Category Of Research Question Research Articles

Diagnostic accuracy of cytology for canine osteosarcoma compared to histopathology

PICO question
 What is the sensitivity and specificity of cytology as a test for canine osteosarcoma when compared to histopathology as a gold standard?
 
 Clinical bottom line
 Category of research question
 Diagnosis
 The number and type of study designs reviewed
 Overall, four diagnostic validity studies (two prospective and two retrospective) were critically appraised
 Strength of evidence
 Weak to moderate
 Outcomes reported
 There is evidence of moderate strength to support that cytology is highly sensitive and specific for diagnosing histologically confirmed osteosarcomas as mesenchymal malignant neoplasms (cytological diagnosis of sarcoma). Evidence of weak strength suggests that the sensitivity and specificity of cytology for identifying the exact histotype (cytological diagnosis of osteosarcoma) are low and high, respectively. Finally, there is currently evidence of weak strength indicating that the sensitivity and specificity of cytology are comparable to that of preoperative histopathology after incisional biopsy for the diagnosis of canine osteosarcoma
 Conclusion
 Based on the available evidence, the diagnostic accuracy of cytology in diagnosing histologically confirmed osteosarcomas as sarcomas is high, whereas a confident conclusion cannot be drawn regarding the diagnostic accuracy of cytology for the identification of the exact histotype (cytological diagnosis of osteosarcoma). There is currently scant evidence suggesting that cytology has comparable diagnostic accuracy to preoperative histopathology (i.e. after incisional biopsy) for the diagnosis of canine osteosarcomas, however, more studies are warranted to confirm 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.
 

The effect of pre-emptive incisional bupivacaine block on postoperative pain after coeliotomy in dogs

PICO question
 Is there an effect on analgesia following coeliotomy in dogs after a block with local anaesthetics?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 All the available evidence for this PICO question comes from clinical trials and one experimental/pharmacology study. All the studies were randomised; 5/7 were blinded clinical studies and 4/7 studies were prospective
 Strength of evidence
 Moderate
 Outcomes reported
 It is not clear if the use of a local anaesthetic including bupivacaine or lidocaine as incisional blocks minimises the postoperative pain especially in the first 24 hours, as the results are not statistically significant between the groups
 Conclusion
 In conclusion, bupivacaine or lidocaine can minimise the postoperative pain but more clinical trials are needed
 
 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.
 

Is inhaled immunotherapy more effective than environmental management when treating equine asthma?

PICO question
 In horses with severe equine asthma syndrome, is inhaled immunotherapy compared to environmental reduction of allergen exposure more effective in disease modification?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 12 papers were critically reviewed. Nine clinical trials; one crossover study; one split-plot design study; and one cross-sectional study
 Strength of evidence
 Low
 Outcomes reported
 Four studies found inhaled immunotherapy to improve the clinical signs associated with equine asthma and the lung function of horses with asthma. Three papers found environmental modification by improved lung function and the clinical signs associated with equine asthma but two studies provide moderate evidence that environmental management alone is insufficient to permanently cure asthma
 Conclusion
 There is a low level of evidence to support the use of inhaled immunotherapy as a treatment for equine asthma
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

‘Don’t pee on that!’ Comparing environmental modification and medical management in cats with FIC

PICO question
 In cats with feline idiopathic cystitis (FIC) is environmental modification superior than medical management in preventing reoccurrence?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 16 papers were critically reviewed; 14 randomised trials and two case studies
 Strength of evidence
 Critical appraisal of the selected papers meeting the inclusion criteria collectively provide weak evidence in terms of their experimental design and implementation
 Outcomes reported
 There is weak evidence that any medication or environmental modification is successful in reducing the reoccurrence of FIC when compared to a placebo. Short-term use of amitriptyline can contribute to an increase in occurrence of FIC
 Conclusion
 In view of the strength of evidence and the outcomes from the studies the following conclusion is made; in cats with feline idiopathic cystitis there is weak evidence that environmental modification or medication are effective at preventing reoccurrence. Further research is required into the cause of FIC before comparisons on treatment options can be made, however, with the exception of short-term use of amitriptyline, environmental modification and systemic treatment of clinical signs did not contribute to an increase in occurrence of FIC
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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

