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Topic:Evidence-Based Medicine
Evidence-Based Medicine (EBM) in horses involves the systematic use of current, peer-reviewed research and clinical expertise to make informed decisions about equine healthcare. EBM aims to integrate the best available scientific data with practical knowledge to optimize treatment outcomes for horses. This approach includes the assessment and application of research findings to guide clinical practices, diagnostic procedures, and therapeutic interventions. By utilizing evidence-based methodologies, veterinarians and equine health professionals can improve the accuracy of diagnoses and the effectiveness of treatments. This page compiles a collection of peer-reviewed research studies and scholarly articles that explore the principles, application, and impact of Evidence-Based Medicine in the field of equine health.
A systematic review and meta-analysis of the efficacy of furosemide for exercise-induced pulmonary haemorrhage in Thoroughbred and Standardbred racehorses. Furosemide is the most commonly used medication for exercise-induced pulmonary haemorrhage (EIPH); however, critical evaluation of the strength of evidence for efficacy of furosemide is lacking and is warranted so that evidence-based treatment decisions can be made. Objective: To evaluate the efficacy of furosemide to reduce the severity or frequency of detection of EIPH in Thoroughbred and Standardbred racehorses. Methods: Systematic review with meta-analyses. Methods: Primary studies were identified via searches of electronic databases, relevant texts and reference lists of published article...
Equine-related treatments for mental disorders lack empirical support: a systematic review of empirical investigations. Equine-related treatments (ERT) for mental disorders are becoming increasingly popular for a variety of diagnoses; however, they have been subjected only to limited systematic investigation. Objective: To examine the quality of and results from peer-reviewed research on ERT for mental disorders and related outcomes. Methods: Peer-reviewed studies (k = 14) examining treatments for mental disorders or closely related outcomes were identified from databases and article reference sections. Results: All studies were compromised by a substantial number of threats to validity, calling into question t...
Systematic evaluation of evidence on veterinary viscoelastic testing part 1: System comparability. To systematically examine the evidence on system comparability between the thromboelastography and the rotational thromboelastometry viscoelastic point-of-care instruments and to identify knowledge gaps. Methods: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Methods: Academic and referral veterinary medical centers. Results: Medline via PubMed, CAB abstracts, and Google Scholar were searched. A total of 8 rele...
Elasticity and breaking strength of synthetic suture materials incubated in various equine physiological and pathological solutions. Selection of suture material in equine surgery is often based on costs or subjective factors, such as the surgeon's personal experience, rather than objective facts. The amount of objective data available on durability of suture materials with regard to specific equine physiological conditions is limited. Objective: To evaluate the effect of various equine physiological and pathological fluids on the rate of degradation of a number of commonly used suture materials. Methods: In vitro material testing. Methods: Suture materials were exposed in vitro to physiological fluid, followed by biomechan...
Oral examination and charting: setting the basis for evidence-based medicine in the oral examination of equids. The oral examination is performed in equids to assess and monitor oral health status, provide diagnoses, and determine efficacy of treatments. While there is currently insufficient scientific material of adequate quality to enable evidence-based medicine in equine dentistry, this by no means negates the clinician's responsibility to provide oral health care in a scientific and ethical manner. To do so requires that the clinician be knowledgable and skilled in dentistry and general medicine, that each case upholds the principles of scientific method, and that data is gathered and appraised in a...
Eating disorders and equine therapy: a nurse’s perspective on connecting through the recovery process. Patients with eating disorders may have the most complex interdisciplinary treatment plans of any mental illness. Nurses need innovative evidence-based treatment interventions to assist their patients with eating disorders on their road to recovery. Although much has been written about equine-assisted psychotherapy (EAP) and equine-facilitated psychotherapy, the literature has not described a detailed session that can help nurses understand how this experiential treatment works and the impact it can have on the patient. A review of the literature on eating disorders and on the use of equine th...
A systematic review of effectiveness of complementary and adjunct therapies and interventions involving equines. This systematic review examines the empirical literature in an emerging body of evidence for the effectiveness of biopsychosocial interventions involving equines across populations with chronic illness or health challenges. Methods: Selected quantitative studies published in peer-reviewed journals were reviewed for inclusion; the gray literature and white papers were also explored. Population, Intervention, Comparison, and Outcome (PICO) criteria and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) were applied to all studies. Fourteen full reports meeting a priori inc...
Systematic review of efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis. Various treatments of osteoarthritis (OA) have been described, including use of nutraceuticals. Objective: To review systematically the literature about the effects of nutraceuticals on clinical signs of pain or abnormal locomotion in horses, dogs, and cats, and to discuss methodological aspects of trials and systematic reviews. Methods: A systematic search of controlled trials evaluating the impact of nutraceuticals on OA in horses, dogs, and cats was performed, using Medline, CAB Abstracts, and Google Scholar. Scientific evidence was evaluated by means of criteria proposed by the Food and Dr...
Evidence-based medicine and stem cell therapy: how do we know such technologies are safe and efficacious? Evidence-based medicine (EBM) refers to the conscientious, explicit, and judicious use of current best evidence from research for the care of an individual patient. Central to the adoption of EBM is both producing and identifying the best possible evidence for a particular intervention or therapy. This article identifies and reviews the approaches to producing and identifying the best possible evidence that is necessary for the full acceptance of stem cell therapies in the horse and reviews the approaches that will allow future clinical studies in stem cell therapies to provide the best eviden...
