scholarly journals Mortality rate comparison of enterotomy and resection and anastomosis (enterectomy) in dogs with foreign-body obstructions

2021 ◽  
Vol 6 (4) ◽  
Author(s):  
Hillary Mikulak ◽  
Wanda J. Gordon-Evans
Keyword(s):  
Foreign Body ◽  
Mortality Rate ◽  
Research Question ◽  
Perioperative Period ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Foreign Body Obstruction ◽  
The Individual ◽  
Resection And Anastomosis

PICO question In dogs with gastrointestinal foreign-body obstruction undergoing surgical correction, is the mortality rate in the perioperative period for those receiving resection and anastomosis higher, lower, or equivalent to those receiving an enterotomy?   Clinical bottom line Category of research question Outcome The number and type of study designs reviewed Four retrospective studies were reviewed Strength of evidence Weak Outcomes reported It would appear that the mortality rate for resection and anastomosis for the purpose of foreign-body removal is higher than that of enterotomies performed for the same reason Conclusion There is insufficient evidence directly comparing enterotomies with resection and anastomoses in foreign-body obstructions to definitively state that the mortality rate is higher among resection and anastomosis procedures   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 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 In horses undergoing volatile anaesthesia, does intraoperative alpha-2-agonist infusion improve recovery?

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Alison Bennell
Keyword(s):  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Healthy Horse ◽  
Multiple Factors ◽  
Constant Rate ◽  
The Individual ◽  
Study Designs ◽  
Inform Decision Making

PICO question In horses undergoing volatile anaesthesia with isoflurane or sevoflurane, does administration of an alpha-2 agonist as a CRI compared to anaesthetic maintenance with volatile alone improve recovery quality?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Eight papers were critically appraised. All prospective, randomised clinical trials. 7/8 papers were blinded and 4/8 were crossover design Strength of evidence Moderate Outcomes reported One paper investigating detomidine and one on romifidine showed no improvement in recovery quality. 3/3 medetomidine papers and 2/3 dexmedetomidine papers showed a significant improvement in recovery quality in the alpha-2 agonist CRI group Conclusion In a healthy horse undergoing general anaesthesia with isoflurane or sevoflurane maintenance, an intra-operative constant rate of infusion (CRI) of medetomidine and dexmedetomidine can lead to better recovery quality when compared to horses who are maintained on isoflurane or sevoflurane alone   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 Are bisphosphonates a more effective treatment than intra-articular steroids in horses with distal hock osteoarthritis?

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Hannah Greene
Keyword(s):  
Retrospective Study ◽  
Randomised Controlled Trials ◽  
Research Question ◽  
Individual Case ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Bottom Line ◽  
The Individual ◽  
Randomised Controlled

PICO question In horses that are lame due to osteoarthritis of the distal tarsal joints (bone spavin), is intra-articular medication with corticosteroids compared to systemic bisphosphonate treatment more effective in long-term lameness reduction?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three papers were critically reviewed. Two were randomised controlled trials, and one was a retrospective study. Strength of evidence Weak Outcomes reported There is insufficient evidence to support the use of systemic bisphosphonates over intra-articular corticosteroids to treat distal hock osteoarthritis in horses. Conclusion Horses with distal hock osteoarthritis should not be treated with systemic bisphosphonates until further blinded randomised controlled trials are completed. Additionally, supportive evidence for the use of intra-articular corticosteroids as a treatment for degenerative hock osteoarthritis is limited to a retrospective study where modest, short-term improvements are reported: 58% of horses improved after an average of 56 days (Labens et al., 2007). Evidence does not support significant improvement in long-term outcomes: 50% of horses improved after 4 months (Watts et al., 2016) and only 38% of horses improved after a mean follow-up period of 787 days (Labens et al., 2007).   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 Can garlic prevent, repel or kill fleas that infest dogs?

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Louise Anne Buckley
Keyword(s):  
Research Question ◽  
Topical Administration ◽  
Individual Case ◽  
Clinical Expertise ◽  
Inclusion Criteria ◽  
Bottom Line ◽  
The Individual ◽  
Study Designs ◽  
Inform Decision Making

PICO question In dogs, is oral or topical administration of garlic, compared to no treatment, efficacious at preventing or reducing parasitism by fleas?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Zero Strength of evidence Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero evidence in terms of their experimental design and implementation Outcomes reported The outcomes reported were none Conclusion It is concluded that there is a lack of peer-reviewed scientific in vivo evidence to address the PICO   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 Healing of equine heel bulb lacerations: Evidence behind casting compared to bandaging alone

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Julia Dubuc ◽  
Jonny Ruiz
Keyword(s):  
Research Question ◽  
Case Series ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Level Of Evidence ◽  
Expert Opinions ◽  
The Individual ◽  
Study Designs ◽  
Inform Decision Making

