About this course
|Site:||RCVS Knowledge Learn|
|Book:||About this course|
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|Date:||Tuesday, 30 May 2023, 10:21 PM|
1. About EBVM Learning
About EBVM Learning
The development work on the initial version of this course was completed during the EBVM Learning I project (2015). It has been updated during the EBVM Learning II project (2019-20) using feedback from users and a review of each section by team members.
The projects have been supported by RCVS Knowledge which also manages the course website.
The content of this course can be used and shared in accordance with the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International licence (CC BY-NC-SA 4.0) . Find out more about acceptable use of the material in this course.
A group of people (academics and practitioners) have contributed to the development of EBVM Learning and were involved in the projects ‘EBVM Learning I’ to develop the original version of EBVM Learning (2014-15) and/or ‘EBVM Learning II’ to gather feedback on the resources and produce the updated version (2019-20).
- Ellie Sellers, University of Bristol, UK (EBVM II Project Co-lead)
- Sarah Baillie, University of Bristol, UK (EBVM II Project Co-lead)
- Emma Gallop, University of Bristol, UK (EBVM I Project Co-lead)
- Kristen Reyher, University of Bristol, UK (EBVM I Project Co-lead)
- Rachel Dean, Vet Partners, UK (EBVM I Project Co-lead)
- Sebastian P. Arlt, Freie Universität Berlin, Germany
- Clare Boulton, RCVS Knowledge, UK
- Marnie Brennan, University of Nottingham, UK
- David Brodbelt, Royal Veterinary College, UK
- Fiona Brown, University of Edinburgh, UK
- Louise Buckley, University of Edinburgh, UK
- Myai Du, RCVS Knowledge, UK
- George Goran, University of Agricultural Sciences and Veterinary Medicine of Bucharest, Romania
- Douglas J. C. Grindlay, University of Nottingham, UK
- Laura Haddock, University of Bristol, UK
- Ian Handel, University of Edinburgh, UK
- Mark Holmes, University of Cambridge, UK
- Jo Ireland, University of Liverpool, UK
- Heidi Janicke, St. George’s University, Grenada
- Alison Mann, University of Bristol, UK
- Catherine McGowan, University of Liverpool, UK
- Heather K. Moberly, Texas A&M University, USA
- Tim Parkin, University of Glasgow, UK
- Emma Place, University of Bristol, UK
- Md Mizanur Rahman, Chattogram Veterinary and Animal Sciences University, Bangladesh
- Gwen Rees, University of Bristol, UK
- Javier Sanchez, University of Prince Edward Island, Canada
- Johan P. Schoeman, University of Pretoria, South Africa
- Darren Shaw, University of Edinburgh, UK
- Paul Smith, PJS Web, UK
- Laura Urdes, University of Agricultural Sciences and Veterinary Medicine of Bucharest, Romania
- John VanLeeuwen, University of Prince Edward Island, Canada
- Kristien Verheyen, Royal Veterinary College, UK
- Sheena Warman, University of Bristol, UK
3.1. Using the course
Using the course
There are a number of ways of approaching this course. We recommend that you work through the entire course, however you may wish to use the individual sections as standalone learning.
- If you are entirely new to the concept of EBVM, it is best to start with the ABCs of EBVM and work through the course from there.
- You may wish to tackle one section this week and the next section in a few weeks’ time, or you may wish to spend the day learning about EBVM and work through the whole course in one go.
- The right-hand menu displays the content in each section. If you’re accessing the course on your mobile, this menu will appear beneath the main page content.
- If you want to learn more about a specific topic, the pink expandable boxes enable you to read about the subject in more detail, or you can use the search button at the top right of the screen to identify every place this subject is discussed.
- Each page has previous/next links at the bottom to help you progress through the course. Alternatively you can jump to specific sections or pages in the course using the main navigation bar at the top, or the menu on the right-hand side.
- Remember to use the glossary for any clarification of words and terms you don’t understand.
- You can download a pdf version of the entire EBVM Learning course.
- Please note that the hyperlinks were correct at the time of publication, but may become out of date over time.
Accredited practices (RCVS): The Royal College of Veterinary Surgeons is the United Kingdom’s professional registration body. The RCVS Practice Standards Scheme is a voluntary initiative to accredit veterinary practices in the UK. Through setting standards and carrying out regular inspections, the Scheme aims to promote and maintain the highest standards of veterinary care.
