PICO question In dogs with snakebites does the use of antimicrobials compared to no antimicrobials reduce incidence of wound infection? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Seven case series. Strength of evidence Weak. Outcomes reported Three studies looked at the incidence of wound infection in envenomated dogs, three compared antimicrobial use to mortality and one compared other outcomes, such as time in hospital. The incidence of wound infection was low in the studies and overall antimicrobials seemed to have no significant effect on outcomes such as survival or wound infection. Therefore, the routine use of antimicrobials for snakebite treatment is not supported by the results, however further studies are required to provide conclusive evidence. Conclusion There is currently insufficient evidence from literature to either support or reject the use of antimicrobials in the treatment of snakebites. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
{"title":"In dogs with snakebites does the use of antimicrobials compared to no antimicrobials reduce incidence of wound infection?","authors":"M. Ballman, David S. Messina","doi":"10.18849/ve.v8i3.513","DOIUrl":"https://doi.org/10.18849/ve.v8i3.513","url":null,"abstract":"PICO question\u0000In dogs with snakebites does the use of antimicrobials compared to no antimicrobials reduce incidence of wound infection?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000Seven case series.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000Three studies looked at the incidence of wound infection in envenomated dogs, three compared antimicrobial use to mortality and one compared other outcomes, such as time in hospital. The incidence of wound infection was low in the studies and overall antimicrobials seemed to have no significant effect on outcomes such as survival or wound infection. Therefore, the routine use of antimicrobials for snakebite treatment is not supported by the results, however further studies are required to provide conclusive evidence.\u0000Conclusion\u0000There is currently insufficient evidence from literature to either support or reject the use of antimicrobials in the treatment of snakebites.\u0000 \u0000How to apply this evidence in practice\u0000The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.\u0000Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114287468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PICO question In dogs with acute abdominal signs is radiography or ultrasonography superior at detecting surgical patients with intestinal obstructions? Clinical bottom line Category of research Diagnosis. Number and type of study designs reviewed Six relevant studies were identified and reviewed, all diagnostic validity studies. Four had cross sectional designs in place and two have a prospective cohort study design. Strength of evidence Moderate. Outcomes reported All studies showed that ultrasound and radiography were useful in the diagnosis of small intestinal obstruction in dogs. One study with moderate evidence showed that ultrasound is superior to three-view abdominal radiography for diagnosing small intestinal mechanical obstructions in dogs with acute vomiting (p = 0.013). Most of the studies suggested that ultrasound might be more accurate than radiography at detecting surgical patients with intestinal obstructions, but no sufficient evidence was reported. In some studies, the results are too similar for a statistically significant difference to be claimed without further investigation. All studies suggest that the experience of the person who performs or estimates the diagnostic imaging studies can affect the accuracy of each technique, but no statistical comparisons were made to support this hypothesis. Conclusion The results of these studies suggest that both techniques are helpful in the diagnosis of small intestinal obstructions in dogs. There are limitations on each technique and factors that can affect accuracy, like the level of training and expertise but more studies are needed to estimate that. Future studies should focus on the comparison of results when ultrasonography is performed in a general practice setting and knowledge base rather than specialists. The majority of studies included in this summary suggest that ultrasound is generally superior if only one modality can be used, but this is mostly based on weak evidence and further investigations to confirm statistical significance are needed. Considering that all studies were performed by diagnostic imaging experts, the only conclusion that can be safely made is that abdominal ultrasound is superior to three-view abdominal radiographs for diagnosing small intestinal mechanical obstructions in dogs with acute vomiting. Additionally it suggests this modality combined with a good level of training on ultrasonography interpretation or, if possible, cooperation with an expert to get the most out of this tool while treating future patients with relevant issues. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making.
