Category Of Research Question Research Articles

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

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
 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.
 

PyCSP: A Python package for the analysis and simplification of chemically reacting systems based on Computational Singular Perturbation

PyCSP is a Python package for the analysis and simplification of chemically reacting systems, using algorithms based on the Computational Singular Perturbation (CSP) theory. It provides tools for the local characterization of the chemical dynamics, enabled by the recognition of a convenient projection basis which carries out a timescale-based uncoupling. The tools supplied within the package allow one to identify the rate-controlling chemical reactions, the intrinsic chemical timescales, the driving chemical timescale and indicators of the system's explosive or dissipative propensity. Possible applications are the analysis of numerical simulations of reacting flows, and the reduction of chemical kinetics models, based on the CSP information. This manuscript provides a brief overview of the foundations of CSP, a description of the libraries, and demonstrations of the features implemented in PyCSP with code examples, along with practical advices and guidelines for users. Program summaryProgram Title:PyCSPCPC Library link to program files:https://doi.org/10.17632/59pw7pvkkb.1Developer's repository link:https://github.com/rmalpica/PyCSPLicensing provisions: MITProgramming language: PythonSupplementary material: Code documentation and Python scripts employed to generate the figures.Nature of problem: The evermore increasing availability of high-performance computing resources, and the compelling need for more advanced and sustainable energy conversion devices, based on unconventional combustion regimes and alternative fuels, are driving towards an unprecedented massive production of data in numerical simulations of reacting flows. The research questions behind the production of such huge datasets are typically related to (i) the fundamental understanding of combustion phenomena, and (ii) the development of reduced order models and/or turbulence-chemistry interaction sub-grid scale (closure) models, both with the aim of accelerating large scale simulations of real combustion devices.Solution method: Both categories of research questions can widely benefit from the numerical tools available in PyCSP. The computational singular perturbation (CSP) framework allows one to extract concise information from chemically reacting systems, automatically and at reasonable cost. This is especially useful when the dataset is so massive and the number of degrees of freedom so large, i.e., hundreds of species/reactions per cell, that even a visual inspection becomes unmanageable. PyCSP offers a fast, user-friendly implementation of numerous analysis tools, enabling a more systematic data processing and, ultimately, providing the user with a deeper physical understanding of the problem under investigation. Moreover, the CSP theoretical framework can be exploited to generate reduced order models (ROMs), tailored to and to be employed in specific applications, in order to drastically reduce the computational cost of a numerical simulation, while retaining accuracy in global observables. The ROM is in the form of a skeletal kinetic mechanism of adjustable fidelity, or an adaptive chemistry integrator.Additional comments including restrictions and unusual features:PyCSP relies on Cantera, an open-source suite of tools for problems involving chemical kinetics, thermodynamics, and transport processes, to efficiently incorporate detailed chemical thermo-kinetics models into the CSP calculations.

In horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology?

PICO question
 In adult horses with secondary sinusitis caused by dental disease, is computed tomography more accurate than radiography for the identification of apical dental pathology?
 
 Clinical bottom line
 Category of research question
 Diagnosis
 The number and type of study designs reviewed
 The literature search identified four papers that were critically reviewed. The publications consist of two retrospective case-controlled studies, one clinical study and one descriptive study
 Strength of evidence
 Weak
 Outcomes reported
 Four studies reported the sensitivity of computed tomography (CT) for the diagnosis of apical dental pathology in horses presented for evaluation of clinical signs of sinus disease with histopathological evidence of apical dental pathology. All studies reported the radiographic changes present in these horses or used absence of definitive radiographic changes consistent with apical dental disease as a reason to undertake further CT evaluation. All four papers found that CT identified teeth with apical pathology that radiography had not
 Conclusion
 CT is more accurate than radiography for the diagnosis of equine maxillary apical dental pathology; however, clear guidelines on the CT changes associated with apical dental pathology are required. Loss of the lamina dura, infundibular changes or pulpal gas as singular findings on CT imaging can be seen in teeth with no underlying histopathological evidence of apical disease, and in maxillary teeth imaged in horses without clinical signs of maxillary cheek tooth pathology
 
 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 aural haematoma does draining and injecting corticosteroids versus drainage alone reduce the risk of recurrence?

