Tara Freeman, Amelia Wisbey, Kate Burroughs, Samantha Gentle, Connie Ellis, Sarah Batt-Williams
PICO question In cats undergoing midline ovariohysterectomy, is the use of local anaesthesia with bupivacaine via intraperitoneal or subcutaneous injections, in comparison with the use of a control substance or other analgesic measure, associated with a reduction in postoperative pain score? Clinical bottom line The category of research question: Treatment. The number and type of study designs that were critically appraised: Three studies were critically appraised in this Knowledge Summary. They included two prospective, blinded, randomised, controlled clinical trials and one prospective randomised, blinded clinical trial. Strength of evidence: Weak. The outcomes reported: Bupivacaine does not eliminate postoperative pain in cats undergoing ovariohysterectomies; minimal evidence was found to suggest that it was better at reducing postoperative pain scores in comparison to other analgesics. However, bupivacaine may provide analgesic benefits to cats when administered via intraperitoneal or subcutaneous injections as local anaesthesia and in combination with other analgesic agents. The need for postoperative rescue analgesia was minimised when bupivacaine was administered prior to or during the ovariohysterectomy. Conclusion: When compared to a control, pain scores for the participating cats were lower after administration of bupivacaine, however, statistical significance was only reached in one of the studies. Additionally, other medications were found to lower the post operative pain score to a greater effect. However, bupivacaine administration is cheap and simple to perform, so it’s use as part of a multimodal analgesic protocol is supported. Confounding factors within the studies may have altered the perceived effectiveness of the analgesic properties of bupivacaine though, so further investigation involving larger cohorts with standardised controls would be prudent. 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 cats undergoing midline ovariohysterectomy, is the use of local anaesthesia with bupivacaine associated with a reduction in postoperative pain score?","authors":"Tara Freeman, Amelia Wisbey, Kate Burroughs, Samantha Gentle, Connie Ellis, Sarah Batt-Williams","doi":"10.18849/ve.v8i1.552","DOIUrl":"https://doi.org/10.18849/ve.v8i1.552","url":null,"abstract":"PICO question \u0000In cats undergoing midline ovariohysterectomy, is the use of local anaesthesia with bupivacaine via intraperitoneal or subcutaneous injections, in comparison with the use of a control substance or other analgesic measure, associated with a reduction in postoperative pain score?\u0000 \u0000Clinical bottom line\u0000The category of research question:\u0000Treatment.\u0000The number and type of study designs that were critically appraised:\u0000Three studies were critically appraised in this Knowledge Summary. They included two prospective, blinded, randomised, controlled clinical trials and one prospective randomised, blinded clinical trial.\u0000Strength of evidence:\u0000Weak.\u0000The outcomes reported:\u0000Bupivacaine does not eliminate postoperative pain in cats undergoing ovariohysterectomies; minimal evidence was found to suggest that it was better at reducing postoperative pain scores in comparison to other analgesics. However, bupivacaine may provide analgesic benefits to cats when administered via intraperitoneal or subcutaneous injections as local anaesthesia and in combination with other analgesic agents. The need for postoperative rescue analgesia was minimised when bupivacaine was administered prior to or during the ovariohysterectomy.\u0000Conclusion:\u0000When compared to a control, pain scores for the participating cats were lower after administration of bupivacaine, however, statistical significance was only reached in one of the studies. Additionally, other medications were found to lower the post operative pain score to a greater effect. However, bupivacaine administration is cheap and simple to perform, so it’s use as part of a multimodal analgesic protocol is supported. Confounding factors within the studies may have altered the perceived effectiveness of the analgesic properties of bupivacaine though, so further investigation involving larger cohorts with standardised controls would be prudent.\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":"189 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123846150","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}
