Deficiencies of effectiveness of intervention studies in veterinary medicine: a cross-sectional survey of ten leading veterinary and medical journals

One Health policy for combatting African trypanocide resistance

The rise of African trypanocide resistance (ATr) is influenced by various factors such as evolutionary changes in the pathogen, the presence of resistance genes in the population, poor policy decisions, limited private-public partnerships to engage local communities, and insufficient funding for the development of new drugs over the past sixty years. These challenges have been exacerbated by the inadequate implementation of drug liberalization policies in the mid 20th century, leading to poor pharmacovigilance practices for veterinary drugs in low and middle income countries (LMICs). One health (OH), a disease management framework, provides practical solutions for addressing ATr, drawing on its success in managing previous epidemics like avian influenza in 2004 and the recent COVID-19 pandemic, where institutional collaborations were rapidly established. To combat ATr, OH initiatives involving both international and local partners at the policy and grassroots levels are crucial to generate community interest. The importance of political commitment, media involvement, and nongovernmental organizations cannot be overstated, as they are essential for resource mobilization and long-term sustainability in LMICs.

The standards of reporting trials in pets (PetSORT): Explanation and elaboration

Well-designed randomized controlled trials (RCTs) provide the best evidence of the primary research designs for evaluating the effectiveness of interventions. However, if RCTs are incompletely reported, the methodological rigor with which they were conducted cannot be reliably evaluated and it may not be possible to replicate the intervention. Missing information also may limit the reader's ability to evaluate the external validity of a trial. Reporting guidelines are available for clinical trials in human healthcare (CONSORT), livestock populations (REFLECT), and preclinical experimental research involving animals (ARRIVE 2.0). The PetSORT guidelines complement these existing guidelines, providing recommendations for reporting controlled trials in pet dogs and cats. The rationale and scientific background are explained for each of the 25 items in the PetSORT reporting recommendations checklist, with examples from well-reported trials.

Maximizing value and minimizing waste in clinical trial research in swine: Design features to minimize bias

Researchers designing trials should implement design features intended to reduce bias. These include random allocation to intervention groups and blinding of caregivers and outcome assessors. The method of generating the random sequence should be reported, as well as methods for stratification or blocking if used. When blinding is not possible, objectively measured outcomes should be used. Allocation concealment may not be essential when all eligible pens or animals are enrolled and there is no preference for intervention group. An a priori trial protocol should be made publicly available, and results for all outcomes evaluated should be reported.

Maximizing value and minimizing waste in clinical trials in swine: Selecting outcomes to build an evidence base

Researchers planning clinical trials should identify the primary trial outcome and adequately power the trial to detect clinically meaningful differences in this outcome. All primary and secondary outcomes and their measurement should be comprehensively described, and their results reported. There is evidence that trials on the same subject use different outcomes or measure the same outcome in different ways, making it difficult to compare intervention effectiveness across clinical trials. Consensus development of core outcome sets could improve consistency in outcome measures used across trials and aid in development of an evidence-based body of literature on intervention effectiveness in swine populations.

What Kinds of Dogs Are Used in Clinical and Experimental Research?

Simple Summary

The objective of this study was to evaluate the signalment of dogs used in veterinary research in six different specialties. In total, 150 randomly chosen clinical studies (25 studies per specialty) published between 2007 and 2019 were evaluated for the breed, sex, neuter status, age, and weight information of the dogs used. Breed information was given for 5.7% of the included animals. Beagles were used 1.9% of the time, which was a less significant role in research than we expected. Information about the sex of the dogs was lacking for 16.2% of the included animals, while age and weight information were missing for 22.7 and 32.7%, respectively. The neuter status was not given in 38.7% of the clinical studies. The results show deficits in the reporting of demographic data for the dogs. The need for an improvement in the documentation and/or reporting of animal signalment is obvious and should be addressed by authors, reviewers, and journal editors in the future.

