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      Risk factors for acute abdominal pain (colic) in the adult horse: A scoping review of risk factors, and a systematic review of the effect of management-related changes

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          Abstract

          Acute abdominal pain (colic) is the most common reason for emergency veterinary treatment in the horse. Consolidation of data through a systematic review is important to inform evidence-based medicine and clinical guidelines, but there are currently no published systematic reviews on colic in the horse. The aim of this study was to identify, categorize and appraise the evidence on factors associated with increased risk of developing abdominal pain (colic) due to gastrointestinal disease in the adult horse. A scoping review was performed to identify and categorize evidence on all risk factors for colic. A systematic review of management-related risk factors was then performed following PRISMA guidelines. Both searches were conducted in Medline, CAB Abstracts and Web of Science databases, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. For the systematic review, cohort, case-control or cross-sectional studies investigating acute abdominal pain in horses within two weeks of management changes were assessed. Study characteristics, participant characteristics and study results of included publications for the systematic review were extracted and tabulated. Included publications were appraised using the Joanna Briggs Institute Critical Appraisal Tools for cohort, case-control and cross-sectional studies. The scoping review search identified 3,756 publications. Fifty eight studies met final inclusion criteria, and 22 categories of risk factors were identified. These were grouped into three broad areas: horse-related factors, management-related factors and environment-related factors. The largest body of evidence related to management change. The systematic review of management change identified 410 publications: 14 met inclusion criteria for analysis. These consisted of one cohort, eight case-control and five cross-sectional studies. The studies were conducted between 1990–2008, and the majority of studies were located in the USA (8/14) or UK (3/14). The risk factors related to management change that were assessed were feed, carer, exercise, pasture, water and housing. The largest bodies of evidence for increased risk of colic associated with management change were changes in feed (5/14 publications) and recent change in housing (3/14). Most studies (8/14) did not meet the JBI criterion on confounding factors. There was marked heterogeneity of study methodologies and measures. This is the first study to use a combined scoping and systematic review to analyse evidence for modifiable risk factors for a common condition in the horse. It provides a comprehensive review that will be a key resource for researchers, veterinary practitioners and horse owners. It identified modifiable risk factors associated with an increased risk of colic which should be a key target for preventative health programmes. The findings from the critical appraisal were used to develop recommendations for future research to improve the quality of evidence-based veterinary medicine.

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          Most cited references 62

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          Extending an evidence hierarchy to include topics other than treatment: revising the Australian 'levels of evidence'

          Background In 1999 a four-level hierarchy of evidence was promoted by the National Health and Medical Research Council in Australia. The primary purpose of this hierarchy was to assist with clinical practice guideline development, although it was co-opted for use in systematic literature reviews and health technology assessments. In this hierarchy interventional study designs were ranked according to the likelihood that bias had been eliminated and thus it was not ideal to assess studies that addressed other types of clinical questions. This paper reports on the revision and extension of this evidence hierarchy to enable broader use within existing evidence assessment systems. Methods A working party identified and assessed empirical evidence, and used a commissioned review of existing evidence assessment schema, to support decision-making regarding revision of the hierarchy. The aim was to retain the existing evidence levels I-IV but increase their relevance for assessing the quality of individual diagnostic accuracy, prognostic, aetiologic and screening studies. Comprehensive public consultation was undertaken and the revised hierarchy was piloted by individual health technology assessment agencies and clinical practice guideline developers. After two and a half years, the hierarchy was again revised and commenced a further 18 month pilot period. Results A suitable framework was identified upon which to model the revision. Consistency was maintained in the hierarchy of "levels of evidence" across all types of clinical questions; empirical evidence was used to support the relationship between study design and ranking in the hierarchy wherever possible; and systematic reviews of lower level studies were themselves ascribed a ranking. The impact of ethics on the hierarchy of study designs was acknowledged in the framework, along with a consideration of how harms should be assessed. Conclusion The revised evidence hierarchy is now widely used and provides a common standard against which to initially judge the likelihood of bias in individual studies evaluating interventional, diagnostic accuracy, prognostic, aetiologic or screening topics. Detailed quality appraisal of these individual studies, as well as grading of the body of evidence to answer each clinical, research or policy question, can then be undertaken as required.
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            Searching the veterinary literature: a comparison of the coverage of veterinary journals by nine bibliographic databases.

            A thorough search of the literature to find the best evidence is central to the practice of evidence-based veterinary medicine. This requires knowing which databases to search to maximize journal coverage. The aim of the present study was to compare the coverage of active veterinary journals by nine bibliographic databases to inform future systematic reviews and other evidence-based searches. Coverage was assessed using lists of included journals produced by the database providers. For 121 active veterinary journals in the "Basic List of Veterinary Medical Serials, Third Edition," the percentage coverage was the highest for Scopus (98.3%) and CAB Abstracts (97.5%). For an extensive list of 1,139 journals with significant veterinary content compiled from a variety of sources, coverage was much greater in CAB Abstracts (90.2%) than in any other database, the next highest coverage being in Scopus (58.3%). The maximum coverage of the extensive journal list that could be obtained in a search without including CAB Abstracts was 69.8%. It was concluded that to maximize journal coverage and avoid missing potentially relevant evidence, CAB Abstracts should be included in any veterinary literature search.
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              Feeding practices associated with colic in horses.

              To determine whether specific feeding practices were associated with development of colic in horses. Prospective matched case-control study. 364 horses examined by veterinarians in private practice in Texas because of colic (cases; n = 182) or any other reason (controls; 182). Participating veterinarians were sent forms at the beginning of the study to collect information on signalment, feeding management practices, farm management practices, and preventive medical treatments. Case and control horses were compared by use of conditional logistic regression to identify factors associated with colic. Risk factors for colic were a recent change in batch of hay, decreased exposure to pasture, a recent change in type of grain or concentrate fed, feeding > 2.7 kg (6 lb) of oats/d, feeding hay from round bales, and Thoroughbred breed. Recent anthelmintic administration decreased the risk of colic. Results suggest that certain changes in diet (eg, change in batch of hay, change in type of grain or concentrate, feeding hay from round bales) and management (eg, decreased availability of pasture) increase the risk of colic in horses.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Funding acquisitionRole: Project administrationRole: SupervisionRole: Validation
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 July 2019
                2019
                : 14
                : 7
                Affiliations
                School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonnington, Loughborough, Leicestershire, United Kingdom
                University of Illinois, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤]

                Current address: 10 Cranage Place, Middlewich, Cheshire

                Article
                PONE-D-19-07552
                10.1371/journal.pone.0219307
                6622499
                31295284
                © 2019 Curtis et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 8, Pages: 32
                Product
                Funding
                Funded by: University of Nottingham
                Award Recipient :
                Dr Laila Curtis PhD studentship was funded by the University of Nottingham. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Organisms
                Eukaryota
                Animals
                Vertebrates
                Amniotes
                Mammals
                Equines
                Horses
                Research and Analysis Methods
                Research Assessment
                Systematic Reviews
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Pain
                Abdominal Pain
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Pain
                Abdominal Pain
                Research and Analysis Methods
                Database and Informatics Methods
                Database Searching
                Biology and Life Sciences
                Veterinary Science
                Veterinary Medicine
                Veterinary Surgery
                Social Sciences
                Sociology
                Education
                Schools
                Universities
                Biology and Life Sciences
                Veterinary Science
                Veterinary Medicine
                Veterinary Diagnostics
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

                Uncategorized

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