Vetlexicon Bovis - Providing Evidence Based Advice...

22/11/2019

Providing evidenced based advice, when there is no (or little) evidence base available!
 
Here at Vetstream, we pride ourselves on providing excellent, evidence-based, yet practical information for busy veterinary surgeons. However, what do we do when the evidence base available is poor, or sometimes non-existent? To reassure our subscribers we thought it might be useful to give you a glimpse behind the scenes as to how the editorial team deal with this issue.

Essentially the key points are:
  • Research, research, research and a little more research.
  • Critically appraise the information that is identified.
  • Decide whether the information is truly evidence based or not.
  • If the conclusion is that there is little evidence to support advice on diagnosis or decision making etc regarding a particular topic; then we must decide whether including an article on this topic will be beneficial to vets anyway. If nothing else, it may save our subscribers from putting all the time and leg work in, to come to this conclusion themselves!
  • Once the decision has been made to include a topic, knowing that the evidence base is weak, then we work with the authors and reviewers to produce an article that is practical and genuinely useful to vets, but that is also transparent and honest regarding the lack of evidence.
In reality, vets deal with this same situation most days in practice when advising owners or farm clients. Sometimes it’s a case of saying:
“This is what I know to be true ..............”
“This is what I think is probably going on.................”
“But there is no definitive answer and as such we need to work together to agree a way forward”.

Honesty and integrity result in longstanding and trusting client relationships and we feel the same way about the relationship we have with our subscribers.

Some recent examples of topics which have been tackled this way include:

Bovine cutaneous histiocytoma
  • You’ve probably never seen a case and you probably never will, as we’re not 100% convinced that cattle even get cutaneous histiocytoma!
  • However, we’re not afraid to shy away from a little controversy and so if you ever do think you may have such a case, then you will find all of our research on this topic within Bovis, along with many disclaimers making it clear that the authors and editor have reservations about some of the references mentioned.
  • This information is different to what you will find if you googled this topic, as not only has all the available information on this topic been pulled together by the author, into one handy article; it has also been critically appraised by the reviewer (who also consulted a number of experienced pathologist colleagues) and the Bovis Editorial Team.
  • We doubt many vets will ever need to consult this article, but as we strive to make Bovis the most comprehensive cattle resource that vets turn to, it is included for the one vet who may one day find this useful!
Buhner suture
  • The Buhner suture technique article caused some disagreement between the author and reviewer:
    • The author's opinion was that it is a safe technique to use on select prolapsed uterus cases.
    • The reviewer felt that this is not an appropriate technique for uterine prolapses.
  • Author and reviewer disagreements do happen from time to time but are usually fairly easy to deal with. If the author and reviewer have polar opposite views then generally, we turn to the evidence base and reach a mutually agreeable solution through discussion between the author, reviewer and Editor.
  • However, if there is no real evidence base to determine who is right, then what do we do? The answer is be honest with the reader.
  • In the case of the Buhner suture, the Editor was of the opinion that this “marmite” situation probably reflected the situation in practice pretty accurately. Some vets love a Buhner suture, and some don’t! At the time of publishing the Buhner article, we could find no reliable evidence to definitively ascertain whether these sutures should be used following uterine prolapses or whether alternative techniques would be preferable. It really does seem to be down to personal preference. If and when such evidence becomes available, then we will update this article accordingly.
  • In the meantime, the author and reviewer did agree that the article content accurately explains the correct way to perform this technique and as such the article was published, but with a caveat explaining the differing opinions of the author and reviewer on the appropriateness of the technique and inviting the reader to make up their own minds.
In both these examples, as with all topics within Bovis, we always invite user feedback and so if anyone ever does discover any new evidence relating to a topic then please let us know. This way we can update articles accordingly and keep Bovis the up to date resource that it is.

Check out RCVS Knowledge for further information on Evidence-Based Veterinary Medicine.

We hope you found this insight useful.

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