Veterinary Evidence

Thank you to our contributors: reflections on 2024

2025-01-30T16:19:39+00:00

All submissions to Veterinary Evidence are handled by an Associate Editor specialising in the relevant topic area. We would like to thank these volunteer veterinary professionals for their expertise and time to support the journal. Associate Editors play a central role, assessing submitted papers, guiding the peer review process, and making decision recommendations based on peer review reports. We have welcomed six new Associate Editors to the journal in recent months, and we welcome new applications to join our editorial team. Our grateful thanks also extend to our peer reviewers, who are critical in ensuring we maintain the highest standards of excellence in our published articles.

In conjunction with our Editorial Board and publishing team, we have developed a new strategy for Veterinary Evidence, aiming to increase the visibility and findability of journal content and develop ways to measure real impact. We will aim to increase the volume and breadth of what we publish and expand the journal’s editorial capacity and capability to enable that. Quality remains central and we will continue to set strong standards for published content through our policies and processes, and to ensure we make the best use of the support from RCVS Knowledge, we will continually improve editorial processes and timelines to increase editorial efficiency and reduce publication timelines.

We are pleased to announce that Veterinary Evidence has recently been accepted for indexing in Scopus and has also been approved for inclusion in PubMed Central. The technical work for indexing to happen is underway, and we will continue to explore options to increase journal content visibility.

Knowledge Summaries guide readers through the evidence on a clinical question. To help with understanding the context of an included study, we have expanded the evidence summary sections to include the full title of the study, a link out to the original article, and a summary of the main aims. The journal continues to grow annually in terms of users and views, and in 2024 we saw a 13% increase in users and a 5% in page views. Submission to the journal also continue at a steady rate.

The process for updating published Knowledge Summaries has now been agreed. The journal runs an annual report of Knowledge Summaries that have search dates (the date that the search was carried out) that are 3 to 4 years old. For that set of papers, we review the usage metrics (views, downloads, citations) and consider whether the questions remain clinically relevant. On this basis, the Editor in Chief will select the top five papers of interest under each of the main three species categories (small animal, production animal, and equine), and we will aim to publish updates of these knowledge summaries.

Finally, we would like to encourage the continued submission of clinical queries and papers for consideration for publication so that the journal can continue to thrive and go from strength to strength.

Professor Peter Cockcroft
Editor in Chief, Veterinary Evidence

In dogs with gastric dilatation volvulus (GDV) undergoing gastropexy, what is the rate of recurrence of GDV?

2024-10-23T11:04:29+01:00

Question

In dogs with a gastric dilatation volvulus (GDV) treated surgically and undergoing a gastropexy, what is the rate of recurrence of GDV?

Clinical bottom line

The category of research question was:

Risk.

The number and type of study designs that were critically appraised were:

Sixteen studies were critically appraised. Two were prospective randomised controlled trials, two were prospective cohort studies, one was a case-control study, and eleven were case series.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Weak.

The outcomes reported are summarised as follows…

A low rate of recurrence of GDV after gastropexy was consistently reported, although methodological limitations were recognised in all studies.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

Overall, the studies provide weak evidence that the rate of recurrent GDV is low after gastropexy.

In sheep undergoing general anaesthesia does inclusion of medetomidine result in hypoxaemia?

2024-10-10T15:31:42+01:00

Question

In healthy adult female non-pregnant sheep undergoing general anaesthesia for research studies does the inclusion of intravenous medetomidine as part of the anaesthetic protocol cause hypoxaemia?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Four papers were available for critical appraisal. The quality of the evidence is weak. There were four experimental studies; three of which were cross-over studies and one study which was run in parallel with primary orthopaedic research. None of the studies were specifically focussed on the potential hypoxaemic effects of medetomidine.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Weak.

