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News & Reports
bva congress
Overcoming barriers to evidence-based veterinary medicine Recent years have seen an increased emphasis on evidence-based medicine – treating patients based on the best available evidence. But, while awareness of evidence-based veterinary medicine is increasing, widespread implementation may be hampered by a lack of data. A debate at the BVA Congress in November last year asked whether, and if so how, vets can obtain the best evidence and use this in their practice. ‘The expectation must be that the collection of appropriate case data is the responsibility of all veterinary professionals.’ So said Lance Lanyon, former principal of the Royal Veterinary College, outlining his views on how evidence-based veterinary medicine might really be achieved. He was speaking in a BVA Congress debate about whether the profession was in a position to deliver evidence-based medicine, which was held during the London Vet Show on November 21. The problem, Professor Lanyon explained, was the difficulties inherent in conducting patient-based research. While, in the human medical field, evidencebased medicine was defined by the BMJ as being ‘primarily derived systematic research in patients’, veterinary science had historically focused on laboratory-based research, with patient-based research being mainly undertaken by individuals who were primarily practising clinicians. This disjoint between laboratory and clinical research, he explained, was the crux of the problem. Patient-based research, he said, ‘has no external funding base, interferes with the smooth-running of the organisation, costs money and is regarded by many colleagues in those organisations as unethical, by the public as unjustifiable, by the animal societies as unsupportable and by the authorities as illegal.’ And yet, Professor Lanyon explained, good-quality
Lance Lanyon and Marnie Brennan: evidence-based veterinary medicine is achievable, but there are a number of obstacles to overcome
patient-based research is key to evidencebased practice. So what could be done to overcome these obstacles? The answer, he argued, was for veterinary practices to accurately record all case data in electronic templates and for these data to be gathered together and coordinated into a database that could then be interrogated to produce evidence. This would, however, be a large undertaking and Professor Lanyon suggested that it would require the joint involvement of the most prominent organisations in the
veterinary field, including the RCVS, the BVA and academic institutions, as well as individual veterinary practices. ‘The RCVS, in my view, should state clearly that the systematic collection of standardised data is a responsibility of every veterinarian and of every veterinary nurse,’ he said. The veterinary schools, he argued, also had a responsibility to ensure that students understood their ‘scientific responsibilities toward the profession’ as well as toward individual animals. It also needed to become more widely January 11, 2014 | Veterinary Record | 37
Downloaded from http://veterinaryrecord.bmj.com/ on June 19, 2015 - Published by group.bmj.com
News & Reports accepted, he argued, that some of the data collected and recorded would not be for the benefit of the particular animal but would be collected in order to aid the larger cohort. He suggested that some animal welfare groups were ‘not helpful’ in this regard and needed to better understand that ‘trivial procedures on some animals that may not provide a direct benefit to them may be required to produce data that will benefit the greater population’. Following Professor Lanyon’s presentation, Marnie Brennan, deputy director of the Centre for Evidence-based Veterinary Medicine at Nottingham university, outlined her view that, while evidence-based medicine was achievable, there were various problems to be overcome. She went on to explain what she thought were the main barriers to the implementation of evidence-based medicine from the point of view of the clinician. One of the problems she addressed was the time and cost constraints experienced by practitioners. Reading a research paper in detail, she explained, was a time-consuming task and time spent doing this would usually
38 | Veterinary Record | January 11, 2014
mean less time spent with patients. This caused some practitioners to read just the abstract of a scientific paper to try to glean information; however, Dr Brennan cited studies that showed that abstracts do not always reflect the actual content of the paper and should be treated with caution. In order to overcome this issue, she said, it was important for vets to have access to synthesised forms of information, similar to those available to medics. These would ideally take the form of summaries of all of the published evidence and would be quick and easy for clinicians to read and understand. This was something that Dr Brennan and her colleagues were currently working on in the form of ‘BestBETS for Vets’ (VR, September 28, 2013, vol 173, p 284). However, she also explained that producing such syntheses was costly and time-consuming, and raised the question of who, ultimately, should fund the production of such summaries. A further potential problem, Dr Brennan suggested, was the ability of vets in practice to accurately critique scientific papers. While some veterinary schools now taught
undergraduates how to evaluate the quality of evidence, not all practitioners would have been taught to do so. A potential solution lay in the availability of resources that explained how to do this. Such resources, she said, were already accessible and were quick and easy to read. Finally, Dr Brennan noted that there were some areas of veterinary medicine for which there was no evidence on which to base practice. When faced with such areas, vets often turned to textbooks to glean information; however, studies had shown that there could be lengthy delays between evidence being published in the literature and being incorporated into standard textbooks, suggesting that these resources may not always be up-to-date. The solution to this, she said, was to learn from the field of human medicine, for which there were organisations that identified gaps in knowledge, prioritised them and then funded relevant research. ‘Let’s learn to put our hands up and say: we don’t know a lot about this topic, let’s focus on that and see what we can do next’, she suggested. doi: 10.1136/vr.f7644
Downloaded from http://veterinaryrecord.bmj.com/ on June 19, 2015 - Published by group.bmj.com
Overcoming barriers to evidence-based veterinary medicine Veterinary Record 2014 174: 37-38
doi: 10.1136/vr.f7644 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/174/2/37
These include:
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
News & Reports
bva congress
Overcoming barriers to evidence-based veterinary medicine Recent years have seen an increased emphasis on evidence-based medicine – treating patients based on the best available evidence. But, while awareness of evidence-based veterinary medicine is increasing, widespread implementation may be hampered by a lack of data. A debate at the BVA Congress in November last year asked whether, and if so how, vets can obtain the best evidence and use this in their practice. ‘The expectation must be that the collection of appropriate case data is the responsibility of all veterinary professionals.’ So said Lance Lanyon, former principal of the Royal Veterinary College, outlining his views on how evidence-based veterinary medicine might really be achieved. He was speaking in a BVA Congress debate about whether the profession was in a position to deliver evidence-based medicine, which was held during the London Vet Show on November 21. The problem, Professor Lanyon explained, was the difficulties inherent in conducting patient-based research. While, in the human medical field, evidencebased medicine was defined by the BMJ as being ‘primarily derived systematic research in patients’, veterinary science had historically focused on laboratory-based research, with patient-based research being mainly undertaken by individuals who were primarily practising clinicians. This disjoint between laboratory and clinical research, he explained, was the crux of the problem. Patient-based research, he said, ‘has no external funding base, interferes with the smooth-running of the organisation, costs money and is regarded by many colleagues in those organisations as unethical, by the public as unjustifiable, by the animal societies as unsupportable and by the authorities as illegal.’ And yet, Professor Lanyon explained, good-quality
Lance Lanyon and Marnie Brennan: evidence-based veterinary medicine is achievable, but there are a number of obstacles to overcome
patient-based research is key to evidencebased practice. So what could be done to overcome these obstacles? The answer, he argued, was for veterinary practices to accurately record all case data in electronic templates and for these data to be gathered together and coordinated into a database that could then be interrogated to produce evidence. This would, however, be a large undertaking and Professor Lanyon suggested that it would require the joint involvement of the most prominent organisations in the
veterinary field, including the RCVS, the BVA and academic institutions, as well as individual veterinary practices. ‘The RCVS, in my view, should state clearly that the systematic collection of standardised data is a responsibility of every veterinarian and of every veterinary nurse,’ he said. The veterinary schools, he argued, also had a responsibility to ensure that students understood their ‘scientific responsibilities toward the profession’ as well as toward individual animals. It also needed to become more widely January 11, 2014 | Veterinary Record | 37
Downloaded from http://veterinaryrecord.bmj.com/ on June 19, 2015 - Published by group.bmj.com
News & Reports accepted, he argued, that some of the data collected and recorded would not be for the benefit of the particular animal but would be collected in order to aid the larger cohort. He suggested that some animal welfare groups were ‘not helpful’ in this regard and needed to better understand that ‘trivial procedures on some animals that may not provide a direct benefit to them may be required to produce data that will benefit the greater population’. Following Professor Lanyon’s presentation, Marnie Brennan, deputy director of the Centre for Evidence-based Veterinary Medicine at Nottingham university, outlined her view that, while evidence-based medicine was achievable, there were various problems to be overcome. She went on to explain what she thought were the main barriers to the implementation of evidence-based medicine from the point of view of the clinician. One of the problems she addressed was the time and cost constraints experienced by practitioners. Reading a research paper in detail, she explained, was a time-consuming task and time spent doing this would usually
38 | Veterinary Record | January 11, 2014
mean less time spent with patients. This caused some practitioners to read just the abstract of a scientific paper to try to glean information; however, Dr Brennan cited studies that showed that abstracts do not always reflect the actual content of the paper and should be treated with caution. In order to overcome this issue, she said, it was important for vets to have access to synthesised forms of information, similar to those available to medics. These would ideally take the form of summaries of all of the published evidence and would be quick and easy for clinicians to read and understand. This was something that Dr Brennan and her colleagues were currently working on in the form of ‘BestBETS for Vets’ (VR, September 28, 2013, vol 173, p 284). However, she also explained that producing such syntheses was costly and time-consuming, and raised the question of who, ultimately, should fund the production of such summaries. A further potential problem, Dr Brennan suggested, was the ability of vets in practice to accurately critique scientific papers. While some veterinary schools now taught
undergraduates how to evaluate the quality of evidence, not all practitioners would have been taught to do so. A potential solution lay in the availability of resources that explained how to do this. Such resources, she said, were already accessible and were quick and easy to read. Finally, Dr Brennan noted that there were some areas of veterinary medicine for which there was no evidence on which to base practice. When faced with such areas, vets often turned to textbooks to glean information; however, studies had shown that there could be lengthy delays between evidence being published in the literature and being incorporated into standard textbooks, suggesting that these resources may not always be up-to-date. The solution to this, she said, was to learn from the field of human medicine, for which there were organisations that identified gaps in knowledge, prioritised them and then funded relevant research. ‘Let’s learn to put our hands up and say: we don’t know a lot about this topic, let’s focus on that and see what we can do next’, she suggested. doi: 10.1136/vr.f7644
Downloaded from http://veterinaryrecord.bmj.com/ on June 19, 2015 - Published by group.bmj.com
Overcoming barriers to evidence-based veterinary medicine Veterinary Record 2014 174: 37-38
doi: 10.1136/vr.f7644 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/174/2/37
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
