Cross-sectional survey of sources of information accompanying veterinary product advertisements in two professional print publications

BACKGROUND

Veterinarians should be able to easily access scientific evidence about medical products and devices to incorporate into their clinical decision making. While the characteristics and quality of supporting information accompanying device and pharmaceutical advertisements have been studied in human medicine, little is known about this topic in veterinary medicine. The aim of this study was to characterise the supporting information provided by manufacturers of prescribed products, tests or devices in promotional material found in two commonly read UK-based veterinary publications.

METHODS

Advertisements contained in issues of two veterinary periodicals published between July 2017 and July 2018 were analysed for advertisement and product characteristics and for items of accompanying information. Literature searches were conducted to assess the availability of peer-reviewed sources of information on advertised products.

RESULTS

A minority (16%) of the 451 analysed advertisements were accompanied by references to peer-reviewed literature, despite the availability of scientific literature for many of the products advertised.

LIMITATION

This study sampled two professional publications over a narrow time period.

CONCLUSIONS

There may be insufficient evidence being provided to veterinary professionals via marketing features; this may limit the accessibility of scientific information for clinical decision making around advertised products.

Antimicrobial prophylaxis in companion animal surgery: A scoping review for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines

Surgical antimicrobial prophylaxis (SAP) is widely used to reduce the risk of surgical site infections (SSI), but there is uncertainty as to what the proportion of SSI reduction is. Therefore, it is difficult for surgeons to properly weigh the costs, risks and benefits for individual patients when deciding on the use of SAP, making it challenging to promote antimicrobial stewardship in primary practice settings. The objective of this study was to map the veterinary evidence focused on assessing the effect of SAP on SSI development and in order to identify surgical procedures with some research evidence and possible knowledge gaps. In October 2021 and December 2022, Scopus, CAB Abstracts, Web of Science Core Collection, Embase and MEDLINE were systematically searched. Double blinded screening of records was performed to identify studies in companion animals that reported on the use of SAP and SSI rates. Comparative data were available from 34 out of 39123 records screened including: eight randomised controlled trials (RCT), 23 cohort studies (seven prospective and 16 retrospective) and three retrospective case series representing 12476 dogs and cats in total. Extracted data described peri- or post-operative SAP in nine, and 25 studies, respectively. In the eight RCTs evaluating SAP in companion animals, surgical procedure coverage was skewed towards orthopaedic stifle surgeries in referral settings and there was large variation in SAP protocols, SSI definitions and follow-up periods. More standardized data collection and agreement of SSI definitions is needed to build stronger evidence for optimized patient care.

Efficacy of antimicrobial and nutraceutical treatment for canine acute diarrhoea: A systematic review and meta-analysis for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines

Systemic antimicrobial treatments are commonly prescribed to dogs with acute diarrhoea, while nutraceuticals (prebiotics, probiotics, and synbiotics) are frequently administered as an alternative treatment. The aim of this systematic review and meta-analysis was to assess the effectiveness of antimicrobials and nutraceutical preparations for treatment of canine acute diarrhoea (CAD). The results of this study will be used to create evidence-based treatment guidelines. PICOs (population, intervention, comparator, and outcome) were generated by a multidisciplinary expert panel taking into account opinions from stakeholders (general practitioners and dog owners). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the certainty of the evidence. The systematic search yielded six randomised controlled trials (RCT) for antimicrobial treatment and six RCTs for nutraceutical treatment meeting the eligibility criteria. Categories of disease severity (mild, moderate, and severe) were created based on the presence of systemic signs and response to fluid therapy. Outcomes included duration of diarrhoea, duration of hospitalization, progression of disease, mortality, and adverse effects. High certainty evidence showed that antimicrobial treatment did not have a clinically relevant effect on any outcome in dogs with mild or moderate disease. Certainty of evidence was low for dogs with severe disease. Nutraceutical products did not show a clinically significant effect in shortening the duration of diarrhoea (based on very low to moderate certainty evidence). No adverse effects were reported in any of the studies.

Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study

BACKGROUND

Understanding ethical challenges experienced in relation to adverse events is necessary to inform strategies that optimise patient safety and practitioner wellbeing.

METHODS

A qualitative exploration of UK veterinary practitioners' experiences of adverse events was conducted. Data were collected via 12 focus groups and 20 interviews and analysed using an inductive coding technique.

RESULTS

Questions surrounding acceptable boundaries of care, decision-making autonomy, personal scope of practice, use of evidence and speaking up about patient safety concerns were identified as ethically challenging to practitioners when endeavouring to prevent adverse events. Issues of appropriate accountability, interaction and communication with animal owners and the prioritisation of emotional and technical support for themselves and others were identified as ethically challenging in the aftermath of adverse events.

LIMITATIONS

The qualitative nature of this study limits the generalisability of the findings.

CONCLUSIONS

Ethical challenges are experienced by veterinary practitioners in relation to both preventing and responding in the aftermath of adverse events. Strategies that facilitate ethical decision making and reflection and encourage openness and learning from adverse events would likely improve patient safety and enhance practitioner wellbeing. Further research is needed to develop and implement support for practitioners who experience ethical challenges in relation to adverse events.

Factors within A Veterinarian-Cattle Farmer Relationship That May Impact on Biosecurity Being Carried out on Farms: An Exploratory Study

Veterinarians (vets) appear to be one of the main gateways to biosecurity information for cattle farmers, and therefore are likely to affect the implementation of these measures. The aim of this study was to explore factors within the vet-farmer relationship that may impact on biosecurity being carried out on cattle farms in England. Interviews were conducted with cattle farmers and large-animal vets, with a focus on individuals deemed to implement good levels of biosecurity or those working with said individuals. The questions explored how each stakeholder felt the communication occurred between the groups and the perceived consequential influence each had on the other. Inductive Thematic analysis was used to explore participants' experience of vet-farmer interactions with a focus on areas of reciprocity between the two groups. Five primary themes were identified. Factors within the vet-cattle farmer relationship, such as trust and familiarity, which were interconnected with time spent with each other, appeared to influence the uptake of biosecurity measures on cattle farms. These factors purportedly impacted the ability of vet-farmer pairs to have cooperative discussions and enter into shared decision-making. In order to enhance animal and human health and welfare, these relationship factors might be key to the development of sustainable optimisation frameworks.

The use of theories, models, and frameworks to inform the uptake of evidence-based practices in veterinary medicine - a scoping review

Evidence-based practices (EBPs) provide strategies to improve the health, welfare and productivity of animal species. However, ensuring implementation and uptake into routine practice of these EBPs is often challenging. In human health research, one approach used to improve uptake of EBPs is the use of theories, models and/or frameworks (TMFs), however the extent of the use of this approach in veterinary medicine is unknown. The aim of this scoping review was to identify existing veterinary uses of TMFs to inform the uptake of EBPs, and to understand the focus of these applications. Searches were conducted in CAB Abstracts, MEDLINE, Embase and Scopus, alongside grey literature, and ProQuest Dissertations & Theses. The search strategy consisted of a list of known existing TMFs that have been used to improve uptake of EBPs in human health, alongside more generic terminology for implementation and terminology relevant to veterinary medicine. Peer reviewed journal articles and grey literature detailing the use of a TMF to inform uptake of EBP(s) in a veterinary context were included. The search identified 68 studies that met the eligibility criteria. Included studies represented a diverse spread of countries, areas of veterinary concern and EBP. A range of 28 different TMFs were used, although the Theory of Planned Behaviour (TPB) predominated, featuring in 46% of included studies (n = 31). The majority of studies (n = 65, 96%) utilised a TMF with the aim to understand and/or explain what influences implementation outcomes. Only 8 studies (12%) reported the use of a TMF alongside/in conjunction with the actual implementation of an intervention. It is clear there has been some use to date of TMFs to inform uptake of EBPs in veterinary medicine, however it has been sporadic. There has been a heavy reliance on usage of the TPB and other similar classic theories. This has typically been to inform the understanding of factors, such as barriers and facilitators, that may influence the outcome of an implementation effort without then applying this knowledge to the actual implementation of an intervention. Furthermore, there has been a lack of acknowledgement of wider contextual factors and consideration of sustainability of interventions. There is clear potential to increase and expand the usage of TMFs to improve uptake of EBPs in veterinary medicine, including utilising a wider range of TMFs and developing interdisciplinary collaborations with human implementation experts.