The outcomes reported are summarised as follows…

Sheep across all four studies developed hypoxaemia (indicated by arterial oxygen tension; either P_aO₂ < 80 mmHg/10 kPa when breathing room air, or a statistically significant fall in P_aO₂ compared with baseline, when breathing oxygen enriched gases), when medetomidine was administered intravenously and in combination with various drugs (i.e. midazolam, propofol, ketamine, halothane, and isoflurane). However, as the sheep were receiving various doses of medetomidine at various timepoints, different quantities of supplemental oxygen (if any), varying ventilatory management (two studies used mechanical ventilation and two studies allowed sheep to breathe spontaneously), and different agents were used to maintain anaesthesia, the clinical significance of the P_aO₂ values was difficult to assess.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

In clinically healthy (judged by clinical examination) adult female non-pregnant sheep undergoing general anaesthesia (characterised by placement of an endotracheal tube and/or the use of anaesthetic induction agents i.e. barbiturates, ketamine, propofol), the weak evidence presented here suggests that use of intravenous medetomidine can be expected to cause hypoxaemia. However, hypoxaemia is variable and its clinical effects can be lessened with anaesthetic techniques such as the provision of supplemental oxygen.

Veterinary Evidence: moving forward

2024-09-18T15:27:36+01:00

Unrecognised and unknown information needs can significantly impact on the quality of decision making, advice, and patient care. In the practice of veterinary medicine, additional information may be required in one or more of epidemiology, diagnosis, treatment, prognosis, control (risk reduction), and prevention (risk avoidance), in order to optimise patient care.

Veterinary Evidence publishes Knowledge Summaries, which aim to answer a specific and focused clinical query by appraising the best available evidence published in peer-reviewed scientific journals. By presenting the evidence in a structured and easily digestible format, Knowledge Summaries enable veterinary professionals to stay informed and apply the best available evidence to their decision-making.

To assist in the identification of unrecognised deficits and the generation of clinical queries Veterinary Evidence has developed a list of common conditions for each species, alongside the different categories of information. The aim is to prompt and support the generation of new clinical queries in a more systematic format. This resource sits alongside our species-based lists of clinical queries that have already been suggested by practicing veterinarians, veterinary nurses, and other paraprofessionals (see veterinaryevidence.org/index.php/ve/clinical-queries). We hope readers and prospective authors will use these resources to generate new clinical queries or as a starting point for writing their own Knowledge Summaries.

Most of the papers published in Veterinary Evidence are Knowledge Summaries, but the journal has always accepted and will continue to accept and encourage other types of reviews and original research that provide evidence to inform clinical practice. For example, in this issue we have published a commentary paper by Professor Jonathan Elliott regarding the processes and evidence required for the registration of veterinary medicinal products which provides some important insights and debate into the publication of evidential information (Elliott, 2024).

A Knowledge Summary may not always be the best format to synthesise and summarise evidence on a multifaceted topic; scoping reviews, systematic reviews, or narrative reviews maybe more appropriate. Munn et al. (2018) provide a useful account of scoping reviews and how they differ from traditional literature and systematic reviews. In particular, we are keen to receive articles on artificial intelligence applications, sustainability, and quality improvement in clinical practice, as the impact and importance of these topics grows.

We are also making some changes to the presentation of Knowledge Summaries in Veterinary Evidence, to help readers more easily understand the details and context of the summarised evidence. In order to support everyone in appraising and understanding quantitative clinical studies, we will be publishing a glossary and guidance on basic statistical terms and tests on the journal website.

Clinical audit of nonoperative anaesthesia time and surgical site infections of canine tibial plateau osteotomy procedures

2024-09-17T15:49:03+01:00

Aims and objectives: The aim of this clinical audit was to reduce nonoperative anaesthesia time from 131 minutes to 102 minutes while maintaining surgical site infection rates below 10% for canine tibial plateau osteotomy procedures. Data collected from anaesthesia records and electronic medical records provided the data to measure these aims.

Background: Increased anaesthesia time increases the risk for perianaesthetic complications including surgical site infections. Through anaesthesia record analysis we recognised that nonoperative anaesthesia time was a variable that could be targeted for improvement. Nonoperative anaesthesia time is defined as total anaesthetic time minus surgical time.

Methods: Review of 40 total anaesthetic records (24 initial audit, 16 re-audit) and electronic medical records provided the data we recorded to determine anaesthesia time information and surgical site infection information. Manual audits were conducted to create a value stream map and nonoperative anaesthesia times were analysed for special cause variation utilising statistical process control.

Results: Nonoperative anaesthesia time was 131 minutes, roughly half of total anaesthesia time (270 minutes), while surgical site infection rate was 8.3%.

