quality and comparability of clinical trials investigating the efficacy of prostaglandin F2α for the treatment of bovine endometritis

The objective of this study was to evaluate the quality and comparability of published literature, and to summarize the effect of prostaglandin F(2α) (PGF(2α)) for the treatment of endometritis. It has been postulated that there is a dearth of high-level evidence-based research results in veterinary medicine. Also, there is a marked variation in the quality of studies in veterinary and animal science. Post-partum uterine infections occur commonly in dairy cattle and are reported to have a negative impact on reproductive performance. A comprehensive literature search was conducted utilizing online databases revealing a total of 2723 references. After applying specific exclusion criteria, a total of 68 trials were eligible for further analysis. These articles were evaluated utilizing specific parameters listed in an evaluation form such as randomization and the involvement of control groups. The analysis revealed that more than half of the trials (51·5%) were at least 20 years old. Furthermore, we found that about one third (36·8%) of all trials were controlled and randomized, while 3 of those (4·4%) were also blinded. Of those trials which calculated a calving-to-conception interval (n=30), 50% of the authors claimed an improvement, which was statistically significant in 23·3% of the cases. We conclude that there is a wide discrepancy between research results investigating the efficacy of PGF(2α)

a meta-analysis

The objective of the conducted meta-analysis was to assess the efficacy of the treatment of bovine endometritis with PGF(2α) by statistical means. Postpartum uterine infections have a high prevalence and a very negative effect on reproductive performance in dairy cattle. Because of a wide discordance between research results, a meta-analysis of the efficacy of the treatment of bovine endometritis with PGF(2α) was conducted. A comprehensive literature search was performed using online databases to reveal a total of 2,307 references. In addition, 5 articles were retrieved by reviewing citations. After applying specific exclusion criteria and evaluating specific evidence parameters, 5 publications, comprising 6 trials, were eligible for being analyzed by means of meta-analysis. Data for each trial were extracted and analyzed using meta-analysis software Review Manager (version 5.1; The Nordic Cochrane Centre, Copenhagen, Denmark). Estimated effect sizes of PGF(2α) were calculated on calving to first service and calving to conception interval. Prostaglandin F(2α) treatment of cows with chronic endometritis had a negative effect on both reproductive performance parameters. Heterogeneity was substantial for calving to first service and calving to conception interval [I(2) (measure of variation beyond chance)=100 and 87%, respectively]; therefore, random-effects models were used. Sensitivity analysis as well as subgroup analysis showed that the performance of randomization was influential in modifying effect size of PGF(2α) treatment. The funnel plot illustrated a publication bias toward smaller studies that reported a prolonged calving to conception interval after a PGF(2α) treatment. We conclude that the investigation of this subject by means of meta-analysis did not reveal an improvement of reproductive performance of cows with endometritis after treatment with PGF(2α). Furthermore, there is a shortage of comparable high quality studies investigating reproductive performance after PGF(2α) treatment of cows with chronic endometritis

Teaching small animal reproduction via virtual patients

Virtual patients have become an interesting alternative in medical education. Due to increasing demands regarding theoretical and clinical teaching and to improve an interdisciplinary approach, a new blended learning concept including virtual patients was developed and implemented in the veterinary curriculum of the Freie Universität Berlin. In the presented project, three virtual patients from the field of canine reproduction were developed. They focus on pregnancy diagnosis with suspected luteal insufficiency, pyometra and benign prostatic hyperplasia, respectively. The results of an evaluation by veterinary students of the 7th semester showed a high acceptance of virtual patients in a blended learning reproduction module in the interdisciplinary lectures. Students especially preferred videos, such as video lectures, hands‐on videos and animations as well as a glossary for background information, to successfully and autonomously work on a virtual case. The content covered by the new modules that were developed in the context of this project is part of a spiral curriculum; they will be revised and enhanced during the clinical year