{"title":"Is radiography or ultrasonography superior at detecting intestinal obstructions in dogs with acute abdominal signs?","authors":"Josephine Corrick","doi":"10.18849/ve.v8i2.483","DOIUrl":"https://doi.org/10.18849/ve.v8i2.483","url":null,"abstract":"PICO question\u0000In dogs with acute abdominal signs is radiography or ultrasonography superior at detecting surgical patients with intestinal obstructions?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Diagnosis.\u0000Number and type of study designs reviewed\u0000Six relevant studies were identified and reviewed, all diagnostic validity studies. Four had cross sectional designs in place and two have a prospective cohort study design.\u0000Strength of evidence\u0000Moderate.\u0000Outcomes reported\u0000All studies showed that ultrasound and radiography were useful in the diagnosis of small intestinal obstruction in dogs. One study with moderate evidence showed that ultrasound is superior to three-view abdominal radiography for diagnosing small intestinal mechanical obstructions in dogs with acute vomiting (p = 0.013). Most of the studies suggested that ultrasound might be more accurate than radiography at detecting surgical patients with intestinal obstructions, but no sufficient evidence was reported. In some studies, the results are too similar for a statistically significant difference to be claimed without further investigation. All studies suggest that the experience of the person who performs or estimates the diagnostic imaging studies can affect the accuracy of each technique, but no statistical comparisons were made to support this hypothesis.\u0000Conclusion\u0000The results of these studies suggest that both techniques are helpful in the diagnosis of small intestinal obstructions in dogs. There are limitations on each technique and factors that can affect accuracy, like the level of training and expertise but more studies are needed to estimate that. Future studies should focus on the comparison of results when ultrasonography is performed in a general practice setting and knowledge base rather than specialists. The majority of studies included in this summary suggest that ultrasound is generally superior if only one modality can be used, but this is mostly based on weak evidence and further investigations to confirm statistical significance are needed. Considering that all studies were performed by diagnostic imaging experts, the only conclusion that can be safely made is that abdominal ultrasound is superior to three-view abdominal radiographs for diagnosing small intestinal mechanical obstructions in dogs with acute vomiting. Additionally it suggests this modality combined with a good level of training on ultrasonography interpretation or, if possible, cooperation with an expert to get the most out of this tool while treating future patients with relevant issues.\u0000 \u0000How to apply this evidence in practice\u0000The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.\u0000Knowledge Summaries are a resource to help reinforce or inform decision making.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"59 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114022495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PICO question In dogs suffering from degenerative lumbosacral stenosis (DLSS), is surgical treatment more effective than nonsurgical therapy in reducing lumbosacral pain and neurological dysfunction in the long-term? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Two papers were critically reviewed. They were prospective and retrospective studies. Strength of evidence Weak. Outcomes reported Besides the two studies, there are no other studies currently available that directly compare long-term clinical outcome of patients that have undergone nonsurgical and surgical treatment respectively. In the study comparing clinical outcome of nonsurgical treatment by epidural steroid injection (ESI) and surgical treatment of degenerative lumbosacral stenosis, dogs were classified into clinical severity groups ranging from mild to moderate to severe. Mild cases demonstrated degenerative lumbosacral stenosis (DLSS) compatible clinical signs such as lumbosacral pain, reluctance to climb stairs / jump / raise up, lameness and muscle atrophy but no neurological deficits. Moderate cases presented DLSS compatible clinical signs in combination with neurological deficits such as reduced flexor withdrawal, proprioceptive deficits and nerve root signature. Severe cases demonstrated DLSS compatible clinical signs with more severe neurological deficits such as tail paresis and absent perineal reflex. Clinical outcomes were considered complete if clinical signs had