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Special report
Launching an evidence-based veterinary medicine manifesto to drive better practice

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Last year this journal published a draft manifesto designed to improve the health and welfare of animals.

The evidence-based veterinary medicine (EBVM) manifesto was created by a group of vets, vet nurses and academics at the Evidence Live conference in Oxford in July 2019.

It sets out a list of actions that vet professionals can take to make better evidence-based decisions and also generate evidence to inform their future decision making.

Making it work for the profession

In a panel discussion hosted by Vet Record, vets, vet nurses and academics with an interest in EBVM reviewed a manifesto for evidence-based medicine in human healthcare,1 developed by Carl Heneghan and colleagues at the University of Oxford’s Centre for Evidence-Based Medicine and The BMJ.

They considered how it could be adapted for veterinary medicine and produced a draft version. We published this shortly afterwards and invited comments (VR, 3 August 2019, vol 185, pp 128-131).

A year on, in July 2020, we issued a call-out for people and organisations to endorse the manifesto and make further comments (VR, 22 July 2020, vol 187, e15) and here we publish the updated manifesto (see opposite page).

In publishing the manifesto, this journal’s aim is to drive best practice by helping vets and vet nurses access, assess and use the best evidence to treat and care for animals. The expected outcome of using the manifesto would be to reduce unnecessary or harmful treatments, better educate clients on the best options for their animals and inform policymakers on the best approach to advocate for policy changes.

A starting point for action

We see the manifesto as a starting point for conversations that can lead to actions. For example, we hope that vet professionals will bring the manifesto to practice meetings and use it to discuss how they can obtain better evidence to address particular problems, or bring the best available evidence into the consultation room so that clients are better informed about the options they are given.

It is also hoped that the manifesto will drive a better understanding of evidence, how useful it is, how accessible it is and how it can be improved. As well as seeing practitioners take action, the manifesto should encourage researchers to conduct relevant research that reduces bias and wastage. The hope is the manifesto will also encourage more veterinary research to become widely accessible, as well as identify the next generation of EBVM leaders.

Vet Record’s senior clinical research editor, Tom McNeilly, highlights the importance of using the best evidence: ‘In order to achieve the optimum health and welfare of animals, it is critical that we use current best evidence to make decisions about the management of animals in our care. This requires the generation of robust scientific evidence, being proactive about making this evidence available to end users in an understandable format, and being able to quickly adapt best practice guidelines if and when the evidence changes.’

While not every call to action in the manifesto will be relevant to every organisation or individual, we encourage those who endorse the manifesto to act on the actions that they can.

Time for a more evidence-based approach

Since publishing our draft manifesto a year ago, we have received feedback from around the globe on how it could be improved to support the veterinary profession better. We have published the draft manifesto and feedback here http://doi.org/10.1136/vr.m3412

Vet Record has been a keen proponent of EBVM ever since it appeared as an area in its own right, which started in earnest in the 2000s. We see it as a vital way to develop the veterinary discipline to provide the highest standards of care.

Manifesto endorsers

At the time of going to press the evidence-based veterinary medicine manifesto has been endorsed by 62 organisations and individuals. Among them, 17 are ‘enhanced endorsers’ – between them they have funded the open access fee for the publication for the manifesto. The enhanced endorsers are: Avacta Animal Health, Boehringer Ingelheim, BVA, IVC Evidensia, Linnaeus, Medivet, Moredun Research Institute, Petplan, RCVS Knowledge, Society of Practising Veterinary Surgeons, School of Veterinary Medicine at the University College Dublin, VetPartners, Vets4Pets, Vets Now, Virbac, Virtual Recall and The Webinar Vet.

