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.  

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 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 cats and dogs with traumatic diaphragmatic rupture, does surgical timing affect outcome?

2021 ◽  
Vol 6 (4) ◽  
Author(s):  
Alison Robertson
Keyword(s):  
Mortality Rate ◽  
Research Question ◽  
Case Series ◽  
Diaphragmatic Rupture ◽  
Sufficient Evidence ◽  
Current Evidence ◽  
Bottom Line ◽  
Surgical Timing ◽  
Significant Information ◽  
Traumatic Diaphragmatic Rupture

PICO question In cats and dogs with traumatic diaphragmatic rupture undergoing herniorrhaphy does surgical timing affect outcome?   Clinical bottom line Category of research question Prognosis The number and type of study designs reviewed Ten studies were critically appraised. All of these were retrospective case series Strength of evidence Zero Outcomes reported Overall, there is not sufficient evidence reporting if timing of surgical intervention has an effect on the mortality rate in dogs and cats with traumatic diaphragmatic rupture. Mortality rate was 6.8–50% in all cases Conclusion There is no statistically significant information available with only several retrospective studies published that are a low quality of evidence. Clinical practice can be reviewed based upon current evidence assessing timing of herniorrhaphy of traumatic diaphragmatic rupture. However, there are no clear recommendations and future studies are warranted   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 Current evidence supporting simultaneous prophylactic gastropexy in canine patients undergoing complete splenectomy

2021 ◽  
Vol 6 (4) ◽  
Author(s):  
Olivia Harris
Keyword(s):  
Research Question ◽  
Case Series ◽  
Conclusive Evidence ◽  
Current Evidence ◽  
Clinical Expertise ◽  
Limited Information ◽  
Cross Sectional Survey ◽  
Retrospective Case ◽  
Bottom Line ◽  
Cross Sectional

PICO question In dogs that have undergone a complete splenectomy, does performing a concurrent gastropexy decrease the risk of future gastric dilatation-volvulus (GDV) development when compared to not performing a concurrent gastropexy?   Clinical bottom line Category of research question Risk The number and type of study designs reviewed Five papers were critically reviewed which included one retrospective case series, one retrospective case-control study, and three combined retrospective cohort and cross-sectional survey studies Strength of evidence Weak Outcomes reported In dogs that have had a complete splenectomy, there is no conclusive evidence that prophylactic gastropexy decreases the risk of lifetime GDV development Conclusion Based on the limited information available, it is difficult to conclude if prophylactic gastropexy should be recommended routinely at the time of complete splenectomy   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 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.

scholarly journals Insulin choice in feline diabetes mellitus

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Yaiza Gomez Mejias
Keyword(s):  
Diabetes Mellitus ◽  
Research Question ◽  
Clinical Signs ◽  
Individual Case ◽  
Clinical Expertise ◽  
Bottom Line ◽  
Strength Of Evidence ◽  
Good Glycaemic Control ◽  
The Individual ◽  
Study Designs

PICO question In cats with diabetes mellitus, do protamine zinc insulin (PZI) and glargine show a similar effect in reducing clinical signs and hypoglycaemia episodes?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed The number and type of study designs that were critically appraised was one. This study was a non-randomised retrospective trial. A systematic review was also found, which analyses the influence of insulin in diabetic remission Strength of evidence Weak Outcomes reported Compared to PZI, using glargine in recently diagnosed diabetic cats fed exclusively an ultra-low carbohydrate-high protein canned diet, may result in lower fructosamine and mean 12 hour blood glucose concentrations as well as less episodes of hypoglycaemia Conclusion In view of the strength of evidence and the outcomes from the study the following conclusion is made: in cats with diabetes mellitus where currently licensed insulin fails to result in a good glycaemic control, glargine may be considered   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 Effectiveness of a Malaysian Media Intervention Workshop: Safe Reporting on Suicide

