Handbook of Evidence-Based Veterinary Medicine

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ISBN: 9781405108904 | 1405108908
Cover: Paperback
Copyright: 5/16/2003

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The application of evidence-based veterinary medicine (EBVM) can assist in improving and optimising the diagnosis, prognosis, control, treatment and ultimately the welfare of animals. It can also provide the user with a methodology for appropriate, patient orientated life-long, self-directed, learning. To practise evidence-based veterinary medicine we require a range of skills that we may not have. This book will explain what evidence-based veterinary medicine is and show how it can be applied to veterinary practice to improve the quality of care for patients and provide informed choices for owners. It will provide the reader with a toolkit of skills necessary to practise evidence-based veterinary medicine. This book is aimed at practitioners but will be of interest to veterinary surgeons at any stage of their training or career wishing to learn about EBVM.

Preface

xiii

Acknowledgements

xiv

Introduction

(22)

Who is this book for?

(1)

Who isn't this book for?

(1)

What do we mean by EBVM? A brief description

(1)

Comparison of the traditional methods and EBVM

(1)

Why should we practise EBVM?

(7)

Because we can

(1)

Because our clients can too

(1)

We need the information

(3)

Time for learning, a diminishing resource faced with expanding demands

(1)

Increasing the speed of adopting the results of science

(1)

To better direct clinical research

(1)

Ethical aspects of proof

(1)

Ethical conduct in the absence of scientific evidence

(1)

A return to science

(1)

Are we ready to ask questions about our own performance?

(1)

A more detailed description of EBVM

(3)

The process

(2)

The need for evidence

(1)

Other sources of information and evidence

(1)

EBM in human medicine

(1)

EBM in veterinary medicine

(1)

Are we already practising EBVM?

(1)

EBVM case studies

(3)

Small animals: megavoltage radiotherapy of nasal tumours in dogs

(1)

Farm animals: restocking after foot and mouth disease

(1)

Horses: efficiency of prednisolone for the treatment of heaves (COPD)

(1)

How this book is organised

(4)

The aims and objectives of this book

(1)

Outline of the structure of this book

(1)

References and further reading

(2)

Review questions

(1)

Turning Information Needs into Questions

(11)

Introduction

(1)

Refining clinical questions so that evidence can be found

(1)

Is this a good treatment for a disease?

(1)

How good is a test?

(1)

Four main elements of a well-formed clinical question

(1)

Patient or problem

(1)

The diagnostic or therapeutic intervention, prognostic factor or exposure

(1)

Comparison of interventions (if appropriate or required)

(1)

The outcome

(1)

Categorising the type of question being asked

(1)

Prioritising the questions

(1)

Checklist of information needs

(4)

Epidemiological risk factors

(1)

Diagnostic process

(1)

Treatment

(1)

Harm/aetiology

(1)

Prognosis

(1)

Control (risk reduction) and prevention (risk avoidance)

(1)

Potential pitfalls in constructing questions

(1)

Complexity of the questions

(1)

The need for sufficient background knowledge

(1)

Further reading

(1)

Review questions

(1)

Sources of Information

(21)

Introduction

(1)

Background and foreground knowledge

(1)

Hierarchy of evidence

(2)

Important traditional information resources

(3)

Journals

(2)

Textbooks and other review type publications

(1)

Personal experience and background knowledge

(1)

Colleagues

(1)

Practice records

(1)

The Internet

(2)

Veterinary information resources on the Internet

(9)

CABdirect

(1)

Consultant

(1)

Inno-vet

(1)

International Veterinary Information Service

(1)

Medline/Pubmed

(4)

The Merck Veterinary Manual

(1)

Montreal Veterinary School

(1)

NetVet and the Electronic Zoo

(1)

RCVS and RCVS library

(1)

VetGate

(1)

VIN

(1)

Wildlife Information Network

(1)

Other computer-based information resources

(2)

BSAVA

(1)

