Great, thank you very much, Stacey, for that introduction. And it is a, yeah, pleasure to be able to, speak to everyone this morning on a nice sunny, morning here in the Netherlands, actually, which is where I'm based, on this Sunday morning. Very pleased to talk to you about using medicines responsibly, mainly because it's sort of an interest to me, and I guess that's partly because I've worked in several places.
And just as an example, I think of using medicines responsibly. I thought there's a lot of differences between different countries and actually different vets within the country, perhaps as well. But if I take vaccination as an example, I'm trained in Utrech University in the Netherlands a little while ago, and there's certain compulsory vaccination programmes that have been used.
Vaccines are almost always applied by veterinarians in, in the Netherlands. When I then moved to New Zealand, still a lot of vaccines are being used, but there's only certain vaccines that were used or that were, applied by veterinarians. Lots of them were done by farmers or by technicians on farm.
And that was actually the same in Canada when I then moved to the UK 10 years or so ago. It was predominantly actually farmers that vaccinate themselves, and uptake of vaccination is quite different as well. So I think what I find interesting is that there's lots of different ways of using medicines in veterinary practise in different places where I've worked in the past, and I'm hoping that this morning, I could somehow bring across some of those different aspects and, and help people to think about this way, the way they do their, they do things in their, in, in their own practise.
So to get started, I think the first thing that I wanted to do is just go through those learning objectives. So these are sort of the things I would like to achieve in the next 45 minutes. So we're gonna talk about defining the role and the challenges of the vet surgeon.
We're making treatment decisions in farm animals. Describe some of the considerations that we make when we decide on treatments. Also, think about constructing the best treatment plans and how they are supported by the best available evidence and how we can get to that evidence.
Recognising some of the limitations that we have as vets working with food, animals, with regards to the legal and professional framework, and then also explaining and discussing the importance of interpersonal skills and trying to think of certain methods, how we can improve those skills to actually make better treatment choices. Now, I'd like to, I guess, when I teach you, when I talk about stuff, I'd like to make it as interactive as possible. Now, that's a bit more challenging, perhaps, in this virtual environment.
But what I've done, because I think it's quite, a challenge to listen to me for 45 minutes in one bit, I've put in some questions in between, the different topics for, people who are Listening to think about, ways that they, apply those things in their own practise, and perhaps also they would be willing to share some of their thoughts or some of their answers. So what I would like to suggest people to do is at least have some pen and paper close by, to write down some stuff, because there will be 4, I think, occasions where I'll give you a minute to think about things for a little bit. If you're a, person very familiar with Twitter, I would be very keen if people would be willing to share some of their thoughts with Twitter using the Twitter address from the webinar vet or my Twitter address, and use the hashtag of the virtual congress 2018, because I think it's a nice Opportunity, right?
I've got a lot of things that I would like to talk about, but there's also, definitely lots of experience within the group, international group of people that's listening, that would be really nice, I think, to share. And we can share that during the webinar for the people that are really quick in their tweeting, skills, but perhaps also do that afterwards, when you had a bit more time to think about things. So that's how I'd like to get through the next 45 minutes and we'll go sort of through each of those learning objectives one by one.
Now, I think when we're thinking about making best treatment decisions, it is really important, I think, for us to realise that there's lots of different factors that play a role when we have to decide on responsible medicine use. And I've got lots of pictures in this slide, so I forgot to say that as well. So I've got lots of pictures.
I've got very little words or text on the slide. Don't feel like people have to make notes or anything because there's comprehensive notes and all the references with regards to the research data that I'll present will be in those notes as well. So I haven't put all that in material on the slides here, because I thought it would be nicer to talk a little bit around, some of the images that I've put up, but all the references and notes will be available, as well.
So please don't worry about that. These two pictures I took, within the first month of working in the UK when I moved to the UK, 10 years or so ago. And I think what this really highlights is that there's so much variety of what we have with regards to the clients that we deal with or the environments that we deal with, that we need to take that into account when we make treatment decisions with regards to responsible use.
So there may be farmers that are motivated to reduce the medicine use or antimicrobial use on their farm. There might be organic farmers, they might, they might be for different reasons. There might be farmers that will go out of business soon that will make their treatment choices or business choices, I guess, very different from people that are just starting up, a business and, and are in there for the long term.
So there's a big variety and I guess non-clinical factors that play a role. There's all sorts of other factors as well with regards to ethical considerations and legal considerations that I think we should consider as that's and that we'll talk about as well. But it's on the farm and there's quite a few differences on the farm that will sort of partly explain why we make different treatment choices.
And it's not only on the farm choices, but there's also the differences within the veterinary environment, I guess, that will make our choices of which medicines to use or what kind of protocol to use different. And that's why I put these two pictures up here. So on the left.