Implementation of changes (team discussion & changes made): A new communication protocol was trialed between anaesthesia and surgical teams.

Re-audit: The same procedure and analysis were used for the initial audit and re-audit. During the re-audit nonoperative anesthesia time was reduced to 109 minutes and surgical site infection rate was 6.3%.

Application: The communication protocol trialed during the re-audit is still in practice. This audit can be applied to other practices looking to better analyse their anaesthetic time variables and to re-evaluate communication procedures for better patient outcomes.

Process audit of pain assessment recording in hospitalised canine ophthalmology patients

2024-08-15T16:40:49+01:00

Aims and objectives: The aim of this process audit was to assess if pain assessment in hospitalised canine ophthalmology patients was being documented and if found to be undocumented, implementing changes to improve this.

Background: Pain scoring anecdotally appeared to be recorded less in ophthalmology patients than in other patients in the practice. This was of particular concern to veterinary staff working out of hours shifts who rely on hospital records to monitor changes in patient condition. The target was for all patients to have a pain assessment recorded.

Methods: The records of 30 patients were analysed to find out how many had a pain score chart completed when requested or if they had any notes regarding pain assessment recorded on their hospital sheet.

Results: The initial audit data collected confirmed the suspicion that pain scoring was not adequately recorded in hospitalised canine ophthalmology patients, with 57% of patients having no pain assessment recorded.

Implementation of changes (team discussion & changes made) and re-audit: One month after implementing interventions that required staff to record signs of ocular pain on the patients hospital sheet, and the development of a mnemonic to remind staff of these signs and as the placement of reminder signs in prominent areas, a re-audit was performed. This showed significant improvement; 96% of patients had a pain assessment recorded.

Application: Performing this clinical audit enabled the practice to identify an area where improvements needed to be made. The team collaborated to devise a set of interventions they felt would address this issue improved the recording of pain assessment in this practice. This has allowed staff on differing shifts to recognise changes promptly and ultimately improve the wellbeing of patients. Other practices may find the interventions useful and wish to perform a similar audit.

Methadone or buprenorphine: which is the better analgesic for feline ovariohysterectomy?

2024-08-08T13:20:31+01:00

Question

In female cats undergoing routine ovariohysterectomy, is using methadone in the anaesthetic protocol associated with lower post-operative pain scores, compared to buprenorphine?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Four assessor-blinded randomised controlled trials.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Moderate.

The outcomes reported are summarised as follows…

Two studies found methadone to be associated with significantly lower postoperative pain scores than buprenorphine; one showed significantly different pain scores over the entire 8-hour postoperative period and one only at 10 minutes postextubation. One study found buprenorphine to be associated with lower postoperative pain scores at some time points postsurgery. One study found no significant difference in pain scores between methadone and buprenorphine.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

It can be concluded that using methadone in the anaesthetic protocol may provide better analgesia for cats undergoing ovariohysterectomy compared to buprenorphine. The two papers that used validated pain scoring both concluded that methadone was associated with lower pain scores at some points postoperatively. Although one of the studies concluded that buprenorphine is associated with lower postoperative pain scores, this paper provides only very weak evidence because an unvalidated pain scoring method was used. More evidence is needed to confidently recommend using one opioid over another.

The efficacy of transversus abdominus plane (TAP) blocks in reducing pain scores in dogs undergoing elective spay procedures

2024-08-01T16:12:17+01:00

Question

In dogs undergoing an elective spay procedure (ovariohysterectomy or ovariectomy), does the use of a transversus abdominus plane (TAP) block compared to non-TAP reduce postoperative pain scores?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Three studies were appraised, all of which were prospective, blinded, randomised, controlled trials.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Moderate.

The outcomes reported are summarised as follows…

The available studies deemed a reduction in postoperative pain scores as a marker of treatment efficacy.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

There is moderate evidence to suggest that, when compared to a control group, the use of a TAP block reduces postoperative pain scores, in dogs undergoing elective spay procedures (ovariohysterectomy or ovariectomy). The need for postoperative analgesia was reduced when a TAP block had been administered prior to the spay procedure.

Do opioids provide adequate analgesia for surgical coeliotomy in teleost fish?

