@article{hinchcliff_acvim consensus statement taskforce_morley_dibartola_taylor_harrell_2023, title={ACVIM-Endorsed Statements: Consensus statements, evidence-based practice guidelines and systematic reviews}, volume={10}, ISSN={["1939-1676"]}, DOI={10.1111/jvim.16869}, abstractNote={The American College of Veterinary Internal Medicine (ACVIM) has commissioned groups of experts to produce “Consensus Statements” since 2000 to provide veterinarians with information about topics important to ACVIM Diplomates and the veterinary profession. The ACVIM Consensus Statements have been relatively succinct statements intended to guide decision-making about diagnosis, management or treatment of diseases of animals. During the past 20 years, Consensus Statements have evolved and several versions of guidelines have been developed by the ACVIM Board of Regents (BoR) and staff to facilitate selection of the topics, identify panel members, and determine logistics related to format and dissemination of the statements. The general purpose of these guidelines has been to clarify the responsibilities of the Chair and members of the panel, define the length of the statement, set timelines, and establish a financial agreement with panelists. Little attempt has been made to define how ACVIM Consensus Statements are prepared and the manner in which they consider the relevant literature and evaluate and report on evidence. The medical and veterinary communities increasingly rely on evidence-based statements on a particular topic for guidance and counsel on decisions relating to management of diseases.1, 2 There are several conventional formats for these statements, including consensus statements, practice guidelines, systematic reviews and position statements.3-8 Recently, scoping reviews have become more common and are gaining some traction in the veterinary literature.9 The methodology underlying each of these types of statements differs, but what all have in common is a well-described and accepted methodology for objectively considering and reporting the amount and quality of evidence. For example, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach is now widely used for developing practice (and other) guidelines, Cochrane prescribes a particular methodology for undertaking evidence-based reviews, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) defines how systematic reviews should be carried out, and the Delphi method is widely accepted for development of consensus statements.4, 5, 7, 8, 10-15 Scoping reviews are not designed or intended to produce a critically appraised and synthesized result/answer to a particular question and are therefore not included as an ACVIM-Endorsed Statement (AES).9 Narrative reviews are common in both the human and veterinary medical literature and there is a proposed methodology for evaluating their quality,16 but they are not considered sufficient to provide a rigorous, evidence-based assessment of a topic.17 Narrative reviews are not listed in the Oxford Centre for Evidence-Based Medicine hierarchy of evidence.17 There is increasing recognition of the need for clear guidelines for the development of expert statements.1 The variety of formats for these evidence-based statements reflects that the underlying reason for commissioning a statement dictates its format. One size does not fit all, and such is the case with ACVIM Consensus Statements as reflected by the variety of formats found in the 45 Consensus Statements published through the end of 2020. Most (n = 34, 76%) of these Consensus Statements are narrative reviews, although recently some statements have followed GRADE, Delphi or similar methodologies, likely reflecting increased recognition that ACVIM Consensus Statements should be developed using explicit and transparent criteria and methodologies. Of the 45 ACVIM Consensus Statements published between 2000 and 2020, only 13/45 (29%) describe the methodology used to develop the statement, 11 (24%) define particular questions to be addressed in the statement, 9 (20%) utilize descriptions of levels of evidence, and 4 (9%) address a limited number of questions (ie, narrowly define the topic) yet 20 (44%) provide specific recommendations. Clearly, guidelines in effect to date have not resulted in ACVIM Consensus Statements consistently conforming to contemporary standards for such expert statements. The ACVIM Consensus Statements make valuable contributions to the veterinary literature, providing practicing specialists and nonspecialists with recommendations developed by experts in the field and are consistently the most widely read of all articles published in the Journal of Veterinary Internal Medicine (based on downloads and citations). The ACVIM Consensus Statements are increasingly recognized as being an important source of expert advice and, as such, reflect well on the College. However, quality standards for such statements are increasing, and we believe that it is time that the College consider developing more uniform and rigorous practices and policies for creation of these statements. Doing so will ensure that readers