Nontraditional approaches to pain management.

The word nontraditional in the context of this article implies those modalities not normally taught in veterinary medical schools. This word has the same definition of Complementary and Alternative Medicine (CAM) as put forth by the Harvard medical school. CAM is a field of medicine that has enjoyed a recent increase in popularity in both human and equine medicine, particularly in regard to pain management. Some of the more recognized modalities include acupuncture, herbalism, and homeopathy. A brief discussion regarding the theory, scientific evidence and use of these therapies in the treatment of pain will be discussed.     

Non-steroidal anti-inflammatory drugs in equine orthopaedics

Orthopaedic disorders are commonly encountered in equine veterinary medicine, and non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in the management of many equine orthopaedic disorders. There are multiple NSAIDs available for use in horses, including both non-selective and selective NSAIDS, and the body of literature evaluating the efficacy of these medications, their effects on normal and inflamed musculoskeletal tissues, and their side effects is broad. This review aims to summarise the current literature on the use of NSAIDs for equine orthopaedic disorders and examines new and future avenues for the management of inflammation in equine orthopaedics.     

Ophthalmic imaging.

The availability of advanced imaging modalities in veterinary medicine has greatly widened the diagnostic imaging capabilities possible.Ultrasonography provides a rapid noninvasive modality that provides detailed examination and resolution of the intraocular structures and soft tissues surrounding the orbit of opaque eyes.Ultrasonography is cost-effective and widely available to practitioners,referral centers, and academic institutions. In many areas,mobile specialist ultrasonographers are available to supplement the equipment and skills of the practitioner. The added strengths of CT and MRI lie in their cross-sectional capability and better image quality. Unfortunately, the cost of CT and MRI currently limits their availability to referral centers and academic institutions.Primarily because of financial considerations, CT is currently more widely available for evaluation of equine disorders than MRI. A thorough evaluation of the multiple images and an understanding of normal anatomy and abnormal tissue patterns are indicated to maximize the use of each modality. Unlike ultrasonography, which can be performed in awake horses, the costs and contraindications of general anesthesia in some critical patients should also be considered when using CT and MRI. Finally, imaging artifacts are frequently encountered with each of these modalities. Thus, a thorough understanding of the various types of artifacts that occur is important so as to avoid interpretation pitfalls.     

Tools for the diagnosis of equine respiratory disorders.

Respiratory disorders are among the most common problems leading horse owners to seek veterinary attention. Accurate diagnosis of these conditions allows for proper treatment to be instituted, much to the benefit of the patient and satisfaction of the client. As an introduction to this issue on equine respiratory disorders, we review some of the tools that are available to equine veterinarians for the diagnosis of respiratory disorders. Physical and endoscopic examination, radiology, diagnostic ultrasound, techniques for sampling the respiratory tract, hematology, blood gas analysis, respiratory mechanics, and some modern diagnostic tools are briefly covered.     

Veterinary Neurologic Rehabilitation: The Rationale for a Comprehensive Approach

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients.The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes—many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture’s ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury.Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.     

Results of a survey on educational and research programs in complementary and alternative veterinary medicine at veterinary medical schools in the United States

OBJECTIVE: To document educational and research programs in complementary and alternative veterinary medicine (CAVM) at US veterinary schools and to develop recommendations for additional curriculum development and research in these modalities. DESIGN: Mail questionnaire. SAMPLE POPULATION: Deans, curriculum committees, and interested faculty at US veterinary schools. PROCEDURES: Questionnaires were mailed to personnel at all 27 US veterinary schools. Nonrespondents received a follow-up letter and telephone contact. Information was used to establish the current status of CAVM. RESULTS: Responses were received for 41 of 120 (34%) questionnaires. Responses were received from 23 of 27 veterinary schools, but number of respondents varied at each institution (range, 1 to 4) and some surveys were not complete. Seven of 27 US veterinary schools had an educational program in CAVM. Thirty-six (87%) respondents believed that acupuncture, nutraceuticals, nutritional supplements, and physical therapy should be included in the curriculum, 25 (61%) indicated that botanical (herbal) medicine should be included, and 25 (61%) believed that chiropractic should be included. Only 17 (44%) respondents believed that homeopathy should be included. The majority of respondents believed that CAVM should be offered as elective courses. Research in CAVM has been conducted at 6 responding schools. CONCLUSIONS: Currently, few veterinary schools offer educational or research programs in CAVM. Veterinary schools are aware of the interest in CAVM and acknowledge a lack of educational and research programs in these areas. More veterinary schools are in the process of developing educational and research programs in various aspects of CAVM.     

