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The EBVMA hosted the first conference dedicated to evidence-based veterinary medicine in 2004. Biennial events spanning one to three days were held in various locations in the United States. In 2014 it became a yearly one-day event held online for an international audience.

EBVMA members are also involved in presentations at various conferences and in educational programs offered by schools or colleges of veterinary medicine.

If you are interested in presenting an educational webinar, netcast (e.g., podcast or screencast), or participating in our annual symposium regarding EBM related research or methodologies, or applications, please contact us at conference@ebvma.org.

8th EBVMA Symposium (10 February 2017)

Translating Research Into Practice. The 8th Evidence-based Veterinary Medicine Association Symposium, Friday 10 February, 2017 from 7:00 am to ~ 2:00 pm Pacific Time. Call for speaker proposals are now open through 20 September 2016. The EBVMA is AAVSB/RACE Provider #895.

General Information & Registration | Speaker Requirements | Submit a Proposal (EasyChair)

7th EBVMA Symposium (13 November 2015)

Best Evidence. Better Care. The 7th Evidence-based Veterinary Medicine Association Symposium was held Friday 13 November 2015, from 07:00 am to ~ 2:00 pm Pacific Standard Time

AAVSB/RACE Provider Number: 895 (6.-7.0 veterinarian and nurse/technician CEUs pending). Program Number (EBVMA): pending approval (October 2015)

Conference Chairs

Dr. Virginia Fajt (Co-chair), President-Elect, EBVMA | Dr. Stuart Turner (Co-Chair), President, EBVMA | Dr. Eli Larson (Co-Chair), Transformative HIT Solutions | Dr. Renee Dewell (Co-Chair), Veterinary Diagnostic and Production Animal Medicine/Center for Food Security and Public Health Iowa State University

Keynote Presentation: Missing Trials

Ben Goldacre, MBBS, MA (Philosophy), MRCPsych

Senior Clinical Research Fellow at the Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, U.K. | TED Talks | Bad Science | Wikipedia

Abstract:
We like to imagine that medicine is based on good quality evidence from clinical trials. The reality is much darker: around half of all the trials done on treatments today or left on published, the results withheld from the doctors, researchers, and patients who need the most. And yet nobody has broken the law. This talk is and how did it gets withheld, why it matters, & a battle to get all trials reported.

Systematic Reviews including Non-Randomized Studies

Annette M. O’Connor, BVSc, MVSc, DVSc, Member of the Australian College of Veterinary Scientists (Epidemiology), Fellow of the Australian College of Veterinary Scientists (Epidemiology)

Professor, Veterinary Diagnostic and Production Animal Medicine, Iowa State University College of Veterinary Medicine

Abstract

While the randomised-controlled trial is considered the gold standard to ensure that study subjects under evaluation are only being compared based on the impact of the study intervention, the paucity of RCTs in veterinary medicine make this especially challenging in conducting systematic reviews of interventions. Also not all review questions relate to interventions. This presentation will talk about the benefits and risks , trends and criticisms, and unique design features in the use of non-randomized clinial study designs.

In this section we will discuss the important considerations that must be made when including non-randomized studies into an evidence base. The session will discuss how the role of non-randomized studies might differ based on the different types of review questions – interventions, causation, prevalence and diagnostic tests. The contribution of non-randomized studies to the evidence base and the potential sources of bias must be careful considered at the protocol development stage. At this protocol development stage of the review decisions need to be made about if such studies will be eligible for the review. If it is decided to included non randomizes studies as part of the evidence base, the protocol should outline what risk domains will be considered when assessing the risk of bias.

Keywords:
systematic reviews, non-randomized studies, evidence-based medicine

The Electronic Health Record as an EBM Platform: Context-Aware Knowledge Retrieval (Infobuttons)

Guilherme Del Fiol, M.D., M.S (Computer Science)., Ph.D. (Biomedical Informatics)

Assistant Professor, Biomedical Informatics, University of Utah School of Medicine

Abstract:
Clinicians’ patient care information needs are frequent and largely unmet. Knowledge resources are available that can help clinicians meet these information needs. Yet, significant barriers limit the use of these resources within the clinical workflow. Infobuttons are clinical decision support tools that integrate electronic medical record systems into information resources as an attempt to lower these barriers. The author will describe a life cycle of infobutton research and development, including: research on clinicians’ information needs, the impact of infobuttons on clinicians, the HL7 (Health Level Seven) Infobutton Standard, and OpenInfobutton, an open source software platform that provides infobutton functionality to clinicians at several health care organizations.

Keywords:
Information needs, Health Information Technology Standard, Clinical decision support, Electronic health record system, Knowledge resource

Veterinary Technician’s Role in Evidence-Based Practice

Erik Fausak, MA, MS

Instructor, Bel-rea Institute of Animal Technology; Online Veterinary Athenaeum

Abstract:
Practicing Evidence-Based Veterinary Medicine (EBVM) is difficult to be done by any individual. EBVM, like all of medicine, should be a team approach. Veterinary Technicians can play a role in being able to retrieve, evaluate, and prioritize the evidence to reduce the time for the veterinarian to acquire the research. Strategies that the veterinary technician can employ to help themselves and the veterinarian will be discussed. A team approach to EBVM can answer a wide range of clinical questions from the technician’s own aspect of nursing care to assisting the veterinarian in finding reliable evidence to help support clinical decision-making. Aspects that will be examined:

  1. Technician’s as research leads for finding evidence
  2. Utilizing tools for evidence evaluation
  3. Discussion of a novel system to prioritize research from highest quality to least quality.

