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Baur-Bernhardt S, Käsbohrer A, Doherr MG, Meemken D, Sonnenschein-Swanson L, Stetina BU, Sommer MA, Weiermayer P. Assessing the Feasibility of a Two-Cohort Design to Assess the Potential of Homeopathic Medicinal Products to Reduce Antimicrobial Resistance in Turkeys (The HOMAMR Project)-Study Protocol. HOMEOPATHY 2024. [PMID: 38574753 DOI: 10.1055/s-0044-1781448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a serious public health concern worldwide. The European Union requires a reduction in the use of antibiotics by 50% by 2030, with separate regulations on organic production that give preference to homeopathy and phytotherapy in organic farms before the use of conventional medicines (including antibiotics). We have therefore designed a two-phased project whose overarching aim is to investigate the potential role of homeopathic medicinal products (HMPs) in combating AMR in turkeys (the HOMAMR project): a two-cohort feasibility study using turkey-farm data that have been collected and analyzed retrospectively, followed by a prospective two-cohort study in turkey farms that would examine the impact of HMPs on changing antibiotic use. OBJECTIVE The objective of this paper is to describe the protocol for the first phase of HOMAMR, which is a study under field conditions to assess the feasibility of collecting data retrospectively about turkeys that have been managed conventionally only or with HMPs. METHODS Surveys performed on farms in Germany and Austria, including interviews with consenting farmers, will determine the feasibility of comparing retrospectively gathered data on antibiotic use and performance/production data in two cohorts of turkeys: (1) homeopathic treatment with conventional care (antibiotics) added if necessary or (2) conventional care (antibiotics) only. Co-primary outcomes to be studied are the amount of antimicrobial use and production period-related mortality. In addition, other production/performance parameters will be compared between the two treated cohorts. CONCLUSION To our knowledge, this is the first feasibility study on the treatment of turkeys using homeopathy, and whose retrospectively obtained data will inform a prospective study that would examine the impact of HMPs on antibiotic use in commercial turkey raising, fattening and breeding production.
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Affiliation(s)
- Silvia Baur-Bernhardt
- Department Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität, Berlin, Germany
| | - Annemarie Käsbohrer
- Unit for Veterinary Public Health and Epidemiology, University of Veterinary Medicine, Vienna, Austria
| | - Marcus Georg Doherr
- Department Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität, Berlin, Germany
| | - Diana Meemken
- Department Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität, Berlin, Germany
| | - Lena Sonnenschein-Swanson
- Department Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität, Berlin, Germany
| | | | - Mary-Ann Sommer
- Department Veterinary Medicine, Institute of Food Safety and Food Hygiene, Freie Universität, Berlin, Germany
| | - Petra Weiermayer
- Unit for Veterinary Public Health and Epidemiology, University of Veterinary Medicine, Vienna, Austria
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Gaertner K, von Ammon K, Fibert P, Frass M, Frei-Erb M, Klein-Laansma C, Ulbrich-Zuerni S, Weiermayer P. Recommendations in the design and conduction of randomised controlled trials in human and veterinary homeopathic medicine. Complement Ther Med 2023; 76:102961. [PMID: 37393961 DOI: 10.1016/j.ctim.2023.102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are an established research method to investigate the effects of an intervention. Several recent systematic reviews and meta-analyses of RCTs with homeopathic interventions have identified shortcomings in design, conduct, analysis, and reporting of trials. Guidelines for RCTs in homeopathic medicine are lacking. OBJECTIVES This paper aims to fill this gap in order to enhance the quality of RCTs in the field of homeopathy. METHODS Identification of the homeopathy-specific requirements for RCTs by reviewing literature and experts' communications. Systematization of the findings using a suitable checklist for planning, conducting, and reporting RCTs, namely the SPIRIT statement, and high-quality homeopathy RCTs as examples. Cross-checking of the created checklist with the RedHot-criteria, the PRECIS criteria, and a qualitative evaluation checklist. Consideration of the REFLECT statement and the ARRIVE Guidelines 2.0 for veterinary homeopathy. RESULTS Recommendations for future implementation of RCTs in homeopathy are summarized in a checklist. Alongside, identified useful solutions to the issues encountered when designing and conducting homeopathy RCTs are presented. CONCLUSIONS The formulated recommendations present guidelines additional to those in the SPIRIT checklist, on how to better plan, design, conduct, and report RCTs in homeopathy.