Abstract

Background: Dogs are widely used in research to answer questions about canine or human conditions. For the latter, research dogs are often used as models, since they are physiologically more similar to humans than other species used in research and they share similar environmental conditions. From a veterinary perspective, research findings are widely based on academic research, and thus are generated under experimental conditions. In that regard, the question arises: do the dogs used for research adequately represent the dog population seen in veterinary practice? It may, for example, be assumed that Beagle dogs are often used as experimental animals. The objective of this study was to evaluate the signalment of dogs used in veterinary research. Furthermore, we aimed to assess other relevant criteria regarding the validity of clinical trials in the context of six different veterinary medicine specialties: cardiology, internal medicine, neurology, orthopaedics, reproduction, and surgery. Methods: A literature search was conducted and 25 studies per specialty were randomly selected. The breed, sex, neuter status, median age, and median weight of the dogs used for clinical studies (n = 150) published between 2007 and 2019 were evaluated. Results: In total, 596,542 dogs were used in the 150 trials. Breed information was given for 33,835 of these dogs (5.7%). Of the latter, 1.9% were Beagles. Nine clinical trials exclusively used Beagles. The most frequently used breeds were German Shepherds (7.3%), Labrador Retrievers (6.7%), and Golden Retrievers (4.7%). The major reporting deficits found were missing breed specification in 25.3% of the articles; missing information about the sex of the dogs in 16.2%; missing age and weight information in 22.7 and 32.7%, respectively; and missing neuter status in 38.7% of the clinical studies. The median sample size was 56 (Q1:29; Q3:365) dogs. Conclusions: The presented project revealed that Beagle dogs represent only a small proportion of dogs in veterinary research. Based on the evaluated publications, it seems that some relevant dog attributes differ between the specialties. The results, however, show deficits in the reporting of demographic data for the dogs. The need for an improvement in the documentation and/or reporting of animal signalment is obvious and should be addressed by authors, reviewers, and journal editors in the future.

Most veterinarians treating exotic animals use formularies to select drug dosages without consistently checking their sources

OBJECTIVE

To assess what information sources veterinarians use to select drug dosages for treating exotic animals and how they implement this information.

SAMPLE

936 veterinarians from Europe, Asia, Australia, Africa, and the Americas.

PROCEDURES

An anonymous, online survey was used to collect data on information sources used for dosage decisions by veterinarians treating exotic species. Logistic regression models were built to identify associations between individual characteristics and primary outcomes.

RESULTS

Respondents reported their single most common source for establishing drug dosages as formularies (682/936 [72.9%]), followed by scientific journals (96 [10.3%]), other textbooks (68 [7.3%]), colleagues (47 [5.0%]), or continuing education notes (38 [4.1%]). Over two-thirds of the respondents (645, 68.9%) consulted a specific exotic animal formulary for establishing drug dosages in most situations. Of the 936 respondents, 407 (43.5%) reported that they sometimes (318 [34.0%]) or never (89 [9.5%]) checked the source of a dosage in a textbook or a formulary, 503 (55.3%) reported that they sometimes (399 [42.6%]) or never (104 [11.1%]) searched the original publication on a dosage, and 486 (51.9%) reported that they would base their dosage decision on the abstract of an article if they had no access to the full-text. Several respondents' reported characteristics were significant predictors of primary outcomes.

CLINICAL RELEVANCE

Considering our findings, we recommend authors of formularies and textbooks should focus on evidence-based information and state clearly when information is anecdotal. Tailored strategies to educate veterinarians treating exotic animals on the importance of primary sources are also recommended.

Study design quality of research on dogs published in peer-reviewed journals

BACKGROUND

In the past it has been criticised that only a low proportion of well-designed and well-reported studies in some medical specialities is available. The objective of this study was to systematically evaluate the quality of literature about canine medicine published in peer-reviewed journals in relation to six specific veterinary medicine specialities.

METHODS

A literature search was conducted and 25 studies per speciality were selected. The quality of the articles (n = 150) published between 2007 and 2019 was evaluated with a validated checklist.

RESULTS

In articles related to all specialities, deficits were found, such as not adequate number of animals in 60.0% of the studies. In 88.0%, information about housing and feeding of the dogs were not specified. In 69.4% of the prospective clinical studies, an ethical approval was reported, and written informed consent of the owners was obtained in 46.2%.