PICO question
 In dogs with aural haematomas does draining and injecting corticosteroids versus drainage alone reduce the risk of recurrence?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three papers were critically reviewed, a retrospective multi-centre cohort study, a randomised case control trial and an observational survey
 Strength of evidence
 Weak
 Outcomes reported
 Drainage alone at daily or weekly frequency consistently resulted in aural haematoma (AH) recurrence and lack of resolution. Corticosteroid instillation alongside drainage reduced the risk of rapid recurrence for AHs, across both the cohort and the case control studies, provided drainage was frequent
 Conclusion
 The strength of evidence for local steroid instillation was weak given the type of studies reviewed, alongside small sample sizes and variations in treatment protocol. However, consistently drainage alone appears an insufficient means of addressing AHs in dogs.
 In cases where frequent drainage was the chosen treatment option, the addition of local corticosteroid application appeared to improve the outcome compared to drainage alone.
 However, as systemic treatment was often employed alongside local corticosteroid instillation, success cannot necessarily be attributed solely to local treatment. Larger, randomised control trials would be required to assess the effect of each individual intervention providing clearer evidence for the most effective medical protocol for treating aural haematomas in dogs
 
 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.
 

What prognostic information does flow cytometry provide in canine B-cell lymphoma?

PICO question
 In dogs with B-cell lymphoma, does the use of flow cytometry provide useful prognostic information?
 
 Clinical bottom line
 Category of research question
 Prognosis
 The number and type of study designs reviewed
 Twelve papers were critically reviewed. All were cohort studies
 Strength of evidence
 Moderate
 Outcomes reported
 There are multiple potential prognostic indicators in canine B-cell lymphoma that flow cytometry can be used to evaluate, including lymphoma stage, survival time and time to progression. There is promising evidence for the use of percentage expression of CD25 and Ki67 cellular markers in providing prognostic information in canine B-cell lymphoma and these should be assessed further in clinical practice. Flow cytometry has also been shown to be useful in assessing bone marrow infiltration and providing prognostic information relating to this. There is also evidence for the prognostic value of measuring expression of class II MHC and CTLA-4 cellular markers, peripheral lymphocyte / monocyte ratio, nodal regulatory T-cell populations and the ratio between T and B lymphocytes in extranodal locations. Peripheral regulatory T-cell populations and cellular size were also assessed, however further investigations are required before confirming their prognostic value
 Conclusion
 Flow cytometric analysis offers useful measures of prognosis in canine B-cell lymphoma, although further validation is required before introducing their routine use. Percentage expression of CD25 and Ki67 cellular markers from lymph node aspirates of dogs with B-cell lymphoma appear to be promising prognostic indicators in clinical investigations, however this needs to be translated into clinical practice. While there is evidence for the prognostic value of bone marrow infiltration measured flow cytometrically, expression of class II MHC and CTLA-4, peripheral lymphocyte / monocyte ratio, nodal regulatory T-cell populations and the ratio between T and B lymphocytes in extranodal locations, these need to be further investigated before introducing into clinical practice. As new antibodies against cellular targets in dogs become available, it is likely that flow cytometry will become even more useful in providing prognostic information
 
 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 effectiveness of oxytetracycline in the treatment of calves with contracted flexor tendons