Future diagnostic methods. A brief look at new technologies and their potential application to equine diagnosis

We live in an age in which highly sophisticated computerized equipment and imaging methods are becoming increasingly available. Demand from clients requires that we as veterinary professionals keep our eyes on the future potential of these technologies for diagnosis and treatment. This article briefly reviews some of the techniques that are just around the corner for the progressive equine practitioner.     

Equine dental advances.

The reintroduction and development of safe motorized instruments, the increased availability of continuing education, and the understanding and implementation of appropriate procedures allow practitioners to provide better dental care. Veterinarians realize that sedation, analgesia, a full-mouth speculum, and proper instrumentation are necessary to provide these services. Continued instrument design, future research, and new treatment and prophylactic protocols should have a positive impact on the future of equine dental health. New and rediscovered procedures for equilibrating equine occlusion are allowing horses to masticate more efficiently, carry a bit more comfortably, and experience improved performance. The horse, the horse owner, and the veterinary profession all benefit from providing complete equine dental care.     

Computed radiography.

CR is a useful tool for the equine veterinarian and has many advantages. Its only major disadvantage is the initial cost, in dollars and time, for setup in one's practice. CR is already in use at several universities and private practices in the United States and around the world. In the future, as is the case with any computer-based technology, this modality should become more affordable and readily available to smaller practices. The potential of CR in veterinary medicine combined with saturation of the human market is driving the development of specialized software and algorithms for veterinary medicine.     

兽用中药生物学检测方法与评价技术

兽用中药化学成分复杂、药效物质基础研究薄弱,质量控制与评价一直是其研究的难点。现行的以理化检测方法为主的质量控制手段难以满足现代中兽医药发展的需要,难以很好地反映中药的有效性、安全性。本文阐述了显微、DNA条形码分子鉴定、基因芯片等生物学检测方法与评价技术在兽用中药质量控制中的应用价值,建议加强生物学相关检测及评价技术的研究和应用,弥补传统质控方法的不足,促进兽用中药质量控制水平的全面提升。     

Use of complementary veterinary medicine in the geriatric horse.

The use of complementary and alternative veterinary medicine continues to grow within the veterinary community. As more clients seek out complementary and alternative medicine for their own health care, they begin to seek out these forms of therapy for their animals. For the equine practitioner, this includes those clients with geriatric animals. It is hoped that this article provides some insight into what conditions may be helped with CVM (complementary veterinary medicine) and when an equine practitioner may want to consider CVM as a form of therapy for the geriatric horse.     

Aerosol therapy in the equine species

Inhalation therapy plays an increasing role in the management of equine respiratory disorders. Thisalternative to systematic treatment permits a high concentration of medication to act locally while minimizing side effects and residues. In human medicine, literature in this field is prolific and continuously renewed, whereas in veterinary medicine, applications of aerosol therapy are less extensive. This review considers the principles of action of the different types of devices used for inhalation, i.e., nebulization, metered-dose inhalation and dry powder inhalation, describes the technical and practical requirements for their use in the equine species and considers the advantages and disadvantages of each inhalation device. The pharmacological agents currently administered to horses by inhalation are also discussed. Perspectives of aerosol therapy in the equine species, including aerosols already used in human medicine and their potential applications for horses are described.     

Advanced imaging for veterinary cancer patients.