You see Urich University Hospital environment where students in their elective for farm animal practise will still do an elective caesarean on a cow, and you can see, and although this picture is already from quite a while ago, the environment is pretty good with regards to the risk of contamination there it's pretty low. And it's the ideal environment with lots of light and everything is nice and clean, and there's lots of staff available. If you compare that to the picture on the right hand side, where we're doing a freeotomy on a cow that's been trying to carve for a very long time already.
She's quite tired. You can see, with the people that they're not particularly happy, perhaps with their environment either. But you can imagine that in that environment, the decision to use antibiotics, for example, is pretty straightforward because the patient and the environment doesn't really lend itself to making perhaps the most responsible choice or the most responsible, maybe the best choice of saying, oh, well, we're going to try to reduce antibiotic in that environment on the right hand side.
That's a pretty risky decision to make. Well, actually, if you would be in that university hospital environment, there's definitely a discussion to be had with regards to our anti-mercurials actually really necessary? And we can't really expect every situation to be like that image on the left.
So that's why we need to think about each situation by itself and we're making treatment decisions. So there's this environment that we need to think about. There's the client that we need to think about and the situation that they're in.
But I think there's also, and that's more and more so, societal expectations, I think, and political pressures with regards to using medicine in the food animal industry. And we can discuss on, on how evidence-based or how real that. That perception really is.
So, hey, how, how, how important is it really the amount of medicine that we use in the food industry, for example, with regards to antimicrobial resistance, and that will be a whole seminar in itself, I guess, to talk about the evidence base behind that. But what I think for us as a veterinary professionals is important, is that we think about that perception that the public has of the food animal industry, and that's where we're playing a really important part in, I think. And there's loads of work to be done in that area to try to make sure that the treatment decisions that we make, that we can defend those to the consumer, but also that actually all the good stuff that we're already doing, that we make that clear to the consumer and that they don't have this perhaps bad impression of the food animal industry that sometimes gets exposed via YouTube videos or in, in, in other situations.
So lots of clinical or non-clinical factors to consider, I guess. And that brings me to that first question of, that I'd actually like to ask you to think about. So, how do you decide when you're treating a certain case on the farm, what kind of medicine you would use?
Like, how, what kind of decision making steps. Do you take? What kind of things do you consider?
And I'm just gonna give you a brief minute to sort of think about that and perhaps write down a few things. And if you're keen, tweet a few of those ideas as well, please. So I'm just going to keep quiet for a little bit to give you a little bit of time to think about that particular question.
And that's your minute up, really. So lots of things I think that that people would think about before they make it to that treatment decision or that choice. And what we actually did with the BCVA workshop a couple of years ago, the year before last, is we actually asked to a group of vets in practise around those decision making choices that they have, and that was particularly with regards to the therapeutic use during cattle surgery.
And that's what you see in the, in the spider diagram here was that there's lots of different things that we need to think about when we need to make that treatment decision and how we can responsibly do that. So there's obviously the patient to think about and welfare considerations there. There's the biology of what kind of pathogen we're dealing with and what the spectrum is of the antibiotic that we might want to use.
Then there's legislation and that there's, there's definitely some limitations there that I'll talk about in a minute as well. And then there's this political pressure with regards to reducing antimicrobial use that is really at a worldwide level at the moment. There's society that expects us to deal in a certain way within that food supply chain.
And then there's also sometimes some I guess guidelines from within the practise about products that they're using, or certain protocols that will be used within that practise. And then there's the experience that you have as a vet, or the experience that other vets within your practise have an information and knowledge that you share there. And then there's obviously that evidence base.
So, what is the evidence base that is available to be able to make a certain, responsible treatment choice. And that's the bit that I would like to focus on now, for a little while, sort of think about the evidence hierarchy. So we've got this evidence hierarchy that most of you will have seen with different levels of evidence, starting at the bottom with the weakest evidence, which could be anecdotes that you'll have from colleagues in practise.
And with at the top of that pyramid, the systematic reviews and meta-analysis, that would be perceived to be the strongest evidence. Now, within veterinary medicine, it's always a bit challenging because there's lots of anecdotes. There's, there's quite a few other studies out there as well, but there's few systematic reviews or meta analysis compared to, for example, the medical profession where they would have the Cochrane library that is particularly put in place to sort of contribute to that evidence based on a continuous basis.
So that's a bit more challenging within the veterinary environment. However, I would say that there's lots of opportunities and things that have been developed out there in the last couple of years that are really, really useful to think about when you make those treatment decisions. So I just wanted to give you a few examples of those that you might be able to use in practise.
So, obviously, we can go online and we can go to Google Scholar or to PupMed or all those resources and try to find the literature. The challenging bit, I think, for people in practise is that those journals are often not accessible without paying for it. And that's maybe for a university, hey, for working in a university environment as I do, it is absolutely brilliant because we've got loads of access to lots of resources, and it's really We really do have the opportunity to assess the evidence that's out there.
That's a bit more challenging in practise. However, I would say that the RCVS has done a really great job with their library and information service. So if you're an MRCVS member, you pay a relatively low price to become a part of that library and information service, which gives you access to electronic resources to help you find the literature that you need to answer a particular question.