PICO question
 In horses undergoing volatile anaesthesia with isoflurane or sevoflurane, does administration of an alpha-2 agonist as a CRI compared to anaesthetic maintenance with volatile alone improve recovery quality?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Eight papers were critically appraised. All prospective, randomised clinical trials. 7/8 papers were blinded and 4/8 were crossover design
 Strength of evidence
 Moderate
 Outcomes reported
 One paper investigating detomidine and one on romifidine showed no improvement in recovery quality. 3/3 medetomidine papers and 2/3 dexmedetomidine papers showed a significant improvement in recovery quality in the alpha-2 agonist CRI group
 Conclusion
 In a healthy horse undergoing general anaesthesia with isoflurane or sevoflurane maintenance, an intra-operative constant rate of infusion (CRI) of medetomidine and dexmedetomidine can lead to better recovery quality when compared to horses who are maintained on isoflurane or sevoflurane alone
 
 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 ranitidine administration improve gastrointestinal motility in dogs presented with vomit and/or anorexia?

PICO question
 In dogs presenting with gastrointestinal (GI) hypomotility is ranitidine administration (any route) beneficial in improving GI motility?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 One prospective controlled clinical trial and five experimental crossover studies
 Strength of evidence
 Weak
 Outcomes reported
 The vast majority of the evidence investigating ranitidine as a prokinetic has been carried out in experimental settings both in vivo with healthy conscious and anaesthetised dogs and in vitro. Under these circumstances ranitidine has shown some prokinetic properties. However, it is difficult to translate these results into reliable clinical recommendations, as the doses mentioned in these studies are often higher than the ones clinically recommended and healthy canine patients might respond differently to clinically affected ones
 Conclusion
 Although in experimental settings ranitidine has shown some prokinetic activities, no reliable clinical recommendations can be drawn from the appraised studies. There is a need of prospective clinical trials evaluating the administration of ranitidine to dogs presenting with GI hypomotility. Until further relevant studies become available, the efficacy of ranitidine administration as a prokinetic agent in dogs with GI hypomotility remains uncertain
 
 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 bitches, is ovariectomy/ovariohysterectomy by laparoscopy less painful postoperatively than by midline open laparotomy?

PICO question
 In bitches, is an ovariectomy/ovariohysterectomy by laparoscopy superior to an ovariectomy/ovariohysterectomy by a midline surgical laparotomy in causing less postoperative pain?
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Seven papers were critically appraised. They comprised of three blinded randomised controlled trials, two non-blinded randomised controlled trials and two non-blinded non-randomised controlled trials
 Strength of evidence
 Weak
 Outcomes reported
 In bitches, ovariectomy/ovariohysterectomy by laparoscopy is superior to ovariectomy/ovariohysterectomy by a midline laparotomy in causing less postoperative pain
 Conclusion
 Despite the widely held belief that laparoscopic surgery is associated with less postoperative pain, the available veterinary literature only provides weak evidence to support this in bitches undergoing ovariectomy/ovariohysterectomy. There are many uncontrolled variables to consider across these underpowered studies including surgeon number (and experience), the choice of perioperative analgesia, method of pain scoring and the laparoscopic technique. It is therefore clear that laparoscopic procedures cannot be viewed equally and the strength of the answer to the clinical question may change based upon these variables. It is also important to note that the incidence of complications or the effect of the above variables on postoperative pain have not been critically reviewed and warrant careful consideration when deciding on a laparoscopic approach
 
 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 horses with trigeminal-mediated headshaking, is neuromodulation with EquiPENS™ more effective than with electroacupuncture?

PICO question
 In horses diagnosed with trigeminal-mediated headshaking, is EquiPENS™ therapy more efficacious when compared to electroacupuncture in terms of remission of clinical signs?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three papers were critically reviewed, all three were descriptive case series
 Strength of evidence
 Weak
 Outcomes reported
 Remission was achieved following both EquiPENS™ and electroacupuncture therapy in a proportion of horses for variable lengths of time. Median remission times appear to be longer with repeated treatment of EquiPENS™ compared to electroacupuncture
 Conclusion
 The evidence for EquiPENS™ treatment is more robust than for electroacupuncture, and remission defined more clearly, and so could be recommended with greater confidence
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Does meniscal release confer similar clinical benefits to meniscal tear treatment when compared to meniscectomy?

