scholarly journals Efficacy of EMLA™ cream for reducing pain associated with venepuncture in felines

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Erina Leask
Keyword(s):  
Research Question ◽  
Safety Margin ◽  
Eutectic Mixture ◽  
Cephalic Vein ◽  
Blood Collection ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Double Blind ◽  
Noninvasive Treatment ◽  
Pain Responses

PICO question In adult cats undergoing a venepuncture procedure, does the application of a topical lidocaine based anaesthetic to the skin at the venepuncture site reduce the severity of signs associated with pain when compared to no topical anaesthetic?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Four papers were critically reviewed. Three were prospective, double-blind, randomised, controlled clinical trials, and one was a prospective, double-blind, controlled experimental trial Strength of evidence Moderate Outcomes reported The application of Eutectic Mixture of Local Anaesthetics (EMLA™) cream to clipped skin over the procedure site, a minimum of 30 minutes prior to the venepuncture procedure, significantly reduced the severity of pain-associated behaviours during jugular phlebotomy in healthy, conscious feline patients when compared to a placebo1,2. In felines sedated with dexmedetomidine and either methadone or nalbuphine, the administration of EMLA™ cream to clipped skin for 20 minutes significantly decreased the severity of pain responses during intravenous (IV) cephalic vein catheterisation when compared to no treatment3. In clinically unwell feline patients, the use of EMLA™ cream on clipped skin at the site of jugular catheterisation 60 minutes prior demonstrated reduced pain responses compared to a placebo, but further investigation with a larger sample size is required to verify statistical significance4 Conclusion The available evidence moderately supports the hypothesis that EMLA™ cream is an effective and noninvasive treatment for providing enhanced pain-relief during jugular and cephalic vein phlebotomy for the purposes of blood collection and catheterisation, respectively. The areas for treatment should be clipped free of hair, and the cream applied for a minimum of 30 minutes in non-sedated cats and 20 minutes in cats sedated with dexmedetomidine and either methadone or nalbuphine. Moreover, when applied to normal, intact skin and covered by an occlusive bandage to avoid ingestion, it is well supported by supplementary evidence that EMLA™ cream has a wide safety margin for topical use in cats4,5   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 Distal tarsal joints osteoarthritis: Evidence behind bisphosphonates and NSAIDs to improve lameness

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Julia Dubuc
Keyword(s):  
Research Question ◽  
Treatment Options ◽  
Individual Case ◽  
Placebo Control ◽  
Clinical Expertise ◽  
Long Term Effects ◽  
Bottom Line ◽  
Double Blind ◽  
The Individual

PICO question In lame horses affected by osteoarthritis of the distal tarsal joints (bone spavin), are bisphosphonates more effective than NSAIDs in long-term alleviation of lameness?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Two papers were critically reviewed. There was one field study and a multicentric randomised double-blind placebo control study Strength of evidence Weak Outcomes reported Each study looked at the effect of either Tiludronate or Firocoxib on alleviation of tarsal lameness. Both Tiludronate and Firocoxib, while administered independently, provided some degree of relief (for up to 120 days) and improved the lameness related to tarsal osteoarthritis. Conclusion Since no study was found to directly compare the use of non-steroidal anti-inflammatory drugs and bisphosphonates and that none evaluate the long-term effects of these treatment options on lameness, it is not possible to recommend one treatment option over the other to alleviate lameness caused by tarsal osteoarthritis in horses.   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 dogs weighing under 15 Kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Tafara Mapuvire
Keyword(s):  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Research Question ◽  
Tibial Tuberosity ◽  
Clinical Expertise ◽  
Best Interest ◽  
Bottom Line ◽  
Cranial Cruciate Ligament ◽  
Cranial Cruciate Ligament Disease

PICO question In dogs weighing under 15 kg with unilateral cranial cruciate ligament disease, does tibial tuberosity advancement lead to better long-term functional outcomes than lateral fabellar suture?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed There were no papers that answered the PICO question Strength of evidence Zero Outcomes reported Between TTA and LFS none of the techniques was shown to provide better long-term functional outcomes than the other in dogs weighing less than 15 kg Conclusion Given the absence of evidence answering the PICO question, choice and recommendation of procedure between TTA and LFS in dogs weighing under 15 kg should be guided by what the surgeon deems to be in the best interest of the 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 Does meniscal release confer similar clinical benefits to meniscal tear treatment when compared to meniscectomy?

