Can we publish something, how hard is it?

RE: Can we publish something, how hard is it?

Rob Loxley — Sun, 29 Apr 2018 15:56:15 GMT

[quote user="Anthony Todd"]

[quote user="Beats"]

I prefer the hotspot suggestion to aural haematoma

1) Parenteral steroids only

[/quote]

Not to start a tangent,

[/quote]

There's a button for that

RE: Can we publish something, how hard is it?

Anthony Todd — Sun, 29 Apr 2018 10:48:07 GMT

[quote user="Beats"]

I prefer the hotspot suggestion to aural haematoma

1) Parenteral steroids only

[/quote]

Not to start a tangent, but in cats and dogs method 1) worked every time. Any local treatment just increased the local irritation and exacerbated the lesion with more self-trauma.

No A/Bs, no clipping, no culture and sens, no local bathing or cleaning, no nuffing!

Distraction therapy [sellotape/electrician's tape] on the diagonally opposite foot helped initially and immensely.

Must repeat steroid at first signs of recurrence or relapse.

RE: Can we publish something, how hard is it?

Anthony Todd — Sun, 29 Apr 2018 10:38:51 GMT

[quote user="robloxley"]see previous reference,[/quote]

https://www.ncbi.nlm.nih.gov/m/pubmed/26273010/

Is this the one??

RE: Can we publish something, how hard is it?

Rob Loxley — Sun, 29 Apr 2018 10:08:26 GMT

[quote user="David Mills"]

This in a nutshell is the problem with EBVM.

Statisticians - the new sorcerers of medicine

[/quote]

Are you being dismissive of statistics, or just statisticians?

[quote user="Anthony Todd"]But. at the moment we've got nothing and despite all the theoretical statistical disadvantages and supported by pictures I'd be happy with anything over a small number[/quote]

If we are to move from anecdote (and there's lots already written about aural hamatomas) towards clinically useful evidence then we need some estimate of what sample size is needed, or should we be dismissive of any attempts at 'study design'.

[quote user="Anthony Todd"]If we had 20 odd saying steroids were given and seemed to make a difference[/quote]

But I'm still not sure for aural haematomas what everyone is looking looking to measure as outcome, before deciding how?

[quote user="Anthony Todd"]At the moment we've got absolutely nothing![/quote] see previous reference, case series etc.

[quote user="Beats"]I prefer the hotspot suggestion to aural haematoma[/quote]

It's easily measurable

RE: Can we publish something, how hard is it?

Beats — Sun, 29 Apr 2018 07:39:36 GMT

I prefer the hotspot suggestion to aural haematoma

1) Parenteral steroids only

2) Clip and clean and local antisepsis (eg chlorhexidine) and parenteral steroids only

3) Topical steroids only

4) Topical steroids/antimicrobials only

5) Clip and clean then topical treatment only

6) Parenteral antibacterials and steroids

7) Apoquel

I've heard advocates for most of these approaches, I'd be interested to know even approximate success rates.

Seeing is believing and I think the photo idea is great, even if only for initial visit. [A phonecall a week later if not seen back might be more realistic than insisting on follow-up photo]

20-odd participants each choosing one primary treatment method, over a year, would give useful data in my eyes. Obviously the more the merrier, but you have to be realistic...

PS - anal sac abscess for next year?

PPS - oh and then please, please a 10 year study on cherry eye removal (partial) versus replacement versus benign neglect

RE: Can we publish something, how hard is it?

Anthony Todd — Sun, 29 Apr 2018 00:32:25 GMT

[quote user="robloxley"] a better statistician than me might be able to suggest how big a sample size is needed to overcome the variables to ensure a sufficiently powered study?[/quote]

But. at the moment we've got nothing and despite all the theoretical statistical disadvantages and supported by pictures I'd be happy with anything over a small number.

If we had 20 odd saying steroids were given and seemed to make a difference [purely as an example] I'd be happy to use them all the time.

At the moment we've got absolutely nothing!

RE: Can we publish something, how hard is it?

David Mills — Sat, 28 Apr 2018 23:49:47 GMT

[quote user="robloxley"]a better statistician than me might be able to suggest how big a sample size is needed to overcome the variables to ensure a sufficiently powered study?[/quote]

This in a nutshell is the problem with EBVM.

Statisticians - the new sorcerers of medicine.

RE: Can we publish something, how hard is it?

Rob Loxley — Sat, 28 Apr 2018 23:31:58 GMT

[quote user="Neil Wheadon"]If every regular contributor on here followed 2 or maybe 5 dogs in a year, you'd have several hundred dogs, enough to negate what I feel are tiny variables. The main issue as Michael quite rightly says are the placebo/no treatment group.[/quote]

And all assessed by the vets who have chosen that route of intervention who are therefore completely unbiased?
And moreover, I'm not sure even what the assessment criteria are for 'the best methods of treating aural haematomas' - appearance (which may be more evident depending on the breed and is rather subjective), pain/discomfort (assessed how and by whom, I'm not sure there's an aural haematoma pain scoring tool?), cost-effectiveness, time to resolution (of what?)?