CONCLUSIONS

The findings revealed extensive deficits in the design and reporting of studies in canine medicine. The demand for improvement is obvious and should be addressed by authors, reviewers and journal editors in the future. Our results underline that practitioners should critically appraise the quality of literature before implementing information into practice.

Reporting quality of abstracts of veterinary randomized controlled trials

OBJECTIVE

To evaluate the adherence of veterinary randomized controlled trial (RCT) abstracts to the recommendations on minimum abstract information included in the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCT abstracts and to identify characteristics associated with the number of CONSORT items reported.

SAMPLE

212 abstracts representing all RCTs published in 5 general veterinary journals in 2013 and 2018.

PROCEDURES

2 investigators independently assessed whether each of the 15 CONSORT checklist items for abstracts applicable to veterinary medicine was reported. Generalized linear mixed models were built to explore associations of selected variables with the total number of checklist items reported.

RESULTS

Abstracts included a median of 5 checklist items (range, 2 to 10 items). None met the recommendations for reporting participant recruitment and funding source. Less than 25% of abstracts met the recommendations for the title, participant eligibility criteria, primary outcome, randomization technique, blinding, numbers analyzed, primary outcome results, and harms to participants. The number of items reported was higher in abstracts of RCTs that included clinical patients (vs other participants; OR, 1.13; 95% CI, 1.05 to 1.22). The number of items reported did not significantly change over time.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that the reporting quality of abstracts of RCTs in general veterinary journals was suboptimal per CONSORT recommendations. Because abstracts may be the only reference material available in certain settings, improvements are warranted to ensure readers have the information they need to properly interpret reported findings.

Evaluating farm-level livestock interventions in low-income countries: a scoping review of what works, how, and why

Livestock interventions can improve nutrition, health, and economic well-being of communities. The objectives of this review were to identify and characterize livestock interventions in developing countries and to assess their effectiveness in achieving development outcomes. A scoping review, guided by a search strategy, was conducted. Papers needed to be written in English, published in peer-reviewed journals, and describe interventions in animal health and production. Out of 2739 publications systematically screened at the title, abstract, and full publication levels, 70 met our inclusion criteria and were considered in the study. Eight relatively high-quality papers were identified and added, resulting in 78 reviewed publications. Only 15 studies used randomized controlled trial designs making it possible to confidently link interventions with the resulting outcomes. Eight studies had human nutrition or health as outcomes, 11 focused on disease control, and four were on livestock production. Eight interventions were considered successful, but only four were scalable. We found good evidence that livestock-transfer programs, leveraging livestock products for nutrition, and helping farmers manage priority diseases, can improve human well-being. Our report highlights challenges in garnering evidence for livestock interventions in developing countries and provides suggestions on how to improve the quantity and quality of future evaluations.

Management of otitis externa with an led-illuminated gel: a randomized controlled clinical trial in dogs

BACKGROUND

Canine otitis externa is a painful condition which can be challenging to treat due to difficulties in the administration of otic medication. This can be due to lack of owner compliance in the application of ear drops or due to the resentment that some dogs demonstrate when attempts are made to administer topical medication into a sensitive ear canal. The aim of the study was to assess the efficacy of a topical LED-illuminated gel (LIG) in canine otitis externa in comparison to standard of care therapy. Dogs with spontaneous otitis externa were randomly allocated in three groups: groups QW received LIG once weekly; BW received LIG twice weekly; group C received enrofloxacin and silver sulfadiazine twice daily. LIG consists of a topical application of a gel containing chromophores that, when illuminated by a LED lamp, re-emit fluorescent light which can stimulate physiological responses, promoting healing and controlling bacteria. The evaluation protocol (T0 to T5) considered clinical assessment (OTIS-3-index-scoring-system; pruritus-severity-scale; pain-severity-score; aural temperature), cytological scoring system, quali-quantitative bacteriologic assessment.

