Category Of Research Question Research Articles

A pragmatic perspective on social entrepreneurial opportunities

PurposeScholars have applied a number of theoretical perspectives to enhance understanding of social entrepreneurial opportunities, and have most recently turned to the lens of critical realism. Although this metatheoretical perspective overcomes some problems with previous views and helps to identify the essence of a construct, the level of abstraction required by this approach leaves unanswered questions related to how social entrepreneurs leverage opportunities. The purpose of this paper is to create a framework to describe social entrepreneurial opportunities in a way that facilitates action and decision-making by social entrepreneurs.Design/methodology/approachThrough adapting Davidsson's (2015) deconstruction of the opportunity construct and using it to inform the pragmatist view of entrepreneurs as theory-testing scientists, this paper develops a framework for understanding social entrepreneurial opportunities. The paper explores the idea that social opportunities are composed of external enablers, a new social venture idea, and social opportunity confidence, and integrates the existing literature on social opportunities into this framework.FindingsUsing the framework developed, the authors advance a template of questions, hypotheses and quasi-experimental means that social entrepreneurs can use to determine how to move forward in social opportunity actualization. The authors also expand three categories of research questions that scholars may explore to extend the practical and theoretical understanding of social opportunities.Originality/valueThis work is among the first to adopt the pragmatist lens to elucidate social opportunities in a practical way. It takes an important first step in offering a means for social entrepreneurs to investigate when or where the requisite components of a social entrepreneurial opportunity may exist. Furthermore, it advances the pragmatist perspective of social opportunities by using Davidsson's model to explain the components of theories about what may or may not be a social opportunity.

Factors related to the occurrence of and recovery from gaming disorder: A qualitative study.

Gaming disorder (GD) has gained tremendous attention in the past 2 decades. Although the 11th revision of the International Classification of Diseases accepted GD as a formal diagnosis in 2018, debate continues about whether this condition constitutes an independent psychiatric disorder. Many scholars observed that we lack reliable information regarding the natural history of GD. Quantitative studies have identified many risk factors related to GD, but those risk factors were rarely connected, provided with context, or mapped into a coherent big picture to explain GD’s pathway and development process. This qualitative study aims to fill the gap by clarifying GD’s course of development in 15 patients. To do so, it adopts a qualitative, longitudinal, and retrospective approach that is based on the life histories and narratives of individuals with GD. Individual in-depth interviews were conducted with 15 young adult participants who were attending a residential, outpatient program specializing in GD treatment. Each interview lasted approximately 2.5 hr and was audio-recorded with the participant’s permission and informed consent. Four categories of research questions that targeted participants’ life stories—specifically how gaming addiction entered and manifested in their lives—guided the interviews and generated follow-up questions during each interview, using a theoretical sampling strategy. Recordings were transcribed, then subthemes and themes were identified, constructed, and organized based on a grounded theory, thematic analysis method. Results revealed 12 subthemes, which can be sequentially and suitably placed into three developmental stages. These stages provide a clearer understanding of how gaming behaviors progress from normal into pathological. Implications for prevention and treatment are discussed.

In clinically hyperthyroid cats, is I-131 treatment superior to thyroidectomy in normalising serum T4 level?

PICO question
 In clinically hyperthyroid cats, is iodine-131 (I-131) treatment superior to unilateral or bilateral thyroidectomy in normalising serum thyroxine (T4) levels?
 
 Clinical bottom line
 Category of research question
 Treatment.
 The number and type of study designs reviewed
 35 papers were critically reviewed. These were mostly retrospective studies with a small proportion of prospective cohort studies.
 Strength of evidence
 Moderate.
 Outcomes reported
 More papers were available evaluating the effect of radioiodine therapy on T4 levels compared to thyroidectomy. Long-term follow-up of T4 is a relatively new component of study designs. Most papers suggested between 40–87% cats had normal T4 6 months after treatment. 19–47% cats receiving unilateral or bilateral thyroidectomy, and 100% cats receiving radioiodine therapy were in long-term remission in one study.
 Conclusion
 In view of the of evidence and outcomes from the studies, there is moderate evidence that I-131 treatment is superior to unilateral or bilateral thyroidectomy.
 
 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.

Do inhaled or oral glucocorticoids more effectively control feline asthma?

