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1.
Vet J ; 304: 106101, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38490359

RESUMO

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.


Assuntos
Anti-Infecciosos , Doenças do Gato , Doenças do Cão , Humanos , Animais , Gatos , Cães , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/veterinária , Antibioticoprofilaxia/métodos , Animais de Estimação , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/veterinária , Infecção da Ferida Cirúrgica/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Doenças do Gato/tratamento farmacológico , Doenças do Gato/prevenção & controle , Doenças do Cão/tratamento farmacológico , Doenças do Cão/prevenção & controle , Doenças do Cão/cirurgia
2.
Vet J ; 303: 106054, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38049062

RESUMO

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.


Assuntos
Anti-Infecciosos , Probióticos , Cães , Animais , Diarreia/tratamento farmacológico , Diarreia/veterinária , Hidratação/veterinária
3.
Vet J ; 292: 105950, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36642241

RESUMO

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.

4.
Prev Vet Med ; 192: 105348, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34022713

RESUMO

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.


Assuntos
Doenças do Gato , Insuficiência Renal Crônica , Projetos de Pesquisa/normas , Medicina Veterinária/normas , Animais , Doenças do Gato/terapia , Gatos , Consenso , Técnica Delphi , Qualidade de Vida , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/veterinária , Resultado do Tratamento
5.
Vet J ; 272: 105658, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33941335

RESUMO

Quality of life (QoL) is an important parameter to assess in cats, as it can be pivotal to important decision-making. Research reports that owners of cats with heart disease would trade longevity for QoL, and treatment associated improvement in QoL is very important for cats with chronic kidney disease. This systematic review aimed to explore the published literature to identify the number and range of QoL assessment tools available to researchers and veterinary professionals, by discovering tools which have already been used in published studies. Medline and CAB Abstracts were searched in March 2018, using terms relevant to cats and QoL or well-being. Inclusion and exclusion criteria were applied and information on uniqueness, validation and a short description of each tool extracted. A total of 1138 manuscripts were identified, of which 96 met all criteria. Forty of 96 manuscripts contained an assessment of QoL, using one of 32 unique tools identified. Sixteen of the tools identified were structured, making detailed patient assessments. Only eight of the structured tools were validated, and of these, three could be applied to healthy cats; the remainder being specific to a disease or being hospitalised. Some validated tools appeared in more than one manuscript. Overall, 12 manuscripts used a validated tool. In the 16 unstructured tools, five tools assessed QoL by assigning a single word (e.g. 'poor'). Eight tools assessed QoL on a single Likert scale (e.g. a number between 1 and 5). This work identifies the tools that are currently available for the assessment of QoL by researchers and veterinary professionals. Additionally, it demonstrates that many are not validated or lack detailed animal assessment, highlighting that further work in this important area is needed.


Assuntos
Gatos , Qualidade de Vida , Animais , Doenças do Gato/fisiopatologia , Doenças do Gato/terapia , Nível de Saúde , Cardiopatias/veterinária , Insuficiência Renal Crônica/veterinária , Reprodutibilidade dos Testes
6.
Equine Vet J ; 52(2): 262-267, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31461570

RESUMO

BACKGROUND: Colic is the most common emergency problem in the horse. An owner's ability to recognise colic and seek assistance is a critical first step in determining case outcome. OBJECTIVES: The aim of this study was to assess horse owners' knowledge and opinions on recognising colic. STUDY DESIGN: Cross-sectional study. METHODS: An online questionnaire was distributed to horse owners with open and closed questions on their knowledge of normal clinical parameters in the horse, confidence and approach to recognising colic (including assessment through case scenarios), and their demographics. Descriptive and chi squared statistical analyses were performed. RESULTS: There were 1564 participants. Many respondents either did not know or provided incorrect estimates for their horse's normal clinical parameters: only 45% (n = 693/1540) gave correct normal values for heart rate, 45% (n = 694/1541) for respiratory rate and 67% (n = 1028/1534) for rectal temperature. Knowledge of normal values was statistically associated with participants' educational qualifications (P<0.01). Owners said if they suspected their horse had colic they would assess faecal output (76%; n = 1131/1486), gastrointestinal sounds (75%; n = 1113/1486), respiratory rate (65%; n = 967/1486) and heart rate (54%; n = 797/1486). There was a lack of consensus on whether to call a vet for behavioural signs of colic, unless the signs were severe or persistent. The majority of participants (61%) were confident that they could recognise most types of colic. In the case scenarios, 49% were confident deciding that a surgical case had colic, but 9% were confident deciding an impaction case had colic. MAIN LIMITATIONS: Most respondents were UK based; risk of self-selection bias for owners with previous experience of colic. CONCLUSIONS: There was marked variation in horse owners' recognition and responses to colic, and significant gaps in knowledge. This highlights the need for the development of accessible educational resources to support owners' decision-making.


