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Background: Patients with advanced incurable cancer face difficult decisions about palliative treatment options towards their end of life. However, they are often not provided with the appropriate information and support that is needed to make informed decisions. This review aimed to identify contexts and mechanisms associated with communication tools, patient decision-aids and shared decision-making (SDM) approaches that influence patient outcomes., Methods: We used a realist review method to search for published studies of patients (adults > 18) with advanced cancer who were expected to make a decision about palliative treatment and/or supportive care in consultation with healthcare practitioners. We appraised and synthesised literature describing the contexts of (when and how) decision aids and SDM approaches are used, and how these contexts interact with mechanisms (resources and reasoning) which impact patient outcomes. Stakeholders including academics, palliative healthcare professionals (HCPs) and people with lived experience of supporting people with advanced incurable cancer contributed to identifying explanatory accounts. These accounts were documented, analysed and consolidated to contribute to the development of a programme theory., Results: From the 33 included papers, we consolidated findings into 20 explanatory accounts to develop a programme theory that explains key contexts and mechanisms that influence patient and SDM. Contexts include underlying patients' and HCPs' attitudes and approaches. These need to be understood in relation to key mechanisms, including presenting information in multiple formats and providing adequate time and opportunities to prepare for and revisit decisions. Contexts influenced mechanisms which then influence the levels of patient decisional satisfaction, conflict and regret., Conclusions: Our programme theory highlights mechanisms that are important in supporting shared treatment decisions for advanced noncurative cancer. The findings are informative for developing and evaluating interventions to improve understanding and involvement in SDM for patients with advanced incurable cancer., Patient and Public Contribution: We included patient and public involvement (PPI) representatives in four stakeholder meetings. PPI helped to define the scope of the review, identify their unique experiences and perspectives, synthesise their perspectives with our review findings, make decisions about which theories we included in our programme theory and develop recommendations for policy and practice and future research., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Contrast media in CT is widely used in dogs and cats to provide superior tissue delineation and increase the diagnostic capabilities. These contrast-enhanced imaging techniques are gaining popularity in rabbits; published studies reporting the safety of doing so are lacking., Methods: This retrospective observational study aimed to determine the incidence of adverse events following the intravenous administration of iodinated non-ionic contrast medium in 350 rabbits. The medical records of this subset of rabbits admitted between January 2009 and November 2018, that underwent CT examination and received intravenous contrast media, were evaluated., Results: From the 350 rabbits, 342 rabbits were still alive 7 days after the scan. A total of eight rabbits died within 7 days of the scan, seven of which within the first 24 h. All deaths were presumed to be sequelae to the diseases they were being investigated for and not thought to be related to the administration of intravenous contrast medium., Conclusions: The results indicated that the use of intravenous non-iodinated contrast medium was well tolerated and safe in rabbits undergoing conscious CT examination., Competing Interests: The authors declare they have no conflicts of interest., (© 2022 The Authors. Veterinary Record Open published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Ear disease, involving the middle and external ear, is commonly reported in pet rabbits, with lop-eared breeds predisposed. CT is the most reliable imaging modality for identifying otitis media (OM) in rabbits. This study aimed to develop a CT-based grading scale to classify the severity of CT changes in rabbits with presumed OM. Three observers independently reviewed CT images of 36 rabbits with OM. For both OM and material within the external ear canal, a grade of I to IV was used, (I=mild, IV=severe disease) and the level of agreement between reviewers was statistically evaluated. The study demonstrated that grades from the three reviewers showed a strong level of interobserver agreement. Comparisons between clinical signs and CT grade were also evaluated. Rabbits with grade IV OM had a high grade of material in the external ear canal. A high proportion of rabbits (83 per cent) underwent CT scanning conscious, demonstrating that diagnostic quality CT images are achievable without the need for anaesthetic intervention, minimising patient risk. This novel CT-based grading scale provides a methodology to correlate grade of disease with clinical signs, ear canal cytology, predisposing factors, treatment options and outcomes for rabbits with ear disease., Competing Interests: Competing interests: None declared., (© British Veterinary Association 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Late-onset Pompe disease (LOPD) is a rare, multisystem disorder that is well established to mainly impair skeletal muscle function. Systematic studies exploring brain functions in LOPD are lacking. The aim of this study was to detect morphological and functional brain alterations as well as neuropsychological impairment in LOPD., Methods: We studied 21 patients (10 male, mean age 49 ± 18.4 years) with defined diagnosis of LOPD, divided into two groups: one with pre-symptomatic hyperCKemia with no muscle weakness and the second with limb-girdle muscle weakness. All patients underwent 3T magnetic resonance imaging (MRI) to obtain morphological/angiographic evaluation as well as normalized cortical brain volume and resting-state functional MRI. Fazekas score was applied to quantify white matter lesions, whereas Smoker's criteria were used to examine dolichoectasia. A complete neuropsychological assessment was performed., Results: The MRI data showed that 12/21 patients (57%) demonstrated signs of cerebral vasculopathy, with a Fazekas score >2 in 67%. According to Smoker's criteria, 11/21 patients (52%) had a dolichoectasia of the vertebrobasilar system; an intracranial aneurysm was detected in 3/21 patients (14%). Resting-state functional MRI demonstrated significantly decreased brain connectivity in the salience network with a more relevant reduction in the bilateral middle and superior frontal gyrus. Gray matter atrophy correlated with age and disease duration. A mild impairment in executive functions was also identified., Conclusions: In this LOPD cohort the results showed morphological and functional brain alterations with mild neuropsychological dysfunction, mainly in the limb-girdle muscle weakness group. Cerebrovascular alterations seemed to be not related to common risk factors, suggesting a major role of enzymatic deficiency in the pathogenesis of brain abnormalities., (© 2018 EAN.)