scholarly journals In dogs with osteoarthritis, how effective is treatment with tramadol in providing analgesia?

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Adrian Wong ◽  
Fernando Martinez-Taboada
Keyword(s):  
Controlled Trial ◽  
Research Question ◽  
Clinical Signs ◽  
Pain Severity ◽  
Pain Interference ◽  
Vertical Force ◽  
Bottom Line ◽  
End Of Treatment ◽  
Significant Difference ◽  
Interference Score

PICO question In dogs with osteoarthritis how effective is treatment with tramadol in reducing the severity of the clinical signs associated with pain when compared to no treatment?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Two papers were critically reviewed. There was one randomised crossover controlled trial and one non-randomised controlled trial Strength of evidence Strong Outcomes reported Budsberg et al. (2018) found no significant differences in the objective gait analyses (vertical ground reaction forces, and peak vertical force) between baseline and end of treatment, between tramadol and placebo. Similarly, there was no significant difference in the proportion of dogs with positive response based on the subjective Canine Brief Pain Inventory questionnaire (CBPI) between tramadol and placebo. The positive control of carprofen yielded significant differences to both placebo and tramadol in all outcomes measured. Malek et al. (2012) found no significant differences in the objective outcomes measured (gait analyses, and total daily activity) between tramadol and placebo. There were significant improvements in the subjective CBPI (total score, pain severity and pain interference score) between the baseline and end of treatment, within the tramadol group. However, there was no significant difference in the percentage change of the total score, pain severity or pain interference score between all treatment groups including tramadol and placebo Conclusion In dogs with osteoarthritis, the use of tramadol alone did not demonstrate any significant analgesic effects   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.  

scholarly journals The use of metronidazole in adult dogs with acute onset, uncomplicated, diarrhoea

2021 ◽  
Vol 6 (4) ◽  
Author(s):  
Emma Rogers-Smith
Keyword(s):  
Supportive Care ◽  
Negative Impact ◽  
Research Question ◽  
Clinical Signs ◽  
Acute Onset ◽  
Intestinal Microbiome ◽  
Current Evidence ◽  
Bottom Line ◽  
Care Protocol ◽  
Significant Difference

PICO question In adult, non-geriatric, dogs with acute onset (<7 days duration) uncomplicated diarrhoea does the addition of metronidazole to a supportive care protocol such as dietary modification or probiotics (excluding other antimicrobials) reduce the time to resolution of diarrhoea compared to supportive care protocols alone?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Four studies were included in this appraisal. Two prospective, double blinded, placebo controlled clinical trials, one prospective treatment trial and one retrospective longitudinal observational study Strength of evidence Weak Outcomes reported One study found a shortened duration of clinical signs (by 1.5 days; p = 0.04) in the metronidazole treated group compared to control. However, a separate study found no significant difference between control and metronidazole groups in the regards to resolution of clinical signs. One study demonstrated a long standing (>28 day) negative impact of metronidazole treatment on gut microbiome with no difference in time to resolution of clinical signs when compared with faecal matter transplant Conclusion The current evidence for the superiority of metronidazole compared to supportive treatment alone is weak and at this time there is no evidence-based rationale for its use in cases of uncomplicated, acute, canine diarrhoea. Furthermore, the negative implications of metronidazole on the intestinal microbiome have been found to be long standing (>28 days as a minimum) and should not be discounted by the prescribing 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.  

Acupuncture for Treatment of Noncyclic Breast Pain: A Pilot Study

2011 ◽  
Vol 39 (06) ◽  
pp. 1117-1129 ◽  
Author(s):  
Lori A. Thicke ◽  
Jennifer K. Hazelton ◽  
Brent A. Bauer ◽  
Carl W. Chan ◽  
Elizabeth A. Huntoon ◽  
...  
Keyword(s):  
Pilot Study ◽  
Controlled Trial ◽  
Brief Pain Inventory ◽  
Well Being ◽  
Pain Interference ◽  
Response To Treatment ◽  
Breast Pain ◽  
Breast Clinic ◽  
End Of Treatment ◽  
Average Pain