Abstract Background The first cases of Schmallenberg virus (SBV) infection in the UK were confirmed in congenitally malformed lambs born in South East England in January 2012. Epidemiological studies confirmed that SBV infection could have severe negative impacts on animal welfare and productivity in affected flocks of sheep (Ovis aries), but there was a lack of specific research on the impacts of infection on recorded reproductive performance, animal welfare, financial performance, and farmers’ emotional well-being in some of the first affected early lambing flocks in South West England in 2012 / 2013. Objectives This mixed methods veterinary practice-based descriptive study aimed to describe the clinical signs observed by sheep farmers in the region experiencing outbreaks of disease due to SBV for the first time; to evaluate physical records (quantitative data) on reproductive performance in early lambing flocks prior to and during the affected 2012 / 2013 production year; and to gauge farmers’ perceptions (qualitative interview data and quantitative severity scores) of the impacts of SBV infection on animal welfare, financial performance, and their emotional well-being, and risks of future outbreaks of disease and preventive strategies including SBV vaccination. Evidentiary value This mixed-methods descriptive study reported farmers’ detailed experiences, and recorded and perceived impacts, of SBV infection in six pedigree and purebred flocks in South West England, lambing early between November 2012 and January 2013. Previous surveys were larger than the current study and assessed the impacts of SBV at farm rather than flock level and on a more diverse range of British sheep farms lambing over extended periods; impacts were compared between three categories of farms based on laboratory confirmation or farmers’ suspicions of infection i.e. ‘SBV confirmed’, ‘SBV suspected’ and ‘SBV not suspected’. This study was able to capture and compare the reproductive performance of these flocks in the SBV affected production year in 2012 / 2013 with up to three previous unaffected years; it found variable negative effects of SBV not only on ewe and lambs losses, stillbirths and abortions, levels of dystocia and need for variable levels of assistance to deliver lambs, but also on overall flock reproductive performance, barren rate, lambing percentage and lamb rearing percentage. The qualitative elements of the study enabled new insights into the variable effects of SBV infection in flocks on ewes and lambs and on farmers’ perceptions of the impacts on animal welfare, flock financial performance and their own emotional well-being. The findings suggest previous surveys may not have fully captured the impacts of SBV infection in high value pedigree and purebred early lambing flocks infected for the first time during the second wave of virus circulation and peak midge vector activity in the southwest region in summer and autumn 2012. The findings highlight the
{"title":"Impacts of Schmallenberg virus infection in early lambing sheep flocks following the second wave of virus circulation in South West England in 2012/2013: a mixed-methods descriptive study","authors":"M. Glover, N. Blake, C. Phythian","doi":"10.18849/ve.v8i1.604","DOIUrl":"https://doi.org/10.18849/ve.v8i1.604","url":null,"abstract":"Abstract\u0000Background\u0000The first cases of Schmallenberg virus (SBV) infection in the UK were confirmed in congenitally malformed lambs born in South East England in January 2012. Epidemiological studies confirmed that SBV infection could have severe negative impacts on animal welfare and productivity in affected flocks of sheep (Ovis aries), but there was a lack of specific research on the impacts of infection on recorded reproductive performance, animal welfare, financial performance, and farmers’ emotional well-being in some of the first affected early lambing flocks in South West England in 2012 / 2013.\u0000Objectives\u0000This mixed methods veterinary practice-based descriptive study aimed to describe the clinical signs observed by sheep farmers in the region experiencing outbreaks of disease due to SBV for the first time; to evaluate physical records (quantitative data) on reproductive performance in early lambing flocks prior to and during the affected 2012 / 2013 production year; and to gauge farmers’ perceptions (qualitative interview data and quantitative severity scores) of the impacts of SBV infection on animal welfare, financial performance, and their emotional well-being, and risks of future outbreaks of disease and preventive strategies including SBV vaccination.