PICO question
 In adult dogs with naturally occurring medial meniscal tears concurrent to cranial cruciate ligament disease does meniscal release confer the same benefits in lameness resolution as meniscectomy?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 A single prospective cross-sectional study was reviewed, that fulfilled the criteria
 Strength of evidence
 None
 Outcomes reported
 Meniscal release, meniscectomy (partial, hemi- or complete), or the two combined performed for concurrent medial meniscal pathology at time of surgery for naturally occurring cranial cruciate ligament (CCL) rupture resulted in an acceptable long-term outcome. Difference in outcome between the techniques was not reported
 Conclusion
 There is no evidence that meniscal release provides an equal or superior treatment option for medial meniscal injury treated at the time of surgery for CCL rupture when compared to meniscectomy. The study critically reviewed performed meniscal release via radial transection through the meniscotibial ligament, and therefore does not represent mid-body abaxial radial release. Neither is this summary appropriate for considering prophylactic meniscal release of the normal meniscus. In addition, the surgical treatments for cranial cruciate ligament rupture were either ‘Tightrope’ or tibial plateau levelling osteotomy (TPLO) procedures. Further studies are required to compare clinical outcome between meniscal release or meniscectomy for treatment of concurrent meniscal tears
 
 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 offer total hip replacement to feline patients?

PICO question
 In cats with traumatic coxofemoral injury, does total hip replacement (THR) offer improved outcome when compared with femoral head and neck excision (FHNE) arthroplasty?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 One paper was critically reviewed. It was a non-randomised retrospective observational study
 Strength of evidence
 Moderate evidence
 Outcomes reported
 THR results in superior clinical outcome and owner satisfaction compared to FHNE in cats
 Conclusion
 In cats with traumatic coxofemoral injury, although the evidence is not conclusive and somewhat limited, the literature reviewed here suggests that THR offers a superior outcome in feline patients.
 There is currently insufficient evidence to determine if there is a difference in long-term outcome, complications or osteoarthritis (OA) development following THR or FHNE in feline patients
 
 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.
 

Continuous digital hypothermia in the prevention and treatment of acute equine laminitis

PICO question
 Does continuous digital hypothermia improve clinical outcome in equids with acute laminitis compared to supportive treatment alone?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Six experimental randomised controlled trials and one multicentre retrospective case series were reviewed
 Strength of evidence
 Moderate
 Outcomes reported
 The outcomes reported were reduced severity of histopathological lamellar lesions in limbs treated with continuous digital hypothermia (CDH; initiated prior to or soon after the onset of experimentally induced acute laminitis) compared to limbs remaining at an ambient temperature in all five experimental studies where histology was performed. A significant reduction was observed in the prevalence or severity of clinical signs of laminitis in limbs treated with CDH compared to limbs remaining at an ambient temperature. In a single retrospective case series, significantly reduced prevalence of clinical laminitis was reported amongst animals receiving CDH compared to those that did not in a referral hospital population of animals treated for colitis
 Conclusion
 There is moderate evidence to support that CDH when used prior to or in the early stages of clinical signs, may reduce the severity and progression of lamellar lesions in acute laminitis and no evidence demonstrating that it improves clinical outcome compared to supportive treatment alone. Further research into the clinical outcome of equids treated for acute laminitis using CDH is warranted
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

In dogs undergoing elective procedures is medetomidine superior to acepromazine when used as a premedication?

PICO question
 In dogs undergoing elective procedures does the use of medetomidine during premedication result in an increase in anaesthetic complication rates, when compared to acepromazine?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Four papers were critically reviewed, all of which were randomised controlled trials
 Strength of evidence
 Strong
 Outcomes reported
 There were some statistically significant differences between using medetomidine and acepromazine as premedications in the outcomes measured, but as the clinical parameters including blood pressure were still within acceptable clinical limits, the clinical benefits of these findings remain undetermined. There is also evidence to suggest that patients premedicated with medetomidine have less of a perioperative stress response than those receiving acepromazine, but in addition may have increased risk of cardiac conduction disturbances, but the clinical importance of these findings is also unknown
 Conclusion
 The overall findings showed that either drug can be used as a suitable premedication, but the differences in pain score postoperatively shown in one small study mean that due to its poor analgesic properties it is recommended when using acepromazine instead of medetomidine, that additional analgesia should be given to reduce postoperative pain for better animal welfare
 
 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 topical honey result in a faster rate of second intention wound healing in dogs?

PICO question
 In healthy dogs undergoing open wound management, does the topical application of honey, when compared to wounds treated with daily saline washes only, reduce the time to complete wound healing?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Two studies satisfied the inclusion criteria for answering the PICO; both were prospective randomised controlled trials
 Strength of evidence
 Weak
 Outcomes reported
 The studies demonstrated a possible effect size of clinical importance of the use of honey in the treatment of canine wounds in terms of time to complete wound healing and antibacterial effect. However, the strength of the evidence provided by both studies is severely weakened by flaws in trial design, implementation and reporting, and the possible risk of pseudo replication between the two trials reported
 Conclusion
 The use of topical honey in canine open wound management may reduce time to complete wound healing. However, the evidence for this is weak. At present, the evidence that use of topical honey in canine wounds reduces time to healing is insufficient to warrant a change in clinical practice
 
 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.
 