Audit cycle: A systematic review of a practice, process or performance to establish how well it meets predetermined criteria. The procedure includes identifying problems, developing solutions, making changes to practice and then reviewing the whole operation or service again.1
Best Evidence Topic (BET): A BET is a simple, unbiased review of current best evidence on a very specific clinical topic. It is designed to be a quick and achievable method of incorporating evidence into clinical practice. It is similar to a Critically Appraised Topic (CAT) or a Knowledge Summary (KS). See: https://bestbetsforvets.org
Bias: Systematic (as opposed to random) deviation of the results of a study from the ‘true’ results, which is caused by the way the study is designed or conducted.1
Bibliographic databases: Bibliographic databases store information about journal articles and conference proceedings (e.g. title, author, abstract, key words) within a specified subject area. Databases can be searched to help find references.
Boolean operators: Simple words (AND, OR, NOT or AND NOT) used to combine or exclude keywords in a search, resulting in more focused and productive results.
Case report: A case report is a description of a single case (or small number of cases).
Case series: A case series is a description of the presentation, diagnosis, treatment and outcome of a group of animals with the same disease. There are no disease-free animals for comparison, and any differences in management are not randomly allocated (for example, they may be due to the owners’ preferences or different protocols between centres).
Case-control study: A case-control study is a retrospective study comparing animals with the disease (cases) and without the disease (controls) of interest. The animals’ histories are examined to identify risk factors for the disease.
Citation search: A citation search allows you to specify a key article, author or book, and find other articles that have included that specific resource in their bibliographies.
Clinical audit: A process for monitoring standards of clinical care to ensure the best possible care (known as ‘best practice’). Clinical audit can be described as a systematic ‘cycle’. It involves measuring care against specific criteria, taking action to improve care if necessary and monitoring the process to sustain improvement. As the process continues, an even higher level of quality is achieved.1
Clinical bottom line: This is the overall answer to a clinical question, based on critical appraisal of the relevant evidence found through searching the veterinary literature.
Clinical decision-making: Clinical decision-making is a balance of experience, awareness and knowledge and information gathering, along with using appropriate assessment tools, your colleagues and evidence-based practice to guide you.
Clinical governance: Clinical governance is a systematic approach to continuously maintaining and improving the quality of patient care within a health system.
Clinical question: A question that may occur in veterinary practice. The question may be regarding drug efficacy, diagnostic test evaluation, prognosis, risk, etc.
Clinical relevance: How relevant the study results are to actual clinical outcomes. Effects identified as statistically significant are not always clinically significant, either because the effect is small or the outcome is not important.
Clinical research: Clinical research is scientific research in a clinical context. Clinical research directly involves a particular patient or population. A clinical trial is one type of clinical research that follows a pre-defined plan or protocol.
Cohort study: A cohort study is an observational study where exposed and unexposed groups (cohorts) are followed over a period of time. At the end of the study period, the outcome (e.g. disease) is measured. Cohort studies can identify risk factors associated with disease and estimate incidence.
Comparator: The standard intervention against which an intervention is compared in a study. The comparator can be no intervention (for example, best supportive care) or a commonly administered treatment.1
Complication rate: The number of subjects in an at-risk population that will develop complications in a given amount of time.
Control: A group of patients in a study who do not receive the treatment or test being studied. Instead, they may receive the standard treatment (sometimes called ‘usual care’) or a dummy treatment (placebo). The results for the control group are compared with those for a group receiving the treatment being tested, in order to assess any differences in response.1
Critically Appraised Topic (CAT): A ‘critically appraised topic’ is a quick and simple form of evidence synthesis where a specific clinical question is answered by searching the relevant literature. It is similar to a Best Evidence Topic (BET) or a Knowledge Summary (KS).
Cross-sectional study: A cross-sectional study looks at a sample of the population at a single point in time, most commonly to determine the prevalence of a certain disease.
Diagnostic tests: Tests used in order to aid diagnosis of a patient (e.g. haematology, biochemistry, etc.).
Diagnostic test validation study: A diagnostic test validation study is used to establish the usefulness of new diagnostic tests. Animals are tested using the new diagnostic test and the current gold standard to establish the sensitivity, specificity and likelihood ratios for the new diagnostic test.
Electronic communication: Communication such as email, web forums, wiki software, Facebook and Twitter accounts.
