ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats.

Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

Creating a more inclusive journal: the Journal of the Medical Library Association's evolving process for selecting editorial board members.

The Journal of the Medical Library Association (JMLA) selects new editorial board members every year. In the spring of 2021, JMLA used a new process for reviewing and selecting applicants for the limited number of open editorial board positions. This reevaluation of the selection process was spurred by a desire to create a more diverse and representative board. Changes to the procedures for selecting new editorial board members included having an open call for editorial board members, creating an application form, creating a selection committee to screen applicants, creating a form for the selection committee to extract data from applications, and creating a two-step process for screening and then selecting board members. As part of construction of this new process, areas for continued improvement were also identified, such as refining the application form to allow more specific answers to areas of interest to the selection committee. The newly created selection process for editorial board members constitutes a significant change in JMLA processes; however, more can be done to build on this work by further refining the selection process and ensuring that new members are selected in a transparent and streamlined manner.

Leveraging microgrants to support capacity-building workshops in low- and middle-income countries for meeting the Sustainable Development Goals.

Twenty fifteen marked the year of assessment for the Millennium Development Goals (MDGs). The MDGs that achieved the greatest success were those where evidence-based practice (EBP) interventions were implemented. The ability to practice evidence-based medicine is grounded in the creation of and access to medical literature that synthesizes research findings. The role that global health literature played in the success of the MDGs demonstrates that medical libraries and librarians have a role to play in achieving the Sustainable Development Goals (SDGs). Librarians can hold capacity-building workshops that provide instruction on how to access evidence-based literature and also train health professionals to conduct synthesis research. Research findings conducted by in-country health professionals are more likely to address issues being faced by local communities and will afford the possibility of obtaining the necessary evidence-based answers that can then be used to implement policies to resolve public health issues identified in the SDGs. This paper discusses how an international team of librarians leveraged funding from a Medical Library Association/Librarians without Borders/Elsevier Foundation/Research4Life grant to hold a capacity-building workshop in Zimbabwe and follow-up online trainings. The workshop focused on accessing evidence-based resources and conducting synthesis research. Outcomes included the creation and policy implementation of evidence-based knowledge products in alignment with local needs and galvanizing a multisectoral group of key individuals who have gone on to collaborate toward the vision of creating a Zimbabwe innovation hub. Looking ahead, such grants can be leveraged to conduct capacity-building to support knowledge translation and other local training needs.

Striving for equity: An update from the Journal of the Medical Library Association.

In 2020, the Journal of the Medical Library Association (JMLA) launched an initiative aimed at providing more equitable opportunities for authors, reviewers, and editorial team members. This editorial provides an update on the steps we have taken thus far to empower authors, increase the diversity of our editorial team, and make equity-minded recommendations to the Medical Library Association.

Racial, gender, sexual, and disability identities of the Journal of the Medical Library Association's editorial board, reviewers, and authors.

The Journal of the Medical Library Association (JMLA) recently issued a call for submissions that recognize and address social injustices; speak to diversity, equity, and inclusion in our workforce and among our user populations; and share critical perspectives on health sciences librarianship as well as those on any topic within JMLA's scope written by authors who are Black, Indigenous, or People of Color. We also committed to creating more equitable opportunities for authors, reviewers, and editorial board members from marginalized groups. As part of this effort, we conducted a demographic survey of all individuals who served as a member of the JMLA editorial board or reviewer or had submitted a manuscript to JMLA between 2018 and 2020. We found that most survey respondents are white, heterosexual, women and do not identify with a disability, meaning that JMLA is missing out on a diversity of perspectives and life experiences that could improve the journal's processes and policies, enrich its content, and accelerate the research and practice of health sciences librarianship. Therefore, to avoid perpetuating or aggravating systemic biases and power structures in scholarly publishing or health sciences librarianship, we pledge to take concrete steps toward making JMLA a more diverse and inclusive journal.

Levels of Evidence in Small Animal Dentistry and Oral Surgery Literature Over 40 Years.