PICO question
 In cats with chronic bronchospasm and airway hypersensitivity (asthma) do oral glucocorticoids or inhaled glucocorticoids more effectively control the clinical signs?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three prospective randomised clinical trials were appraised. Two of the studies followed a crossover design and had a control group, whilst the third study described an interrupted time series
 Strength of evidence
 Weak
 Outcomes reported
 The available studies deemed a reduction in eosinophilia on bronchoalveolar lavage fluid analysis, and a reduction in airway resistance as markers of treatment efficacy
 Conclusion
 There is weak evidence to suggest equal treatment efficacy of oral and inhaled glucocorticoid therapy for management of feline asthma. Higher powered studies would be required before a definitive recommendation can be made
 
 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.

Does the use of supraglottic device in rabbits cause less injury than other airway management devices?

PICO question
 In rabbits, undergoing general anaesthesia, does the placement of a v-gel® device result in less airway trauma compared to the use of other airway management devices?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three papers were critically appraised, two blinded randomised experimental trial studies and one randomised crossover experimental trial study
 Strength of evidence
 Weak
 Outcomes reported
 One blinded randomised trial study demonstrated that the trauma to the upper airways of rabbits during anaesthesia is not significantly different between the use of v-gel® and an endotracheal tube. The other blinded randomised trial study demonstrated that the trauma to the upper airway caused by endotracheal intubation is significantly more than that caused by v-gel® placement. The randomised crossover trial study demonstrated that v-gel® placement causes more significant compression to the larynx compared to a laryngeal mask or face mask
 Conclusion
 The current evidence suggests that use of the v-gel® in rabbits causes less trauma / injury to the airways compared to placement of an endotracheal tube but not compared to the use of a laryngeal or face mask. However, based on the low number and quality of published studies, this evidence is weak, and better-quality studies are required to support the routine use of v-gel® over other airway devices in rabbits. While v-gel® may be a safer alternative for securing airways in rabbits compared to endotracheal intubation, knowing the injuries this device can cause to the upper airways is useful for managing rabbits during post anaesthesia recovery
 
 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.

Does the selective serotonin reuptake inhibitor (SSRI) fluoxetine modify canine anxiety related behaviour?

PICO question
 Does administration of the selective serotonin reuptake inhibitor (SSRI) fluoxetine reduce the severity and / or frequency of some anxiety related behaviours in companion dogs, of at least 8 months of age, when compared with no pharmacological treatment?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Two studies, both randomised, were critically appraised. Each had a placebo control group and the dog's owners were blinded to the treatments
 Strength of evidence
 Moderate
 Outcomes reported
 Both studies provide moderate evidence that fluoxetine, when dispensed at 1–2 mg/kg per day by oral administration and not involving a behavioural modification program for the patient, may reduce some behaviours associated with separation anxiety and / or compulsive disorders. Both studies indicate that a reduction in some unwanted behaviours may be observed after 1 week of fluoxetine medication. Both studies recommend that behavioural and environmental modifications are important adjuncts to pharmacologic treatment of dogs with either compulsive disorders or separation anxiety. Both studies also report that some dogs treated with fluoxetine experienced anorexia / decreased appetite and lethargy, although most of these effects were transient
 Conclusion
 The clinical recommendation is that fluoxetine at 1–2 mg/kg administered orally, once daily, may be beneficial in reducing the severity of some canine anxiety related behaviours
 
 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.

Does clicker training reduce stress in shelter cats?

PICO question
 In domestic cats in a shelter setting, does clicker training decrease proxy measures of a stressed emotional state (behavioural or physiological) compared to no clicker training?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Two papers were critically reviewed. One was a prospective quasi-randomised clinical trial, the other was a quasi-experimental before-and-after study with each cat being its own control
 Strength of evidence
 Weak
 Outcomes reported
 Both papers reported a decrease in behavioural stress indicators in shelter cats following a clicker training programme. Not all of these decreases were statistically significant and there are large issues with confounding factors in both papers
 Conclusion
 Preliminary evidence suggests that clicker training can be implemented as one form of enrichment to reduce stress in shelter cats alongside other means. Further evidence is required to demonstrate superiority to other forms of enrichment to reduce stress in shelter cats, especially given the practical limitations of implementing such a programme in most shelters
 
 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.

Gastric dilatation volvulus in dogs: utility of lactate as a predictor of survival

PICO question
 In dogs presenting with gastric dilatation volvulus, is an admission or pre-operative lactate level a reliable predictor of survival to discharge?
 