RESULTS

All groups (QW, n = 21; BW, n = 23; C, n = 20) showed improvement during the study (QW: P < 0.02 for cytological and pain scores, P < 0.003 for bacteriologic assessment, P < 10- 4 for pruritus, total OTIS-3 and temperature assessments; BW: P < 10- 4 for all clinical, cytological and bacteriologic assessments; C: P < 0.02 for all clinical and cytological assessments, P < 10- 4 for bacteriologic assessment). The highest clinical score reduction occurred in Group BW (P < 0.014 in T3; P < 0.001 in T4 and P < 10- 4 in T5). BW reached the clinically relevant effect level at T3 (- 3.26 ± 1.21 levels), QW reached it at T4 (- 3.24 ± 0.99), C did not reach it. No differences between groups were seen in the reduction of CFU/mL (T0-T5).

CONCLUSIONS

All treatment groups showed a positive clinical effect. LIG administered twice-a-week was the most favourable protocol of the study. LIG may be considered beneficial in the management of canine otitis externa; it seems to be effective in controlling the clinical condition, including the signs of inflammation and local pain, the bacterial growth, and it may help increasing treatment compliance.

Benchmarking veterinary librarians' participation in systematic reviews and scoping reviews

OBJECTIVES

The objectives of this study were to benchmark roles that veterinary librarians at universities and colleges play in systematic reviews (SRs) and scoping reviews that are conducted by faculty and students at their institutions, to benchmark the level of training that veterinary librarians have in conducting SRs, to identify barriers to their participation in SRs, and to identify other types of literature reviews that veterinary librarians participate in.

METHODS

Sixty veterinary librarians in universities and colleges in Canada, the United States, England, Scotland, Ireland, Australia, and New Zealand were surveyed online about their roles and training in conducting SRs, barriers to participation in SRs, and participation in other types of literature reviews.

RESULTS

Veterinary librarians' highest participation was at an advising level in traditional librarian roles as question formulator, database selector, search strategy developer, and reference manager. Most respondents reported pretty good to extensive training in traditional roles and no or some training in less traditional roles. Sixty percent of respondents received few or no requests to participate in SRs, and only half of respondents had participated in SRs as a review team member. Sixty percent of respondents stated that their libraries had no policies regarding librarian roles and participation in SRs.

CONCLUSIONS

The surveyed veterinary librarians participated in SRs to a lesser degree than human health sciences librarians, experienced low demand from veterinary faculty and students to participate in SRs, and participated as review team members at significantly lower rates than human health sciences librarians. The main barriers to participation in SRs were lack of library policies, insufficient training, and lack of time.

An empirical assessment of research practices across 163 clinical trials of tumor-bearing companion dogs

Comparative clinical trials of domestic dogs with spontaneously-occurring cancers are increasingly common. Canine cancers are likely more representative of human cancers than induced murine tumors. These trials could bridge murine models and human trials and better prioritize drug candidates. Such investigations also benefit veterinary patients. We aimed to evaluate the design and reporting practices of clinical trials containing ≥2 arms and involving tumor-bearing dogs. 163 trials containing 8552 animals were systematically retrieved from PubMed (searched 1/18/18). Data extracted included sample sizes, response criteria, study design, and outcome reporting. Low sample sizes were prevalent (median n = 33). The median detectable hazard ratio was 0.3 for overall survival and 0.06 for disease progression. Progressive disease thresholds for studies that did not adopt VCOG-RECIST guidelines varied in stringency. Additionally, there was significant underreporting across all Cochrane risk of bias categories. The proportion of studies with unclear reporting ranged from 44% (randomization) to 94% (selective reporting). 72% of studies also failed to define a primary outcome. The present study confirms previous findings that clinical trials in dogs need to be improved, particularly regarding low statistical power and underreporting of design and outcomes.

Sample size and number of outcome measures of veterinary randomised controlled trials of pharmaceutical interventions funded by different sources, a cross-sectional study

Background

Randomised controlled trials (RCTs) are a key component of the veterinary evidence base. Sample sizes and defined outcome measures are crucial components of RCTs.

To describe the sample size and number of outcome measures of veterinary RCTs either funded by the pharmaceutical industry or not, published in 2011.

Methods

A structured search of PubMed identified RCTs examining the efficacy of pharmaceutical interventions. Number of outcome measures, number of animals enrolled per trial, whether a primary outcome was identified, and the presence of a sample size calculation were extracted from the RCTs. The source of funding was identified for each trial and groups compared on the above parameters.