And they've been really, really helpful to, to lots of people. So if you're an MRE CVS, then it would be actually pretty easy or it would be an easy decision, I would argue, to become a member that would help you improve, access to that, evidence-based resource. If you're not an MICVS member, you can join the library and information service from the RCVS as well.
It's just a bit more expensive for you. But if you go on their website, you can have a look around and see all the opportunities that they offer, and there's actually lots of great opportunities for private pets in practise to actually explore all the resources that they have. So that's definitely a great possibility that I'd recommend to anyone.
The challenge, I think, having been in practise, is that to find the time to critically appraise that literature and actually draw the conclusions from it that are relevant for you in your day to day practise are definitely possible, but it's quite time consuming. And that's why I thought it would be nice to show you this other initiative, that's developed years ago by the centre of Evidence Based Veterinary Medicine, which is best vets for vets. And what they try to do is they really try to pick very common and specific clinical questions, and they try to answer those relatively simple clinical questions, by reviewing the literature that's currently available and critically appraising that literature with regards to the quality of research done, and then try to answer that question.
So oxytetracycline spray following this budding of calves, does that, is that better than not using any spray, for example, or around NSAIDs use in cows with toxic mastitis, for example. So there's lots of answers to the relatively basic but important practical questions out there. And what they do, within the sense.
Is they try to answer these questions, or with final rotation students, because we really try to teach them in an evidence-based thinking as well. But what is perhaps even more exciting, I guess, for vets in practise is that you can also submit the own question, your own question, and together with the team, you can help answer that question, and you can Published the answer to that question, in the vet record or in or put that online as well. So lots of opportunities there, and I guess the big advantage of best bets is that that critical appraisal of the literature has already been done for you.
So it's quite an efficient way of trying to get access to some, some evidence. The other thing that the centre has done is developed this database for veterinary systematic reviews. So think of what I showed you at the start with this pyramid where those systematic reviews and the meta-analysis are at the top of the hierarchy.
Although there might not be as many out there as within the medical profession, there is actually more systematic reviews out there than a lot of us would know. And what the centre for Evidence Based Veterinary Medicine has done is it has developed a search database that will actually highlight when new systematic reviews come out. So you can go on the website, you can put the topic in that you're interested in, respiratory disease treatment in feet or cattle, for example.
And it will give you the answer if there is a systematic review available on that. The big advantage being that you then don't need to read each individual piece of research, because there might have been 50 papers contributing to that systematic review, but you only read the actual systematic review, which will give you sort of a summary of the evidence out there. Now, you'll have to have access to that journal that publishes that review.
So that brings me back to the library again and trying to get access to that type of literature. I think for us as as vets in practise, it is really important to sort of try to encourage and try to find the time to actually look into some of those resources and try to make sure that we stay up to date with it. And I'm thinking with Best Bets, for example, that has given as a slightly more, perhaps time efficient way of, of doing that.
Now, these are just some examples, and I'm sure that for people out there that are listening to the webinar, that they can think of other resources that they will use to make their evidence-based decisions. And again, I would really like to give you half a minute. To a minute or so, to just quickly reflect on what kind of resources you use and what kind of sources you have found to be really helpful to you, and perhaps, some of those resources that you would like to share with us via Twitter or perhaps via, Stacey, via the webinar.
So I'll just give you a half a minute or so to to think about that and write a few things down. OK. So, that was more with regards to some of the evidence base that we can try to find.
There's something coming up on my screen. OK. That, that should be OK.
What I would like to focus on next was the other learning objectives that talks about these limitations that we have within our legal and professional framework. And I guess the example that I have here is particular to the UK. So, but it will be the same worldwide.
But within the UK we have the Veterinary Medicines directorate that provide us with a really good product database that we can search, and we can actually find what kind of information or what which products are allowed to use and for which indication and for which. And all that sort of thing, and that gets updated on a regular basis. And that helps us to stay within that legal framework.
Now, that's always easier said than done. And if you deal with cattle, that's relatively straightforward, most of the time, you deal with sheep and goats, for example, it's much more challenging because there's far less projects registered for that. To then work under the cascade, we'll need to be able to move to that table of allowed substances that sits within the European regulations that will tell us for which species we're allowed to use a product and for what indication they're available, all those type of things.
If we then wouldn't have anything available for sheep, for example, we can see if there's any bovine products registered, and we will be able to use those under the cascade. Now, That sometimes sounds very straightforward and the information on the website is pretty clear, I would argue nowadays with regards to prescribing unauthorised medicines, because that's what we would then talk about if we would use them under the cascade. However, it often delivers some challenging situations with regards to what we think is best as practising vets and perhaps what the legal framework tells us what we should do.
