Risk factors for acute abdominal pain (colic) in the adult horse: A scoping review of risk factors, and a systematic review of the effect of management-related changes

Acute abdominal pain (colic) is the most common reason for emergency veterinary treatment in the horse. Consolidation of data through a systematic review is important to inform evidence-based medicine and clinical guidelines, but there are currently no published systematic reviews on colic in the horse. The aim of this study was to identify, categorize and appraise the evidence on factors associated with increased risk of developing abdominal pain (colic) due to gastrointestinal disease in the adult horse. A scoping review was performed to identify and categorize evidence on all risk factors for colic. A systematic review of management-related risk factors was then performed following PRISMA guidelines. Both searches were conducted in Medline, CAB Abstracts and Web of Science databases, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. For the systematic review, cohort, case-control or cross-sectional studies investigating acute abdominal pain in horses within two weeks of management changes were assessed. Study characteristics, participant characteristics and study results of included publications for the systematic review were extracted and tabulated. Included publications were appraised using the Joanna Briggs Institute Critical Appraisal Tools for cohort, case-control and cross-sectional studies. The scoping review search identified 3,756 publications. Fifty eight studies met final inclusion criteria, and 22 categories of risk factors were identified. These were grouped into three broad areas: horse-related factors, management-related factors and environment-related factors. The largest body of evidence related to management change. The systematic review of management change identified 410 publications: 14 met inclusion criteria for analysis. These consisted of one cohort, eight case-control and five cross-sectional studies. The studies were conducted between 1990–2008, and the majority of studies were located in the USA (8/14) or UK (3/14). The risk factors related to management change that were assessed were feed, carer, exercise, pasture, water and housing. The largest bodies of evidence for increased risk of colic associated with management change were changes in feed (5/14 publications) and recent change in housing (3/14). Most studies (8/14) did not meet the JBI criterion on confounding factors. There was marked heterogeneity of study methodologies and measures. This is the first study to use a combined scoping and systematic review to analyse evidence for modifiable risk factors for a common condition in the horse. It provides a comprehensive review that will be a key resource for researchers, veterinary practitioners and horse owners. It identified modifiable risk factors associated with an increased risk of colic which should be a key target for preventative health programmes. The findings from the critical appraisal were used to develop recommendations for future research to improve the quality of evidence-based veterinary medicine

Veterinary practitioners’ selection of diagnostic tests for the primary evaluation of colic in the horse

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

Task analysis for error identification: Theory, method and validation

This paper presents the underlying theory of Task Analysis for Error Identification. The aim is to illustrate the development of a method that has been proposed for the evaluation of prototypical designs from the perspective of predicting human error. The paper presents the method applied to representative examples. The methodology is considered in terms of the various validation studies that have been conducted, and is discussed in the light of a specific case study

UK horse owners and veterinary practitioners' experiences of decision‐making for critical cases of colic

BackgroundThe survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary practitioner.ObjectivesTo explore UK horse owners' and veterinary practitioners' experiences of decision-making for critical cases of equine colic.Study designQualitative study using a phenomenological approach.MethodsIndividual, semi-structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A purposive, convenience sample of participants was recruited. Sessions explored participant's experience of colic, including recognition, help-seeking behaviour, and challenges. Thematic analysis was performed on collected data.ResultsFour over-arching themes were identified; ‘head’, ‘heart’, ‘practicalities’ and ‘impact’. Owners acknowledged responsibility for their horse's welfare but had different perspectives than vets on the importance of finance (‘head’). Both vets and owners described how the horse–human relationship (‘heart’) often led to conflict during decision-making. The vet–client relationship was influential on decision-making for both owners and vets; involving other people in decision-making was described both positively and negatively by participants (‘heart’). ‘Practicalities’, such as lack of preparedness, transport issues and adverse weather conditions, were identified by both owners and vets as barriers. Owners described a ‘rollercoaster’ of emotions after a critical decision, with profound impacts on their mental wellbeing, feelings of guilt, and long-term changes in behaviour (‘impact’), and a lack of support to manage these feelings

A scoping review of the current evidence on treatment and outcomes following synovial sepsis