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Ben Garland
Keyword(s):  
Cruciate Ligament ◽  
Research Question ◽  
Meniscal Tear ◽  
Clinical Expertise ◽  
Meniscal Tears ◽  
Bottom Line ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Time Of Surgery ◽  
Naturally Occurring

PICO question In adult dogs with naturally occurring medial meniscal tears concurrent to cranial cruciate ligament disease does meniscal release confer the same benefits in lameness resolution as meniscectomy?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed A single prospective cross-sectional study was reviewed, that fulfilled the criteria Strength of evidence None Outcomes reported Meniscal release, meniscectomy (partial, hemi- or complete), or the two combined performed for concurrent medial meniscal pathology at time of surgery for naturally occurring cranial cruciate ligament (CCL) rupture resulted in an acceptable long-term outcome. Difference in outcome between the techniques was not reported Conclusion There is no evidence that meniscal release provides an equal or superior treatment option for medial meniscal injury treated at the time of surgery for CCL rupture when compared to meniscectomy. The study critically reviewed performed meniscal release via radial transection through the meniscotibial ligament, and therefore does not represent mid-body abaxial radial release. Neither is this summary appropriate for considering prophylactic meniscal release of the normal meniscus. In addition, the surgical treatments for cranial cruciate ligament rupture were either ‘Tightrope’ or tibial plateau levelling osteotomy (TPLO) procedures. Further studies are required to compare clinical outcome between meniscal release or meniscectomy for treatment of concurrent meniscal tears   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 mares with placentitis does the duration of antibiotic treatment affect foal outcome?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Elizabeth Barter
Keyword(s):  
Antibiotic Treatment ◽  
Research Question ◽  
Individual Case ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Length Of Treatment ◽  
Diseased State ◽  
The Individual ◽  
Short Courses

PICO question In mares with placentitis does treatment with long-term antibiotics result in improved foal viability when compared to repeated short courses of 7 to 10 days?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed The literature search identified six publications that included length of antibiotic treatment and foetal outcome. The publications consisted of four non-randomised non-blinded controlled trials and two randomised non-blinded controlled trials Strength of evidence Collectively there was weak evidence to support either an intermittent or continuous antibiotic protocol in the treatment of placentitis in mares Outcomes reported The literature involved experimental induction of ascending placentitis with foal survival or viability as the outcome Conclusion Further research is required into the diagnosis of placentitis, length of treatment and choice of antibiotic/s to penetrate the uterus in a diseased state   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 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 In Greyhounds with paw pad corns, is surgical excision more effective at resolving lameness than extirpation?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Dan Kenny
Keyword(s):  
Research Question ◽  
Case Series ◽  
Surgical Excision ◽  
Individual Case ◽  
Repeated Treatment ◽  
Clinical Expertise ◽  
Recurrence Rates ◽  
Bottom Line ◽  
Level Of Evidence

PICO question In Greyhounds (and Sighthounds) with recurring pedal corns, is surgical excision in comparison to corn extirpation more effective at resolving lameness?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three case series were included, all three were retrospective, one included a prospective component. There was one opinion-based narrative review and one opinion-based article. Strength of evidence Weak Outcomes reported Extirpation allows only a short palliation of lameness and repeated treatment is required at variable intervals. Surgical excision may provide good rates of short-term resolution however, in the long-term recurrence rates are still moderate. It should also be born in mind that further corns may develop in different digits. Conclusion In Greyhounds (and Sighthounds) with recurring pedal corns, surgical excision of the corn is more likely to provide long-term resolution of lameness in comparison to extirpation. However, the current level of evidence on this topic is weak.   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 osteoarthritis, is mesenchymal stem cell therapy more effective at managing lameness than intra-articular corticosteroids?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Laura Pratley
Keyword(s):  
Stem Cell ◽  
Mesenchymal Stem Cell ◽  
Cell Therapy ◽  
Stem Cell Therapy ◽  
Research Question ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Cell Therapies ◽  
Mesenchymal Stem Cell Therapy ◽  
Moderate Evidence

PICO question In horses with osteoarthritis, is mesenchymal stem cell therapy more effective at managing lameness than intra-articular corticosteroids?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Nine papers were critically reviewed; seven experimental trials and two randomised controlled double-blinded trials. Strength of evidence Weak to moderate Outcomes reported There is moderate evidence to suggest that chondrogenically induced mesenchymal stem cells combined with equine allogenic plasma have a good efficacy at reducing lameness in the short-term, in horses with mild to moderate lameness associated with osteoarthritis. However, there is no definitive evidence directly comparing mesenchymal stem cell therapy and corticosteroids, to identify if mesenchymal stem cell therapy is more effective than intra-articular corticosteroids. Conclusion In horses with mild to moderate lameness associated with osteoarthritis, there is moderate evidence to suggest that mesenchymal stem cell therapies are effective at managing lameness. However, it is undetermined whether they are more effacious than intra-articular corticosteroids.   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 Is a cross-match necessary before a cat’s first blood transfusion?

