Vetlexicon Lapis - Providing Evidence Based Advice...


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 base 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 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 examples of topics which might be tackled in this way include:

  • Incredibly rare diseases:
    • A recent example would be Bovine Cutaneous Histiocytoma, published in Bovis.
    • You’ve probably never seen a case of this disease and you probably never will! We may not even be 100% convinced that the disease exists or is experienced by a particular species, but someone, somewhere, at some point in history has reported a case and as such it’s on our radar to be added as Vetlexicon content. We’re not afraid to shy away from a little controversy!
    • By publishing information on such weird, wonderful and controversial topics, alongside more mainstream information, we hope that should you ever be the unfortunate soul who has this topic on your differential list one day, that you will find all of our research useful. You will also have full transparency via many disclaimers within the article, 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 the disease in question, as not only will all the available information on this topic be pulled together by the author, into one handy article; it will also be critically appraised by the reviewer and our Editorial Team.
    • We doubt many vets will ever need to consult some of these more obscure articles, but as we strive to make Vetlexicon the most comprehensive resource that vets turn to, we’ll continue to include these for the one vet who may one day find them useful!
  • Controversies between authors and reviewers:
    • 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 would turn to the evidence base and reach a mutually agreeable solution through discussion between the author, reviewer and Editor. Readers of the published article will usually be unaware that these disagreements ever surfaced.
    • 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 this case, congruence is key, and the reader is made aware that this is the situation.
    • In the example of a surgical technique, it may be that the author and reviewer agree that the article accurately describes how to correctly perform the technique – in which case the article can be published. However, if they disagree as to whether the technique is welfare friendly, or relevant in certain situations, then caveats will be added to explain the differing opinions of the author and reviewer and the reader will be invited to make up their own mind.
We always invite user feedback and so if you do discover any new evidence relating to a topic then please let us know. This way we can consider updating articles accordingly and keep the Vetlexicon services the up-to-date resources that they are.

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

We hope you found this insight useful.