Sheila Keay

Veterinarians are expected to make treatment and intervention recommendations that are specific to client needs, based on clinical expertise, and made in consideration of the best available research evidence. Consideration of research evidence requires not just keeping up with new studies but also critically appraising and assessing their relevance within the larger context of the body of evidence. Ideally, a veterinarian could access robust and transparent reviews such as systematic reviews and meta-analyses, but few are available in veterinary medicine. Therefore, veterinarians seek other sources of information including individual research papers. This process is time-intensive, and veterinarians face barriers of access, skill and time as obstacles to keeping up. Recognizing time as the greatest barrier, the Evidence-Based Veterinary Medicine Association (EBVMA) Board, in collaboration with invited colleagues, developed QUIT—the Quality and Uncertainty Indicator Triage tool. The QUIT tool is comprised of 10 binary questions designed to help the reader flag concerns potentially affecting the reliability of treatment studies. As flags accumulate, the reader can more confidently quit reading and set the study aside. The QUIT tool is intended as a guide for ruling out studies and is not to be used for ruling in studies for inclusion in decision making ; questions are inadequate to fully assess study validity. This is a subtle but important distinction. The QUIT tool and all supporting materials are freely available on the EBVMA website. Lastly, QUIT is a prototype and we invite your feedback by submitting a completed feedback form to info@ebvma.org .

Introduction: Antimicrobial resistance (AMR) is a complex One Health problem that requires continuous surveillance to minimize the potential hazards. Information must be disseminated promptly in easily understandable formats to support informed decisions and actions by data end-users. One way to address this is through real-time visualizations, such as dashboards, to help key interest-holders understand and monitor AMR. A scoping review was conducted to understand the current body of evidence surrounding real-time AMR visualizations in both veterinary and human health. Methods: Twelve sources were searched for relevant citations. 1763 citations were included in the screening process. Citations were screened for four main criteria: (i) the text had to be a primary research article in English (ii) published between 1990 and 2023, and (iii) it had to discuss the methodology of an AMR display (iv) that was updated at least quarterly. Results: Forty-two publications were identified as relevant. Publication information, information about the data used in the described displays, display information, and user information were charted. Publications were from 25 countries and utilized data from over 40 databases. Various bacterial genera and species were reported; the most common bacterial species were Escherichia coli and Staphylococcus aureus . Displays were most focused mainly on human data. Conclusions: AMR data visualization has been implemented globally and is a critical component of continued AMR surveillance. Displays are often part of a larger surveillance system. A key challenge is designing a visualization for an intended audience and the information then being utilized by that audience.

Previously, we systematically reviewed more than 20 years of influenza vaccine challenge trial research in pigs to answer the question, “does vaccinating sows protect offspring?” Overall, most studies were well designed but clinical heterogeneity made between-study comparisons challenging. Studies varied by samples, outcomes, and assays selected for measurement. Additionally, data essential for inclusion of findings in meta-analyses were often insufficiently reported and as a result, summary effect measures were either not derived or were not meaningful. Clinical heterogeneity and reporting issues complicate and limit what can be learned cumulatively from research and both represent two types of avoidable research waste. Here, we illustrate each concern using data collected tangentially during the systematic review and propose two corrective strategies, both of which have broad applicability across veterinary intervention research; (i) develop a Core Outcome Set (COS) to reduce unnecessary clinical heterogeneity in future research and (ii) encourage funders and journal editors to require submitted research protocols and manuscripts adhere to established reporting guidelines. As a reporting corollary, we developed a supplemental checklist specific to influenza vaccine challenge trial research in swine and propose that it is completed by researchers and included with all study protocol and manuscript submissions. The checklist serves two purposes: as a reminder of details essential to report for inclusion of findings in meta-analyses and sub-group meta-analyses (e.g., antigenic or genomic descriptions of influenza vaccine and challenge viruses), and as an aid to help synthesis researchers fully characterize and comprehensively include studies in reviews.