of such expert statements are confident of the quality of the statement and that the statement reflects well on the ACVIM and the authors. The ACVIM supports the production of materials intended to assist clinicians and others in assessing the best available or optimal approach to providing veterinary care of animals or in understanding aspects of animal disease. These have been referred to as ACVIM Consensus Statements. One of the roles of the ACVIM is to identify appropriate topics and to ensure that these Consensus Statements are uniformly reliable and of high quality. To achieve this purpose, the ACVIM must ensure that topics are timely and relevant, panels are appropriately comprised of experts who are free of conflicts of interest, methodology is rigorous and transparent, and that there is a process for review of the draft statement. We proposed, and the Board of Regents accepted, that subsequent expert statements endorsed by the ACVIM be collectively referred to as AESs and that they be developed using specific methodologies. The roles of the Board of Regents and the Education and Research Committee may be modified from that proposed below to align with changes in the functions of the Board and Board officers. Narrative reviews, scoping reviews, and position papers are not considered suitable forms of AES. A narrative review provides a summary of current and relevant literature, but with few or limited comments on the quality of evidence and no formal recommendations for action. Importantly, they do not use PRISMA methodology.2, 15, 16 Scoping reviews do not seek to answer a particular question or questions, but are intended to identify certain characteristics or concepts in papers or studies, and examine the mapping, reporting or discussion of these characteristics or concepts.9 A position paper provides the view of an individual or group on a particular issue, is not developed with any defined methodology, and is in many cases an opinion piece. The appropriate format for an AES will vary depending on the topic, the available published evidence, and the intent of the statement. The AES can be developed using one of three approved methodologies. The methodology chosen for a particular AES will be decided as part of the process for selecting a topic, convening a panel, and developing specific questions. Consensus statements are always developed using the Delphi method and reflect the collective opinions of a group of content experts. The opinions of the experts will be based on their individual expertise, experience, and knowledge of the literature. Consensus is tested and demonstrated using prescribed methodology to identify areas of agreement and disagreement within the group of experts.14, 18 Consensus statements are applicable to situations where evidence is limited or lacking, but where there is the opportunity to reduce uncertainty and improve quality of care.6, 14 Consensus statements take advantage of the collective wisdom of a group of experienced clinicians and researchers, substituting expert opinion for objective fact. The opinion of the experts is based on their individual experience and knowledge of the relevant scientific literature. A consensus statement is applicable to situations where the evidence base is of insufficient quantity, quality, or is too varied for development of practice guidelines. An example of development of clinical consensus statements is the process used by otolaryngologists in human medicine.14 Consensus statements should not be based on a general statement of a topic (eg, “Asthma in cats”) but should be more narrowly focused. In this example, a more narrowly defined topic would be “Treatment of asthma in cats,” which addresses the specific statements: (1) inhaled corticosteroids are indicated; (2) betamethasone is the optimal inhaled corticosteroid; (3) oral corticosteroids are less effective than inhaled corticosteroids; and (4) beta-adrenergic bronchodilators are indicated. When considering the topic and its breadth, the available length of the final document should be considered. Statements should be concise and precise. Topics should be defined narrowly enough so as to be addressed within the limitations on length of the statement. Evidence-based practice guidelines (“guidelines”) guide provision of current best practice care to animals and are ideally based on a rigorous, methodical, evidenced-based review of the relevant literature. Guidelines have become increasingly important and useful to practicing clinicians given the increasing availability of novel or innovative treatments, interventions, or diagnostic methodologies and large quantity of scientific literature. Guidelines should have a consistent and transparent method of development, be of uniformly high quality, and be free of bias or conflict of interest by the developers of the guidelines. High quality guidelines recommend a course of action based on a comprehensive and systematic review, grading of the evidence, and explicit comparison of the benefits and harms of a given test or treatment, such as achieved