Jean-Michel Vandeweerd

Is evidence-based medicine so evident in veterinary research and practice? History, obstacles and perspectives

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. The concept of EBM was first described in human medicine in the early 1990s and was introduced to veterinary medicine 10 years later. However, it is not clear that the EBM approach promulgated in human medicine can be applied to the same extent to veterinary medicine. EBM has the potential to help veterinarians to make more informed decisions, but obstacles to the implementation of EBM include a lack of high quality patient-centred research, the need for basic understanding of clinical epidemiology by veterinarians, the absence of adequate searching techniques and accessibility to scientific data bases and the inadequacy of EBM tools that can be applied to the busy daily practise of veterinarians. This review describes the development of EBM in the veterinary profession, identifies its advantages and disadvantages and discusses whether and how veterinary surgeons should further adopt the EBM approach of human medicine.

Understanding Veterinary Practitioners' Decision-Making Process: Implications for Veterinary Medical Education

Understanding how veterinary practitioners make clinical decisions, and how they use scientific information to inform their decisions, is important to optimize animal care, client satisfaction, and veterinary education. We aimed to develop an understanding of private practitioners process of decision making. On the basis of a grounded-theory qualitative approach, we conducted a telephone survey and semi-structured face-to-face interviews. We identified a decision-making framework consisting of two possible processes to make decisions, five steps in the management of a clinical case, and three influencing factors. To inform their decision, veterinary surgeons rarely take the evidence-based medicine (EBM) approach. They consult first-opinion colleagues, specialists, laboratories, and the Internet rather than scientific databases and peer-reviewed literature, mainly because of limited time. Most interviewees suggested the development of educational interventions to better develop decision-making skills in veterinary schools. Adequate information and EBM tools are needed to optimize the time spent in query and assessment of scientific information, and practitioners need to be trained in their use.

Use of computed tomography to diagnose new bone formation associated with desmitis of the proximal aspect of the suspensory ligament in third metacarpal or third metatarsal bones of three horses.

CASE DESCRIPTIONn3 horses with lameness localized to the proximal aspect of the metacarpus or metatarsus.nnnCLINICAL FINDINGSnAll horses had evidence of problems that originated from the proximal aspect of the suspensory ligament (PASL), including signs of pain on palpation, positive results of diagnostic nerve blocks, ultrasonographic detection of enlargement and diffuse areas of reduced echogenicity in the proximal region of insertion of the ligament, and radiographic detection of increased mineral opacity in the proximal aspect of the metacarpus or metatarsus. Desmitis of the PASL was diagnosed in each horse; however, conservative treatment failed to improve the lameness. The horses were taken to surgery for splitting of the PASL and osteostixis of the proximal aspect of the third metacarpal or metatarsal bone. At that time, the proximal aspect of the metacarpus or metatarsus was evaluated via computed tomography (CT), which identified new bone formation at the proximal aspect of the third metacarpal or metatarsal bone that had not already been identified.nnnTREATMENT AND OUTCOMEnIn all horses, the newly formed bone was removed surgically under radiographic and CT guidance, and the splitting and osteostixis that had been planned were performed. After rehabilitation, all horses returned to full training at 6 months after surgery. All horses responded well to the surgical treatment and were sound 8 months afterward.nnnCLINICAL RELEVANCEnUse of CT imaging should be considered in lame horses with pain associated with the proximal aspect of the third metacarpal or metatarsal bones that does not improve with conservative treatment.

