Molly Crews

Veterinarians are expected to make treatment and intervention recommendations that are specific to client needs, based on clinical expertise, and made in consideration of the best available research evidence. Consideration of research evidence requires not just keeping up with new studies but also critically appraising and assessing their relevance within the larger context of the body of evidence. Ideally, a veterinarian could access robust and transparent reviews such as systematic reviews and meta-analyses, but few are available in veterinary medicine. Therefore, veterinarians seek other sources of information including individual research papers. This process is time-intensive, and veterinarians face barriers of access, skill and time as obstacles to keeping up. Recognizing time as the greatest barrier, the Evidence-Based Veterinary Medicine Association (EBVMA) Board, in collaboration with invited colleagues, developed QUIT—the Quality and Uncertainty Indicator Triage tool. The QUIT tool is comprised of 10 binary questions designed to help the reader flag concerns potentially affecting the reliability of treatment studies. As flags accumulate, the reader can more confidently quit reading and set the study aside. The QUIT tool is intended as a guide for ruling out studies and is not to be used for ruling in studies for inclusion in decision making ; questions are inadequate to fully assess study validity. This is a subtle but important distinction. The QUIT tool and all supporting materials are freely available on the EBVMA website. Lastly, QUIT is a prototype and we invite your feedback by submitting a completed feedback form to info@ebvma.org .

Objective: To survey academic journals for the presence and clarity of author instructions for submitting veterinary systematic reviews. Methods: Instructions to authors for submitting systematic reviews were surveyed across the 10 academic journals publishing the greatest number of veterinary systematic reviews listed in VetSRev, a citation database exclusively listing systematic reviews of topics relevant to veterinary medicine. Two investigators independently reviewed each author instructions section to answer predetermined survey questions. Data were collected and reviewed from October 21, 2023, through April 9, 2024. Results: Instructions to authors varied across journals, and the requirements for compliance with established reporting guidelines (eg, Preferred Reporting Items for Systematic Reviews and Meta-Analyses) were inconsistent. Four of 10 journals clearly stated the need to follow systematic reporting guidelines, 4 recommended or encouraged the use of guidelines, and 2 had no specific instructions for systematic reviews or reporting guidelines. Conclusions: Instructions for authors submitting veterinary medical systematic reviews are often incomplete or unclear. Clinical Relevance: In the absence of clear and consistent journal requirements for compliance with established systematic review reporting guidelines, the risk of publishing bias or misleading systematic reviews may be increased, which may negatively impact clinical decision making. Ensuring clear and concise instructions for authors will improve the quality of evidence and reporting. Greater clarity and consistency of author instructions and reporting requirements across all journals and increasing author awareness of the need to use reporting guidelines will improve the quality of veterinary systematic reviews.

Bovine respiratory disease (BRD) is a multifactorial disease complex commonly affecting beef and dairy operations. Vaccination against major BRD-related pathogens is routinely performed for disease prevention; however, uniform reporting of health and performance outcomes is infrequent. Our objective was to evaluate the effect of commercially available BRD-pathogen vaccination on titer response with respect to health or performance in beef and dairy cattle. This study was conducted under Prisma 2020 guidelines for systematic reviews and PRESS guidelines utilizing five databases. Criteria for study inclusion were as follows: research conducted in the USA or Canada, between 1982 and 10 October 2022, on beef or dairy cattle, using a commercially available vaccine labeled for a respiratory pathogen of interest, which evaluated antibody titers alongside either performance or morbidity. A total of 3020 records underwent title and abstract evaluation. Full-text analysis was conducted on 466 reports; 101 studies were included in the final review. Approximately 74% of included studies were beef cattle-based versus 26% dairy cattle-based. This review aimed to assess how vaccination titer responses affect beef and dairy cattle health and performance, but varying study methods made comparisons difficult, highlighting the need for consistent reporting.

Objective: To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps.Design: Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.Setting: Transdisciplinary, international collaboration in university, specialty, and emergency practice.Results: Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open‐chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open‐chest CPR. We recommend against high‐dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats.Conclusions: These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.

Objective: To systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps.Design: Standardized, systematic evaluation of literature pertinent to peri‐CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.Setting: Transdisciplinary, international collaboration in university, specialty, and emergency practice.Results: Thirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end‐tidal CO₂ (ETco₂) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.Conclusions: The Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re‐arrest, or under general anesthesia. This report highlights the utility of ETco₂ monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra‐arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome‐relevant interventions.

Objective: To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.Design: Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.Setting: Transdisciplinary, international collaboration in university, specialty, and emergency practice.Results: Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high‐quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide‐chested dogs. When intubation is not possible, bag–mask ventilation using a tight‐fitting facemask with oxygen supplementation is recommended rather than mouth‐to‐nose ventilation.Conclusions: These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation‐specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.