by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) process.4, 5, 7, 8, 14 The Institute of Medicine provides a detailed user guide for preparation of guidelines as does the Cochrane website and Cochrane handbook on preparation of systematic reviews and guidelines, which also includes access to software for preparing guidelines compliant with GRADE (https://gradepro.org/product/#about; Table 1).7, 10, 11 An important component of a Guideline is the Summary of Findings table. A Summary of Findings table presents the main findings of a review in a transparent and simple tabular format. In particular, the table provides key information concerning the quality of evidence, the magnitude of effect of the interventions examined, and the sum of available data on the main outcomes.7 Systematic reviews are important to veterinarians because they provide an objective assessment of existing data to assist with decisions about clinical practice, can provide rationale and justification for research, and are used as the basis for evidence-based practice guidelines. The usefulness of a systematic review depends on the methodology and the clarity of reporting. A systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. The methodology must follow that of PRISMA or Cochrane systematic reviews.15 PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting of reviews that evaluate randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions.19 The difference between evidence-based practice guidelines and systematic reviews relates more to the topic being reviewed and the scope of the review. Guidelines address an area of clinical practice and may have a large number of questions (>5) or statements to evaluate and collate in Summary of Findings tables. Guidelines provide explicit recommendations on clinical practice. Systematic reviews may address topics that are not directly related to clinical practice, for which there are a small number of questions (<5), or both. Systematic reviews might not provide explicit recommendations. The difference between the two approaches is not always clear and the methodologies have much in common. Historically, the topic was chosen by the At-Large BoR members after consulting with colleagues and solicitation of ideas from ACVIM Diplomates. Our opinion, after reviewing all of the ACVIM Consensus Statements published to date, is that the topics chosen have been timely and well-balanced with respect to topical areas that are important to the broad interests of ACVIM Diplomates. Ideally methods to receive proposals for topics from the ACVIM should continue to be developed. Oversight of the AES program will now be provided by the Education and Research Committee (ERC) of the ACVIM. We recommend that the ERC members, in consultation with the ACVIM BoR, develop a short list of proposed topics that then is posted on the ACVIM website, with the membership being notified and asked to respond within a specified period to rank and provide comments about the proposed topics, or make suggestions for additional topics. The process for developing an AES would be to agree on the general topic and then for the ERC to seek advice from the President of the relevant specialty and the Chair of the panel on the most suitable format (ie, consensus statement, guidelines, or systematic review). The ERC and the relevant specialty President, guided by the methodologist, will be responsible for final approval of the AES topic and format. The AES should be developed by a panel comprised of individuals who are widely recognized as having expertise on the topic. Ideally, most panel members will have published basic research, clinical studies, or both on the topic or in closely related areas. The process for identifying and selecting panel members should be carefully considered to ensure that selection is impartial, all potentially interested and qualified people have been identified and considered, potential conflicts of interest have been identified and effectively managed, the process for identifying panel members is accepted and actively supported by the ACVIM membership, and the final panel composition is approved by the ACVIM BoR, which may delegate this approval to the ERC. The process also likely will differ depending on the type of statement that is being developed (Table 2). Panels for all types of AES will have a Chair who will be assigned specific responsibilities documented in a formal role description. The panel Chair should be an ACVIM Diplomate unless there are strong reasons to select a non-ACVIM-Diplomate for this role. The Chair and, if needed, Assistant Chair, of each panel will be selected after the topic of the statement has been finalized, and will be identified by consultation of the ERC with the relevant specialty President (if the topic is relevant to more than one specialty, then the Presidents of each of the relevant specialties will participate in the appointment). The ERC may seek additional advice from content experts and may call for nominations for the role(s). The process for appointing panel members differs for each type of expert statement. Typically, recommendations