2024-07-11T15:35:12+01:00

Question

For teleost fish undergoing surgical coeliotomy, do intramuscular exogenous opioids reduce perioperative pain, compared with no analgesia?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Four studies were critically reviewed. All were randomised controlled trials, 2 with a parallel group design, and 2 with a factorial crossover group design.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Moderate.

The outcomes reported are summarised as follows…

The studies produced contradicting results regarding the analgesic efficacy of opioids perioperatively, with some evidence of pain alleviation when assessing behavioural parameters, but not when assessing clinical pathology or quantitative cardioventilatory data.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

Perioperative use of opioids for teleost fish undergoing invasive surgical procedures may reduce behavioural changes associated with pain compared with no analgesia, but there is insufficient evidence to determine if they provide adequate pain relief based on the study methodologies.

Does oral cannabidiol oil in adjunct to pain medications help reduce pain and improve locomotion in dogs with osteoarthritis?

2024-07-11T11:12:13+01:00

Question

In dogs with osteoarthritis (OA), does the oral supplementation of cannabidiol (CBD) oil, compared to conventional treatment alone, improve treatment outcomes of reducing pain and improving locomotion?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Four papers were critically reviewed. Two of the studies were prospective, randomised, placebo-controlled, double-blind, cross-over clinical trials. One trial was a prospective clinical trial. One study was a prospective, randomised, controlled, clinical trial.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Weak.

The outcomes reported are summarised as follows…

The analgesic effect of CBD oil supplementation on dogs with OA, as assessed by different parameters. These parameters included pain scoring systems (Canine Brief Pain Inventory (CBPI): comprised of the Pain Severity Score and Pain Interference Score (PIS), Liverpool Osteoarthritis in Dogs (LOAD), and veterinarian assessment), activity assessments (Hudson activity scale, Activities of Daily Living (ADLs): based on Cincinnati Orthopaedic Disability Index (CODI), informal gait analysis, and objective gait analysis), and Quality of Life Index (QoL).

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

CBD oil oral supplementation displayed a significant effect of extra pain relief on top of conventional treatment of canine OA in the clinical trials based on subjective pain assessments. However, the only study that evaluated pain and activity using objective measurements did not show significant improvements between treatment groups; therefore, the evidence supporting its use as an adjuvant to conventional therapy remains weak. Further studies utilising objective measurements are needed to improve the strength of the supporting evidence for a general use of CBD oil as additional analgesia for dogs with OA.

Does conservative or arthroscopic management of canine medial coronoid disease lead to improved outcomes?

2024-07-11T10:47:31+01:00

Question

In dogs diagnosed with medial coronoid disease, does arthroscopic surgical intervention, compared with conservative management, result in improved mobility and reduced pain?

Clinical bottom line

Category of research:

Treatment.

Number and type of study designs reviewed:

Three studies were identified directly addressing the PICO question. One paper was a retrospective cohort study, another study was a prospective randomised control trial, and the third was a non-randomised non-blinded observational study.

Strength of evidence:

Weak.

Outcomes reported:

The first study was a prospective non-randomised study that did not identify a difference in gait evaluation at the 52 week recheck in dogs treated conservatively compared to those treated arthroscopically, with lameness exacerbated in the arthroscopic treatment group until the 26 week recheck. The second study, a retrospective non-randomised cohort study, showed greater, but not statistically different, owner-reported clinical metrology scores in dogs treated arthroscopically compared to those treated conservatively. Liverpool Osteoarthritis in Dogs (LOAD) and Pain Severity Scores (PSS) were higher but not statistically significant, yet Pain Interference Scores (PIS) were statistically significantly higher at 52 weeks in arthroscopically treated dogs compared to conservatively treated dogs. Age at diagnosis and at time of questionnaire completion were statistically significant for LOAD, PSS, and PIS, with older dogs having higher scores. The third study performed a non-blinded observational study assessing canine patients with bilateral medial coronoid disease, with unilateral arthroscopic subtotal coronoidectomy performed on the most clinically affected limb. Radiographs and computed tomography (CT) imaging were performed at diagnosis, with radiographs taken at follow-up. At the time of follow-up, arthroscopically treated limbs had a higher radiographic score than those treated conservatively, although a significant improvement in lameness was seen at the walk in arthroscopically treated limbs. Conservatively managed dogs showed an unchanged (non-significant) gait. Radiographic changes did not appear to correlate to severity of clinical signs.