\u0000Evidentiary value\u0000This mixed-methods descriptive study reported farmers’ detailed experiences, and recorded and perceived impacts, of SBV infection in six pedigree and purebred flocks in South West England, lambing early between November 2012 and January 2013. Previous surveys were larger than the current study and assessed the impacts of SBV at farm rather than flock level and on a more diverse range of British sheep farms lambing over extended periods; impacts were compared between three categories of farms based on laboratory confirmation or farmers’ suspicions of infection i.e. ‘SBV confirmed’, ‘SBV suspected’ and ‘SBV not suspected’. This study was able to capture and compare the reproductive performance of these flocks in the SBV affected production year in 2012 / 2013 with up to three previous unaffected years; it found variable negative effects of SBV not only on ewe and lambs losses, stillbirths and abortions, levels of dystocia and need for variable levels of assistance to deliver lambs, but also on overall flock reproductive performance, barren rate, lambing percentage and lamb rearing percentage. The qualitative elements of the study enabled new insights into the variable effects of SBV infection in flocks on ewes and lambs and on farmers’ perceptions of the impacts on animal welfare, flock financial performance and their own emotional well-being. The findings suggest previous surveys may not have fully captured the impacts of SBV infection in high value pedigree and purebred early lambing flocks infected for the first time during the second wave of virus circulation and peak midge vector activity in the southwest region in summer and autumn 2012. The findings highlight the","PeriodicalId":257905,"journal":{"name":"Veterinary Evidence","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123823302","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 diagnosed with osteoarthritis (OA), how safe is treatment with bedinvetmab, when compared to a placebo and how effective in long-term reduction of the severity of the clinical signs associated with OA-related pain? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Two papers were critically reviewed. One was a randomised, blinded, multi-arm laboratory safety study; the other a multi-center field trial consisting of a block-randomised, double blind, placebo-controlled phase, followed by a non-comparative, open-label case series study. Strength of evidence Weak. Outcomes reported One study rated the reduction of the severity of clinical signs associated with OA pain using owner Canine Brief Pain Inventory (CBPI) ratings and non-validated veterinary clinical assessments (VCAs). Safety was addressed by evaluating adverse health effects (AHEs), concentration of antidrug antibodies (ADAs), and clinical pathology. Significant improvements in pain scores and VCAs were reported in this treatment study. The second safety-only study used clinical observation to evaluate AHEs. Both studies reported AHEs. Conclusion A single study suggests that treatment with bedinvetmab is effective. Two studies support the drug having few AHEs. Both studies have significant design limitations preventing the evaluation of bedinvetmab effectiveness. There is weak / inconclusive evidence for long-term efficacy and short-term safety of OA treatment with bedinvetmab. The decision to use bedinvetmab remains dependent on the judgement and experience of the clinician. 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 diagnosed with osteoarthritis, how safe and effective is long-term treatment with bedinvetmab in providing analgesia?","authors":"K. Kronenberger","doi":"10.18849/ve.v8i1.598","DOIUrl":"https://doi.org/10.18849/ve.v8i1.598","url":null,"abstract":"PICO question\u0000In dogs diagnosed with osteoarthritis (OA), how safe is treatment with bedinvetmab, when compared to a placebo and how effective in long-term reduction of the severity of the clinical signs associated with OA-related pain?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000Two papers were critically reviewed. One was a randomised, blinded, multi-arm laboratory safety study; the other a multi-center field trial consisting of a block-randomised, double blind, placebo-controlled phase, followed by a non-comparative, open-label case series study.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000One study rated the reduction of the severity of clinical signs associated with OA pain using owner Canine Brief Pain Inventory (CBPI) ratings and non-validated veterinary clinical assessments (VCAs). Safety was addressed by evaluating adverse health effects (AHEs), concentration of antidrug antibodies (ADAs), and clinical pathology. Significant improvements in pain scores and VCAs were reported in this treatment study. The second safety-only study used clinical observation to evaluate AHEs. Both studies reported AHEs.