EBVMA Podcast

This is the 4th episode of our Evidence Anxiety Series and will discuss the importance of allocation in study design.  Infograph and transcript are available at ebvma.org. Narrated by Laura M Rey.

As a rule of thumb, if the researchers expect the treatment effect to be small, then the study has to be big, conversely, the smaller the study, the more likely it is that a small or rare effect is missed2. This relationship is the same regardless of the treatment applied, be it a surgical method, a behavior modification strategy, a drug, or a vaccine. Put even more simply, big studies have more power to det­­­ect differences.

1.  Jones SR, Carley S, Harrison M. An introduction to power and sample size estimation. Emerg Med J. 2003;20(5):453-458. doi:10.1136/emj.20.5.453

2.  Wilson Van Voorhis CR, Morgan BL. Understanding Power and Rules of Thumb for Determining Sample Sizes. Tutor Quant Methods Psychol. 2007;3(2):43-50. doi:10.20982/tqmp.03.2.p043

3.  Feinberg WE. Teaching the Type I and Type II Errors : The Judicial Process. Am Stat. 1971;25(3):30-32.

This is the second podcast in the questioning authority series.  In this podcast, we look at the importance of comparison to evaluate claims made about the efficacy of any procedure or intervention.  Infograph and transcript are available at ebvma.org. Narration by Dr. Sheila Keay.

An overview of how practitioners can question any claim made in media, conferences, sales representatives and, essentially, any medical wisdom.  Infograph is available at ebvm.org.  Narration by Dr. Bob Larson.

The process of developing a clinical question is divided into four categories:

1. Patient

2. Intervention

3. Comparison

4. Outcome

The practice of evidence-based veterinary medicine (EBVM) starts with forming a clinicalquestions. Forming a question that is highly specific, particularly in outcomes is very importantin retrieving relevant research.

Originally recorded October 2016 via Skype at Bel-Rea Institute of Animal Technology

Recorded August 2016

The process of Evidence-Based Medicine (EBM) is divided into 5 phases: 1. Developing the clinical question

1.  Developing the clinical question
2. Finding 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.

1st Podcast April 2016

What is EBVM?

Dr. McKenzie started the podcast by discussing Evidence-Based Veterinary Medicine (EBVM) and its role in the clinical environment. Key points as follows:

• EBVM is the integration of scientific research into clinical practice in a more systematic and less haphazard way than in the past. It is important to understand that different evidence has different reliability.
• EBVM allows for flexibility in practice. We aren't bound by what we were told to do, but can utilize recent science to inform new and better practices.
• Sometimes finding the evidence can be challenging but allows us to know the limitations of our knowledge and acknowledging information gaps.

EBVM advantages in practice include:

• Alleviation of practitioner bias that has always existed and is well documented by Clinical Psychology. It is a methodology and system for veterinarians to check themselves in practice.
• Better patient care, staying current on the best interventions, which may sometimes mean no intervention.
• Better ethics, being able to give the degree of certainty in patient care.

Client surveys conducted by Dr. McKenzie suggest that many clients are OK with clinician uncertainty but truth is paramount.

Discussion points included the following themes:

Communicating certainty to clients:

Dr. McKenzie pointed out that Science doesn't take the art out of medicine, but the art in medicine is client communication. Clients pay the veterinarian for the background work and expertise to find answers to their pet's problems.

Dr. Esposito stated that many veterinarians are interested in an honest exchange with their client and not necessarily trying to be a sales person, but at the end of the day, client wishes become a huge influence. Dr. Esposito mentioned that many clients now come out with multiple internet handouts that she helps them negotiate the information and reliability of these resources.

Present information to clients as you know it and dig deeper later. A clinician can start with the common questions and create their own resource. Utilizing that background research the clinician has done can later be shared with the veterinary community and the clinician becomes a producer of evidence.

Clients are OK with uncertainty, are veterinarians?

Dr. McKenzie emphasizes that EBVM is not about becoming robots and clinical decisions do not have to be based on a RCT, that is where clinical experience comes into play.

The culture is changing, and often more experienced clinicians can already accept their knowledge limitations, students are learning to utilize tools (like the RCVS Toolkit) to better inform theirs. Students are being trained to accept uncertainty.

Finally, What are limitations to the incorporation into EBVM?

Key limitations cited by many practitioners is time, two tools were mentioned in improving implementation:

Leveraging nursing staff, by training them in evidence finding

Utilizing and developing technology to make evidence easier to find. Much like what is being used in human medicine.