Assuntos
Cólica/veterinária , Doenças dos Cavalos , Animais , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Cavalos , Inquéritos e Questionários
7.
Prev Vet Med ; 158: 18-24, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30220392

RESUMO

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.


Assuntos
Gatos , Cães , Medicina Preventiva/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Medicina Veterinária/métodos , Animais , Medicina Preventiva/estatística & dados numéricos , Medicina Veterinária/estatística & dados numéricos
8.
Ir Vet J ; 71: 14, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29946419

RESUMO

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.

9.
Prev Vet Med ; 155: 61-74, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29786526

RESUMO

It has been recognised that few cattle farmers undertake biosecurity practices on their farms. Approaches that take into consideration individuals' preparedness for change, alongside beliefs thought to motivate the enactment of certain behaviours, may provide a framework for actuating tangible change. The aim of this study was to use a combination of behaviour change models to link beliefs with behaviour and identify possible key interventions to improve the uptake of biosecurity measures by dairy cattle farmers in Great Britain (GB). This is the first study to explore farmers' practices and attitudes in relation to the prevention of direct (animal to animal contact); indirect (via fomites); and other biosecurity measures using a multitheory approach. A cross-sectional study was carried out, with postal questionnaires sent to 2505 dairy cattle farmers. Questions were asked about the extent to which a host of biosecurity measures were used, the influence of various stakeholders (e.g. veterinarians, industry bodies) in informing biosecurity choices, and the perceived control farmers felt they had over biosecurity on their farms. Farmer attitudes towards biosecurity were also explored. Two behaviour change models, the Transtheoretical Model, and the Theory of Planned Behaviour, were utilised. A variety of analysis methods were used to interrogate the data, including multivariable logistic regression. A total of 908/2505 (36.2%) farmers responded, with 757 responses (30.2%) deemed eligible for inclusion. Farmers generally fell into one of two categories: those that reported not applying biosecurity measures with no intention of doing so in the future, and those that reported undertaking biosecurity measures for some time. Farmers felt that biosecurity improved cattle health and welfare, but also felt that disease was inevitable. More farmers agreed with statements relating to their ability to control, rather than prevent disease. Analysis suggested a difference between influencing beliefs and whether specific types of measure were more likely to be undertaken. For example, farmers' beliefs about other stakeholders appeared to play a role in influencing the utilisation of measures preventing direct contact (e.g. nose to nose contact), rather than indirect contact (e.g. fomite transmission). The use of a combination of behaviour change models has identified key variables to use for interventional approaches targeted towards the different type of biosecurity measure (preventing direct or indirect transmission) to improve the uptake of biosecurity on dairy cattle farms in GB. Other industry stakeholders should be aware of these variables when working with farmers to achieve optimal cattle herd health.


Assuntos
Criação de Animais Domésticos/métodos , Fazendeiros/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Animais , Bovinos , Doenças dos Bovinos/prevenção & controle , Estudos Transversais , Humanos , Inquéritos e Questionários , Reino Unido
10.
BMC Vet Res ; 13(1): 295, 2017 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-28978314

RESUMO

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.


Assuntos
Financiamento de Capital , Tratamento Farmacológico/veterinária , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto/veterinária , Tamanho da Amostra , Animais , Estudos Transversais , Tratamento Farmacológico/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/economia
11.
BMC Vet Res ; 13(1): 234, 2017 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-28807033

RESUMO

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.


Assuntos
Viés , Tratamento Farmacológico/veterinária , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/veterinária , Resultado do Tratamento , Animais , Gatos , Bovinos , Conflito de Interesses , Cães , Indústria Farmacêutica/economia , Cavalos , Projetos de Pesquisa , Ovinos
12.
Prev Vet Med ; 139(Pt A): 1-9, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28364827

RESUMO

In order for veterinary surgeons to undertake an evidence-based approach to making decisions about their patients, it is important that new evidence is generated to support the clinical decision-making process. Many of the decisions are likely to be around the actions taken to treat or manage health problems discussed during the consultation, and little is currently known about the factors which affect the type of action taken. The aim of this study was to determine the decisions made and actions taken for health problems discussed during first-opinion small-animal consultations, as well as identifying factors which may affect the decision-making process. Data were gathered during direct observation of small-animal consultations conducted by 62 veterinary surgeons in eight first-opinion practices in the United Kingdom. For each patient presented, data were gathered on all health problems discussed during the consultation. The decision made (whether an action was taken or not) and the action taken where applicable (e.g. therapeutic treatment with antibiotics) was also recorded. 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), and a binary outcome variable of action versus no action. At least one action was taken for 69% (n=2203/3192) of all problems discussed. Therapeutic treatment was the most common action taken (n=1286/3192 problems; 40.3%), followed by management advice (n=1040/3192; 32.6%) and diagnostic work-up (n=323/3192; 10.1%). The most common therapeutic treatment was antibiotics (n=386/1286; 30%), while the most common management advice given was dietary advice (n=509/1040; 48.9%). The three explanatory variables remaining in the final model were whether the problem was a presenting or non-presenting problem, the type of diagnosis made, and the body system affected. Explanatory variables which did not remain in the final model were patient signalment, problem history, consultation type, clinical examination type, and who raised the problem (veterinary surgeon or owner). For over two-thirds of problems discussed, an action was taken which suggests these problems may be seen as important by the veterinary surgeon and/or pet owner. No action was taken for almost a third of cases which could represent 'watchful waiting', which has been highlighted as important in human healthcare. Future research should focus on the common actions taken, further exploring the complex decision-making process, and examining the effect of the decisions made on long-term patient outcomes.