Keywords:
evidence hierarchy, veterinary technician, veterinary nurse, evidence-based practice, clinical research

Innovations in EBVM Publications

Richard B. Evans, PhD

Editor-in-Chief, Royal College of Veterinary Surgeons (RCVS) Knowledge Veterinary Evidence; University of Missouri

Abstract:
Veterinary information is like a gold mine. The wealth of information is hard to get, buried in bits and pieces in original articles published in hard-to-access subscription journals. That makes it difficult for most veterinary practitioners to access information. Even if they have access to journals, it’s a challenge to process the information in a clinically useful way.

RCVS Knowledge’s EBVM program aims to change the way practitioners access veterinary information by publishing knowledge summaries (also called CATs) as well as other EBVM-related articles.

Practitioners (including students, fellows, and others) can write the knowledge summaries themselves because RCVS Knowledge has opened access to over 1,000 journals, simplified the research process with software and EBVM toolkits, and incentivized publishing knowledge summaries.

RCVS Knowledge’s library and information services staff are developing Discovery, a way of seamlessly searching through thousands of journals without logging into each publisher’s website. The library and information services staff can aid practitioners in designing search strategies and in some cases retrieve the articles for them. Practitioners working on knowledge summaries can access journals through Discovery for one month, free of charge.

The RCVS Knowledge’s open access journal, Veterinary Evidence, will publish peer-reviewed knowledge summaries and other evidence-based manuscripts, letters and editorials as well as primary research. Publishing evidence-based manuscripts not only disseminates knowledge but also gives credit to authors and evidence-based researchers, providing them with public acknowledgement of their contributions to veterinary medicine.

Keywords:
evidence-based, publishing, critically appraised topic

Systematic Reviews in Veterinary Medicine: Resources and Tools to find, appraise, and conduct reviews

Margaret Foster, MS, MPH

Associate Professor, Systematic Reviews and Research Coordinator, Texas A&M University; Joint Assistant Professor, Department of Health Promotion and Community Health Sciences, Texas A&M Health Sciences Center School of Public Health

Abstract:
Systematic reviews play an important role in evidence-based practices by providing practitioners with synthesized research about a particular topic. However, as a research project they can be cumbersome and time consuming due to the numerous processes that need to be completed as well as to the various types of data that generated. This presentation will cover locating reviews, appraisal checklists, and tools to improve efficiency in completing reviews. Examples from a variety of veterinary topics will be shown to demonstrate the most appropriate use of the available tools. In addition, steps to take to determine the feasibility of a systematic review will be described as this can be one of the most difficult stages in the review process.

Keywords:
systematic reviews, evidence-based practices

A Revised Evidence Pyramid for Veterinary Clinical Resources

Suzanne Fricke, DVM, MLIS

Animal Health Librarian, Washington State University

Abstract:
Veterinary medicine is a field traditionally dependent on textbooks and expert opinion, often in the form of conference proceedings and monitored discussion boards, for clinical decision support. As electronic health record systems evolve with potential to bring more current research to the point of care, interest in evidence-based medicine grows. Evidence-based veterinary medicine (EBVM) integrates the best available research with clinical expertise, patient circumstances, and client values. Teaching of EBVM often relies on a hierarchical pyramid to visually represent studies in terms of their level of evidence. Though considered the highest level of evidence in the original 4S evidence pyramid, systematic reviews, and the randomized controlled trial studies on which they are based, are limited in veterinary medicine. In this imperfect information infrastructure, emerging veterinary resources, found in various forms such as critically appraised topics and clinical guidelines, seek to apply current best evidence to everyday clinical problems. Where do these new resources fit in terms of their level of evidence? While the human medical evidence pyramid was revised to a 5S or 6S model (Haynes 2006, Dicenso 2009) to incorporate newer synopses and summaries, current evidence hierarchies in veterinary medicine are still based on the 4S model. This project reviews current evidence hierarchies and newly emerging veterinary medical evidence resources for placement in a 6S hierarchy model. The revised pyramid provides an educational framework for veterinarians and veterinary students tasked with supporting clinical decisions with evidence in an evolving information environment. This model assumes a best case scenario and cautions that resources must be individually evaluated for quality.

Keywords:
evidence-based veterinary/methods, evidence hierarchy, evidence pyramid, decision support techniques

The Global Resource for Online Evidence-Based Veterinary Medicine Learning

Kristen Reyher, BSc, DVM, PhD, MRCVS [1], Emma Crowther, Rachel Dean, Sarah Baillie, Sebastian Arlt, Marnie Brennan, David Brodbelt, Fiona Brown, Douglas Grindlay, Ian Handel, Mark Holmes, Catherine McGowan, Timothy Parkin, Emma Place, Gwen Rees, Darren Shaw, Javier Sanchez, Laura Urdes, John Vanleeuwen, Kristien Verheyen and Sheena Warman

[1] Senior Lecturer in Farm Animal Science, University of Bristol School of Veterinary Sciences

Abstract
Evidence-based veterinary medicine (EBVM) can be defined as the use of the best and most relevant available scientific evidence in conjunction with clinical expertise to make the best possible decision about a veterinary patient, while considering the circumstances of each patient and its owners/carers.

To help direct the uptake of EBVM in the veterinary consciousness, we have assembled an extensive international team with a collective passion for delivering high-quality teaching of EBVM. The team is currently working together to develop an open access series of online, re-usable learning objects presented as a coherent web tutorial designed to introduce learners to the key concepts of EBVM.

