About BETs

Simple reviews of current best evidence to answer specific clinical questions.

There are 6 sections in every BET

Clinical Scenario

Sets the context of the BET and describes a common clinical situation where a decision has to be made.

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3-part Question

All BET questions are very specific and structured in 3 parts. If your clinical question differs from the BET question, the evidence may not apply.

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Literature Search

Each BET has 2 sets of search terms, one for each of the 2 databases we use to search the literature. The results are filtered to include only relevant studies in the BET.

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Evidence

The relevant studies are critically appraised allowing us to assess their quality. The key information from each study is summarised in a table.

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Comments

The authors highlight any additional useful and important points about the BET here.

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Bottom Line

The clinical bottom line is the answer to the original question and is the authors’ opinion on what the evidence suggests the answer is.

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1: A clinical scenario

The clinical scenario describes a common situation which may be on a farm, in the consulting room or a situation when there is a difference of opinion. They are real-life scenarios where there is ambiguity or uncertainty about what is the right thing to do. All scenarios finish with ‘you wonder if’.... and the BET aims to assess the available evidence to address the level of uncertainty.

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2: A 3-part question

The 3-part question in each BET is designed using the PICO framework. Structuring research and clinical questions in this way means you can be very clear about the clinical conundrum you are interested in. PICO stands for

  • P: The patient group, problem or population of interest
  • I: The intervention or factor of interest being considered (e.g. treatment, diagnostic test, risk factor)
  • C: The comparator or most likely alternative if appropriate
  • O: The clinical outcome of interest

For example, if the subject of interest is the role of prescription renal diets in the therapy of feline chronic renal disease, one option is to read everything you can find on prescription diets and renal disease in cats. However this will take a significant length of time! It is better to focus the question down by considering what outcomes of therapy you are interested in (e.g. the effect on life expectancy) and being specific about the species of interest (e.g. cats).
E.g. In [cats with chronic renal failure] does [the use of a prescription renal diet versus a normal diet] [increase the life expectancy of the cat]?

  • P - Cats with chronic renal failure
  • I - A renal diet
  • C - A normal diet
  • O - Increased life expectancy
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3: A literature search


Search strategy

The two literature databases we search are CAB Abstracts and MEDLINE. We use CAB Abstracts as research we have done shows that it covers 90% of journals relevant for veterinary medicine (http://dx.doi.org/10.3138/jvme.1111.109R). MEDLINE is also searched as it often contains more recent articles than CAB Abstracts. We do not try and cover all databases as this would be very time consuming and limit the number of BETs we can do.

This means BETs may not contain all evidence on a topic and readers need to be aware that some relevant papers on the subject may be missing from the BET. Within the limitations of a BET we try to do the most sensitive search possible. The search terms are clearly displayed so if people want to repeat the BET they can. The search terms are defined within brackets for the ‘P’, ‘I’ and ‘C’ elements of the PICO question. We don’t usually search for the ‘O’, as outcome terms can often be difficult to define and may narrow the search too much.

More details about how to search for veterinary literature are available on the CEVM website (CEVM website).


Search outcome

This section details how many papers were found in the searches and how many were actually included in the BET. CAB Abstracts and MEDLINE often give slightly different search results. The results from each search are filtered in a methodical way and studies will only be included if they directly address the PICO question and are a primary research study. We exclude studies that are:

  • In a foreign language as it is not possible within the time frame of a BET to translate the papers.
  • Narrative literature reviews, editorials or lecture notes from conferences. These kinds of publication do not contain any new primary research data but are based on studies read by the author.
  • Papers that are about in vitro research. Basic science and in vitro research are some of the building blocks of clinical research, and are very important to the advancement of veterinary medicine. However it is not possible to directly apply an in vitro study to a clinical patient.
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4: A summary of the evidence

All the studies that are to be included in the BET are critically appraised using a standard set of questions. This allows us to assess the quality of each study and identify any potential biases that may have affected its conclusions.

A summary of the evidence is presented in a table outlining the outcomes that were measured, the key results of the study and any study weaknesses we have identified which may affect the validity or applicability of the results. See our CEVM website to look at the critical appraisal tools we use and for more information on study types.

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5: A comments section

The comments section may be used by the authors to give more details about why certain studies were included in, or excluded from, the BET. This section can also be used to highlight some of the difficulties encountered when appraising the evidence and the limitations in applying it to the clinical scenario. Sometimes other useful references that were found during the searching process may be referenced here.

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6: A clinical bottom line: ‘lay your BET’

The bottom line should be a simple yes or no and we try hard not to ‘sit on the fence’, but sometimes there is not enough, none at all, or only very poor evidence available, which means reaching a clinical bottom line is not possible! It is up to each vet to decide how to use this evidence and if it is appropriate – please go to Using BETs for more details.

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