resolved at follow-up consultations, partial if there was substantial but incomplete improvement in clinical signs and failed if the dog did not improve or deteriorated further. Improvements in patient condition were measured in terms of clinical outcome grading which is in relation to the initial clinical severity group assigned to each dog. Improvement after single dose of ESI was seen in 27/32 dogs, with 17/22 (after accounting for four dogs whose owners have refused further treatment, five dogs lost to follow-up after re-check as well as one dog whose owners have opted for repeated ESI instillations) relapsing within 6 months. All 17 of these dogs that suffered a relapse after single ESI subsequently underwent surgical treatment and demonstrated improvement in clinical signs, with a complete response seen in eight dogs and a partial response seen in nine dogs. In the study comparing clinical outcome of conservative treatment of exercise restriction with phenylbutazone administration and surgical treatment of degenerative lumbosacral stenosis, outcomes were classified as good in dogs that regained preoperative activity levels; acceptable in dogs with persistent abnormality or requiring continued medication though otherwise active, and poor in all other cases. Out of 16 dogs treated surgically, 11 were treated by dorsal lumbosacral laminectomy and excision of the dorsal portion of the lumbosacral disc, while the other five had additional unilateral facetectom
{"title":"Comparing clinical outcomes of dogs suffering from degenerative lumbosacral stenosis upon surgical or nonsurgical treatment","authors":"K. Goh","doi":"10.18849/ve.v8i2.575","DOIUrl":"https://doi.org/10.18849/ve.v8i2.575","url":null,"abstract":"PICO question\u0000In dogs suffering from degenerative lumbosacral stenosis (DLSS), is surgical treatment more effective than nonsurgical therapy in reducing lumbosacral pain and neurological dysfunction in the long-term?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000Two papers were critically reviewed. They were prospective and retrospective studies.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000Besides the two studies, there are no other studies currently available that directly compare long-term clinical outcome of patients that have undergone nonsurgical and surgical treatment respectively.\u0000In the study comparing clinical outcome of nonsurgical treatment by epidural steroid injection (ESI) and surgical treatment of degenerative lumbosacral stenosis, dogs were classified into clinical severity groups ranging from mild to moderate to severe. Mild cases demonstrated degenerative lumbosacral stenosis (DLSS) compatible clinical signs such as lumbosacral pain, reluctance to climb stairs / jump / raise up, lameness and muscle atrophy but no neurological deficits. Moderate cases presented DLSS compatible clinical signs in combination with neurological deficits such as reduced flexor withdrawal, proprioceptive deficits and nerve root signature. Severe cases demonstrated DLSS compatible clinical signs with more severe neurological deficits such as tail paresis and absent perineal reflex. Clinical outcomes were considered complete if clinical signs had resolved at follow-up consultations, partial if there was substantial but incomplete improvement in clinical signs and failed if the dog did not improve or deteriorated further. Improvements in patient condition were measured in terms of clinical outcome grading which is in relation to the initial clinical severity group assigned to each dog. Improvement after single dose of ESI was seen in 27/32 dogs, with 17/22 (after accounting for four dogs whose owners have refused further treatment, five dogs lost to follow-up after re-check as well as one dog whose owners have opted for repeated ESI instillations) relapsing within 6 months. All 17 of these dogs that suffered a relapse after single ESI subsequently underwent surgical treatment and demonstrated improvement in clinical signs, with a complete response seen in eight dogs and a partial response seen in nine dogs.\u0000In the study comparing clinical outcome of conservative treatment of exercise restriction with phenylbutazone administration and surgical treatment of degenerative lumbosacral stenosis, outcomes were classified as good in dogs that regained preoperative activity levels; acceptable in dogs with persistent abnormality or requiring continued medication though otherwise active, and poor in all other cases. Out of 16 dogs treated surgically, 11 were treated by dorsal lumbosacral laminectomy and excision of the dorsal portion of the lumbosacral disc, while the other five had additional unilateral facetectom","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130366011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PICO question In dogs with cranial cruciate ligament disease, is conservative non-surgical treatment as effective as surgical treatment with the lateral fabellotibial suture technique in reducing time to recovery? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed One retrospective study. Strength of evidence Zero. Outcomes reported There is no evidence that surgical treatment with the lateral fabellotibial suture (LFTS) reduces time to recovery compared to conservative treatment in dogs with cranial cruciate ligament disease. Conclusion In dogs with cranial cruciate ligament disease there is no statistical evidence to support recommendation of surgical treatment with the LFTS technique compared to conservative treatment in reducing time to recovery. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
{"title":"In canine cranial cruciate ligament disease, are conservative treatment and lateral fabellotibial suture recoveries comparable?","authors":"Tafara Mapuvire","doi":"10.18849/ve.v8i2.612","DOIUrl":"https://doi.org/10.18849/ve.v8i2.612","url":null,"abstract":"PICO question\u0000In dogs with cranial cruciate ligament disease, is conservative non-surgical treatment as effective as surgical treatment with the lateral fabellotibial suture technique in reducing time to recovery?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000One retrospective study.\u0000Strength of evidence\u0000Zero.\u0000Outcomes reported\u0000There is no evidence that surgical treatment with the lateral fabellotibial suture (LFTS) reduces time to recovery compared to conservative treatment in dogs with cranial cruciate ligament disease.\u0000Conclusion\u0000In dogs with cranial cruciate ligament disease there is no statistical evidence to support recommendation of surgical treatment with the LFTS technique compared to conservative treatment in reducing time to recovery.\u0000 \u0000How to apply this evidence in practice\u0000The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.\u0000Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"182 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131643200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Three papers were critically reviewed. One was a prospective, randomised, blinded observational study, another was a randomised, placebo-controlled clinical trial, and the last was a non-randomised prospective, open-label clinical trial. Strength of evidence Weak. Outcomes reported The administration of trazodone to hospitalised dogs reduced several observed stress related behaviours compared to a control group that was environmentally matched to the treatment group (Gilbert-Gregory et al., 2016). In dogs subjected to postsurgical confinement at home, trazodone administration was not more effective at reducing stress related behaviours compared with a placebo in one study (Gruen et al., 2017); however, it was effective when observed in a non-placebo controlled clinical trial (Gruen et al., 2014). Further investigation with a larger sample size would assist in strengthening the evidence of an association between trazodone administration and a reduction in the behavioural signs of stress in dogs. Conclusion The available evidence weakly supports the hypothesis that administration of trazodone is an effective treatment in reducing stress related behaviours in hospitalised dogs and dogs confined post-surgery, and further studies are required to confirm its efficacy. The quality of the evidence when hospitalised dogs was studied was moderate (Gilbert-Gregory et al., 2016), however in dogs studied that were confined postsurgery, the evidence is weaker (Gruen et al., 2014; Gruen et al., 2017). Different trazodone doses were evaluated in the studies and so further studies focusing on dose effects are required to determine appropriate dose rates. Further studies also need to be conducted to evaluate the appropriate length of time that trazodone should be given prior to a stressful event, as well as whether trazodone needs to be used in conjunction with other anxiolytic drugs to optimise efficacy. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
临床底线研究类别治疗。审查的研究设计的数量和类型3篇论文被严格审查。一项是前瞻性、随机、盲法观察性研究，另一项是随机、安慰剂对照临床试验，最后一项是非随机、前瞻性、开放标签临床试验。证据强度:弱。结果报告:与环境与治疗组相匹配的对照组相比，给住院狗服用曲唑酮减少了几种观察到的压力相关行为(Gilbert-Gregory et al.， 2016)。在一项研究中，对于在家接受手术后禁闭的狗，曲唑酮在减少压力相关行为方面并不比安慰剂更有效(Gruen et al.， 2017);然而，在非安慰剂对照临床试验中观察到它是有效的(Gruen et al.， 2014)。更大样本量的进一步调查将有助于加强曲唑酮服用与减少狗的压力行为迹象之间联系的证据。结论曲唑酮能有效降低住院犬和术后受限犬的应激相关行为，尚需进一步研究证实。研究住院犬时的证据质量中等(Gilbert-Gregory et al.， 2016)，但在研究术后受限犬时，证据质量较弱(Gruen et al.， 2014;Gruen等人，2017)。研究中评估了不同的曲唑酮剂量，因此需要进一步研究剂量效应，以确定适当的剂量率。还需要进行进一步的研究，以评估在应激事件发生前曲唑酮应给予的适当时间长度，以及曲唑酮是否需要与其他抗焦虑药物联合使用以优化疗效。如何将证据应用于实践应考虑多种因素，不限于:个人临床专业知识、患者的情况和所有者的价值观、您工作的国家、地点或诊所、您面前的个案、治疗方法和资源的可用性。知识摘要是帮助加强或告知决策的资源。他们不会凌驾于从业者的责任或判断之上，去做对他们照顾的动物最好的事情。
