Veterinary Evidence

Erratum to: Does the use of supraglottic device in rabbits cause less injury than other airway management devices?

2023-02-10T18:20:35+00:00

Unfortunately the original version of the article was missing the following statement.

This Knowledge Summary has reviewed the available evidence on the use of a SGAD (v-gel®) in rabbit anaesthesia. Since writing a new design of a single use supraglottic airway device (SGAD) has been introduced; currently there is no published evidence on whether this new device has an impact on the risk of injury.

This error was in both the HTML and PDF versions. This has now been updated in both the HTML and PDF versions, and can be found in the clinical bottom line and the evidence section.

Thank you to our reviewers 2022

2023-01-31T20:57:52+00:00

As 2023, dawns we are faced with a very different world than at the start of 2022, COVID-19 is in the rear-view mirror, but we now face the war in Ukraine, energy prices and inflation. Perhaps this is a glimpse of the ‘new world’ where we will be continually challenged by crisis whether it be conflict, infectious disease or the impacts of global warming.

On a more positive note it has been another busy and productive year for Veterinary Evidence as we strive to continually improve the journal whether you are a reader, author or reviewer. In April we said ‘goodbye’ to Daniel Edwards who had covered Bridget Sheppard’s maternity leave as Managing Editor. I would like to take the opportunity to thank Dan for all his hard work for Veterinary Evidence initiating a number of projects that have come to fruition through the year and to welcome Bridget back. As Veterinary Evidence has grown, we have been fortunate to be able to expand our staff to meet the need and ensure efficient turnaround of submissions so another welcome, William Smith has joined the team and is now a permanent full time Editorial Assistant.

It is not just staff changes that happened in 2022, we have also improved the governance of Veterinary Evidence with the appointment of new board members and creation of a Deputy Editor-in-Chief position ably filled by Louise Buckley. We also submitted a successful application to COPE (The Committee on Publication Ethics) further strengthening the journal’s oversight and reputation.

We have had a major website redesign, now live, which has greatly improved the look, feel, and functionality of Veterinary Evidence for all users. Readers can find relevant papers quickly and efficiently. Our student awards continue to be a success and I would like to thank the whole team of staff and reviewers for turning round these submissions so quickly. I had the pleasure of talking to the prize-winning authors and it was great to hear their enthusiasm but also how much they have valued the help and support from the journal.

We have also been developing our processes for reviewing papers to make sure that papers are ready to go out for review. We are working on ways to make sure that, for papers requiring revision, authors respond to each of the comments made by reviewers, and reviewers can quickly see that there has been an author response to their comments and suggestions. A new submission system, Editorial Manager, has been implemented that should make life easier for everyone as well as provide accessible data on papers as they go through the system so we can see what we do well and where we can do better.

None of this would be possible without the input from our reviewers and I would like to take this opportunity to say a huge thank you to all our reviewers and everyone who has served on the Editorial Board this year for their tireless efforts on behalf of Veterinary Evidence – without your support the journal could not exist. This year the Board has again had three online meetings, which have been essential in helping develop the strategy for Veterinary Evidence such as how we ensure our Knowledge Summaries remain current, what literature should be included in Knowledge Summaries and how we improve the reviewer and author experience.

Once again, a massive thank you to everyone who works for and supports Veterinary Evidence, wishing you all a safe and productive 2023.

Kit Sturgess

Editor-in-Chief

Ultrasonographic detection of cranial cruciate ligament pathology in canine stifles without cranio-caudal instability

2023-01-26T15:57:53+00:00

Objective

Explore the value of musculoskeletal ultrasound in detecting cruciate ligament pathology

Background

Partial tears of the cranial cruciate ligament (CCL) can be difficult to diagnose due to the lack of instability present on orthopedic examination. Advanced diagnostics would be required for further evaluation. While a common tool in human medicine, MRI is of limited use in canines due to cost and the need for general anesthesia. Musculoskeletal ultrasound (MSK-US) can be performed without anesthesia but there are no current studies to date evaluating its usefulness in detecting partial tears of the cruciate ligaments

Evidentiary value

This is a retrospective case series (n=32) of dogs that underwent diagnostic MSK-US of the stifle who later had a surgical procedure (stifle arthroscopy/arthrotomy) to evaluate the intra-articular space.