for membership are developed by the panel Chair in consultation with the ERC and President of the relevant specialty, with the assistance of the methodologist. The final composition of each panel is approved by the ACVIM BoR, which may delegate this approval to the ERC. At least half of the expert panel should be ACVIM Diplomates. For the Delphi method, the panel Chair, Assistant Chair, President of the relevant specialty and ERC will select 2-3 panel members who will serve as core organizers and authors of the consensus statement. These panel members, with the support of a methodologist, then will identify the additional 11-25 participants who will provide expert opinions that are the basis for content for the consensus statement. The methodologist should have expertise in the Delphi method and ensure that the correct approach and format are followed. The methodologist also will participate in writing the final document and ensure that submission deadlines are met. After a call for nominations (including self-nomination), participants would be chosen from interested Diplomates who would need to provide evidence of their qualifications, including published research and clinical experience. Diplomates also could nominate qualified persons who are not members of the ACVIM (again, providing evidence of qualifications). The panel Chair, Assistant Chair, President of the relevant specialty and ERC will select 4-6 expert panelists who will work remotely to develop the guidelines, with the support of a methodologist. The methodologist should have expertise in the GRADE method and help ensure that the correct approach and format are followed. The methodologist also can participate in writing the final document and ensure that submission deadlines are met. After a call for nominations (including self-nomination), participants would be chosen from interested Diplomates who would need to provide evidence of their qualifications (ie, published research, clinical experience). Diplomates also could nominate qualified persons who are not members of the ACVIM (again, providing evidence of qualifications). When using PRISMA guidelines or the Cochrane methodology to conduct a systematic review, the ERC and President of the relevant specialty will select a content expert as panel Chair who then would recommend 2-3 other content experts familiar with the development of meta-analyses and systematic reviews to develop the statement. This approach also would benefit from the support of a methodologist familiar with meta-analyses and systematic reviews. Regardless of the method used to identify the panel Chair and members, the Chair should drive the process, encourage equal participation by all panel members, coordinate the roles of the panel members, ensure diversity of opinion, drive the writing process to meet submission deadlines, format and editorial standards, and manage any identified conflicts of interest that become apparent (including potentially having a member with a relevant conflict of interest recuse themselves from the panel). Where applicable, the definition of “consensus” must be based on criteria specified before the panel convenes to review evidence or prepare the content of their report. When a consensus statement is developed using the Delphi method, the planned number of rounds/iterations as well as criteria for stopping discussion should be specified before development of the consensus statement, and consensus will be defined as at least 75% agreement among authors.18 When the Guideline/GRADE approach is used, consensus or lack of consensus should be reported regarding rating of evidence quality and conclusions that can be drawn from that finding but is less impactful because recommendations are rated based on quality of evidence.7 When the systematic review methodology is used, reaching consensus is not generally necessary because recommendations are based on summarized, objective data. All AES will be made available to ACVIM Diplomates for review and comment before finalizing and publishing. The draft documents will be posted on the ACVIM website, available only to Diplomates, for online provision of comment and feedback. The document will be available for no less than 30 days and its availability will be announced to all ACVIM Diplomates by email. However, formal peer review of consensus statements or practice guidelines will not be conducted. At the discretion of the panel Chair and the JVIM Co-Editors-In-Chief, it may be appropriate and desirable to obtain peer review for systematic reviews. Results of a 2020 survey of ACVIM Diplomates regarding Consensus Statements shows that the ACVIM membership is keenly aware of the potential for conflict of interest (COI) to adversely affect the outcome and content of AES. It is critically important that such conflicts be identified and managed, and the Chair of the panel and the ERC, with support from ACVIM Staff, should be charged with this responsibility. Simple disclosure of a potential COI does not represent management of that COI,20 and care must be taken that disclosure does not release