The resource is organised into modules addressing the five key areas of EBVM:

  • Ask – how to formulate answerable questions
  • Acquire – how to obtain relevant information
  • Appraise – how to evaluate the available evidence
  • Apply – how to apply the evidence to clinical practise
  • Assess – how to measure the effect of implemented changes

The purpose of this online resource is to introduce EBVM to learners, hence it will be appropriate for students and practitioners for self-study; it is also envisaged that the resource will be used in whole or in part as standalone teaching modules to support other EBVM teaching. The resource utilises best pedagogical approaches, and includes formative multiple choice questions, short tasks and recommendations for further study. Development of the resource has followed an iterative cycle of development which includes review by both the core team as well as other identified stakeholders (e.g. students, practitioners, industry representatives).

It is hoped that the development of this resource will increase awareness of EBVM in the veterinary profession, and allow practitioners the opportunity to develop the skills needed to utilise EBVM in everyday clinical practice. It is expected that the resource will be launched at the RCVS Knowledge EBVM Skills Day on October 30th, 2015, in London, England. Future aims of the project team include designing methods of cataloguing and disseminating evidence syntheses to support clinical decision making and evidence-based veterinary practice as well as building a community of practice in this area.

The project team would like to acknowledge RCVS Knowledge for funding the development of the online EBVM resource.

Keywords:
EBVM teaching, online resource, open access

Bias in Evidence-based Medicine

Sidonie N. Lavergne, DVM, IPSAV, PhD, Postdoctoral Fellow

Assistant Professor, College of Agricultural, Consumer and Environmental Sciences, Division of Nutritional Sciences, University of Illinois

Abstract:
There are various definitions of the word bias, such as “an unfair personal opinion that influences judgment” or “tendency or preference towards a particular perspective, ideology or result, especially when the tendency interferes with the ability to be impartial, unprejudiced, or objective”. In addition to impacting our personal life, biases also impact biomedical research (funding, study outcome, and publication) and clinical decisions. It is important for clinicians and clinical researchers to understand what biases are in order to avoid them. After emphasizing these points, the presentation will also introduce the audience to the different types of bias in biomedical science and medicine: personal biases (e.g. culture background, past experiences, personal conflict of interest); scientific biases (e.g. selection, performance, attrition, professional conflict of interest); and confounding factors. Finally, the webinar will explain how each type of bias can either be avoided or how researchers and clinicians can limit their impact on a study outcome or clinical decision: e.g. randomization; blinding; intent-to-treat.

Keywords:
bias, confounding factor, conflict of interest, randomization, blinding

P values and NNTs: What they are and their roles in critical assessment

Richard B. Evans, PhD

Editor-in-Chief, Royal College of Veterinary Surgeons (RCVS) Knowledge Veterinary Evidence; University of Missouri

Abstract:
The elevator pitch for a canine orthopedics research paper might go something like this: “We did a blinded RCT on 100 dogs comparing TTA to Tightrope and got statistical significance on PVF.”

That single-sentence summary reports two design features, the study design and sample size, and it gives two results, the statistical significance on an outcome variable. Understanding statistical significance (P values) and making outcomes meaningful (NNTs) are the topics of this talk.

P values, which are used to identify real results, are ubiquitous in veterinary research, but their basic interpretation (especially P>0.05) is often misunderstood and incorrectly applied. Moreover, researchers often P hack their results, teasing out a few P<0.05 among a forest of P>0.05, giving the impression that results are real when they probably aren’t.

It’s the job of critical appraisers, and a central part of this talk, to understand what P values mean in the larger context of determining if the results in an article are real or due to chance.

P values are one side of the outcomes coin. The other side is the clinical importance of the results. For example, are group differences large enough to effect changes in practice patterns among clinicians? Often results are described in terms of means of outcome variable: the mean peak vertical force, the mean body condition score, and so on. But is a change of 0.5 in BCS meaningful? That depends.

Numbers needed to treat (NNTs) are way of summarizing outcomes in a way that is clinically useful. I’ll describe NNTs and give examples when they are needed and how to calculate them.

Keywords:
evidence-based veterinary medicine (EBVM), Critically Appraised Topic (CAT), p-value, Number Needed to Treat/Harm (NNT/NNH), critical assessment

Veterinary All Trials Initiative (VetAllTrials)

Panel Presentation: Dr. Lauren Quattrochi, Director, All Trials Campaign USA and Sense About Science USA; Dr. Rachel Dean, Director, Centre for Evidence-based Veterinary Medicine at Nottingham University (CEVM); Dr. Stuart Turner, President, EBVMA

Abstract:
VetAllTrials (vetalltrials.org) is an emerging international consortium dedicated to the development of one or more veterinary clinical trial registries. The group is also involved in the development of policies and standards that support the open access publication of research outcomes and clinical trial data – worldwide. The World Health Organization asserts that the registration of all interventional trials is a scientific, ethical and moral responsibility.

VetAllTrials is aligned with the broader AllTrials initiative which is focused on clinical trials in human medicine. AllTrials currently has support from approximately 85,000 individuals and 575 organisations. The AllTrials ethos is All trials registered, all results reported.

While there are many similarities, veterinary medicine has unique technical and knowledge representation requirements, incentives, policies and resource constraints compared to human medicine. This panel presentation will highlight the objectives, requirements, challenges and work to begin to harmonize requirements and specifications with existing clinical trial registry environments such as clinicaltrials.gov or the WHO International Clinical Trial Registry Platform.

Keywords:
clinical trial registry, open access publication, clinical trial data, open content licensing, open data licensing, linked open data

To Be Determined

We are currently confirming one of two additional presentations.