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Affiliation(s)
- Katharina Gaertner
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland; Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, DE-58313 Herdecke, Germany
| | - Klaus von Ammon
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Philippa Fibert
- Department of Psychology and Pedagogic Science, St Mary's University, Twickenham, UK
| | - Michael Frass
- em. Medical University of Vienna, Department of Medicine I, A-1090 Vienna, Austria; Institute for Homeopathic Research, Columbusgasse 20, A-1100 Vienna, Austria
| | - Martin Frei-Erb
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Christien Klein-Laansma
- Louis Bolk Institute, Health and Nutrition, Kosterijland 3-5, NL-3981 AJ Bunnik, the Netherlands
| | | | - Petra Weiermayer
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany.
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Keller P, Vanwesenbeeck I, Decloedt A. Surveying dog owners' use and understanding of, and communication with veterinarians about, complementary and alternative veterinary medicine. Vet Rec 2023; 192:e2343. [PMID: 36331424 DOI: 10.1002/vetr.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Complementary and alternative veterinary medicine (CAVM) seems to be gaining acceptance by pet owners. Client-veterinarian communication about CAVM is important to explore client perceptions and facilitate open exchange of ideas between owners and veterinarians. METHODS This study includes an online, cross-sectional survey of dog owners to evaluate CAVM use and client-veterinarian communication about CAVM. Based on the extended theory of planned behaviour, factors influencing the intention to use CAVM were evaluated. RESULTS Past CAVM use was reported by 45.3% clients based on 1000 valid surveys. The attitude towards CAVM was generally positive. Perceived knowledge about CAVM positively predicted perceived behavioural control and attitude towards CAVM. Both were the strongest predictors of future CAVM use. Around 45.7% of clients had already talked to their veterinarian about CAVM. This conversation was mainly initiated by the owner (66.3%). Owners expected the veterinarian to have knowledge about CAVM (91.5%) and offer referral (71.5%). LIMITATIONS The limitation is difficulty in classifying and defining CAVM modalities. CONCLUSIONS Owners' perceived behavioural control and attitude towards CAVM predict CAVM use. Failure to engage in a conversation about CAVM hampers clients to partner with veterinarians to discuss the treatment approach and maximise patient outcome. The veterinarian plays an essential role in providing objective accurate information about CAVM.
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Affiliation(s)
- Pia Keller
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ini Vanwesenbeeck
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, The Netherlands
| | - Annelies Decloedt
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Wisener LV, Sargeant JM, O'Sullivan TL, O'Connor AM, McEwen SA, Reist M, Churchill KJ. Non-antibiotic Approaches for Disease Prevention and Control in Nursery Pigs: A Scoping Review. Front Vet Sci 2021; 8:620347. [PMID: 33969029 PMCID: PMC8097137 DOI: 10.3389/fvets.2021.620347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/19/2021] [Indexed: 01/21/2023] Open
Abstract
Swine producers are encouraged to practice antibiotic stewardship by reducing their use of antibiotics belonging to classes of medical importance to humans. We conducted a scoping review of non-antibiotic approaches in the form of products or management practices that might prevent or control disease and thus reduce the need for antibiotics in nursery pigs. Our objectives were to systematically describe the research on this broad topic for the North American context, identify specific topics that could feasibly support systematic reviews, and identify knowledge gaps. A search of multiple databases identified 11,316 articles and proceedings for relevance screening. From these, 441 eligible clinical trials and observational studies were charted. The majority were clinical trials (94%). Study results from EU countries were mostly communicated through journal articles, whereas study results from the USA were mostly communicated through conference proceedings. Interventions and health outcomes were diverse. The two most frequent intervention categories were feed additives and piglet vaccines. The three most frequent outcomes reported were diarrhea, mortality, and indices of vaccine immunity. There were 13 specific topics comprising various feed additives and vaccines that might feasibly support systematic reviews. There were relatively few studies in which interventions were compared with antibiotic comparison groups and relatively few studies evaluating management practices.
