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Ubbink DT, Augustinus S, Feenstra TM, De Graaf N, Van der Burgt SM, Koelemaij MJ, Nieveen van Dijkum EJ. Evidence-Based Medicine Course in Combination With Journal Clubs to Promote Evidence-Based Surgery. Cureus 2023; 15:e37318. [PMID: 37181957 PMCID: PMC10167562 DOI: 10.7759/cureus.37318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction To provide high-quality surgical care, surgeons must critically appraise medical literature to adapt their clinical practice whenever convincing evidence emerges. This will promote evidence-based surgery (EBS). Over the last decade, we have organized monthly journal clubs (JCs) and more extensive quarterly EBS courses for surgical residents and PhD students, supervised by surgical staff. We evaluated the participation, satisfaction, and knowledge gained by this EBS program, to make the program future-proof and aid other educators. Materials and methods An anonymous digital survey was distributed via email among residents, PhD students, and surgeons of the Amsterdam University Medical Centers' (UMC) surgical department in April 2022. The survey included general questions on EBS education, specific course-oriented questions for the residents and PhD students, and questions about supervision for surgeons. Results The survey was completed by 47 respondents from the surgery department of the Amsterdam UMC University Hospital, of whom 63.8% (n=30) were residents or PhD students and 36.2% (n=17) were surgeons. During one year of the combined EBS course and JCs, the EBS course was attended by 40.0% (n=12) of PhD students and was rated with a mean score of 7.6/10. JCs were attended by 86.6% (n=26) of residents or PhD students and received a mean score of 7.4/10. Reported strengths of the JCs were their easy accessibility and the acquisition of critical appraisal skills and scientific knowledge. A reported point of improvement was to focus more deeply on specific epidemiological topics per meeting. Of the surgeons, 64.7% (n=11) had supervised at least one JC and gave a mean score of 8.5/10. The main reasons to supervise JCs were the distribution of knowledge (45.5%), scientific discussion (36.3%), and contact with PhD students (18.1%). Conclusion Our EBS educational program, including JCs and EBS courses, was well appreciated by residents, PhD students, and staff. This format is advocated for other centers aiming to better implement EBS in surgical practice.
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Affiliation(s)
- Dirk T Ubbink
- Surgery, Amsterdam University Medical Centers, Amsterdam, NLD
| | | | - Tim M Feenstra
- Surgery, Amsterdam University Medical Centers, Amsterdam, NLD
| | - Nine De Graaf
- Surgery, Amsterdam University Medical Centers, Amsterdam, NLD
| | | | - Mark J Koelemaij
- Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, NLD
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Singh RD, van Dijck JTJM, Maas AIR, Peul WC, van Essen TA. Challenges Encountered in Surgical Traumatic Brain Injury Research: A Need for Methodological Improvement of Future Studies. World Neurosurg 2022; 161:410-417. [PMID: 35505561 DOI: 10.1016/j.wneu.2021.11.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Investigating neurosurgical interventions for traumatic brain injury (TBI) involves complex methodological and practical challenges. In the present report, we have provided an overview of the current state of neurosurgical TBI research and discussed the key challenges and possible solutions. METHODS The content of our report was based on an extensive literature review and personal knowledge and expert opinions of senior neurosurgeon researchers and epidemiologists. RESULTS Current best practice research strategies include randomized controlled trials (RCTs) and comparative effectiveness research. The performance of RCTs has been complicated by the heterogeneity of TBI patient populations with the associated sample size requirements, the traditional eminence-based neurosurgical culture, inadequate research budgets, and the often acutely life-threatening setting of severe TBI. Statistical corrections can mitigate the effects of heterogeneity, and increasing awareness of clinical equipoise and informed consent alternatives can improve trial efficiency. The substantial confounding by indication, which limits the interpretability of observational research, can be circumvented by using an instrumental variable analysis. Traditional TBI outcome measures remain relevant but do not adequately capture the subtleties of well-being, suggesting a need for multidimensional approaches to outcome assessments. CONCLUSIONS In settings in which traditional RCTs are difficult to conduct and substantial confounding by indication can be present, observational studies using an instrumental variable analysis and "pragmatic" RCTs are promising alternatives. Embedding TBI research into standard clinical practice should be more frequently considered but will require fundamental modifications to the current health care system. Finally, multimodality outcome assessment will be key to improving future surgical and nonsurgical TBI research.