PICO question In horses with heel bulb lacerations, does casting the distal limb compared to bandaging result in increased speed of healing and functional outcome?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed A single retrospective study was found to be relevant to the topic along with one case report and two case series, including one tutorial article Strength of evidence The majority of the current recommendations come from expert opinions, making the level of evidence low Outcomes reported There are currently insufficient data to compare the effect of foot/slipper casts versus bandaging alone on the rate of healing of equine heel bulb lacerations Conclusion Based on the information from these three publications, it is not possible to recommend the use of a foot cast over a bandage alone at this time   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 Uncomplicated gallbladder mucoceles – is it better for prognosis to perform cholecystectomy or medically manage?

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Rachel T. Griffiths ◽  
Wanda J. Gordon-Evans
Keyword(s):  
Research Question ◽  
Direct Analysis ◽  
Individual Case ◽  
Clinical Expertise ◽  
Survival Times ◽  
Bottom Line ◽  
Term Survival ◽  
Long Term Survival ◽  
The Individual

PICO question In dogs with an uncomplicated gallbladder mucocele, is the long-term survival when surgically managed superior, inferior, or equal to those medically managed?   Clinical bottom line Category of research question Treatment and prognosis The number and type of study designs reviewed Three papers were critically reviewed. All of the studies were retrospective analyses of medical records, two of which were cohort studies, and one which was a case control study Strength of evidence Weak Outcomes reported There is some evidence that surgical management of gallbladder mucoceles is associated with longer survival times than medically managed cases, although there is no direct analysis of uncomplicated vs complicated cases Conclusion We cannot clearly make a conclusion based on the available evidence. To date, there is only one retrospective analysis that directly compares the long-term survival of cases medically vs surgically managed, but this study does not separate uncomplicated vs complicated cases of gallbladder mucocele. In order to more accurately determine which type of treatment should be recommended for uncomplicated cases of gallbladder mucoceles, a prospective study comparing long-term survival with each treatment should be performed. These studies should also standardise medical management in order to more accurately compare survival time to surgical treatment   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 Comparison of the safety of alfaxalone and propofol as anaesthetic induction agents in bitches un-dergoing c-section

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Benjamin Haythornthwaite
Keyword(s):  
Caesarean Section ◽  
Randomised Controlled Trials ◽  
Research Question ◽  
Individual Case ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Anaesthetic Induction ◽  
Bottom Line ◽  
The Individual ◽  
Randomised Controlled

PICO question In bitches and their puppies undergoing caesarean section, is an alfaxalone or a propofol induction safer?   Clinical bottom line Category of research question Risk The number and type of study designs reviewed Six papers were critically reviewed. There were two randomised controlled trials directly comparing alfaxalone and propofol inductions, two randomised controlled trials including a propofol induction in one of the experimental groups and two non-comparative studies. Strength of evidence Moderate Outcomes reported Propofol and alfaxalone can both be used safely for the anaesthesia of bitches and their puppies undergoing caesarean section. There is evidence that alfaxalone may provide better anaesthesia quality for the bitches, and the puppies may be delivered with higher indicators of puppy vitality following its use. Further research into the beneficial clinical outcomes of alfaxalone should be investigated. Conclusion The use of both propofol and alfaxalone for the induction of bitches undergoing caesarean section can be recommended.   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 ranitidine administration improve gastrointestinal motility in dogs presented with vomit and/or anorexia?

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Lara Brunori
Keyword(s):  
Research Question ◽  
Individual Case ◽  
Controlled Clinical Trial ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Clinical Recommendations ◽  
The Individual ◽  
Study Designs

PICO question In dogs presenting with gastrointestinal (GI) hypomotility is ranitidine administration (any route) beneficial in improving GI motility?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed One prospective controlled clinical trial and five experimental crossover studies Strength of evidence Weak Outcomes reported The vast majority of the evidence investigating ranitidine as a prokinetic has been carried out in experimental settings both in vivo with healthy conscious and anaesthetised dogs and in vitro. Under these circumstances ranitidine has shown some prokinetic properties. However, it is difficult to translate these results into reliable clinical recommendations, as the doses mentioned in these studies are often higher than the ones clinically recommended and healthy canine patients might respond differently to clinically affected ones Conclusion Although in experimental settings ranitidine has shown some prokinetic activities, no reliable clinical recommendations can be drawn from the appraised studies. There is a need of prospective clinical trials evaluating the administration of ranitidine to dogs presenting with GI hypomotility. Until further relevant studies become available, the efficacy of ranitidine administration as a prokinetic agent in dogs with GI hypomotility remains uncertain   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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