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Do we need an evidence manifesto?
  1. Rachel Dean, BVMS, PhD, MSc, DSAM, MRCVS and
  2. Carl Heneghan, BM, BCH, MA, MRCGP, DPhil
  1. email: rachel.dean{at}vetpartners.co.uk
  2. email: carl.heneghan{at}phc.ox.ac.uk

Abstract

In the first of a new evidence column, Rachel Dean and Carl Heneghan argue that while evidence-based veterinary medicine is not perfect we need to stop grumbling about the shortcomings and get on with it in practice

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Rachel Dean is the director of clinical research and excellence in practice for VetPartners.

Carl Heneghan is the director of the Centre for Evidence-based Medicine at the University of Oxford.

Making the right decisions for each of our patients – whatever the species, whatever the discipline – requires vets to use the best available evidence.

But, in practice, the application of evidence-based veterinary medicine (EBVM) is often problematic. This is because vets tend to focus too much on the evidence itself, rather than the context.

For EBVM to be effective, it needs to be applied properly to the situation. It is therefore important to involve clients, vets, nurses, and paraprofessionals in the decisions about the quality of care an animal receives.

Without that vital context, EBVM can seem dull and irrelevant – but it’s not. Rather, it is evidence in isolation that is the problem because it undervalues the importance of clinical decision makers in ensuring the base care for our patients.

There are other obstacles to delivering EBVM.

It is often said that it is not possible to practice EBVM because of deficiencies in the evidence base and that researchers and journals are to blame. There is a vast amount of veterinary evidence published every day, with at least 1139 journals publishing material relevant to veterinary medicine and science. But even when you find the relevant article for the problem you are faced with, the evidence is sometimes not sufficiently robust.

What is evidence-based veterinary medicine?

Evidence-based veterinary medicine (EBVM) is the use of best relevant evidence in conjunction with clinical expertise to make the best possible decision about a veterinary patient. The circumstances of each patient, and the circumstances and values of the owner/carer, must also be considered when making an evidence-based decision.1

Clearly, veterinary evidence needs to be of better quality, relevant to decision makers and more accessible.

We all have a responsibility to improve the evidence base

However, we all have a responsibility to improve the evidence base through enhancing the planning and delivery of our services, auditing our practice and by getting involved in research. Ultimately, only decision makers can act upon evidence, so it is vital that they are made aware of it and are able to apply it.

To ensure our profession remains the leading provider of veterinary healthcare and that it is continually improving, we need to embrace and advance EBVM. We need to stop grumbling about how bad the veterinary evidence base is, how difficult EBVM is to put into practice and how our patients are being let down, and do something about it.

It is time to talk about the problems, the mistakes and uncertainties within the evidence and find solutions to the growing problem of the vast amount of poor-quality evidence that pervades practice. To achieve this, we must do it collectively with the involvement of practitioners, journals, researchers, funders, regulators, the pharmaceutical industry, the corporates, the universities and the consumers of veterinary healthcare – our clients. We also need to learn from the successes and failures of other healthcare professions to move forwards.

In June 2017, the evidence-based medicine (EBM) manifesto for better healthcare was published in The BMJ.2 The manifesto (Box 1) was the result of the increasing awareness of both the difficulties of, and solutions for, translating primary research into better quality, affordable medical healthcare. It highlights the known problems of poor untrustworthy evidence and the negative impact this has on care. More importantly, it outlines the solutions for better healthcare through improving the evidence base on which decisions are made. It highlights why this requires several different groups to work together to solve the problems faced by the profession.

Box 1:

Evidence-based medicine manifesto for better health

  • Expand the role of patients, health professionals, and policy makers in research

  • Increase the systematic use of existing evidence

  • Make research evidence relevant, replicable, and accessible to end users

  • Reduce questionable research practices, bias, and conflicts of interests

  • Ensure drug and device regulation is robust, transparent, and independent

  • Produce better usable clinical guidelines

  • Support innovation, quality improvement, and safety through the better use of real world data

  • Educate professionals, policy makers, and the public in evidence-based healthcare to make an informed choice

  • Encourage the next generation of leaders in evidence-based medicine

Putting Evidence in practice

This is the first column in a new series making the case for a new approach to EBVM. Please contribute to the debate.

If you would like to share your experiences or an opinion on EBVM with Vet Record readers, please email: vet.editorial{at}bmj.com

In the following months, in this column, the elements of the EBM manifesto will be looked at from the veterinary perspective by a number of different authors. Is now the time to develop an EBVM manifesto? If it is, what would it look like; would it look the same as or different to the EBM manifesto?

What is clear, is that it is time to talk openly, inclusively, critically and freely about EBVM as it is everyone’s problem to find the solutions together to provide the best available evidence for the care of our patients.

Interpreting abdominal radiographs in cats and dogs

Getting the most out of an abdominal radiographic study requires a systematic approach to looking at the images. In an article in the July/August issue of In Practice, copies of which are distributed to BVA members and subscribers with this week’s Vet Record, Andrew Parry and Paul Mahoney provide a pictorial review of the major changes which may occur within the abdomen in dogs and cats, as well as different types of abdominal pathology.

Also in this issue, Jon Reader discusses the main considerations and challenges for managing the veterinary input in large dairy herds. His article focuses on the way that the veterinarian can satisfy the demands of the modern day dairy farmer while facilitating an expert team on the farm.

Tom Eaton-Evans reviews the demands of Endurance riding and its potential to present veterinarians with challenging medical emergencies. His article describes the veterinary inspections performed and advises how veterinary practitioners should manage each medical emergency that may be encountered.

In another article, Yvonne McGrotty and Susan Randell measure water consumption in dogs to determine a diagnostic approach to canine patients suffering from polyuria and polydipsia. Other indicators, such as blood count and urinalysis, are also discussed to appropriately tailor the next diagnostic step for each patient.

In the practice management section, Carolyne Crowe and Tom Oxtoby highlight the importance of building and maintaining relationships with farmers, and how effective communication can help vets influence positive outcomes on farm. Crowe and Oxtoby recognise that communication, as well as how that communication is delivered, is key to improving vet-farm relations.

References

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