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Affiliation(s)
- Ranjit D Singh
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Centre, Haaglanden Medical Center, and Haga Teaching Hospital, Leiden University, The Hague, The Netherlands.
| | - Jeroen T J M van Dijck
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Centre, Haaglanden Medical Center, and Haga Teaching Hospital, Leiden University, The Hague, The Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Wilco C Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Centre, Haaglanden Medical Center, and Haga Teaching Hospital, Leiden University, The Hague, The Netherlands
| | - Thomas A van Essen
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Centre, Haaglanden Medical Center, and Haga Teaching Hospital, Leiden University, The Hague, The Netherlands
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Toxopeus E, van der Schaaf M, van Lanschot J, Lagergren J, Lagergren P, van der Gaast A, Wijnhoven B. Outcome of Patients Treated Within and Outside a Randomized Clinical Trial on Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: Extrapolation of a Randomized Clinical Trial (CROSS). Ann Surg Oncol 2018; 25:2441-2448. [PMID: 29948420 PMCID: PMC6029046 DOI: 10.1245/s10434-018-6554-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Indexed: 12/11/2022]
Abstract
Background Randomized clinical trials (RCTs) can provide a high level of evidence for medical decision making, but it is unclear if the results apply to patients treated outside such trials. Objective The aim of this study was to retrospectively compare outcomes of patients with esophageal cancer treated within and outside an RCT.
Methods All patients receiving neoadjuvant chemoradiotherapy (nCRT) plus surgery for esophageal cancer between 2002 and 2008 (ChemoRadiotherapy for Esophageal cancer followed by Surgery Study [CROSS] cohort) who participated in multicenter, phase II–III trials were compared with patients who underwent the same treatment outside the trial between 2008 and 2013 (post-CROSS cohort). The differences between these cohorts were analyzed using t tests, while logistic regression models were used to evaluate adverse events. Overall and disease-free survival were calculated using the Kaplan–Meier method and Cox regression analyses. Results A total of 208 CROSS patients and 173 post-CROSS patients were included in this study. Patients from the post-CROSS cohort were older, had more co morbidities, and had poorer performance status. Clinical N stage, but not cT stage, was worse in the post-CROSS cohort. There were no statistically significant differences in adverse events (pulmonary, cardiac, or anastomotic complications) or survival between the comparison cohorts. Conclusion The outcomes of patients treated with nCRT plus esophagectomy for cancer have a high external consistency and can be extrapolated to the daily practice of physicians involved in the treatment and care of esophageal cancer patients. Electronic supplementary material The online version of this article (10.1245/s10434-018-6554-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eelke Toxopeus
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands.
| | - Maartje van der Schaaf
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Jan van Lanschot
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Division of Cancer Studies, King's College London, London, UK
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Ate van der Gaast
- Department of Medical Oncology, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands
| | - Bas Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands
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White Gibson A, Clesham K, Tully O, Quinlan JF. The changing tides of Irish orthopaedic research. Ir J Med Sci 2018; 188:141-147. [PMID: 29728819 DOI: 10.1007/s11845-018-1821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Research is fundamental to bridging theory, practice and education in orthopaedics. Following the restructuring of the surgical training pathway in Ireland, the opportunity to undertake clinical- or lab-based research has fallen. AIMS Our aim was to investigate the trends of research in orthopaedics and the implications there. METHODS We reviewed the trend in publications by Irish trauma and orthopaedic (T&O) trainees over the past 20 years across three different classes of journal. We also reviewed the Irish participation in the annual British Orthopaedic Association (BOA) meeting over the past 10 years as well as the rates of abstract submission to the annual Irish Orthopaedic Association (IOA) meeting. RESULTS We found that publication rates were as follows: JBJS 2005-2010 mean 4.8 vs. 2000-2005 mean 1.6 and 2010-2015 mean 0.2; Injury 2005-2010 mean 3.6 vs. 2000-2005 mean 3.4 and 2010-2015 mean 2.2; IJMS 2010-2015 mean 4.4 vs. 2000-2010 mean 1.1. The number of Irish presentations at the BOA fell from a mean of 5 between 2000 and 2010 to a mean of 1.2 between 2011 and 2017. The rate of IOA abstract submissions compared over the same period has fallen by 21%. We also found that 4% of Irish orthopaedic publications in the IJMS were scientific in nature; this figure was 3.7% of publications in injury and 32.6% in JBJS (UK). CONCLUSIONS There has been a significant decrease in publication rates by T&O trainees in high-quality journals. There has also been a notable decline in Irish representation at the BOA and a drop in the number of abstract submissions to the IOA. We suggest these findings coincide with the streamlining of surgical training in Ireland, which does not provide for the pursuit in research that is crucial to our practice as clinicians, to the future of our specialty and to the Irish orthopaedic representation internationally.