Conclusion:

The quality of the published evidence available to answer the PICO question is weak, due to the design of the three reviewed studies. Low patient populations in these three studies also hinder the statistical power of any recommendations made. None of the three studies assesses the complex nature of medial coronoid disease to clearly answer the question posed. The decision to recommend arthroscopy over conservative management therefore depends on the judgement and experience of the veterinary surgeon attending the case. Additionally, assessment of the imaging findings is important when discussing prospective treatment options.

Should joint lavage be performed in the treatment of juvenile canine spontaneous/haematogenous septic arthritis?

2024-07-08T17:08:09+01:00

Question

In dogs less than 18 months old, with spontaneous/haematogenous bacterial septic arthritis, how effective is treatment with joint lavage and antimicrobial therapy compared to antimicrobial therapy alone?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

One case series of 5 dogs.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Weak.

The outcomes reported are summarised as follows…

Successful clinical outcomes were reported in patients both with and without joint lavage.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

No conclusions can be made regarding the impact of joint lavage on haematogenous septic arthritis in juvenile dogs as excellent outcomes were achieved in patients with and without lavage. However appropriate antibiosis continues to be pertinent with one case persistently infected when inappropriate antibiotics were selected.

Fasciola hepatica: can the coproantigen ELISA replace the faecal egg sedimentation test?

2024-06-26T11:56:41+01:00

Question

In adult cattle, is the sensitivity of the coproantigen ELISA test equal or superior to the sensitivity of the faecal egg sedimentation test for the diagnosis of Fasciola hepatica?

Clinical bottom line

The category of research question was:

Diagnosis.

The number and type of study designs that were critically appraised were:

Three studies were appraised. This included two cross-sectional diagnostic accuracy studies and one case control diagnostic accuracy study.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Moderate.

The outcomes reported are summarised as follows…

The first study reported the findings from 619 tested cattle over 3 sample periods comparing the sensitivity and specificity of the different tests. The sensitivity of the faecal egg sedimentation test varied greatly between the sample periods from 0.81 (95% beta coefficient (BCI) 0.72–0.90) to 0.58 (95% BCI 0.43–0.72) with the coproantigen ELISAs sensitivity remaining consistent at 0.77 (95% BCI 0.64–0.88) throughout.

The second study reported the findings of 200 tested cattle over 2 sampling periods comparing the sensitivity and specificity of the different tests. The mean sensitivity of the coproantigen ELISA was significantly higher than the 4 g/10 g preparations of the faecal egg sedimentation tests at 94% (95% CI 87%–98%) (P < 0.001).

The third study reported the findings of Coproantigen ELISA testing on 250 bovine faecal samples with 94 confirmed positive for liver fluke via faecal sedimentation testing. The sensitivity of the coproantigen ELISA was 80% and the specificity was 100% compared with 70% and 80% respectively for the faecal egg sedimentation test.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

All three studies demonstrated either an increased or equivalent sensitivity of the coproantigen ELISA to the faecal sedimentation test, but only one study reported a statistically significant increase in test sensitivity. Whilst all three studies were diagnostic accuracy validity studies, the systematic sampling strategy of one study was superior to the convenience sampling method of one of the other studies and to the case control method of the other.

Several sources of bias also exist within the included studies. Sampling and selection bias is present in the two of studies due to the animals selected only being sampled over one year. The results of these studies are susceptible to changes in the fluke lifecycle of that year, and the sampled animals are more likely to be fit and well-conditioned as they are presenting for slaughter, and as such are less likely to carry significant/chronic fluke burdens. All three studies are susceptible to validity issues due to an absence of clinical information regarding flukicide treatment and concurrent parasitic diseases which, whilst not impacting the efficacy of diagnostic testing, may cause issues if the studies are to be repeated.

The coproantigen ELISA can be utilised as a suitable adjunctive test to aid in the diagnosis of Fasciola hepatica in adult cattle and has the scope to be used as an early diagnostic test, but whilst the results of the reported studies indicate that the coproantigen ELISA is an accurate and reliable test, it does not provide definitive evidence to warrant the discontinuation of the simple and affordable faecal egg sedimentation test. In order to come to a conclusion regarding the more sensitive test more literature is required that directly compares the coproantigen ELISA to the faecal egg sedimentation test in different clinical scenarios and exploring different diagnostic techniques.