6th EBVMA Symposium (14 November 2014)

AAVSB/RACE Program Number: 16960 (7.0 veterinary CEUs). Provider Number (EBVMA): 895

Conference Chairs

Dr. Stuart Turner (Chair), President, EBVMA | Dr. Brennen McKenzie (Co-Chair), Past-President, EBVMA | Dr. Virginia Fajt (Co-chair), President-Elect, EBVMA, College of Veterinary Medicine, Texas A&M University | Ann Viera (Co-chair), Regional Director, EBVMA; Pendergrass Agriculture and Veterinary Medicine Library, University of Tennessee at Knoxville | Dr. Marnie Brennan (Co-chair), Centre for Evidence-Based Medicine, University of Nottingham | Dr. Renee Dewell (Co-Chair), Veterinary Diagnostic and Production Animal Medicine/Center for Food Security and Public Health Iowa State University | Dr. Eli Larson (Co-Chair), Pewaukee Veterinary Service | Dr. Ashok Jadhav (Co-Chair), Department of Pharmacology, College of Medicine, University of Saskatchewan

Table of Contents

Click on title to see authors, abstract, links to full proceedings (where available), tutorials or slidedecks. Note: some resources, such as screencasts, will be made available only to active EBVMA members.

  1. Using Big Data to Shift from Evidence-based Practice to Practice-based Evidence (KEYNOTE)
  2. Evidence-Based Medicine: An Ethical Imperative
  3. Why use scientific literature in clinical decision making?
  4. Research Data Publication Policies in Veterinary Medicine
  5. Evidence-based Nursing Practices: The Veterinary Technician’s Perspective
  6. The use of clinical audit in farm animal veterinary practice
  7. Small animal consultations: What is the role of the clinical examination?
  8. A systematic review and meta-analyses of commercially available viral and bacterial vaccines for bovine respiratory disease complex: Realizing gaps in recommendations from existing immunization guidelines
  9. Interpreting the results of scientific studies (it’s not black and white)
  10. What is bias and confounding and why are they important?
  11. A web-enabled database of evidence tables from USP monographs
  12. Utilization of Freely Available Resources to Find and Access the Evidence
  13. The Centre for Evidence-based Veterinary Medicine: Four years on!
  14. Moving forward in the use of evidence based medicine in the clinical setting
  15. RCVS Knowledge, 1st International EBVM Network Conference Review

Summaries

Keynote: Using Big Data to Shift from Evidence-based Practice to Practice-based Evidence

Christopher Longhurst, MD, MS, DABP (Pediatrics), DABPM (Clinical Informatics)

Clinical Associate Professor, (Pediatrics – Systems Medicine; General Pediatrics; Medicine – Biomedical Informatics Research), Fellowship Director, Clinical Informatics; VP of Analytics; Chief Medical Information Officer (CMIO), Stanford Children’s Health; Lucille Packard Children’s Hospital, Stanford School of Medicine, Stanford University

Human pediatric medicine shares many similarities to veterinary medicine such as the intrinsic nature of patient proxies (e.g. parents, pet owners or herd managers) and the characteristics of reporting and evaluating outcomes of interventions in a clinical environment or research study. Another is the relative paucity of good prospective research. There is a heavy reliance on evidence at levels III through V, especially case studies or expert opinion. Dr. Longhurst will share work he and his colleagues have highlighted in Evidence-Based Medicine in the EMR Era (PDF); NEJM, 10 Nov 2011; 365:1758-1759, which demonstrates the use of an institutional (Stanford Childrens Health) clinical data repository built from a robust electronic medical record system, to perform patient cohort analysis where evidence from publications may be lacking .

MS-Powerpoint_icon.jpg|link=https://ebvma.org/home/files/slides/6th-EBVMA-Symposium_Big-Data_Longhurst_Slides.pdfDownload slidedeck (PDF) | Proceedings not available | Screencast (EBVMA members only)

Evidence-Based Medicine: An Ethical Imperative

David Ramey, DVM

Equine Medicine; Contributor, Science-Based Medicine Blog; Author:

Ethical treatment of animals is more than merely a matter of causing no harm and pleasing the client. A veterinarian has a moral and ethical obligation to provide treatment for which there is good evidence of effectiveness. Indeed, society desires and expects that effective treatments are being provided. For any treatment, establishing proof of efficacy as well as potential risks and benefits is an ethical requirement.

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_David-Ramey.pdfDownload full proceedings (PDF) | Slidedeck & Screencast (EBVMA members only)

Why use scientific literature in clinical decision making?

Robert Larson, DVM, PhD, DACT, DACVPM (Epidemiology), DACAN

Professor, Production Medicine; Edgar E. and M. Elizabeth Coleman Chair Food Animal Production Medicine; Executive Director, Veterinary Medical Continuing Education; College of Veterinary Medicine, Kansas State University

The human mind is pretty good at properly linking cause-and-effect when the initiating cause and outcome are easily detected with human senses, straightforward with no interactions, and closely spaced in time, location, and magnitude. However, if either a causative factor or its outcome is undetectable by human senses aided by technology; or if multiple causes either must or can interact to bring about the outcome, the human mind makes many erroneous conclusions. Many of these problems exist in veterinary medicine, in that nearly all causes of disease and repair are completely outside the ability of human senses to detect even when aided by advanced technology, the time-frame between a causative factor and a clinically important outcome can be prolonged (with many other visible factors occurring in the interim time), and very slight or undetectable changes in homeostatic mechanisms can result in profound changes in perceivable disease or repair outcomes (with more-easily detectable – but wholly non-influential changes occurring prior to disease or repair outcomes). Fortunately, veterinary medicine can be a data-rich area of scientific investigation. Even though many of the factors affecting animal disease and repair are difficult or impossible to detect, the outcomes (recovery, length of life, improved growth, etc.) are readily measurable and occur within reasonable time frames. In a science like veterinary medicine, our investigations of nature can be data-driven because of the relative ease of collecting clinically important outcome data.