Assessment of a joint farmer-veterinarian discussion about biosecurity using novel social interaction analyses

Veterinarians are trusted by farmers and play an important role in assisting them to implement biosecurity. More research is needed that particularly focuses on the impact of joint farmer-veterinarian discussions to further understand the role of communication in altering biosecurity behaviours. The aim of this study was to analyse joint dairy cattle farmer-veterinarian discussions about the adoption of on-farm biosecurity using novel social interaction methodologies. Farmer and veterinarian stakeholders were invited to take part in a face-to-face meeting. Introductory presentations were given, followed by separate facilitated veterinarian and farmer discussions. All stakeholders were brought together for a final facilitated group discussion which was audio recorded. Corresponding transcripts from the recordings were analysed via thematic and conversation analyses. Conversation analysis assessments such as turn taking, repair, sequence organisation, overlap and asymmetry were employed to investigate the nature of the conversation. Thematic analysis identified the negative repercussions of conflicting information or ineffective communication surrounding biosecurity implementation. The type of, and importance of, the relationship farmers had with veterinarians and other stakeholders was highlighted. The need to provide personalised biosecurity protocols on farms was identified. Four key factors were identified via conversation analyses. These included: 1) how the conversation facilitated agreement, 2) how the conversation allowed the farmer and veterinarian participants to learn from one another in real time, 3) how the discussion enabled participants to expand upon points they were making, and 4) how participants were able to obtain a greater understanding of the other participants' opinions, even without total resolution. Debate around the effective implementation of biosecurity measures on farms, explored using novel techniques, demonstrated the potential for utilising a discussive approach between veterinarians and farmers to lead to solutions not previously considered. Because of the nature of the discussion, conversation analysis resulted in an informative approach to encapsulating the nuanced dialogue between stakeholders, highlighting the potential of this analysis framework.

Implementation of biosecurity on equestrian premises: A narrative overview

Biosecurity measures are designed to prevent the introduction and spread of pathogens, and play a vital role in the equine industry, controlling endemic diseases and reducing the threat of exotic disease incursion. Equestrian premises differ with respect to disease risks, biosecurity requirements and available facilities. This narrative review summarises reported frequency of implementation for selected biosecurity measures, as well as evidence relating to potential barriers to implementation of biosecurity on equestrian premises. Possible opportunities for improvement in the adoption of equine biosecurity measures are also discussed.

Levels of Evidence, Quality Assessment, and Risk of Bias: Evaluating the Internal Validity of Primary Research

Clinical decisions in human and veterinary medicine should be based on the best available evidence. The results of primary research are an important component of that evidence base. Regardless of whether assessing studies for clinical case management, developing clinical practice guidelines, or performing systematic reviews, evidence from primary research should be evaluated for internal validity i.e., whether the results are free from bias (reflect the truth). Three broad approaches to evaluating internal validity are available: evaluating the potential for bias in a body of literature based on the study designs employed (levels of evidence), evaluating whether key study design features associated with the potential for bias were employed (quality assessment), and applying a judgement as to whether design elements of a study were likely to result in biased results given the specific context of the study (risk of bias assessment). The level of evidence framework for assessing internal validity assumes that internal validity can be determined based on the study design alone, and thus makes the strongest assumptions. Risk of bias assessments involve an evaluation of the potential for bias in the context of a specific study, and thus involve the least assumptions about internal validity. Quality assessment sits somewhere between the assumptions of these two. Because risk of bias assessment involves the least assumptions, this approach should be used to assess internal validity where possible. However, risk of bias instruments are not available for all study designs, some clinical questions may be addressed using multiple study designs, and some instruments that include an evaluation of internal validity also include additional components (e.g., evaluation of comprehensiveness of reporting, assessments of feasibility or an evaluation of external validity). Therefore, it may be necessary to embed questions related to risk of bias within existing quality assessment instruments. In this article, we overview the approaches to evaluating internal validity, highlight the current complexities, and propose ideas for approaching assessments of internal validity.

Welfare indicators for stunning versus non-stunning slaughter in sheep and cattle: A scoping review

BACKGROUND

While most cattle and sheep in the United Kingdom are stunned before slaughter, non-stun methods are permitted to supply meat to specific consumers. This study aimed to identify the existing literature that compared animal welfare indicators during stun and non-stun slaughter, using a scoping review framework.

METHOD

Following a structured search strategy, including the establishment of a PICO (population, intervention, comparator and outcomes) question, a comprehensive literature search of the CAB Abstracts, MEDLINE and PubMed databases, was conducted. A total of 962 papers were identified, of which 16 were selected for data extraction.

RESULTS

Fourteen papers concluded that welfare at slaughter was negatively impacted at non-stun slaughter in comparison to stun slaughter; two papers were inconclusive. Welfare indicators identified included biochemical parameters, brain activity and visual signs of consciousness. Limitations regarding inconsistent restraint method, neck cut position and non-standardised measures of welfare at slaughter are highlighted.

CONCLUSIONS

This study provides further evidence that stunning is an effective method to improve the welfare of sheep and cattle at slaughter. Animal welfare advisors, politicians, religious communities and others interested in animal welfare could use the findings to further discuss and establish new dialogues for producing updated guidance on animal welfare at slaughter.

Youngstock Management as “The Key for Everything”? Perceived Value of Calves and the Role of Calf Performance Monitoring and Advice on Dairy Farms

Replacement heifers are key to the future milking herd and farm economic efficiency but are not always prioritised on dairy farms. Dairy enterprises are comprised of components which compete for limited resources; scarce information about calf performance and the associated losses and (potential) gains on farms can mean calves are prioritised less in management and investment decisions. The research reported in this paper explored the personal and contextual factors that influence calf management decisions on dairy farms. Forty in-depth, semi-structured interviews were conducted with dairy farmers (26 interviews) and farm advisors (14 interviews) who were recruited using purposive and “snowball” sampling. Interviews were recorded, transcribed, and thematically analysed. Six major themes were constructed from the interview data relating to: the perceived importance of youngstock management, the role and influence of calf rearers, calf performance monitoring, farmer engagement with information and advice, the quality of communication and advice, and veterinary involvement in calf rearing. Results indicated that although the wider dairy industry has promoted the importance of youngstock, calves often have not been fully integrated into the whole dairy farm system, nor culturally accepted as an integral part of the productive herd. Calves tended to be marginalised on farms, largely due to limited resources, lack of data monitoring, and their unrecognised potential, as well as social norms and scarcity of support structures impacting upon farm investment and management decisions. Many calf rearers were disappointed by the repetition and impractical nature of information in print media. Most farmers did not routinely consult their veterinarian about their calves, rather following a reactive treatment model even when a preventive herd health strategy was applied to the adult herd. Advisory structures often require a driven individual with calf-centric interest to prevent calves from being overlooked. Furthermore, advisory efforts often failed to motivate farmers to act on advice. These findings indicate the need for greater focus on how to achieve rearing targets by provision of technical and support structures to foster action toward improved calf wellbeing, and for the status of calves to be raised in line with their vital importance for the future dairy herd.