\u0000Conclusion\u0000A single study suggests that treatment with bedinvetmab is effective. Two studies support the drug having few AHEs. Both studies have significant design limitations preventing the evaluation of bedinvetmab effectiveness. There is weak / inconclusive evidence for long-term efficacy and short-term safety of OA treatment with bedinvetmab. The decision to use bedinvetmab remains dependent on the judgement and experience of the clinician.\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":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134534552","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 type I immune-mediated polyarthritis (IMPA), is sole treatment with other immunosuppressive agents as effective as treatment with corticosteroids at reducing clinical signs? Clinical bottom line Category of research question Treatment. Number and type of study designs reviews One pragmatic open-label randomised controlled clinical trial. Strength of evidence Weak. Outcomes reported In the single randomised controlled clinical trial reviewed, 7/10 (70%) of dogs in both treatment groups (prednisone or cyclosporine), were reported to have shown resolution of owner-reported symptoms, clinical symptoms and improved locomotor scores and cytologic signs of disease at the end of the 90 day trial period. Of the remaining dogs, 2/3 cyclosporine treated dogs required change to prednisone, and 2/3 prednisone treated dogs required combination therapy to achieve clinical response. Conclusion There is insufficient evidence to support the use of alternative immunosuppressive agents in place of corticosteroids for the treatment of IMPA type I. Further controlled clinical trials are needed before a change to clinical practice can be considered. 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":"Immune-mediated polyarthritis in dogs: Are corticosteroids the best bet?","authors":"Hannah K Walker","doi":"10.18849/ve.v8i1.584","DOIUrl":"https://doi.org/10.18849/ve.v8i1.584","url":null,"abstract":"PICO question\u0000In dogs with type I immune-mediated polyarthritis (IMPA), is sole treatment with other immunosuppressive agents as effective as treatment with corticosteroids at reducing clinical signs?\u0000 \u0000Clinical bottom line\u0000Category of research question\u0000Treatment.\u0000Number and type of study designs reviews\u0000One pragmatic open-label randomised controlled clinical trial.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000In the single randomised controlled clinical trial reviewed, 7/10 (70%) of dogs in both treatment groups (prednisone or cyclosporine), were reported to have shown resolution of owner-reported symptoms, clinical symptoms and improved locomotor scores and cytologic signs of disease at the end of the 90 day trial period. Of the remaining dogs, 2/3 cyclosporine treated dogs required change to prednisone, and 2/3 prednisone treated dogs required combination therapy to achieve clinical response.\u0000Conclusion\u0000There is insufficient evidence to support the use of alternative immunosuppressive agents in place of corticosteroids for the treatment of IMPA type I. Further controlled clinical trials are needed before a change to clinical practice can be considered.\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":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130578462","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}
Alexandra Robinson, Tsim Christopher Sun, Eduardo Uquillas Uquillas
PICO question In horses undergoing volatile anaesthesia, is recovery quality superior with the use of sevoflurane compared to isoflurane during the maintenance phase? Clinical bottom line The category of research question Treatment Number and type of study designs reviewed Seven papers were available for critical appraisal. Of the seven papers, six were prospective, randomised trials and four of these were of crossover design. Of the same seven papers, three were experimental and four were clinical. Strength of evidence Moderate Outcomes reported Five out of seven critically appraised articles found that there was no clinically significant improvement in recovery quality following volatile anaesthesia with sevoflurane compared to isoflurane. Two of the seven articles did find improvement in recovery quality following the use of sevoflurane over isoflurane, but both studies were of crossover design, one of these studies used non-blinded evaluators and the second study used both unblinded and blinded evaluators and a recovery quality scoring scale that did not show interobserver reliability. Conclusion In healthy horses presented for elective surgical and diagnostic imaging procedures in a clinical setting, there is no significant difference in recovery quality following the use of sevoflurane or isoflurane for the maintenance phase. 