Veterinary Evidence

Erratum to: Clinical audit of POM-V / POM prescriptions by remote consultation via a veterinary video telemedicine smartphone application

2022-06-20T10:15:27+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Erratum to: Should we prescribe oral metronidazole or probiotics for acute gastroenteritis in dogs?

2022-06-28T13:59:15+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Erratum to: In horses undergoing volatile anaesthesia, does intraoperative alpha-2-agonist infusion improve recovery?

2022-05-31T10:27:02+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Does treatment with clomipramine reduce cat psychogenic alopecia?

2022-06-29T19:34:15+01:00

PICO question

In cats with psychogenic alopecia, is overgrooming reduced by the use of clomipramine compared to untreated cats?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

One pseudo-randomised controlled study

Strength of evidence

Weak

Outcomes reported

Effect of clomipramine using owner report of number, intensity, and / or duration of grooming episodes, owner reported clinical improvement, and veterinary measured alopecia, extent of tissue damage, and hair regrowth

Conclusion

The only controlled study found no evidence that clomipramine alone is effective in reducing grooming episodes, alopecia, or improved hair regrowth. Further research with randomised, double blind controlled trials and limitation of confounding factors is required to determine the efficacy of clomipramine alone or in addition to behavioural / environmental therapies

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.

In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the score of a recognised scoring system?

2022-06-22T10:01:40+01:00

PICO question

In dogs with atopic skin disease, is lokivetmab more effective than oclacitinib in reducing the Canine Atopic Dermatitis Lesion Index score (or some other recognised scoring system)?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

One randomised controlled trial and one before and after study were critically appraised

Strength of evidence

Weak

Outcomes reported

One randomised controlled trial studied the effects of lokivetmab and oclacitinib and found that both drugs were similar in reducing the Canine Atopic Dermatitis Lesion Index (CADESI-03) score.

An additional study was evaluated but had non-standardised data as it was a before-and-after study on use of lokivetmab. The paper noted that dogs’ response to oclacitinib can be used to predict how well these dogs respond to lokivetmab. This study also reported a reduction in Pruritus Visual Analog Scale (PVAS) score between before and after lokivetmab administration

Conclusion

In view of the strength of evidence and outcomes from the studies, there is insufficient quality of evidence to answer the PICO question and so further comparative study is required

How to apply this evidence in practice

A comparison of supraglottic airway devices versus endotracheal intubation for use in rabbit anaesthesia

2022-07-06T09:33:36+01:00

PICO question

In domestic rabbits undergoing anaesthesia, how does the use of supraglottic airway devices compare to endotracheal intubation for ease of use in achieving a patent airway and maintaining a stable anaesthesia?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Five papers were reviewed to answer this clinical question including four randomised controlled trials, one of which was a randomised crossover trial and one peer-reviewed conference proceeding

Strength of evidence

Moderate

Outcomes reported

There is evidence to support that supraglottic devices were easier and faster to insert than endotracheal tubes and were used effectively to achieve and maintain a patent airway and anaesthesia. They were however, more easily displaced and took up more space in the oral cavity. Evidence also supports endotracheal intubation can be used to effectively achieve a patent airway and maintain a stable anaesthesia however, can result in more damage to tracheal mucosa when attempted blindly and required higher doses of induction drugs to use

Conclusion

Based on current available evidence, endotracheal intubation is an excellent option for maintaining a patent airway and anaesthesia in rabbit patients as it is a tried and tested method, however, can cause tracheal damage if conducted blindly. Supraglottic airways devices can be used as an alternative where endotracheal intubation is unsuccessful. They can also be used where speed of obtaining a patent airway is imperative such as in an emergency as they may be easier and faster to apply, especially in inexperienced practitioners without the necessary equipment for safe endotracheal intubation. Supraglottic devices are unsuitable for procedures that require access to the oral cavity and / or patient movement, due to the size and easier loss of seal during movement potentiating risk of aspiration. Both supraglottic devices and endotracheal intubation are superior to face masks which evidence shows have more leakage, dead space and increased risk of hypercapnia

How to apply this evidence in practice

Thank you to our 2021 reviewers

2022-01-21T15:05:15+00:00

As 2021 draws to a close I suspect few of us could have foreseen the past year. In the early part of the year, as COVID-19 vaccination gathered pace, like many, I was hopeful that we would be seeing coronavirus in the rear-view mirror by the end of the year ― only then to find ourselves in the midst of another wave of cases.

Despite all the headwinds of coronavirus and the impact of working from home, Veterinary Evidence has continued to flourish, publishing more papers this year than last. Published papers have covered an amazing range of different topics, illustrating not just the wide diversity of questions that are being answered, but the depth and breadth of the team of reviewers that give their time to extend veterinary knowledge, supported by a dedicated group of assistant editors and staff at the journal who coordinate activity, ensure standards, and continue to develop the journal.

