Equine Veterinary Journal ISSN 0425-1644 DOI: 10.1111/evj.12425


Recent initiatives in evidence-based veterinary medicine Evidence-based veterinary medicine has been gaining momentum recently, and the recent Evidence-Based Veterinary Medicine (EBVM) and Evidence-Based Veterinary Medicine Association (EBVMA) conferences have helped to inspire and engage veterinary surgeons. Although these conferences took different forms, with the first being a networking event with invited speakers and abstract presentations and the latter being a webinar, both focused on methods used to obtain data and how this can then be utilised in clinical practice. In order to best utilise evidence-based veterinary medicine, it is essential that a question is posed in a specific way, defining the patient or population, the intervention, the comparison or control group and the outcome of interest (the PICO method [1]). Once this question has been defined there are numerous freely available resources for practitioners to gather evidence; Pubmed (http://www.ncbi.nlm.nih.gov/pubmed [2]) and Google Scholar (http://scholar.google.co.uk/ [3]) can both be used to identify papers of interest; Royal College of Veterinary Surgeons (RCVS) knowledge summaries (http://knowledge.rcvs.org.uk/evidence-basedveterinary-medicine/knowledge-summaries/ [4]) and Best Bets for Vets (https://bestbetsforvets.org/ [5]) are concise summaries of the latest evidence for specific clinical questions (the latter does not currently have equine content; but this will be available soon). Equine Veterinary Education (EVE) has compiled a series of Critically Appraised Topics (CATS), which are being published in the current volume. These CATS, together with systematic reviews and articles on critical appraisal skills from both EVE and EVJ form a free online collection on Clinical Evidence in Equine Practice available at http://onlinelibrary.wiley.com/journal/10.1001/ (ISSN)2042-3306/homepage/clinical_evidence_in_equine_practice_online _collection.htm [6] VetSRev (http://webapps.nottingham.ac.uk/refbase/ [7]) is a database of veterinary systematic reviews provided by the University of Nottingham and DVM Evidence is a database of evaluations of evidence-based secondary research publications in veterinary medicine and animal science which is currently being piloted by a team led by Margaret Foster at Texas A&M. Joining the RCVS knowledge library (http://knowledge.rcvs .org.uk/library-and-information-services/ [8]) provides access to scientific journals for minimal cost and is easily accessible to practitioners. In addition to accessing scientific studies, the use of practice-generated data was discussed extensively at both conferences. Within veterinary medicine, prospective studies are relatively scarce; Christopher Longhurst drew parallels with the situation in paediatric medicine at the EBVMA conference and described the use of electronic medical records to generate data on outcomes. The use of electronic medical records for clinical audit and in a large practice setting was included in the EBVM plenary session with Sandi Lefebvre describing how the use of practice-generated data allowed the question of incidence of vaccination reactions within her practice population to be answered. Marco Duz described during the abstract sessions at EBVM how he had validated automated content analysis of electronic medical records and found this method to be more accurate than manual classification. Therefore practitioners have the resources to generate their own data to answer specific clinical questions within their own practice population. By standardising terminology within clinical records, this process is simplified; the formal application of this process is being undertaken by a joint venture between the Royal Veterinary College, University of Glasgow and the People’s Dispensary for Sick Animals and was described by Dave Broadbelt at the EBVM conference (venomcoding .org [9]). In the small animal field, SAVSNET (http://www.savsnet.co.uk/ [10]) is a recent combined venture between small animal practices and diagnostic laboratories to monitor disease trends and act as a form of surveillance. Within the EBVMA webinar, Erin Kerby broached the subject of research data publication policies: some journals have such policies in place where the availability and accessibility of data in the long term are defined by the journal. This is yet to become commonplace in the veterinary field Equine Veterinary Journal 47 (2015) 503–504 © 2015 EVJ Ltd