Methods

Medical records were evaluated between May 2014 - April 2020 for canines with clinically stable stifles that underwent both an MSK-US of the stifle followed by stifle surgery. Ultrasound findings of the CCL were compared to surgical findings (considered gold standard).

Results

Compared to arthroscopy, ultrasound was a very sensitive test in detecting CCL pathology however it is less specific. Its sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were 100%, 58.3%, 81.5%, and 100% respectively.

Conclusion

MSK-US is a non-invasive test that can be performed with little to no sedation. Using a high frequency 18-5MHz linear transducer, MSK-US is a sensitive test for detecting partial CCL injuries in dogs and may aid in its diagnosis for canines without stifle instability and be useful in guiding treatment. As it is less specific, arthroscopy would be necessary to further confirm the intra-articular pathology.

Application

Diagnostic MSK-US is a non-invasive tool that can be used to detect CCL pathology in the stifle. Its application can help guide treatment recommendations prior to a more invasive diagnostic/therapeutic procedure such as surgery or arthroscopy.

Erratum to: Clinical audit of POM-V / POM prescriptions by remote consultation via a veterinary video telemedicine smartphone application

2022-06-20T10:15:27+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Erratum to: Should we prescribe oral metronidazole or probiotics for acute gastroenteritis in dogs?

2022-06-28T13:59:15+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Does the use of supraglottic device in rabbits cause less injury than other airway management devices?

2022-12-02T11:09:57+00:00

There is an erratum to this paper published in Veterinary Evidence Vol 8, Issue 2 (2023): https://doi.org/10.18849/ve.v8i2.663

PICO question

In rabbits, undergoing general anaesthesia, does the placement of a v-gel® device result in less airway trauma compared to the use of other airway management devices?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Three papers were critically appraised, two blinded randomised experimental trial studies and one randomised crossover experimental trial study

Strength of evidence

Weak

Outcomes reported

One blinded randomised trial study demonstrated that the trauma to the upper airways of rabbits during anaesthesia is not significantly different between the use of v-gel® and an endotracheal tube. The other blinded randomised trial study demonstrated that the trauma to the upper airway caused by endotracheal intubation is significantly more than that caused by v-gel® placement. The randomised crossover trial study demonstrated that v-gel® placement causes more significant compression to the larynx compared to a laryngeal mask or face mask

Conclusion

The current evidence suggests that use of the v-gel® in rabbits causes less trauma / injury to the airways compared to placement of an endotracheal tube but not compared to the use of a laryngeal or face mask. However, based on the low number and quality of published studies, this evidence is weak, and better-quality studies are required to support the routine use of v-gel® over other airway devices in rabbits. While v-gel® may be a safer alternative for securing airways in rabbits compared to endotracheal intubation, knowing the injuries this device can cause to the upper airways is useful for managing rabbits during post anaesthesia recovery

How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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

2022-07-13T11:50:27+01:00

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 veterinary practice-based 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 need for further research to explore factors influencing uptake of SBV vaccination by farmers to protect flocks against future waves of infection, and to develop more rational vaccination programmes based on ‘early warning’ surveillance systems.

Methods

Face-to-face semi-structured interviews were conducted in 2013. Qualitative interview data were thematically analysed to gain an understanding of the perspectives, perceptions and lived experiences of sheep farmers. Quantitative data in the form of (i) farmers’ self-appraised severity scores of the perceived impacts on flock welfare, financial performance and their emotional well-being; and (ii) flock records of pregnancy scanning results, lambing dates, and mortality records for ewes and lambs, were collected for the SBV affected 2012/2013 production year and for up to 3 previous years for comparison.