I'm not against collecting data from practice to answer such questions, but a study to identify a superior method of treatment needs good design to get meaningful results. For instance, does each of us 'following 2-5 cases reach a good number'?: a better statistician than me might be able to suggest how big a sample size is needed to overcome the variables to ensure a sufficiently powered study?

RE: Can we publish something, how hard is it?

Neil Wheadon — Sat, 28 Apr 2018 22:37:49 GMT

[quote user="robloxley"]What are you then comparing: different dogs, different ears, different owners - as well as just different management?[/quote]

Really?

Different dogs, usually in medium sized dogs. Are there any papers with 100 dogs of the same breed?

Different ears. Right or left?

Different owners, every study has this, what variable do we have here? It's not like an orthopaedic condition, where we don't know how still if they are truly rested? These are pinna, there's not a lot a different client will do is there?

If every regular contributor on here followed 2 or maybe 5 dogs in a year, you'd have several hundred dogs, enough to negate what I feel are tiny variables. The main issue as Michael quite rightly says are the placebo/no treatment group.

Neil

RE: Can we publish something, how hard is it?

Rob Loxley — Sat, 28 Apr 2018 20:48:26 GMT

[quote user="Kate Richardson"]Could compare no treatment to drain only to drain plus corticosteroid injection to surgery? [/quote]

What are you then comparing: different dogs, different ears, different owners - as well as just different management?

RE: Can we publish something, how hard is it?

Kate Richardson — Sat, 28 Apr 2018 18:50:36 GMT

Anthony’s idea of monitoring via photos is a good one

Could compare no treatment to drain only to drain plus corticosteroid injection to surgery?

Photos at presentation, then weekly?

However I think trying to get everyone to remember would be the hard bit and can foresee lots of oops I forgot.

But theoretically useful ‘study’.

Or ’hotspots’- same principle.

RE: Can we publish something, how hard is it?

Neil Wheadon — Sat, 28 Apr 2018 17:41:38 GMT

[quote user="Niall Taylor"]That's why I can'y understand the point of draining via a needle - purely cosmetic, usually fills up again, risk of infection and leaves the fibrin clot where it is .[/quote]

I guess it's because the client wants it and the dog is uncomfortable

If you drain via a needle, it will swell again but will be gone in about 2 weeks

If you leave it, how long do they stay?? (that's the critical figure) Longer than 2 weeks is my guess and you'd be a brave vet to say, leave that and it'll go down eventually when drainage and DMV is straightforward and far more pleasant than surgery

Neil

RE: Can we publish something, how hard is it?

Anthony Todd — Sat, 28 Apr 2018 17:02:55 GMT

[quote user="Michael Woodhouse"]

How?

Without an untreated control population how could we ever know that?

This sort of study is interesting, but doesn't add much more than a survey of what people are doing. One persons view of 'excellent' outcome is very different to another's. How do you define a complication and how accurately are they recorded

[/quote]

Easy Peesy, with this condition,; just take pictures with your mobile phone...."

"done x, this is the best [see Pic 1] and this is the worst [see pic 7]

"I did nothing at all with all of them and gave them, this, that or the other treatment and they all got the same."

If everyone on here did the above with all of their aural haematomata you'd have a good idea in a year or so.

PS none of mine ever got infected but, as it's an unsterile procedure, they all got a shot of some A/B.

[probably not necessary but didn't have the courage not to]

RE: Can we publish something, how hard is it?

Anthony Todd — Sat, 28 Apr 2018 14:01:50 GMT

[quote user="Jill Butterworth"] I would say complications from treated ears (mine and other people's before you ask!) are relatively common, compared to other procedures: crinkly ears, infection,[/quote]

I did quite a few of these back in the day [and this has been discussed before....]

I got perfect cosmetic results in prick eared dogs or cats with a stitched through matched profile splint in every case I did and, as far as I recall, never any problems.

I can post the procedure if anyone is interested.

RE: Can we publish something, how hard is it?

Niall Taylor — Fri, 27 Apr 2018 21:32:52 GMT

[quote user="Jill Butterworth"] 'It's fine to leave them, they almost always resolve spontaneously, eventually (weeks), albeit with varying degrees of crinkly ear...[/quote]

Absolutely true, they will always resolve spontaneously, they're no different from any other haematoma/seroma in that respect. The only reason to operate is to remove the fibrin clot and reduce the risk of distortion as a result of the clot contracting. That's why I can'y understand the point of draining via a needle - purely cosmetic, usually fills up again, risk of infection and leaves the fibrin clot where it is .

Niall

RE: Can we publish something, how hard is it?

David Mills — Fri, 27 Apr 2018 21:22:45 GMT

[quote user="Jo Dyer"]Do you have the reference for the Vet Record piece?[/quote]

https://www.ncbi.nlm.nih.gov/m/pubmed/26273010/

[quote user="Jo Dyer"]Keep us informed about what you find out![/quote]

Will do. Probably nothing!