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Bob-Larson_Scientific-Literature.pdfDownload tutorial (PDF) | Slidedeck & Screencast (EBVMA members only)

Research Data Publication Policies in Veterinary Medicine

Erin E. Kerby, MS

Veterinary Medicine Librarian; Assistant Professor, University Library, Veterinary Medicine Library, University of Illinois at Urbana-Champaign

Many professionals working in the field of veterinary medicine have recognized the need to improve the quality and reliability of published research, but little progress has been made on this front in the past decade. While the researchers themselves could do much to improve the situation, there are other stakeholders involved who need to step up to the plate. This presentation puts forth the idea that veterinary journal publishers and editors need to be more clear and rigorous with their policies and author instructions, specifically with regards to research data. An article recently published in BMC Veterinary Research suggests that “wider adoption of reporting guidelines by veterinary journals would improve the quality of published veterinary research.” Such an improvement would allow for more effective appraisal of the literature and accordingly increase the quality of evidence available and used in veterinary practice. These reporting guidelines could be further strengthened by a policy for the inclusion and/or sharing of research data. Several recent governmental mandates and initiatives at the federal level have caused entities such as NSF (National Science Foundation) and NIH (National Institutes of Health) to begin creating policies requiring grant applicants to create research data management plans. Despite this, there has been little incentive so far for veterinary researchers to create data management plans or to make their data more widely available because many grant recipients do not reach the funding threshold for the NSF and NIH requirements. Although a handful of veterinary journals currently have some sort of research data policy, wider adoption would create more incentive for the researchers and authors, improve the peer review process, and contribute to better quality published research

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Erin-Kerby.pdfDownload full proceedings (PDF) | Slidedeck & Screencast (EBVMA members only)

Evidence-based Nursing Practices: The Veterinary Technician’s Perspective

Kenichiro Yagi, BS, MS1 and David Liss, BA, RVT, VTS (ECC, SAIM), CVPM 2

[1] PetEd Veterinary Education and Training Resources; ICU Supervisor, Blood Bank Manager, Adobe Animal Hospital, Los Altos, California, United States
[2] Program Director- Veterinary Technology at Platt College, South Pasadena, California, United States

The RECOVER initiative has influenced many to evaluate their perspective on evidence-based practices in veterinary medicine. The Nursing Standard Committee of the Academy of Veterinary Emergency and Critical Care Technicians is currently working on creating evidence-based guideline for nursing practices employed in the veterinary ECC. The process is modeled after the RECOVER initiative process described, with indirect mentorship from Dr. Daniel Fletcher (a co-chair of the RECOVER committee). Current work is focused on urinary catheter placement and maintenance, with a group of approximately 20 veterinary technician specialists from a variety of background asking practical nursing questions and evaluating the evidence available through literature. This is the first effort we are aware of driven completely by veterinary technicians to produce practical guidelines for technicians, and hope to be one of the first of many fruitful guidelines to be established. Such an effort has some of its unique challenges to be overcome, including the state of the veterinary technician profession and familiarity with evidence searches and critical analysis of levels of evidence.

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Ken-Yagi.pdfDownload abstract (PDF) | Slidedeck & Screencast (EBVMA members only)

The use of clinical audit in farm animal veterinary practice

Katie Waine1*; Chris Hudson1; Rachel Dean, BVMS PhD DSAM (Fel) MRCVS1; Jon Huxley1 and Marnie Brennan, BSc (VB), BVMS, PhD1

[1] School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Loughborough, Leicestershire LE12 5RD, United Kingdom

Clinical audit has been used by the medical profession for nearly 30 years, yet is still a relatively new concept in farm animal veterinary practice. The Royal College of Veterinary Surgeons (RCVS), the governing veterinary organisation in the UK, now stipulate that individual veterinary surgeons and practices under the RCVS Practice Standards Scheme should be carrying out audit as part of their clinical governance to improve clinical standards. Types of practice, such as farm animal practice, requiring visits to individual premises as opposed to seeing cases within a hospital environment have additional challenges when conducting clinical audit. There are no current guidelines advising farm animal veterinary surgeons on how best to run clinical audit in practice. This presentation will discuss how clinical audit could be used in farm animal veterinary practice.

* Speaker Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Katie-Waine.pdfDownload full proceedings (PDF) | Slidedeck & Screencast (EBVMA members only) | See the Clinical Audit Toolkit from the RCVS

Small animal consultations: What is the role of the clinical examination?

Natalie Robinson1*; Marnie Brennan, BSc (VB), BVMS, PhD1; Malcolm Cobb1 and Rachel Dean, BVMS PhD DSAM (Fel) MRCVS1

[1] School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Loughborough, Leicestershire LE12 5RD, United Kingdom; * Speaker

* Speaker Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Natalie-Robinson.pdfDownload abstract (PDF) | Slidedeck & Screencast (EBVMA members only)

A systematic review and meta-analyses of commercially available viral and bacterial vaccines for bovine respiratory disease complex: Realizing gaps in recommendations from existing immunization guidelines

Miles Theurer, DVM, PhD

Kansas State University, United States

Vaccination of cattle is routine procedure in the beef industry with the goal to suppress and delay the severity of bovine respiratory disease complex (BRDC). Bovine respiratory disease is a multi-factorial disease with one of the primary causes due to viral or bacterial infection. We performed a systematic review and meta-analysis to evaluate the efficacy of vaccinating cattle with commercially available viral and bacterial agents to mitigate the effects of BRDC. Determination of clinical efficacy from induced-disease challenge models requires caution as induction models are different from natural exposure. The published literature provides some guidance for veterinarians, but does not provide definitive recommendations for which viral and/or bacterial components are necessary for a vaccination program. This presentation will discuss the outcomes of this review as well as the challenges in the design, execution and publication of systematic reviews in veterinary medicine.