{"title":"The efficacy of trazodone in reducing stress related behaviours in hospitalised dogs or dogs confined postsurgery","authors":"Lara Dillon","doi":"10.18849/ve.v8i2.550","DOIUrl":"https://doi.org/10.18849/ve.v8i2.550","url":null,"abstract":"Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000Three papers were critically reviewed. One was a prospective, randomised, blinded observational study, another was a randomised, placebo-controlled clinical trial, and the last was a non-randomised prospective, open-label clinical trial.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000The administration of trazodone to hospitalised dogs reduced several observed stress related behaviours compared to a control group that was environmentally matched to the treatment group (Gilbert-Gregory et al., 2016). In dogs subjected to postsurgical confinement at home, trazodone administration was not more effective at reducing stress related behaviours compared with a placebo in one study (Gruen et al., 2017); however, it was effective when observed in a non-placebo controlled clinical trial (Gruen et al., 2014). Further investigation with a larger sample size would assist in strengthening the evidence of an association between trazodone administration and a reduction in the behavioural signs of stress in dogs.\u0000Conclusion\u0000The available evidence weakly supports the hypothesis that administration of trazodone is an effective treatment in reducing stress related behaviours in hospitalised dogs and dogs confined post-surgery, and further studies are required to confirm its efficacy. The quality of the evidence when hospitalised dogs was studied was moderate (Gilbert-Gregory et al., 2016), however in dogs studied that were confined postsurgery, the evidence is weaker (Gruen et al., 2014; Gruen et al., 2017). Different trazodone doses were evaluated in the studies and so further studies focusing on dose effects are required to determine appropriate dose rates. Further studies also need to be conducted to evaluate the appropriate length of time that trazodone should be given prior to a stressful event, as well as whether trazodone needs to be used in conjunction with other anxiolytic drugs to optimise efficacy.\u0000 \u0000How to apply this evidence in practice\u0000The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.\u0000Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115250329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective Explore the value of musculoskeletal ultrasound in detecting cruciate ligament pathology Background Partial tears of the cranial cruciate ligament (CCL) can be difficult to diagnose due to the lack of instability present on orthopedic examination. Advanced diagnostics would be required for further evaluation. While a common tool in human medicine, MRI is of limited use in canines due to cost and the need for general anesthesia. Musculoskeletal ultrasound (MSK-US) can be performed without anesthesia but there are no current studies to date evaluating its usefulness in detecting partial tears of the cruciate ligaments Evidentiary value This is a retrospective case series (n=32) of dogs that underwent diagnostic MSK-US of the stifle who later had a surgical procedure (stifle arthroscopy/arthrotomy) to evaluate the intra-articular space. Methods Medical records were evaluated between May 2014 - April 2020 for canines with clinically stable stifles that underwent both an MSK-US of the stifle followed by stifle surgery. Ultrasound findings of the CCL were compared to surgical findings (considered gold standard). Results Compared to arthroscopy, ultrasound was a very sensitive test in detecting CCL pathology however it is less specific. Its sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 100%, 58.3%, 81.5%, and 100% respectively. Conclusion MSK-US is a non-invasive test that can be performed with little to no sedation. Using a high frequency 18-5MHz linear transducer, MSK-US is a sensitive test for detecting partial CCL injuries in dogs and may aid in its diagnosis for canines without stifle instability and be useful in guiding treatment. As it is less specific, arthroscopy would be necessary to further confirm the intra-articular pathology. Application Diagnostic MSK-US is a non-invasive tool that can be used to detect CCL pathology in the stifle. Its application can help guide treatment recommendations prior to a more invasive diagnostic/therapeutic procedure such as surgery or arthroscopy.
