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THE Centre for Evidence-based Veterinary Medicine (CEVM) at Nottingham university defines evidence-based veterinary medicine (EVM) as: 'The use of the best relevant evidence, in conjunction with clinical expertise, to make the best possible decision about a veterinary patient. The circumstances of each patient, and the circumstances and values of the owner/carer must also be considered when making an evidence-based decision.'
To integrate EVM into everyday practice, veterinary surgeons need relevant, high-quality, unbiased evidence at their fingertips to aid decision making.
Taking a gamble
Every day veterinary surgeons are making difficult decisions about their patients, such as:
[black square] What treatment is best?
[black square] Which diagnostic test should I use?
Where possible, these decisions should be based on the best evidence that is available but this can sometimes be hard to find. In response to this need, an online resource, BestBETs for Vets ( www.bestbetsforvets.org ), has been developed by the CEVM to help veterinary surgeons make better evidence-based decisions. This has been done in collaboration with BestBETs ( www.bestbets.org ), based at Manchester Royal Infirmary.
What is evidence?
In veterinary medicine there are many sources of evidence to inform clinical decisions, including peer-reviewed primary research studies (such as those published in Veterinary Record ), narrative reviews (such as those published in In Practice ), didactic information given in textbooks, and expert opinion sought and shared. These different types of evidence vary in quality, quantity and accessibility, and some are more reliable than others.
Evidence synthesis
Systematic reviews are the most reliable form of evidence for clinical decision-making (eg, Cochrane Collaboration, www.cochrane.org ). A systematic review aims to find all the evidence (published or unpublished) on a particular question using a comprehensive search strategy. The evidence is then assessed in an explicit, repeatable and unbiased way (critically appraised), and the findings combined to reach an answer to the question. This process is termed evidence synthesis.
Evidence syntheses are different from the narrative reviews that are found, for example, in textbooks, CPD notes and in the introduction of most research papers. Evidence syntheses have a clear methods section (including search terms and databases used) describing how the papers included in the review were identified; this does not occur in narrative reviews. All the papers included in...