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Affiliation(s)
- Ailbhe White Gibson
- Department of Trauma and Orthopaedics, Adelaide and Meath Incorporating the National Children's Hospital, Dublin, Ireland.
| | - Kevin Clesham
- Department of Trauma and Orthopaedics, Adelaide and Meath Incorporating the National Children's Hospital, Dublin, Ireland
| | - Oisin Tully
- Department of Trauma and Orthopaedics, Adelaide and Meath Incorporating the National Children's Hospital, Dublin, Ireland
| | - John F Quinlan
- Department of Trauma and Orthopaedics, Adelaide and Meath Incorporating the National Children's Hospital, Dublin, Ireland
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Perioperative Risk Adjustment for Total Shoulder Arthroplasty: Are Simple Clinically Driven Models Sufficient? Clin Orthop Relat Res 2017; 475:2867-2874. [PMID: 27905060 PMCID: PMC5670040 DOI: 10.1007/s11999-016-5147-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure. Comparing clinically driven with statistically derived risk models of total shoulder arthroplasty (TSA) offers insight into potential gaps between common practice and evidence-based medicine. QUESTIONS/PURPOSES (1) Does a statistically driven model better explain the variation in unplanned readmission within 30 days of discharge when compared with an a priori five-variable model selected based on expert orthopaedic surgeon opinion? (2) Does a statistically driven model better explain the variation in adverse events within 30 days of discharge when compared with an a priori five-variable model selected based on expert orthopaedic surgeon opinion? METHODS Current Procedural Terminology codes were used to identify 4030 individuals older than 17 years of age who had TSA in which osteoarthritis was the primary etiology. A logistic regression model for adverse event and unplanned readmission within 30 days was constructed using (1) five variables chosen a priori based on clinic expertise (age, American Society of Anesthesiologists classification ≥ 3, body mass index, smoking status, and diabetes mellitus); and (2) by entering all variables with p < 0.10 in bivariate analysis. We then excluded 870 patients (22%) based on preoperative factors felt to make large discretionary surgery unwise to focus our research on appropriate procedures. Infirm patients have more pressing needs than alleviation of shoulder pain and stiffness. Among the remaining 3160 patients, logistic regression models for adverse event and unplanned readmission within 30 days were constructed in a similar manner to the complete models. The five a priori risk factors used in each model based on clinical expertise were selected by consensus of an expert orthopaedic surgeon panel. RESULTS When patients unfit for discretionary surgery were excluded, the clinically driven model found no risk factors and accounted for 1.4% of the variation in unplanned readmission. In contrast, the statistically driven model explained 4.6% of the variation and found operating time (hours) (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.04-1.53) and hypertension requiring medications (OR, 1.95; 95% CI, 1.01-3.76) were associated with unplanned readmission accounting for all other factors. However, neither the clinically driven model (pseudo R2, 1.4%) nor statistically driven model (pseudo R2, 4.6%) provided much explanatory power. When patients unfit for discretionary surgery were excluded, no factors in the clinically driven model were significant and the model accounted for 0.95% of the variation in adverse events. In the statistically driven model, age (OR, 1.03; 95% CI, 1.01-1.06), men (OR, 1.64; 95% CI, 1.05-2.57), operating time (hours) (OR, 1.27; 95% CI, 1.07-1.52), and high BUN (OR, 3.12; 95% CI, 1.35-7.21) were associated with adverse events when accounting for all other factors, explaining 3.3% of the variation. However, neither the clinically driven model (pseudo R2, 0.95%) nor the statistically driven model (pseudo R2, 3.3%) provided much explanatory power. CONCLUSIONS The observation that a statistically derived risk model performs better than a clinically driven model affirms the value of research based on large databases, although the models derived need to be tested prospectively. CLINICAL RELEVANCE Clinicians can utilize our results to understand that clinician intuition may not always offer the best risk adjustment and that factors impacting TSA unplanned readmission and adverse events may be best derived from large data sets. However, because current analyses explain limited variation in outcomes, future studies might look to better define what factors drive the variation in unplanned readmission and adverse events.