Ein evidenzbasierter Ansatz

The decision making process of practicing veterinarians as well as farm personnel and animal scientists should be based on objective information. Therefore, the implementation of evidence based medicine becomes increasingly important. However, there is a dearth of methodologically performed, rigorous, large-scale clinical studies in veterinary medicine resulting in a lack of research results of high evidence. Also, there is a remarkable variation in the quality of studies in veterinary and animal science. Hence, in veterinary medicine the increase of knowledge is mainly based on reviewing field reports rather than randomized, controlled clinical studies. Nevertheless, randomized, controlled, double blinded studies are the gold standard with regard to the evaluation of a given treatment. Postpartum uterine infections are a frequent disorder in dairy cattle with a prevalence up to 57.7%. In addition, they are reported to have an immense negative impact on reproductive performance resulting in high opportunity costs for the farmers. The overall objective of the conducted studies was to elucidate the status quo concerning the evidence of available literature and the implementation of evidence-based veterinary medicine (EBVM). In the first study, the quality and comparability of published literature concerning the treatment of bovine endometritis with PGF2α was evaluated. A comprehensive literature search was conducted utilizing online databases revealing a total of 2723 references. After applying specific exclusion criteria, a total of 68 trials were eligible for further analysis. These articles were evaluated utilising specific parameters listed in an evaluation form such as randomization and the involvement of control groups. The analysis revealed that more than half of the trials (51.5%) were at least 20 years old. Furthermore, we found that about one third (36.8%) of all trials was controlled and randomized, while 3 of those (4.4%) were also blinded. In conclusion, the first study showed a wide discrepancy between research results investigating the efficacy of PGF2α. The second study aimed at a quantitative assessment of the efficacy of the treatment of bovine endometritis with PGF2α by means of meta-analysis. After applying specific exclusion criteria and evaluating specific evidence parameters, a total of five publications, comprising six trials, were eligible for being analysed by means of meta- analysis. Data for each trial were extracted and analysed using meta-analysis software Review Manager 5.1. Estimated effect sizes of PGF2α were calculated on calving to first service and calving to conception interval. PGF2α treatment of cows with chronic endometritis had a negative impact on both reproductive performance parameters. Heterogeneity was substantial for calving to first service and calving to conception interval [I2 (measure of variation beyond chance) = 100% and 87%, respectively]; therefore, random effects models were used. Sensitivity analysis as well as subgroup analysis showed that the performance of randomization was influential in modifying effect size of PGF2α treatment. The funnel plot illustrated a publication bias towards smaller studies that reported a prolonged calving to conception interval after a PGF2α treatment. In conclusion, the investigation of this subject by means of meta- analysis did not reveal an improvement of reproductive performance of cows with endometritis after treatment with PGF2α. The objective of the third study was to outline the current assessment and employment of evidence-based veterinary medicine with the help of a survey among practitioners concerning continuing education (EBVM) and their skills in obtaining and evaluating scientific information. For this purpose, a survey amongst veterinary practitioners was conducted throughout five conferences between Mai 2010 and November 2011. The questionnaire contained 32 questions concerning demographic data and profession (n = 4), qualification (n = 3), continuing education (n = 5) and skills concerning EBVM (n = 20). Besides evaluating the statements of all participants, veterinarians were classified based on the type of practice and their statements compared. In total, 293 questionnaires were returned. The majority of small animal practitioners (58.3%) and those working with food animals (54.9%) declared being capable of comprehending scientific talks or papers in English without difficulty. 10.4% of all practitioners negated reading veterinary journals on a regular basis, while 20.8% stated to regularly read English veterinary journals. The majority of the practitioners sought advice from their employer or a colleague. They attribute a high or very high quality to both information sources. Almost every participant (92.6%) stated to consult medical books, and 88.6% certify this information source a high or very high quality. 68.6% of the practitioners evaluated their skills in finding suitable literature as high or very high. However, only about half (52.1%) of all participants attributed themselves a high ability to evaluate the quality of the found literature. Based on these findings, it can be concluded that most practitioners are hardly able to assess the evidence of scientific information. Therefore, courses that introduce EBVM should be taught in veterinary education and post graduate education to train critical appraisal of information and to support decision-making based on valid, clinically relevant data.Entscheidungsfindungen in der täglichen tierärztlichen Praxis und Wissenschaft sowie durch Mitarbeiter landwirtschaftlicher Betriebe sollten stets auf objektiven Informationen basieren. Deshalb gewinnt die Anwendung der Evidenzbasierten Medizin zunehmend an Bedeutung. Allerdings sehen wir in der Veterinärmedizin einen Mangel an gründlich