Results

Literature searches returned 972 papers; 86 papers comprising 126 individual trials were analysed. The median number of outcomes per trial was 5.0; there were no significant differences across funding groups (p = 0.133). The median number of animals enrolled per trial was 30.0; this was similar across funding groups (p = 0.302). A primary outcome was identified in 40.5% of trials and was significantly more likely to be stated in trials funded by a pharmaceutical company. A very low percentage of trials reported a sample size calculation (14.3%).

Conclusions

Failure to report primary outcomes, justify sample sizes and the reporting of multiple outcome measures was a common feature in all of the clinical trials examined in this study. It is possible some of these factors may be affected by the source of funding of the studies, but the influence of funding needs to be explored with a larger number of trials. Some veterinary RCTs provide a weak evidence base and targeted strategies are required to improve the quality of veterinary RCTs to ensure there is reliable evidence on which to base clinical decisions.

Electronic supplementary material

The online version of this article (10.1186/s12917-017-1207-0) contains supplementary material, which is available to authorized users.

Comparison of veterinary drugs and veterinary homeopathy: part 2

Part 2 of this narrative review outlines the theoretical and practical bases for assessing the efficacy and effectiveness of conventional medicines and homeopathic products. Known and postulated mechanisms of action are critically reviewed. The evidence for clinical efficacy of products in both categories, in the form of practitioner experience, meta-analysis and systematic reviews of clinical trial results, is discussed. The review also addresses problems and pitfalls in assessing data, and the ethical and negative aspects of pharmacology and homeopathy in veterinary medicine.

How to Report Exotic Animal Research

Reporting the results of primary research is a key step in knowledge creation. Many well-conducted studies are rejected by journal editors, criticized by peers, or unsuitable for systematic reviewers because of poor reporting. This article summarizes the most important methodological items to report when writing an original research article.

Clinical Trials in Veterinary Medicine: A New Era Brings New Challenges

Randomized clinical trials (RCTs) are among the most rigorous ways to determine the causal relationship between an intervention and important clinical outcome. Their use in veterinary medicine has become increasingly common, and as is often the case, with progress comes new challenges. Randomized clinical trials yield important answers, but results from these studies can be unhelpful or even misleading unless the study design and reporting are carried out with care. Herein, we offer some perspective on several emerging challenges associated with RCTs, including use of composite endpoints, the reporting of different forms of risk, analysis in the presence of missing data, and issues of reporting and safety assessment. These topics are explored in the context of previously reported veterinary internal medicine studies as well as through illustrative examples with hypothetical data sets. Moreover, many insights germane to RCTs in veterinary internal medicine can be drawn from the wealth of experience with RCTs in the human medical field. A better understanding of the issues presented here can help improve the design, interpretation, and reporting of veterinary RCTs.

Reporting and communication of randomisation procedures is suboptimal in veterinary trials

To evaluate randomisation mechanisms in the veterinary literature, all trials defined as ‘randomised’ were extracted from five leading veterinary journals for the year 2013. Three blinded investigators evaluated (1) if the random sequence generation was actually non-random, and (2) whether method (CONSORT item 8A) and (3) type of randomisation (CONSORT item 8B) were reported. Trialists were contacted via email to establish (1) willingness to respond to questions on randomisation procedures, (2) whether reporting of randomisation improved following a suggestion to use the CONSORT 2010 guideline. Seven per cent ((95 per cent CI 2 to 12 per cent); 8/114) of the trials defined as ‘randomised’ explicitly used methods that are considered non-random. Almost half of the trials (49 per cent (40 to 59 per cent); 52/106) did not report any mechanism of randomisation. Only 13 trials (12.3 per cent (6 to 19 per cent); 13/106) reported both items. 39 of 114 (34.2 per cent) trialists contacted were willing to respond to further questions on randomisation mechanisms; 4 (3.5 per cent) trialists were unwilling and 71 (62.3 per cent) trialists did not respond. Email correspondence resulted in a mean clarification of 0.7 items (95 per cent CI 0.4 to 1.0) for the 15 trials for trialists that replied. Improved adherence to CONSORT guidelines and trialists communication is imperative to increase the quality of published evidence in veterinary medicine and to reduce research waste.