And we can think about the use of lidocaine and procaine in caesareans, for example, in cattle, and the paper that discusses the workshop that we had in BCVA describes this in a lot more detail. I haven't really got time to think about that now, but what I would mention with With regard to with regards to the responsible use of veterinary medicine, I think it's crucial for us as a veterinary profession, to be actively engaged, I guess, to start to stay within that legal framework. And again, that is particularly because of the role that we can play with regards to how we portray ourselves to the public and the perception that the public has of vets prescribing antimicrobials or Farmers are using medicines in practise.
And it's pretty important that those people buying our products actually trust, the way in which we, which we do that. And I think that's important to think about. It's also important, it's not just me that things that's important to think about, but it also came up as an topic during that workshop with the BCVA.
And it was really interesting actually to see that particularly our recent graduates that were taking. Part in that workshop, felt that vets, that we as vets could have a massive influence in trying to re-establish some of that respect that vets or the food industry can have with their consumers. So that changing landscape that we're in, that that can actually play a really important role.
Then it was really great to hear from some of those recent grads, how strongly they believe and how strongly they wanted to play a part in that. So, that brings me to my next question for you, I guess, is to think about when you're in practise, what kind of things do you do or can you think of doing to improve that consumer confidence in practise. So how in practise can you, what can you do in practise to try to improve that consumer confidence?
Again, I'll give you a little bit of time for that to think about that if you can tweet something about it afterwards, that would be great as well. But just a little bit of time to write a few things down that you would consider could be useful. And I'm looking at the time and I'm thinking I can't give you a lot more time to think about that, but, areas that we've discussed are using open days within practise to talk about treatment plans and those type of things and talk about how we use antimicrobials or fis, particularly, I think for mixed practitioners, there's huge opportunities to talk to the people.
That come in with, companion animals to talk about some of those issues, that you, that people would perceive to see happening in farm animals or food animals. And, and I think as a as a mixed petition, you can play a really important role in trying to explain some of the things that are happening there. And that sometimes that sort of brings me to this to this next topic, which I call the considered choice.
So there's all these different things that we need to think about. Hey, there's some of the ethical aspects where we say, oh, well, we have to use as little as possible, but as much as necessary of medicines, where there's definitely welfare implications, animal welfare implications that we want to think about. And when we think about disease control programmes, for example, and we can pick BVD as an example.
Actually, the use of medicines would be best controlled by actually preventing disease in the first place, and there's a massive input in various countries actually, but in the UK as well to try to control or eradicate BVD. But there's always this question of how much you can motivate people, or if there's actually sometimes perhaps a good reason to put in some legal requirements or some. A bit more of a stick, I guess.
So I put in this picture of a, of a, of the Twitter feed, that came up during a presentation from Professor Brownlee during BCVA last year. And it was absolutely great. So he came onto the stage with this massive carrot, and he also brought a little stick with him, and he was talking about the fact that, well, actually, yes, some people like carrots, but maybe some people prefer parsnips.
Everyone is scared of sticks. So maybe sometimes using that stick might not necessarily be a bad thing because how big does that carrot need to be? And I think that is a really, important thing with regards to responsible medicine use to think about and how we can actually make us use medicines more responsibly, and we can try to motivate people to do that, but sometimes we perhaps need to push people a little bit.
And following on from that, I think the example of in Holland or in the Netherlands how they managed to reduce antimicrobial use over the years is, is sort of an example of that. So between 2009 and 2014, antimicrobial use in food animals in the Netherlands had been reduced by more than 50%, which was a massive, step. And, and the big change actually, or one of the big factors that made that change possible, I think, was that the Dutch government said, well, if you're not going to reduce that antimicrobial you use within 50%, more than 50% in that time frame, we're going to take the veterinary pharmacy away from the veterinary professional.
And you can imagine that that caused quite a bit of . Concern within the veterinary profession, but that actually led to something positive because people then try to think about, OK, so how can we now communicate that best to our farmers? What can we now do to talk about prevention and all those sort of things, and they managed to make that change.
So sometimes that stick is actually perhaps used appropriately if we want to make a change in the right direction. And the other thing that I wanted to show, from the Dutch, side of things, and again, the slide is in Dutch, so it might not be that easy to read, or perhaps for some of it, for some of you it will be, but what they've developed is a guideline for each of the different species with regards to antimicrobials being used and what the 1st, 2nd, or third choice would be for specific diseases. So here we talk about cal.
For example, and would give you the guideline with regards to what the first choice antimicrobial would be, and that very much to try to come to a more unified response with regards to how we prescribe medicines for certain diseases. Now, this is not a guideline that people have to stick to. It truly is a guideline, gets updated on a regular basis, provided using the evidence that is available.
From antimicrobial resistance research and all those type of things, but particularly for new grads, that gives a really good handle to, to come up with some of those difficult treatment decisions in some situations. There's quite a few nice examples there, I think, on how to best use or how to most responsibly use those medicines. Nice example in the UK as well.