PICO question
 In neonatal calves with contracted flexor tendons is the use of a 3 day course of oxytetracycline in conjunction with other treatments more effective in returning the hoof to normal full weight bearing on both the toe and heel compared to no oxytetracycline?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three papers were critically reviewed. One randomised controlled study, one case series and one case study
 Strength of evidence
 Weak
 Outcomes reported
 Oxytetracycline as a treatment for contracted flexor tendons in calves was found to be slightly more effective in returning the hoof to normal weight bearing compared to no oxytetracycline. In contrast, oxytetracycline infusions for the treatment of contracted flexor tendons in calves do not have an influence on weight bearing and have no significant clinical effect
 Conclusion
 There was limited confidence that the estimated effect reported by the studies were close to the true effect, this is due to the studies having a number of limitations as well as the case series / study having limited evidentiary power. There is currently insufficient evidence from the literature to support or reject the use of oxytetracycline in the treatment of contracted flexor tendons in calves. Further studies, with higher strengths of evidence, are required to provide conclusive evidence
 
 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 extent of the surgical margin affect the likelihood of local recurrence in Patnaik grade I or II cutaneous mast cell tumours?

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
 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.
 

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

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
 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 measurement of glucose levels in blood and peritoneal fluid be used to diagnose septic peritonitis in dogs?

PICO question
 Can the measurement of blood and peritoneal fluid effusion glucose levels be used to accurately diagnose septic peritonitis in dogs when compared to cytology and bacterial culture?
 
 Clinical bottom line
 Category of research question
 Diagnosis
 The number and type of study designs reviewed
 Three papers were critically reviewed, all of which were diagnostic test evaluation studies
 Strength of evidence
 Moderate
 Outcomes reported
 Glucose measurements can be used to diagnose septic peritonitis when the blood plasma glucose level is >2.1 mmol/L higher than that of the peritoneal fluid glucose when using a veterinary point of care (POC) glucometer. If using a biochemistry analyser, a whole blood glucose >1.1 mmol/L higher than that of the peritoneal fluid can be used to diagnose septic peritonitis. This is only relevant when the peritoneal fluid is collected by abdominocentesis and not in a postoperative period
 Conclusion
 At present, there is moderate evidence that glucose measurements are useful as a patient side test for the diagnosis of septic peritonitis and are especially useful in cases where intracellular bacteria cannot be identified on cytology. However, despite the so far promising accuracy results, the cut-offs reported are quite variable and overall, there is not a single diagnostic test that is 100% sensitive and specific in repeated studies. Therefore, the results of the glucose measurements should be evaluated alongside other biomarker testing, imaging modalities and the clinical presentation of the patient. Glucose measurements cannot currently replace culture / sensitivity and cytology as the gold standard for the diagnosis of septic peritonitis
 
 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.
 

Borrelia burgdorferi exposure in coyotes: an indicator of B. burgdorferi levels in urban versus rural environments

PICO question
 Do wild coyotes in the US that are in an urban habitat compared to a rural habitat have a higher prevalence of Borrelia burgdorferi seroconversion?
 
 Clinical bottom line
 Category of research question
 Prevalence
 The number and type of study designs reviewed
 Two papers, both utilising a cross-sectional study design
 Strength of evidence
 Zero
 Outcomes reported
 The relevant studies provide very limited to no evidence towards answering this PICO question. In one, while the absolute percentage of Borrelia-antibody-positive canines (including dogs in addition to coyotes) is higher in metropolitan areas, the effect was not found to be statistically significant, possibly due to their small sample sizes. In the second study, prevalence of antibodies against Borrelia was compared between different rural habitats, but no urban coyotes were tested as a comparison and thus the PICO question cannot be evaluated
 Conclusion
 There is a knowledge gap concerning the prevalence of Borrelia in coyotes and how it differs between urban and rural environments. Wild coyotes could be used as a sentinel species of Lyme disease activity and to assess potential for domestic pet and human infections, which would inform clinical differential diagnoses as well as testing and vaccination recommendations. More studies are needed before this PICO question can be answered in a confident manner
 
 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 surgical or medical management of extrahepatic portosystemic shunts in dogs carry a better prognosis for the resolution and reduction of neurological dysfunction?