Noncyclic breast pain is a common breast disorder prompting women to seek medical evaluation. We aimed to perform a pilot study on the relief of noncyclic breast pain using acupuncture. Thirty-seven women seen at a diagnostic breast clinic between April 2003 and January 2009 were enrolled. Treatment consisted of four acupuncture sessions over two weeks, with three months of follow-up. Response to treatment was measured with use of a breast pain questionnaire, a quality of life (QOL) questionnaire, and the Cleeland Brief Pain Inventory (BPI) assessed at baseline, end of treatment, and three months after treatment. Data were analyzed using standard descriptive statistics. Twenty-two patients completed four acupuncture sessions. Pain described as throbbing and heavy decreased significantly after acupuncture (p = 0.04 and p = 0.03, respectively). After treatment, pain scores (on the 10-point BPI scale) decreased by an average of 3.5 points for the worst pain during the previous month (p = 0.001), by 2.7 points for average pain (p < 0.001), and by 2.3 points for pain interference (p = 0.002). The percentage of patients reporting a clinically meaningful decrease of 2 points from baseline to the end of treatment included 67% (12/18) for the worst pain, 65% (11/17) for average pain, and 56% (10/18) for pain interference. QOL data showed no improvement in QOL measures (mental, physical, emotional, social, or spiritual well-being). The results of this preliminary study suggest that a randomized controlled trial may be warranted to evaluate the effect of acupuncture on noncyclic breast pain, as well as the optimal frequency of acupuncture treatments.

scholarly journals Is inhaled immunotherapy more effective than environmental management when treating equine asthma?

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Amy Leather ◽  
Sarah Smith
Keyword(s):  
Environmental Management ◽  
Lung Function ◽  
Research Question ◽  
Clinical Signs ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Equine Asthma

PICO question In horses with severe equine asthma syndrome, is inhaled immunotherapy compared to environmental reduction of allergen exposure more effective in disease modification?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed 12 papers were critically reviewed. Nine clinical trials; one crossover study; one split-plot design study; and one cross-sectional study Strength of evidence Low Outcomes reported Four studies found inhaled immunotherapy to improve the clinical signs associated with equine asthma and the lung function of horses with asthma. Three papers found environmental modification by improved lung function and the clinical signs associated with equine asthma but two studies provide moderate evidence that environmental management alone is insufficient to permanently cure asthma Conclusion There is a low level of evidence to support the use of inhaled immunotherapy as a treatment for equine asthma   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.  

scholarly journals The effectiveness of Chair Massage on Stress and Pain in Oncology

2021 ◽  
Vol 14 (3) ◽  
pp. 27-38
Author(s):  
Talita Pavarini Borges de Souza, PhD ◽  
Leonice Fumiko Sato Kurebayashi, PhD ◽  
Juliana Nery de Souza-Talarico, PhD ◽  
Ruth Natalia Teresa Turrini, PhD
Keyword(s):  
Chronic Stress ◽  
Positive Impact ◽  
Controlled Trial ◽  
Signs And Symptoms ◽  
Pain Interference ◽  
Oncology Nursing ◽  
Time Interaction ◽  
Significant Difference ◽  
Nursing Team ◽  
Group Time

Background: There is a high prevalence of moderate-to-high levels of chronic stress among nurses, as well as an occurrence of musculoskeletal disorders. Purpose: To evaluate the effectiveness of chair massage to reduce chronic stress and musculoskeletal pain in the Oncology Nursing team. Setting: Two teaching cancer hospitals, one public and the other private, in São Paulo city, Brazil. Participants: A total of 60 women from the Oncology Nursing team. Research Design: A randomized controlled trial divided into two groups: chair massage and control without intervention. Intervention: The massage group received two chair massage sessions lasting 15 minutes, twice a week, for three weeks. Main Outcome Measure: Reduction of stress and pain measured by the List of Signs and Symptoms (LSS) and the Brief Pain Inventory (BPI), respectively. Results: The average age was 32 (± 5.3) years. There was a reduction of stress measured by the LSS with a statistical difference in the group-time interaction (p < .001), with a Cohen’s d value of 1.21 between groups. The BPI analysis showed a statistically significant difference in the group-time interaction for general activity (p < .008), mood (p < .03), work (p < .000), and sleep (p = .03), with reduced pain interference in these components. Conclusion: Chair massage reduced stress and pain interference in the team’s daily life activities, bringing a positive impact in the context of work stress and pain in Oncology nursing professionals.

scholarly journals For horses undergoing general anaesthesia, are rope recoveries or free recoveries better?