Results

Farmers perceived generally high but widely variable negative impacts of SBV infection on animal welfare (median score: 3.5/5, range: 2–5), financial performance (median score: 3.5/5, range: 2–5) and their own well-being (median score: 4/5, range: 2–5); variation between farmers in the severity of impacts appeared not to be directly related to recorded lamb losses (of all lambs born, an overall average of 21% (range: 13.7–42.6%) were stillborn or died within 7 days; 15% (range: 4.1–42.6%) were stillborn or died due to SBV), or to reductions in lamb rearing percentage (10–37% fewer lambs reared in the affected year compared to previous reproductive performance or an industry benchmark). 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 semi-structure interviews captured narrative descriptions of the distressing clinical signs seen in ewes and lambs, the variable levels of dystocia, and the lived experiences of farmers caring for affected sheep including the increased workload during the lambing period, greater feelings of tiredness and anxiety than in ‘normal’ lambing periods, depression, and also more positive emotions of resilience and ability to cope with an unexpected and novel disease outbreak. Three of the six farmers subsequently vaccinated with SBV vaccine to protect their early lambing flocks before the next early breeding season. Of the three farmers who decided not to vaccinate: one delayed the start of the subsequent breeding season; the second felt uncertain about using the rapidly developed and authorised vaccine so close to the start of the breeding season but was reassured by veterinary advice that the risk of a further disease outbreak in the subsequent breeding season was low as flock SBV seroprevalence was high (~90% of ewe were seropositive) following the first outbreak; and the third experienced the lowest sheep losses of the six farmers in the first outbreak and perceived the severity of the impacts to be at the lowest level, but felt uncertain about the risks of repeat infections and future disease outbreaks.

Conclusion

Severity of farmer perceived impacts of SBV infection was generally high; farmers’ detailed descriptions of their experiences during the outbreak, and perceptions of the impacts on ewe and lamb welfare, financial performance and their emotional well-being, captured during semi-structured interviews, are reported for the first time. Variation in severity of impacts appeared not to be directly related to the number and proportion of lambs stillborn or that died in the first week of life and the overall reduction in percentage of lambs reared for sale. Qualitative interview data taken together with quantitative data on recorded flock performance suggested multiple factors and variable effects of SBV in flocks were likely to have contributed to, and variably influenced, the severity of impacts perceived by farmers. Uncertainty about the safety, efficacy and use of the vaccine so close to the next early breeding season when it was first authorised in May 2013, and the risks of repeat SBV infections and future disease outbreaks for farmers who decided not to vaccinate their flocks may have added to the impact on farmers’ emotional well-being. Reductions in lamb rearing percentage appeared to be higher in flocks that artificially inseminated ewes in synchronised oestrus in July 2012 than in those that mated ewes naturally in spontaneous oestrus in June 2012. These findings are important and suggest that recorded lamb losses and reduction in rearing percentage should not be used as proxy measures of the severity of impacts of SBV infection on farmers and sheep flocks. Further outbreaks have occurred in the UK in 2016/2017 and 2021/2022 and it is expected this pattern of virus circulation and disease re-emergence will be repeated every 3–6 years. Flocks remain at-risk of future SBV infection and, in high risk flocks, of severe impacts on animal health and welfare, flock financial performance and farmers’ emotional well-being. Further research is needed to explore farmers’ future risk perceptions, uncertainty and decision-making around preventive vaccination, and to explore the potential for more rational vaccination programmes based on active arbovirus (SBV and Bluetongue virus [BTV]) surveillance systems.

Application

These findings will be of interest to all stakeholders in the sheep industry e.g. farmers, veterinarians, advisers, researchers, welfare organisations, pharmaceutical companies, the UK Government, industry levy boards and other research funding bodies. The study offers new insights into the impacts of SBV infection in sheep flocks, particularly in production systems dependent upon early breeding (so called ‘out of season breeding’) overlapping with periods of peak midge activity and circulation of SBV in which risks of high impacts appear to be greater. Other studies are needed to investigate further possible associations between variability in reproductive outcomes and factors such as breed (not reported here) and timing and method of breeding (natural mating or artificial insemination; at a spontaneous or synchronised oestrus). Research is needed to better understand farmers’ decision-making around SBV vaccination and to investigate the potential for more rational vaccination programmes based on early warning systems, such as national or Europe-wide arbovirus surveillance systems.

Box rest and analgesia compared to arthroscopic debridement for lame horses with hindlimb subchondral lucencies

2023-02-15T15:47:52+00:00

Category of research

Treatment.

Number and type of study designs reviewed

Two relevant publications were found, both were retrospective case series.

Strength of evidence

Weak.