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 horses undergoing volatile anaesthesia, is recovery quality superior with sevoflurane compared to isoflurane?","authors":"Alexandra Robinson, Tsim Christopher Sun, Eduardo Uquillas Uquillas","doi":"10.18849/ve.v8i1.582","DOIUrl":"https://doi.org/10.18849/ve.v8i1.582","url":null,"abstract":"PICO question\u0000In horses undergoing volatile anaesthesia, is recovery quality superior with the use of sevoflurane compared to isoflurane during the maintenance phase?\u0000 \u0000Clinical bottom line\u0000The category of research question\u0000Treatment\u0000Number and type of study designs reviewed\u0000Seven papers were available for critical appraisal. Of the seven papers, six were prospective, randomised trials and four of these were of crossover design. Of the same seven papers, three were experimental and four were clinical.\u0000Strength of evidence\u0000Moderate\u0000Outcomes reported\u0000Five out of seven critically appraised articles found that there was no clinically significant improvement in recovery quality following volatile anaesthesia with sevoflurane compared to isoflurane. Two of the seven articles did find improvement in recovery quality following the use of sevoflurane over isoflurane, but both studies were of crossover design, one of these studies used non-blinded evaluators and the second study used both unblinded and blinded evaluators and a recovery quality scoring scale that did not show interobserver reliability.\u0000Conclusion\u0000In healthy horses presented for elective surgical and diagnostic imaging procedures in a clinical setting, there is no significant difference in recovery quality following the use of sevoflurane or isoflurane for the maintenance phase.\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":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132109826","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 horses with a suspensory ligament branch injury, does high-intensity laser therapy (energy output greater than 500 mW) combined with conservative management, compared to conservative management alone, result in a faster return to primary function? Clinical bottom line Category research Treatment. Number and type of study deisgns reviewed The number and type of study designs that were critically appraised were two peer-reviewed studies: a non-randomised controlled clinical trial and a randomised controlled experimental study. Strength of evidence Weak. Outcomes reported The outcomes reported are summarised as follows: the two appraised studies report positive effects of high-intensity laser therapy (HILT) on equine tendon and ligament injuries as measured by pain to palpation, lameness, swelling and ultrasonographic and magnetic resonance imaging (MRI) evaluation of HILT-treated lesions. Conclusion In view of the strength of evidence and the outcomes from the studies the following conclusion is made: the two appraised studies provide only weak evidence to show that horses treated with high-intensity laser therapy (HILT) and conservative management return to primary function sooner than horses treated with conservative management alone. Issues of design, methodology, statistical analysis and reporting reduce the reliability and external validity of these studies. 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":"Does high-intensity laser therapy speed return to primary function in horses with suspensory ligament desmopathy?","authors":"James Rushing","doi":"10.18849/ve.v8i1.564","DOIUrl":"https://doi.org/10.18849/ve.v8i1.564","url":null,"abstract":"PICO question\u0000In horses with a suspensory ligament branch injury, does high-intensity laser therapy (energy output greater than 500 mW) combined with conservative management, compared to conservative management alone, result in a faster return to primary function?\u0000 \u0000Clinical bottom line\u0000Category research\u0000Treatment.\u0000Number and type of study deisgns reviewed\u0000The number and type of study designs that were critically appraised were two peer-reviewed studies: a non-randomised controlled clinical trial and a randomised controlled experimental study.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000The outcomes reported are summarised as follows: the two appraised studies report positive effects of high-intensity laser therapy (HILT) on equine tendon and ligament injuries as measured by pain to palpation, lameness, swelling and ultrasonographic and magnetic resonance imaging (MRI) evaluation of HILT-treated lesions.