So this is from my colleagues at Nottingham University. So Bobby Hyde developed together with lots of other colleagues in antibiotic usage calculator that particularly for our dairy farmers, is quite useful, so they can put all the products in there that they use, that will then tell them how many critically important antibiotics they use, and by which route they use them, and that will then give the vet a much better handle on how they can actually engage with trying to think of ways to improve responsible use of medicine there. And what was really interesting in that paper, they also did some research with regards to antimicrobial use on farms and what they actually found is that the majority of farms, and that what you, that's what you would see at the horizontal axis here, the majority of farms are fine with regards to their antimicrobial use.
However, there's only this subset of farmers that would use sort of a maybe extreme amount of antibiotics, and it's unlikely that that that that can't be improved. But that also focuses the mind a little bit for us as vets that we say. Well, those are the ones that we should focus on.
So it's not a one size fits all strategy on this is how you reduce antimicrobial use, but there's targeted responses necessary. And the paper that they published talks about that in a, in a lot more detail. But what I think I definitely don't want to forget talking about is this bit of prevention that is better than cure, right?
So we can talk about responsible medicine use and which antibiotics you should use and why this particular one, but actually, it is perhaps far more important to take a step back and say, well, actually, we shouldn't be using those medicines in the first place. So that then comes down to he herd health, preventive her health management. And you can see these students here being highly excited on the left, doing data analysis, trying to figure out what the risk factors are for mastitis on that farm, then going out on the farm and talking to those clients about what they do, how they do it, how they could change.
To actually prevent mastitis happening in the first place. And I think that's an area that we've been working on for the last 30, 40 years or so. Hey, her health management is not something new on the agenda, but it is, I'd argue the key point, if we're talking about using medicines responsibly, is really trying to prevent, to have to use them in the first place.
And we really try to get that across to our vet students as well. So when they come onto the farm, like what you see in the picture here, they're coming onto a farm to practise some rectal palpation. Before they come onto the farm, we're being really strict on trying to get them onto the farms squeaky clean and not bringing in any pathogens that could develop disease, but then also, before they leave the farm, we're gonna make it really clear that there's nothing from that farm coming off to the farm that might be a risk for the next farm that they'll move on to.
And It's difficult to equate a certain risk to each of these different factors that we can control to limit disease, but I think for us as a veterinary professional, it's incredibly important that to the to a farmer we really role model how important that prevention of disease is and how important biosecurity on that farm is if we're thinking about responsible medicine use. So what I'd like to do next, and I still have, oh, about 10 minutes or so to go, so we're gonna try to get through this, is show you some of the more recent research findings that we that relate to responsible medicine use. And so this is not so much about a particular product, but it's very much thinking about, OK, so if we're using medicines, do we actually use them responsibly?
Do we use them correctly? So Liz Creswell, undergraduate students, a couple of years ago, did a really interesting study where she asked farmers about vaccine use and how they use those vaccines. And I've just highlighted some key points.
I would recommend you to read the full paper because there's lots more interesting stuff in there. But needle changes, or maybe when they're only broken or blunt, 43% of those respondents would only change a needle when it's broken or blunt. Only 41% of the respondents would use a different needle for injecting animals and for drawing up the vaccine from the bottle.
You can see the risk of contamination there as well. So there's room for improvement with how we use that vaccine. But what was actually even more interesting is what she also did is she asked them what kind of vaccines are you using?
How are you using those vaccines? And then she was comparing that to the SPC to the summary of product characteristics that sits within that So within that product database of the VMD. And she then compared to see if they were applying those vaccines correctly or not.
And I've just highlighted clostridial disease there. And again, the numbers are not massive, but the indication is definitely there that there's room for improvement. So, half of those people were not giving the second dose within the primary vaccine cause at the recommended time.
And that could have quite severe consequences with regards to the efficacy of that vaccine. So definitely some areas to consider there. Nice picture of, of, of Liz there who did all this work, who's now in, in farm practise in in Australia.
What she also found out is that when we actually try to change people and say, OK, do you actually read that data sheet before you go and vaccinate those animals? Mm, quite a few people would say, Well, I've done it before. I don't need instructions.
I'm just going to do the same thing again. However, knowing what kind of things change within vaccine development, it is actually quite important for us as vets to make sure that we're aware of those changes and that we tell the people that go and vaccinate those animals to make sure that they're aware of that as well. It's slightly different, as I said at the start, in the UK it's hardly ever vets vaccinating animals.
It's lots of times technical stuff, and I won't say that that's not possible. I think that's fine, but we just need to make sure that we get the message across correctly because it's us as vets that know most about how that vaccine should be applied to that animal. That's not something that we can expect, of the farmer to be totally aware of.
So knowing that information that came out of that study, we then developed together with AHDB dairy a video about vaccinating cattle safely and effectively that's available on YouTube for farmers to watch. And it's lovely to develop all that sort of material, but I'm always a bit worried that people might actually not look at it. So we we had a Undergraduate student Jordan Smith, who actually evaluated the quality of that video.
So he showed that video to farmers and asked them to answer questions before and after watching the video, and he actually did demonstrate that it that it did improve their knowledge, and he collected some information with regards to the quality of the videos and what farmers liked and didn't like about it, that we will use in, in other material that we've developed. So since then, we've also developed a webinar with best practise. Tips in the hope that farmers engage with that material and in that way, use their medicines more responsibly.