the affected panel members and the panel Chair from further management or responsibility for the COI. A COI is a set of conditions in which professional judgment concerning a primary interest (such as a patient's welfare or the validity of research) could be unduly influenced by a secondary interest (such as financial gain or career interests).20-22 Conflict of interest rules regulate the disclosure and avoidance of these conditions. A COI occurs when an entity or individual potentially becomes unreliable because of a clash between personal (or self-serving) interests and professional duties or responsibilities. Such potential conflicts affect the ability to trust recommendations or the veracity of evidentiary statements when a company or person has a vested interest (such as money, status, knowledge, relationships, or reputation) that puts into question whether their actions, judgment, or decision-making can be unbiased.20 Conflicts of interest can exist in the absence of any financial implications. When such a situation arises, the party is usually asked to recuse themselves. Importantly, perceived or potential COIs can tarnish the AES and the ACVIM unless clearly and transparently managed from the beginning of the process. Important concepts in managing COI are identifying the potential COI (disclosure or discovery) and managing the COI. To be managed, a COI must be identified. This can be done by either the individual (self-disclosure) or by a third party (discovery). Although considered by some to be critically important to managing COI, there is limited evidence regarding the effect of COI disclosure. Research suggests that disclosure can have “perverse effects” or, at least, is not the panacea it is often perceived to be. These perverse effects include unwarranted immunity of the individual declaring the COI from criticism or censure for their role in developing an AES. Disclosure could have the unintended result of enabling or permitting a COI without preventing the effect of the COI. Those with a COI are expected to recuse themselves from (ie, abstain from) decisions where such a conflict exists. It may be sufficient to recuse an individual regarding discussions and decisions of a specific topic, or it may be more appropriate for an affected party to be fully excused from participating in the AES. The obligation to recuse depends on: 1) the potentially conflicted individual identifying (ie, being aware of) and disclosing the potential COI, and 2) the individual recusing themselves (as opposed to a neutral party removing them from the situation). It could be appropriate for a neutral adjudicator to assess the potential COI and to decide on whether to retain or remove the individual in question. Optimally, AES panels would only include members who are free of COIs relevant to the topic of the statement. However, this will not always be feasible or possible, and processes must be in place to identify and manage COI. Transparency is key, and privacy concerns can be addressed by having the process widely acknowledged with details of the specific COI and management being private until publication of the statement, when COIs and management should be disclosed. Review of COI information is conducted as follows: Panel Chairs and panel members: The ERC, the ACVIM Chief Executive Officer and the ACVIM President will review all COI information and determine whether any relationship represents a potentially relevant COI. The final recommendations on management of the COI are provided to the ACVIM BoR for information, endorsement and approval. If a relevant COI exists, it will be managed as follows: Disclosure and Review: Recusal: Divestment: Transparency: This editorial was prepared by the authors and was not peer reviewed. Kenneth Hinchcliff and Stephen DiBartola are Co-Editors-in-Chief of the JVIM. None of the other authors declares a conflict of interest.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Hinchcliff, Kenneth W. and ACVIM Consensus Statement Taskforce, Paul S. and Morley, Paul S. and Dibartola, Stephen P. and Taylor, Sandra D. and Harrell, Karyn A.}, year={2023}, month={Oct} }
 @article{rank_lynch_green_reed-jones_harrell_ueda_2023, title={Case report: Laryngospasm following ethanol ablation of a parathyroid nodule in a dog with primary hyperparathyroidism}, volume={10}, ISSN={["2297-1769"]}, DOI={10.3389/fvets.2023.1201663}, abstractNote={A 12-year-old female spayed dachshund was presented for emergency assessment of respiratory distress, characterized by inspiratory dyspnea with stridor. Percutaneous ultrasound-guided ethanol ablation of a functional parathyroid tumor was performed 72-h earlier for management of primary hyperparathyroidism. The dog was hypocalcemic (ionized calcium 0.7 mmol/L, reference interval: 0.9–1.3 mmol/L) at the time of presentation and had evidence of laryngospasm on a sedated oral exam. The dog was managed conservatively with supplemental oxygen, anxiolysis, and parenteral calcium administration. These interventions were associated with rapid and sustained improvement in clinical signs. The dog did not demonstrate any recurrence of signs afterwards. To the authors' knowledge, this is the first description of laryngospasm following ethanol ablation of a parathyroid nodule in a dog that developed hypocalcemia.}, journal={FRONTIERS IN VETERINARY SCIENCE}, author={Rank, Kaitlyn and Lynch, Alex M. and Green, Randolph and Reed-Jones, Leslie and Harrell, Karyn and Ueda, Yu}, year={2023}, month={Jun} }