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Miles-Theurer.pdfDownload abstract (PDF) | Slidedeck & Screencast (EBVMA members only)

Interpreting the results of scientific studies (it’s not black and white)

Robert Larson, DVM, PhD, DACT, DACVPM (Epidemiology), DACAN

Professor, Production Medicine; Edgar E. and M. Elizabeth Coleman Chair Food Animal Production Medicine; Executive Director, Veterinary Medical Continuing Education; College of Veterinary Medicine, Kansas State University

Critical thinking is a process, and as such is never completed. Critically thinking about a clinical problem involves repeating the steps of gathering information, evaluating that information, reflecting on the information and coming to tentative conclusions. Because no single study can fully address most clinical questions and because every study has limitations either in internal and/or external validity, using scientific studies to enhance clinical decision-making requires combining different pieces of evidence of varying strengths. While gaining competence in each step of the critical thinking process requires education, skill, and experience, probably the most difficult to master is to reflect deeply about what is known and what is unknown and how to tie multiple pieces of information and evidence together.

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Bob-Larson_Interpreting-Results.pdfDownload tutorial (PDF) | Slidedeck & Screencast (EBVMA members only)

What is bias and confounding and why are they important?

Robert Larson, DVM, PhD, DACT, DACVPM (Epidemiology), DACAN

Professor, Production Medicine; Edgar E. and M. Elizabeth Coleman Chair Food Animal Production Medicine; Executive Director, Veterinary Medical Continuing Education; College of Veterinary Medicine, Kansas State University

Well-designed studies differ from clinical experience because explicit constraints are implemented to control for sources of bias. Clinical experience is particularly prone to bias because the same person provides and then evaluates interventions. Biases that occur commonly, and often inadvertently, when relying on clinical experience are typically grouped into categories of selection bias, information bias, and confounding.

Observations in clinical settings are plagued by selection bias because although this bias is a crucial flaw if one wants to compare interventions, it is perfectly appropriate and beneficial when applied to clinical case management. Essentially, selection bias occurs when animals with certain signalment, history, or physical examination findings are treated differently than animals without those case characteristics. While clinically reasonable, this practice prevents any attempt to accurately compare alternative risks or treatments.

Similarly, information bias is very common in clinical case management because we intentionally gather different types and amounts of information about different animals. For example, it is reasonable to observe some animals more closely, under different circumstances, or for longer periods of time than other animals. However, this bias can lead to incorrect associations with either disease-causation or treatment factors.

Adobe PDF file icon 24x24.png|link=https://ebvma.org/home/files/proceedings/2014/6th-EBVMA-Symposium_2014_Bob-Larson_Bias-Confounding.pdfDownload tutorial (PDF) | Slidedeck & Screencast (EBVMA members only)

A web-enabled database of evidence tables from USP monographs*

Ronette Gehring, BVSc, MMedVet (Pharm), MRCVS, DACVCP

Associate Professor, Clinical Pharmacology, Kansas State University

The United States Pharmacopeial Convention (USP) monographs contain Evidence Tables that summarize all items of the literature pertaining to contentious label and extra label use of drugs for species-specific indications in clinical veterinary practice. These have now been digitized with support from an EBVMA grant and are available through a web-enabled database. The objective of this presentation is to introduce the methods of making evidence assertions for the clinical indication and use of these drugs, to introduce this database to the evidence-based veterinary medicine community, and encourage participants to become involved in updating and expanding this online resource.

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* Roy Montgomery Research Award Winner

Utilization of Freely Available Resources to Find and Access the Evidence

Erik Fausak, MA, MS

Instructor, Bel-rea Institute of Animal Technology; Online Veterinary Athenaeum

Evidence-Based Veterinary Medicine is contingent on one important idea, that you have access to the evidence to evaluate it. The following presentation is about how to utilize freely available resources for the limited resources of a private practitioner. Review the utilization of robust databases that are freely available: PubMed and Google Scholar. Additionally, the oft overlooked resource in your neighborhood often has many veterinary resources, your local library. This presentation or tutorial is about how to utilize these databases and public libraries to access the resources you want without leaving the comfort of your clinic.

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The Centre for Evidence-Based Veterinary Medicine: Four Years On!

Rachel Dean, BVMS PhD DSAM (Fel) MRCVS & Marnie Brennan, BSc (VB), BVMS, PhD

Centre for Evidence-Based Veterinary Medicine, Faculty of Medicine & Health Sciences, University of Nottingham, United Kingdom

The Centre for Evidence-based Veterinary Medicine (CEVM) was established at the School of Veterinary Medicine and Science at the University of Nottingham in 2009. The CEVM is now a team of 15 veterinary and non-veterinary researchers dedicated to promoting the awareness and use of the EVM principles in veterinary practice. Since it started the CEVM has identified aspects of Evidence Based Medicine (EBM) that can be adapted for the veterinary profession to help practitioners integrate evidence into their clinical decision-making. The CEVM uses both qualitative and quantitative methods and works directly with the profession at every available opportunity.