Another bit of research that I thought would be interesting to mention here is a paper that we recently published around the risk of sciatic nerve damage in dairy cattle after injection. So, we know that damage to the nerve can cause pain and paralysis. We sort of know that we shouldn't inject it in the gluteal region, particularly in young animals.
However, what we knew from other research is that there's still quite a few vets in the UK in dairy cattle, not so much beef for. Known reasons of pay meat quality there, but quite a few, dairy animals that still would be injected in the luteal region. We were wondering what the risk of sciatic nerve damage would be in that area.
So Rosanna Kirkwood was an undergraduate student who worked in this area. She dissected cadavers and she actually demonstrated. That that sciatic nerve that you see here can actually be up to 4.5 centimetres wide.
So that's a pretty wide nerve, quite thin, hey, only 5 millimetres or less, and a bit dependent on the body condition of the animal, it might only lie 2.5 centimetres underneath the skin. So that made us think about how risky it is that we will actually damage that sciatic nerve when we inject animals in that area.
So that's why we did the experiment that you see here on the right hand side, where we've asked anyone who ever injected an animal in the gluteal region to do that on cadaver specimens. And what you see is particularly on the animals with a low condition score, there's lots of injection sites right on or very close to that sciatic nerve. And that's what demonstrated in the graph here as well.
And what you see is that actually some people inject straight through the sciatic nerve and get into the pelvic cavity. You could argue that that might not be the most responsible way of using your medicines. So based on that information, we came up with some recommendations, and of course, we say, well, if there's an opportunity to inject in the neck, you should always inject in the neck.
But we know out of practise that sometimes that doesn't happen. So we now say that, OK, if that's not possible, and you have to inject in the gluteal region. Then at least inject in the right place that has the lowest risk of damaging the sciatic nerve, which is a hand width behind the tubercocate.
So that's what Rosanna is indicating in the image there. Quick picture before moving on to the other bits of research. So this is just to sort of engage the other bit of your brain for a second.
There should be a cow in this image, and hopefully, you will see her. And I haven't really got a lot of time to spend on it, so I'm sort of giving you the answer, perhaps by saying there's an ear here. And there's another ear there.
She's got some eyes, 2 eyes, to be precise, here, and that's her nose over there and the rest of her body sits sort of in that area. So that's her head right here, little heifer looking at you. Just to engage the other part of the brain for a few seconds.
However, a few other interesting things that I would like to share before I have to wrap up. And that's very much around those interpersonal skills that I've talked about. So, that I talked about at the start.
So Andrew Bates, did a study in New Zealand where he asked farm consultants about their attitudes towards vets, and the data that he collected showed that farm consultants are often consulted around animal health topics. So they're definitely a part of the professionals within the food industry that we should engage with. When he then asked those farm consultants to identify the roles that vets play.
In improving animal health, the roles that vets can play in improving animal health and performance, and the roles where vets are essential in in in in playing a role within that farm, within the dairy farm industry. It's interesting to see that they definitely think vets play a role with with regards to prevention of disease. But if you then ask them, well, where do you think vets are really essential, it's very much more practical things like vaccines and dry cow treatments, and actually, staff training and reproduction are really not areas where they feel it is essential for veterinarians to have a role.
Well, I guess if you would ask us as vets, we do feel we have an essential role there. So there's definitely room to improve our collaboration with other professionals on the farm. Some other research that we did earlier, also highlights that point that there's room for improvement there with regards to communication between vets and farmers.
So we asked dairy clients what kind of topics do recur when your vets. The farm, and we asked the vet, well, when you visit your dairy farm clients, what kind of topics do you discuss? And there's areas around culling rates and scis control and medicines where there's pretty reasonable agreement and both vets and farmers say, yeah, we talk about those type of things.
But if we then look at other areas like farm finance, or milk production, or calf mortality, there's a quite a discrepancy where vets say, yeah, yeah, I talk about that, but farmers actually don't appreciate that, right? They don't perceive that the vet is talking. About it and I think there's lots of great stuff going on in Bristol University, but also within Nottingham, trying to sort of disentangle where that communication goes wrong and see how we can improve that and see how we can get that message across better.
In that same bit of research, just a bit of an interesting finding is we ask vets and farmers, how would you present yourself to your dairy clients, and we would ask those farmers, what approach to you and your farm do you feel your vet has and what approach would you prefer them to have. And what was interesting is that quite a few vets said, oh, we would like to sort of portray a personal friend of the farmer style approach, but actually, that's not really what the majority of those farmers would actually prefer. They were perhaps more looking for someone to give technical advice, a proactive person who would identify problems on the farms.
So there's some room for improvement there as well with regards to interpersonal skills and developing that relationship. With that, Developing that relationship on the farm. Now, the other bit of, the other challenge, I guess that we're dealing with as vets is that there's a great variety in the beliefs that we have within the veterinary profession.