It is unclear if piglets benefit from vaccination of sows against influenza. For the first time, methods of evidence-based medicine were applied to answer the question: “Does vaccine-induced maternally-derived immunity (MDI) protect swine offspring against influenza A viruses?”. Challenge trials were reviewed that were published from 1990 to April 2021 and measured at least one of six outcomes in MDI-positive versus MDI-negative offspring (hemagglutination inhibition (HI) titers, virus titers, time to begin and time to stop shedding, risk of infection, average daily gain (ADG), and coughing) (n = 15). Screening and extraction of study characteristics was conducted in duplicate by two reviewers, with data extraction and assessment for risk of bias performed by one. Homology was defined by the antigenic match of vaccine and challenge virus hemagglutinin epitopes. Results: Homologous, but not heterologous MDI, reduced virus titers in piglets. There was no difference, calculated as relative risks (RR), in infection incidence risk over the entire study period; however, infection hazard (instantaneous risk) was decreased in pigs with MDI (log HR = −0.64, 95% CI: −1.13, −0.15). Overall, pigs with MDI took about a ½ day longer to begin shedding virus post-challenge (MD = 0.51, 95% CI: 0.03, 0.99) but the hazard of infected pigs ceasing to shed was not different (log HR = 0.32, 95% CI: −0.29, 0.93). HI titers were synthesized qualitatively and although data on ADG and coughing was extracted, details were insufficient for conducting meta-analyses. Conclusion: Homology of vaccine strains with challenge viruses is an important consideration when assessing vaccine effectiveness. Herd viral dynamics are complex and may include concurrent or sequential exposures in the field. The practical significance of reduced weaned pig virus titers is, therefore, not known and evidence from challenge trials is insufficient to make inferences on the effects of MDI on incidence risk, time to begin or to cease shedding virus, coughing, and ADG. The applicability of evidence from single-strain challenge trials to field practices is limited. Despite the synthesis of six outcomes, challenge trial evidence does not support or refute vaccination of sows against influenza to protect piglets. Additional research is needed; controlled trials with multi-strain concurrent or sequential heterologous challenges have not been conducted, and sequential homologous exposure trials were rare. Consensus is also warranted on (1) the selection of core outcomes, (2) the sizing of trial populations to be reflective of field populations, (3) the reporting of antigenic characterization of vaccines, challenge viruses, and sow exposure history, and (4) on the collection of non-aggregated individual pig data.

Background: Food animal veterinarians face commodity specific and urgent global challenges yet conditions preventing use of best available knowledge have been sparsely studied. The American Association of Swine Veterinarians (AASV) membership (N = 1289) was surveyed online to benchmark their information priorities and their motivations and sources for keeping current with infectious disease research, and to describe their reported time, skill, access, and process as barriers to knowledge translation (KT). Results: Respondents (n = 80) were mostly from Canada (n = 40) and the U.S.A (n = 31) and demographics approximated the AASV’s. Colleagues are the first choice for information on difficult cases (49%, 95%CI: 38–61). Half of respondents (53%, 95%CI: 41–64) spend an hour or less per week keeping up with infectious disease research. The majority reported moderate or less than moderate efficiency (62%, 95%CI: 51–72), and moderate or greater stress (59%, 95%CI: 48–70) with their process for keeping up. Journal article methods sections are commonly not read, almost a third (32%, 95% CI: 22–43) reported either they do not evaluate statistical methods or that they had poor confidence to do so, and half (52, 95%CI: 41–63) could not explain ‘confounding bias’. Approximately half (55%, 95%CI: 41-69) with direct oversight of swine herds had full access to 2 or fewer academic journals. Approximately a third of respondents (34%, 95%CI: 24–46) selected only formats involving single research studies (either full text or summaries) as preferred reading materials for keeping current over expert summaries of the body of evidence. Conclusion: KT barriers are considerable and a source of stress for many swine veterinarians. Sub-optimal efficiency with keeping up and low confidence to appraise aspects of research are concerns. Results are consistent with previous literature and illustrate need for improved KT infrastructure and for additional training in statistical methods and interpretation of primary research. Further evaluation is warranted of why approximately a third of veterinarians in this study, for the purpose of keeping up, preferentially choose to review individual research studies over choices that would include an expert summary of the body of evidence. Consideration of reasons for this preference will be important in the planning of KT infrastructure improvements.

Influenza A viruses of swine (IAV-S) are a global zoonotic and economic concern. Primary control is through vaccination yet a formal evidence map summarizing vaccine research conducted in pigs is not available. Ten characteristics of English language primary IAV-S vaccine research, conducted at the level of the pig or higher, were charted to identify research gaps, topics for systematic review, and coverage across different publication types. Six online databases and grey literature were searched, without geographic, population, or study type restrictions, and abstracts screened independently and in duplicate for relevant research published between 1990 and May 2018. Full text data was charted by a single reviewer. Over 11,000 unique citations were screened, identifying 376 for charting, including 175 proceedings from 60 conferences, and 170 journal articles from 51 journals. Reported outcomes were heterogeneous with measures of immunity (86%, n = 323) and virus detection (65%, n = 246) reported far more than production metrics (9%, n = 32). Study of transmissibility under conditions of natural exposure (n = 7), use of mathematical modelling (n = 11), and autogenous vaccine research reported in journals (n = 7), was limited. Most research used challenge trials (n = 219) and may have poor field relevance or suitability for systematic review if the purpose is to inform clinical decisions. Literature on vaccinated breeding herds (n = 89) and weaned pigs (n = 136) is potentially sufficient for systematic review. Research under field conditions is limited, disproportionately reported in conference proceedings versus journal articles, and may be insufficient to support systematic review.