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Equine Vet J ; 52(1): 13-27, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31657050


Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.

Analgesia/veterinária , Doenças dos Cavalos/tratamento farmacológico , Dor/veterinária , Guias de Prática Clínica como Assunto , Sociedades Científicas/normas , Medicina Veterinária/normas , Animais , Cavalos , Dor/tratamento farmacológico , Reino Unido
Equine Vet J ; 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31710379


BACKGROUND: Chondromalacia of the cranial medial femoral condyle (CMFC) is a potential cause of stifle lameness in adult horses. However, there is scant published evidence of either its occurrence or its clinical significance. OBJECTIVES: To document the occurrence of CMFC seen during diagnostic arthroscopy in adult horses with stifle lameness and to investigate its prognostic significance. STUDY DESIGN: Retrospective cohort study. METHODS: The records were reviewed of all horses with unilateral or bilateral lameness localised to the stifle that underwent diagnostic arthroscopy of the cranial medial femorotibial joint at a UK equine hospital. The surgical findings were noted from each. Case outcomes were determined by unstructured telephone discussions with owners. A satisfactory outcome was defined as a horse that was in ridden work without ongoing anti-inflammatory medication. Multivariable logistic regression was used to create a model with an outcome time point at 12 months post-operatively. RESULTS: One hundred and four horses were included in the study. CMFC was found in 79. In 25 CMFC was the only finding, 54 horses had CMFC plus other pathology and 25 had other pathology, but no CMFC. At 12 months horses with CMFC were 9.9 (95% CI 2.2 - 45.0, p<0.01) times more likely to have an unsatisfactory outcome than horses without CMFC. MAIN LIMITATIONS: The study relied on retrospective analysis of clinical notes and archived arthroscopy videos. Assessment of outcome was determined by unstructured telephone interview and therefore there is potential for reporting errors to exist. CONCLUSIONS: CMFC is a common arthroscopic finding in horses with stifle lameness and is significantly associated with an increased likelihood of the horse not being in ridden work at long term follow up.

Equine Vet J ; 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31461570


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.

Vet Rec Open ; 2(2): e000145, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26457192


The aim of this study was to survey veterinary practitioners' selection of diagnostic tests for horses with clinical signs of abdominal pain. A questionnaire was distributed to veterinary surgeons involved in the primary evaluation of horses with abdominal pain, including the respondent's demographics, selection of diagnostic tests and factors affecting decision-making. Data analysis included descriptive analysis, categorisation of free text and simple univariable correlations to explore the relationships between independent variables and the relative self-estimated frequency that diagnostic tests were performed. A total of 228 responses were analysed. Participants worked in mixed practice (55.7 per cent), first opinion equine (22.8 per cent), first and second opinion equine (17.9 per cent) and referral practice (3.1 per cent). The majority (48.2 per cent, 105/218) were very confident managing a colic case (confidence level 4/5). The most frequently used diagnostic tests were 'response to analgesia' (87.2±24.0 per cent cases), rectal examination (75.9±21.2 per cent) and nasogastric intubation (43.8±27.6 per cent). Approach varied between practitioners, and for all diagnostic tests with frequency of use ranging from 0 to 100 per cent of cases. 'Risk to personal safety' was the most common reason for not using rectal examination. Practitioner's opinion of their confidence level in managing a colic case was associated with how frequently they used different diagnostic tests. There was marked variation in practitioners' approaches, highlighting the need for further evidence to support decision-making.

Equine Vet J ; 47 Suppl 48: 4, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26375015


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.

Equine Vet J ; 47 Suppl 48: 5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26375173


REASONS FOR PERFORMING STUDY: Colic is a common reason for owners to seek veterinary treatment for their working equids in Morocco. There is no information available regarding cultural, religious or educational barriers to obtaining treatment or about the typical workload of these animals which may predispose them to colic. OBJECTIVES: To characterise the typical workload and feeding regimens of working equids in Morocco; to characterise the ability of owners to recognise the clinical signs and causes of colic; and to identify specific barriers to the veterinary treatment of colic. STUDY DESIGN: Questionnaire-based survey. METHODS: A standardised, structured questionnaire was administered, with the assistance of an Arabic speaking interpreter, to the owners of working equids presenting their animals to 2 centres run by SPANA (The Society for the Protection of Animals Abroad). Participation was voluntary and informed consent was obtained prior to the interview. RESULTS: All of the 102 participants that completed questionnaire were male. Ninety-eight owners used their animals for pulling carts, with 12% of animals working 7 days per week. 14% of animals were offered water by their owner once per day and 2% every other day. 25% of animals were loose and allowed free to feed unsupervised when not working. 29% of owners were not able to name any cause of colic and 25% did not recognise any clinical signs; only 12% associated colic with gastrointestinal pain. 83% of owners would not seek veterinary treatment due to financial constraints if free treatment at SPANA centres were not available. CONCLUSIONS: Colic remains a common problem amongst working equids in Morocco. Improved knowledge of management factors associated with colic and how to recognise abdominal pain may reduce the incidence of colic and improve prognosis. The findings presented can be used to inform and develop owner education programmes. Ethical animal research: The study was reviewed and approved by the Ethics Committee, School of Veterinary Medicine and Science, University of Nottingham. Informed consent for participation in the study was obtained from all owners and was delivered in the native language. No details identifying the owner were recorded. SOURCE OF FUNDING: None. Competing interests: None declared.