The use of theories, models, and frameworks to inform the uptake of evidence-based practices in veterinary medicine - a scoping review

Evidence-based practices (EBPs) provide strategies to improve the health, welfare and productivity of animal species. However, ensuring implementation and uptake into routine practice of these EBPs is often challenging. In human health research, one approach used to improve uptake of EBPs is the use of theories, models and/or frameworks (TMFs), however the extent of the use of this approach in veterinary medicine is unknown. The aim of this scoping review was to identify existing veterinary uses of TMFs to inform the uptake of EBPs, and to understand the focus of these applications. Searches were conducted in CAB Abstracts, MEDLINE, Embase and Scopus, alongside grey literature, and ProQuest Dissertations & Theses. The search strategy consisted of a list of known existing TMFs that have been used to improve uptake of EBPs in human health, alongside more generic terminology for implementation and terminology relevant to veterinary medicine. Peer reviewed journal articles and grey literature detailing the use of a TMF to inform uptake of EBP(s) in a veterinary context were included. The search identified 68 studies that met the eligibility criteria. Included studies represented a diverse spread of countries, areas of veterinary concern and EBP. A range of 28 different TMFs were used, although the Theory of Planned Behaviour (TPB) predominated, featuring in 46% of included studies (n = 31). The majority of studies (n = 65, 96%) utilised a TMF with the aim to understand and/or explain what influences implementation outcomes. Only 8 studies (12%) reported the use of a TMF alongside/in conjunction with the actual implementation of an intervention. It is clear there has been some use to date of TMFs to inform uptake of EBPs in veterinary medicine, however it has been sporadic. There has been a heavy reliance on usage of the TPB and other similar classic theories. This has typically been to inform the understanding of factors, such as barriers and facilitators, that may influence the outcome of an implementation effort without then applying this knowledge to the actual implementation of an intervention. Furthermore, there has been a lack of acknowledgement of wider contextual factors and consideration of sustainability of interventions. There is clear potential to increase and expand the usage of TMFs to improve uptake of EBPs in veterinary medicine, including utilising a wider range of TMFs and developing interdisciplinary collaborations with human implementation experts.

Approaches to endocrinopathic laminitis in the field: Results of a survey of veterinary practitioners in North America

Endocrinopathic laminitis is the most common cause of laminitis in the field. Insulin has recently been implicated as a key factor in development of endocrinopathic laminitis; however, it is unclear whether diagnostic and treatment approaches reflect insights derived from recent research. This study sought to evaluate North American veterinary practitioners' approach to endocrinopathic laminitis in the field. Demographic information, approach to diagnosis, management, and prognosis of endocrinopathic laminitis, as well as factors influencing changes in approach to laminitis were collected. To compare regional differences in approach to laminitis, results were compared to a recently published study from the United Kingdom. Findings of the present study suggest that North American practitioners have changed their approach to laminitis to more readily incorporate diagnostic testing for endocrine disease.

The Educated Guess: Determining Drug Doses in Exotic Animals Using Evidence-Based Medicine

Lack of species-specific pharmacokinetic and pharmacodynamic data is a challenge for pharmaceutical and dose selection. If available, dose extrapolation can be accomplished via basic equations. If unavailable, several methods have been described. Linear scaling uses an established milligrams per kilograms dose based on weight. This does not allow for differences in species drug metabolism, sometimes resulting in toxicity. Allometric scaling correlates body weight and metabolic rate but fails for drugs with significant hepatic metabolism and cannot be extrapolated to avians or reptiles. Evidence-based veterinary medicine for dose design based on species similarity is discussed, considering physiologic differences between classes.