Use of Computed Tomography in Standing Position to Identify Guidelines for Screw Insertion in the Distal Phalanx of Horses: An Ex Vivo Study

OBJECTIVESnTo compare the precision of radiography and computed tomography (CT) preoperatively in the standing position for identification of guidelines for screw insertion in the distal phalanx, and to identify whether standing CT might improve operative time compared with preoperative radiographic planning.nnnSTUDY DESIGNnExperimental ex vivo study.nnnANIMALSnCadaveric equine thoracic limb pairs (n=10).nnnMETHODSnInsertion of a 4.5 mm cortex screw in lag fashion into an intact distal phalanx was evaluated in 2 groups (n=10) of cadaveric equine thoracic limbs. In 1 group, the site, direction, and length of the implant were determined by radiography, and in the other group, by CT. Accuracy of screw placement was verified by specimen dissection. Outcomes were (1) absence of penetration of the articular surface, the solar surface, or the semilunar canal (2) appropriate length and direction of the screw. Surgical time was also measured.nnnRESULTSnNo screw penetrated the articular surface, the solar surface, or the semilunar canal in either group. CT was more accurate to identify guidelines for screw insertion (U=23.50, P=.049). With CT, surgical time (mean, 7.7 minutes) was significantly shorter (U=0.000, P=.000) than with radiography (mean, 12.7 minutes).nnnCONCLUSIONnStanding CT can be used to accurately determine anatomic landmarks for screw insertion in lag fashion in sagittal fractures of the distal phalanx.nnnCLINICAL RELEVANCEnThis study has a clear clinical relevance for improved internal fixation of sagittal fractures of the distal phalanx.

Computed tomography to identify preoperative guidelines for internal fixation of the distal sesamoid bone in horses: an in vitro study.

Objective: To assess the reliability of computed tomography (CT) to identify the direction of implant insertion for cortical screws along the longitudinal axis of intact (nonfractured) distal sesamoid bones. n n n nStudy Design: In vitro study. n n n nSample Population: Cadaveric paired equine forelimbs (n=16). n n n nMethods: Insertion of a cortical screw in lag fashion along the longitudinal axis of intact (nonfractured) distal sesamoid bones was evaluated in 2 groups (3.5 and 4.5xa0mm) of 8 paired limbs. In each group, the direction of the distal sesamoid bone was determined by CT (Equine XTC 3000 pQCT scanner). Screw placement was verified by specimen dissection. Implant direction was considered satisfactory if the entire screw length was within the distal sesamoid bone and not damaging the articular or flexural surfaces. n n n nResults: In our sample and according to our criteria, the proportion of satisfactory direction of screws was 0.63 (5/8) for 4.5xa0mm implants, and 0.87 (7/8) for 3.5xa0mm implants. n n n nConclusions: CT is a useful imaging modality to identify anatomic landmarks for insertion of a 3.5xa0mm cortical screw in the distal sesamoid bone.OBJECTIVEnTo assess the reliability of computed tomography (CT) to identify the direction of implant insertion for cortical screws along the longitudinal axis of intact (nonfractured) distal sesamoid bones.nnnSTUDY DESIGNnIn vitro study.nnnSAMPLE POPULATIONnCadaveric paired equine forelimbs (n=16).nnnMETHODSnInsertion of a cortical screw in lag fashion along the longitudinal axis of intact (nonfractured) distal sesamoid bones was evaluated in 2 groups (3.5 and 4.5 mm) of 8 paired limbs. In each group, the direction of the distal sesamoid bone was determined by CT (Equine XTC 3000 pQCT scanner). Screw placement was verified by specimen dissection. Implant direction was considered satisfactory if the entire screw length was within the distal sesamoid bone and not damaging the articular or flexural surfaces.nnnRESULTSnIn our sample and according to our criteria, the proportion of satisfactory direction of screws was 0.63 (5/8) for 4.5 mm implants, and 0.87 (7/8) for 3.5 mm implants.nnnCONCLUSIONSnCT is a useful imaging modality to identify anatomic landmarks for insertion of a 3.5 mm cortical screw in the distal sesamoid bone.

The impact of detailed explanatory leaflets on patient satisfaction with urodynamic consultation: A double-blind randomized controlled trial†‡

To develop and validate a scale that is applicable in Belgium to investigate the aspects of female patients satisfaction with urodynamic consultation, and to use it to measure the impact of a detailed explanatory leaflet on their satisfaction.