Comparison of the effect of marine-derived omega-3 fatty acids (n-3 FAs) as an adjunct to a non-steroidal inflammatory drug (NSAID) therapy vs NSAID therapy alone, for dogs with osteoarthritis

PICO question Does treatment with a non-steroidal anti-inflammatory drug (NSAID) with supplementation of marine-derived omega-3 fatty acids (n-3FAs) compared to the NSAID alone, result in an increased ability to exert force by the osteoarthritic limb(s) of dogs or alleviate other measures of osteoarthritis? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Two prospective, block-randomised, clinical trials Strength of evidence None Outcomes reported Kwananocha et al. (2016) investigated administration of carprofen supplemented with marine-derived n-3 FAs, to carprofen alone, administered over 4 weeks. Vijarnsorn et al. (2019) investigated administration of firocoxib supplemented with n-3FA, to firocoxib alone, for 4 weeks. There were no statistical differences between treatment groups at week 2 and week 4 post-treatment for either study. Both studies also reported orthopaedic assessment score (OAS) based on scoring the extent of patient lameness and pain in the affected joint. There were no statistical changes in OASs between treatment groups at week 2 or week 4 post-treatment for either study Conclusion There is no evidence that marine-derived n-3 FAs provide additional benefit when used as adjunctive agents with NSAIDs for the treatment of canine osteoarthritis 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.

Are dogs with hip dysplasia in less pain after total hip replacement than femoral head ostectomy?

PICO question In large breed juvenile dogs with hip dysplasia and radiographic bilateral osteoarthritis, is a total hip replacement superior/inferior/or equivalent to bilateral femoral head ostectomy at reducing the severity of long-term hip pain? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Twelve papers were critically appraised. One paper was a systematic review. Six papers were prospective case series. Five papers were retrospective case series Strength of evidence Weak Outcomes reported Besides one systematic review, there are no other studies available that directly compare pain reduction with total hip replacement and femoral head ostectomy for the treatment of hip dysplasia in large breed juvenile dogs with radiographic evidence of secondary osteoarthritis. In one study, 12/12 (100%)of owners that responded to an owner outcome questionnaire reported no hip pain with femoral head and neck ostectomy. In this study, owners assessed pain based on activity level of the dog (running, playing, jumping, using stairs normally), gait abnormalities (only when running or after strenuous exercise), and duration of postoperative medications. In eight studies, 91–100% of cases had no hip pain with total hip replacement reported via clinical examination and/or owner outcome questionnaire Conclusion There is evidence suggesting that both total hip replacement and femoral head ostectomy may be capable of reducing long-term pain as a result of osteoarthritis, secondary to hip dysplasia, however, based on the current literature, it is challenging to say whether total hip replacement is superior to femoral head and neck ostectomy at reducing long-term hip pain. It is important to recognise that other factors considered as outcomes (i.e. range of motion, ground reaction forces, force-plate analysis, etc.) may contribute to differing outcomes overall for total hip replacement vs femoral head ostectomy, but this paper focused specifically on pain. While there is a systematic review that provides evidence supporting that total hip replacement is superior at returning dogs to normal function, evaluating return to normal function was not the focus of this Knowledge Summary 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.

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

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.

Among homeless individuals, does owning a pet improve their mental health?

PICO question Among homeless individuals, does owning a pet improve their mental health? Clinical bottom line Category of research question Qualitative assessment The number and type of study designs reviewed Fifteen (eight qualitative assessments, two cross-sectional quantitative studies, three qualitative/cross-sectional studies, and two scoping/systematic reviews) Strength of evidence Moderate Outcomes reported Homeless individuals who own pets reported improvement in their mental health status by having fewer symptoms of depression, reduced feelings of loneliness, reduced stress, increased feelings of happiness, and decreased intentions of suicide, all as a result of owning a pet. However, homeless individuals who own pets may suffer a decrease in mental health due to the loss or anticipated loss of their pet Conclusion It is concluded among qualitative and cross-sectional studies that there are clearly multiple benefits to mental health associated with pet ownership among homeless individuals. However, the lack of quantitative, longitudinal, and/or experimental studies in this topic prevents a causative relationship from being established and caution should be exercised when interpreting the results as pet ownership causing an improvement in mental health 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.

Current evidence supporting simultaneous prophylactic gastropexy in canine patients undergoing complete splenectomy

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.

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

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.