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Affiliation(s)
- Lee V Wisener
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | - Jan M Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | - Terri L O'Sullivan
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Annette M O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Scott A McEwen
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Mark Reist
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Katheryn J Churchill
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Sargeant JM, O'Connor AM. Scoping Reviews, Systematic Reviews, and Meta-Analysis: Applications in Veterinary Medicine. Front Vet Sci 2020; 7:11. [PMID: 32047759 PMCID: PMC6997489 DOI: 10.3389/fvets.2020.00011] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Evidence-based decision making is a hallmark of effective veterinary clinical practice. Scoping reviews, systematic reviews, and meta-analyses all are methods intended to provide transparent and replicable ways of summarizing a body of research to address an important clinical or public health issue. As these methods increasingly are being used by researchers and read by practitioners, it is important to understand the distinction between these techniques and to understand what research questions they can, and cannot, address. This review provides an overview of scoping reviews, systematic reviews, and meta-analysis, including a discussion of the method and uses. A sample dataset and coding to conduct a simple meta-analysis in the statistical program R also are provided. Scoping reviews are a descriptive approach, designed to chart the literature around a particular topic. The approach involves an extensive literature search, following by a structured mapping, or charting, of the literature. The results of scoping reviews can help to inform future research by identifying gaps in the existing literature and also can be used to identify areas where there may be a sufficient depth of literature to warrant a systematic review. Systematic reviews are intended to address a specific question by identifying and summarizing all of the available research that has addressed the review question. Questions types that can be addressed by a systematic review include prevalence/incidence questions, and questions related to etiology, intervention efficacy, and diagnostic test accuracy. The systematic review process follows structured steps with multiple reviewers working in parallel to reduce the potential for bias. An extensive literature search is undertaken and, for each relevant study identified by the search, a formal extraction of data, including the effect size, and assessment of the risk of bias is performed. The results from multiple studies can be combined using meta-analysis. Meta-analysis provides a summary effect size, and allows heterogeneity of effect among studies to be quantified and explored. These evidence synthesis approaches can provide scientific input to evidence-based clinical decision-making for veterinarians and regulatory bodies, and also can be useful for identifying gaps in the literature to enhance the efficiency of future research in a topic area.
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Affiliation(s)
- Jan M Sargeant
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University College of Veterinary Medicine, Ames, IA, United States
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Keller D, Sundrum A. Comparative effectiveness of individualised homeopathy and antibiotics in the treatment of bovine clinical mastitis: randomised controlled trial. Vet Rec 2018; 182:407. [PMID: 29374099 PMCID: PMC5890642 DOI: 10.1136/vr.104555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/11/2017] [Accepted: 12/31/2017] [Indexed: 01/21/2023]
Abstract
Based on the widespread use of homeopathy in dairy farm practice when treating mastitis, a blind randomised controlled trial (RCT) was conducted to assess the effectiveness of homeopathic treatment of clinical mastitis on four dairy farms. The study considered specific guidelines for RCTs as well as the basic principles of individualised homeopathy and involved 180 lactating dairy cows. Evaluation of cure rates was based on clinical investigation of the udder and on laboratory analysis of milk samples. In culture-positive cases, the antibiotic treatment provided suboptimal bacteriological cures (60–81 per cent) but was more effective than individualised homeopathy (33–43 per cent) whose effects appeared little different to those of placebos (45–47 per cent) (P≤0.05). On the cytological cure level, all three treatment methods were similarly ineffective: antibiotic being 2–21 per cent, individualised homeopathy 0–8 per cent and placebo 3–13 per cent (P≤0.05; P=0.13). Antibiotics, individualised homeopathy and placebo had similar effects on bacteriological and cytological cure in cases of culture-negative milk samples (P>0.4) and Escherichia coli infections (P=1.0). The study results implied that the effectiveness of individualised homeopathy does not go beyond a placebo effect and successful treatment is highly dependent on the specific mastitis pathogen. Thus, antimicrobial or alternative remedies used should be based on the bacterial culture of the milk sample.
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Affiliation(s)
- Diana Keller
- Department of Animal Health and Animal Nutrition, University of Kassel, Witzenhausen, Germany
| | - Albert Sundrum
- Department of Animal Health and Animal Nutrition, University of Kassel, Witzenhausen, Germany
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Non-antibiotic approaches at drying-off for treating and preventing intramammary infections: a protocol for a systematic review and meta-analysis. Anim Health Res Rev 2017; 17:169-175. [PMID: 28155803 DOI: 10.1017/s1466252316000177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intramammary infection (IMI) treatment and prevention at drying-off is one of the leading causes for using antimicrobials on dairy farms. The objective of the current paper is to describe the protocol used for conducting a systematic review of the literature on non-antibiotic strategies that can be used on dairy cows at dry off to treat and prevent IMI. Relevant literature will be identified using a combination of database search strategies and iterative screening of references. To be included in the review, articles will have to: (1) be published after 1969; (2) be written in English, French, or Spanish; (3) use a study design such as a controlled trial, an observational study, or an experimental study conducted in vivo; (4) be conducted on commercial dairy cows; (5) investigate a non-antibiotic intervention used at dry off; and finally, (6) report on a relevant mastitis outcome. Titles and abstracts, then full articles will be reviewed for inclusion. Specific data will be extracted and risk of bias will be assessed for all included articles. The planned systematic review will be the first to colligate, in a coherent whole, studies investigating non-antibiotic strategies for treating and preventing IMI at drying-off.