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Research amongst Irish surgical trainees: what’s the trend? Ir J Med Sci 2017; 187:183-187. [DOI: 10.1007/s11845-017-1621-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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Ubbink DT, Legemate DA, Koelemay MJ. The Merits of a Two-Day Evidence-Based Medicine Course for Surgical Residents. World J Surg 2016; 40:1809-14. [PMID: 26964544 PMCID: PMC4943971 DOI: 10.1007/s00268-016-3495-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Over 10 years ago, we introduced a two-day, evidence-based surgery course for surgical residents. During the last 4 years, we evaluated its effect on the participants’ evidence-based medicine (EBM) knowledge and skills. Methods Between 2012 and 2015, six courses were organised for residents of various surgical specialties of allied hospitals in the Amsterdam educational district. The courses covered the literature search, critical appraisal of surgical papers, and how to communicate and weigh the benefits and harms of surgical interventions. Proficiency regarding interpreting evidence was tested before and directly after the course using a modified Berlin questionnaire. Results One hundred participants attended the courses, comprising residents in surgery (61 %), orthopaedics (16 %), urology (7 %), plastic surgery (7 %), and surgical PhD students (9 %), most of whom had already been taught EBM during their medical curriculum. Pre-course score levels were already fairly high (6.19 out of 10), but scores after the course were significantly higher (7.04); mean difference 0.85 (95 % confidence interval 0.4–1.3). No significant differences were observed among the surgical specialties. Attendees highly appreciated the course. Conclusions A two-day, evidence-based surgery course improved EBM aptitude of surgical residents. Hence, the course appears useful to refresh the EBM paradigm among future Dutch surgeons.
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Affiliation(s)
- Dirk T Ubbink
- Department of Surgery, G4-184, Academic Medical Center at the University of Amsterdam, 1105AZ, Amsterdam, The Netherlands.
| | - Dink A Legemate
- Department of Surgery, G4-184, Academic Medical Center at the University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Mark J Koelemay
- Department of Surgery, G4-184, Academic Medical Center at the University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
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Apramian T, Watling C, Lingard L, Cristancho S. Adaptation and innovation: a grounded theory study of procedural variation in the academic surgical workplace. J Eval Clin Pract 2015; 21:911-8. [PMID: 26096874 PMCID: PMC5578747 DOI: 10.1111/jep.12398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 12/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Surgical research struggles to describe the relationship between procedural variations in daily practice and traditional conceptualizations of evidence. The problem has resisted simple solutions, in part, because we lack a solid understanding of how surgeons conceptualize and interact around variation, adaptation, innovation, and evidence in daily practice. This grounded theory study aims to describe the social processes that influence how procedural variation is conceptualized in the surgical workplace. METHOD Using the constructivist grounded theory methodology, semi-structured interviews with surgeons (n = 19) from four North American academic centres were collected and analysed. Purposive sampling targeted surgeons with experiential knowledge of the role of variations in the workplace. Theoretical sampling was conducted until a theoretical framework representing key processes was conceptually saturated. RESULTS Surgical procedural variation was influenced by three key processes. Seeking improvement was shaped by having unsolved procedural problems, adapting in the moment, and pursuing personal opportunities. Orienting self and others to variations consisted of sharing stories of variations with others, taking stock of how a variation promoted personal interests, and placing trust in peers. Acting under cultural and material conditions was characterized by being wary, positioning personal image, showing the logic of a variation, and making use of academic resources to do so. Our findings include social processes that influence how adaptations are incubated in surgical practice and mature into innovations. CONCLUSIONS This study offers a language for conceptualizing the sociocultural influences on procedural variations in surgery. Interventions to change how surgeons interact with variations on a day-to-day basis should consider these social processes in their design.