{"title":"Ultrasonographic detection of cranial cruciate ligament pathology in canine stifles without cranio-caudal instability","authors":"Helen Tsoi, S. Canapp, D. Canapp","doi":"10.18849/ve.v8i2.632","DOIUrl":"https://doi.org/10.18849/ve.v8i2.632","url":null,"abstract":"Objective\u0000Explore the value of musculoskeletal ultrasound in detecting cruciate ligament pathology \u0000Background\u0000Partial tears of the cranial cruciate ligament (CCL) can be difficult to diagnose due to the lack of instability present on orthopedic examination. Advanced diagnostics would be required for further evaluation. While a common tool in human medicine, MRI is of limited use in canines due to cost and the need for general anesthesia. Musculoskeletal ultrasound (MSK-US) can be performed without anesthesia but there are no current studies to date evaluating its usefulness in detecting partial tears of the cruciate ligaments\u0000Evidentiary value\u0000This is a retrospective case series (n=32) of dogs that underwent diagnostic MSK-US of the stifle who later had a surgical procedure (stifle arthroscopy/arthrotomy) to evaluate the intra-articular space.\u0000Methods\u0000Medical records were evaluated between May 2014 - April 2020 for canines with clinically stable stifles that underwent both an MSK-US of the stifle followed by stifle surgery. Ultrasound findings of the CCL were compared to surgical findings (considered gold standard).\u0000Results\u0000Compared to arthroscopy, ultrasound was a very sensitive test in detecting CCL pathology however it is less specific. Its sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 100%, 58.3%, 81.5%, and 100% respectively.\u0000Conclusion\u0000MSK-US is a non-invasive test that can be performed with little to no sedation. Using a high frequency 18-5MHz linear transducer, MSK-US is a sensitive test for detecting partial CCL injuries in dogs and may aid in its diagnosis for canines without stifle instability and be useful in guiding treatment. As it is less specific, arthroscopy would be necessary to further confirm the intra-articular pathology.\u0000Application\u0000Diagnostic MSK-US is a non-invasive tool that can be used to detect CCL pathology in the stifle. Its application can help guide treatment recommendations prior to a more invasive diagnostic/therapeutic procedure such as surgery or arthroscopy.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114407149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unfortunately the original version of the article was missing the following statement. This Knowledge Summary has reviewed the available evidence on the use of a SGAD (v-gel®) in rabbit anaesthesia. Since writing a new design of a single use supraglottic airway device (SGAD) has been introduced; currently there is no published evidence on whether this new device has an impact on the risk of injury. This error was in both the HTML and PDF versions. This has now been updated in both the HTML and PDF versions, and can be found in the clinical bottom line and the evidence section.