As a journal, Veterinary Evidence is maturing with two of the main focuses this year being to further develop our internal journal systems ― which has allowed us to apply for membership of COPE (Committee on Publication Ethics) ― and work towards improving the discoverability and accessibility of our published papers. In order to achieve this, the team is working hard to redesign our current website and fulfil the criteria for inclusion in other citation databases beyond CAB Abstracts, such as Medline.

We have been delighted this year to expand our Editorial Board ensuring, as the journal grows, we have the necessary range of skills on the Board to maintain high quality, effective reviews delivered in a timely manner. I would like to take this opportunity to thank all our reviewers and everyone who has served on the Board this year for their tireless efforts on behalf of Veterinary Evidence – without your support the journal could not exist. This year the Board has had three online meetings, more than ever before, which have been essential in helping develop the strategy for Veterinary Evidence over the coming years, expanding the influence and reach of the journal with various strategic initiatives. Other key areas have included developing our policy on standard terminology, looking at the best ways to ensure Knowledge Summaries remain current and working towards making editorial decisions as consistent as possible.

And finally… a huge thank you to everyone who works for and supports Veterinary Evidence, wishing you all a safe and productive 2022.

Clinical audit of POM-V / POM prescriptions by remote consultation via a veterinary video telemedicine smartphone application

2022-06-20T10:13:38+01:00

There is an erratum to this paper published in Veterinary Evidence Vol 7, Issue 2 (2022): 10.18849/VE.V7I2.627

Objective: To assess outcomes of a limited period (7 months) of remote video consultation with prescribing of prescription-only (POM) or prescription-only-veterinary (POM-V) medications by Royal College of Veterinary Surgeons (RCVS) registered veterinary surgeons to UK clients via a veterinary telemedicine smartphone application.

Background: Objective evidence is needed to inform the veterinary profession on the impact that remote prescribing, without physical examination in person, has on animal health and welfare. During the COVID-19 pandemic, the RCVS allowed remote prescribing temporarily.

Methods: Clinical records from all veterinary video consultations from 1 April–31 October 2020 were reviewed. Details were assessed pertaining to: signalment, body system / disease categories managed, referrals into practice, medication classes prescribed and outcomes following POM-V / POM medications. Records of adverse events and antimicrobial prescribing were reviewed.

Results: 16.6% (3,541/21,383) of video consults had a POM-V / POM prescribed; with a (mild) adverse event rate of 0.8% (30/3541). Antibacterials were prescribed in 5.88% of all consultations (1,258/21,383), 99.3% (1249/1258) being first line. Follow-up on prescribing was available in 67.7% (2,399/3541) of cases. 89% (2135/2399) of all known treatment outcomes were complete or had an expected response to treatment. Dermatological disease was the most common body system / disease category seen and prescribed for.

Conclusion: Low prescribing rates (including antibacterials) were recorded, treatments were efficacious and no harm was done by prescribing remotely via a veterinary video consult app.

Application: Veterinary surgeons and governing bodies are invited to use the information provided in this clinical audit to inform decisions on the suitability of remote consultations and prescribing in veterinary medicine.

Personal health and nutrition information-seeking attitudes and behaviours of first year Canadian and United States veterinary students

2022-04-13T12:49:19+01:00

Objective: To identify the primary sources of information first year Canadian and US veterinary students relied on for their personal health and nutrition information, and to explore their attitudes towards, and perceptions of, health information resources.

Background: Though the animal health information-seeking behaviours (HISB) of veterinary students have been explored, research regarding personal HISB of this professional student population is limited.

Evidentiary value: Participants were first year veterinary students (n=322) at the five Canadian veterinary schools and five randomly selected US veterinary schools. An online questionnaire was used to gather students’ demographic information, sources of health and nutrition information, and information-seeking attitudes and perceptions. This study may impact practice at the institutional level for veterinary educators.

Methods: STATA 15.1^© was used for quantitative analysis; involving multivariate logistic regression models, univariate analyses, and measures of frequency.

Results: Results indicated high reliance on the Internet for personal health 213/322 (66%) and nutrition 196/322 (61%) information. While respondents revealed high trust levels in dietary recommendations from family doctors, 132/322 (41%) of students revealed their doctor did not provide any information on healthy diets. Students who reported the use of peer-reviewed journal articles for personal nutrition information were at greater odds of having confidence in knowing where to find nutrition information (Odds Ratio [OR] = 6.61, p<0.001).

Conclusion: Participating students reported a high reliance on the Internet search engine Google, and a general lack of guidance from medical professionals regarding general health needs.