Biosecurity and the ornamental fish trade: A stakeholder perspective in England

The freshwater and marine ornamental fish industry is a primary route of hazard introduction and emergence, including aquatic animal diseases and non-native species. Prevention measures are key to reducing the risk of hazard incursion and establishment, but there is currently little understanding of the biosecurity practices and hazard responses implemented at post-border stages of the ornamental fish supply chain. This study addresses this knowledge gap, using questionnaires to collate information on actual biosecurity behaviours and hazard responses practised by ornamental fish retailers and hobbyist communities in England. Actual behaviours varied considerably within retailers and hobbyists, suggesting that reliance on preventative practices by individuals in the post-border stages of the ornamental fish supply chain is likely to be ineffective in minimizing the risk of hazard incursion and establishment. Resources should be allocated towards improving and enforcing robust pre- and at-border control measures, such as risk-based surveillance of ornamental fish imports at border controls. In addition, these findings should be used to implement targeted awareness-raising campaigns and help create directed training on biosecurity practices for individuals involved in the post-border stages of the ornamental supply chain.

Re-parameterisation of a mathematical model of African horse sickness virus using data from a systematic literature search

African horse sickness (AHS) is a vector‐borne disease transmitted by Culicoides spp., endemic to sub‐Saharan Africa. There have been many examples of historic and recent outbreaks in the Middle East, Asia and Europe. However, not much is known about infection dynamics and outbreak potential in these naive populations. In order to better inform a previously published ordinary differential equation model, we performed a systematic literature search to identify studies documenting experimental infection of naive (control) equids in vaccination trials. Data on the time until the onset of viraemia, clinical signs and death after experimental infection of a naive equid and duration of viraemia were extracted. The time to viraemia was 4.6 days and the time to clinical signs was 4.9 days, longer than the previously estimated latent period of 3.7 days. The infectious periods of animals that died/were euthanized or survived were found to be 3.9 and 8.7 days, whereas previous estimations were 4.4 and 6 days, respectively. The case fatality was also found to be higher than previous estimations. The updated parameter values (along with other more recently published estimates from literature) resulted in an increase in the number of host deaths, decrease in the duration of the outbreak and greater prevalence in vectors.

Developing consensus for definitions of key veterinary-specific quality improvement (QI) terms using an eDelphi-study method

BACKGROUND

Quality improvement (QI) methods are a continuous process of iterative tests to improve the quality of a service or product. Using common language has been linked to the successful implementation of QI in human healthcare. This study aimed to assimilate and achieve consensus on veterinary-specific definitions for terms associated with quality care and QI methods in UK veterinary practice.

METHODS

A four-round modified eDelphi process with a panel of 50 UK veterinary practice stakeholders was used to generate consensus. The panel selected or suggested the definition they best felt 'fitted' each term. Consensus was reached if there was >70% agreement, and terms were eliminated if there was <15% selection.

RESULTS

Thirty-one panellists completed all three rounds of eDelphi; eight participants completed an optional feedback round. From 14 terms, 10 reached consensus, leaving four unresolved definitions.

CONCLUSIONS

A majority of terms reached consensus; 90% were new or amended definitions proposed by panel members. Utilising plain English refined by stakeholders will allow successful implementation of QI in veterinary healthcare. Not all terms achieved consensus, highlighting a need for further research to enable successful integration of QI principles as seen in human healthcare.

Stakeholder Perceptions of Disease Management for Dairy Calves: "It's Just Little Things That Make Such a Big Difference"

Calf morbidity and mortality rates are often high in dairy herds, raising animal welfare concerns and negatively affecting farm economic efficiency and future performance. Disease prevention is critical to maintain calves in good health, but interventions are dependent upon the persons conducting them. This paper explores the perceptions of farmers, farm workers, veterinarians, and other advisors on the management of calfhood disease on dairy farms in England. Participants were recruited using purposive and "snowball" sampling, resulting in 40 in-depth, semi-structured interviews-26 with dairy farmers and 14 with advisors. Interviews were recorded, transcribed, and thematically coded. Three major themes were derived on the basis of interview data: disease occurrence and treatments, management of calf environment, and the role of stockmanship and perceived control. Respiratory and gastrointestinal diseases in calves were those reported to be most problematic on dairy farms. Limited time and financial resources caused some farmers and advisors to experience a perceived inability to control calf health without antimicrobial treatments. Overall, the findings emphasise the importance of human influences on calf health and disease in the context of influencing the interactions among the host, pathogens, and the environment. Further research should investigate what "attention to detail" means within different farm contexts and practices, as this was believed to be important in the promotion of better husbandry standards and health. We recommend the use of supportive knowledge exchange processes, including facilitation, to empower farmers to promote continuous improvement in calf health.

Priorities for Research into the Impact of Canine Surgical Sterilisation Programmes for Free-Roaming Dogs: An International Priority Setting Partnership

Surgical sterilisation is a core activity of free-roaming dog population management (DPM) programmes globally. However, there is limited published evidence on its impact at the population level. To support evidence-based decision making in this field, it is important that research conducted is relevant to those involved in working with free-roaming dogs and implementing such programmes. The aim of this study was to adapt the James Lind Alliance (JLA) user involvement approach to systematically identify the top 10 research priorities regarding the impact of canine sterilisation. International stakeholders with experience working in DPM were asked in an online survey what unanswered questions they had regarding the impact of sterilisation programmes. Thematic analysis of survey responses was used to develop a long list of collated indicative research questions (CIRQs). A literature review was performed to identify questions that were 'true uncertainties' (had not been answered by evidence review). These questions were reduced to a shortlist via an online interim prioritisation survey, and a Delphi consensus process determined the top 10 priorities. The top 10 questions related to dog population size and turnover, dog bite incidents, rabies control, implementation in the field and human behaviour change. These priorities were identified and shaped by people with direct experience of canine surgical sterilisation programmes, and as such are an essential resource for directing future funding and research. Addressing these priorities will generate evidence that is directly applicable to policy makers and practitioners who make decisions regarding the management of free-roaming dogs (FRDs) worldwide.

What outcomes should be measured in feline chronic kidney disease treatment trials? Establishing a core outcome set for research

Chronic Kidney Disease (CKD) is an important cause of feline morbidity and mortality. There is currently no agreement on which outcomes are most important in CKD treatment trials to assist evidence-based decision making. Core Outcome Sets (COSs) originated in human healthcare and are an agreed set of outcomes to be measured and reported as a minimum in any trial conducted relating to a particular disease. To establish a COS for feline CKD, this study used a systematic review and two consensus methodologies (an electronic Delphi (eDelphi), and an in-person consensus meeting), with an international panel of key stakeholders. The systematic review identified 104 unique published parameters, which were rated by panellists in round 1 of the eDelphi. Panellists were also asked to suggest additional parameters. In round 2 these additional parameters were rated and any parameters not understood by >10 % of panellists in round 1 were redefined and re-rated. Parameters reaching consensus in rounds 1 and 2 were removed from round 3, when all remaining parameters were re-rated by panellists who could view their own previous rating alongside the median rating of the whole panel. To reach inclusion in the COS, parameters had to be rated 8 or 9 on a Likert scale of 1-9 (where 1 was not important and 9 was very important) by more than 80 % of panellists. In the consensus meeting, panellists discussed and re-rated borderline parameters and streamlined the final COS. Borderline parameters were those that had been closest to, but not achieved, the 80 % threshold for inclusion. The eDelphi panel (n = 73) rated 24/104 parameters highly enough for inclusion and proposed an additional 20 parameters, of which 3 reached the inclusion threshold. This totalled 27 parameters for inclusion. The consensus meeting panel (n = 16) rated an additional 6/20 borderline parameters highly enough for inclusion. During the streamlining process, 4 parameters were removed as one was considered not an outcome, and three were already addressed by other parameters. The remaining COS totalled 29 parameters. These were grouped into 9 core themes: clinical examination, quality of life, serum biochemistry, complete blood count, urinalysis, total amount of food eaten, CKD progression, survival time and cause of death. This is the first COS for feline medicine. In future treatment efficacy trials the COS will strengthen the evidence-base for this condition, by facilitating easier comparison of results between studies, and reduce research waste.