 @article{tucker_baja_rasche_watanabe_harrell_2023, title={Immune-mediated haemolytic anaemia with severe thrombocytopenia in a Pembroke Welsh Corgi}, volume={9}, ISSN={["2052-6121"]}, DOI={10.1002/vrc2.727}, abstractNote={Abstract}, journal={VETERINARY RECORD CASE REPORTS}, author={Tucker, Samuel M. and Baja, Alexie J. and Rasche, Brittany L. and Watanabe, Tatiane Terumi Negrao and Harrell, Karyn A.}, year={2023}, month={Sep} }
 @article{anderson_murillo_womble_gibbs_harrell_watanabe_2022, title={Case Report: Novel Disseminated Paecilomyces formosus Infection in a Dog}, volume={9}, ISSN={["2297-1769"]}, DOI={10.3389/fvets.2022.878327}, abstractNote={A 2.5-year-old, 25.5 kg, spayed female Australian Shepherd dog had a 2-month history of shifting leg lameness in all limbs, tetraparesis, progressive lethargy, and severe pain. On the physical examination, fever (40.61°C), tachycardia, tachypnea, mild diffuse pelvic limb muscular atrophy, left prescapular and right popliteal lymphadenomegaly were observed. Due to the poor prognosis and difficult pain management, humane euthanasia was elected. Macroscopic and histological findings revealed multifocal to coalescing granulomas with central areas of lytic necrosis within the right femur, left humerus, left scapula, left biceps brachii, right semimembranosus muscle, liver, spleen, and lymph nodes. The necrotic areas contained myriad intralesional, intracellular, and extracellular negatively stained, non-pigmented, septate acute angle branching hyphae with parallel walls measuring 3–6 μm in width with polar bulbous projections measuring 7–13 μm in width. Fresh samples of the liver were submitted for fungal culture. Panfungal PCR targeting the major conserved genes-ITS, TUB, CAL-confirmed Paecilomyces formosus. Paecilomyces spp. are members of anamorphic fungi classified under the phylum Ascomycota. Paecilomycosis is an uncommon fungal infection caused by Paecilomyces spp with a disease reported in humans and animals ranging from superficial to systemic clinical forms affecting both immunocompromised and immunocompetent individuals. In dogs, disseminated paecilomycosis has been reported, but the species of fungi are not always determined. To our knowledge, this is the first case of disseminated paecilomycosis caused by P. formosus infection in a dog.}, journal={FRONTIERS IN VETERINARY SCIENCE}, author={Anderson, Stephanie and Murillo, Daniel Felipe Barrantes and Womble, Mandy and Gibbs, Nicole and Harrell, Karyn and Watanabe, Tatiane Terumi Negrao}, year={2022}, month={May} }
 @article{goggs_brainard_levine_calabro_harrell_mills_stone_davidson_iacovetta_harris_et al._2020, title={Lyophilized platelets versus cryopreserved platelets for management of bleeding in thrombocytopenic dogs: A multicenter randomized clinical trial}, volume={34}, ISSN={["1939-1676"]}, DOI={10.1111/jvim.15922}, abstractNote={Abstract}, number={6}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Goggs, Robert and Brainard, Benjamin M. and LeVine, Dana N. and Calabro, Janine and Harrell, Karyn and Mills, Tracy and Stone, Richard and Davidson, Benjamin and Iacovetta, Christine and Harris, Lauren and et al.}, year={2020}, month={Nov}, pages={2384–2397} }
 @article{aitee_harrell_2016, title={Systemic Lupus Erythematosus-A Review}, journal={Clinician’s Brief}, author={Aitee, G. and Harrell, K.A.}, year={2016}, month={Apr} }
 @article{takara_harrell_2014, title={Noncombat-related injuries or illnesses incurred by military working dogs in a combat zone}, volume={245}, ISSN={["1943-569X"]}, DOI={10.2460/javma.245.10.1124}, abstractNote={Abstract}, number={10}, journal={JAVMA-JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Takara, Matt S. and Harrell, Karyn}, year={2014}, month={Nov}, pages={1124–1128} }
 @inbook{harrell_2009, place={New York}, title={Activated Clotting Time Canine and Feline}, booktitle={Blackwell’s Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures}, publisher={Wiley-Blackwell Publishing}, author={Harrell, K.A.}, editor={Vaden, S.L. and Knoll, J.S. and Smith, Fwk, Jr and Tilley, L.P.Editors}, year={2009}, pages={24–25} }
 @inbook{harrell_2009, place={New York}, title={Arthrocentesis with Synovial Fluid Analysis Canine and Feline}, booktitle={Blackwell’s Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures}, publisher={Wiley-Blackwell Publishing}, author={Harrell, K.A.}, editor={Vaden, S.L. and Knoll, J.S. and Smith, FWK, Jr and Tilley, L.P.Editors}, year={2009}, pages={64–68} }
 @inbook{harrell_2009, place={New York}, title={Bleeding Time Canine and Feline}, booktitle={Blackwell’s Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures}, publisher={Wiley-Blackwell Publishing}, author={Harrell, K.A.}, editor={Vaden, S.L. and Knoll, J.S. and Smith, Fwk, Jr and Tilley, L.P.Editors}, year={2009}, pages={98–100} }