Application: Veterinary schools should consider this information to enhance student information literacy skills, particularly to facilitate personal HISB, and consequently help in management of personal health throughout the growing demands of the programme.

Erratum to: Are glucocorticoids or NSAIDs more effective in reducing idiopathic feline urinary tract disease signs than no treatment or placebo?

2021-11-09T10:27:58+00:00

The original article was published in Veterinary Evidence Vol 6, Issue 4 (2021): https://doi.org/10.18849/ve.v6i3.439

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

2022-01-12T12:47:13+00:00

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

Erratum to: Does UK licensed NSAID administration reduce signs of postoperative pain in calves castrated without local anaesthesia?

2021-07-19T15:19:05+01:00

The original version of the article has been corrected, please see the full text for details of the correction.

Potential therapeutic effects of GS-441524 and GC376 in cats with feline infectious peritonitis

2022-02-02T15:11:30+00:00

PICO question

In cats with feline infectious peritonitis (FIP), does treatment with the nucleoside analogue GS-441524 or the protease inhibitor GC376, compared to supportive measures alone, lead to longer survival times?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Five studies, including four uncontrolled interventional studies and one case-series were critically reviewed

Strength of evidence

Moderate

Outcomes reported

The reviewed studies collectively provide moderate evidence in support of the application of GS-441524 or GC376 to extend the survival time of cats suffering from feline infectious peritonitis

Conclusion

While these antiviral drugs are considered the most likely options for FIP treatment, more robust evidence should be obtained through well-designed randomised controlled trials to verify the observed positive effects in treating various forms of the disease and the potential long-term side effects. However, the ethical dilemmas of conducting double blinded placebo-controlled trials, which by necessity include untreated cats with an invariably fatal disease are recognised

How to apply this evidence in practice

When treating medial patellar luxation in dogs is a block trochleoplasty superior over a wedge trochleoplasty?

2022-07-15T11:28:18+01:00

PICO question

As part of the surgical correction for medial patellar luxation in dogs, which procedure results in a better outcome for the patient: block or wedge recession trochleoplasty?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Three studies satisfied the inclusion criteria for answering the PICO; one cadaver study, one retrospective observational study and one clinical case series

Strength of evidence

Weak

Outcomes reported

Postoperative complications including reluxation rates.

Ex vivo: Trochlear groove depth, patella articular contact, percentage of recessed trochlear surface area, resistance to medial patella luxation

Conclusion

There is only weak evidence to support block recession trochleoplasty over wedge recession trochleoplasty as part of the surgical correction for medial patella luxation in dogs. Both procedures are associated with a good clinical outcome. There are some proposed benefits to trochlear block recession made from an ex vivo study comparing the two procedures. These include an increased patellar volume under the trochlear ridges when the stifle is extended. The articular contact and recessed trochlear surface area were also increased in the trochlear block recession group when compared to trochlear wedge recession. However, the clinical relevance of these perceived benefits remains unproven. In practice, and until prospective randomised controlled trials are carried out, veterinary surgeon preference and previous experience remain relevant factors in choosing which procedure to perform

How to apply this evidence in practice

Can IDEXX Angio Detect™ accurately detect canine Angiostrongylosis?

2022-04-14T13:24:46+01:00

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

Practice what you preach: Importance of veterinarian involvement in zoonotic disease prevention – A Michigan focus

2022-04-27T10:02:25+01:00

Objective: Determine the extent to which practicing veterinarians in Michigan, USA engaged in commonly recommended practices for the prevention of zoonotic diseases (ZDs).

Background: Follow-up to Lipton et al. (2008) Washington State study.

Methods: Online survey link was emailed February 2020 to 3,410 Michigan licensed veterinarians practicing clinical medicine with emails on file with Michigan Licensing and Regulatory Affairs.

Results: 402 veterinarians responded. A high proportion (161/214 [75%]) of respondents agreed it was very important for veterinarians to advise clients about the potential for ZD, yet only 34% (74/215) reported they had initiated discussions about ZDs with clients on a daily basis, although 64% (137/214) indicated they had client educational materials on ZDs available in their practices. Nearly 62% (47/76) of veterinarians who obtained their degree after 2010 were likely to eat / drink in animal handling areas as compared to only 33% (18/54) of those who graduated before 1989. Over 30% of respondents (64/210) indicated there were no written infection control guidelines for staff members in the practice, and 28% (60/214) reported having been infected with a ZD in practice.

Conclusion: Veterinarians appreciate their important role in ZD prevention and welcome increased communication between human and veterinary medicine plus assistance from public health agencies regarding ZD prevention. Communication / coordination / collaboration among human medicine / animal medicine / environmental health (i.e., One Health) is necessary to protect the public’s health from zoonoses.

