EBVM and dentistry

Re: EBVM and dentistry

Rob Loxley — Wed, 10 Jul 2013 23:37:10 GMT

[quote user="James Laidlaw"]talking less in code may help us understand what you're going on about, maybe I'm just thick, but you do write in a rather "cryptic crossword" style...[/quote]

Re: EBVM and dentistry

John Flynn — Wed, 10 Jul 2013 13:49:06 GMT

[quote user="J G Wray"]Oh I think so[/quote]

glad to see that "EBVM" still leaves plenty of room for personal opinion. (I was evidentially worried that there was evidence that the evidence for dental procedures was evidentially inferior to the evidence for other less-evidenced procedures such as orthopedic surgery)

Here's mine:

I think the percentage of stuff I do in general practice that has a decent direct evidence base with respect to clinical outcome is so miniscule that the concept of "EBVM" confuses me. Does the presence of this term increase the evidence-base? What exactly is "new" here? Was "non-EBVM" ever an opposing concept?

[quote user="J G Wray"]If the public also acknowledge our shift in Values then we will be fine. We will just have to educate them.[/quote]

I think the public generally prefer to feel that you and I are educated and free to use our brains in advising them and treating their pets. Ultimately they have to find a vet whose judgement they Trust and philosophy they identify with.

Re outcome auditing:

SOunds great, but practical implications are pretty limited and usually retrospective really, aren't they? Not to be confused with clinical research.

Re: EBVM and dentistry

J G Wray — Wed, 10 Jul 2013 13:16:06 GMT

[quote user="Rob Davis"]Which are....?[/quote]

Most.

Why not do what I did and ask what hasn't been audited?Just a suggestion.

The organisation I asked isn't represented here, so no names from me. You could ask The Vet from Bangor or the Vet from Harrogate about their audits for instance - one is in the PSS and the other isn't, which should give balance.

JGW

Re: EBVM and dentistry

Rob Davis — Wed, 10 Jul 2013 13:08:17 GMT

[quote user="J G Wray"]

The ones that haven't been subject to audit.

JGW

[/quote]

Which are....?

Re: EBVM and dentistry

James Laidlaw — Wed, 10 Jul 2013 08:21:06 GMT

Maybe join the BVDA and read some of the published material? Also talking less in code may help us understand what you're going on about, maybe I'm just thick, but you do write in a rather "cryptic crossword" style... Again, what specific procedures are you/he/they condemning?

Re: EBVM and dentistry

J G Wray — Wed, 10 Jul 2013 07:32:40 GMT

[quote user="John Flynn"]Why dentistry?[/quote]

Circumstance listening to a True Believer and thought crystallising.

[quote user="John Flynn"]I'm not sure why the focus on dentistry? Have dental specialists been any lazier than orthopedic surgeons or general practitioners? Really?[/quote]

Oh I think so, given how little is published on the inluence of procedure on outcome, e.g. prolongation of life, but like I wrote, it's possible EBVM might bugger things which have become Sacred Cows and by the same token simplify others. I'm just not getting carried away with EBVM. I'm intrigued by it, because it looks like a concept for Good and it will influence how Generalists work, requiring changes in Values. If the public also acknowledge our shift in Values then we will be fine. We will just have to educate them.

JGW

Re: EBVM and dentistry

John Flynn — Tue, 09 Jul 2013 23:22:17 GMT

[quote user="J G Wray"]Veterinary dentists...providing evidence for their work and their outcomes being superior to more consevative methodolgies...I think they've been a tad lazy in this respect so far, compared to orthopods[/quote]

Really?

Why dentistry?

There's VERY little convincing "EBVM" out there for, well, most stuff - expensive or not.

Is ciclosporin safer long-term than prednisolone for atopy?

What is the benefit of elbow arthroscopy?

Why, precisely, can't I splint a young toybreed with a distal antebrachial fracture?

Is partial resection of third eyelid glands inferior to various tacking procedures?

What is the diagnostic or prognostic value of interpreting "lung patterns" on radiographs?

Does the use of expensive 'veterinary-licensed' products result in superior outcomes than the generic drug used in any other form?

Does routine manual expression of anal glands lead to less or more clinical problems in future?

What is the average life expectancy for castrated versus non-castrated labradors?

etc.

I'm not sure why the focus on dentistry? Have dental specialists been any lazier than orthopedic surgeons or general practitioners? Really?

Re: EBVM and dentistry

J G Wray — Tue, 09 Jul 2013 22:51:01 GMT

This intrigued me in Today's Top People's Newspaper

".. Normal 0 false false false EN-GB X-NONE X-NONE

A cut-price “Alka-Seltzer IVF” technique has proved just as effective as traditional methods at a tenth of the cost, paving the way for “no frills” fertility clinics in Britain.

The technique is designed to help millions of childless women in the developing world, but plans are being made to bring it to Britain to help the NHS to offer fertility treatment to more couples, who now face rationing and postcode lotteries.

Instead of a climate-controlled laboratory costing £2 million, only two test tubes are required. Its creators say it could bring the cost of a cycle of IVF down to about £200, compared with more than £2,000 at present.

Twelve babies have been born using the method, with a 30 per cent success rate — very similar to that for conventional IVF techniques — researchers told the annual meeting of the European Society of Human Reproduction and Embryology in London yesterday..."

ON the other bit

Veterinary dentistry is, in my mind a particularly vulnerable area when it comes to audit. Veterinary dentists can harumph about this or get down to providing evidence for their work and their outcomes being superior to more consevative methodolgies. I think they've been a tad lazy in this respect so far, compared to orthopods or soft tissue surgeons and the EBVM thing might be a bit embarrassing if they don't grasp the nettle.

JGW.

Re: EBVM and dentistry

J G Wray — Tue, 09 Jul 2013 22:25:01 GMT

[quote user="Rob Davis"]What "elaborate "dental procedures"" are you talking about?[/quote]

The ones that haven't been subject to audit.

JGW

Re: EBVM and dentistry

Niall Taylor — Tue, 09 Jul 2013 21:47:42 GMT

[quote user="Rob Davis"] What "elaborate "dental procedures"" are you talking about?[/quote]

Allow me to correct that for you:

"What "elaborate "dental procedures"" are you talking about?

Cheers,

Niall

Re: EBVM and dentistry

Rob Davis — Tue, 09 Jul 2013 19:25:57 GMT

[quote user="J G Wray"] what evidence is there for the elaborate "dental procedures" undertaken here providing superior, measurable and, from the owner point of view appreciable clinical outcomes compared with simpler procedures?"[/quote]

What "elaborate "dental procedures"" are you talking about?