Epidemiology: Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.2
Evidence: Information on which a decision or guidance is based. Evidence is obtained from a range of sources, including randomised controlled trials, observational studies and expert opinion (of healthcare and other professionals and/or patients).1
Evidence synthesis or summary: An evidence synthesis is a collation of the current evidence available to answer a clinical question. Evidence syntheses may come in many forms and can appraise the evidence in various ways. Some examples are Knowledge Summaries, Critically Appraised Topics, Best Evidence Topics, systematic reviews and meta-analyses.
Expert opinion: Expert opinion can be one individual’s opinion or part of an elicitation process based on a panel of experts used to answer a question of interest. Expert opinion may provide some evidence where no information is available (e.g. new treatment efficacy or application to a new population).
External validity: The degree to which the results of a study hold true in non-study situations, for example in routine veterinary practice. May also be referred to as the generalisability of study results to non-study populations.1
Grey literature: Grey literature is information or research output produced by organisations outside of commercial or academic publishing and distribution channels.
Intervention: In clinical terms, a drug treatment, surgical procedure, diagnostic test or management change.
Journal club: Normally, practice-run journal clubs involve clinicians meeting at regular intervals to review recently published literature of relevance in an in-depth way.
Knowledge Summary (KS): A Knowledge Summary is a short critical summary of the best available information on a defined clinical question. It provides a concise conclusion which should be easily accessible by clinical staff. It is similar to a Critically Appraised Topic (CAT). See: https://www.veterinaryevidence.org/
Meta-analysis: A meta-analysis is a quantitative statistical analysis (generally) conducted as part of a systematic review. By combining the data, a meta-analysis provides more evidence than each individual study is able to on its own.
Morbidity: The number of cases of an illness, injury or condition within a given time (usually a year). It can also refer to the percentage of patients with a particular illness, injury or condition within a defined population.
Mortality: The proportion of a population that dies within a particular period of time. The rate is often given as a certain number per 1000 animals.
Narrative reviews: A narrative review is a review of the evidence done by an expert in the area, without the use of systematic guidelines and checklists which sets them apart from systematic reviews.
Open access: Literature that is available to be viewed and used without subscription.
Outcome: The impact that a test, treatment, policy, programme or other intervention has on an animal, group or population.
Peer-review: Review of a study, service or recommendation by those with similar interests and expertise to the people who produced it to make sure the study results are accurate and valid. Peer-reviewers can include both professionals and ‘lay’ experts. The peer-review process subjects scientific research papers to independent scrutiny by other qualified scientific experts (peers) before they are made public.1, 3
PICO: Acronym indicating Population, Intervention, Comparison and Outcome framework. This is a structured approach for developing review questions, dividing each question into four components: the population (the population under study); the interventions (what is being done); the comparators (other main treatment options); and the outcomes (measures of how effective the interventions have been).1
Pilot study: A small-scale ‘test’ of a particular approach that aims to highlight any problems or areas of concern and amend it before a full-scale study begins.1
Population: A group of patients with a common link, sharing the same medical condition, breed or other characteristics. The population for a clinical trial will be all the patients the test or treatment is designed to help (such as Labradors with hip dysplasia). It is best if populations involved in studies are representative of the whole population of interest.1
Population health: Not merely the sum of the health of the individuals that make up a population, but the distribution of disease and health factors within that population.
Primary evidence: Primary evidence in EBVM generally refers to the original research papers written by those who conducted the study at the time of the study e.g. peer-reviewed journal articles that report on a single scientific study.
Publication bias: Publication bias occurs when the results of studies showing that a treatment works well are published, and studies showing it did not have any effect are not published. If this happens, analysis of the published results will not give an accurate idea of how well the treatment works.1
Practice meetings: Practice meetings are a formal forum for all practice staff to raise and discuss any issues concerning the practice.
Practice protocols: Protocol-based care within veterinary practices means having standardised, evidence-based guidelines for veterinarians to use in certain circumstances (e.g. a farm animal practice might have protocols for first and second line antimicrobial treatment of mastitis based on pathogens known to be present on a farm).
Randomised controlled trial: A randomised controlled trial is an intervention study used to assess a treatment or other intervention. Study subjects are randomly allocated to either the intervention group or a control group (which receives either no treatment, a placebo, the current best treatment or a comparator). Ideally, the study should be ‘blinded’ so that anyone involved with the animals does not know which treatment each animal received.
Recurrence rate: The number of an at-risk population that will have a recurrence of a disease in a given amount of time.
Reflection: Reflection on current practices means looking back at the effect the current guidelines, protocols or standards of care have on clinical outcomes, and assessing whether changes may be necessary.