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Affiliation(s)
- Tavis Apramian
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Christopher Watling
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Lorelei Lingard
- Department of Medicine and Director, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Sayra Cristancho
- Department of Surgery and Scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
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Cunningham BP, Harmsen S, Kweon C, Patterson J, Waldrop R, McLaren A, McLemore R. Have levels of evidence improved the quality of orthopaedic research? Clin Orthop Relat Res 2013; 471:3679-86. [PMID: 23846606 PMCID: PMC3792258 DOI: 10.1007/s11999-013-3159-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/28/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Since 2003 many orthopaedic journals have adopted grading systems for levels of evidence (LOE). It is unclear if the quality of orthopaedic literature has changed since LOE was introduced. QUESTIONS/PURPOSES We asked three questions: (1) Have the overall number and proportion of Level I and II studies increased in the orthopaedic literature since the introduction of LOE? (2) Is a similar pattern seen in individual orthopaedic subspecialty journals? (3) What is the interobserver reliability of grading LOE? METHODS We assigned LOE to therapeutic studies published in 2000, 2005, and 2010 in eight major orthopaedic subspecialty journals. Number and proportion of Level I and II publications were determined. Data were evaluated using log-linear models. Twenty-six reviewers (13 residents and 13 attendings) graded LOE of 20 blinded therapeutic articles from the Journal of Bone and Joint Surgery for 2009. Interobserver agreement relative to the Journal of Bone and Joint Surgery was assessed using a weighted kappa. RESULTS The total number of Level I and II publications in subspecialty journals increased from 150 in 2000 to 239 in 2010. The proportion of high-quality publications increased with time (p < 0.001). All subspecialty journals other than the Journal of Pediatric Orthopaedics and the Journal of Orthopaedic Trauma showed a similar behavior. Average weighted kappa was 0.791 for residents and 0.842 for faculty (p = 0.209). CONCLUSIONS The number and proportion of Level I and II publications have increased. LOE can be graded reliably with high interobserver agreement. The number and proportion of high-level studies should continue to increase.
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Affiliation(s)
- Brian P. Cunningham
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
| | - Samuel Harmsen
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
| | - Chris Kweon
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
| | - Jason Patterson
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
| | - Robert Waldrop
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
| | - Alex McLaren
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
| | - Ryan McLemore
- Orthopaedic Residency, Banner Good Samaritan Medical Center, 901 East Willetta Street, Floor 2, Phoenix, AZ 85006-2511 USA
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Abstract
Evidence-based medicine (EBM) is increasingly important for clinical surgery and for promotion of best practices into surgical decision making. Although barriers exist in the current surgical literature, for certain surgical scenarios, formal efforts to promote evidence-based surgery (EBS) into surgical education are helping to equip future surgeons with these important tools for optimizing patient care. As our evidence-base grows and standards of care evolve, incorporating EBM into everyday practice for trainees and staff surgeons remains an ongoing challenge.
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Affiliation(s)
- Mary R Kwaan
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open 2013. [PMID: 23355664 DOI: 10.1136/bmjopen‐2012‐001881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP. DESIGN Systematic review. Two investigators independently performed the systematic reviewing process. INFORMATION SOURCES MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings. RESULTS We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside. CONCLUSIONS More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.
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Affiliation(s)
- Dirk T Ubbink
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
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Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open 2013; 3:bmjopen-2012-001881. [PMID: 23355664 PMCID: PMC3563143 DOI: 10.1136/bmjopen-2012-001881] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP. DESIGN Systematic review. Two investigators independently performed the systematic reviewing process. INFORMATION SOURCES MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings. RESULTS We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside. CONCLUSIONS More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.
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Affiliation(s)
- Dirk T Ubbink
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Hester Vermeulen
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam School of Health Professions, University of Amsterdam, Amsterdam, The Netherlands
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Wong-Lun-Hing EM, Lodewick TM, Stoot JHMB, Bemelmans MHA, Olde Damink SWM, Dejong CHC, van Dam RM. A survey in the hepatopancreatobiliary community on ways to enhance patient recovery. HPB (Oxford) 2012; 14:818-27. [PMID: 23134183 PMCID: PMC3521910 DOI: 10.1111/j.1477-2574.2012.00546.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/14/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Both laparoscopic techniques and multimodal enhanced recovery programmes have been shown to improve recovery and reduce length of hospital stay. Interestingly, evidence-based care programmes are not widely implemented, whereas new, minimally invasive surgical procedures are often adopted with very little evidence to support their effectiveness. The present survey aimed to shed light on experiences of the adoption of both methods of optimizing recovery. METHODS An international, web-based, 18-question, electronic survey was composed in 2010. The survey was sent out to 673 hepatopancreatobiliary (HPB) centres worldwide in June 2010 to investigate international experiences with laparoscopic liver surgery, fast-track recovery programmes and surgery-related equipoise in open and laparoscopic techniques and to assess opinions on strategies for adopting laparoscopic liver surgery in HPB surgical practice. RESULTS A total of 507 centres responded (response rate: 75.3%), 161 of which finished the survey completely. All units reported performing open liver resections, 24.2% performed open living donor resections, 39.1% carried out orthotopic liver transplantations, 87.6% had experience with laparoscopic resections and 2.5% performed laparoscopic living donor resections. A median of 50 (range: 2-560) open and 9.5 (range: 1-80) laparoscopic liver resections per surgical unit were performed in 2009. Patients stayed in hospital for a median of 7 days (range: 2-15 days) after uncomplicated open liver resection and a median of 4 days (range: 1-10 days) after uncomplicated laparoscopic liver resection. Only 28.0% of centres reported having experience with fast-track programmes in liver surgery. The majority considered the instigation of a randomized controlled trial or a prospective register comparing the outcomes of open and laparoscopic techniques to be necessary. CONCLUSIONS Worldwide dissemination of laparoscopic liver resection is substantial, although laparoscopic volumes are low in the majority of HPB centres. The adoption of enhanced recovery programmes in liver surgery is limited and should be given greater attention.