\u0000Conclusion\u0000In view of the strength of evidence and the outcomes from the studies the following conclusion is made: the two appraised studies provide only weak evidence to show that horses treated with high-intensity laser therapy (HILT) and conservative management return to primary function sooner than horses treated with conservative management alone. Issues of design, methodology, statistical analysis and reporting reduce the reliability and external validity of these studies.\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":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132375156","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 male dogs undergoing surgical castration, does a pre-scrotal approach in comparison to a scrotal approach lead to a superior recovery, in terms of duration of postoperative pain and/or reduced post-operative complications? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Two prospective clinical trials were critically appraised. Strength of evidence Weak. Outcomes reported Woodruff et al. (2015) evaluated postoperative recovery in 206 dogs following surgical castration using a scrotal incision in comparison to 231 dogs using a pre-scrotal approach. Complications observed in order of frequency, included: incisional swelling; haemorrhage; pain; and self-trauma, however, apart from self-trauma, complications were not influenced by incision location. Dogs castrated using a scrotal approach had reduced odds of self-trauma (OR: 0.51, P = 0.04, 95% CI 0.27–0.97). Moreover, mean duration of surgery was faster for the scrotal versus the pre-scrotal approach (3.6 minutes, P<0.01, 95% CI 3.38–3.82 versus 5.1 minutes, 95% CI 4.86–5.41). Miller et al. (2018) evaluated complication rates following open or closed castration using a scrotal approach in 400 shelter dogs under the age of 6 months. Complications involving intra-operative bleeding were not observed, while marginal rates of post-operative events were reported, including peri-incisional dermatitis (2.3%), skin bruising (1.0%), and swelling (0.3%). No self-trauma or rescue analgesia was recorded. In comparing surgical time, the mean duration was 1 minute ± 0.2 minutes in dogs undergoing scrotal surgery, in comparison to canine patients undergoing the same procedure using a pre-scrotal approach, where the mean duration was 3.5 minutes ± 0.4 minutes. Conclusion The outcomes of these two studies imply that a scrotal incisional approach in canine castration is at least no worse in the first 24 hours than a traditional pre-scrotal approach and may also reduce mean duration of surgery. However, limitations to the evidence do not permit a firm conclusion and it also remains unclear whether these advantages persist in the longer postoperative period. Further research is needed to confirm initial findings suggested here. 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.
PICO问题:在接受阉割手术的雄性犬中，在术后疼痛持续时间和/或减少术后并发症方面，与阴囊入路相比，阴囊前入路是否能更好地恢复?临床底线研究类别治疗。审查的研究设计的数量和类型对两项前瞻性临床试验进行了严格评价。证据强度:弱。woodruff等人(2015)评估了206只使用阴囊切口进行手术阉割的狗的术后恢复情况，与231只使用阴囊前入路的狗进行了比较。观察到的并发症发生率依次为:切口肿胀;出血;疼痛;而自我创伤方面，除自我创伤外，并发症不受切口位置的影响。使用阴囊入路阉割的狗减少了自我创伤的几率(OR: 0.51, P = 0.04, 95% CI 0.27-0.97)。此外，阴囊入路的平均手术时间比阴囊前入路快(3.6分钟，P<0.01, 95% CI 3.38-3.82比5.1分钟，95% CI 4.86-5.41)。Miller等人(2018)对400只6个月以下的收容所狗进行了阴囊开式或闭式阉割后的并发症发生率评估。未观察到术中出血的并发症，但报告了手术后事件的边际率，包括切口周围皮炎(2.3%)，皮肤瘀伤(1.0%)和肿胀(0.3%)。无自我创伤或抢救性镇痛记录。在比较手术时间时，接受阴囊手术的犬平均持续时间为1分钟±0.2分钟，而采用阴囊前入路的犬患者平均持续时间为3.5分钟±0.4分钟。结论阴囊切口入路在犬去势手术的前24小时内至少不比传统的阴囊前入路差，而且可以缩短平均手术时间。然而，由于证据的限制，尚不能得出确切的结论，并且尚不清楚这些优势是否在术后较长时间内持续存在。需要进一步的研究来证实这里提出的初步发现。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":"Surgical castration in dogs: does the incision approach influence postoperative recovery?","authors":"Ariel Brunn","doi":"10.18849/ve.v7i4.587","DOIUrl":"https://doi.org/10.18849/ve.v7i4.587","url":null,"abstract":"PICO question\u0000In male dogs undergoing surgical castration, does a pre-scrotal approach in comparison to a scrotal approach lead to a superior recovery, in terms of duration of postoperative pain and/or reduced post-operative complications?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000Two prospective clinical trials were critically appraised.\u0000Strength of evidence\u0000Weak.\u0000Outcomes reported\u0000Woodruff et al. (2015) evaluated postoperative recovery in 206 dogs following surgical castration using a scrotal incision in comparison to 231 dogs using a pre-scrotal approach. Complications observed in order of frequency, included: incisional swelling; haemorrhage; pain; and self-trauma, however, apart from self-trauma, complications were not influenced by incision location. Dogs castrated using a scrotal approach had reduced odds of self-trauma (OR: 0.51, P = 0.04, 95% CI 0.27–0.97). Moreover, mean duration of surgery was faster for the scrotal versus the pre-scrotal approach (3.6 minutes, P<0.01, 95% CI 3.38–3.82 versus 5.1 minutes, 95% CI 4.86–5.41).