{"title":"Erratum to: Does the use of supraglottic device in rabbits cause less injury than other airway management devices?","authors":"Jasmine Gheini, S. Zaki","doi":"10.18849/ve.v8i2.663","DOIUrl":"https://doi.org/10.18849/ve.v8i2.663","url":null,"abstract":"Unfortunately the original version of the article was missing the following statement.\u0000This Knowledge Summary has reviewed the available evidence on the use of a SGAD (v-gel®) in rabbit anaesthesia. Since writing a new design of a single use supraglottic airway device (SGAD) has been introduced; currently there is no published evidence on whether this new device has an impact on the risk of injury.\u0000This error was in both the HTML and PDF versions. This has now been updated in both the HTML and PDF versions, and can be found in the clinical bottom line and the evidence section.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129826790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Category of research Treatment. Number and type of study designs reviewed Two relevant publications were found, both were retrospective case series. Strength of evidence Weak. Outcomes reported The success rate of horses returning to previous level of competition following arthroscopic debridement varies widely in the literature available, from 25–86%. While a study reports 64% return to soundness following rest, it is not clear which horses received strict box rest or paddock rest, the duration of the rest period, and whether non-steroidal anti-inflammatory drugs were also prescribed. It is also worth noting that all horses which undergo surgery will also undergo a period of box rest – which makes the two treatment options difficult to compare. Conclusion Newer techniques with better success rates are now available and should be considered in lieu of box rest or arthroscopic debridement. Across all treatments available, age remains an important factor with regards to return to soundness, with older horses having a poorer prognosis. Thorough examinations should therefore be performed to rule out concurrent conditions before deciding upon treatment options. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
{"title":"Box rest and analgesia compared to arthroscopic debridement for lame horses with hindlimb subchondral lucencies","authors":"C. Taylor, J. Dubuc","doi":"10.18849/ve.v8i2.603","DOIUrl":"https://doi.org/10.18849/ve.v8i2.603","url":null,"abstract":"Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000Two relevant publications were found, both were retrospective case series.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000The success rate of horses returning to previous level of competition following arthroscopic debridement varies widely in the literature available, from 25–86%. While a study reports 64% return to soundness following rest, it is not clear which horses received strict box rest or paddock rest, the duration of the rest period, and whether non-steroidal anti-inflammatory drugs were also prescribed. It is also worth noting that all horses which undergo surgery will also undergo a period of box rest – which makes the two treatment options difficult to compare.\u0000Conclusion\u0000Newer techniques with better success rates are now available and should be considered in lieu of box rest or arthroscopic debridement. Across all treatments available, age remains an important factor with regards to return to soundness, with older horses having a poorer prognosis. Thorough examinations should therefore be performed to rule out concurrent conditions before deciding upon treatment options.\u0000How to apply this evidence in practice\u0000The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.\u0000Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129843243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Haddock, S. Baillie, Ellie Sellers, S. Warman
An evidence-based veterinary medicine (EBVM) training resource, ‘EBVM Learning’, was created in 2015 and updated in 2019. Following feedback from users, it was decided that a more concise practitioner-focused version was needed. Seven online focus groups, with a total of 22 veterinary practitioners, explored the motivations of practitioners to engage with EBVM. They considered the challenges and barriers to implementing EBVM in practice, and specific supportive measures they felt would increase adoption of EBVM in practice. Participants identified time, support from colleagues and management, and accessing and appraising evidence as being the most important challenges and barriers to the use of EBVM in general practice. However, the value of EBVM was appreciated, and there was an appetite amongst the participants to utilise more EBVM to inform their clinical decision-making. At a workshop attended by experts in EBVM, educators and practitioners, the results of the focus groups were presented and discussed to inform the development of a new online training resource. This study has been used to produce ‘EBVM for Practitioners’, to attempt to reduce some of the barriers and challenges faced by practitioners and support them in increasing their use of EBVM. Further work by the leaders in the veterinary profession will be needed to expand and improve the quality of the evidence base on which EBVM relies, and to ensure practitioners have the skills, access, and motivation to utilise it.