2021 ◽  
Vol 12 ◽  
Author(s):  
Jane Tze Yn Lim ◽  
Qijin Cheng ◽  
Yin Ping Ng ◽  
Kai Shuen Pheh ◽  
Ravivarma Rao Panirselvam ◽  
...  
Keyword(s):  
Lived Experience ◽  
Suicidal Behavior ◽  
Negative Impact ◽  
Current Evidence ◽  
Control Group ◽  
Media Content ◽  
Increased Risk ◽  
Significant Difference ◽  
Before And After ◽  
The Media

Background: Suicide remains an important cause of premature deaths and draws much media attention. However, unsafe reporting and portrayal of suicides by the media have been associated with increased risk of suicidal behavior. Current evidence suggests that media capacity-building could potentially prevent suicide. However, there are still knowledge gaps in terms of a lack of data on effective strategies for improving awareness and safe reporting of suicide-related media content. This study aims to investigate the effectiveness of a workshop conducted with members of the media community on the safe reporting of suicide-related content.Methods: An interventional single-arm pre and post pilot study was conducted on a sample of the Malaysian media community recruited through purposive and snowball sampling. The media safe reporting workshop was conducted by a suicide prevention expert with a media industry background. Thirty participants completed a self-reported evaluation questionnaire on their awareness and knowledge of reporting on suicide-related media content; before and after the interventional workshop.Results: There was a significant difference between the total scores before and after the intervention, with a large effect size. Post-intervention scores were significantly improved in 8 items, namely those related to the reporting of: (i) the content of any suicide note; (ii) headlines with methods of suicide; (iii) headlines with the location of suicide; (iv) cases of suspected suicide despite the unconfirmed cause of death; (v) suicide news to cater to readers’ interests; (vi) cause of suicide; (vii) details of the location of suicide; and (viii) the negative impact to media community when reporting suicide stories. In particular, there was an improvement in the majority of items for people from the media community with no lived experience of suicidal behavior.Conclusion: The media safe reporting workshop is a potentially effective intervention for improving awareness and knowledge measures relating to safe reporting on suicide among the media community, with a more pronounced effect in those without lived experience of suicidal behavior. Limitations in the sample size, generalizability, short-term evaluation, and lack of a control group warrant future larger, longer-term controlled, and more representative studies.

scholarly journals Does medical or surgical treatment for aortic stenosis improve outcome in dogs?

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Julia Thomas ◽  
Sophie Marshall ◽  
Karin Gormley ◽  
Georgia Conway ◽  
Kieran Borgeat
Keyword(s):  
Surgical Treatment ◽  
Aortic Stenosis ◽  
Beta Blockers ◽  
Clinical Signs ◽  
Physiological Parameters ◽  
Controlled Study ◽  
Survival Times ◽  
Bottom Line ◽  
Ethical Implications ◽  
Significant Difference

PICO question In adult dogs with aortic stenosis does treatment with beta blockers compared with surgical intervention show a longer survival time with improved clinical parameters?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Eight studies were reviewed. One was a randomised controlled study, three were cohort studies, one was a case series and three were case reports Strength of evidence Moderate to weak Outcomes reported Intervention appeared to improve survival times ± physiological parameters when compared to no treatment at all. The severity of clinical signs was reduced, but the risk of sudden cardiac-related death was not diminished according to a number of papers. The direct comparison of surgical treatment with the use of beta blockers showed no significant difference in survival times or physiological parameters across all papers. There is not enough evidence available comparing the different beta blockers used for treatment to draw a meaningful conclusion as to which is more effective Conclusion Treatment of some form should be given to a dog diagnosed with aortic stenosis. This will improve clinical signs and there is evidence to say that it will prolong survival as well as improve quality of life.More research into this area is essential. Controlled, randomised clinical trials should be carried out in order to find a reliable and strong recommendation for treatment. Ethical implications need to be considered when going forward with this, which is why the evidence pool is likely to be so limited currently   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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