Veterinary dentistry and oral surgery are relatively new clinical disciplines that have rapidly evolved in the last few decades. Although clinical standards of care are supported by a growing body of literature, the extent to which peer-reviewed, evidence-based studies have contributed to advancing the practice of dentistry and oral surgery has not been assessed. The purpose of this study was to survey literature on the clinical practice of small animal dentistry and oral surgery published over the past 40 years to evaluate the levels of evidence over time, authorship affiliation, funding, and clinical subdisciplines within the field. A literature search was conducted in PubMed and the identified articles were screened for inclusion. A total of 1,083 articles were included for final analysis. Three reviewers independently assessed and assigned each article to one of nine predetermined study design categories. Systematic reviews and meta-analyses were considered the highest level of evidence, whereas expert opinion and experimental (ex vivo, in vitro, or in silico) studies were deemed the lowest levels of evidence. For statistical analysis and interpretation, study type was dichotomized into high evidence designs from which causal inference and/or associations could be derived, and low evidence designs which were purely descriptive or non-clinical experiments. No statistically significant difference in the distribution of study type was seen over time, with the majority of research in the last 5 years being largely at high risk of bias and descriptive in nature: 80.6% of articles published between 2014 and 2019 were assigned to the low evidence design tier. The type of study was found to differ by author affiliation: high evidence study designs were found more often than expected when author affiliation was multi-institutional or industrial, whereas private practice authorship was underrepresented in the high evidence design tier. To meet the increasing demand for evidence-based studies on the practice of dentistry and oral surgery in dogs and cats, researchers are encouraged to consider study design when testing hypotheses to improve the quality of research.

The effect of tylosin on antimicrobial resistance in beef cattle enteric bacteria: A systematic review and meta-analysis.

BACKGROUND: Tylosin is a commonly used in-feed antimicrobial and is approved in several countries to reduce the incidence of liver abscesses in beef cattle. Macrolides are critically important antimicrobials in human health and used to treat some foodborne bacterial diseases, such as Campylobacter jejuni and Salmonella. Feeding tylosin could select for resistant enteric bacteria in cattle, which could contaminate beef products at slaughter and potentially cause foodborne illness. We conducted a systematic review and meta-analysis to evaluate the impact of feeding tylosin to cattle on phenotypic and genotypic resistance in several potential zoonotic enteric bacteria: Enterococcus species, Escherichia coli, Salmonella enterica subspecies enterica, and Campylobacter species. This review was registered with PROSPERO (#CRD42018085949). RESULTS: Eleven databases were searched for primary research studies that fed tylosin at approved doses to feedlot cattle and tested bacteria of interest for phenotypic or genotypic resistance. We screened 1,626 citations and identified 13 studies that met the inclusion criteria. Enterococcus species were tested in seven studies, Escherichia coli was isolated in five studies, three studies reported on Salmonella, and two studies reported on Campylobacter species. Most studies relied on phenotypic antimicrobial susceptibility testing and seven also reported resistance gene testing. A random-effects meta-analyses of erythromycin-resistant enterococci from four studies had significant residual heterogeneity. Only two studies were available for a meta-analysis of tylosin-resistant enterococci. A semi-quantitative analysis demonstrated an increase in macrolide-resistant enterococci after long durations of tylosin administration (>100 days). Semi-quantitative analyses of other bacteria-antimicrobial combinations revealed mixed results, but many comparisons found no effect of tylosin administration. However, about half of these no-effect comparisons did not record the cumulative days of tylosin administration or the time since the last dose. CONCLUSIONS: When fed at approved dosages for typical durations, tylosin increases the proportion of macrolide-resistant enterococci in the cattle gastrointestinal tract, which could pose a zoonotic risk to human beef consumers. Feeding tylosin for short durations may mitigate the impact on macrolide-resistant enterococci and further studies are encouraged to determine the effect of minimizing or eliminating tylosin use in beef cattle. There may also be an impact on other bacteria and other antimicrobial resistances but additional details or data are needed to strengthen these comparisons. We encourage authors of antimicrobial-resistance studies to follow reporting guidelines and publish details of all comparisons to strengthen future meta-analyses.

Information seeking and evaluation: a multi-institutional survey of veterinary students.

OBJECTIVE: To practice evidence-based medicine, clinicians must be competent in information literacy (IL). Few studies acknowledge the critical role that reading strategies play in IL instruction and assessment of health professional students. The purpose of this study was to understand the information-seeking and evaluation behaviors of doctor of veterinary medicine (DVM) students in regard to scientific papers. METHODS: The authors studied DVM student behaviors across eight programs in North America using a web-based survey of closed- and open-ended questions about finding and evaluating scientific papers, including a task to read a linked scientific paper and answer questions about it. RESULTS: A total of 226 individuals responded to the survey. The sections of a scientific paper that were most commonly read were the abstract, introduction, and conclusions. Students who reported reading a higher proportion of scientific papers were more likely to feel confident in their abilities to interpret them. A third of respondents answered open-ended questions after the paper reading task. Respondents felt the least amount of confidence with one of the final steps of evidence-based medicine, that of interpreting the significance of the paper to apply it in veterinary medicine. CONCLUSIONS: DVM students may lack the skills needed to evaluate scientific literature and need more practice and feedback in evaluating and interpreting scientific papers. Librarians who support DVM students can (1) help DVM students to efficiently evaluate scientific literature, (2) seek training opportunities in alternative modes of teaching and learning IL skills, and (3) partner with veterinary faculty and clinicians to provide students with practice and feedback in information evaluation.

