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Frontiers in veterinary science2020; 7; 266; doi: 10.3389/fvets.2020.00266

Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards.

Abstract: Inflammatory airway disease (IAD) is a commonly diagnosed but variably defined syndrome of equine lower airway inflammation. The most recent American College of Veterinary Internal Medicine (ACVIM) consensus statement, informed by research evidence, recommends a case definition based on clinical signs (poor performance or occasional coughing of at least 3 weeks duration), increased endoscopically-visible tracheal mucus, and bronchoalveolar lavage cytology, and proposes that the condition should be termed 'mild-moderate equine asthma' (mEA). In British Thoroughbred racehorses, research to date has focused on airway inflammation defined by increased tracheal mucus and inflammatory tracheal wash sample cytology. It has been unclear whether or to what extent the ACVIM consensus statement has influenced the practice of British racing veterinarians. The aim of this qualitative study was to characterize and understand rationales for current practices relating to diagnosing and managing airway inflammation in British racehorses. Audio-recorded focus group discussions were conducted with 25 participants from four veterinary practices in England. Practices were purposively selected to represent those responsible for different types of racehorse, in different geographical regions. Thematic analysis of transcripts identified (i) an over-arching theme of within which two further themes (ii) and (iii) were nested. The requirement to serve the racing industry was a key driver of clinical approaches, strongly influenced in particular by the trainer. Participants widely disregarded the consensus case definition of IAD/mEA for British racehorses because of perceived differences in etiology, perceived lack of practicability, particularly of BAL sampling, and perceived lack of understanding of the British racing context by consensus authors. Participants shared a strong professional identity as pragmatic clinicians providing an individualized clinical approach based on direct experience, which was often prioritized as the most valuable evidence with which to inform clinical decision-making. Lack of alignment with international consensus presents a barrier to practicing and furthering evidence-based medicine. Improved dialogue and partnership in research would be valuable and further research tailored for this population, including continuing development of contextually acceptable diagnostic methods, may be required.
Copyright © 2020 Kinnison and Cardwell.
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Publication Date: 2020-05-27 PubMed ID: 32537459PubMed Central: PMC7267464DOI: 10.3389/fvets.2020.00266Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The study investigates current practices and the reasons behind them in terms of diagnosing and managing inflammatory airway disease (now referred to as mild-moderate equine asthma) in British racehorses. Researchers found that many veterinarians ignored the standardized, research-backed definition and treatment on the basis of practicality and personal experience, presenting a challenge to evidence-based medicine.

Study Objective and Methodology

  • This qualitative research aims to comprehend and outline the existing practices related to the diagnosis and management of airway inflammation in British racehorses.
  • Twenty-five participants from four distinct veterinary practices in England became part of the audio-recorded focus group discussions. The practices were specifically picked to symbolize those catering to various types of racehorses, situated in different geographical regions.
  • A thematic analysis of the transcripts was conducted to identify the main themes discussed during these group discussions.

Findings and Themes

  • From the thematic analysis, the authors identified an overarching theme: the conflict between direct experience and research-based evidence, under which two more themes: the service to the racing industry and professional identity as pragmatic clinicians were nested.
  • Participants commonly rejected the consensus definition (as given by the American College of Veterinary Internal Medicine) for equine mild asthma because they felt it did not take into account the unique factors associated with British racehorses.
  • The refusal to follow the consensus case definition was influenced by several factors including perceived differences in causation of the disease, perceived impracticality of bronchoalveolar lavage sampling, and lack of understanding of the British racing context by consensus authors.
  • Participants shared the identification as pragmatic clinicians who preferred their direct experience over research-based evidence when making decisions about treatment of the racehorses.

Conclusion and Implications

  • The study concluded that the disparity with the international consensus presents an obstacle for practising and promoting evidence-based medicine.
  • This research suggests that improved dialogue and partnership are needed in the research domain along with further research specifically tailored for the target population.
  • Moreover, it concludes that the continued development of contextually acceptable diagnostic techniques may be necessary to help align the practices of British racing veterinarians with evidence-based medicine.

Cite This Article

APA
Kinnison T, Cardwell JM. (2020). Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards. Front Vet Sci, 7, 266. https://doi.org/10.3389/fvets.2020.00266

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 7
Pages: 266
PII: 266

Researcher Affiliations

Kinnison, Tierney
  • Royal Veterinary College (RVC), London, United Kingdom.
Cardwell, Jacqueline M
  • Royal Veterinary College (RVC), London, United Kingdom.

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