Acupuncture and Chinese herbal medicine for treating horses. Acupuncture exerts diffuse analgesic effects through the release of endogenous opioids and other locally and centrally acting mediators. Successful therapeutic interventions for various musculoskeletal conditions in horses are well documented, and acupuncture may significantly enhance performance. The use of acupuncture is specifically supported in treating nonsurgical gastrointestinal disorders, in which specific techniques can alter motility and contribute to visceral analgesia. This article describes the use of acupuncture and Chinese herbal medicine for equine reproductive management and f...
An evidence-consultation base for developing child injury prevention priorities for Australian farms. Child injury on farms is a significant public health problem. This article describes the evidence and consultation base for development of a national strategy for child safety on farms in Australia. Methods: A data profile describing farm child injury was compiled, with evidence for the effectiveness of solutions being defined and the strength of recommendations determined. Representative working groups played a key role in assessing the evidence and advising on the best ways to communicate prevention messages within the farming community. Results: The main risks identified were drowning; farm...
Evidence-based medicine in equine critical care. One of the fundamental skills required for practicing evidence-based medicine is the development of a well-built clinical question, which specifies the patient group or problem, intervention, and outcome of interest. For this purpose, various "levels of evidence" have been developed in the human literature, which rank the validity of evidence. Our established conclusions and advice are thus supported by specific "grades of recommendations," which are intended to give an indication of the "strength" of a clinical recommendation. This article was compiled with these principles in mind.
Evidence-based gastrointestinal medicine in horses: it’s not about your gut instincts. The use of an evidence-based approach allows veterinary clinicians to assess questions that are clinically relevant to the diagnosis and treatment of equine gastrointestinal tract disease. This approach involves formulating a clinical question, searching the literature, and answering the question with the best available evidence, with the results summarized as a clinical "bottom line." This article is organized to reinforce the principle that the cornerstone of evidence-based medicine is the clinical question. Specific questions are further categorized as to topic, with epidemiologic risk fact...
Evidence-based drug use in equine medicine and surgery. The nature of the equine industry and equine veterinary medicine often requires veterinarians to prescribe drugs with little evidence for a drug's formulation safety or efficacy, or even assurance of the chemistry of the drug used. This means that equine veterinarians must remain skeptics and understand the limitations in their ability to attribute safety and efficacy to a particular drug or treatment. An evidence-based approach to pharmacology demands rigorous testing and an unbiased analysis of results.
Evidence-based gastrointestinal surgery in horses. Colic surgery is now performed at many equine hospitals around the world. Despite the tremendous improvements in survival rates over the past 30 years, the morbidity and mortality rates remain relatively high. This fact, coupled with the high cost of treatment, makes it important to apply evidence-based medicine principles to establish the best possible treatment plans and surgical techniques whereby the outcomes can be optimized. Factors affecting survival rates and rates of major complications (incisional complications and postoperative ileus) are discussed. Preoperative assessment and posto...
An evidence-based approach to selected joint therapies in horses. There is an enormous volume of published material about most of the agents used to treat or prevent arthritis in horses. Unfortunately, most of the claims made by nearly all purveyors of arthritis medications in such media are largely unsubstantiated. In addition, the quality of the available information is highly inconsistent, making evidence-based recommendations difficult. This article concentrates on injectable polysulfated glycosaminoglycan, injectable hyaluronan, and the common oral "nutraceuticals".
Evidence-based respiratory medicine in horses. It is clear from a review of the current scientific literature that an evidence-based approach to medical treatment of equine respiratory disease can be applied, at least in the instance of common lower respiratory diseases. In particular, there is clear evidence for efficacious treatments for recurrent airway obstruction and exercise-induced pulmonary hemorrhage, and with the recognition of this evidence, these treatments should be the first to be considered by a practitioner when treating these conditions. The purpose of this article is not only to identify the existence of relevant high-qua...
A graphic framework for teaching critical appraisal of randomised controlled trials. Students of evidence-based medicine often try unsuccessfully to commit to memory a particular critical appraisal framework (often lengthy), or they have to depend on pocket cards and are lost without them. We have described a pedagogic aid: a flow diagram of an RCT, which has been developed over years of teaching residents. This diagram focuses on the steps in an RCT, and by drawing arrows, it highlights the biases possible at each step. This diagram serves as a framework on which the list of critical appraisal questions can be hung and is easy to remember.
Look before you leap. Learning to critically evaluate therapeutic claims is vital to the success of the practicing veterinarian and the veterinary profession as a whole. Until such time as good scientific data in support of therapies are obtained, veterinarians should be careful in their advocacy and employment of new and unproved practices. They should also be aware of the many reasons why therapeutic "success" may be the result of a variety of factors unrelated to the treatment modality itself. Only by relying on rigorous standards of evidence can equine veterinarians prevent a return to the sincere but misguided...
Diagnosing and treating pain in the horse. Where are we today? This chapter begins by providing an overview of current philosophies relevant to equine pain management. Objective and subjective techniques for assessing pain and the limitations of these are then described in depth. The conclusion emphasizes the need for an evidence based approach to managing pain in the horse and sets the stage for subsequent chapters in this edition.
