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Pragmatic decision-making in the charity situation

image of Pragmatic decision-making in the charity situation
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Abstract

This chapter introduces basic concepts of clinical decision-making and evidence-based veterinary medicine, and suggests how they can be applied in a pragmatic way in a shelter or charitable environment. Decisions made in shelters and charitable organizations can be very different to those made in private clinical practice. Dealing with the elderly thin cat; Dealing with the elderly dog; Dealing with heart murmurs in dogs and cats.

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Figures

Image of 3.2
3.2 Use of System 1 and System 2 in clinical decision-making.
Image of 3.3
3.3 Different options arranged in a ‘decision’ tree to help the decision-making process. (The numbers in the example are fictional and are for explanatory purposes only.)
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3.4 The decisions made for cats in a shelter environment may be very different compared to decisions made for a privately owned cat with a dedicated owner – the evidence will be the same. (© Rachel Dean)
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3.5 The cycle of the five steps of Evidence-based Veterinary Medicine.
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3.6 A pragmatic approach to the multiple treatments available for many conditions involves careful consideration of which drug will make the most difference. (© Rachel Dean)
Image of Palpation for a thyroid nodule (goitre) is an essential component of physical examination of the elderly cat. Approximately 80% of cats with hyperthyroidism have a palpable goitre. (© Sarah Caney)
Palpation for a thyroid nodule (goitre) is an essential component of physical examination of the elderly cat. Approximately 80% of cats with hyperthyroidism have a palpable goitre. (© Sarah Caney) Palpation for a thyroid nodule (goitre) is an essential component of physical examination of the elderly cat. Approximately 80% of cats with hyperthyroidism have a palpable goitre. (© Sarah Caney)
Image of Assessing the bodyweight of a cat. (© Sarah Caney)
Assessing the bodyweight of a cat. (© Sarah Caney) Assessing the bodyweight of a cat. (© Sarah Caney)
Image of Flowchart to illustrate the assessment of an older dog’s health status when the animal’s history is unknown.
Flowchart to illustrate the assessment of an older dog’s health status when the animal’s history is unknown. Flowchart to illustrate the assessment of an older dog’s health status when the animal’s history is unknown.
Image of Providing some of the daily feed in suitable toys can help prevent boredom in older dogs with reduced exercise tolerance. (© Gemma Bourne)
Providing some of the daily feed in suitable toys can help prevent boredom in older dogs with reduced exercise tolerance. (© Gemma Bourne) Providing some of the daily feed in suitable toys can help prevent boredom in older dogs with reduced exercise tolerance. (© Gemma Bourne)
Image of Older dogs may appreciate a more sedentary lifestyle. (© Zoe Belshaw)
Older dogs may appreciate a more sedentary lifestyle. (© Zoe Belshaw) Older dogs may appreciate a more sedentary lifestyle. (© Zoe Belshaw)
Image of Rehoming an older dog can be very fulfilling for dog and owner alike. (© Zoe Belshaw)
Rehoming an older dog can be very fulfilling for dog and owner alike. (© Zoe Belshaw) Rehoming an older dog can be very fulfilling for dog and owner alike. (© Zoe Belshaw)
Image of Approach to the asymptomatic dog with a heart murmur. Note that in all cases, the gold standard is echocardiography performed by a cardiologist. If not available, see suggestions above. CHF = congestive heart failure; DCM = dilated cardiomyopathy; LA = left atrium; MMVD = myxomatous mitral valve disease; NT-proBNP = N-terminal pro B-type natriuretic peptide; PCV = packed cell volume; PDA = patent ductus arteriosus; PH = pulmonary hypertension.
Approach to the asymptomatic dog with a heart murmur. Note that in all cases, the gold standard is echocardiography performed by a cardiologist. If not available, see suggestions above. CHF = congestive heart failure; DCM = dilated cardiomyopathy; LA = left atrium; MMVD = myxomatous mitral valve disease; NT-proBNP = N-terminal pro B-type natriuretic peptide; PCV = packed cell volume; PDA = patent ductus arteriosus; PH = pulmonary hypertension. Approach to the asymptomatic dog with a heart murmur. Note that in all cases, the gold standard is echocardiography performed by a cardiologist. If not available, see suggestions above. CHF = congestive heart failure; DCM = dilated cardiomyopathy; LA = left atrium; MMVD = myxomatous mitral valve disease; NT-proBNP = N-terminal pro B-type natriuretic peptide; PCV = packed cell volume; PDA = patent ductus arteriosus; PH = pulmonary hypertension.
Image of Approach to the asymptomatic cat with a heart murmur. BP = blood pressure; LA = left atrium; NT-proBNP = N-terminal pro B-type natriuretic peptide; PCV = packed cell volume; T4 = thyroxine.
Approach to the asymptomatic cat with a heart murmur. BP = blood pressure; LA = left atrium; NT-proBNP = N-terminal pro B-type natriuretic peptide; PCV = packed cell volume; T4 = thyroxine. Approach to the asymptomatic cat with a heart murmur. BP = blood pressure; LA = left atrium; NT-proBNP = N-terminal pro B-type natriuretic peptide; PCV = packed cell volume; T4 = thyroxine.
Image of Right parasternal short-axis echocardiographic view showing the aortic valve (Ao) and left atrium (LA) in a cat with left atrial enlargement. A normal LA:Ao ratio is <1.5; values >1.8 are likely to indicate left atrial enlargement.
Right parasternal short-axis echocardiographic view showing the aortic valve (Ao) and left atrium (LA) in a cat with left atrial enlargement. A normal LA:Ao ratio is <1.5; values >1.8 are likely to indicate left atrial enlargement. Right parasternal short-axis echocardiographic view showing the aortic valve (Ao) and left atrium (LA) in a cat with left atrial enlargement. A normal LA:Ao ratio is <1.5; values >1.8 are likely to indicate left atrial enlargement.

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