And Helen Higgins was, my PhD student, and she did some really interesting research asking vets, If I do a certain intervention on the farm to reduce Yonni's disease, for example, or to reduce lameness, or to reduce mastitis incidence, if I apply a certain intervention, how much do you think that will reduce Yoni's disease prevalence, lameness prevalence or mastitis prevalence? And what you can see in those graphs here. Is that there's a massive range in what vets think the difference in reduction of prevalence will be for that same intervention.
So if we take Joni's disease as an example, Some vets, so these are all individual vets that you see here on the horizontal axis. Some vets will say, oh, it will probably make around a 10% difference, or get a 10% reduction in prevalence. But actually, some other vets will say, well, actually, if you make that change, you'll get an 80% reduction in prevalence.
And that's different. You can see that for farmers that will be sometimes difficult to understand that that's give different answers to sort of similar questions. And I hope that some of the stuff, some of the stuff that I've presented before, you can see that there's different.
Factors that play a role in us giving that prediction. I think it's important for us as a veterinary profession to, to build on that evidence base and to talk to each other and to try to come up to us to with a sort with a more unified approach. There's definitely some room for discussion there.
Last bit of research that I wanted to present that I thought was interesting, particularly for this morning, is also research as done by Helen Higgins, and what she looked into is the probability of vets to be involved with regular control advice or gold standard monitoring, depending on certain characteristics that they had. So gold standard monitoring or regular control advice, sort of, is a proxy for herd health management. Right, so gold standard would be perfect, preventive herd health management, regular control adviser would be being involved.
Again, the paper describes the detail of of what was involved within that each of those definitions. But I think the key point to get across here. If you look at that probability of a vet that has no postgraduate qualification, that's an assistant in a practise, and that has not had any CPD, the chance of that type of person, the probability of that type of person being involved in gold standard monitoring is actually pretty slim, only a very small chance, and the same would apply to that regular control advice, although a little bit higher.
However, if we would provide that person with no postgra qualification who's an assistant in that practise, with the maximum amount of CPD that they can get, that actually quite dramatically improves their probability of being involved in that gold standard monitoring, and even more improves that probability or increases that probability of being involved in reg control advice. And I thought that was quite nice, particularly for people involved now in CPD, that it, from the research that she's done, interviewing and collecting data from vets in practise, it definitely shows that it's worth being engaged in CPD, if we want to progress, within the, within the food animal field. And that was the last bit of research that I wanted to show you.
What I would like to do in the last minute or so is just walk through those learning objectives that we talked about at the start, just to sort of see how we touched on those learning objectives. So we started off about defining the role and the challenges of the veterinary surgeon we making treatment decisions, and we discussed about how varied that decision making can be dependent on the people that we deal with, and dependent on the relationship we have with the farmer and the trust that we build within that relationship there, and that there's lots of different factors that we need to, need to consider. The second learning objective was around describing considerations when we're deciding on the treatment of farm animals.
And, I had a lot more to tell around these pictures, but I'm just going to try to sum it up relatively briefly. I think the key bit here is that we need to think about that farm client and what his or her considerations are. And we put that together with the information we get from our clinical examinations.
So those are our final. Students on their routine fertility visits. And yes, we need to be able to find that CL to then think about if we would need to give that kind of prostate landing or not.
And there might be some ethical considerations there where we need to include that farmer to come to that best treatment decision, because is that always necessary, or is there other ways to manage that? That 3rd learning objective was around constructing treatment plans supported by the best available evidence. Now, giving you some examples of the library of best bets of the vets ref database.
And I've put this picture in here sort of highlight that all those resources are really important, but I think also the key resource that we try to teach students within the vet school is that our basic clinical examination skills are also really important sources of evidence and that we need to consider, we need to put that together with the knowledge base that's out there. That 4th learning objective was around recognising limitations provided by the legal and professional framework, specific to the farm animal industry, trying to regain or keep that trust with the consumer that we have. And I've put this picture in there, because it's sort of related to that, because we can say, oh, well, we have to stick within the legal framework, and this is not possible, or we can sort of go think outside the box a little bit and say, oh, well, in this particular situation, I may contact the VMD or the VDS and try to discuss what the best solution would be.
So this is just an example of one of our teaching cows that got lame. And perhaps with the commercial situation, we would have never taken radiographs, but because of the situation that we're in at a university, we had that opportunity to do so, which was a great teaching opportunity and was actually great for the animal as well because she's still around and she's still progressing or living on happily and, and teaching our undergraduate students. And then that last learning objective was around explaining the importance of interpersonal skills and creating methods to improve these with the aim to make better treatment choices.
So that's really where the data comes in around how we are as that's being perceived by other professionals that come onto the farm, or how we're being perceived with regards to our communication with farmers and what things they get or don't get from us. How we perhaps need to more unify our approach on farms, as vets in a food and profession. And I put these pictures in because what we try to do when we teach students is we only not only try to teach them the practical skills, but actually, we say, well, when you're out on farm or even in small animal practise, it would be the same.