Outcomes reported

The success rate of horses returning to previous level of competition following arthroscopic debridement varies widely in the literature available, from 25–86%. While a study reports 64% return to soundness following rest, it is not clear which horses received strict box rest or paddock rest, the duration of the rest period, and whether non-steroidal anti-inflammatory drugs were also prescribed. It is also worth noting that all horses which undergo surgery will also undergo a period of box rest – which makes the two treatment options difficult to compare.

Conclusion

Newer techniques with better success rates are now available and should be considered in lieu of box rest or arthroscopic debridement. Across all treatments available, age remains an important factor with regards to return to soundness, with older horses having a poorer prognosis. Thorough examinations should therefore be performed to rule out concurrent conditions before deciding upon treatment options.

How to apply this evidence in practice

Exploring the motivations, challenges, and barriers for implementing evidence-based veterinary medicine (EBVM) in general practice

2022-12-07T10:08:09+00:00

An evidence-based veterinary medicine (EBVM) training resource, ‘EBVM Learning’, was created in 2015 and updated in 2019. Following feedback from users, it was decided that a more concise practitioner-focused version was needed.

Seven online focus groups, with a total of 22 veterinary practitioners, explored the motivations of practitioners to engage with EBVM. They considered the challenges and barriers to implementing EBVM in practice, and specific supportive measures they felt would increase adoption of EBVM in practice. Participants identified time, support from colleagues and management, and accessing and appraising evidence as being the most important challenges and barriers to the use of EBVM in general practice. However, the value of EBVM was appreciated, and there was an appetite amongst the participants to utilise more EBVM to inform their clinical decision-making.

At a workshop attended by experts in EBVM, educators and practitioners, the results of the focus groups were presented and discussed to inform the development of a new online training resource.

This study has been used to produce ‘EBVM for Practitioners’, to attempt to reduce some of the barriers and challenges faced by practitioners and support them in increasing their use of EBVM. Further work by the leaders in the veterinary profession will be needed to expand and improve the quality of the evidence base on which EBVM relies, and to ensure practitioners have the skills, access, and motivation to utilise it.

When treating canine diabetic ketoacidosis, do balanced crystalloids provide superior outcomes compared to 0.9% Saline?

2022-08-24T16:01:35+01:00

PICO question

When treating canine diabetic ketoacidosis, do balanced crystalloids provide superior outcomes compared to 0.9% saline?

Clinical bottom line

Category of research question

Treatment and prognosis

The number and type of study designs reviewed

Zero

Strength of evidence

Zero

Outcomes reported

There is currently a lack of studies looking at comparing 0.9% saline to a buffered crystalloid solution (such as Hartmann's) in dogs with diabetic ketoacidosis

Conclusion

In view of the strength of evidence and the outcomes from the analysed studies, there is currently no evidence that the use of 0.9% saline or the use of a buffered crystalloid affects the outcome in dogs with diabetic ketoacidosis

How to apply this evidence in practice

In dogs diagnosed with osteoarthritis, how safe and effective is long-term treatment with bedinvetmab in providing analgesia?

2022-11-30T10:29:52+00:00

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

Erratum to: In horses undergoing volatile anaesthesia, does intraoperative alpha-2-agonist infusion improve recovery?

2022-05-31T10:27:02+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Surgical castration in dogs: does the incision approach influence postoperative recovery?

2022-10-26T10:33:08+01:00

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

Does the selective serotonin reuptake inhibitor (SSRI) fluoxetine modify canine anxiety related behaviour?

2022-11-23T13:36:02+00:00

PICO question

Does administration of the selective serotonin reuptake inhibitor (SSRI) fluoxetine reduce the severity and / or frequency of some anxiety related behaviours in companion dogs, of at least 8 months of age, when compared with no pharmacological treatment?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Two studies, both randomised, were critically appraised. Each had a placebo control group and the dog's owners were blinded to the treatments

Strength of evidence

Moderate

Outcomes reported

Both studies provide moderate evidence that fluoxetine, when dispensed at 1–2 mg/kg per day by oral administration and not involving a behavioural modification program for the patient, may reduce some behaviours associated with separation anxiety and / or compulsive disorders. Both studies indicate that a reduction in some unwanted behaviours may be observed after 1 week of fluoxetine medication. Both studies recommend that behavioural and environmental modifications are important adjuncts to pharmacologic treatment of dogs with either compulsive disorders or separation anxiety. Both studies also report that some dogs treated with fluoxetine experienced anorexia / decreased appetite and lethargy, although most of these effects were transient

Conclusion

The clinical recommendation is that fluoxetine at 1–2 mg/kg administered orally, once daily, may be beneficial in reducing the severity of some canine anxiety related behaviours

How to apply this evidence in practice

Immune-mediated polyarthritis in dogs: Are corticosteroids the best bet?

