EBVMA Podcast – Ep 02 – EBVM Methodology (Fausak, Larson, Hemming)

This is part 2 of 2 in the series The EBVMA Podcast

The EBVMA Podcast – Episode 02 – “How to do EBVM” with Dr. Robert Larson, Dr. Patrick Hemming and Erik Fausak

Download an infographic summary (PDF)

Author: Erik Fausak | 15 November 2016

Abstract

The process of Evidence-Based Medicine (EBM) is divided into 5 phases:

  1. Developing the clinical question
  2. Find the evidence
  3. Retrieve the evidence
  4. Evaluate the evidence
  5. Implement the evidence

The practice of evidence-based veterinary medicine (EBVM) starts with forming a clinical questions. Questions, like evidence, should be prioritized. Likewise, once the question is formed and the evidence is found, a critical eye should examine factors the reader understands, most clinicians are not statisticians, put emphasis on the methodology over the statistical method when evaluating quality.

Introduction to EBVM by Dr. Robert Larson

Dr. Larson lead the discussion of incorporating EBVM into practice.
– Dr. Larson went from academia to private practice and back to academia and learned the value of putting the best research into practice.
– EBVM is difficult to implement but technology is making it easier. Resources described were Best Bets for Vets, VetSRev, PubMed, and CABI VetMedResource.
– EBVM requires two key skill sets that require training: How to find the evidence and how to evaluate the evidence.
– Truth claims, be they commercial or research, are best supported by Randomized Control Trials (RCTs) but attention should also be paid in how close the research population matches your patient population.
– Dr. Larson stated the area of greatest need is more critically appraised topics or systematic reviews or “predigested” material that critically evaluates the primary research or RCTs.
– EBVM starts with the question, questions that are frequently addressed by the clinician should be fully researched, less common questions could be addressed with systematic reviews alone (reinforced later in discussion).
– “Replicating mode” is just taking information from advertisement or CE that are incorporated that may or may not be helpful and could be harmful. Using EBVM can help determine the efficacy of treatments versus just copying information the clinician receives.

Discussion Key Points

VetSRev

Dr. Hemming pointed out the value of a database that indexes only secondary research or systematic reviews, VetSRev. Dr. Larson pointed out that as time progresses, the amount of systematic reviews that are populating this database are increasing significantly. Not only that, but Dr. Larson also mentioned that systematic reviews are constantly improving in quality, because despite being the best level of evidence, they are limited by their quality.

Alleviating Bias with Quality Research

Dr. Hemming addressed another important issue that EBVM may alleviate. Many studies are funded by the companies trying to sell a product, can EBVM address this inherent bias in research?

Dr. Larson stated that as the quality of these systematic reviews improve, it can alleviate the bias of interested funding sources. Dr. Larson also touched on the less measured existence of publication bias that anyone receiving grant money from any foundation (including government) have a pressure to publish positive results. The consensus was that some factors of publication bias can be alleviated with transparency and quality research. This topic has been compellingly discussed at the 2015 7th EBVMA Symposium.

Dr. Larson mentioned that when conducting systematic reviews, drug manufacturers were often contacted for information that may not be complimentary or published, sometimes they may share information or sometimes they may not. Vet All Trials is an initiative to index all research being conducted whether published or not, whether positive results, or not.

How to Evaluate Literature Without Strong Statistical Knowledge or Background

Dr. Hemming asked another key question that concerns many clinicians. Many studies that seem to have good information may often be discounted for statistical reasons (typically power), how can a non-statistician evaluate a study? Dr. Larson brought up two good points, as a clinician, a critical eye should be placed on what the clinician can evaluate, the trial methodology. Dr. Larson stated that in many cases the reader has to trust the effort of the statistician involved in the study and the peer reviewers, but the reader can evaluate the animals used in the study and how the study is conducted. Erik mentioned in Trisha Greenhalgh’s book, “How to Read a Paper” [@Greenhalgh1997] , that typically only certain tests are used in clinical trials and when abnormal statistical methods are applied, it may raise eyebrows. Dr. Larson supported this with the caveat that in some cases, a different statistical test may need to be used to best evaluate the study. A different statistical test could be used for a unique type of a study.