(Relative) Risk: The ratio of the risk of disease or death among those exposed to certain conditions compared with the risk for those who are not exposed to the same conditions. If both groups face the same level of risk, the relative risk equals 1.1
Rounds: Practice rounds is a forum for clinicians to meet in order to discuss ongoing and hospitalised cases. This is an effective way of ensuring case continuity as well as discussing case management.
Sample: Participants of a study recruited from the study’s target population. If these participants are recruited in an unbiased way, it may be possible to generalise the results to the target population as a whole.1
Search strategies: Search strategies are the methods we can employ in order to systematically search the veterinary literature for evidence that may answer our clinical question.
Secondary evidence: Secondary evidence in EBVM generally refers to publications that review, summarise or synthesise previous studies and are usually written by a third party e.g. text books, review articles, meta-analyses, knowledge summaries, systematic reviews.
Sensitivity: The sensitivity of a clinical test refers to the ability of the test to correctly identify those patients with the disease.
Specificity: The specificity of a clinical test refers to the ability of the test to correctly identify those patients without the disease.
Strength of evidence: The strength of evidence is determined by a combination of the study type, robustness of study design and applicability of study results.
Study design: The way a study is designed. Case-control study, cohort study, non-randomised controlled trial, and randomised controlled trial are all examples of study designs using different research methodologies.1
Study quality: The extent to which a study has conformed to recognised good practice in the design and execution of its research methods.1
Survey: A study in which information is systematically collected from people (usually from a sample within a defined population).1
Synonym: A word or phrase that means the same as another word or phrase in the same language.
Systematic review: A systematic review is a defined and rigorous method of collating and summarising the information from all published papers addressing a particular question. The methods used to search the literature, assess the quality, and make conclusions are explicitly stated in the methods section.
Veterinary literature: Veterinary literature is the source of evidence available for us in the veterinary profession. There are many veterinary peer-reviewed journals published worldwide, some are subscription only and some are increasingly open access.
This page contains all the links to websites and resources which have been referenced within the course. They are listed by section and page, and are presented in the order in which they appear in the text.
1. About EBVM Learning
2. What is EBVM?
3. History of EBVM
4. The development of EBVM
- NICE guidelines
- British Veterinary Association (BVA)
- American Veterinary Medical Association (AVMA)
- Evidence-based Veterinary Medicine Association (EBVMA)
- Centre for Evidence-based Veterinary Medicine
- RCVS Knowledge
- Veterinary Evidence
- RCVS Knowledge: inFOCUS
- RCVS Knowledge Library and Information Services
- Evidence-Based Veterinary Medicine Matters
- CIVME EBVM Toolbox
5. Why is EBVM important?
5.1 Information overload
5.2 How does EBVM apply to Quality Improvement?
6. Challenges of EBVM
7. What is helping to address EBVM challenges?
6. Example scenarios using the PICO format
2. Acquiring evidence
3.1 Secondary sources
3.2 Evidence syntheses
3.4 Bibliographic databases
3.5 Internet search tools
4. How do I access the evidence?
4.2 For vets in practice
5. How do I search for the evidence?
5.7 Refining your search
5.8 Citation searching
6.2 Sharing a search for publication
6.3 Reference management tools
3.1. How to read a paper
4.1 What is the study type (or design)?
5.2 Critical appraisal and appraisal toolkits
5.3 Other sources of bias
3.1 Consider the individual circumstances of your clinical scenario
3.2 Sharing evidence with your clients
4. Developing clinical practice guidelines and protocols
3.2 Assess as part of clinical governance
5. Clinical audit as a quality improvement tool
- RCVS Knowledge Quality improvement resources
- RCVS Knowledge e-learning course on clinical audit
- RCVS Knowledge: The Clinical Audit Walkthrough
- Eight-stage clinical audit cycle from RCVS Knowledge
- Measure current practice
- Analysis of existing data
- Basic summary/ descriptive statistics
- Influence activities of an individual practice
6. Clinical audit in the veterinary world
6.1 Where to start in clinical audit
6.3 Setting audit aims and objectives
6.4 Defining audit criteria/standards
7. Beyond clinical audit - alternative ways to assess
- Run chart is a graph of data over time
3.4. Acceptable use
3.4 Acceptable use
Reuse of course material
The content of this course may be shared in accordance with the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International licence (CC BY-NC-SA 4.0).
How to cite
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EBVM Learning 2020, Acceptable use. Available from: https://learn.rcvsknowledge.org/mod/book/view.php?id=76&chapterid=162 [17th November 2020]. (where the date is the date of access)
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