Data-driven space planning: using Suma to collect data.

Library users frequently make individual requests to staff about how they would like us to improve the services and resources, but it can be difficult to prioritize such requests. To proactively understand how we can improve our library, library staff undertook a comprehensive assessment of spaces and resources using Suma.

Minimum Time Dose in Nature to Positively Impact the Mental Health of College-Aged Students, and How to Measure It: A Scoping Review.

Background: Across the U.S., college and university students exhibit high levels of stress, anxiety, depression, and other mental health issues. While counseling, medications and, in more severe cases, hospitalization are all appropriate treatments for such conditions, an increasing body of evidence has demonstrated that spending time in nature can provide tangible benefits for mental health and well-being. The aim of this study was to define a "dose" of time in nature that could be prescribed to college-age students, as a preventative and supportive mental health and well-being intervention. The specific objectives of this scoping review were thus: to define the minimum amount of time in nature that results in positive impact on mental health and well-being for college-aged students; to describe the types of engagement with nature that elicited the impact; and to describe and explore the most commonly used measure of effect pre- and post-time in nature. Methods: This scoping review was conducted following the PRISMA-ScR Checklist. A review protocol was developed but not registered. Fourteen bibliographic databases were searched and all results were blindly screened using established inclusion criteria. All titles and abstracts were screened by at least two reviewers, a third being used as a tie-breaker if needed. Studies were included if: subjects were of average college age; they examined a treatment of time (hours or minutes) in nature; they examined change in measures of mental health and well-being pre- and post-exposure; they compared participants across at least two environments; the study was published in English or French; and if the study was <20 years old. Results: Initially, 11,799 titles were identified and once de-duplicated, 10,917 titles were screened. One hundred fifty-five papers were given full text reviews, of which 14 studies were included in this review. In summary, 13 of the 14 papers explicitly noted that the participants were college students. Two-thirds of the studies (n = 10) took place in Japan. One study took place in Sweden, and the remaining studies took place in the United States (n = 3). These studies show that, when contrasted with equal durations spent in urbanized settings, as little as 10 min of sitting or walking in a diverse array of natural settings significantly and positively impacted defined psychological and physiological markers of mental well-being for college-aged individuals. Within the included studies, 22 different measures were used to assess the effects of nature doses on mental health and well-being. Conclusions: This review provides time-dose and activity-type evidence for programs looking to use time in nature as a preventative measure for stress and mental health strain, and also demonstrates opportunities in six specific foci for more research in this area.

The deterrent effect of bird song in territory defense.

Using the responses of territory owners to playback to infer the territorial function of acoustic signals is common practice. However, difficulties with interpreting the results of such experiments have obscured our understanding of territorial signalling. For instance, a stronger response to playback is often interpreted as more aggressive, but there is no consensus as to whether this should be in response to the least or most threatening simulated intruder. Rather than following a gradual increase or decrease, the relationship between signal intensity and response strength may instead describe a peaked curve. We manipulated banded wren (Thryophilus pleurostictus) songs to simulate low-, median-, and high-performance singers and used these songs as stimuli in playback experiments. Banded wrens were less likely to approach the high-performance stimulus compared with the low- and median-performance stimuli. However, the birds that did approach the high-performance stimulus sang more than those that approached the low-performance stimulus. In addition, birds were more likely to match the songs when exposed to the median- and high-performance stimuli compared with the low-performance stimuli, and song matching predicted approach behavior. These results are in accordance with theoretical models of aggressive encounters in which low-performance opponents are challenged without further assessment. Median- and high-performance opponents, however, may require further assessment, and the latter may be perceived as too intimidating for approach.

Trill consistency is an age-related assessment signal in banded wrens.

Older males tend to have a competitive advantage over younger males in sexual selection. Therefore, it is expected that signals used in sexual selection change with age. Although song repertoire size in songbirds is often mentioned as an age-related trait, many species, including the banded wren (Thryothorus pleurostictus), do not increase their repertoires after the first year. Here, we show that banded wrens reproduce the trill notes in their songs with less variability between them (i.e. more consistently) when they grow older. In a playback experiment, we also show that banded wrens discriminate between younger and older birds based on structural aspects of their song. In a second experiment, banded wrens also respond differentially to natural songs versus songs with artificially enhanced consistency. We argue that consistency in trill note reproduction may be achieved through practice. Sexual selection in the form of male-male competition may therefore operate on a phenotypic trait, the expression of which is enhanced by practice.