Assuntos
Doenças do Gato/terapia , Tomada de Decisões , Doenças do Cão/terapia , Relações Profissional-Família , Coelhos , Animais , Antibacterianos/uso terapêutico , Doenças do Gato/diagnóstico , Gatos , Doenças do Cão/diagnóstico , Cães , Humanos , Modelos Logísticos , Encaminhamento e Consulta , Reino Unido , Médicos Veterinários/psicologia
13.
Vet Rec ; 179(16): 410, 2016 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-27629862

RESUMO

The use of vaccines in the cattle industry is widespread; however, there is limited published guidance for use by decision-makers such as farmers and vets. To best support vets in advising dairy farmers on the optimisation of vaccination strategies, it is important to understand how and why vets make decisions about recommending the vaccination of cattle. The objective of this study was to explore in-depth farm animal vets' motivators and barriers to the implementation of vaccination strategies on British dairy farms. Semistructured interviews were conducted with 15 vets. Results indicated that vets have a positive attitude towards the use of vaccination and have few barriers to advising its implementation. Vets appear to group farmers into three 'character types'. This characterisation influences the vet-farmer relationship and how the vet communicates with the farmer. Vets required evidence of disease or a risk of disease as a motivator to advise vaccination. However, this seemed to be sometimes overruled by a risk-averse attitude; resulting in vaccination being advised 'just in case'. Crucially, the need for resources to support and build on the vet-farmer relationship is highlighted as an area requiring further exploration in order to optimise vaccination strategies on farm.


Assuntos
Doenças dos Bovinos/prevenção & controle , Tomada de Decisão Clínica , Indústria de Laticínios , Vacinação/veterinária , Médicos Veterinários/psicologia , Animais , Atitude do Pessoal de Saúde , Bovinos , Fazendeiros/psicologia , Feminino , Masculino , Motivação , Relações Profissional-Paciente , Pesquisa Qualitativa , Reino Unido , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Médicos Veterinários/estatística & dados numéricos
14.
Prev Vet Med ; 131: 87-94, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27544257

RESUMO

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.


Assuntos
Doenças do Gato/diagnóstico , Doenças do Cão/diagnóstico , Encaminhamento e Consulta , Animais , Gatos , Cães , Feminino , Masculino , Reino Unido , Medicina Veterinária
15.
Prev Vet Med ; 124: 69-77, 2016 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-26775818

RESUMO

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.


Assuntos
Animais de Estimação , Padrões de Prática Médica/estatística & dados numéricos , Medicina Preventiva/métodos , Médicos Veterinários/estatística & dados numéricos , Animais , Gatos , Cães , Inglaterra , Modelos Logísticos , Coelhos , Escócia
16.
Vet Rec ; 177(18): 465, 2015 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-26530434

RESUMO

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.


Assuntos
Doenças dos Bovinos/prevenção & controle , Indústria de Laticínios , Fazendeiros/psicologia , Papel Profissional/psicologia , Vacinação/veterinária , Médicos Veterinários , Animais , Bovinos , Humanos , Pesquisa Qualitativa , Reino Unido
17.
Equine Vet J ; 47 Suppl 48: 4, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26375015

RESUMO

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.

18.
Vet Rec ; 177(7): 172, 2015 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-26246397

RESUMO

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.


Assuntos
Medicina Baseada em Evidências , Comportamento de Busca de Informação , Médicos Veterinários/psicologia , Medicina Veterinária , Animais , Atitude do Pessoal de Saúde , Humanos , Educação de Pacientes como Assunto , Inquéritos e Questionários , Reino Unido
20.
Vet Rec ; 176(18): 463, 2015 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-25564472

RESUMO

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.


Assuntos
Comunicação , Coleta de Dados/métodos , Observação , Relações Médico-Paciente , Medicina Veterinária , Animais , Gatos , Cães , Humanos , Coelhos
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