{"title":"Exploring the motivations, challenges, and barriers for implementing evidence-based veterinary medicine (EBVM) in general practice","authors":"Laura Haddock, S. Baillie, Ellie Sellers, S. Warman","doi":"10.18849/ve.v8i1.602","DOIUrl":"https://doi.org/10.18849/ve.v8i1.602","url":null,"abstract":"An evidence-based veterinary medicine (EBVM) training resource, ‘EBVM Learning’, was created in 2015 and updated in 2019. Following feedback from users, it was decided that a more concise practitioner-focused version was needed.\u0000Seven online focus groups, with a total of 22 veterinary practitioners, explored the motivations of practitioners to engage with EBVM. They considered the challenges and barriers to implementing EBVM in practice, and specific supportive measures they felt would increase adoption of EBVM in practice. Participants identified time, support from colleagues and management, and accessing and appraising evidence as being the most important challenges and barriers to the use of EBVM in general practice. However, the value of EBVM was appreciated, and there was an appetite amongst the participants to utilise more EBVM to inform their clinical decision-making.\u0000At a workshop attended by experts in EBVM, educators and practitioners, the results of the focus groups were presented and discussed to inform the development of a new online training resource.\u0000This study has been used to produce ‘EBVM for Practitioners’, to attempt to reduce some of the barriers and challenges faced by practitioners and support them in increasing their use of EBVM. Further work by the leaders in the veterinary profession will be needed to expand and improve the quality of the evidence base on which EBVM relies, and to ensure practitioners have the skills, access, and motivation to utilise it.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127278793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Question In sea turtles presenting for cold-stunning (sustained hypothermia), what blood analytes routinely evaluated at intake provide the most prognostic value? Clinical bottom line Category of research question Prognosis. The number and type of study designs reviewed Ten studies were included in this evaluation including the following study designs: eight retrospective case series, one cross-sectional, and one retrospective cohort. Strength of evidence Weak. Outcomes reported The most consistent finding across all included studies in cold-stunned sea turtles was acidosis (suspected both respiratory or metabolic components) characterised by reduced blood pH, elevated partial pressure of carbon dioxide (pCO2), and reduced partial pressure of oxygen (pO2). However, this finding was not necessarily linked with failure of rehabilitation. Rather, sea turtles presenting for cold-stunning that did not survive rehabilitative therapy were typically in extreme states of homeostatic derangement involving acidosis, but often in conjunction with additional abnormalities (e.g. anaemia, sepsis, organ failure or dysfunction, pneumonia, etc.). Conclusion As might be expected, the evaluated literature did not reveal a single or series of blood analytes that were definitively linked with the success or failure of rehabilitation in sea turtles presenting for cold-stunning. However, they did identify analytes that may provide the most clinical value in this clinical situation including packed cell volume (PCV), estimated white blood cell count (WBC), total and / or ionised calcium, pH, potassium (K), and lactate. Review of the available studies on the topic provides insightful information that can aid clinicians addressing this syndrome to triage and treat affected individuals most effectively. It also elucidated areas of opportunity for further research. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
{"title":"In sea turtles presenting for cold-stunning (sustained hypothermia), what blood analytes routinely evaluated at intake provide the most prognostic value?","authors":"McCaide T. Wooten","doi":"10.18849/ve.v8i1.561","DOIUrl":"https://doi.org/10.18849/ve.v8i1.561","url":null,"abstract":"Question\u0000In sea turtles presenting for cold-stunning (sustained hypothermia), what blood analytes routinely evaluated at intake provide the most prognostic value?\u0000Clinical bottom line\u0000Category of research question\u0000Prognosis.\u0000The number and type of study designs reviewed\u0000Ten studies were included in this evaluation including the following study designs: eight retrospective case series, one cross-sectional, and one retrospective cohort.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000The most consistent finding across all included studies in cold-stunned sea turtles was acidosis (suspected both respiratory or metabolic components) characterised by reduced blood pH, elevated partial pressure of carbon dioxide (pCO2), and reduced partial pressure of oxygen (pO2). However, this finding was not necessarily linked with failure of rehabilitation. Rather, sea turtles presenting for cold-stunning that did not survive rehabilitative therapy were typically in extreme states of homeostatic derangement involving acidosis, but often in conjunction with additional abnormalities (e.g. anaemia, sepsis, organ failure or dysfunction, pneumonia, etc.).\u0000Conclusion\u0000As might be expected, the evaluated literature did not reveal a single or series of blood analytes that were definitively linked with the success or failure of rehabilitation in sea turtles presenting for cold-stunning. However, they did identify analytes that may provide the most clinical value in this clinical situation including packed cell volume (PCV), estimated white blood cell count (WBC), total and / or ionised calcium, pH, potassium (K), and lactate. Review of the available studies on the topic provides insightful information that can aid clinicians addressing this syndrome to triage and treat affected individuals most effectively. It also elucidated areas of opportunity for further research.\u0000 \u0000How to apply this evidence in practice\u0000The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.\u0000Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124147439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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