Evidence Based Veterinary Medicine (EBVM) is the application of evidence to decision making in the course of a treatment or procedure. Evidence can take many forms from high level evidence consisting of expensive, highly controlled randomised trials to the lowest level being personal experience.
In practice Vets and Nurses adopting EBVM to guide their decision making will be actively seeking out the highest form of evidence to support their choice of care. In reality, this can only be taken into account based upon the resources and skills available to achieve the best outcome for the patient and owner.
Pharmaceutical and medicinal products are generally well supported in terms of their specific role and proposed medicinal effect. This is because it is a legal requirement to have conclusive clinical and safety data to support the marketing authorisation and Veterinary prescription medicine status (POMV) that will allow the product to be legally prescribed in practice.
When it comes to wound management products and medical devices evidence can be rather thinner on the ground. The legal requirement being that the products must not make medicinal or pharmaceutical claims without a marketing authorisation. However, they can claim to support healing, to create an optimal environment, to soothe or even provide the benefits of a natural ingredient (that may or may not cytotoxic). As long as the product makes no medicinal claims it can be promoted for Veterinary use without any regulatory restriction.
So why don’t we use the wound products with the best evidence?
Unfortunately most wound products are intended for human use, so data is often extrapolated from human trials on chronic rather than acute wounds. Furthermore, it is notoriously difficult to get high level randomised data for medical devices, even in humans, where a wound is made deliberately and a randomised controlled trial performed. For one, it is hard to blind a study where dressings vary markedly depending on brand and function, and that the variables involved with the stage of healing, patient profile and wound location mean the list of potential studies is endless.
In terms of veterinary use, the relatively small size of the market (compared to human healthcare) and the ethical constraints of deliberately wounding a control group large enough to prove a benefit means there is a dearth of quality evidence. We therefore rely on lower level evidence consisting of small group evaluation, individual experience and personal recommendations. This creates a lot of room for a lot of varied products that may be perceived to assist healing even when the wound may have healed anyway.
The result is a wealth of products aiming to be the product of choice for all wounds while users become confused about hypothetical benefits that are hard to substantiate with high level research. When many wounds heal anyway the lack of distinct clinical benefit can confuse and contradict leading to a loss of confidence and timely decision making.
EBVM Matters - RCVS Knowledge
RCVS Knowledge last year published Evidence-Based Veterinary Medicine Matters: Our commitment to the future with the charity Sense about Science, in which 15 of the major UK member organisations, vet schools and policy-making bodies have come together to affirm their commitment to veterinary medicine based on sound scientific principles.
EBVM Matters is a commitment to advocating and using EBVM that RCVS Knowledge and the contributing author organisations have made, and are encouraging veterinary professionals and organisations to make i.e. to make clinical decisions according to their professional judgement, based on the best available evidence at the time and what is right for the individual animal and owner. “When rigorous research underpins medical decisions, adverse events can be minimised and patient outcomes can be improved.” – RCVS Knowledge
Several organisations and individuals have since signed up to this commitment. Our Founder, Georgie Hollis BSc, has pledged her support to the RCVS Knowledge EBVM Matters commitment on behalf of The Veterinary Wound Library.
Georgie wrote: "I believe that a pledge to uphold animal welfare can only be sustained where decisions are made based on best available evidence. Our field of wound care tech and education relies upon extrapolation of evidence from human healthcare where animal studies are lacking and RCT's are too costly to industry to focus in this area. As an independent advisory service (Veterinary Wound Library) we pledge to question the products promoted in the Veterinary sector for wound care and to encourage an evidence based approach, both in practice and in industry. We are committed to independence, dissemination and support of ethical, evidence based research that enables modern technologies to benefit the veterinary sector and animal welfare."
Find out more about the EBVM Matters commitment and pledge your support
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