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Affiliation(s)
- Edgar M Wong-Lun-Hing
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Toine M Lodewick
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,Department of Surgery, Orbis Medical CentreSittard, the Netherlands
| | - Marc H A Bemelmans
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,Nutrim School for Nutrition, Toxicology and MetabolismMaastricht, the Netherlands,Department of Surgery, University College Hospital LondonLondon, UK
| | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,Nutrim School for Nutrition, Toxicology and MetabolismMaastricht, the Netherlands
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
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Chan CP, Wang BY, Cheng CY, Lin CH, Hsieh MC, Tsou JJ, Lee WJ. Randomized Controlled Trials in Bariatric Surgery. Obes Surg 2012; 23:118-30. [DOI: 10.1007/s11695-012-0798-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mittal R, Perakath B. Evidence-based surgery: knowledge, attitudes, and perceived barriers among surgical trainees. JOURNAL OF SURGICAL EDUCATION 2010; 67:278-282. [PMID: 21035766 DOI: 10.1016/j.jsurg.2010.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 05/27/2023]
Abstract
OBJECTIVES This study was conducted to assess the knowledge and attitude of surgical trainees toward evidence-based medicine (EBM) and their perceived barriers to its practice. DESIGN The McColl questionnaire and the BARRIERS scale were modified and incorporated into a single questionnaire, which was administered to all surgical trainees attending a Continuing Surgical Education meeting. SETTING Department of Surgery, Christian Medical College, Vellore, India. PARTICIPANTS One hundred ten surgical trainees from 22 medical colleges. RESULTS In all, 84.5% (93/110) trainees returned the questionnaire. The attitudes toward EBM were welcoming, although individual participants reported they welcomed EBM more than their colleagues did. Participants agreed that EBM was useful in everyday practice and that it improved patient care. About 50% of actual practice was considered evidence based. In all, 12.6% (10/89) of participants had received formal training in EBM, and 64.3% (54/84) of participants were aware of the Cochrane database of systemic reviews, but only 35.7% (30/84) read it regularly. Also, 67.8% (61/90) of respondents used protocols and guidelines developed by colleagues. However, 61.5% (56/91) of participants were interested in learning the skills of EBM. The terms absolute risk, relative risk, and clinical effectiveness were understood by >80% of respondents, whereas publication bias, confidence interval, and heterogeneity were poorly understood. The major barriers to practice of EBM were the inability to understand statistical analysis, inadequate facilities for implementation, lack of a single compiled source of literature, relevant literature not being readily available, and insufficient time on the job. CONCLUSIONS Surgical trainees have a positive attitude towards EBM and have some familiarity with the common terms used in EBM. There is a need to increase awareness of, and provide access to, available sources of medical literature. Formal training in EBM, as well as basic statistical analysis, should form a part of the surgical curriculum to foster an environment favorable to the practice of EBM.
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Affiliation(s)
- Rohin Mittal
- Department of Surgery, Unit 5, Christian Medical College, Vellore, Tamilnadu, India.
