent in veterinary medicine, and the way these are conducted has a major impact on the veterinarian-client relationship. In human medicine, and more recently also in veterinary medicine, several strategies have been formulated for delivering bad news in order to reduce stress and enhance satisfaction for both the veterinarian and the client. Five essential elements can be found in the different models for these challenging interactions. First, the conversation should be prepared ahead if possible, and an appropriate setting for the conversation should be created. Next, the client’s perspective about his animal’s disease is explored, followed by the bad news message itself in short, understandable pieces, while responding empathically to emotions, which may arise. Further information and planning is then provided in small chunks when the client is ready for this

Use of tissue Doppler imaging and two-dimensional speckle tracking for quantification of left ventricular function in horses

In horses with cardiac disease or poor performance, echocardiography is an essential tool for non-invasive evaluation of myocardial function. Left ventricular (LV) function is usually quantified by calculating fractional shortening (FS). Tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2DST) are two echocardiographic techniques that might provide a more extensive quantification of left ventricular function. TDI measures myocardial velocities based on the Doppler principle. Myocardial deformation can be calculated from the velocity gradient between the endo- and epicardium. The total amount of wall deformation is described as strain (%), the rate of deformation as strain rate (s-1). Using 2DST, acoustic speckle patterns which are unique for each myocardial region are tracked in the two dimensions of the ultrasound image. As a result, longitudinal and circumferential shortening can be measured in addition to radial wall thickening. The aim of this study was to evaluate the use of TDI and 2DST for quantification of LV function in horses. First, the feasibility and reproducibility of TDI and 2DST measurements were described in ten healthy trotter horses. Using a modified four-chamber view, 2DST allowed quantification of global and segmental longitudinal LV velocity, displacement, strain rate and strain. Using short-axis images acquired at chordal and papillary muscle level, circumferential and radial LV function could be assessed by 2DST. Using TDI, radial velocity, strain rate and strain measurements were feasible from left and right parasternal short-axis views at chordal and papillary muscle level. The high frame rate allowed accurate measurements of systolic and diastolic time intervals. Next, the influence of the atrioventricular (AV) delay on mitral valve closure and LV peak velocity and acceleration during isovolumic contraction was investigated. This study demonstrated that AV interaction should be kept in mind when using peak pre-ejectional velocity and acceleration as parameters of LV contractility. The clinical use of TDI and 2DST was evaluated in horses with myocardial damage caused by an accidental ionophore intoxication on a farm in Belgium with eighty-one horses. Twenty horses were included in the echocardiographic study as they showed signs of myocardial damage. These horses showed abnormal TDI, 2DST and FS measurements, indicating impaired LV function. In a horse with myocardial fibrosis, TDI and 2DST could detect regional alterations of myocardial function caused by the predominant presence of fibrosis in the interventricular septum. Over all horses, TDI measurements, SL, SR at chordal level and FS correlated significantly with maximal cTnI. Over all examinations, TDI and 2DST measurements correlated well with FS. The ability of TDI and 2DST to detect myocardial dysfunction in horses with normal FS was investigated in twelve horses with atypical myopathy (AM). AM is an acute, highly fatal rhabdomyolysis in grazing horses. Eleven horses with AM had elevated cTnI concentrations and ten horses ventricular premature depolarizations (VPDs). All horses presented a prolonged corrected QT (QTcf) interval and an abnormal LV wall motion pattern. FS was normal in all horses. TDI measurements revealed abnormal LV relaxation with prolonged contraction duration, increased isovolumic relaxation time and decreased ratio of early to late diastolic (E/A) LV radial velocities. Decreased LV global longitudinal strain and increased mechanical dispersion between myocardial segments could be detected by 2DST. One of four surviving horses still showed VPDs and a mildly prolonged QTcf after ten weeks follow-up, although the wall motion abnormality had disappeared. In conclusion, TDI and 2DST can be considered complimentary for the comprehensive quantification of LV function. In the future, TDI and 2DST might be applied for detection of subclinical myocardial dysfunction in horses with valvular disease, for evaluating the effect of training or for quantification of right ventricular and atrial function

Authentic evaluation of communication skills by a video assignment for preclinical veterinary students

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Quantification of left ventricular longitudinal strain, strain rate, velocity and displacement in healthy horses by 2-dimensional speckle tracking

