Evidence based veterinary medicine

What is evidence based medicine

The process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients

How should EBM be approached

1. Ask a specific question

2. Search for the best information

3. Critically appraise information

4. Apply it to a clinical situation

5. Review and update as required

What specific questions should be asked

• Define patient and condition

• define drug and procedure

• Active control or placebo

• Define clinical response

Where should you search for the best information

• Anecdote or expert opinion

• Textbooks

• Continuing professional development

• Journals

• Databases

• Internet and news media

What should you critically appraise evidence on

• Amount and depth of evidence

• Quality of evidence

• Balance of evidence

What is the hierarchy of evidence

What are the features of a case control study

• Compare cases with a group of controls

• Usually retrospective

• Not blinded or randomised

What are the features of a cohort study

• Follow cases to see what happens to them

• Can assess different treatments

• Not blinded or randomised

What are the features of a randomised controlled trial

• Compare treatment to a control

• Control can be a placebo or another treatment

• Always prospective

• Randomised and often blinded

• Designed to eliminate bias

Why should controls be included

• Placebo effect

• May be an actual physiological response

• The effect can be marked

What are the features of a systematic review

• Review of all published research in a field

• Critical appraisal

• Quality of evidence

What are the features of meta-analysis

• A systematic review

• Uses stats to integrate results of different studies

What is publication bias

• Trials are more likely to be published if they have positive findings

• Positive results at 3-4x more likely to be published

• Negative results often not published at all

• Sponsored trials more likely to be positive