 Editorial notice: Upon conducting the literature search for this Knowledge Summary the author discovered that the same paper had been published in two separate journals and that a third paper by the same author appeared to have used data from the same experimental subjects as the duplicate publication, despite reporting different methodology. The duplicate publications have been appraised by the author as one paper. The editorial office alerted the journals in question which resulted in the article that appeared in the Iranian Journal of Veterinary Surgery (Jalali, F.S. S., Tajik, H., Saifzaideh, S and Fartash, B. (2007b) Topical Application of Natural Urmia Honey on Experimental Burn Wounds in the Dog: Clinical and Microbiological Studies. Iranian Journal of Veterinary Surgery. 2(2), 13–21) being retracted: http://www.ivsajournals.com/article_114759.html. See our own policy on duplicate publication for more information.
 

In dogs undergoing anaesthesia do pre-anaesthetic gastroprotectants reduce gastro-oesophageal reflux?

PICO question
 In dogs undergoing anaesthesia do pre-anaesthetic gastroprotectants reduce gastro-oesophageal reflux?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Five papers were critically reviewed. There was a randomised prospective study, two randomised blinded prospective studies, randomised non-blinded prospective study and a randomised, double blinded and placebo-controlled prospective study.
 Strength of evidence
 Moderate
 Outcomes reported
 Evidence of high quality suggests omeprazole or cisapride with esomeprazole decrease the incidence of gastro-oesophageal reflux (GOR) in the anaesthetised dog. In addition, a study of lower quality showed that continuous infusion of metoclopramide at a higher than normal dose rate decreased the incidence of GOR.
 Conclusion
 Omeprazole or cisapride with esomeprazole decreases the incidence of GOR in the anaesthetised dog.
 
 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 congestive heart failure, is torasemide superior to furosemide as a first line diuretic treatment?

PICO question
 In dogs with congestive heart failure, does the use of torasemide as a first line diuretic result in a superior survival time when compared to furosemide?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Five studies were critically appraised, they were all prospective randomised controlled trials
 Strength of evidence
 Moderate
 Outcomes reported
 There is currently a lack of studies looking at comparing furosemide directly with torasemide in patients with congestive heart failure. There are many similarly drawn conclusions from the studies: torasemide is not inferior to furosemide in the treatment of CHF, torasemide is comparable to furosemide at one tenth the dose (or less) and that torasemide may be more effective at diuresis than furosemide with a prolonged duration of action
 Conclusion
 There is currently no clear and obvious benefit for the use of torasemide, over furosemide, as a first line diuretic for dogs with congestive heart failure
 
 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 Greyhounds with paw pad corns, is surgical excision more effective at resolving lameness than extirpation?

PICO question
 In Greyhounds (and Sighthounds) with recurring pedal corns, is surgical excision in comparison to corn extirpation more effective at resolving lameness?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three case series were included, all three were retrospective, one included a prospective component. There was one opinion-based narrative review and one opinion-based article.
 Strength of evidence
 Weak
 Outcomes reported
 Extirpation allows only a short palliation of lameness and repeated treatment is required at variable intervals. Surgical excision may provide good rates of short-term resolution however, in the long-term recurrence rates are still moderate. It should also be born in mind that further corns may develop in different digits.
 Conclusion
 In Greyhounds (and Sighthounds) with recurring pedal corns, surgical excision of the corn is more likely to provide long-term resolution of lameness in comparison to extirpation. However, the current level of evidence on this topic is weak.
 
 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 safety of alfaxalone and propofol as anaesthetic induction agents in bitches un-dergoing c-section

PICO question
 In bitches and their puppies undergoing caesarean section, is an alfaxalone or a propofol induction safer?
 