but would have the advantages of ensuring data are accessible even when the researcher has moved to a new location or role, making data that have been paid for by external or government funding available for all interested parties to view and specifying the specific responsibilities with regards to data management at both an individual and institutional level. In addition to discussing methods used to obtain data, both conferences also had the additional focus of utilising these data in clinical decisionmaking. Every scientific study has some limitations and whilst these should be evident and made clear in the discussion section of a paper it is not always easy for the practitioner to determine whether these limitations make the study valid for the population in question. Evidencebased medicine fundamentally requires applying population-based studies to an individual. A consistent theme throughout both conferences was that evidence alone will not make a clinical decision; this must be combined with clinical experience and patient-specific factors to allow the best decision to be made for that individual. The lack of quantity of data in veterinary medicine prohibits many evidence-based medicine techniques such as systematic reviews being applied to veterinary populations. More than 6000 systematic reviews exist in the human medical field, compared with only 415 in the veterinary field. Most of these have been written in the last few years. EVJ has published only two: a systematic review of interventions for dynamic dorsal pharyngeal collapse [11], and more recently, a systematic review of the efficacy of furosemide for exercise-induced pulmonary haemorrhage [12] and there will remain many areas in which sufficient data to generate a systematic review is lacking, or such a review would be inappropriate for the clinical question. Additional techniques were described at the EBVM conference to compensate for this; for example a Bayesian approach, which combines data from studies in species other than the species of interest and weighting them accordingly; Haifang Ni described this approach using Higler et al. [13] as an example. It is clear that the field of veterinary evidence-based medicine is rapidly advancing and practitioners are encouraged to question and update their knowledge with the latest evidence in mind. RCVS knowledge has recently released a collection of resources aimed at practitioners wishing to learn more about evidence-based veterinary medicine; this is called the EBVM toolkit and is available at http://knowledge.rcvs.org.uk/evidence-basedveterinary-medicine/ebvm-toolkit [14]. N. Kerbyson School of Veterinary Medicine, University of Glasgow, UK.

References 1. RCVS Knowledge - EBVM toolkit 1: Asking an answerable clinical question [WWW Document] (2015) RCVS Knowl. URL http://knowledge.rcvs.org.uk/ document-library/ebvm-toolkit-1-asking-an-answerable-clinical-question/ 2. Pubmed [WWW Document] (2015) Pubmed. URL http://www.ncbi.nlm.nih .gov/pubmed 3. Google Scholar [WWW Document] (2015) Google Sch. URL http://scholar .google.co.uk/ 4. RCVS Knowledge: Knowledge summaries [WWW Document] (2015) RCVS Knowl. URL http://knowledge.rcvs.org.uk/evidence-based-veterinarymedicine/knowledge-summaries/ 5. University of Nottingham (2015) Best Bets for Vets [WWW Document]. Best Bets Vets. URL https://bestbetsforvets.org/ 6. Clinical Evidence in Equine Practice (2015) http://onlinelibrary.wiley.com/ journal/10.1001/(ISSN)2042-3306/homepage/clinical_evidence_in_equine _practice_online_collection.htm 7. University of Nottingham (2015b) VetSRev - database of veterinary systematic reviews [WWW Document]. VetSRev. URL http://webapps.nottingham.ac.uk/ refbase/


Recent initiatives in evidence-based veterinary medicine

8. RCVS Knowledge - Library and Information Service [WWW Document] (2015) RCVS Knowl. URL http://knowledge.rcvs.org.uk/library-and-information -services/ 9. Veterinary Nomenclature [WWW Document] (2015) Vet. Nomencl. VeNom. URL http://www.venomcoding.org 10. BSAVA, University of Liverpool (2015) Savsnet: The Small Animal Veterinary Surveillance Network [WWW Document]. Savsnet. URL http://www.savsnet .co.uk/ 11. Allen, K.J., Christley, R.M., Birchall, M.A. and Franklin, S.H. (2012) A systematic review of the efficacy of interventions for dynamic intermittent dorsal displacement of the soft palate. Equine Vet. J. 44, 259-266.

N. Kerbyson

12. Sullivan, S.L., Whittem, T., Morley, P.S. and Hinchcliff, K.W. (2015) A systematic review and meta-analysis of the efficacy of furosemide for exerciseinduced pulmonary haemorrhage in Thoroughbred and Standardbred racehorses. Equine Vet. J. 47, 341–349. 13. Higler, M.H., Brommer, H., L’Ami, J.J., de Grauw, J.C., Nielen, M., van Weeren, P.R., Laverty, S., Barneveld, A. and Back, W. (2014) The effects of three-month oral supplementation with a nutraceutical and exercise on the locomotor pattern of aged horses: effects of a nutraceutical and exercise on the locomotor pattern of horses. Equine Vet. J. 46, 611-617. 14. RCVS Knowledge: EBVM toolkit [WWW Document] (2015) http://knowledge .rcvs.org.uk/evidence-based-veterinary-medicine/ebvm-toolkit

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Equine Veterinary Journal 47 (2015) 503–504 © 2015 EVJ Ltd

Recent initiatives in evidence-based veterinary medicine.

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