CLIVE

(1)

Lifelearn

(1)

Vetstream

(1)

Critically appraised topics

(2)

Further reading

(1)

Review questions

(1)

Searching for Evidence

(12)

Introduction

(1)

RCVS library

(1)

Other online book catalogues

(1)

Consultant

(1)

Searching strategies: simple Boolean logic

(1)

Using Pubmed

(2)

Sensitivity and specificity

(1)

Special veterinary considerations

(1)

Searching for the answers to questions about therapy

(1)

Searching for the answers to questions about diagnosis

(1)

Searching for the answers to questions about aetiology

(1)

Searching for the answers to questions about prognosis

(1)

Using the `Clinical Queries' option in Pubmed

(1)

Depth of the veterinary scientific literature

(2)

Developing searching skills

(2)

References and websites

(1)

Review questions

(1)

Research Studies

(17)

Hierarchy of evidence and experimental design

(1)

Guide to research methods

(1)

Literature reviews

(2)

Systematic reviews

(1)

Meta-analyses

(1)

Experimental studies

(2)

Randomised controlled trials

(2)

Cross-over designs

(1)

Observational studies

(5)

Cohort studies

(1)

Cross-sectional survey

(1)

Case-control studies

(2)

Diagnostic tests and screening tests

(1)

Poorly controlled or uncontrolled trials

(1)

Comparisons between groups at different times

(1)

Comparisons between different places

(1)

n = 1 trials (the `treat and see' method)

(1)

Uncontrolled trials (before and after trials)

(1)

Non-random allocation trials

(1)

Descriptive studies

(5)

Surveys

(1)

Case series and case reports

(1)

Further reading

(1)

Review questions

(2)

Appraising the Evidence

(23)

Some introductory concepts

(3)

The importance of statistics

(1)

Likelihood: probability and odds

(1)

Risk and uncertainty

(1)

Appraising articles on veterinary therapy

(5)

Is the study valid?

(2)

Are the results important?

(1)

Quantifying the risk of benefit or harm

(2)

Confidence intervals (CIs)

(1)

Making a decision about therapy

(1)

Appraising articles on veterinary diagnosis

(5)

Is the study valid?

(1)

Are the results important?

(3)

SpPin and SnNout

(1)

Making a decision about a diagnostic test

(1)

Appraising articles on harm or aetiology

(4)

Is the study valid?

100

(1)

Are the results important?

101

(1)

Statistical analysis

102

(1)

Appraising studies on prognosis

102

(5)

Is the study valid?

103

(1)

Are the results important?

104

(1)

References and further reading

104

(1)

Review questions

105

(1)

Solution to the probability example used in Section 1

106

(1)

Diagnosis

107

(18)

Introduction

108

(1)

Definitions

108

(2)

Types of diagnosis

109

(1)

The clinical examination: evidence for the presence of disease

110

(1)

Hypothetico-deductive reasoning

111

(1)

The diagnostic process

112

(2)

Recall and ranking

114

(2)

Pattern matching

114

(1)

Probabilities

114

(1)

Pathophysiological reasoning (functional reasoning)

115

(1)

Which method of pattern recognition is used?

116

(1)

Clinical reasoning strategies used in hypothetico-deductive reasoning

116

(2)

The properties of clinical signs

116

(1)

Logical exclusion of a disease

117

(1)

Inductive and deductive reasoning

117

(1)

Abstraction/aggregation

117

(1)

Prevalence

118

(1)

Errors in hypothetico-deductive reasoning

118

(1)

Logic, sets, Venn diagrams, Boolean algebra

119

(3)

Clinical sign sensitivities

120

(1)

Disease subsets

120

(1)

Venn diagrams and Boolean algebra

120

(2)

Clinical staging of metritis in cattle

122

(3)

References and further reading

122

(1)

Review Questions

123

(2)

Clinical Diagnostic Decision Support Systems (CDDSSs)

125

(29)

Introduction

126

(1)

Definition

126

(1)

Questions you should ask

127

(1)

Understanding the methodology used by CDDSSs

127

(4)

Logic

128

(1)

List matching

129

(1)

Probabilities (Bayes' rule)

129

(1)

Knowledge-based systems incorporating symbolic reasoning (syntactical systems)

130

(1)

Bayesian belief networks

131

(1)

Neural networks

131

(1)

Sources of uncertainty or inaccuracies

131

(1)

Evaluation of the performance of CDDSSs

132

(1)

Which is the best method to measure the performance of a CDDSS?