und systematisch durchgeführten groß angelegten klinischen Studien, was wiederum einen Mangel an Forschungsergebnissen hoher Evidenz nach sich zieht. Zusätzlich beobachtet man eine enorme Variation hinsichtlich der Qualität veterinärmedizinischer Studien. Daher basiert der Wissenszuwachs im veterinärmedizinischen Bereich v.a. auf Erfahrungsberichten anstatt auf randomisierten, kontrollierten klinischen Studien. Randomisierte, kontrollierte, doppelt verblindete Studien stellen jedoch den Goldstandard bezüglich der Beurteilung einer bestimmten Behandlungsstrategie dar. Postpartale Gebärmutterentzündungen stellen mit einer Prävalenz von bis zu 57,7% eine häufige Störung bei der Milchkuh dar. Diese verursachen aufgrund von beträchtlichen negativen Auswirkungen auf die Folgefruchtbarkeit hohe Zusatzkosten für die Landwirte. Daher war es das übergreifende Ziel der durchgeführten Studien, den Status Quo hinsichtlich der Evidenz der verfügbaren Literatur sowie der Anwendung bzw. der Umsetzung der Evidenzbasierten Veterinärmedizin (EBVM) einmal näher zu beleuchten. In einer ersten Studie wurde die Qualität und Vergleichbarkeit der verfügbaren Literatur zum Thema Behandlung der bovinen Endometritis mit PGF2α ausgewertet. Dafür wurden mithilfe einer umfassenden, systematischen Literaturrecherche in Online Datenbanken bzw. Suchmaschinen 2723 Referenzen zu der untersuchten Thematik gefunden. Nach Anwendung spezifischer Ausschlusskriterien verblieben 68 Studien für eine weitere Auswertung. Diese Artikel wurden mithilfe eines speziellen Bewertungsbogens hinsichtlich spezifischer Parameter, wie z.B. dem Vorhandensein einer Kontrollgruppe sowie der Zuordnung zu den einzelnen Gruppen, beurteilt. Diese Auswertung zeigte, dass mehr als die Hälfte der Studien (51,5%) älter als 20 Jahre waren. Zusätzlich zeigte sich, dass etwa ein Drittel (36,8%) der untersuchten Studien kontrolliert und randomisiert waren, während 3 dieser Studien (4,4%) zusätzliche verblindet durchgeführt worden waren. Zusammenfassend lässt sich sagen, dass die Forschungsergebnisse hinsichtlich der Wirksamkeit von PGF2α sehr unterschiedlich sind. Aufbauend auf die erste Studie zielte die zweite Studie auf die quantitative metaanalytische Bewertung der Behandlung der chronischen Endometritis der Kuh mittels PGF2α ab. Nach der Anwendung spezifischer Ausschlusskriterien und der Bewertung der verbliebenen Studien hinsichtlich bestimmter Evidenzparameter konnten 5 Publikationen, welche insgesamt 6 Studien umfassten, in die Metaanalyse eingeschlossen werden. Die Extraktion und Auswertung der Studiendaten erfolgte unter Verwendung des Review Managers 5.1. Dabei wurden mithilfe dieser Software Effektgrößen bezüglich der Auswirkung einer PGF2α Behandlung auf Rast- und Güstzeiten berechnet. Die Ergebnisse zeigten eine negative Beeinflussung beider Reproduktionsparameter durch eine PGF2α Behandlung. Auch bezüglich beider Parameter zeigte sich eine beachtliche Heterogenität zwischen den Studien [I2 (echte Varianz) Rastzeit = 100% bzw. Güstzeit = 87%]. Sowohl die durchgeführte Sensitivitätsanalyse sowie die Untersuchung einzelner Untergruppen machten deutlich, dass die Durchführung einer Randomisierung die Effektgröße durch eine PGF2α Behandlung beeinflusste. Im Rahmen der Untersuchung auf einen Publikationsbias zeigte die erstellte Trichtergraphik eine Verzerrung durch kleine Studien, die eine verlängerte Güstzeit nach einer PGF2α Behandlung bescheinigten. Zusammenfassend ist festzustellen, dass die Metaanalyse keine Verbesserung der Folgefruchtbarkeit nach einer Behandlung der bovinen Endometritis mit PGF2α aufzeigen konnte. Die dritte Studie, eine Umfrage unter praktizierenden Tierärzten, hatte zum Ziel, einen Überblick über die momentane Einschätzung und Anwendung der Konzepte der EBVM zu erhalten. Zu diesem Zweck wurden im Rahmen von 5 verschiedenen Fortbildungsveranstaltungen klinisch tätige Tierärzte/innen hinsichtlich ihres Informationsbeschaffungs-, -bewertungs- und Fortbildungsverhaltens befragt. Der Fragebogen enthielt insgesamt 32 Fragen, welche sich auf Person/Tätigkeit (n = 4), erworbene Qualifikationen (n = 3), das Fortbildungsverhalten (n = 5) sowie die Anwendung der EBVM (n = 20) bezogen. Zusätzlich zur Auswertung der Angaben aller Befragten wurden die Angaben von Kleintier-, Großtier- und Gemischtpraktikern miteinander verglichen. Insgesamt wurden 293 Fragebögen ausgefüllt. Mehr als die Hälfte aller Klein- (58,3%) bzw. Großtierpraktiker (54,9%) gaben an, ihre Englischkenntnisse reichten aus, um englischsprachige Fachvorträgen oder Publikationen ohne Mühe erfassen zu können. 10,4% aller Befragten gab an, keine veterinärmedizinischen Zeitschriften regelmäßig zu lesen, während 20,8% der klinisch tätigen Tierärzte angaben, regelmäßig englischsprachige Fachliteratur zu lesen. Der überwiegende Anteil der Tierärzte fragte im Problemfall ihren Chef oder Kollegen um Rat. Diese beiden Informationsquellen werden als qualitativ hoch oder sehr hoch eingeschätzt. Beinahe alle Teilnehmer (92,6%) gaben an, die Lösung für auftretende fachliche Probleme in einem Fachbuch zu suchen, dem ebenfalls eine hohe bzw. sehr hohe Qualität einräumt wird. 68,6% der Befragten schätzen ihre Fähigkeit, geeigneteLiteratur zu finden, als sehr hoch oder hoch ein. Eine hohe Fähigkeit, die gefundene Literatur hinsichtlich ihrer Qualität (Evidenz) kritisch beurteilen zu können, schrieben sich jedoch lediglich 52,1% der Befragten zu. Schlussfolgernd ist zu sagen, dass die Mehrheit der klinisch tätigen Tierärzte nur begrenzt in der Lage ist, Informationen hinsichtlich ihrer Evidenz einzuschätzen. Daher sollte ein Ziel sein, es Tierärzten bereits im Studium sowie in ihrer postgraduellen Ausbildung näher zu bringen, sich mit medizinischen Informationen kritisch auseinanderzusetzen und klinische Entscheidungen basierend auf soliden Daten zu treffen