Analysing the opinions of UK veterinarians on practice-based research using corpus linguistic and mathematical methods

The use of corpus linguistic techniques and other related mathematical analyses have rarely, if ever, been applied to qualitative data collected from the veterinary field. The aim of this study was to explore the use of a combination of corpus linguistic analyses and mathematical methods to investigate a free-text questionnaire dataset collected from 3796 UK veterinarians on evidence-based veterinary medicine, specifically, attitudes towards practice-based research (PBR) and improving the veterinary knowledge base. The corpus methods of key word, concordance and collocate analyses were used to identify patterns of meanings within the free text responses. Key words were determined by comparing the questionnaire data with a wordlist from the British National Corpus (representing general English text) using cross-tabs and log-likelihood comparisons to identify words that occur significantly more frequently in the questionnaire data. Concordance and collocation analyses were used to account for the contextual patterns in which such key words occurred, involving qualitative analysis and Mutual Information Analysis (MI3). Additionally, a mathematical topic modelling approach was used as a comparative analysis; words within the free text responses were grouped into topics based on their weight or importance within each response to find starting points for analysis of textual patterns. Results generated from using both qualitative and quantitative techniques identified that the perceived advantages of taking part in PBR centred on the themes of improving knowledge of both individuals and of the veterinary profession as a whole (illustrated by patterns around the words learning, improving, contributing). Time constraints (lack of time, time issues, time commitments) were the main concern of respondents in relation to taking part in PBR. Opinions of what vets could do to improve the veterinary knowledge base focussed on the collecting and sharing of information (record, report), particularly recording and discussing clinical cases (interesting cases), and undertaking relevant continuing professional development activities. The approach employed here demonstrated how corpus linguistics and mathematical methods can help to both identify and contextualise relevant linguistic patterns in the questionnaire responses. The results of the study inform those seeking to coordinate PBR initiatives about the motivators of veterinarians to participate in such initiatives and what concerns need to be addressed. The approach used in this study demonstrates a novel way of analysing textual data in veterinary research.

Understanding how new evidence influences practitioners' beliefs regarding dry cow therapy: A Bayesian approach using probabilistic elicitation

This study used probabilistic elicitation and a Bayesian framework to quantitatively explore how logically practitioners' update their clinical beliefs after exposure to new data. The clinical context was the efficacy of antibiotics versus teat sealants for preventing mammary infections during the dry period. While most practitioners updated their clinical expectations logically, the majority failed to draw sufficient strength from the new data so that their clinical confidence afterwards was lower than merited. This study provides quantitative insight into how practitioners' update their beliefs. We discuss some of the psychological issues that may be faced by practitioners when interpreting new data. The results have important implications for evidence-based practice and clinical research in terms of the impact that new data may bring to the clinical community.

Factors influencing common diagnoses made during first-opinion small-animal consultations in the United Kingdom

It is currently unclear how frequently a diagnosis is made during small-animal consultations or how much of a role making a diagnosis plays in veterinary decision-making. Understanding more about the diagnostic process will help direct future research towards areas relevant to practicing veterinary surgeons. The aim of this study was to determine the frequency with which a diagnosis was made, classify the types of diagnosis made (and the factors influencing these) and determine which specific diagnoses were made for health problems discussed during small-animal consultations. Data were gathered during real-time direct observation of small-animal consultations in eight practices in the United Kingdom. Data collected included characteristics of the consultation (e.g. consultation type), patient (e.g. breed), and each problem discussed (e.g. new or pre-existing problem). Each problem discussed was classified into one of the following diagnosis types: definitive; working; presumed; open; previous. A three-level multivariable logistic-regression model was developed, with problem (Level 1) nested within patient (Level 2) nested within consulting veterinary surgeon (Level 3). Problems without a previous diagnosis, in cats and dogs only, were included in the model, which had a binary outcome variable of definitive diagnosis versus no definitive diagnosis. Data were recorded for 1901 animals presented, and data on diagnosis were gathered for 3192 health problems. Previous diagnoses were the most common diagnosis type (n=1116/3192; 35.0%), followed by open (n=868/3192; 27.2%) then definitive (n=660/3192; 20.7%). The variables remaining in the final model were patient age, problem history, consultation type, who raised the problem, and body system affected. New problems, problems in younger animals, and problems raised by the veterinary surgeon were more likely to result in a definitive diagnosis than pre-existing problems, problems in older animals, and problems raised by the owner. The most common diagnoses made were overweight/obese and periodontal disease (both n=210; 6.6%). Definitive diagnoses are rarely made during small-animal consultations, with much of the veterinary caseload involving management of ongoing problems or making decisions around new problems prior to a diagnosis being made. This needs to be taken into account when considering future research priorities, and it may be necessary to conduct research focused on the approach to common clinical presentations, rather than purely on the common diagnoses made. Examining how making a diagnosis affects the actions taken during the consultation may shed further light on the role of diagnosis in the clinical decision-making process.