Delayed versus on arrival modified live viral vaccination in stocker cattle on bovine respiratory disease

2022-03-09T16:50:41+00:00

PICO question

In auction market calves at high risk of developing bovine respiratory disease (BRD), does delayed (14–30 days) vaccination with a modified live vaccine (MLV) for viral respiratory pathogens versus administration of MLV on arrival (within 24 hours of arrival) to the stocker operation, result in less calves with BRD morbidity diagnosed based on visual signs and rectal temperature >40°C, or less calves with BRD mortality?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Four papers were critically reviewed. All were randomised complete block designs

Strength of evidence

Moderate

Outcomes reported

In stocker calves, delaying administration of a MLV for respiratory viruses may result in numerically lower initial BRD morbidity rates, while giving at arrival may result in numerically lower BRD retreatments. One study shows statistically lower cases of BRD morbidity after the third antimicrobial treatment in cattle vaccinated on arrival with both a clostridial and MLV for respiratory viruses compared to cattle vaccinated on arrival with clostridial vaccine and delayed MLV for respiratory viruses. No conclusion about mortality can be drawn due to inconsistent numerical conclusions between studies

Conclusion

Due to conflicting evidence and a general lack of statistically significant differences in morbidity and mortality outcomes, a definite answer regarding the impact of delayed MLV respiratory vaccination in stocker calves cannot be made

How to apply this evidence in practice

A comparison of gonadotropin-releasing hormone and human chorionic gonadotropin in dairy cows with ovarian follicular cysts

2022-06-09T15:17:09+01:00

PICO question

In adult dairy cows with ovarian follicular cysts, does treatment with gonadotropin-releasing hormone (GnRH) compared to human chorionic gonadotropin (hCG) result in a more rapid return to cyclicity?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

The publications consisted of six non-blinded randomised comparative or controlled trials

Strength of evidence

Weak

Outcomes reported

Recovery time, clinical cure, and interval to conception were consistently evaluated. Many studies also evaluated other fertility parameters such as first estrus or first treatment conception, overall pregnancy and conception risks, and breedings per conception

Conclusion

At this time, there is insufficient evidence to suggest whether GnRH or hCG is more efficacious for treating ovarian follicular cysts in dairy cattle. Ultimately, further research is essential to elucidate which treatment results in a more rapid return to cyclicity for dairy cattle afflicted with cystic ovarian follicles

How to apply this evidence in practice

Does the extent of the surgical margin affect the likelihood of local recurrence in Patnaik grade I or II cutaneous mast cell tumours?

2022-03-10T11:22:05+00:00

PICO question

Does the extent of the surgical margin affect the likelihood of local recurrence in Patnaik grade I or II cutaneous mast cell tumours?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Eight papers were critically reviewed. Five were retrospective case series, two prospective clinical trials, and one prospective case series

Strength of evidence

Low

Outcomes reported

Sequin et al. (2001) reported a local recurrence rate of 5%, but this study is 20 years old. In the studies of Simpson et al. (2004), Fulcher et al. (2006), Pratschke et al. (2013), Saunders et al. (2020), and Itoh et al. (2021), no local recurrence was observed in grade I and II mast cell tumours, while in the Milovancev et al. (2019) study, only 1/30 low-grade cutaneous mast cell tumors developed local recurrence. Therefore, there is some evidence that conservative surgical excision is sufficient to achieve local control with low recurrence rates

Conclusion

There is increasing evidence in the literature for conservative surgical excision of grade I and II MCTs, but because the quality of evidence is low, no clear recommendations can be made. Further studies are needed to determine recommendations for surgical excision of cutaneous MCTs based on the biological characteristics of the tumour and the completeness of histologic margins

How to apply this evidence in practice

Comparing delayed versus on-arrival administration of a modified live viral vaccine in feedlot cattle

2022-06-15T09:23:00+01:00

PICO question

In auction market calves at high risk of developing bovine respiratory disease (BRD), does delayed (14–30 days) vaccination with a modified live vaccine (MLV) for viral respiratory pathogens versus administration of MLV on-arrival (within 24 hours of arrival) to the feedlot, result in a decreased percentage of calves with BRD morbidity diagnosed based on visual signs and rectal temperature >40 degrees Celsius?

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Two papers were critically reviewed. Both are randomised complete block designs

Strength of evidence

Weak

Outcomes reported

Delaying administration of a modified live respiratory vaccine to feedlot cattle may result in lower BRD retreatments

Conclusion

In feedlot calves, delaying modified live vaccine administration for viral respiratory pathogens may result in lower BRD retreatment rates than cattle receiving the vaccine on arrival to the feedlot. Significant statistical data from one study supported this conclusion while another showed numerically less retreatments in calves vaccinated on arrival versus delayed vaccination

How to apply this evidence in practice