132

(1)

Alternative desirable indicators of performance using accuracy

133

(1)

Veterinary diagnostic decision support systems

133

(16)

A decision support algorithm for individual cow infertility

133

(1)

Consultant

134

(4)

Vetstream Canis

138

(1)

PROVIDES (Problem Orientated Veterinary Information and Decision System)

138

(3)

Bovid

141

(4)

EqWise

145

(1)

Cattle Disease Diagnostic System (CaDDiS)

146

(1)

Application of probability techniques to the objective interpretation of veterinary clinical biochemical data

147

(2)

Sources of information of the CDDSSs described in this chapter

149

(5)

Further reading

151

(1)

Review questions

152

(2)

Decision Analysis, Models and Economics as Evidence

154

(28)

Introduction

155

(1)

Decision analysis

155

(2)

Methods for clinical decision making

155

(1)

Situations in which decision analysis may be helpful

156

(1)

The five steps in decision analysis

156

(1)

Disadvantages of decision analysis

157

(1)

Decision trees

157

(12)

Utilities

158

(1)

Solving the decision tree

158

(1)

Sensitivity analysis

158

(1)

Missing options

158

(1)

Helping owners decide

159

(1)

Obtaining utility values from clients and owners

160

(1)

Decision analysis tree for therapeutic decisions

161

(1)

Decision analysis tree for economic decisions

161

(2)

Decision analysis tree of diagnostic tests

163

(3)

Pay-off tables

166

(3)

User checklist for clinical decision analysis

169

(1)

Testing and treating thresholds

169

(2)

General properties of testing and treating thresholds

170

(1)

Modelling

171

(5)

Modelling herd infection dynamics

172

(2)

Modelling and the control of foot and mouth disease

174

(1)

Modelling Staphylococcus aureus infection in a herd

175

(1)

User guide to models

175

(1)

Economic analysis

176

(2)

Partial budgets and cost--benefit analysis

176

(2)

User guide to economic analysis

178

(1)

Medline search functions

178

(4)

References and further reading

178

(2)

Review questions

180

(2)

EBVM: Education and Future Needs

182

(8)

EBM in medical education

183

(1)

Resources for the practice of EBM

183

(2)

Critically appraised topics (CATs)

183

(1)

High quality systematic reviews

183

(1)

The Cochrane Library

184

(1)

Secondary journals (e.g. EBM)

185

(1)

EBM in veterinary education

185

(1)

Evidence-based veterinary toolkit

185

(1)

Finding out what is in the literature and what is not in the literature

185

(1)

What resources do we need for the practice of EBVM?

185

(1)

Clinical (EBVM) audits in veterinary practice

186

(1)

What is a clinical audit?

186

(1)

Why do we need a clinical audit?

186

(1)

What has a clinical audit got to do with EBVM?

186

(1)

How do we carry out an EBVM audit?

186

(1)

Clinical audits and the future

187

(1)

Other future developments

187

(3)

References and further reading

188

(2)

Glossary of Terms Used in EBVM

190

(11)

Bibliography

201

(3)

Answers to Review Questions

204

(2)

Index

206

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Handbook of Evidence-Based Veterinary Medicine

Summary

Author Biography

Table of Contents

Supplemental Materials

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Handbook of Evidence-Based Veterinary Medicine

Summary

Author Biography

Table of Contents

Supplemental Materials

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