Cattle farmers' perception of biosecurity measures and the main predictors of behaviour change: The first European-wide pilot study

The importance of biosecurity as a strategy to prevent and control infectious diseases has increased substantially over the last few decades. Several studies have reported a low implementation level of biosecurity measures (BSM), particularly in cattle farms. In addition, a recent study demonstrated that cattle farmers are well aware of the recommended BSM and recognize them as more effective (in terms of time and costs) than treatment for disease. Therefore, other factors must be considered when it comes to understanding the decision-making process followed by a farmer regarding the adoption of BSM. This study analysed the possible influence of five mental constructs described in the health belief model (HBM) on the adoption of BSM and assessed the possible association of these constructs with different demographic and socio-psychological factors. Through an online survey, 988 questionnaires were completed by cattle farmers originating from Belgium, France, Germany, Spain and the Netherlands. The study revealed that the actual implementation of the BSM seems to be significantly influenced by the farmers' perception of the measures' benefits and the perception of health responsibility. Both constructs are influenced by the farmers' personality in terms of risk aversion and biosecurity knowledge. It was also found that organic farmers had a significantly lower perception of the BSM benefits and of their responsibility towards animal, public and environmental health when compared with other types of farmer. Organic farmers in this study seemed less likely to implement biosecurity measures. To increase the adoption of BSM by cattle farmers, it is therefore important to emphasise the actual evidence-based benefits of the measures and to investigate further how to strengthen cattle farmers' sense of responsibility towards animal, public and environmental health.

Evaluating the role of surgical sterilisation in canine rabies control: A systematic review of impact and outcomes

Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB Abstracts, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

Critically Appraised Topics (CATs) in Veterinary Medicine: Applying Evidence in Clinical Practice

Critically appraised topics (CATs) are evidence syntheses that provide veterinary professionals with information to rapidly address clinical questions and support the practice of evidence-based veterinary medicine (EBVM). They also have an important role to play in both undergraduate and post-registration education of veterinary professionals, in research and knowledge gap identification, literature scoping, preparing research grants and informing policy. CATs are not without limitations, the primary one relating to the rapid approach used which may lead to selection bias or restrict information identified or retrieved. Furthermore, the narrow focus of CATs may limit applicability of the evidence findings beyond a specific clinical scenario, and infrequently updated CATs may become redundant. Despite these limitations, CATs are fundamental to EBVM in the veterinary profession. Using the example of a dog with osteoarthritis, the five steps involved in creating and applying a CAT to clinical practice are outlined, with an emphasis on clinical relevance and practicalities. Finally, potential future developments for CATs and their role in EBVM, and the education of veterinary professionals are discussed. This review is focused on critically appraised topics (CATs) as a form of evidence synthesis in veterinary medicine. It aims to be a primary guide for veterinarians, from students to clinicians, and for veterinary nurses and technicians (hereafter collectively called veterinary professionals). Additionally, this review provides further information for those with some experience of CATs who would like to better understand the historic context and process, including further detail on more advanced concepts. This more detailed information will appear in pop-out boxes with a double-lined surround to distinguish it from the information core to producing and interpreting CATs, and from the boxes with a single line surround which contain additional resources relevant to the different parts of the review.

Appropriate Dairy Calf Feeding from Birth to Weaning: "It's an Investment for the Future"

Dairy calves must be fed appropriately to meet their nutritional needs, supporting optimal growth and development to achieve the recommended target age at first calving (AFC) of 24 months. Traditional restricted milk feeding practices suppress growth, contribute to negative welfare states and may result in malnutrition and immunosuppression. Despite more recent recommendations to increase milk allowances for pre-weaned calves, restricted feeding remains a common practice. This study explored the rationales behind the calf feeding protocols used by dairy farmers in England. Forty qualitative interviews (26 farmers, 14 advisors) were conducted between May 2016 and June 2017, transcribed in full, then coded into themes. Results indicate that a variety of calf feeding regimes are used on farms, largely determined by farmers' attitudes regarding ease of management and the wellbeing of calves. Advisors were concerned about widespread underfeeding of calves, which may be partially due to insufficiently clear recommendations for calf milk replacer (CMR) feeding rates. There was also evidence of uncertainty regarding best practices for weaning calves. Collaboration between academic research and industry is essential to establish a consensus on calf feeding standards which support physiological function, facilitate weaning, support growth targets and ensure calf health and welfare is protected.

Giving calves 'the best start': Perceptions of colostrum management on dairy farms in England

Good colostrum management can confer protective immunity to newborn calves, making calves less susceptible to infectious disease, and fundamentally improving both their short- and long-term health, welfare and productivity. Industry recommendations commonly refer to 'The Three 'Q's' of colostrum management: the need for calves to receive sufficient 'Quantity' of high 'Quality' colostrum 'Quickly' after birth; some also include 'sQueaky clean' and 'Quantification of passive transfer'. However, research to date suggests that the failure of passive transfer of colostral antibodies is common on commercial dairy farms, contributing to sub-optimal calf health and mortality. This paper explores why this may be the case by investigating stakeholder perceptions of colostrum management and how these perceptions might affect the practice of ensuring adequate colostrum administration to newborn calves. Calf rearing and youngstock management practices on English dairy farms were investigated using 40 in-depth semi-structured interviews: 26 with dairy farmers and 14 with advisors (including veterinarians, feed and pharmaceutical company representatives). Interviews were audio-recorded, transcribed and thematically coded for analysis. 'The Three 'Q's' were found to act as useful reminders about the goals of colostrum management, and a case can be made for further publicising the inclusion of 'sQueaky clean' and 'Quantification of passive transfer' as there remains a lack of focus on colostrum hygiene and measurement of successful antibody transfer. Knowledge of the 'Q's' did not guarantee implementation, and time and labour constraints alongside farmer misconceptions must be addressed when offering professional advice on improving calf health. Further research to encourage on-farm collection and analysis of monitoring data including rates of passive transfer is particularly needed. Advisors must not overlook the importance of colostrum management when assessing farm practices and ensure that they promote evidence-based recommendations if dairy calf morbidity and mortality is to be reduced.

A Cross-Sectional Study of Experiences and Attitudes towards Clinical Audit of Farm Animal Veterinary Surgeons in the United Kingdom

Clinical audit is a quality improvement tool used to assess and improve the clinical services provided to patients. This is the first study to investigate the extent to which clinical audit is understood and utilised in farm animal veterinary practice. A cross-sectional study to collect experiences and attitudes of farm animal veterinary surgeons in the UK towards clinical audit was conducted using an online nationwide survey. The survey revealed that whilst just under three-quarters (n = 237/325; 73%) of responding veterinary surgeons had heard of clinical audit, nearly 50% (n = 148/301) had never been involved in a clinical audit of any species. The participants’ knowledge of what a clinical audit was varied substantially, with many respondents reporting not receiving training on clinical audit at the undergraduate or postgraduate level. Respondents that had participated in a clinical audit suggested that protected time away from clinical work was required for the process to be completed successfully. This novel study suggests that clinical audit is undertaken to some extent in farm animal practice and that practitioner perception is that it can bring benefits, but was felt that more resources and support were needed for it to be implemented successfully on a wider scale.

