How Can Veterinarians Base Their Medical Decisions on the Best Available Scientific Evidence?

Influence of age, gender, and willingness to adopt former foodstuffs on the perception of Italian farm animal veterinarians

Background

Veterinarians play an essential role in improving animal care, as they are often viewed as trusted advisors, particularly in relation to disease control and management; however, little is known about veterinarians' perceptions and attitudes toward alternative feeds. The aim of this study was to investigate the influence of age, gender, and willingness to adopt on the attitudes of livestock veterinarians toward the use of alternative feeds in farm animals.

Methods

A total of 136 active veterinarians completed the online survey, distributed through the main veterinary associations in Italy. The questionnaire contained items on dietary recommendation, awareness, benefit and safety perceptions, and a willingness to adopt former foodstuffs (FFs), complemented with socio-demographic questions.

Results

Almost 90% of the population reported a willingness to adopt FFs as feed. Men and women did not share the same perceptions of the nutritional composition of FFs, while the importance of product availability was found to be a key factor driving the age difference. Participants willing to adopt FFs as feed linked positive attitudes to attributes such as digestibility, energy intake, and positive social implications.

Conclusion

Our findings provide a basic background on the current use of the FFs in Italy and suggest the need for the development of educational programs and marketing strategies to enhance the acceptability of FFs in farm animals to ultimately promote the transition toward more sustainable animal production. This study has limitations, including the number of recorded responses and reliance on national estimates. Future research is needed to investigate the perceptions of farmers and animal nutritionist from different countries. This could provide a more detailed picture of the current situation in Europe about the potential of using FFs in farm animals' feed, thus further contributing toward a greener and safer livestock production sector.

Scoping review on clinical definition of bovine respiratory disease complex and related clinical signs in dairy cows

Bovine respiratory disease complex (BRD) is a worldwide multifactorial infectious disease. Antimicrobials are commonly used for treating BRD because bacteria are often involved. The clinical diagnosis of BRD is a challenge, especially in adult dairy cows, where information on this syndrome is scant. Having a definition based on consistent and reliable clinical signs would improve the accuracy of BRD diagnosis and could help to develop an optimal treatment approach by an early detection. The aim of this scoping review was to review clinical signs that could be recognized by producers in dairy cattle suffering from naturally occurring infectious respiratory disease, as reported in the literature. A review of the literature was performed for articles published between January 1, 1990 and January 1, 2020. The search of literature in English, French, and Italian languages included 2 different databases (Pubmed, https://pubmed.ncbi.nlm.nih.gov/; CAB abstract, https://www.cabi.org/publishing-products/cab-abstracts/). Clinical signs were categorized as follows: (1) "general manifestations of disease," which included behavioral changes or fever; (2) "alterations in respiratory function," which included clinical signs specifically associated with the respiratory tract examination; and (3) "clinical signs of other body systems," which included clinical signs related to other systems such as diarrhea or subcutaneous emphysema. The focus of the review was on clinical signs that could be monitored by animal handlers and producers. A total of 1,067 titles were screened, and 23 studies were finally included. The most common general clinical signs were increased body temperature (reported in 83% of studies, n = 19), change in feed intake (26%, n = 6), altered mentation (22%, n = 5), and decreased milk production (17%, n = 4). The alterations in respiratory function noted were nasal discharge (74%, n = 17), cough (65%, n = 15), altered respiratory dynamic or dyspnea (61%, n = 14), increased respiratory rate (43%, n = 10), and ocular discharge or lacrimation (30%, n = 7). The clinical signs associated with infectious respiratory disease reported in the 23 studies generally lacked a clear description of what constitutes a deviation from normality (0-50% of studies clearly reported what was considered normal versus abnormal depending on the clinical signs). This limitation prevented any comparison between studies that apparently reported the same "clinical sign," but possibly referred to a different assessment and definition of what was considered normal versus abnormal. Therefore, the definition of clinical signs in a repeatable way with validated interobserver agreement to determine the optimal combination for the diagnosis of BRD in dairy cows is needed. This could lead to a more judicious use of antimicrobials for respiratory disease in adult dairy cows.

Veterinarian barriers to knowledge translation (KT) within the context of swine infectious disease research: an international survey of swine veterinarians

Background

Food animal veterinarians face commodity specific and urgent global challenges yet conditions preventing use of best available knowledge have been sparsely studied. The American Association of Swine Veterinarians (AASV) membership (N = 1289) was surveyed online to benchmark their information priorities and their motivations and sources for keeping current with infectious disease research, and to describe their reported time, skill, access, and process as barriers to knowledge translation (KT).

Results

Respondents (n = 80) were mostly from Canada (n = 40) and the U.S.A (n = 31) and demographics approximated the AASV’s. Colleagues are the first choice for information on difficult cases (49%, 95%CI: 38–61). Half of respondents (53%, 95%CI: 41–64) spend an hour or less per week keeping up with infectious disease research. The majority reported moderate or less than moderate efficiency (62%, 95%CI: 51–72), and moderate or greater stress (59%, 95%CI: 48–70) with their process for keeping up. Journal article methods sections are commonly not read, almost a third (32%, 95% CI: 22–43) reported either they do not evaluate statistical methods or that they had poor confidence to do so, and half (52, 95%CI: 41–63) could not explain ‘confounding bias’. Approximately half (55%, 95%CI: 41-69) with direct oversight of swine herds had full access to 2 or fewer academic journals. Approximately a third of respondents (34%, 95%CI: 24–46) selected only formats involving single research studies (either full text or summaries) as preferred reading materials for keeping current over expert summaries of the body of evidence.