Endorsers

American College of Veterinary Clinical Pharmacology; Association of Veterinary Students (AVS); Association of Veterinary Teachers and Research Workers (AVTRW); B Braun; Battersea Dogs and Cats Home; British Equine Veterinary Association (BEVA); British Small Animal Veterinary Association (BSAVA); British Veterinary Hospitals Association (BVHA); British Veterinary Zoological Society (BVZS); Veterinary School, University of Cambridge; Cats Protection; Chipping Norton Veterinary Hospital; Dogs Trust; Evidence-Based Veterinary Medicine Association (EBVMA); Flock Health Limited; FORTE Healthcare Limited; Girling & Fraser Limited; School of Veterinary Medicine, University of Glasgow; Goat Veterinary Society; Carol Gray; Humane Slaughter Association; Mars Petcare; MDC Exports; Medical Library Association; Animal and Veterinary Information Specialist caucus, Medical Library Association; School for Natural and Environmental Science, Newcastle University; School of Veterinary Medicine, University of Nottingham; Nottingham Trent University; Pig Veterinary Society; College of Veterinary Medicine, Purdue University; Sheep Veterinary Society (SVS); Simply Locums and Simply Vets; Small Animal Medicine Society (SAMSoc); Society of Greyhound Veterinarians; Tanya Stephens; School of Veterinary Medicine, University of Surrey; Sydney School of Veterinary Science, University of Sydney; TVM; Universities Federation for Animal Welfare (UFAW); Vet Help Direct; Veterinary Deer Society; Veterinary Faculty of the Universitat Autònoma de Barcelona (UAB); Veterinary Poisons Information Service; Veterinary Public Health Association (VPHA); Ann R Viera, Librarian, University of Tennessee.

Let’s drive evidence through our practice

Rachel Dean says everyone involved in veterinary care can support evidence-based veterinary medicine.

Applying evidence-based veterinary medicine (EBVM) in our practice enables us to change. It enables us to look critically at what we do, review any relevant published research and question our decisions. Are the decisions right or good enough? Do I need to change the way I practise, publish, research, teach, lead or govern?

Having a manifesto to frame that thinking helps us to turn everyday clinical challenges into a list of tasks in order to provide better care for our patients and clients.

It helps us move from a philosophical discussion about what EBVM is – or isn’t – to actually getting on and doing something about it.

EBVM is about people and the decisions they make, not the evidence itself

EBVM is about people and the decisions they make, not the evidence itself.

EBVM is a living, breathing way of doing something with the evidence that is (or is not) there: it is up to us to decide what action we choose to take (or not) on the back of that evidence, and how we decide whether it influences care (or not).

As one of my colleagues put it: ‘the evidence can’t tell us what to do, it doesn’t think or care about the patients and clients – that is our job’. She is right.

Why not use the EBVM manifesto to think about what improvements you can put into effect in your everyday work and with the teams you work with?

So how should you begin to use it? I recommend just starting a conversation with the next person you bump into at work. After all, it applies to you, no matter what you do within the world of veterinary medicine.

Use it as a tool to talk about practice that produces better outcomes. Use it to prompt questions about what you do and how you are going to improve.

When I used it with my team, they came up with a number of ideas, from helping create more relevant research and better guidelines, to undertaking more quality improvement. If you were to ask this question of your team, what would your colleagues say?

In an age of fake news ... it is more than ever essential that we professionals base our actions ... on good scientific evidence

And encouraging a more evidence-based approach has never been more needed. As Professor the Lord Trees, Vet Record’s chief veterinary adviser, says: ‘In an age of fake news, anti-vax opinion, and unmoderated, not to say downright misleading, social media posts, it is more than ever essential that we professionals base our actions and recommendations as far as is possible on good scientific evidence.’

‘Equally important is that, should such evidence be lacking or ambivalent, then we need to consider and communicate that too.’

In an effort to promote the manifesto as widely as possible, it is being published with open access. This means it can be viewed and reused by anyone regardless of whether you are a subscriber to this journal, and without needing to seek permission, but should be credited as per the open access license (see below). The open access has been funded by the enhanced endorsers listed on p 176.

Contribute to the manifesto

We do not believe the manifesto should be set in stone – as the EBVM landscape changes, it should be amended. Vet Record commits to periodically updating it according to the feedback we receive.

If you have comments on, or questions about, the manifesto, or you would like to endorse it, please contact Suzanne Jarvis, managing editor, at sjarvis@bmj.com. Comments can also be added as an e-response to the manifesto at http://doi.org/10.1136/vr.m3409

Acknowledgements

The EBVM manifesto has been collated with the input of many vets, vet nurses and academics including members of the original Vet Record panel at Evidence Live: Marnie Brennan, director of the Centre for Evidence-based Veterinary Medicine at the University of Nottingham; Rachel Dean, director of clinical research and excellence in practice at VetPartners; Daniella Dos Santos, president of the BVA and a small animal practitioner; Lysan Eppink, technical adviser in pig products at Boehringer Ingelheim; Sally Everitt, independent small animal practitioner and a member of the BVA policy committee; as well as the audience at Evidence Live and many vets who have contacted Vet Record on its journey thus far.

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