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Ffion Lloyd ◽  
Pamela Murison
Keyword(s):  
Cohort Study ◽  
General Anaesthesia ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Controlled Trial ◽  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Weak Evidence

PICO question In horses undergoing general anaesthesia, does assistance with ropes result in better recoveries when compared to no assistance (‘free’ recovery)?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed One randomised, non-blinded controlled trial and two retrospective cohort studies Strength of evidence Weak Outcomes reported The three studies reviewed arrive at different conclusions regarding the utility of rope assistance in recovery from general anaesthesia in horses, but examine very different populations. The randomised controlled trial provides weak evidence that rope assistance can shorten recovery and improve recovery quality in healthy (American Society of Anesthesiologists (ASA) I–II) horses. One retrospective cohort study provides weak evidence that rope assistance confers a reduction in fatality in both healthy and sick horses. The other retrospective cohort study provides weak evidence that rope assistance confers no benefit to horses undergoing emergency colic surgery. Both assisted and unassisted groups in each study had fatalities and all studies reported complications related to the rope recovery system Conclusion Insufficient evidence is available to permit a full recommendation regarding rope assistance during recovery from general anaesthesia in horses. Rope assistance may improve recovery time and quality in some horses. The decision to perform a rope-assisted recovery must be made considering individual patient, team and clinic factors. Rope assistance cannot prevent fatalities in 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.  

scholarly journals In horses with trigeminal-mediated headshaking, is neuromodulation with EquiPENS™ more effective than with electroacupuncture?

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Jennifer Hindmarsh
Keyword(s):  
Research Question ◽  
Clinical Signs ◽  
Case Series ◽  
Individual Case ◽  
Repeated Treatment ◽  
Clinical Expertise ◽  
Bottom Line ◽  
The Individual ◽  
Study Designs ◽  
Inform Decision Making

PICO question In horses diagnosed with trigeminal-mediated headshaking, is EquiPENS™ therapy more efficacious when compared to electroacupuncture in terms of remission of clinical signs?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three papers were critically reviewed, all three were descriptive case series Strength of evidence Weak Outcomes reported Remission was achieved following both EquiPENS™ and electroacupuncture therapy in a proportion of horses for variable lengths of time. Median remission times appear to be longer with repeated treatment of EquiPENS™ compared to electroacupuncture Conclusion The evidence for EquiPENS™ treatment is more robust than for electroacupuncture, and remission defined more clearly, and so could be recommended with greater confidence   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.  

scholarly journals Efektivitas asam asetat 2% dalam alkohol 70% dibanding ketokonazol 2% topikal pada terapi otomikosis

2018 ◽  
Vol 48 (1) ◽  
pp. 26
Author(s):  
Hadi Sudrajad ◽  
Sarwastuti Hendradewi ◽  
Yunita Sinaga
Keyword(s):  
Acetic Acid ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Mycological Examination ◽  
Comparison Of Effectiveness