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Ben Safrany ◽  
Sophie Adamantos
Keyword(s):  
Blood Transfusion ◽  
Research Question ◽  
Case Series ◽  
Individual Case ◽  
Randomised Control Trial ◽  
Clinical Expertise ◽  
Retrospective Case ◽  
Bottom Line ◽  
Cross Sectional ◽  
Transfusion Reactions

PICO question In transfusion-naïve cats receiving a type specific blood transfusion is cross-matched blood (major and minor) associated with an increased haematocrit development and reduction in acute transfusion reactions when compared with those receiving non-crossmatched blood?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Ten papers were critically reviewed. There were four retrospective case series, three prospective cross-sectional surveys, a retrospective cohort study, a prospective case series and a prospective randomised control trial. Strength of evidence Weak Outcomes reported It would appear that in the United Kingdom the incidence of non-AB transfusion reactions is low.  A single study suggests that cross-matching may result in a greater improvement in haematocrit, but this is unlikely to be clinically significant. There is evidence to support the hypothesis that non-AB antigens (for example the Mik antigen) differ with geographic distribution. Conclusion Based on the information available it is it is challenging to establish a meaningful clinical conclusion on which to base a recommendation.   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 incidence of uterine pathology in ovariectomised bitches

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Maria Norell Candetoft
Keyword(s):  
Research Question ◽  
Case Series ◽  
Individual Case ◽  
Clinical Expertise ◽  
Retrospective Case ◽  
Bottom Line ◽  
Gynaecological Examination ◽  
Long Term Follow Up ◽  
The Individual ◽  
Study Designs

PICO question What is the incidence of postoperative uterine pathology in ovariectomised bitches compared to ovariohysterectomised bitches?   Clinical bottom line Category of research question Incidence The number and type of study designs reviewed Three retrospective case series Strength of evidence Weak Outcomes reported None of the reviewed case series found any uterine pathology for ovariectomised bitches in the long-term follow-up of several years, although none of the studies performed a proper gynaecological examination to confirm a lack of pathology Conclusion With the limited evidence available, it appears that leaving the uterus when gonadectomising bitches does not seem to have a high risk for developing pathology as long as the ovaries are completely removed.   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 Does the use of topical honey result in a faster rate of second intention wound healing in dogs?

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Louisa Marcombes
Keyword(s):  
Wound Healing ◽  
Topical Application ◽  
Research Question ◽  
Wound Management ◽  
Editorial Office ◽  
Clinical Expertise ◽  
Open Wound ◽  
Bottom Line ◽  
Duplicate Publication ◽  
Complete Wound Healing

PICO question In healthy dogs undergoing open wound management, does the topical application of honey, when compared to wounds treated with daily saline washes only, reduce the time to complete wound healing?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Two studies satisfied the inclusion criteria for answering the PICO; both were prospective randomised controlled trials Strength of evidence Weak Outcomes reported The studies demonstrated a possible effect size of clinical importance of the use of honey in the treatment of canine wounds in terms of time to complete wound healing and antibacterial effect. However, the strength of the evidence provided by both studies is severely weakened by flaws in trial design, implementation and reporting, and the possible risk of pseudo replication between the two trials reported Conclusion The use of topical honey in canine open wound management may reduce time to complete wound healing. However, the evidence for this is weak. At present, the evidence that use of topical honey in canine wounds reduces time to healing is insufficient to warrant a change in clinical practice   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.   Editorial notice: Upon conducting the literature search for this Knowledge Summary the author discovered that the same paper had been published in two separate journals and that a third paper by the same author appeared to have used data from the same experimental subjects as the duplicate publication, despite reporting different methodology. The duplicate publications have been appraised by the author as one paper. The editorial office alerted the journals in question which resulted in the article that appeared in the Iranian Journal of Veterinary Surgery (Jalali, F.S. S., Tajik, H., Saifzaideh, S and Fartash, B. (2007b) Topical Application of Natural Urmia Honey on Experimental Burn Wounds in the Dog: Clinical and Microbiological Studies. Iranian Journal of Veterinary Surgery. 2(2), 13–21) being retracted: http://www.ivsajournals.com/article_114759.html. See our own policy on duplicate publication for more information.  

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