An Evidence-Based Rapid Review of Surgical Techniques for Correction of Prolapsed Nictitans Glands in Dogs

Prolapsed nictitans gland (PNG) is an important ocular condition of dogs. Various surgical interventions have been described, but effective technique is currently considered to be a matter of personal clinician preference. The aim of this rapid review was to evaluate existing peer-reviewed evidence of effectiveness for surgical techniques and their subsequent effects on quantitative and clinical lacrimal outcomes for PNG. We performed a structured bibliographic search of CAB Abstracts, PubMed, and Medline using terms relevant to dogs, nictitans gland, and surgery on 13 September 2017. Included studies were assessed for study design, reporting characteristics, surgical techniques, and surgical and lacrimal outcomes. Fifteen of three hundred fifteen identified studies were eligible for inclusion. Seven different replacement techniques were identified, along with gland excision. All studies were observational or descriptive, with the exception of a single crossover trial. Outcomes reporting was heterogeneous and provided limited detail on lacrimal outcomes or on breed propensity for recurrence. Insufficient data precluded comparison of techniques for either surgical failure rates or lacrimal outcomes, although proportional meta-analysis yielded an overall failure rate of 3% (95% CI 1–7%) for the Morgan’s pocket procedure. Improved reporting of veterinary surgical studies will improve evidence appraisal and synthesis, as well as reduce potential sources of bias.

Measuring the success of canine and feline preventative healthcare consultations: A systematic review

Preventative healthcare consultations account for a large proportion of the veterinary caseload. This novel study is the first to methodically review all literature on canine and feline preventative healthcare consultations. Previous research has found these consultations to be different from health problem consultations in terms of communication style and content. Identifying relevant evidence and previously validated methods of measuring the success of these consultations will be useful when implementing strategies for optimisation. The aim of this study was to identify and assess the quality of existing literature which describes and/or measures the success of preventative healthcare consultations. Database searches of CAB Abstracts and Medline were conducted to identify published literature. Google searches were then conducted to identify any additional published or grey literature. Results were systematically screened to determine whether the returned sources were about cats and/or dogs, whether they related to preventative healthcare, and whether they described and/or measured the success of preventative healthcare consultations. For primary research citations which only described preventative healthcare consultations, data were extracted on the aspects of the consultations described. For citations which additionally measured the success of the consultations, the measures used, sampling technique, key results and key weaknesses were also extracted. Of 17,538 citations identified in total during the database searches, a total of seven relevant primary research citations were identified. All of these citations described aspects of the preventative healthcare consultation, such as consultation length, health problems discussed, actions taken and communication style. Only one primary research citation measured success of the consultation, using veterinarian satisfaction to determine success. In addition, 30 narrative citations, including expert opinion pieces, textbooks, guidelines without transparent methodology and conference presentations were identified. Google searches identified 224 relevant narrative citations, and five of the seven primary research citations identified by the database searches, but did not identify any additional relevant primary research citations. The results suggest that, despite accounting for around a third of all consultations, there is relatively little evidence describing preventative healthcare consultations and only one measure of success has been described for these consultations. This presents potential challenges when implementing strategies to optimise these consultations, as measures which are useful and relevant to veterinary practice should first be identified. Identifying useful measures of success will allow future strategies designed to maximise the benefits of these consultations to be meaningfully assessed for efficacy.

Key actors in driving behavioural change in relation to on-farm biosecurity; a Northern Ireland perspective

Background

Agriculture and farming are valued contributors to local economy in Northern Ireland (NI). There is limited knowledge about farmers’ behaviours and attitudes towards disease biosecurity measures. As part of a larger project, a scenario-based workshop with key stakeholders was organised by the Agri-Food and Biosciences Institute (AFBI)-NI in December 2015.

Results

A total of 22 participants belonging to 12 different institutions took part in the workshop. Participants were presented with an overview of previously conducted biosecurity research in NI and England. In small groups, participants were subsequently asked to discuss and give their opinions about a series of questions across four key areas in a semi-structured approach with an external facilitator. The key areas were 1- disease risk perception at the farm level; 2-perceived barriers to implementing on farm biosecurity measures; 3- avenues to successful behaviour change and 4-key industry responsibilities and roles. The discussion showed that training in biosecurity for farmers is important and necessary. Training was recommended to be provided by veterinary surgeons, preferably via a face-to-face format. The discussion addressing disease disclosure proved particularly challenging between those who were prospective buyers of cattle, and those who sold cattle.

Conclusions

This workshop provided a unique and invaluable insight into key issues regarding farm level biosecurity activities. From a policy perspective, delivering improved on-farm biosecurity must be addressed via a multidisciplinary approach. This can only be achieved with active involvement, commitment and support of a number of key industry and government stakeholders.

Electronic supplementary material

The online version of this article (10.1186/s13620-018-0125-1) contains supplementary material, which is available to authorized users.

Motivators and barriers for dog and cat owners and veterinary surgeons in the United Kingdom to using preventative medicines

Routine use of preventative medicines is advocated as part of responsible dog and cat ownership. However, it has been suggested that the number of owners in the United Kingdom (UK) using preventative medicines to protect their pets is in decline. The aim of this novel study was to use a qualitative methodology to explore the attitudes of pet owners and veterinary surgeons in the UK to using preventative medicine products in dogs and cats. Preventative medicine was defined as "a drug or any other preparation used to prevent disease, illness or injury." Semi-structured interviews were conducted by telephone with owners and veterinary surgeons who had recently participated in a preventative healthcare consultation. Thematic analysis of transcribed recordings of these interviews identified four themes. This paper reports the theme related to motivators and barriers to using preventative medicines. Owners' understanding varied widely about the importance of preventative medicines for pets, as did their confidence in the safety of prescription products. A good relationship with their veterinary surgeon or practice, seeing adverts on the television about specific diseases, advice from a breeder and having personally seen infected animals appeared to be motivators for owners to use preventative medicines. Concern about adverse events and uncertainty about the necessity of using preventative medicines were barriers. Owners who trusted their veterinary surgeons to advise them on preventative medicine products described little use of alternative information sources when making preventative medicine choices. However, owners who preferred to do their own research described reading online opinions, particular in relation to the safety of preventative medicines, which they found confusing. In contrast, veterinary surgeons described broad confidence in the safety and efficacy of prescription preventative medicines and described protection of pet health as a strong motivator for their use. Several expressed some concern about being seen to "sell" products, which may present a barrier to their advocacy. Veterinary surgeons were unsure about owners' level of understanding of the necessity of preventative medicines, particularly in relation to vaccinations, and few recalled instigating conversations with owners about product safety. Owner uncertainties about preventative medicine products may not be adequately addressed in the consulting room. This first qualitative study to investigate dog and cat preventative medicines suggests strategies are needed to increase discussion between pet owners and veterinary surgeons in the UK about the necessity, safety, efficacy and cost of preventative medicines.

Quantitative Outcomes of a One Health approach to Study Global Health Challenges

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.

"I Always Feel Like I Have to Rush…" Pet Owner and Small Animal Veterinary Surgeons' Reflections on Time during Preventative Healthcare Consultations in the United Kingdom

Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK). Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

Use of clinical vignette questionnaires to investigate the variation in management of keratoconjunctivitis sicca and acute glaucoma in dogs

There is little peer-reviewed research assessing therapeutic effectiveness in canine eye disease. Current treatments used in first opinion and ophthalmology referral practices are also somewhat poorly documented. The aim of this study was to investigate the current management of canine keratoconjunctivitis sicca (KCS) and acute primary angle-closure glaucoma (PACG) by veterinary surgeons. Questionnaires using clinical vignettes were administered to a cross section of general practitioners ('GPs') and veterinarians engaged in or training for postgraduate ophthalmology practice ('PGs'). Similar treatment recommendations for KCS (topical cyclosporine, lubricant, antibiotic) were given by both groups of veterinarians with the single exception of increased topical antibiotic use by GPs. Treatment of acute glaucoma diverged between groups: PGs were much more likely to recommend topical prostaglandin analogues and a wider array of both topical and systemic treatments were recommended by both groups. Systemic ocular hypotensive agents were suggested infrequently. Our results suggest that treatments may vary substantially in ocular conditions, particularly in conditions for which neither guidelines nor high-quality evidence exists. This study highlights the need for novel strategies to address evidence gaps in veterinary medicine, as well as for better evaluation and dissemination of current treatment experience.