Exploring how veterinary professionals perceive and use grief support resources to support companion animal caregivers in Ontario, Canada

Objective: The aim of this study was to qualitatively explore veterinary professionals’ use and perceptions of grief resources and services to support companion animal caregivers following companion animal euthanasia. Background: The loss of a companion animal can be a source of great sorrow and grief. Like human loss, many companion animal caregivers may seek out and benefit from grief resources, of which veterinary professionals are often important providers. Yet, little is known about how, when or for what reasons veterinary professionals provide these resources. Methods: A qualitative study consisting of group and individual interviews involving 38 veterinary professionals and staff from 10 veterinary hospitals in Ontario, Canada was conducted. Verbatim transcripts were evaluated using inductive thematic analysis to identify themes and subthemes. Results: Results indicated that typically resources were only provided if a caregiver requested information, or when veterinary professionals recognised that the caregiver may benefit from these resources. To assess a caregiver’s need, participants reported considering their age, the strength of the human-animal bond, their previous and ongoing life circumstances, and their emotional state. Several barriers limiting veterinary professionals’ use of grief resources were also described including perceptions that few adequate resources existed and a lack of knowledge of existing or new resources. Conclusion: Overall, findings suggest that there are substantial opportunities to improve and embed a provision of grief resources within the veterinary profession. There is a need to develop adequate resources to meet caregivers’ supportive needs and implement these resources within the greater veterinary profession.

Can dog appeasing pheromone ameliorate stress behaviours associated with anxiety in mature domestic dogs?

PICO question Does use of dog-appeasing pheromone reduce the frequency and/or severity of non-specific stress behaviours associated with anxiety in domestic dogs, older than 6 months, when compared with no treatment? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Eight controlled trials were appraised. Four were randomised and four were either non-randomised or did not clearly describe the method of allocating subjects into treatment groups. Strength of evidence Weak Outcomes reported There was no evidence that any dog appeasing pheromone (DAP) formulation (spray, diffuser, or collar) was superior. There was moderate evidence that DAP could reduce some behavioural manifestations of fear and/or anxiety stemming from thunderstorm noise and weak evidence that it could ameliorate some non-specific stress behaviours in hospitalised patients. In shelter dogs, there was mild evidence that DAP could reduce barking intensity and increase some behaviours associated with relaxation. When behavioural changes occurred, most were observed during exposure to DAP and there were minimal residual effects post-treatment. Conclusion The evidence for using DAP to manage stress behaviours associated with anxiety in dogs over six months of age remains weak. Until there is a stronger evidentiary basis, clinicians should be aware that a true clinical benefit is undetermined. Nevertheless, DAP is unlikely to cause harm and may still provide some therapeutic benefit. Therefore, DAP may still be employed in a multimodal management plan for some behaviour cases and may exert a placebo effect. However, if an owner’s financial resources are restrictive, clinicians should not prioritise pheromone therapy at the omission of other therapies that have established clinical 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.

Can IDEXX Angio Detect™ accurately detect canine Angiostrongylosis?

PICO question In dogs, is IDEXX Angio Detect™ as accurate as Baermann coprology when diagnosing Angiostrongylus vasorum infection? Clinical bottom line Category of research question Diagnosis The number and type of study designs reviewed Eight papers were critically reviewed: three diagnostic accuracy studies, two cross-sectional studies (one of which also included a retrospective case series), one cohort study, one case-control study, and one case series Strength of evidence Weak Outcomes reported Angio Detect™ (IDEXX) was shown to have low-moderate sensitivity and high specificity in comparison to Baermann coprology. Occasionally, false-negative results occurred with Angio Detect™ when compared to Baermann coprology. This was thought to be due to antigen-antibody complex formation. Positive Angio Detect™ assays were obtained in both symptomatic and asymptomatic canine patients. In an experimental setting, Angio Detect™ was shown to obtain a positive result five weeks post-inoculation Conclusion There is weak evidence supporting Angio Detect™ as a highly specific and moderately sensitive diagnostic test when compared to Baermann coprology 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.

Cryotherapy of the distal limbs: an effective treatment for equine laminitis following onset of lameness?

PICO question In horses with acute laminitis, does cryotherapy of the distal limbs applied after onset of clinical signs lead to improved clinical outcomes compared to horses treated without cryotherapy? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Four papers were critically appraised; there were three randomised, controlled trials, and one retrospective cohort study. Strength of evidence Weak Outcomes reported There were reduced histological changes and lamellar injury in limbs treated with cryotherapy in the randomised controlled trials and reduced clinical severity of laminitis in horses treated with cryotherapy in the retrospective cohort study. Conclusion In horses with acute laminitis there is weak evidence to suggest that cryotherapy of the distal limbs is an effective treatment option when applied following onset of clinical signs. Further randomised, controlled trials should be performed to assess clinical outcomes of cryotherapy in order to draw definitive conclusions. 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.