Conclusion

KT barriers are considerable and a source of stress for many swine veterinarians. Sub-optimal efficiency with keeping up and low confidence to appraise aspects of research are concerns. Results are consistent with previous literature and illustrate need for improved KT infrastructure and for additional training in statistical methods and interpretation of primary research. Further evaluation is warranted of why approximately a third of veterinarians in this study, for the purpose of keeping up, preferentially choose to review individual research studies over choices that would include an expert summary of the body of evidence. Consideration of reasons for this preference will be important in the planning of KT infrastructure improvements.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12917-020-02617-8.

Information Resources for the Exotic Animal Practitioner

An essential component of evidence-based practice is finding the best available evidence to answer a clinical question. Finding evidence is difficult for veterinarians in general, and exotic animal clinicians in particular, owing to the lack of studies that provide a high level of clinically relevant evidence and limited access to resources. Knowing where and how to search for evidence can facilitate evidence-based practice.

Evaluation of a CAT Database and Expert Appraisal of CATs Developed by Students

Five steps have been recommended to provide evidence-based patient care: formulating a clinical question, searching for literature, evaluating the validity and applicability of results, implementing results into practice, and assessing if the new evidence has led to improved health care. Students can be trained in these steps by the development of knowledge summaries such as critically appraised topics (CATs). The aim of the present project was the development, use, and evaluation of a German-language CAT database and an appraisal of the quality of CATs developed by students. A total of 153 fifth-year veterinary medical students (in 21 groups) were enrolled in the project. Each group developed a CAT and most students participated in a survey. To learn more about the quality of the CATs, we asked experts to appraise the texts written by the students. The CATs were indexed with key words and assigned to specific fields corresponding to the European Colleges of Veterinary Specialisation. Currently, 57 CATs have been developed. The majority of students stated that writing CATs is a good exercise and that "it is important to teach the assessment of scientific information." In total, 13 experts completed the questionnaires, out of which 9 graded the CAT they appraised as good. In addition to English-language CAT databases, German tools should also be available for students and practitioners.

International Evidence-Based Medicine Survey of the Veterinary Profession: Information Sources Used by Veterinarians

Veterinarians are encouraged to use evidence to inform their practice, but it is unknown what resources (e.g. journals, electronic sources) are accessed by them globally. Understanding the key places veterinarians seek information can inform where new clinically relevant evidence should most effectively be placed. An international survey was conducted to gain understanding of how veterinary information is accessed by veterinarians worldwide. There were 2137 useable responses to the questionnaire from veterinarians in 78 countries. The majority of respondents (n = 1835/2137, 85.9%) undertook clinical work and worked in a high income country (n = 1576/1762, 89.4%). Respondents heard about the survey via national veterinary organisations or regulatory bodies (31.5%), online veterinary forums and websites (22.7%), regional, discipline-based or international veterinary organisations (22.7%) or by direct invitation from the researchers or via friends, colleagues or social media (7.6%). Clinicians and non-clinicians reportedly used journals most commonly (65.8%, n = 1207/1835; 75.6%, n = 216/286) followed by electronic resources (58.7%, n = 1077/1835; 55.9%, n = 160/286), respectively. Respondents listed a total of 518 journals and 567 electronic sources that they read. Differences in veterinarian preference for resources in developed, and developing countries, were found. The nominated journals most read were the Journal of the American Veterinary Medical Association (12.7% of nominations) for clinicians and the Veterinary Record (5.7%) for non-clinicians. The most accessed electronic resource reported was the Veterinary Information Network (25.6%) for clinicians and PubMed (7.4%) for non-clinicians. In conclusion, a wide array of journals and electronic resources appear to be accessed by veterinarians worldwide. Veterinary organisations appear to play an important role in global communication and outreach to veterinarians and consideration should be given to how these channels could be best utilised for effective dissemination of key research findings.

Teaching Evidence-Based Veterinary Medicine in the US and Canada

There is no comprehensive review of the extent to which evidence-based veterinary medicine (EBVM) is taught in AVMA-accredited colleges of veterinary medicine in the US and Canada. We surveyed teaching faculty and librarians at these institutions to determine what EBVM skills are currently included in curricula, how they are taught, and to what extent librarians are involved in this process. Librarians appear to be an underused resource, as 59% of respondents did not use librarians/library resources in teaching EBVM. We discovered that there is no standard teaching methodology nor are there common learning activities for EBVM among our survey respondents, who represent 22 institutions. Respondents reported major barriers to inclusion such as a perceived shortage of time in an already-crowded course of study and a lack of high-quality evidence and point-of-care tools. Suggestions for overcoming these barriers include collaborating with librarians and using new EBVM online teaching resources.