Investigating preventive-medicine consultations in first-opinion small-animal practice in the United Kingdom using direct observation

Preventive-medicine consultations account for a large proportion of the veterinary caseload and previous research has suggested these consultations are fundamentally different from those in which the animal is presented for a specific health problem. There has been recent controversy around some aspects of preventive medicine for cats and dogs, and the full health benefits of the preventive-medicine consultation remain unclear. The aim of this study was to compare characteristics of the consultation and the problems discussed during the consultation between preventive-medicine consultations and other types of consultations. Data were gathered during direct observation of small-animal consultations in seven first-opinion practices in the United Kingdom. Data collected included type of clinical examination performed, patient signalment, and details of all problems discussed (including whether the problem was presenting or non-presenting, new or pre-existing, who had raised the problem, body system affected and whether an action was taken). A two-level multivariable logistic-regression model was developed, with canine and feline patients at Level 1 nested within consulting veterinary surgeons at Level 2, and a binary outcome variable of preventive-medicine consultation versus specific health-problem consultation. A total of 1807 patients were presented, of which 690 (38.2%) presented for a preventive-medicine consultation. Dogs were the most frequently presented species (n=1168; 64.6%) followed by cats (n=510; 28.2%), rabbits (n=86; 4.8%) and patients of other species (n=43; 2.4%). The five variables remaining in the multi-level model were whether multiple patients were presented, patient age, clinical examination type, weighing and number of problems discussed. Species, breed, sex, neutering status and practice did not remain in the final model. Many non-presenting problems, including both preventive-medicine problems and specific-health problems, were discussed and acted upon during all types of consultations. Dental and behavioural non-presenting problems were discussed more frequently during preventive-medicine consultations compared with specific health-problem consultations. Preventive-medicine consultations represent an opportunity for veterinary surgeons to discuss other aspects of preventive medicine, and to detect and manage new and ongoing health problems. A greater evidence base is needed to understand whether detecting and managing underlying disease during the preventive-medicine consultation has a positive impact on lifelong patient health and welfare.

The role of veterinarians in equestrian sport: a comparative review of ethical issues surrounding human and equine sports medicine

Veterinarians have a key role in providing medical care for sports horses during and between competitions, but the standard client:veterinarian relationship that exists in companion and production animal medicine is distorted by the involvement of third parties in sports medicine, resulting in distinct ethical dilemmas which warrant focused academic attention. By comparing the existing literature on human sports medicine, this article reviews the ethical dilemmas which face veterinarians treating equine athletes, and the role of regulators in contributing to or resolving those dilemmas.

Major ethical dilemmas occur both between and during competitions. These include conflicts of responsibility, conflicts between the need for client confidentiality and the need to share information in order to maximise animal welfare, and the need for an evidence base for treatment. Although many of the ethical problems faced in human and equine sports medicine are similar, the duty conferred upon a veterinarian by the licensing authority to ensure the welfare of animals committed to his or her care requires different obligations to those of a human sports medicine doctor. Suggested improvements to current practice which would help to address ethical dilemmas in equine sports medicine include an enhanced system for recording equine injuries, the use of professional Codes of Conduct and Codes of Ethics to establish acceptable responses to common ethical problems, and insistence that treatment of equine athletes is evidence-based (so far as possible) rather than economics-driven.