RE: Can we publish something, how hard is it?

Jo Dyer — Fri, 27 Apr 2018 20:45:44 GMT

[quote user="David Mills"]Yes, its mealy-mouthed titled is "Epistemology and Ethics of Evidence Based Medicine" currently.[/quote]

Well I've learned a new word!

[quote user="David Mills"]There is lots in the human sphere about this, for particularly strong critiques read those by Goldenberg and Worrall.[/quote]

Thanks, I will.

Do you have the reference for the Vet Record piece?

Keep us informed about what you find out!

RE: Can we publish something, how hard is it?

Michael Woodhouse — Fri, 27 Apr 2018 19:58:50 GMT

[quote user="Anthony Todd"]

Oh, so true, in spades. Just take the depo-med into aural haematomas...

It could well be that the same percentage of them get better if you do sweet nothing.....

But a simple anecdotal recording from easily 100 cases in a year, with a number of you on board ,would really prove, or disprove, the use of Dmed in haematomata!

[/quote]

How?

Without an untreated control population how could we ever know that?

RE: Can we publish something, how hard is it?

Liz Barton — Fri, 27 Apr 2018 16:46:27 GMT

[quote user="Jill Butterworth"]'It's fine to leave them, they almost always resolve spontaneously, eventually (weeks), albeit with varying degrees of crinkly ear, and we don't usually treat them here anymore'.[/quote]

Is this rugby players or dogs? In fact, what do the medics do with rugby-ears? If it's good enough for the Queen's grandson-in-law...

RE: Can we publish something, how hard is it?

Jill Butterworth — Fri, 27 Apr 2018 15:34:21 GMT

Anecdote alert. I was once locumming at a practice and seeing a client's dog with an aural haematoma, and as I started spouting the various treatment options, the nurse said (something like) 'It's fine to leave them, they almost always resolve spontaneously, eventually (weeks), albeit with varying degrees of crinkly ear, and we don't usually treat them here anymore'. I was a bit miffed, but I have to admit it's true. I started offering this to clients who were hard up, unless the pinna was huge and painful, and they are fine with the scarring if warned, you can't see it on long haired dogs, and I would say complications from treated ears (mine and other people's before you ask!) are relatively common, compared to other procedures: crinkly ears, infection, recurrence ...

RE: Can we publish something, how hard is it?

David Mills — Thu, 26 Apr 2018 11:10:35 GMT

[quote user="Liz Barton"]Hi all - this is what SAVSNET was setup to do. Big data from vets in practice: https://www.liverpool.ac.uk/savsnet/[/quote]

I would say careful with SAVSNET and VetCompass. They are epidemiological tools rather than those looking at clinical effectiveness. Any conclusions drawn from these (other than x number vets vets treat condition y with z) have to be very cautiously interpreted.

RE: Can we publish something, how hard is it?

David Mills — Thu, 26 Apr 2018 11:08:25 GMT

[quote user="Jo Dyer"]Am I right in thinking you are doing a PhD in evidence-based medicine David? If so what is the title and what have you learned so far? Agree with you in having doubts about the pyramid.[/quote]

Yes, its mealy-mouthed titled as "Epistemology and Ethics of Evidence Based Medicine" currently.

There is some stuff on the RCVS Knowledge website about some of the work being done from a conference a little while ago, and there will be a round-table discussion podcast on the ethics of EBVM next month. There was a piece in the Vet Record a while ago which stimulated the usual high-handed responses from the high priests. Just completing an empirical chapter on current practice of EBVM and how this relates to the vaunted "ideal".

There is lots in the human sphere about this, for particularly strong critiques read those by Goldenberg and Worrall.

Fundamentally, above and above the hubris of RCTS, animals are different and RCTs limited by the population and logistics. I'm coming round to a justification that observational studies (retrospective or prospective) are far better, and produce better evidence, for our patients.

RE: Can we publish something, how hard is it?

Liz Barton — Wed, 25 Apr 2018 12:27:14 GMT

[quote user="Kate Richardson"]Knowing that x % of the veterinary world treats condition y with z is useful and if a small % use a different treatment but have found it very good if not better, it would warrant looking at that alternative further and getting more information/evidence about it?[/quote]

Hi all - this is what SAVSNET was setup to do. Big data from vets in practice: https://www.liverpool.ac.uk/savsnet/

RE: Can we publish something, how hard is it?

Liz Barton — Wed, 25 Apr 2018 11:29:02 GMT

FYI I'm an increasing convert to use of probiotics - increasing data in both human and animal field on their use in wide ranging diseases including GI, ocular and rhinitis... often chronic cases unresponsive to other treatments.

RE: Can we publish something, how hard is it?

Anthony Todd — Wed, 25 Apr 2018 11:23:26 GMT

Thanks Liz.