Continued Based Veterinary Medicine I
evidence 3 - Evaluate the "evidence" (Critical Review of the literature)
is one of the most important and required, for our part, how to select and evaluate the scientific quality of medical articles.
Although there is extensive scientific and medical literature, only a small part of it is mean or apply to the vet and, within this group, there are few who are really relevant or serving all the criteria of a rigorous methodology.
Our university education provides us with little knowledge required for this assessment (Possibly none) but not overly complicated and can be purchased without a broad knowledge in statistics or epidemiology.
beyond the scope of this post explaining how we deal with a scientific paper (though I hope to devote one to this point later). Valga, in the meantime, this brief sketch taken from the article by Peggy L. Schmidtpara have a reference on the validity of the type of study.
As important as the validity of a study is its "applicability" to our clinical problem, we must ask whether it is able to answer the question we formulated in step 1. There is another acronym to systematize a bit this phase: RAAMbo its acronym in English.
- R (Representation): What is the population represented in the study? Is it representative for our clinical case?
- A (Allocation): How does the study subjects assigned? Did the control group? Did "randomization" and / or stratification?
- A (Consideration): In English "account." "All subjects who began the study were considered when finished? If not, the authors identified that happened to them?
- M (Measurements): Were the measurements obtained objectively evaluated? Did they know the evaluators which was the control group?
4 - Integrate the evidence (Application of the findings of this assessment practice)
transfer the knowledge acquired to track an individual patient or alter subsequent query performance is the next step. This exercise should be accompanied by clinical experience needed to balance the risks and benefits and consider the expectations and preferences.
latter is fundamental in the veterinary clinic, we must ask questions like: Do you accept the customer treatment? Is it compatible with their ethical, religious or cultural beliefs?
Do we, we, the skills or technology to carry it out? Can we refer you to a center of reference?
As you can see it is this point where we integrate our clinical experience, the best evidence available and preferences of the owner to try to provide the best possible clinical practice.
Bear in mind also that the Internet has made medical information more accessible to both veterinarians and to the owners. Therefore, veterinarians must be prepared to hear evidence presented by the owner and to refute a well-formed criteria.
5 - Evaluate the results
In our case, we evaluate two results.
Of course, we must evaluate the medical outcomes, "the results were obtained expected? "Otherwise, the results differ?
Any success or failure in diagnosis, treatment and prognosis can be properly recorded and, where appropriate, shared with the veterinary community.
Thus, the applicability of evidence-based medicine will also develop veterinary medicine.
The second thing to assess is how we developed the steps of EBM.
THE EBM requires certain skills that are developed with practice and critical self-assessment will help us progress faster.
In conclusion.
Veterinary medicine based on experience should be taken as a reference for all our activities taking into account that there are still few studies in veterinary medicine that are useful and easily applicable.
For more information I recommend:
www.infodoctor.org / rafabravo / mbe.htm
http://www.foyel.com/cartillas/29/medicina_veterinaria_basada_en_la_evidencia_mvbe.html
number May 2007 Clinics of North America (Small Practice).
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