Analysing the opinions of UK veterinarians on practice-based research using corpus linguistic and mathematical methods

The use of corpus linguistic techniques and other related mathematical analyses have rarely, if ever, been applied to qualitative data collected from the veterinary field. The aim of this study was to explore the use of a combination of corpus linguistic analyses and mathematical methods to investigate a free-text questionnaire dataset collected from 3796 UK veterinarians on evidence-based veterinary medicine, specifically, attitudes towards practice-based research (PBR) and improving the veterinary knowledge base. The corpus methods of key word, concordance and collocate analyses were used to identify patterns of meanings within the free text responses. Key words were determined by comparing the questionnaire data with a wordlist from the British National Corpus (representing general English text) using cross-tabs and log-likelihood comparisons to identify words that occur significantly more frequently in the questionnaire data. Concordance and collocation analyses were used to account for the contextual patterns in which such key words occurred, involving qualitative analysis and Mutual Information Analysis (MI3). Additionally, a mathematical topic modelling approach was used as a comparative analysis; words within the free text responses were grouped into topics based on their weight or importance within each response to find starting points for analysis of textual patterns. Results generated from using both qualitative and quantitative techniques identified that the perceived advantages of taking part in PBR centred on the themes of improving knowledge of both individuals and of the veterinary profession as a whole (illustrated by patterns around the words learning, improving, contributing). Time constraints (lack of time, time issues, time commitments) were the main concern of respondents in relation to taking part in PBR. Opinions of what vets could do to improve the veterinary knowledge base focussed on the collecting and sharing of information (record, report), particularly recording and discussing clinical cases (interesting cases), and undertaking relevant continuing professional development activities. The approach employed here demonstrated how corpus linguistics and mathematical methods can help to both identify and contextualise relevant linguistic patterns in the questionnaire responses. The results of the study inform those seeking to coordinate PBR initiatives about the motivators of veterinarians to participate in such initiatives and what concerns need to be addressed. The approach used in this study demonstrates a novel way of analysing textual data in veterinary research.

Veterinarian Nominated Common Conditions of Rabbits and Guinea Pigs Compared with Published Literature

Rabbits and guinea pigs are increasingly popular pets in the UK, yet little is known about their common ailments, or how these relate to what appears in the published literature. The aim of this study was to characterise the common conditions of rabbits and guinea pigs, and to compare these with the topics found in the published literature. Information about the common conditions seen in rabbits and guinea pigs in clinical practice was obtained from a survey of UK veterinarians. The common conditions seen were compared with results from a structured literature search. Conditions relating to the dental (29.9%), and skin (37.6%) body systems were commonly nominated by veterinarians for rabbits and guinea pigs, respectively. A total of 655 rabbit and 1086 guinea pig citations were examined and there appeared to be a mismatch between the conditions nominated in the veterinary questionnaire, and those found in the literature. This is the first time that the published literature has been compared to the nominated caseload of veterinarians in practice, and there is concern that the literature about rabbits and guinea pigs may not be representative of, or relevant to the caseload seen in clinical practice. This is of importance for clinicians being able to apply an objective, evidence-based approach. The publishing of clinically-relevant, research-based evidence should be prioritised.

Sample size and number of outcome measures of veterinary randomised controlled trials of pharmaceutical interventions funded by different sources, a cross-sectional study

Background

Randomised controlled trials (RCTs) are a key component of the veterinary evidence base. Sample sizes and defined outcome measures are crucial components of RCTs.

To describe the sample size and number of outcome measures of veterinary RCTs either funded by the pharmaceutical industry or not, published in 2011.

Methods

A structured search of PubMed identified RCTs examining the efficacy of pharmaceutical interventions. Number of outcome measures, number of animals enrolled per trial, whether a primary outcome was identified, and the presence of a sample size calculation were extracted from the RCTs. The source of funding was identified for each trial and groups compared on the above parameters.

Results

Literature searches returned 972 papers; 86 papers comprising 126 individual trials were analysed. The median number of outcomes per trial was 5.0; there were no significant differences across funding groups (p = 0.133). The median number of animals enrolled per trial was 30.0; this was similar across funding groups (p = 0.302). A primary outcome was identified in 40.5% of trials and was significantly more likely to be stated in trials funded by a pharmaceutical company. A very low percentage of trials reported a sample size calculation (14.3%).

Conclusions

Failure to report primary outcomes, justify sample sizes and the reporting of multiple outcome measures was a common feature in all of the clinical trials examined in this study. It is possible some of these factors may be affected by the source of funding of the studies, but the influence of funding needs to be explored with a larger number of trials. Some veterinary RCTs provide a weak evidence base and targeted strategies are required to improve the quality of veterinary RCTs to ensure there is reliable evidence on which to base clinical decisions.

Electronic supplementary material

The online version of this article (10.1186/s12917-017-1207-0) contains supplementary material, which is available to authorized users.

Sponsorship bias and quality of randomised controlled trials in veterinary medicine

BACKGROUND

Randomised controlled trials (RCTs) are considered the gold standard form of evidence for assessing treatment efficacy, but many factors can influence their reliability including methodological quality, reporting quality and funding source. The aim of this study was to examine the relationship between funding source and positive outcome reporting in veterinary RCTs published in 2011 and to assess the risk of bias in the RCTs identified.

METHODS

A structured search of PubMed was used to identify feline, canine, equine, bovine and ovine clinical trials examining the efficacy of pharmaceutical interventions published in 2011. Funding source and outcomes were extracted from each RCT and an assessment of risk of bias made using the Cochrane risk of bias tool.

RESULTS

Literature searches returned 972 papers, with 86 papers (comprising 126 individual RCTs) included in the analysis. There was found to be a significantly higher proportion of positive outcomes reported in the pharmaceutical funding group (P) compared to the non-pharmaceutical (NP) and 'no funding source stated' (NF) groups (P = 56.9%, NP = 34.9%, NF = 29.1%, p < 0.05). A high proportion of trials had an unclear risk of bias across the five criteria examined.

CONCLUSIONS

We found evidence that veterinary RCTs were more likely to report positive outcomes if they have pharmaceutical industry funding or involvement. Consistently poor reporting of trials, including non-identification of funding source, was found which hinders the use of the available evidence.

The Awareness of the International Veterinary Profession of Evidence-Based Veterinary Medicine and Preferred Methods of Training

Evidence-based veterinary medicine (EVM) is an evolving discipline in veterinary medicine so it is important to periodically “benchmark” opinion about EVM across the profession. An international survey to assess veterinarians’ awareness of EVM was conducted. Veterinarians were surveyed via an online questionnaire (all countries) or a postal questionnaire (UK only). Participants were asked whether they had heard of EVM, where they had first heard the term, and their preferences of method for receiving continuing professional development (CPD). There were 6310 respondents, of which 4579 (72.5%) worked in the UK and 5384 (85.3%) were clinicians. Veterinarians that had heard of EVM (n = 5420, 85.9%) were most likely to be clinicians (OR = 4.00; 95% CI: 3.37, 4.75), respondents working in the UK (OR = 1.32; CI: 1.13, 1.54), or respondents with a postgraduate degree or qualification (OR = 1.77; CI: 1.51, 2.08). The most common sources from which respondents had heard of EVM were at vet school or university (n = 1207, 29.8%), via literature (peer-reviewed papers or other publications) (n = 1074, 26.5%), and via CPD courses (n = 564, 13.9%). Most respondents were interested in finding out more about EVM (n = 4256 of 6173, 69%). The preferred methods of CPD were day or evening seminars (n = 2992 of 6017, 49.7%), conferences (n = 1409, 23.4%), and online courses (n = 524, 8.7%), although the order of preference differed slightly between groups. There appears to be substantial awareness of EVM amongst veterinarians internationally. However, it appears that further training in EVM would be welcomed. Preferences on how CPD in general is received differs between groups, so this should be borne in mind by training providers when formulating a strategy for the dissemination of EVM training across the global profession.

Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)

OBJECTIVES

The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool.

DESIGN

An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool.

RESULTS

An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users.

CONCLUSIONS

CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making.

A method for extracting electronic patient record data from practice management software systems used in veterinary practice

Background

Data extracted from electronic patient records (EPRs) within practice management software systems are increasingly used in veterinary research. The use of real patient data gives the potential to generate research that can readily be applied to clinical practice. The use of veterinary EPRs for research in the United Kingdom is hindered by the number of different Practice Management System (PMS) providers used by practices, as obtaining and combining data from different systems electronically can be problematic. The use of extensible mark up language (XML) to extract clinical data for research would potentially resolve the compatibility issues between systems. The aim of this study was to establish and validate a method for the extraction of small animal patient records from a veterinary PMS that could potentially be used across multiple systems. An XML schema was designed to extract clinical information from EPRs. The schema was tested and validated in a test system, and was then tested in a real small animal practice where data was extracted for 16 weeks. A 10 % sample of the extracted records was then compared to paper copies provided by the practice.

Results

All 21 fields encoded by the XML schema, from all of the records in the test system, were extracted with 100 % accuracy. Over the 18 week data collection period 4946 records, from 1279 patients, were extracted from the small animal practice. The 10 % printed records checked and compared with the XML extracted records demonstrated all required data was present. No unrequired, sensitive information e.g. costs or services/products or personal client information was extracted.

Conclusions

This is the first time a method for data extraction from EPRs in veterinary practice using an XML schema has been reported in the United Kingdom. This is an efficient and accurate way of extracting data which could be applied to all PMSs nationally and internationally.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-016-0861-y) contains supplementary material, which is available to authorized users.

Exploring Attitudes and Beliefs towards Implementing Cattle Disease Prevention and Control Measures: A Qualitative Study with Dairy Farmers in Great Britain

Simple Summary

Further understanding of why dairy farmers do not engage in disease prevention and control strategies (biosecurity) is required. Using semi-structured interviews informed by a health psychology approach with 25 dairy farmers, a number of barriers, such as disease testing inaccuracies, types of disease transmission, perceived lack of risk and effectiveness of measures, were identified. Motivators included being advised to undertake measures by veterinarians, and the increased threat and severity of the disease in focus. These results suggest there is an advantage to farm advisors and herd health professionals understanding and working with the beliefs of individual dairy farmers to target appropriate communication and advice strategies relating to biosecurity recommendations.

Abstract

Disease prevention and control practices are frequently highlighted as important to ensure the health and welfare of farmed animals, although little is known as to why not many practices are carried out. The aim of this study was to identify the motivators and barriers of dairy cattle farmers towards the use of biosecurity measures on dairy farms using a health psychology approach. Twenty-five farmers on 24 farms in Great Britain (GB) were interviewed using the Theory of Planned Behaviour framework. Results indicated that farmers perceived they had the ability to control what happened on their farms in terms of preventing and controlling disease, and described benefits from being proactive and vigilant. However, barriers were cited in relation to testing inaccuracies, effectiveness and time-efficiency of practices, and disease transmission route (e.g., airborne transmission). Farmers reported they were positively influenced by veterinarians and negatively influenced by the government (Department for Environment Food & Rural Affairs (DEFRA)) and the general public. Decisions to implement practices were influenced by the perceived severity of the disease in question, if disease was diagnosed on the farm already, or was occurring on other farms. Farmers described undertaking a form of personal risk assessment when deciding if practices were worth doing, which did not always involve building in disease specific factors or opinions from veterinarians or other advisors. These results indicate that further guidance about the intricacies of control and prevention principles in relation to specific animal diseases may be required, with an obvious role for veterinarians. There appears to be an opportunity for farm advisors and herd health professionals to further understand farmer beliefs behind certain attitudes and target communication and advice accordingly to further enhance dairy cattle health and welfare.

International Evidence-Based Medicine Survey of the Veterinary Profession: Information Sources Used by Veterinarians

Veterinarians are encouraged to use evidence to inform their practice, but it is unknown what resources (e.g. journals, electronic sources) are accessed by them globally. Understanding the key places veterinarians seek information can inform where new clinically relevant evidence should most effectively be placed. An international survey was conducted to gain understanding of how veterinary information is accessed by veterinarians worldwide. There were 2137 useable responses to the questionnaire from veterinarians in 78 countries. The majority of respondents (n = 1835/2137, 85.9%) undertook clinical work and worked in a high income country (n = 1576/1762, 89.4%). Respondents heard about the survey via national veterinary organisations or regulatory bodies (31.5%), online veterinary forums and websites (22.7%), regional, discipline-based or international veterinary organisations (22.7%) or by direct invitation from the researchers or via friends, colleagues or social media (7.6%). Clinicians and non-clinicians reportedly used journals most commonly (65.8%, n = 1207/1835; 75.6%, n = 216/286) followed by electronic resources (58.7%, n = 1077/1835; 55.9%, n = 160/286), respectively. Respondents listed a total of 518 journals and 567 electronic sources that they read. Differences in veterinarian preference for resources in developed, and developing countries, were found. The nominated journals most read were the Journal of the American Veterinary Medical Association (12.7% of nominations) for clinicians and the Veterinary Record (5.7%) for non-clinicians. The most accessed electronic resource reported was the Veterinary Information Network (25.6%) for clinicians and PubMed (7.4%) for non-clinicians. In conclusion, a wide array of journals and electronic resources appear to be accessed by veterinarians worldwide. Veterinary organisations appear to play an important role in global communication and outreach to veterinarians and consideration should be given to how these channels could be best utilised for effective dissemination of key research findings.

Factors influencing common diagnoses made during first-opinion small-animal consultations in the United Kingdom

It is currently unclear how frequently a diagnosis is made during small-animal consultations or how much of a role making a diagnosis plays in veterinary decision-making. Understanding more about the diagnostic process will help direct future research towards areas relevant to practicing veterinary surgeons. The aim of this study was to determine the frequency with which a diagnosis was made, classify the types of diagnosis made (and the factors influencing these) and determine which specific diagnoses were made for health problems discussed during small-animal consultations. Data were gathered during real-time direct observation of small-animal consultations in eight practices in the United Kingdom. Data collected included characteristics of the consultation (e.g. consultation type), patient (e.g. breed), and each problem discussed (e.g. new or pre-existing problem). Each problem discussed was classified into one of the following diagnosis types: definitive; working; presumed; open; previous. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3). Problems without a previous diagnosis, in cats and dogs only, were included in the model, which had a binary outcome variable of definitive diagnosis versus no definitive diagnosis. Data were recorded for 1901 animals presented, and data on diagnosis were gathered for 3192 health problems. Previous diagnoses were the most common diagnosis type (n=1116/3192; 35.0%), followed by open (n=868/3192; 27.2%) then definitive (n=660/3192; 20.7%). The variables remaining in the final model were patient age, problem history, consultation type, who raised the problem, and body system affected. New problems, problems in younger animals, and problems raised by the veterinary surgeon were more likely to result in a definitive diagnosis than pre-existing problems, problems in older animals, and problems raised by the owner. The most common diagnoses made were overweight/obese and periodontal disease (both n=210; 6.6%). Definitive diagnoses are rarely made during small-animal consultations, with much of the veterinary caseload involving management of ongoing problems or making decisions around new problems prior to a diagnosis being made. This needs to be taken into account when considering future research priorities, and it may be necessary to conduct research focused on the approach to common clinical presentations, rather than purely on the common diagnoses made. Examining how making a diagnosis affects the actions taken during the consultation may shed further light on the role of diagnosis in the clinical decision-making process.

Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation

Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations. Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation. A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n=1168; 64.6%) followed by cats (n=510; 28.2%), rabbits (n=86; 4.8%) and patients of other species (n=43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model. Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and acted upon during all types of consultations. Dental and behavioural non-presenting problems were discussed more frequently during preventive-medicine consultations compared with specific health-problem consultations. Preventive-medicine consultations represent an opportunity for veterinary surgeons to discuss other aspects of preventive medicine, and to detect and manage new and ongoing health problems. A greater evidence base is needed to understand whether detecting and managing underlying disease during the preventive-medicine consultation has a positive impact on lifelong patient health and welfare.

Farmers' perception of the role of veterinary surgeons in vaccination strategies on British dairy farms

There is limited research investigating the motivators and barriers to vaccinating dairy cattle. Veterinary surgeons have been identified as important sources of information for farmers making vaccination and disease control decisions, as well as being farmers’ preferred vaccine suppliers. Vets’ perception of their own role and communication style can be at odds with farmers’ reported preferences. The objective of this study was to investigate how dairy farmers perceived the role of vets in implementing vaccination strategies on their farm. Semi-structured interviews were conducted with 24 dairy farmers from across Britain. The data were analysed using thematic analysis. Analysis revealed that farmers perceive vets to have an important role in facilitating decision-making in all aspects of vaccination, including the aspects of vaccine distribution and advice on implementation. This important role is acknowledged by farmers who have regular veterinary contact, but also farmers with solely emergency veterinary contact. Given this finding, future work should investigate the attitudes of vets towards vaccination and how they perceive their role. Combining this knowledge will enable optimisation of vaccination strategies on British dairy farms.

Development of a framework for genotyping bovine-derived Cryptosporidium parvum, using a multilocus fragment typing tool

Background

There is a need for an integrated genotyping approach for C. parvum; no sufficiently discriminatory scheme to date has been fully validated or widely adopted by veterinary or public health researchers. Multilocus fragment typing (MLFT) can provide good differentiation and is relatively quick and cheap to perform. A MLFT tool was assessed in terms of its typeability, specificity, precision (repeatability and reproducibility), accuracy and ability to genotypically discriminate bovine-derived Cryptosporidium parvum.

Methods

With the aim of working towards a consensus, six markers were selected for inclusion based on their successful application in previous studies: MM5, MM18, MM19, TP14, MS1 and MS9. Alleles were assigned according to the fragment sizes of repeat regions amplified, as determined by capillary electrophoresis. In addition, a region of the GP60 gene was amplified and sequenced to determine gp60 subtype and this was added to the allelic profiles of the 6 markers to determine the multilocus genotype (MLG). The MLFT tool was applied to 140 C. parvum samples collected in two cross-sectional studies of UK calves, conducted in Cheshire in 2004 (principally dairy animals) and Aberdeenshire/Caithness in 2011 (beef animals).

Results

Typeability was 84 %. The primers did not amplify tested non-parvum species frequently detected in cattle. In terms of repeatability, within- and between-run fragment sizes showed little variability. Between laboratories, fragment sizes differed but allele calling was reproducible. The MLFT had good discriminatory ability (Simpson’s Index of Diversity, SID, was 0.92), compared to gp60 sequencing alone (SID 0.44). Some markers were more informative than others, with MS1 and MS9 proving monoallelic in tested samples.

Conclusions

Further inter-laboratory trials are now warranted with the inclusion of human-derived C. parvum samples, allowing progress towards an integrated, standardised typing scheme to enable source attribution and to determine the role of livestock in future outbreaks of human C. parvum.

Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015

REASONS FOR PERFORMING STUDY

Colic is the most common equine emergency problem, and one of the main causes of equid deaths. The horse owners' ability to recognise colic is a critical first step in determining case outcome.

OBJECTIVES

To assess equine owners' knowledge and recognition of colic.

STUDY DESIGN

Online questionnaire of horse owners.

METHODS

An online survey was designed to evaluate owners' approach to colic in the horse. The survey included questions on owner demographics, their recognition of colic (including owner's opinions of their ability to recognise colic, their approach, and their recognition of colic using case vignettes), and their knowledge of normal ranges for clinical parameters. Descriptive and chi squared statistical analysis was performed.

RESULTS

The survey was completed by 1061 UK respondents. Six per cent of owners thought they could recognise all types of colic, 61% said they could recognise most cases and 30% said they could recognise some but not all cases. Owners said they would assess faecal output (73% of respondents), gastrointestinal sounds (69%), respiratory rate (62%) and heart rate (50%) in horses with suspected colic. One fifth (22%) of owners would call a vet immediately without assessing any parameters. Many respondents either did not know, or provided incorrect estimates of normal values for clinical parameters: 30.4% were 'unsure' of the normal heart rate and 35.5% gave heart rate values which were outside reference ranges; only 24.5% gave appropriate values for normal respiratory rates and only 31% gave normal temperature values. There was no statistical significance between participants' age, educational qualifications, or their experience with horses and their knowledge of normal clinical parameters.

CONCLUSIONS

Owners varied in their approach and ability to recognise colic, and many had significant gaps in their knowledge of normal parameters. Educational materials and/or training to assist owners could help address these issues. Ethical animal research: The study did not involve animal research. The study was reviewed and approved by the Ethics Committee, School of Veterinary Medicine and Science, University of Nottingham. The questionnaire was conducted in accordance with the 1998 Data Protection Act, and the British Educational Research Association's Revised Ethical Guidelines for Educational Research (2004).

SOURCE OF FUNDING

Adelle Bowden's studentship is funded by the School of Veterinary Medicine and Science, University of Nottingham. Competing interests: None declared.

Survey of the UK veterinary profession 2: sources of information used by veterinarians

Access to the most up-to-date evidence is an important cornerstone for veterinarians attempting to practice in an evidence-based manner; therefore, an understanding of what and how information is accessed is vital. The aim of this study was to identify what resources the UK veterinary profession access and regard as most useful. Based on questionnaires received from veterinarians, the Veterinary Times was nominated as most often read journal or magazine by respondents (n=3572, 79 per cent). In Practice (n=3224, 82 per cent) and the Veterinary Record (n=165, 34 per cent) were seen as most useful by clinicians, and non-clinicians, respectively. Google was the most often nominated electronic resource by all respondents (n=3076, 71 per cent), with Google (n=459, 23 per cent) and PubMed (n=60, 17 per cent) seen as most useful by clinicians and non-clinicians, respectively. The abstract and conclusion sections were the most read parts of scientific manuscripts nominated by all respondents. When looking for assistance with difficult cases, colleagues were the common information choice for clinicians. Different sections of the veterinary profession access information, and deem resources useful, in different ways. Access to good quality evidence is important for the practice of evidence-based veterinary medicine, and therefore, researchers should think about disseminating their findings in a targeted way for optimal use by the profession.

Investigating common clinical presentations in first opinion small animal consultations using direct observation

Understanding more about the clinical presentations encountered in veterinary practice is vital in directing research towards areas relevant to practitioners. The aim of this study was to describe all problems discussed during a convenience sample of consultations using a direct observation method. A data collection tool was used to gather data by direct observation during small animal consultations at eight sentinel practices. Data were recorded for all presenting and non-presenting specific health problems discussed. A total of 1901 patients were presented with 3206 specific health problems discussed. Clinical presentation varied widely between species and between presenting and non-presenting problems. Skin lump, vomiting and inappetence were the most common clinical signs reported by the owner while overweight/obese, dental tartar and skin lump were the most common clinical examination findings. Skin was the most frequently affected body system overall followed by non-specific problems then the gastrointestinal system. Consultations are complex, with a diverse range of different clinical presentations seen. Considering the presenting problem only may give an inaccurate view of the veterinary caseload, as some common problems are rarely the reason for presentation. Understanding the common diagnoses made is the next step and will help to further focus questions for future research.