Be Open Minded but Not Gullible

Dr. Larson ended on this key note, “To be open minded is not to accept everything, being open minded means being willing to consider anything and when presented with enough evidence, to change their mind”

Guest Biographies

Bob L. Larson, DVM, PhD, ACT, ACAN, ACVPM

111B Mosier Hall, Manhattan, KS 66506 | Phone: (785)532–4257 Fax: (785)532–2252 | Rlarson@vet.ksu.edu

Dr. Larson attended Kansas State University where he received a bachelor degree in Animal Science followed by a DVM in 1987.

After practicing for a year in southeast Kansas, he returned to Kansas State to pursue graduate training in the department of Animal Sciences and Industry and he received his Ph.D. in 1992. Dr. Larson then spent four years in private practice, primarily in Abilene, Kansas.

In 1996 he joined the faculty at the University of Missouri working in the area of beef production medicine. In 2006 he returned to Kansas State University as the Coleman Chair of Food Animal Production Medicine. He is board certified by the American College of Theriogenologists, the American College of Animal Nutrition, and the American College of Veterinary Preventive Medicine – Epidemiology specialty.

He has served a number of leadership roles including serving as president of the Academy of Veterinary Consultants and the Evidence Based Veterinary Medicine Association. Bob and his wife Laura (DVM ’92) have three daughters, Mariah (18 years), Karrin (15 years), and Annie (11 years).

Patrick Hemming, B.S., D.V.M.

Dr. Hemming attained his doctoral degree in 1976 from Colorado State University. He instructs students in the theoretical and applied aspects of veterinary reproduction.

He owns and operates Animal Reproductive Technologies, a beef cattle production medicine, nutrition, reproduction, and veterinary consulting service. Dr. Hemming operates Aristocrat Angus Ranch’s beef cattle reproduction services and has traveled extensively implementing feasibility studies for livestock projects.

Erik Fausak, MSLIS, CVT, RLAT

Erik has always had an interest in the role of animals and humanity since studying Anthropology at Beloit College, WI. In 1999, Erik attended Bel-Rea Institute of Animal Technology and worked at Alameda East Veterinary Hospital in Denver and Fifth Avenue Veterinary Specialists in New York City. His interest took him to graduate school at City University of New York, Hunter College, where his thesis work focused on langur phylogeny and neonatal coat color. Erik then attended library school at Pratt Institute.

Erik has been an active participant in the EBVMA and EBVM Network while teaching at Bel-Rea Institute of Animal Technology. Since then he has been an active proponent of incorporating evidence-based veterinary medicine in his curriculum and training his students to become research leads in evidence-based veterinary medicine. Currently his journal club has written two articles utilizing EBVM techniques.

Erik enjoys camping, hiking, biking, and boating with his wife, 3 year old son,William, and 2 dogs.

Series Navigation<< EBVMA Podcast – Ep 01 – What is EBVM? (Fausak, McKenzie and Esposito)

About Stuart Turner

Dr. Stuart W. Turner, a former emergency & critical-care veterinarian in Northern California, is a full-time biomedical informaticist (a healthcare information architect). His background includes post-graduate training, teaching and research in biomedical informatics. His work covers various realms such as clinical decision support, translational medicine, public health (biosurveillance) and the semantic interoperability of health information systems from the design of clinical information models and biomedical ontologies. He is past president of the Association of Veterinary Informatics and the Evidence-based Veterinary Medicine Association.

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About Stuart Turner

Dr. Stuart W. Turner, a former emergency & critical-care veterinarian in Northern California, is a full-time biomedical informaticist (a healthcare information architect). His background includes post-graduate training, teaching and research in biomedical informatics. His work covers various realms such as clinical decision support, translational medicine, public health (biosurveillance) and the semantic interoperability of health information systems from the design of clinical information models and biomedical ontologies. He is past president of the Association of Veterinary Informatics and the Evidence-based Veterinary Medicine Association.