 Clinical bottom line
 Category of research question
 Prognosis
 The number and type of study designs reviewed
 15 studies (12 retrospective and 3 prospective) were critically appraised
 Strength of evidence
 Moderate
 Outcomes reported
 At a population level, lower blood lactate concentration, or lactate concentration that decreases following fluid resuscitation, are associated with a better prognosis.
 At a population level, higher blood lactate concentration, or lactate concentration that fails to decrease following fluid resuscitation, is associated with a worse prognosis. However, the lower sensitivity across studies means that a high lactate, or one that does not decrease following fluid therapy, should be interpreted more cautiously than a low lactate; i.e., low lactate predicts survival better than high lactate predicts non-survival.
 In all studies, there was a significant overlap in individual blood lactate concentration between survivors and non-survivors
 Conclusion
 Blood lactate level should only be used to help guide broad, cautiously worded conversations with owners as described above. It should not be used to give a prognosis for individual patients. The overlap between survivors and non-survivors, and the high overall survival rate, means that exploratory laparotomy should be advised irrespective of the blood lactate level
 
 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 undergoing extrahepatic portosystemic shunt attenuation, does pretreatment with levetiracetam reduce postoperative seizure incidence?

PICO question
 PICO
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Four papers were critically reviewed. All were retrospective cohort studies
 Strength of evidence
 Moderate
 Outcomes reported
 In one paper levetiracetam was found to reduce the risk of post-attenuation seizures. In the remaining three papers no difference was found between the frequency of post-attenuation seizures and the use of levetiracetam
 Conclusion
 That prophylactic levetiracetam is not indicated for the use of preventing post-attenuation seizures in dogs surgically treated for extrahepatic portosystemic shunts
 
 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 osteoarthritis, is intra-articular allogenic mesenchymal stem cell therapy more effective than placebo effect?

PICO question
 In dogs diagnosed with osteoarthritis in the hip, elbow, stifle or shoulder joint, is treatment with intra-articular allogenic mesenchymal stem cell therapy, in comparison with a placebo effect, more effective at reducing lameness and pain?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 All three papers were randomised controlled trials
 Strength of evidence
 Weak
 Outcomes reported
 Intra-articular allogenic stem cell therapy is effective at reducing pain and lameness in dogs with osteoarthritis when compared to a placebo effect. Two studies indicated a statistically significant improvement in both client and veterinary outcome measurements. Client outcome measurements utilised included: the canine brief pain inventory; a measure of any changes in pain and lameness based on owners perception, and the client-specific outcome measure; and an evaluation of the impact of osteoarthritis on three client selected activities and how this changed with treatment. Veterinary outcome measurements included veterinary pain score based on manipulation of the limb, veterinary assessment of clinical outcomes and veterinary pre and post lameness examinations, all of which were subjective measures.
 The final study identified a statistically significant improvement in both pain and lameness based on owner assessments utilising the canine brief pain inventory and the Hudson Visual Analogue Scale for lameness scoring. No statistically significant improvement was identified when considering subjective and objective veterinary measurements including force plate gait analysis and veterinary orthopaedic examination
 Conclusion
 There is moderate evidence from owner observation and veterinary assessment to suggest that intra-articular allogenic (adipose and umbilical derived) stem cell therapy has some efficacy for reducing pain and lameness compared to a placebo effect. However, it must be noted that these studies did not compare the use of intra-articular allogenic stem cells with conventional treatments such as intra-articular corticosteroid injections. Therefore, comparison trials are required.
 Whilst all three papers showed significant improvements in the subjective measurements, objective data outcomes and assessment by board certified veterinary surgeons failed to find a significant improvement in peak vertebral force or lameness with the use of intra-articular stem cell therapy in comparison to a placebo effect. Furthermore, whilst no significant adverse reactions to intra-articular stem cell therapy were recorded, information regarding the safety for multiple dosing is lacking and ambiguity remains as to the most appropriate lineage and quantity of allogenic stem cells for the best clinical effect
 
 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.
 

Does trazodone reduce anaesthetic agent requirement in dogs?

PICO question
 In dogs undergoing anaesthesia, does the use of oral trazodone given 2 hours before induction of anaesthesia reduce injectable or inhalant anaesthetic agent requirements?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Two randomised controlled trials were critically appraised
 Strength of evidence
 Moderate
 Outcomes reported
 Trazodone was shown to have a significant isoflurane minimum alveolar concentration (MAC) sparing effect for isoflurane. There is also evidence to suggest trazodone has a similar effect on the cardiovascular system as acepromazine
 Conclusion
 Trazodone should be considered as part of a multimodal approach to anaesthesia in dogs to reduce the injectable and inhalant anaesthetic agent requirements
 
 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.
 

An assessment of client and clinician satisfaction in veterinary teleconsultation compared to in-person consultations

PICO question
 Compared to in-person veterinary consultations, does teleconsultation lead to similar levels of client and clinician satisfaction?
 