\u0000Miller et al. (2018) evaluated complication rates following open or closed castration using a scrotal approach in 400 shelter dogs under the age of 6 months. Complications involving intra-operative bleeding were not observed, while marginal rates of post-operative events were reported, including peri-incisional dermatitis (2.3%), skin bruising (1.0%), and swelling (0.3%). No self-trauma or rescue analgesia was recorded. In comparing surgical time, the mean duration was 1 minute ± 0.2 minutes in dogs undergoing scrotal surgery, in comparison to canine patients undergoing the same procedure using a pre-scrotal approach, where the mean duration was 3.5 minutes ± 0.4 minutes.\u0000Conclusion\u0000The outcomes of these two studies imply that a scrotal incisional approach in canine castration is at least no worse in the first 24 hours than a traditional pre-scrotal approach and may also reduce mean duration of surgery. However, limitations to the evidence do not permit a firm conclusion and it also remains unclear whether these advantages persist in the longer postoperative period. Further research is needed to confirm initial findings suggested here.\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":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122141179","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 Do dogs that are brachycephalic have an increased risk for developing heat-related illness compared to dogs that are not brachycephalics? Clinical bottom line Category of research Risk. Number and type of study designs reviewed Four studies were critically appraised. Three of these were cohort studies, one was a case-control study. Strength of evidence Moderate. Outcomes reported Brachycephalic dogs are at increased risk of developing heat-related illness and brachycephalic breeds are over-represented in presentations for heatstroke. Other factors named, such as body weight, also contributed to the risk of developing heat-related illness. Conclusion Dogs that are brachycephalic are likely to have an increased risk for developing heat-related illness compared to non-brachycephalic dogs. How to apply the 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":"Heatstroke and brachycephalic dogs – is there an increased risk?","authors":"Anna Ewers Clark","doi":"10.18849/ve.v7i4.534","DOIUrl":"https://doi.org/10.18849/ve.v7i4.534","url":null,"abstract":"PICO question\u0000Do dogs that are brachycephalic have an increased risk for developing heat-related illness compared to dogs that are not brachycephalics?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Risk.\u0000Number and type of study designs reviewed\u0000Four studies were critically appraised. Three of these were cohort studies, one was a case-control study.\u0000Strength of evidence\u0000Moderate.\u0000Outcomes reported\u0000Brachycephalic dogs are at increased risk of developing heat-related illness and brachycephalic breeds are over-represented in presentations for heatstroke. Other factors named, such as body weight, also contributed to the risk of developing heat-related illness.\u0000Conclusion\u0000Dogs that are brachycephalic are likely to have an increased risk for developing heat-related illness compared to non-brachycephalic dogs.\u0000 \u0000How to apply the 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":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122435219","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 rabbits with cheyletiellosis is topical selamectin or injectable ivermectin a more effective treatment? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed One paper directly answered the PICO question, a retrospective clinical design study, and was critically reviewed. Strength of evidence. Strong. Outcomes reported Both topical selamectin and injectable ivermectin are safe and effective in treating cheyletiellosis. There is no significant difference in the effectiveness of both drugs in treating the infestation. Conclusion In pet rabbits with Cheyletiella parasitivorax infestations both topical selamectin and injectable ivermectin have been recognised to be a safe and effective treatment. There is currently insufficient evidence that one is more effective than the other and therefore veterinarians should consider their own clinical experience, client preference and use the licensed product first (in the UK, ivermectin (Xeno, Dechra) spot-on). However, this Knowledge Summary does not comment on the effectiveness of topical ivermectin in treating cheyletiellosis. If injectable ivermectin is , topical selamectin can be used under the cascade as an alternative treatment, as it is licensed for the same indication in dogs and cats. 