BackgroundSynovial sepsis is a frequent cause of morbidity and mortality in horses. Despite advances in diagnostics and treatments, persistent infection or chronic lameness can occur.ObjectivesTo perform a scoping review to identify and evaluate the current evidence on factors implicated in the success of treatment for synovial sepsis.Study designJoanna Briggs Institute scoping review.MethodsA protocol was registered and a systematic literature search was performed on CAB abstracts, Medline, Scopus and Embase. Inclusion and exclusion criteria were developed and studies systematically reviewed against this. Studies relating to factors affecting treatment success following synovial sepsis were retained and data was extracted on study method, population characteristics and factors significantly associated with treatment outcome.ResultsIn total, 2338 studies were identified, and 61 were included to full paper analysis. Eight papers reported significant factors, identifying 15 risk factors associated with two measurements of outcome, either survival and/or return to athletic function. The 15 factors were identified and categorised into pre-, intra- and post-operative factors. Risk factors that were identified included the number or type of synovial structures involved, the presence of pannus, tendon and bone pathology, and the use of systemic antimicrobials. There were many discrepancies in inclusion criteria of cases of synovial sepsis as well as measurement and description of outcome variables.Main limitationsNon-English language studies or conference proceedings were not included. Only small numbers of papers had similar findings.ConclusionsStandardisation of inclusion criteria is essential to enable comparisons and analysis between studies on synovial sepsis. Future studies should use methodologies to reduce bias including multicentre and multinational studies, prospective study design, and robust statistical modelling

Prospective case study of critical decision making for horses referred for treatment of colic

BackgroundThere is limited evidence on factors affecting critical decision making for horses with colic. This study's aim was to describe the assessment and decision making involved in horses referred for management of colic.MethodsAn in-depth case analysis was used to document case presentation, decision making and outcomes for horses referred for colic to two UK equine veterinary practices over a 12-month period. The data recorded included previous history, presenting signs, response to treatment, case outcome and factors affecting decisions for further treatment or euthanasia.ResultsData were available for 60 cases: 55 were hospitalised for medical or surgical treatment and five horses were euthanased following initial assessment. The main factors affecting treatment decisions were severity of clinical signs (80%, 47/59), financial concerns (10%, 6/59) and ongoing health issues or previous history of colic (5%, 3/59). Factors associated with euthanasia decisions were postoperative complications (5/18), poor prognosis (4/18), deteriorating clinical signs (3/18) and financial concerns (3/18).LimitationThe limited study population may affect the extent to which the findings can be generalised.ConclusionThe severity of clinical signs was the key factor in treatment decision making. The main factors affecting euthanasia decisions were clinical deterioration, poor prognosis and financial constraints. These findings should be incorporated into clinical case recording to capture the multifactorial nature of decision making

Potential Models for Radiative Rare B Decays

We compute the branching ratios for the radiative rare decays of B into K-Meson states and compare them to the experimentally determined branching ratio for inclusive decay b -> s gamma using non relativistic quark model, and form factor definitions consistent with HQET covariant trace formalism. Such calculations necessarily involve a potential model. In order to test the sensitivity of calculations to potential models we have used three different potentials, namely linear potential, screening confining potential and heavy quark potential as it stands in QCD.We find the branching ratios relative to the inclusive b ->s gamma decay to be (16.07\pm 5.2)% for B -> K^* (892)gamma and (7.25\pm 3.2)% for B -> K_2^* (1430)gamma for linear potential. In the case of the screening confining potential these values are (19.75\pm 5.3)% and (4.74\pm 1.2)% while those for the heavy quark potential are (11.18\pm 4.6)% and (5.09\pm 2.7)% respectively. All these values are consistent with the corresponding present CLEO experimental values: (16.25\pm 1.21)% and (5.93\pm 0.46)%.Comment: RevTeX, 6 pages, 1 eps figur

QCD Sum Rule Analysis of the Decays B→Kℓ+ℓ−B \to K \ell^+ \ell^- and B→K∗ℓ+ℓ−B \to K^* \ell^+ \ell^-

We use QCD sum rules to calculate the hadronic matrix elements governing the rare decays $B \to K \ell^+ \ell^-$ and $B \to K^* \ell^+ \ell^-$ induced by the flavour changing neutral current $b \to s$ transition. We also study relations among semileptonic and rare $B \to K^{(*)}$ decay form factors. The analysis of the invariant mass distribution of the lepton pair in $B \to K^{(*)} \ell^+ \ell^-$ and of the angular asymmetry in $B \to K^* \ell^+ \ell^-$ provides us with interesting tests of the Standard Model and its extensions.Comment: 26 pages REVTEX + 7 figures. Some typos corrected, figure 5 and 7 modified. This version will appear on Physical Review