Background: The quantification of equine left ventricular (LV) function is generally limited to short-axis M-mode measurements. However, LV deformation is 3-dimensional (3D) and consists of longitudinal shortening, circumferential shortening, and radial thickening. In human medicine, longitudinal motion is the best marker of subtle myocardial dysfunction. Objectives: To evaluate the feasibility and reliability of 2-dimensional speckle tracking (2DST) for quantifying equine LV longitudinal function. Animals: Ten healthy untrained trotter horses; 9.6 +/- 4.4 years; 509 +/- 58 kg. Methods : Prospective study. Repeated echocardiographic examinations were performed by 2 observers from a modified 4-chamber view. Global, segmental, and averaged peak values and timing of longitudinal strain (SL), strain rate (SrL), velocity (VL), and displacement (DL) were measured in 4 LV wall segments. The inter- and intraobserver within- and between-day variability was assessed by calculating the coefficients of variation for repeated measurements. Results: 2DST analysis was feasible in each exam. The variability of peak systolic values and peak timing was low to moderate, whereas peak diastolic values showed a higher variability. Significant segmental differences were demonstrated. DL and VL presented a prominent base-to-midwall gradient. SL and SrL values were similar in all segments except the basal septal segment, which showed a significantly lower peak SL occurring about 60 ms later compared with the other segments. Conclusions and Clinical Importance 2DST is a reliable technique for measuring systolic LV longitudinal motion in healthy horses. This study provides preliminary reference values, which can be used when evaluating the technique in a clinical setting

Cardiac troponin I as compared to troponin T for the detection of myocardial damage in horses

Background: Different cardiac troponin I (cTnI) assays give different results. Only 1 manufacturer has marketed troponin T (cTnT) assays. Therefore, cTnT often is preferred for detection of myocardial infarction in human patients. Studies of cTnT in horses are limited. Objectives: To compare a cTnI and a high-sensitive cTnT assay (hs-cTnT) in horses. Animals: Cardiac troponin I and cTnT were determined in 35 healthy horses (group 1), 23 horses suspected to have primary myocardial damage (group 2a), and 41 horses with secondary myocardial damage caused by structural heart disease (group 2b). Methods: All cTnI samples were analyzed at laboratory A (limit of detection [LOD]: 0.03 ng/mL), whereas cTnT samples were analyzed at 2 laboratories with the same hs-cTnT assay (laboratory B, LOD: 10.0 pg/mL; laboratory C, LOD: 4.0 pg/mL). Results: The median cTnI concentration in group 2a (0.90 ng/mL; range, 0.03–58.27 ng/mL) was significantly higher (P < .001) than in group 1 (0.03 ng/mL; range, 0.03–0.09 ng/mL) or group 2b (0.05 ng/mL; range, 0.03–30.92 ng/mL), and the optimal cut-off for detection of primary myocardial damage was 0.095 ng/mL (sensitivity: 90.5%, specificity: 100%). Using an LOD of 10.0 pg/mL for all cTnT samples, a cut-off value of 10.5 pg/mL was found, but sensitivity was low (42.9%). When only samples analyzed at laboratory C (n = 58) were included, a cut-off of 6.6 pg/mL was found (sensitivity: 81%, specificity: 100%). Conclusions and Clinical Importance: Despite large quantitative differences, cTnI and cTnT are both useful for detection of myocardial damage in horses

The use of cardiac biomarkers in veterinary medicine: the equine perspective

In human medicine, cardiac biomarkers, such as natriuretic peptides and troponins, are routinely used for the diagnosis, prognosis and monitoring of heart diseases. Similarly, these biomarkers are determined in small animals to differentiate non-cardiac from cardiac diseases. Knowledge about these biomarkers in horses is limited and requires further investigation. The first equine studies about atrial natriuretic peptide (ANP) and N-terminal ANP (NT-proANP) are promising, and show a clear correlation with atrial dimension size. Equine brain natriuretic peptides assays are still unavailable. The troponins, in particular troponin I, have been more extensively studied in horses, and their use for the diagnosis of myocardial damage has been fully demonstrated. They have replaced the less specific lactate dehydrogenase and creatine kinase isoenzymes, which makes the use of the last mentioned no longer legitimate. A final possible equine biomarker is aldosterone. Reference values in horses have been established. However, in only one study, a correlation between aldosterone and cardiac disease has been reported