GRH EBM and Research

Clinical quality improvement: using YOUR data to change YOUR practice tomorrow

• Describe quality improvement activities in practice
• Plan your next practical QI project with your team
• Understand how to apply data to progress care

Clinical research: using it to improve clinical care

• Understand how to consider whether a paper is relevant to your practice
• Understand how to consider whether a paper is relevant to a particular patient

The aim of critical evaluation is to encourage scientific evidence to be read with a questioning attitude. This introduction provides information and tools to help develop critical appraisal skills and provide greater confidence when applying scientific evidence to veterinary practice.

Will changing my pet’s diet help to cure the cancer? It is common for pet owners to seek advice on nutrition, herbs and dietary supplements when their best friends are diagnosed with cancer. A growing industry has developed to serve this need, and there are many, sometimes very compelling, sources of advice to be found online. Evidence to support such nutritional interventions in veterinary patients is sparse, however. Many ‘cancer’ diets stem from the alteration of cellular energetics seen in some cancers (the ‘Warburg’ effect), however the importance of this effect, and clinical benefit of diets with different carbohydrate levels, has not been demonstrated in veterinary cancer patients. Currently the recommendation is to feed a balanced, cooked diet which is palatable to the animal, seeking to maintain a stable bodyweight. If cachexia develops, dietary alteration to support lean body mass and supplementation to minimise the associated inflammatory state (e.g. with omega 3 fatty acids) may be appropriate. A number of nutraceutical compounds are also widely touted as beneficial to veterinary cancer patients; since there is often no evidence, or weak evidence to support use of these compounds, it may be more pragmatic to consider their risk of adverse effects or interactions with other drugs before supporting or opposing their use.

I have read on the internet about… Using EBM to combat miracle cures: Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. This presentation and discussion includes a summary of evidence-based medicine, the quality and relevance of this in veterinary oncology decision making and how to use this to assist in empowering and including owners in the treatment decisions for their pet. The concept of goal driven care is also discussed. The common situations in which owners present questions around their own research, motivations and questions about their pet’s care are outlined. We discuss how to navigate this and how to guide clients to useful and appropriate sources of information. The session offers practical tips on how to answer queries from owners regarding ‘miracle cures’ using real life experiences to illustrate this. The aim is to develop tools to assist in supporting clients need to be involved in their pets care and treatment decisions.