This article presents an update on the recent advances made in veterinary advanced imaging specifically with regard to cross-sectional modalities (CT and MRI) and nuclear medicine (positron emission tomography [PET] and PET/CT). A brief summary of technical improvements and a review of recent literature are included to provide an overview of the progress made in this important element of the practicing veterinary oncologist's repertoire. An in-depth summary of PET is also included to introduce the technical aspects and potential clinical and research applications of this novel imaging modality in veterinary medicine.     

The use of veterinary medicinal products in equine practices in The Netherlands: Balancing between the law and good veterinary practice

This study investigates the present situation with respect to the use and abuse of (veterinary) medicinal products (VMPs) by equine practitioners and endeavours to substantiate the perceived discrepancies and friction between the availability of VMPs, legislation in force, code of Good Veterinary Practice and reality of day‐today equine practice. It can be concluded that practising equine medicine in The Netherlands using only authorised equine VMPs is impossible. In most cases the ‘cascade’ or list of essential substances is needed to legitimise the use or, even worse, the use is not legitimised at all. Existing differences between European Union member states in the outcome of procedures for obtaining a marketing authorisation for the same product is seen as an obstacle for the availability and development of equine VMPs needed for safeguarding the future of a professional equine veterinary healthcare.     

Gene therapy: future therapies in osteoarthritis.

The field of equine veterinary practice is in an ever-evolving state, requiring current technologies to be constantly evaluated for new applications. The specific use of gene therapy in the horse is a novel application. The authors want to help familiarize the equine practitioner with the concept of gene therapy, and introduce its use and potential future benefits for the equine industry in the treatment of osteoarthritis.     

Quality of equine veterinary care. Part 2: Client satisfaction in equine top sports medicine in The Netherlands

The aim of this study was to evaluate systematically the quality of equine veterinary top sports medicine in The Netherlands and the degree to which the expectations in the field are met. Focus was on structure, process and outcome of care. The structure of care is generally satisfactory but there is insufficient transfer of applicable scientific knowledge to the equine community and a lack of regular checks by team vets. The process of care is hampered by the failure in communication between the veterinary and paraveterinary members of a team. For continuation of the excellent international results of Dutch riders and drivers a more collaborative approach, abandoning the often secretive character of equine medicine in relation to sport horses, is necessary.     

Feline thyroid storm.

Thyroid storm is a syndrome described in human medicine to define a multisystemic disorder resulting from organ exposure to excessive levels of thyroid hormone. This form of acute thyrotoxicosis, although uncommon, can be life threatening and is a significant cause of mortality in human emergency rooms. Although thyroid storm is a well-recognized clinical entity in human medicine, it has not been described in veterinary medicine. This article discusses the human syndrome and defines a similar syndrome in hyperthyroid veterinary patients. The clinical signs of and treatment modalities for feline thyroid storm are also presented.     

我国循证兽医学的应用现状与发展方向

循证兽医学是循证医学的一个分支或单独的学科。对于不同患病个体,它是依据现有的证据,进行认真有效的诊断,可以认为是一种个性化诊疗。循证兽医学在国内属于一个比较新的兽医学研究领域,目前,对于循证兽医学的研究很少。在国外,循证兽医学研究较国内更为完善,并呈逐渐上升的发展趋势。循证兽医学在临床中的应用,主要依据现有临床证据、研究数据等。然而,对于兽医临床证据的缺乏是限制我国循证兽医学发展的主要因素之一。在一定程度上,目前国内兽医学研究的不足与缺陷制约了循证兽医学的发展。从今后的发展趋势来看,循证兽医学势必成为兽医学研究领域中不可或缺的一部分。     

Antimicrobial stewardship in equine practice

Antimicrobial stewardship involves the judicious use of antimicrobials balanced against the requirement to treat the presenting clinical condition. The same mandate and principles as discussed in human medicine and other veterinary disciplines are relevant to equine practice. This brief review will focus on available resources for equine practitioners, emerging perspectives on antimicrobial use and stewardship, and opportunities for more effective antimicrobial use in equine practice. There is a need for improved client education, availability of faster and more accurate techniques for identification and sensitivity testing of bacterial pathogens, and the development of novel agents.