Latar Belakang: Otomikosis merupakan infeksi jamur pada kanalis auditorius eksterna (KAE),yang terkadang dapat menimbulkan komplikasi pada telinga tengah. Walaupun jarang membahayakanhidup, tetapi penyakit ini membuat frustasi bagi pasien dan spesialis Telinga Hidung Tenggorok-BedahKepala Leher (THT-KL), karena memerlukan pengobatan dan perawatan dalam jangka waktu yanglama, serta kemungkinan adanya kekambuhan. Tujuan: Menganalisis perbandingan efektivitas larutanasam asetat 2% dalam alkohol 70% dengan ketokonazol 2% topikal pada terapi otomikosis. Metode:Penelitian eksperimental dengan desain randomized controlled trial. Subjek adalah pasien otomikosis yangsesuai kriteria inklusi dan eksklusi. Penegakkan diagnosis otomikosis berdasarkan pemeriksaan jamurKOH 10%. Subjek dibagi 2 perlakuan yaitu kelompok larutan asam asetat 2% dalam alkohol 70% dankelompok ketokonazol 2% topikal. Dilakukan evaluasi klinis menggunakan skor visual analogue scale(VAS) pada gejala nyeri, gatal, telinga rasa penuh dan tinitus, serta tanda klinis dengan menggunakanotoskopi untuk otore pada hari 0, 3, dan 7. Kemudian dilakukan pemeriksaan mikologi dengan KOH 10%pada hari 0 dan 7. Hasil: Pada hari 7 tidak ada perbedaan signifikan berdasarkan skor gejala nyeri, gataldan telinga penuh, tinitus dan otore antara kelompok asam asetat 2% dibanding ketokonazol 2%, sedangpada pemeriksaan KOH 10% kelompok asam asetat 2% dalam alkohol 70% lebih efektif dibandingkelompok ketokonazol 2% topikal. Kesimpulan: Pada hari ke-7, asam asetat 2% dalam alkohol 70%tidak berbeda signifikan dibandingkan dengan ketokonazol 2% topikal untuk terapi otomikosis. ABSTRACTBackground: Otomycosis is a fungal infection of the external auditory canal but can causecomplications in the middle ear. Although rarely life-threatening, it is frustrating for patients andotorhinolaryngologists, because it requires long-term treatment and care and the possibility of recurrence.Objective: To analyze the comparison of effectiveness of acetic acid 2% solution in alcohol 70% withketoconazole 2% topical in otomycosis therapy. Method: Experimental research with randomizedcontrolled trial design. Subjects were otomycosis patients of appropriate in the inclusion and exclusioncriteria. Otomycosis diagnosis based on examination of fungi with KOH 10%. Subjects were dividedinto 2 treatment groups, acetic acid 2% solution in alcohol 70% group and ketoconazole 2% topicalgroup. A clinical evaluation was performed using visual analogue scale (VAS) scores on symptoms ofpain, itching, full ears and tinnitus, and clinical signs using otoscopy for otorea on day 0, day 3 andday 7. Mycological examination with KOH 10% was also performed on days 0 and 7. Result: On the 7 thday there is no significant difference based on symptoms of pain, itching, full ears, tinnitus and otoreabetween the acetic acid 2% in alcohol 70% group and the ketoconazole 2% topical group . There wasa significant effectiveness (p <0.05) from the results of mycological examination with KOH 10% in theacetic acid 2% in alcohol 70% group compared with the ketoconazole 2% topical group. Conclusion:On the 7 th day, there was no significant difference between acetic acid 2% in alcohol 70% and topicalketoconazole 2% for otomycosis therapy.

PP23  Soiled airway tracheal intubation and the effectiveness of decontamination by north east paramedics: a randomised controlled manikin study. The satiated2 study

2020 ◽  
Vol 37 (10) ◽  
pp. e11.1-e11
Author(s):  
Graham McClelland ◽  
Richard Pilbery ◽  
Sarah Hepburn
Keyword(s):  
Controlled Trial ◽  
Research Question ◽  
Ambulance Service ◽  
Success Rates ◽  
North East ◽  
Significant Difference ◽  
Intubation Success ◽  
First Pass ◽  
Intubation Success Rate ◽  
Randomised Controlled

BackgroundVomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest, but traditional paramedic suctioning techniques may be insufficient to manage severely soiled airways.A technique called Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) has been developed to help clinicians manage these difficult airways. The only UK SALAD study (SATIATED) reported improved paramedic first-pass intubation success rate. This study has now been replicated in a different ambulance service.The primary research question was: Does paramedic first-pass intubation rate in North East Ambulance Service improve following training in SALAD? The secondary research question was: Does training in SALAD affect the time taken to intubate by paramedics?MethodsA randomised controlled trial of SALAD was conducted using a modified airway manikin capable of vomiting to simulate a soiled airway. The intervention comprised SALAD training and the introduction of the DuCanto catheter for post-training attempts. Participants were randomised into two groups: A01A02B01 who made two pre-training intubation attempts and one post-training attempt, and A11B11B12, who made one pre-training and two post-training attempts. Data were collected on length of service, success rates, timings and techniques used.ResultsParamedics (n=102 participants, n=99 completed the study) were recruited between August and December 2019. First-pass intubation success rates on the second attempts (A02versus B11) were 86% and 96% respectively; a non-significant improvement of 10% (95% CI 1–21%, p=0.09). Both groups intubated faster on third attempts compared to first attempts. A01 to B01 mean improvement 5 (SD 14) seconds, A11 to B12 mean improvement 9 (SD 15) seconds. There was no significant difference in improvement between groups (mean difference -4 seconds, 95% CI -11–3 seconds, p=0.22).ConclusionsNorth East Ambulance Service paramedics demonstrated improved first-pass intubation success rates in a simulated soiled airway following SALAD training and improved time to intubation. This study supports the findings of the SATIATED study.

scholarly journals Is soybean therapy better than ClinOleic for reducing recovery time in cats with permethrin toxicosis?

2021 ◽  
Vol 6 (4) ◽  
Author(s):  
Shadira Gordon
Keyword(s):  
Soybean Oil ◽  
Olive Oil ◽  
Recovery Time ◽  
Case Reports ◽  
Research Question ◽  
Clinical Signs ◽  
Randomised Clinical Trial ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line

PICO question Is soybean oil-based intravenous lipid emulsion (IVLE) therapy more effective than olive oil-based (ClinOleic IVLE therapy) for reducing time to recovery in cats with permethrin toxicosis?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Five case reports and one randomised clinical trial Strength of evidence Weak Outcomes reported Soybean oil-based and ClinOleic IVLE therapies can be used safely as adjuvant treatments to reduce time to recovery in cats with permethrin intoxication. However, the evidence collected suggests that soybean oil-based IVLE therapy is better in reducing the recovery time after permethrin toxicosis as compared to ClinOleic IVLE therapy Conclusion The overall findings showed that the average recovery time after soybean oil-based IVLE therapy across patients with permethrin intoxication was 8.5 hours and the average time to recovery after olive oil-based emulsions (ClinOleic therapy) was 39 hours. This may suggest that soybean oil-based formulations are a better option for reducing the recovery time in cats after permethrin toxicity. Dermal decontamination, supportive care, muscle relaxers, and anticonvulsant drugs are examples of recommended treatments before the administration of any intralipid therapies and must be used based on the clinical signs of each patient   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.  

scholarly journals ‘Don’t pee on that!’ Comparing environmental modification and medical management in cats with FIC

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Amelia Poole
Keyword(s):  
Medical Management ◽  
Research Question ◽  
Treatment Options ◽  
Clinical Signs ◽  
Clinical Expertise ◽  
Short Term ◽  
Bottom Line ◽  
Environmental Modification ◽  
Strength Of Evidence ◽  
Weak Evidence

PICO question In cats with feline idiopathic cystitis (FIC) is environmental modification superior than medical management in preventing reoccurrence?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed 16 papers were critically reviewed; 14 randomised trials and two case studies Strength of evidence Critical appraisal of the selected papers meeting the inclusion criteria collectively provide weak evidence in terms of their experimental design and implementation Outcomes reported There is weak evidence that any medication or environmental modification is successful in reducing the reoccurrence of FIC when compared to a placebo. Short-term use of amitriptyline can contribute to an increase in occurrence of FIC Conclusion In view of the strength of evidence and the outcomes from the studies the following conclusion is made; in cats with feline idiopathic cystitis there is weak evidence that environmental modification or medication are effective at preventing reoccurrence. Further research is required into the cause of FIC before comparisons on treatment options can be made, however, with the exception of short-term use of amitriptyline, environmental modification and systemic treatment of clinical signs did not contribute to an increase in occurrence of FIC   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.

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