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Lees P, Pelligand L, Whiting M, Chambers D, Toutain PL, Whitehead ML. Comparison of veterinary drugs and veterinary homeopathy: part 2. Vet Rec 2017; 181:198-207. [PMID: 28821700 PMCID: PMC5738588 DOI: 10.1136/vr.104279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Part 2 of this narrative review outlines the theoretical and practical bases for assessing the efficacy and effectiveness of conventional medicines and homeopathic products. Known and postulated mechanisms of action are critically reviewed. The evidence for clinical efficacy of products in both categories, in the form of practitioner experience, meta-analysis and systematic reviews of clinical trial results, is discussed. The review also addresses problems and pitfalls in assessing data, and the ethical and negative aspects of pharmacology and homeopathy in veterinary medicine.
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Affiliation(s)
| | | | - M Whiting
- Royal Veterinary College, Hawkshead Campus, Hatfield, Hertfordshire
| | - D Chambers
- Hall Manor, Kelly, Lifton, Devon PL16 0HQ, UK
| | - P-L Toutain
- Toxalim, Ecole Nationale Veterinaire de Toulouse, France
| | - M L Whitehead
- Chipping Norton Veterinary Hospital, Banbury Road, Chipping Norton, Oxon OX7 5SY, UK
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Francoz D, Wellemans V, Dupré JP, Roy JP, Labelle F, Lacasse P, Dufour S. Invited review: A systematic review and qualitative analysis of treatments other than conventional antimicrobials for clinical mastitis in dairy cows. J Dairy Sci 2017; 100:7751-7770. [PMID: 28755947 DOI: 10.3168/jds.2016-12512] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/24/2017] [Indexed: 11/19/2022]
Abstract
Clinical mastitis is an important disease in dairies. Its treatment is mainly based on the use of antimicrobial drugs. Numerous non-antimicrobial drugs and treatment strategies have already been reported for clinical mastitis treatment, but data on their efficacy have never been collated in a systematic way. The objective of this systematic review was to identify treatments other than conventional antimicrobials for the treatment of clinical mastitis in lactating dairy cows. A systematic review was performed with studies written in English or French selected from CAB Abstracts, PubMed, and Web of Science from January 1970 to June 2014. Controlled clinical trials, observational studies, and experimental challenges were retained. Lactating dairy cows with clinical mastitis were the participant of interest. All treatments other than conventional antimicrobials for clinical mastitis during lactation were retained. Only studies comparing the treatment under investigation to a negative or positive control, or both, were included. Outcomes evaluated were clinical and bacteriological cure rates and milk production. Selection of the study, data extraction, and assessment of risk of bias was performed by 3 reviewers. Assessment of risk of bias was evaluated using the Cochrane Collaboration tool for systematic review of interventions. A total of 2,451 manuscripts were first identified and 39 manuscripts corresponding to 41 studies were included. Among these, 22 were clinical trials, 18 were experimental studies, and 1 was an observational study. The treatments evaluated were conventional anti-inflammatory drugs (n = 14), oxytocin with or without frequent milk out (n = 5), biologics (n = 9), homeopathy (n = 5), botanicals (n = 4), probiotics (n = 2), and other alternative products (n = 2). All trials had at least one unclear or high risk of bias. Most trials (n = 13) did not observe significant differences in clinical or bacteriological cure rates in comparison with negative or positive controls. Few studies evaluated the effect of treatment on milk yield. In general, the power of the different studies was very low, thus precluding conclusions on noninferiority or nonsuperiority of the treatments investigated. No evidence-based recommendations could be given for the use of an alternative or non-antimicrobial conventional treatment for clinical mastitis. However, probiotics and oxytocin with or without frequent milk out should not be recommended. We concluded that homeopathic treatments are not efficient for management of clinical mastitis.
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Affiliation(s)
- D Francoz
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada
| | - V Wellemans
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada
| | - J P Dupré
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada
| | - J P Roy
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada; Canadian Bovine Mastitis and Milk Quality Research Network, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada
| | - F Labelle
- Valacta, 555 Boul. des Anciens-Combattants, Ste-Anne-de-Bellevue, QC, H9X 3R4, Canada
| | - P Lacasse
- Canadian Bovine Mastitis and Milk Quality Research Network, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada; Sherbrooke Research and Development Centre, Agriculture and Agri-Food Canada, 2000. Collège, Sherbrooke, QC, J1M 0C8, Canada
| | - S Dufour
- Canadian Bovine Mastitis and Milk Quality Research Network, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada; Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada.
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