PICO question
 In dogs with congenital extrahepatic portosystemic shunts that are treated with surgical attenuation what is the persistency, frequency, severity and outcome of neurological signs when compared to dogs that are treated medically?
 
 Clinical bottom line
 Category of research question
 Prognosis
 The number and type of study designs reviewed
 Ten papers were critically reviewed
 Strength of evidence
 Weak
 Outcomes reported
 For short-term success, owners reported an overall decrease in neurological signs associated with neurological dysfunction and an increase in quality of life after the initiation of either medical management or surgical management. Surgical management has a weak association with higher mortality or severe neurological signs in the immediate postoperative period
 Conclusion
 It is challenging to make a direct comparison between medical and surgical management but, overall, both strategies seemed to decrease neurological signs in the short term. There was a lack of evidence and available data about the efficacy of each for long-term control of neurological signs
 
 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 cats which treatment, meloxicam or prednisolone, most quickly reduces clinical signs of feline interstitial cystitis?

PICO question
 In cats with feline interstitial cystitis, which therapy brings a faster resolution of clinical signs: meloxicam or prednisolone?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Two papers evaluated as relevant to the PICO question were critically reviewed. Both were double-blinded randomised controlled trials.
 One paper not related to the PICO question, a single-blinded randomised controlled trial, was also reviewed as it is touched upon in the discussion section
 Strength of evidence
 Appraisal of the literature reveals weak evidence that meloxicam and prednisolone are of equivalent effectiveness when treating feline interstitial cystitis, also known as feline idiopathic cystitis (FIC)
 Outcomes reported
 There is no statistically significant difference in the reduction of clinical signs when meloxicam is compared with a placebo for the treatment of FIC. There is no statistically significant difference in reduction of clinical signs when prednisolone is compared with a placebo for the treatment of FIC. No studies were available for review which directly compared meloxicam against prednisolone as treatment options for FIC
 Conclusion
 In cats with FIC, insufficient evidence exists to truly conclude whether meloxicam or prednisolone is the most efficacious therapy for the reduction of clinical signs. Two double-blinded randomised controlled trials were evaluated – one compared the efficacy of meloxicam against a placebo; the other compared the efficacy of prednisolone against a placebo. Neither study found a statistically significant difference between the assessed treatment modality and the placebo used in reducing the clinical signs of FIC. As such, weak evidence exists that there is no significant difference between the use of meloxicam and a placebo, and prednisolone and a placebo in the reduction of clinical signs of FIC. Additionally, it could therefore be hypothesised that no significant difference exists in the reduction of clinical signs when comparing meloxicam against prednisolone as treatments for FIC however, no study was discoverable which was able to substantiate this claim
 
 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.
 

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.
 

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.
 

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.
 

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.
 

Use of the feline interdigital semiochemical (FIS) to redirect unwanted scratching behaviour in cats

PICO question
 Can the use of a synthetic feline interdigital semiochemical (FIS), with the provision of a scratching post, redirect unwanted scratching behaviour in cats better than provision of a scratching post alone?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three studies were evaluated. One was a randomised blinded trial on a single group of subjects following a crossover repetition design (Cozzi et al., 2013), the second was an open, uncontrolled study (Beck et al., 2018), and the third was a randomised unblinded trial on a single group of subjects using a placebo (Zhang et al., 2019).
 Strength of evidence
 Weak
 Outcomes reported
 In two of the three studies where the FIS pheromone was applied to the scratching posts resulted in a statistically significant increase in the cats’ scratching behaviour compared to the control. The third study showed a result approaching statistical significance (p = 0.06).
 Conclusion
 Based on the assessed studies there is weak evidence that FIS used in conjunction with the provision of a scratching post is more successful in redirecting unwanted scratching behaviour than provision of a scratching post alone. However, further studies using larger and more representative cohorts are needed in order to confirm the accuracy of these results.
 
 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.