 Clinical bottom line
 Category of research question
 Qualitative assessment
 The number and type of study designs reviewed
 Eight studies were critically appraised. There were six cross-sectional studies, one randomised controlled clinical trial, and one case report
 Strength of evidence
 Weak
 Outcomes reported
 All eight studies provided weak evidence of similar levels of clinician and / or client satisfaction
 Conclusion
 Teleconsultation can lead to similar levels of client and clinician satisfaction when compared to in-person consultations. However, the evidence is weak due to the subjectivity and varied methods of measuring satisfaction. Furthermore, the current applicability of veterinary teleconsultation is still very limited to certain select scenarios in which it is appropriate (e.g., emergency, triage, remote locations, non-complicated routine postoperative checks, nutrition and behavioural consults)
 
 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 straw based enrichment treat tail biting in pigs?

PICO question
 Can straw based enrichment be used successfully as a treatment intervention to reduce tail biting injuries in weaner to finisher pigs housed in indoor farming systems?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three papers were critically reviewed. All three papers answered the PICO question and matched the inclusion criteria for this Knowledge Summary, providing moderate evidence. One non-randomised controlled trial and two randomised controlled trials.
 Strength of evidence
 Moderate
 Outcomes reported
 Veit et al. (2016) found that straw based enrichment can reduce tail biting, similarly, Larson et al. (2018) found straw based enrichment could reduce tail biting, however, other factors contribute more so to reducing tail biting. Haigh et al. (2019) did not find evidence to suggest straw-based enrichment could reduce tail biting. Triggers for tail biting injuries are multifaceted, therefore enrichment alone will not eliminate pen mate manipulation
 Conclusion
 In view of the strength of evidence and the outcomes from the studies the following conclusions have been made; it is expected that these findings provide enough evidence to encourage farmers to introduce novel straw based enrichment as a treatment measure, however it would be most effective if other husbandry factors could be considered in addition
 
 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.
 

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

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
 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.
 

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

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
 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.
 

Does treatment with clomipramine reduce cat psychogenic alopecia?

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?

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
 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.
 

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

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
 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.
 

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

PICO question
 In dogs with acute gastroenteritis, is metronidazole faster, slower, or comparable in resolving clinical signs when compared to probiotic administration?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Five studies total, all were blinded, randomised controlled trials
 Strength of evidence
 Moderate
 Outcomes reported
 The use of probiotics as a treatment for acute, uncomplicated diarrhoea in dogs may improve clinical signs faster when compared to a placebo, but showed no difference when compared directly to metronidazole. Metronidazole, when compared to a placebo, produced mixed results with one study finding that treatment with metronidazole did significantly reduce the time to resolution of diarrhoea, while another study found the difference with placebo was not significant
 Conclusion
 Based on the evidence evaluated, the use of oral metronidazole will not decrease time to resolution of clinical signs in cases of acute, uncomplicated diarrhoea in dogs when compared to probiotic administration and thus should not be a first-line treatment in such cases
 
 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.
 

Propofol-diazepam or propofol-midazolam co-induction in healthy dogs: effects on propofol dosages, cardiovascular and respiratory events

PICO question
 In healthy dogs, does the use of diazepam or midazolam administered in co-induction with propofol result in a reduction in the dose of propofol required to induce anaesthesia and a decrease in adverse cardiovascular and respiratory events?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Eight papers were critically reviewed. A total of six manuscripts were prospective, randomised, blinded, clinical studies. One trial was prospective, randomised, blinded, clinical with a Latin square, incomplete design. One study was retrospective, randomised, blinded, crossover, experimental
 Strength of evidence
 Moderate
 Outcomes reported
 Variables assessed in this Knowledge Summary included: propofol dose required to induce anaesthesia (considering successful orotracheal intubation as an end point), changes in cardiovascular variables (heart rate, systolic, mean and diastolic blood pressure) and changes in respiratory variables (development of apnoea, changes in respiratory rates)
 Conclusion
 In healthy dogs, using propofol-diazepam or propofol-midazolam co-induction resulted in a reduction in propofol dose required to induce anaesthesia in some trials only. Midazolam appeared more effective than diazepam in this context. The dosages, timing and sequence of drug administration seemed relevant. No evidence suggested that using propofol-diazepam or propofol-midazolam co-induction resulted in a reduction of adverse cardiovascular or respiratory events. In addition, although this was out of the scope of the PICO question addressed here, adverse events (e.g. excitement, poorer quality of induction) were reported in several studies when diazepam or midazolam were used in co-induction
 
 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.