Once you have identified one or more articles that deal with your question of interest, you can then start to read them. Or you may read an interesting article you came across while thumbing through a scientific journal. Questions that should immediately come to mind are:
- Does the paper have the right study design to answer my clinical question?
- Which level of evidence does the paper provide?
- Is the quality of the paper good enough to help me answer my particular question?
- Is the paper relevant to my clinical question, my population or my patient?
Scientific literature provides one of the most important links between research and practice, as it can be used to disseminate information far and wide, can be translated into a number of different languages, and provides a long-standing record of work that was done and of conclusions reached. However, evidence found may include different sorts of clinical trials, observational risk factor studies, case reports or expert opinions that provide similar or contradicting information. In some cases, authors of these papers advertise for cure-alls and panaceas; in others, they may present revolutionary discoveries they have observed in only two animals. Some of these papers may sound too good to be true – but are they?
As the reader, it is often left up to you to discern quite a bit about the papers you read. Papers may differ considerably, not only in the relevance of information to real, practical scenarios, but also in the certainty you can have that the presented data are valid (Glasziou et al. 1997). Even study results published in prestigious journals may be biased by different factors, or be unreliable because of serious flaws in the design or conduct of the study. These same biases may also occur in other information that you get via expert presentations, drug company leaflets, etc., and it is up to you as a consumer of this information to demand high quality!
Every practitioner’s aim is to provide the best patient care. It is up to you to make a multitude of decisions every day, with the awareness that it is important to use diagnostic procedures and therapeutic interventions that are the most effective and that have an optimal risk:benefit ratio. In addition, as a practitioner, of course you want to be able to provide an owner with accurate information regarding the prognosis for their animal, and to take into consideration established risk factors for certain conditions in your diagnostic work-up.
In order to help you do these things in the best way possible, using EBVM, this section will highlight the skills needed to appraise the quality of information available.