 Clinical bottom line
 Category of research question
 Risk
 The number and type of study designs reviewed
 Six papers were critically reviewed. There were two randomised controlled trials directly comparing alfaxalone and propofol inductions, two randomised controlled trials including a propofol induction in one of the experimental groups and two non-comparative studies.
 Strength of evidence
 Moderate
 Outcomes reported
 Propofol and alfaxalone can both be used safely for the anaesthesia of bitches and their puppies undergoing caesarean section. There is evidence that alfaxalone may provide better anaesthesia quality for the bitches, and the puppies may be delivered with higher indicators of puppy vitality following its use. Further research into the beneficial clinical outcomes of alfaxalone should be investigated.
 Conclusion
 The use of both propofol and alfaxalone for the induction of bitches undergoing caesarean section can be recommended.
 
 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 pregnant bitches, is elective caesarean section more effective than vaginal delivery at improving puppy survival?

PICO question In pregnant bitches due to whelp, is elective caesarean section more effective than vaginal delivery to improve puppy survival? Clinical bottom line Category of research question The category of the research question is regarding the incidence of puppy mortalities as a result of vaginal delivery, emergency caesarean section and elective caesarean section. The number and type of study designs reviewed Two retrospective articles were reviewed and critically appraised; one retrospective study with high single canine breed bias and one study on different canine breeds but limited support in directly answering the PICO question. Strength of evidence The studies selected both had strong uses of experimental designs but together provided weak evidence to determine a definitive answer to the PICO question. Outcomes reported The outcomes from both retrospective studies suggests that the mortality rates of newborn puppies can be reduced if pregnant bitches are scheduled ahead for elective caesareans, in comparison to undergoing an emergency caesarean section when complications develop, particularly in breeds with higher risks of dystocia. Therefore, there is some evidence to support that it may be advantageous to consider the breed, age and overall health of the bitch during pregnancy to determine whether elective caesarean sections, for the safe delivery of puppies, should be considered. Conclusion There are currently insufficient studies, literatures and evidence in veterinary medicine for caesarean sections to become a routine procedure in first opinion practices. Future prospective studies should be conducted and include the optimum anaesthetic protocols with the lowest associated risks for the pregnant bitch and puppies. 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 diagnosed with osteoarthritis, is meloxicam superior to carprofen for reducing patient discomfort?

PICO question
 In dogs diagnosed with osteoarthritis, is meloxicam superior to carprofen for reducing patient discomfort?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Only two papers have compared the efficacy between meloxicam and carprofen in the treatment of dogs diagnosed with osteoarthritis. Both of the papers were clinical, prospective and randomised trials.
 Strength of evidence
 Weak
 Outcomes reported
 One randomised controlled clinical trial compared the level of efficacy between meloxicam and carprofen in reducing pain and discomfort in dogs diagnosed with osteoarthritis1. Orthopaedic surgeons found dogs treated with either meloxicam or carprofen showed significant improvement in ground reaction forces (GRF). The study emphasised that dogs treated with meloxicam had GRF values that returned to normal baseline values, with owners also commenting on gait improvement. This study however, had a low sample size, did not use a validated metrology instrument for assessment by owners and the data used to assess GRF was not conclusive on all parameters to favour meloxicam.
 An additional study was evaluated but this also had very small case numbers, no control group and gave no detailed statistical analysis2. The paper descriptively suggests meloxicam to show a better response than carprofen but there was no scientific analysis or evidence to statistically support and validate this.
 Conclusion
 Both meloxicam and carprofen are validated as effective treatments for canine osteoarthritis but it cannot be suggested that meloxicam is superior to carprofen as the available evidence is weak. To accurately assess this, a future clinical study using validated metrology instruments, adequate sample sizes and proper statistical analysis 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.
 

In horses with osteoarthritis, is mesenchymal stem cell therapy more effective at managing lameness than intra-articular corticosteroids?

PICO question
 In horses with osteoarthritis, is mesenchymal stem cell therapy more effective at managing lameness than intra-articular corticosteroids?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Nine papers were critically reviewed; seven experimental trials and two randomised controlled double-blinded trials.
 Strength of evidence
 Weak to moderate
 Outcomes reported
 There is moderate evidence to suggest that chondrogenically induced mesenchymal stem cells combined with equine allogenic plasma have a good efficacy at reducing lameness in the short-term, in horses with mild to moderate lameness associated with osteoarthritis. However, there is no definitive evidence directly comparing mesenchymal stem cell therapy and corticosteroids, to identify if mesenchymal stem cell therapy is more effective than intra-articular corticosteroids.
 Conclusion
 In horses with mild to moderate lameness associated with osteoarthritis, there is moderate evidence to suggest that mesenchymal stem cell therapies are effective at managing lameness. However, it is undetermined whether they are more effacious than intra-articular corticosteroids.
 
 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.