The CEVM has four core areas: Population Research, Evidence Synthesis, Practice-based Research and Education/Information Exchange. The population research involves both animals and their carers/owners as well as veterinary surgeons themselves and includes the only shelter medicine research programme in the United Kingdom. The CEVM has created resources such as Best BETs for Vets (www.bestbetsforvets.org) and VetSRev (www.nottingham.ac.uk/cevm/evidence-synthesis/systematic-review/vetsrev) as part of the evidence synthesis work. They are both freely available to practising veterinary surgeons and updated on a monthly basis. Our practice-based research has involved working closely with first opinion veterinary practices on research projects to help us prioritise the evidence needs of practices. An international EVM survey of the veterinary profession was also undertaken and the results are being assimilated. Education and information exchange is vital to the work of the CEVM and has involved teaching veterinary undergraduates as well as practitioners and has enabled us to work towards developing the most appropriate methods to best deliver evidence to practice.

The aim of this presentation is to highlight the development and outputs of the CEVM since EBVMA 2010 and highlight the challenges and successes of the CEVM to date.

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Moving forward in the use of evidence based medicine in the clinical setting

Steve Budsberg, DVM, MS, DACVS

Professor, Department of Small Animal Medicine Surgery; Director of Clinical Research; College of Veterinary Medicine, University of Georgia, United States

It is clear over the last decade that evidence based medicine (EBM) advocates have focused on promoting the concepts and ideals of EBM as well as teaching the skills needed to use it efficiently and effectively. With this knowledge and education there has been emergence of a significant number of perceived barriers that seem to prevent the clinician from implementing EBM. Remember, at its’ core EBM attempts to take the results of population studies and apply them to an individual patient. This is in stark contrast to traditional medical practice in which clinical experience (often from individual patients) is commonly used to define and defend the treatment of an entire group of patients with a similar problem. Thus it is apparent that promoting this paradigm shift must emphasize the fact that these data must however be combined with the knowledge of the individual patient/client and the experience of the clinician. When clinicians read and think about evidence based medicine (EBM), thoughts that often come to mind are “how does this really affect me and if I want to use EBM, how I can do this in my daily practice?” It is important to remember the evidence (data), by itself, does not make a decision for you, but it can help support the patient care process. We must now focus on the process of encouragement of collaboration by means of positive and safe communication and shared learning across career stages to overcome these barriers. Recent studies suggest that these types of proactive steps will facilitate the uptake of EBM and reduce cognitive and affective biases in clinical decision-making. Thus, we need look critically at all the pros and cons of EBM and move forward, not as evangelical preachers or high minded academics but as colleagues and mentors to work to improve the use of all the data available when treat our patients. In the next few years, as clinical trial data continues to increase, we must guide and instill in individuals at all levels of their professional careers a sense of how EBM can benefit them when used judiciously and correctly.

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RCVS Knowledge, 1st International EBVM Network Conference Review

Panel presentation
This was a one hour review by organizers and attendees of RCVS Knowledges’ 1st Evidence-Based Veterinary Medicine Network Conference held 23-24 October, 2014 in Windsor, United Kingdom. Conference website (Warning: Adobe Flash based website)

5th EBVMA Symposium (30 May 2012)

Evidence-Based Medicine: It’s Happening Now | Co-located with the American College of Veterinary Internal Medicine (ACVIM) Annual Meeting, New Orleans, Louisiana
Chair: Dr. Brennen McKenzie

  1. Basic Concepts in Evidence-Based Veterinary Medicine
    Peggy Schmidt DVM, MS, DACVPM; Western University College of Veterinary Medicine
  2. Making Sense of Clinical Trials: Believe It or Not?
    Mark Rishniw, BVSc, MS, PhD, DipACVIM (Internal Medicine and Cardiology); Cornell University
  3. SNAP Judgements of Observational Studies
    Sandra Lefebvre, DVM, PhD, & Ashlee Adleman, MPH; Banfield Applied Research & Knowledge (BARK)
  4. Knowledge Synthesis
    Annette O’Connor, BVSc, MVSc, DVSc, FACVSc; University of Iowa
  5. Reporting Guidelines for Clinical Trials in Companion Animals
    Paul Morley, DVM, PhD, DACVIM; Colorado State University College of Veterinary Medicine
  6. Harnessing electronic medical record data to support clinical decision making
    Sandra Lefebvre, DVM, PhD; Banfield Applied Research & Knowledge (BARK), Banfield, the Pet Hospital
  7. RECOVER – The Reassessment Campaign on Veterinary Resuscitation
    Daniel Fletcher, PhD, DVM, DACVECC; Cornell University College of Veterinary Medicine

4th EBVMA Symposium (13–15 June 2010)

Western University College of Veterinary medicine

Workshops

  1. Clinical Trials – How To’s for Performing Clinical Trials and Studies in Your Practice
    Brenda Phillips, DVM, ACVIM and Linda Kidd, DVM, PhD, ACVIM
  2. Finding the Evidence: How to Search and Access the Literature
    Kate Anderson, BA, MA, MA; Head – Zalk Veterinary Medical Library, University of Missouri