You need to go and talk to clients and train clients or teach them. How to make the dog lose weight or how to take a milk sample appropriately. So what we do at Nottingham is what you see here is some of our 4th year students are teaching our 2nd year students how to take an aseptic milk sample or how to perform a certain a certain surgical skill, which is quite helpful because that's going to help them develop their communication skills, which is going to be invaluable for them in practise as well.
That would cover my 5 learning objectives. I'm running out of time a little bit, I think. I'm, but what I would like to do quickly is I would, like to thank everyone for listening.
I would very much like to thank my colleagues within Dairy herd Health Group, but also the centre for Evidence Based Veterinary Medicine, AHDB Dairy, the School of Veterinary Medicine and Science, and all the postgraduates and undergraduate students that have helped put this, information together over the years with all the bits of research that we've done. References provided in notes and, please use the Twitter addresses to, to give us some feedback or perhaps share some of the answers to the questions I posed during the webinar. And, then I think I would like to finish off with this last picture, which, is of the first cow that I carved in New Zealand after I graduated as my first real calving as a vet in practise.
Just because I've shown you lots of pictures with people in it and I guess in my current job, I, I deal with lots of people, perhaps even more than with animals, but I think this is the sort of thing why I became a vet in the first place, and I still look looking at this picture and I think it's still a great job that we can do out there, in practise. And with that, I would like to say thank you very much and hand over to Stacey. Brilliant, thank you very much, Wendola.
You're making me feel like I should have taken a picture of the twins that I first carved as well as a new graduate, kicking myself now, that's such a lovely picture for sharing with us. Thank you. Thank you for so much of the, useful data that you provided with practical uses, and I also really enjoyed the cameo appearance, of Joe Brownlee as well.
So thanks for that. And hopefully, as Wendella said, this discussion will continue on Twitter. And just before we go to questions, the webinar vet team really appreciate your feedback.
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Right, so we've got time for some questions and don't forget you can submit questions in the Q&A box, which you'll find on the taskbar of the webinar. So, we had a question about one of my favourite resources, which is Best Bets. The person asked, is this resource free of charge for people to access?
Yes, definitely. Sorry, I forgot to mention it. There's always lots of things that I forget to mention.
Well, I think, yes, definitely. So, easily except if you, I think if you Google best bets for vets, you get to the website and you can then go to the kettle tab and it will provide you all the different, bets that have been answered with regards to kettle. And definitely I'd recommend if people have questions to submit those to the, to the team of the, of the centre, because they are quite keen to, to answer those clinically relevant topics that vets have in practise, but yeah, that's definitely freely available.
Great. Thank you for clarifying that. I was just wondering, on Friday during the BVA pre-congress session, one of the speakers, Gwen Rees, mentioned that some farmers are doubling the dose of antibiotics, for example, with double tubing mastitis cases, and she asked if vets know whether farmers, that they visit.
Are actually carrying out such practises, because this is something that Gwen hadn't encountered before, and I must admit, I haven't come across this practise before. She was doing her research. So do you have any tips for having conversations with farmers about responsible use?
Perhaps touching on the research you mentioned at Nottingham and Bristol, in terms of communication skills? Yeah, definitely. Yeah, that's a very good point, Soy.
So I would, I would think definitely the anti global usage indicator is a really a calculator is a really nice way to sort of get the conversation started, because it really demonstrates to farmers what they're using. They're often also interested in the cost perspective side of things, and that might be a nice way to get the conversation started. I have to say, out of my own experience, I think it's also sometimes it's interesting to have these conversations around reducing antimicrobial use because everyone reads in the papers that that's what we need to do.
So also farmers, and they are often quite interested to hear our point of view. So to then have that conversation and say, OK, well, let's have a look on your farm, what you're actually doing, and have a slightly more perhaps in-depth conversation instead of just selling the lactating and cow antibiotics that you would usually sell. I'd argue vets are often, sorry, farmers are often more interested than vets think, but it's getting that conversation started.
And I think the calculator is really a nice way of, of, of starting that conversation. Yeah, I think that's the best bit of advice I would, I can give now. I also think I'm just thinking of the motivational interviewing.
Hey, that Alison Barden has done, definitely some CPD courses out there as well that she did with that, in, in the practise that we are associated with this university. That really helps you having That conversation because sometimes it feels like you're sort of picking at or what you're doing is not right, but actually asking them for if they would like your help, asking them if you would, if they would like to hear your suggestion or if they would like to hear your opinion with regards to what they're currently doing, and you'll find that often people are interested in, in your opinion. So there's definitely something around communication techniques that to think about, and then it's trying to pick up some of the tools that are quite helpful to get the conversation started.
That's great. Thank you very much, Wendola. And in the interest of time, I think we will move on to our next speaker now.
So thank you so much for joining us, Wendola and providing so much useful information.