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 rabbits with cheyletiellosis is topical selamectin or injectable ivermectin a more effective treatment?","authors":"Juliette Mouëzy","doi":"10.18849/ve.v7i4.529","DOIUrl":"https://doi.org/10.18849/ve.v7i4.529","url":null,"abstract":"PICO question\u0000In rabbits with cheyletiellosis is topical selamectin or injectable ivermectin a more effective treatment?\u0000 \u0000Clinical bottom line\u0000Category of research\u0000Treatment.\u0000Number and type of study designs reviewed\u0000One paper directly answered the PICO question, a retrospective clinical design study, and was critically reviewed.\u0000Strength of evidence.\u0000Strong.\u0000Outcomes reported\u0000Both topical selamectin and injectable ivermectin are safe and effective in treating cheyletiellosis. There is no significant difference in the effectiveness of both drugs in treating the infestation.\u0000Conclusion\u0000In pet rabbits with Cheyletiella parasitivorax infestations both topical selamectin and injectable ivermectin have been recognised to be a safe and effective treatment. There is currently insufficient evidence that one is more effective than the other and therefore veterinarians should consider their own clinical experience, client preference and use the licensed product first (in the UK, ivermectin (Xeno, Dechra) spot-on). However, this Knowledge Summary does not comment on the effectiveness of topical ivermectin in treating cheyletiellosis. If injectable ivermectin is , topical selamectin can be used under the cascade as an alternative treatment, as it is licensed for the same indication in dogs and cats.\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":"172 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117321224","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 clinically hyperthyroid cats, is iodine-131 (I-131) treatment superior to unilateral or bilateral thyroidectomy in normalising serum thyroxine (T4) levels? Clinical bottom line Category of research question Treatment. The number and type of study designs reviewed 35 papers were critically reviewed. These were mostly retrospective studies with a small proportion of prospective cohort studies. Strength of evidence Moderate. Outcomes reported More papers were available evaluating the effect of radioiodine therapy on T4 levels compared to thyroidectomy. Long-term follow-up of T4 is a relatively new component of study designs. Most papers suggested between 40–87% cats had normal T4 6 months after treatment. 19–47% cats receiving unilateral or bilateral thyroidectomy, and 100% cats receiving radioiodine therapy were in long-term remission in one study. Conclusion In view of the of evidence and outcomes from the studies, there is moderate evidence that I-131 treatment is superior to unilateral or bilateral thyroidectomy. 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 clinically hyperthyroid cats, is I-131 treatment superior to thyroidectomy in normalising serum T4 level?","authors":"Alexander Davies","doi":"10.18849/ve.v7i4.433","DOIUrl":"https://doi.org/10.18849/ve.v7i4.433","url":null,"abstract":"PICO question \u0000In clinically hyperthyroid cats, is iodine-131 (I-131) treatment superior to unilateral or bilateral thyroidectomy in normalising serum thyroxine (T4) levels? \u0000 \u0000Clinical bottom line \u0000Category of research question \u0000Treatment. \u0000The number and type of study designs reviewed \u000035 papers were critically reviewed. These were mostly retrospective studies with a small proportion of prospective cohort studies. \u0000Strength of evidence \u0000Moderate. \u0000Outcomes reported \u0000More papers were available evaluating the effect of radioiodine therapy on T4 levels compared to thyroidectomy. Long-term follow-up of T4 is a relatively new component of study designs. Most papers suggested between 40–87% cats had normal T4 6 months after treatment. 19–47% cats receiving unilateral or bilateral thyroidectomy, and 100% cats receiving radioiodine therapy were in long-term remission in one study. \u0000Conclusion \u0000In view of the of evidence and outcomes from the studies, there is moderate evidence that I-131 treatment is superior to unilateral or bilateral thyroidectomy. \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":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126132162","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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