 @inbook{harrell_2009, place={New York}, title={Nasal Flush and Biopsy Canine and Feline}, booktitle={Blackwell’s Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures}, publisher={Wiley-Blackwell Publishing}, author={Harrell, K.A.}, editor={Vaden, S.L. and Knoll, J.S. and Smith, Fwk, Jr and Tilley, L.P.Editors}, year={2009}, pages={446–449} }
 @article{shaw_harrell_2008, title={IMHA: Diagosing and treating a complex disease}, volume={103}, number={12}, journal={Veterinary Medicine}, author={Shaw, N. and Harrell, K.}, year={2008}, pages={660–671} }
 @article{haber_harrell_marks_2007, title={Polycythemia}, volume={9}, number={5}, journal={Standards of Care Emergency and Critical Care Medicine}, author={Haber, M. and Harrell, K.A. and Marks, S.L.}, year={2007}, pages={1–10} }
 @article{harrell_2006, title={Use of Arthrocentesis in Diagnosing Joint Disease}, volume={4}, number={2}, journal={NAVC Clinician’s Brief}, author={Harrell, K.A.}, year={2006}, month={Feb}, pages={45–49} }
 @article{harrell_kristensen_parrow_1997, title={Canine transfusion reactions. I. Causes and consequences}, volume={19}, number={2}, journal={Compendium on Continuing Education for the Practicing Veterinarian}, author={Harrell, K. and Kristensen, A. and Parrow, J.}, year={1997}, pages={181–190} }
 @article{harrell_kristensen_parrow_1997, title={Canine transfusion reactions. II. Prevention and treatment}, volume={19}, number={2}, journal={Compendium on Continuing Education for the Practicing Veterinarian}, author={Harrell, K. and Kristensen, A. and Parrow, J.}, year={1997}, pages={193–201} }
 @article{harrell_kristensen_1995, title={CANINE TRANSFUSION REACTIONS AND THEIR MANAGEMENT}, volume={25}, ISSN={["1878-1306"]}, DOI={10.1016/S0195-5616(95)50158-5}, abstractNote={There is a wide range of mechanisms by which transfusion reactions may occur. These reactions typically are categorized as immune- or nonimmune-mediated and also as to whether they are acute or delayed in nature. The type and severity of clinical signs vary according to the specific reaction present. Many reactions can be prevented with the use of standard and appropriate transfusion medicine procedures. These methods include careful collection and storage of blood products, adequate screening and blood typing of donor dogs, crossmatching donor and recipient blood, use of component therapy, correct administration of blood products, and the use of pretransfusion prophylaxis when appropriate. Because many reactions are dose dependent, careful monitoring of transfusions cannot be overemphasized. Rapid recognition of a transfusion reaction and immediate discontinuation of the transfusion, along with appropriate supportive therapy, is essential for the successful treatment of transfusion reactions. A summary of transfusion reactions including clinical signs, diagnosis, and basic treatment protocols is given in Table 4. When used appropriately, transfusion of blood products can be a highly beneficial, low-risk form of therapy.}, number={6}, journal={VETERINARY CLINICS OF NORTH AMERICA-SMALL ANIMAL PRACTICE}, author={HARRELL, KA and KRISTENSEN, AT}, year={1995}, month={Nov}, pages={1333-+} }
 @article{graham_brothers_darvishian_harrell_vincent_burkel_stanley_1989, title={Effects of thromboxane synthetase inhibition on patency and anastomotic hyperplasia of vascular grafts}, volume={46}, ISSN={0022-4804}, url={http://dx.doi.org/10.1016/0022-4804(89)90030-9}, DOI={10.1016/0022-4804(89)90030-9}, abstractNote={The efficacy of a thromboxane synthetase inhibitor (U-63,557A, Upjohn) in promoting early patency and inhibiting anastomotic intimal hyperplasia in ePTFE grafts was compared to that of acetylsalicylic acid (ASA) in a canine model. Animals were started on ASA 5 gr po qd (Group I, n = 12) or U-63,557A 10 mg/kg po bid (Group II, n = 12) 1 day before placement of bilateral 5-mm-i.d., 13- to 16.5-cm-long ePTFE aortoiliac grafts and continued on the medication for the 16-week study. Six dogs in each group received autologous endothelial cell-seeded grafts, while the other six received unseeded grafts. Patency was determined weekly by assessment of femoral pulses. At the conclusion of the study anastomotic intimal hyperplasia was measured on serial sections through the distal anastomosis using a computer-linked digitizer. In Group I the patencies of seeded and unseeded grafts were not significantly different, being 100 and 83%, respectively. Furthermore, luminal narrowing due to intimal hyperplasia was not significantly different being 9.1 +/- 7.6% (chi +/- SD) in seeded grafts and 8.8 +/- 8.1% in unseeded grafts. On the other hand, in Group II the seeded grafts had significantly improved patency when compared to the unseeded grafts (83% vs 33%, P less than 0.05) and less luminal narrowing (11.4 +/- 11.1% vs 21.9 +/- 19.5%, P less than 0.01). Although U-63,557A administration promoted patency of unseeded grafts compared to no antiplatelet medication (0% patency), it was significantly less effective than ASA in improving patency (P less than 0.05) and inhibiting luminal narrowing (P less than 0.01).}, number={6}, journal={Journal of Surgical Research}, publisher={Elsevier BV}, author={Graham, Linda M. and Brothers, Thomas E. and Darvishian, David and Harrell, Karyn A. and Vincent, Christopher K. and Burkel, William E. and Stanley, James C.}, year={1989}, month={Jun}, pages={611–615} }