Determination of reference intervals for nonesterified fatty acids in the blood serum of healthy dogs

Background Nonesterified fatty acids (NEFAs) are an important energy substrate in mammals. Measurement of the NEFA concentration in blood serum is common practice and enables reliable detection of a negative energy balance in several species. This parameter can be used to detect subclinical metabolic diseases or to optimise feeding to prevent severe negative energy balance. Since no reference values for dogs have been published, the aim of this study was to establish such values. Methods Blood serum from 85 healthy dogs was examined with a multiparameter clinical chemistry analyser. Given that NEFA values are not usually normally distributed, reference intervals (RIs) were calculated nonparametrically using bootstrapping (5000 replicates) for the 90% confidence intervals. Results The examined cohort had a median age of 62.16 months (2–180 months) and a median weight of 19.2 kg (3.0–55.0 kg) and comprised 27 (31.8%) males and 58 (68.2%) females, with 32 (37.6%) neutered or spayed. The fasting time was 5.9 h (range 0–23 h). The tested confounders age, sex, neuter status, bodyweight and body condition score did not significantly affect the NEFA concentrations. Conclusions The NEFA RI for dogs in this study was 0.2–1.47 mmol/L. The results may be used to adjust food composition and amount in healthy dogs or to detect metabolic disorders. Further research on NEFA metabolism in dogs maintained in standardised conditions and in specific nutritional situations or with particular diseases is warranted

The Use of Mobile Devices and Online Services by German Veterinary Students

Objective: The research question of our study was to determine the adoption and use of mobile devices and online services by veterinary students.Background: New technologies support learning, communication and information transfer during the pre-professional years and the professional lifetime. Hence, mobile devices may also be a feasible tool for information access for the practitioner at any place and any time, and consequently may support better informed clinical decision making.Evidentiary value: We conducted a survey among 124 German veterinary medical students in their third year with a median age of 23.0 years.Methods: The survey was conducted during a lecture and contained 10 questions with preset answers to be ticked and a free text comment section. Participation was voluntary and data processing was performed anonymously.  Results: According to the answers of surveyed third year students 84.7% used a smartphone as a mobile device. The vast majority of the veterinary students used Google, Facebook and WhatsApp besides other applications.  Conclusion: Most students are familiar with mobile devices and the use of social media and information tools. Thus, new learning strategies could be developed and applied that encompass mobile online learning and information access. These strategies could help to better address different learning types, provide sufficient interactivity and feedback and enable veterinarians to seek and share information via the internet. However, despite promising results reporting a positive educational effect, these perceptions need to be validated in further research. In addition, it should be assessed in future surveys if veterinarians would use mobile online access to scientific data or Knowledge Summaries for better informed decision making in practice.Application: Veterinary students, and thus the next generation of veterinary practitioners, are using mobile devices to a high extent. This paves the way to refine existing and to develop new education strategies. New information tools for mobile devices may help veterinarians to seek and share information. In addition, it might be worthwhile to teach veterinary students and practitioners how to search for and appraise online scientific information. </p