2023-01-25T12:56:12+00:00

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

In horses undergoing volatile anaesthesia, is recovery quality superior with sevoflurane compared to isoflurane?

2022-08-03T12:16:15+01:00

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

In dogs undergoing extrahepatic portosystemic shunt attenuation, does pretreatment with levetiracetam reduce postoperative seizure incidence?

2022-08-17T09:37:28+01:00

PICO question

In dogs undergoing surgical attenuation of a congenital extrahepatic portosystemic shunt, does pretreatment with levetiracetam reduce the incidence of post attenuation seizures?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Four papers were critically reviewed. All were retrospective cohort studies

Strength of evidence

Moderate

Outcomes reported

In one paper levetiracetam was found to reduce the risk of post-attenuation seizures. In the remaining three papers no difference was found between the frequency of post-attenuation seizures and the use of levetiracetam

Conclusion

That prophylactic levetiracetam is not indicated for the use of preventing post-attenuation seizures in dogs surgically treated for extrahepatic portosystemic shunts

How to apply this evidence in practice

An assessment of client and clinician satisfaction in veterinary teleconsultation compared to in-person consultations

2022-07-27T09:25:12+01:00

PICO question

Compared to in-person veterinary consultations, does teleconsultation lead to similar levels of client and clinician satisfaction?

Clinical bottom line

Category of research question

Qualitative assessment

The number and type of study designs reviewed

Eight studies were critically appraised. There were six cross-sectional studies, one randomised controlled clinical trial, and one case report

Strength of evidence

Weak

Outcomes reported

All eight studies provided weak evidence of similar levels of clinician and / or client satisfaction

Conclusion

Teleconsultation can lead to similar levels of client and clinician satisfaction when compared to in-person consultations. However, the evidence is weak due to the subjectivity and varied methods of measuring satisfaction. Furthermore, the current applicability of veterinary teleconsultation is still very limited to certain select scenarios in which it is appropriate (e.g., emergency, triage, remote locations, non-complicated routine postoperative checks, nutrition and behavioural consults)

How to apply this evidence in practice

Does treatment with clomipramine reduce cat psychogenic alopecia?

2022-06-29T19:34:15+01:00

PICO question

In cats with psychogenic alopecia, is overgrooming reduced by the use of clomipramine compared to untreated cats?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

One pseudo-randomised controlled study

Strength of evidence

Weak

Outcomes reported

Effect of clomipramine using owner report of number, intensity, and / or duration of grooming episodes, owner reported clinical improvement, and veterinary measured alopecia, extent of tissue damage, and hair regrowth

Conclusion

The only controlled study found no evidence that clomipramine alone is effective in reducing grooming episodes, alopecia, or improved hair regrowth. Further research with randomised, double blind controlled trials and limitation of confounding factors is required to determine the efficacy of clomipramine alone or in addition to behavioural / environmental therapies

How to apply this evidence in practice

In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the score of a recognised scoring system?

2022-06-22T10:01:40+01:00

PICO question

In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the Canine Atopic Dermatitis Lesion Index score (or some other recognised scoring system)?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

One randomised controlled trial and one before and after study were critically appraised

Strength of evidence

Weak

Outcomes reported

One randomised controlled trial studied the effects of lokivetmab and oclacitinib and found that both drugs were similar in reducing the Canine Atopic Dermatitis Lesion Index (CADESI-03) score.

An additional study was evaluated but had non-standardised data as it was a before-and-after study on use of lokivetmab. The paper noted that dogs’ response to oclacitinib can be used to predict how well these dogs respond to lokivetmab. This study also reported a reduction in Pruritus Visual Analog Scale (PVAS) score between before and after lokivetmab administration

Conclusion

In view of the strength of evidence and outcomes from the studies, there is insufficient quality of evidence to answer the PICO question and so further comparative study is required

How to apply this evidence in practice