 @article{lindblad_burkel_graham_darvishian_harrell_sell_stanley_1988, title={Effect of Anticoagulant and Antiplatelet Drugs on InVitro Smooth Muscle Cell Proliferation}, volume={15}, number={4}, journal={Artery}, author={Lindblad, B. and Burkel, W.E. and Graham, L.M. and Darvishian, D.H. and Harrell, K.A. and Sell, R.L. and Stanley, J.C.}, year={1988}, pages={225–233} }
 @article{graham_vincent_brothers_harrell_darvishian_sell_burkel_stanley_1988, title={Efficacy of Antiplatelet Agents in Promoting Patency and Reducing Anastomotic Hyperplasia of Endothelial Cell Seeded and Unseeded e-PTFE Grafts}, volume={39}, journal={Surgery Forum}, author={Graham, L.M. and Vincent, C.K. and Brothers, T.E. and Harrell, K.A. and Darvishian, D.H. and Sell, R.L. and Burkel, W.E. and Stanley, J.C.}, year={1988}, pages={348–350} }
 @article{lamb_king_harrell_burkel_webb_1987, title={Free radical-mediated endothelial damage in blood vessels after electrical stimulation}, volume={252}, ISSN={0363-6135 1522-1539}, url={http://dx.doi.org/10.1152/ajpheart.1987.252.5.h1041}, DOI={10.1152/ajpheart.1987.252.5.h1041}, abstractNote={ The endothelium plays an important role in mediating vasodilator effects of several agents (acetylcholine, thrombin, A23187, etc.). The goal of this study was to determine the ability of oxygen free radicals generated by electrical field stimulation to alter endothelial function in isolated tissue systems. Tail artery strips and the mesenteric microvasculature isolated from Sprague-Dawley rats were used. Following smooth muscle contraction induced by norepinephrine, these preparations relaxed in response to acetylcholine chloride or ionophore A23187. All vessels were then subjected to electrical stimulation (9 V, 1-2 ms, 4 Hz) of the physiological buffer in which they were bathed or perfused. In some of these preparations, an antioxidant, (10(-4) M sodium ascorbate, 3.6 X 10(-5) M glutathione, 1.3 X 10(-2) M dimethyl sulfoxide) was included in the buffer. Relaxation responses persisted in vessels where an antioxidant had been included in the electrically stimulated buffer. Tissues stimulated without this protection did not relax on subsequent exposures to endothelium-dependent vasodilators. Scanning-electron microscopy of the tissues revealed significant endothelial damage (cell membrane pitting) in tissues exposed to electrical stimulation without antioxidant protection. These results suggest that electrical stimulation causes endothelial damage in isolated vascular preparations. This seemingly adverse effect proves to be a useful tool for removing the endothelium in studies of isolated vascular tissues. }, number={5}, journal={American Journal of Physiology-Heart and Circulatory Physiology}, publisher={American Physiological Society}, author={Lamb, F. S. and King, C. M. and Harrell, K. and Burkel, W. and Webb, R. C.}, year={1987}, month={May}, pages={H1041–H1046} }
 @article{graham_harrell_sell_crudup_burkel_stanley_1985, title={Enhanced endothelialization of dacron grafts by external vein wrapping}, volume={38}, ISSN={0022-4804}, url={http://dx.doi.org/10.1016/0022-4804(85)90073-3}, DOI={10.1016/0022-4804(85)90073-3}, abstractNote={The efficacy of external vein wrapping of vascular grafts in promoting the development of a luminal endothelial surface was assessed in 12 dogs who underwent thoracoabdominal bypasses with 26-29 cm X 6-mm i.d. double-velour knitted Dacron grafts. In group I (n = 6) 6-cm segments of the grafts were wrapped with autologous jugular vein with its endothelial surface applied against the outside of the graft. In group II (n = 6) the wrap procedure was performed using abdominal wall fascia. The degree and character of graft incorporation was quantitated in all prostheses at 28 days postimplantation. Group I vein wrap prostheses demonstrated uniform endothelial surface coverage in the vein wrap area (means = 88%) that was significantly greater (P less than 0.04) than coverage in adjacent unwrapped segments (means = 48%). Group II fascial wrap grafts demonstrated variable endothelial coverage in the wrapped area (means = 48%) that was consistently less than in adjacent unwrapped portions (means = 62%), and significantly less than vein wrap sections of group I animals (P less than 0.04). No significant differences existed in endothelial coverage of unwrapped regions of group I and II grafts. This investigation documented that wrapping knitted Dacron grafts with vein enhanced endothelialization of their luminal surface.}, number={5}, journal={Journal of Surgical Research}, publisher={Elsevier BV}, author={Graham, Linda M. and Harrell, Karyn A. and Sell, Ruth L. and Crudup, James W. and Burkel, William E. and Stanley, James C.}, year={1985}, month={May}, pages={537–545} }