Lectures

  1. Keynote: Evidence based veterinary medicine and clinical research: How should they fit?
    Margaret Slater, DVM, PhD; Department of Veterinary Integrative Biosciences College of Veterinary Medicine and Biomedical Sciences Texas A&M University
  2. The role of sentinel practices in evidence-based veterinary research
    Dr. Rachel Dean, Director of the Centre for Evidence-based Veterinary Medicine & Marnie Brennan, Deputy Director of the Centre for Evidence-based Veterinary Medicine; University of Nottingham, UK
  3. Putting Knowledge into Practice
    P Shearer & Ashlee Addleman
  4. Teaching Evidenced Based Veterinary Medicine in an Integrated Curriculum
    Jennifer L. Buur, Peggy Schmidt, and Peggy Barr
  5. REFLECT statement for practitioners
    Annette O’Connor, BVSc, MVSc, DVSc, FACVSc; University of Iowa
  6. An Evidence- Based Assessment of Acupuncture in Animals
    David Ramey, DVM
  7. The Cochrane Collaboration
    Mark A Holmes, MA, VetMB, PhD, MRCVS
  8. Keynote: Using EBM in Daily Clinical Practice
    Blaise Burke, DVM, DACVR
  9. Keynote: EBM in a Parallel World — Experiences with EBM in Physical Therapy
    Julie Tilson, PT, DPT, NCS
  10. Case Reports – Tips for Writing EBVM Friendly Case Reports or Where’s the Evidence Papers
    Sandra Lefebvre, DVM, PhD, Assistant Editor, JAVMS, AJVR

3rd EBVMA Symposium (9–10 June 2008)

State of the Art: Evidence-Based Veterinary Medicine

University of Georgia

  1. What is EBVM? History of EBVM
    Robert Larson, DVM, PhD; Kansas State University
  2. Cows and CAT’s-Challenges to Practicing EBVM
    Dr. Dave Kelton, DVM, MSc, PhD; Ontario Veterinary College, University of Guelph
  3. A Systematic Review of Pain Scoring Systems
    Erik H. Hofmeister, DVM, DACVAA, DECVAA, MA; University of Georgia
  4. It Ain’t the 60s Anymore: An Evidence-Based Medical Approach to Equine Parasite Control
    Ray Kaplan, DVM, PhD; University of Georgia
  5. ”FAMACHA: A New Tool for Applying an Evidence-Based Medical Approach to Small Ruminant Parasite Control ”
    Bob Storey, MS; University of Georgia
  6. MRI Evaluation of Head Trauma in 32 Dogs: Associations with Modified Glasgow Coma Score and Patient Outcome
    Simon R. Platt, BVM&S, MRCVS, DACVIM (Neurology), DECVN; University of Georgia
  7. Experience with Evidence-Based Medicine Journal Clubs in Private Practice and in Cyberspace
    Bob Rosenthal, DVM, DACVIM
  8. ”EBVM in Research: Evidence-Based Medicine and the Morris Animal Foundation – A Desire for Outcome Analysis ”
    Patricia Olson, DVM, PhD; Morris Animal Foundation
  9. ”EBVM in Medicine: A Critical Appraisal and an Intersection with Veterinary Clinical Scientists ”
    Phillip Bergman, DVM, PhD; Bright Heart Foundation
  10. ”EBVM in Surgery: Outcomes Assessments in Small Animal Orthopedics ”
    Steve Budsberg, DVM, MS, DACVS; University of Georgia

2nd EBVMA Symposium (14–15 June 2006)

Using EBM and Outcome Assessment in Veterinary Medicine

Mississippi State University

  1. ”Introduction to EBVM ”
    Mark Holmes, Vet.MB, M.A., PhD; University of Cambridge, UK
  2. EBM/EBVM from the human cognition perspective
    John Gay, DVM, PhD; Washington State University
  3. ”Teaching EBM ”
    Mark Holmes, Vet.MB, M.A., PhD; University of Cambridge, UK
  4. Critically-appraised topics (CAT’s), clinical audit, and practice-based research
    Mark Holmes, Vet.MB, M.A., PhD; University of Cambridge
  5. Update of the 3rd International Conference of Evidence-based Health Care Teachers & Developers
    Donna Shettko, DVM; Western University
  6. ”Therapeutic dogmas and EBVMA-experience in a senior elective ”
    Cory Langston, DVM, PhD, DACVCP; Mississippi State University
  7. The Veterinary Antimicrobial Decision Support (VADS) System: What we actually know about extra-label antimicrobial drug use in food animals
    Mike Apley, DVM, PhD, DACVCP, Kansas State University
  8. USP evidence-based pharmacotherapy
    Amy Neal, DVM; US Pharmacopeia
  9. Clinical nutrition update: What is the evidence?
    Todd Towell, DVM, MS, DACVIM; Hill’s Science and Technology Center
  10. The sharing of data and its role in EBVM
    Allen Hahn, DVM, PhD; University of Missouri
  11. Using critically appraised topics (CATs) to teach EBVM to veterinary students
    Stanley Robertson DVM, Mississippi State University
  12. What are systematic reviews and how are they different from what we are doing now? The process of systematic reviews: Writing systematic review reports
    Jan Sargent, DVM, MSc, PhD; McMaster University
  13. EBVM Association Organizational Meeting
    Robert Larson, DVM, PhD; Kansas State University

1st EBVMA Symposium (18–19 May 2004)

Using Evidence-Based Medicine and Outcome Assessment in Veterinary Medicine

Mississippi State University

  1. EBVM: What is it?
    Philip Roudebush DVM, Dipl ACVIM, Hills Pet Nutrition, Inc., Topeka, KS
  2. Teaching EBVM at Cambridge
    Mark Holmes Vet.MB, M.A., PhD, University of Cambridge, England
  3. Teaching EBM concepts
    Dan Mayer MD, Albany Medical College, NY
  4. Teaching EBM: a team approach
    Dan Mayer MD, Albany Medical College, NY
  5. EBVM: what does the future hold?
    Hugh Lewis, BVMS, Dipl. ACVP, Banfield, The Pet Hospital/Data Savant, Inc.
  6. Where do we go from here?
    Stanley Robertson, DVM; Mississippi State University, Starkville