In cats with cranial cruciate rupture are better long-term outcomes achieved by surgical or conservative management?

2024-06-19T16:51:47+01:00

Question

In cats diagnosed with isolated rupture of the cranial cruciate ligament, does surgical intervention result in improved long-term function, when compared with conservative management?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

One retrospective cohort study comparing surgical management and conservative management.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Weak.

The outcomes reported are summarised as follows…

This study evaluated and compared the long-term Feline Musculoskeletal Pain Index (FMPI) of patients with a cranial cruciate injury (39–87 months post injury). Patients that were managed conservatively showed statistically significant (P = 0.017) lower FMPI scores long term.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

Conservative management can be considered in cats presenting with isolated cranial cruciate rupture; however, further research is required to establish the optimum treatment in these cases. Given the limitations of this study and the current lack of evidence, clinicians must rely on their clinical judgement at this point when managing this condition until further research is available.

Recurrence rates in dogs with GDV treated with gastric decompression versus dogs treated with gastric decompression and gastropexy

2024-06-19T15:52:07+01:00

Question

In dogs diagnosed with gastric dilatation and volvulus (GDV), does gastric decompression and gastropexy reduce the risk of recurrence of dilatation compared to dogs undergoing gastric decompression alone?

Clinical bottom line

Category of research:

Treatment.

Number and type of study designs reviewed:

Four papers were critically reviewed. Two papers were retrospective studies, and two were prospective.

Strength of evidence:

Strong.

Outcomes reported:

In dogs with GDV, the risk of recurrence of this disease was much lower when gastropexy was performed.

Conclusion:

The studies comparing the recurrence rates in dogs with GDV treated either with gastric decompression (with or without gastric repositioning) or with gastric decompression and gastropexy indicate that gastropexy will significantly reduce the risk of recurrence.

Do cats receiving pre-appointment trazodone experience less stress during veterinary visits?

2024-06-18T15:52:36+01:00

Question

In cats does pre-appointment trazodone administration, compared to no trazodone, effectively reduce patients’ stress during veterinary visits?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Two studies were identified and reviewed. One was a double blind, placebo controlled, randomised crossover study. The other was a blinded placebo controlled randomised crossover study.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Weak.

The outcomes reported are summarised as follows…

In the first appraised paper 10 cats with ≥ 1 behavioural sign consistent with transport or veterinary examination associated anxiety were randomly assigned and orally administered a 50 mg trazodone tablet or a placebo (a sodium bicarbonate tablet identical in appearance to a trazodone tablet).

9/10 cats had anxiety-related signs during the veterinary visit when given the placebo, whereas 3/10 had them when given trazodone. Overall, behavioural scores assigned by the veterinarian were significantly (Wilcoxon signed rank test, P = 0.006) lower for cats after receiving trazodone versus the placebo. Trazodone administration resulted in significantly (Wilcoxon signed rank test, P = 0.01) more favourable tractability scores than with the placebo administration, with cats considered relaxed versus tense after receiving trazodone. For all components of the veterinary examination, trazodone administration resulted in significantly (McNemar test, P = 0.03 for each comparison) lower stress scores before, during and after veterinary examination. However, one cat was reported to become more fearful and vocal after trazodone administration.

The second paper assessed the sedative and anxiolytic effects of 50 mg, 75 mg, and 100 mg trazodone administration to 6 purpose-bred, male, neutered laboratory cats, prior to and during a veterinary examination to a placebo (food or treats with no tablet). Since the 50 mg and 75 mg doses were not randomised the author of this Knowledge Summary did not include them as part of the statistical analysis. This study found no statistically significant difference in scoring between the effects of the 100 mg trazodone and the placebo, after analysis of the total behavioural and mean overall stress scores. There was a statistically significant difference in enclosure activity with lower levels of activity in cats administered 100 mg trazodone compared to the placebo. However, this is likely more reflective of the sedative effects of trazodone rather than anxiolysis.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

The first appraised paper found promising evidence that trazodone could be effective at reducing stress in cats during veterinary visits. However, despite the strong study design, many limitations were identified, most notably the small sample size and large number of uncontrolled variables. This undermined the statistically significant data produced. The second study did not produce statistically significant evidence that trazodone ameliorates stress during a veterinary visit.

A conclusion to the PICO question cannot be made due to lack of relevant studies and statistically significant data. Evidence found supporting the PICO question is weak and therefore more studies with larger sample sizes and less variability are needed to determine the efficacy of trazodone use to reduce stress in cats during veterinary visits.

Erratum to: Comparing the effectiveness of clomipramine and fluoxetine in dogs with anxiety-related behaviours

2024-06-14T16:53:26+01:00

The original article was published in Veterinary Evidence Vol 9, Issue 1 (2024): https://doi.org/10.18849/ve.v9i1.679

In the original version of the article the contributions of one of the authors, Christopher Minami, were listed as "Investigation, Writing – Original draft". This has now been corrected to accurately reflect Minami's contributions, with the agreement of all the authors:

Christopher Minami: Conceptualisation, Methodology, Investigation, Writing – Original draft.

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 author contributions section.

Nonsteroidal anti-inflammatory drug administration to periparturient cows to reduce postpartum pain-related behaviours

2024-05-30T17:02:04+01:00

Question

In periparturient cows does the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) aid in reducing pain-related behaviours after parturition when compared to cows not administered NSAIDs?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

Four randomised control trials.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Moderate.

The outcomes reported are summarised as follows…

The evidence suggests that NSAIDs can reduce some pain-related behaviours and increase resting behaviours in postpartum cows, with the effect being most consistently observed when administered between 6 and 48 hours before calving or within 3 hours after calving. This effect was most consistently observed in individuals that had experienced uncomplicated calving events and primiparous animals. Primiparous animals administered meloxicam prior to natural calving displayed significantly more lying bouts on the day of calving when compared to primiparous control animals and primiparous animals administered meloxicam postpartum. A separate study reported that cows administered ketoprofen spent less time in lateral recumbency than cows in the placebo group, irrespective of whether calving was assisted. Additionally, when treatment cows were in sternal recumbency, they spent more time with their head in a rested position than the placebo group. There was no significant difference in feeding behaviours postpartum between treatment and placebo animals. There were conflicting results between papers assessing activity levels.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

In some cows, in particular cows with an uncomplicated parturition, NSAIDs can reduce some pain-related behaviours and increase some resting behaviours postpartum. The NSAID should be administered between 6 and 48 hours before calving or within 3 hours after calving.

The therapeutic effectiveness of oral cannabidiol in addition to current treatment in cats with osteoarthritis

2024-05-30T15:15:28+01:00

Question

In cats with osteoarthritis (OA), does the oral supplementation of cannabidiol (CBD) oil, compared to conventional treatment alone, improve treatment outcomes of reducing pain and improving locomotion?

Clinical bottom line

The category of research question was:

Treatment.

The number and type of study designs that were critically appraised were:

No papers were found relevant to the PICO.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Zero.

The outcomes reported are summarised as follows…

No studies relevant to the PICO were found (in English) on the use of CBD in cats with OA.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

There is currently no evidence to recommend the use of CBD in cats for the treatment of OA and further studies on therapeutic use of CBD in cats with OA are required.

Does wearing facemasks during small animal surgery reduce the incidence of surgical site infections?

2024-05-29T15:39:54+01:00

Question

In small animals undergoing theatre-based surgical procedures does having all theatre personnel masked, compared with not having all theatre personnel masked, result in a reduced incidence of surgical site infections?

Clinical bottom line

The category of research question was:

Incidence.

The number and type of study designs that were critically appraised were:

Zero. No records relevant to the PICO question were retrieved from the literature search.

Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation:

Zero.

The outcomes reported are summarised as follows…

There is no published evidence specific to small animals that assesses the effect of wearing facemasks during surgical procedures on the rate of postoperative surgical site infections.

In view of the strength of evidence and the outcomes from the studies the following conclusion is made…

In small animals undergoing theatre-based surgical procedures, there is no published evidence evaluating the effect of having all theatre personnel masked compared with not having all theatre personnel masked on the incidence of surgical site infections. However, this lack of evidence should not be interpreted as lack of efficacy.