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Closure of cutaneous incision after thyroid surgery: a comparison between metal clips and cutaneous octyl-2-cyanoacrylate adhesive. A prospective randomized clinical trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0477-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lagarde SM, Vrouenraets BC, Stassen LP, van Lanschot JJB. Evidence-Based Surgical Treatment of Esophageal Cancer: Overview of High-Quality Studies. Ann Thorac Surg 2010; 89:1319-26. [DOI: 10.1016/j.athoracsur.2009.09.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 09/23/2009] [Accepted: 09/28/2009] [Indexed: 10/19/2022]
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Knops AM, Vermeulen H, Legemate DA, Ubbink DT. Attitudes, awareness, and barriers regarding evidence-based surgery among surgeons and surgical nurses. World J Surg 2009; 33:1348-55. [PMID: 19412569 PMCID: PMC2691930 DOI: 10.1007/s00268-009-0020-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Evidence-based surgery (EBS) is stressed to increase efficiency and health care quality, but not all surgeons and surgical nurses use EBS in clinical practice. To define future tailor-made interventions to improve evidence-based behavior, the aim of this study was to determine the attitude and awareness among surgeons and surgical nurses as to the paradigm of EBS and the barriers experienced when practicing EBS. Methods In this cross-sectional study, surgeons and surgical nurses at a university hospital in Amsterdam were invited to complete the BARRIERS scale and McColl et al. questionnaire. An evidence quiz was composed for the surgeons. Results Response rates were 67% (29/43) for surgeons and 60% (73/122) for nurses. Attitudes toward EBS were positive. Among the surgeons, 90% were familiar with EBS terms, whereas only 40% of the nurses were. Common barriers for surgeons were conflicting results (79%, 23/29) and the methodologic inadequacy of research reports (73%, 21/29); and for nurses they were unawareness of EBS (67%, 49/73) and unclear reported research (59%, 43/73). Only about half of the convincing evidence presented in the quiz was actually applied. Conclusions Surgeons have a positive attitude toward EBS and are familiar with EBS terminology, but conflicting results and methodologic shortcomings of research reports are major barriers to practicing EBS. Continual confrontations with available evidence through frequent critical appraisal meetings or grand rounds and using more aggregate sources of evidence are advocated. Nurses can probably benefit from EBS training focusing on basic skills. Finally, collaboration is needed among surgeons and nurses with the same zest about EBS.
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Affiliation(s)
- Anouk M Knops
- Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Poolman RW, Petrisor BA, Marti RK, Kerkhoffs GM, Zlowodzki M, Bhandari M. Misconceptions about practicing evidence-based orthopedic surgery. Acta Orthop 2007; 78:2-11. [PMID: 17453386 DOI: 10.1080/17453670610013358] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Rudolf W Poolman
- Division of Orthopedic Surgery, McMaster University, Ontario, Canada.
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Seiler CM, Wente MN, Diener MK, Fröhlich BE, Büchler MW, Knaebel HP. Center for clinical studies in a surgical department—An approach for more evidence-based medicine. Contemp Clin Trials 2006; 27:211-4. [PMID: 16316788 DOI: 10.1016/j.cct.2005.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 05/22/2005] [Accepted: 10/14/2005] [Indexed: 11/18/2022]
Abstract
The concept of evidence-based medicine (EBM) has been introduced into the field of surgery in Germany since 1996, initially focussing on the application of the classical five-step-concept of EBM to the individual patient. Despite the international efforts of the Cochrane Collaboration, few systematic reviews address surgical procedures and the number of high quality randomized-controlled trials (RCTs) are low. External evidence in surgery is a major problem and requires new strategies in research and patient care. Therefore, in the Department of Surgery at the University of Heidelberg a clinical trial unit was founded to create more evidence via two approaches. First, patients admitted to hospital should be treated within RCTs. Since May 2002 1808 patients have been enrolled into a total of 38 pharmaceutical (19 trials with 470 patients enrolled) and investigator initiated (19 trials with 1338 patients enrolled) studies. Second, the clinical site develops and conducts surgical efficacy RCTs and follows new standards including publication and registration of the protocols. Within 3 years it was possible to change practice in an academic setting from the traditional concept to an evidence-based approach.
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Affiliation(s)
- Christoph M Seiler
- Department of General, Visceral and Trauma Surgery, University of Heidelberg, Medical School, Germany
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Affiliation(s)
- Poh-Koon Koh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Abstract
Hospitals and professional bodies require a culture that supports surgeons in their quest for knowledge, and provides the technological and educational environment in which they can promote evidence-based surgery. Surgeons must influence the development of their local information technology systems for data collection and outcome analysis, and deliver training programs that instill an attitude of continually seeking evidence. Identification of clinical problems and critical appraisal of the literature need to be taught. Management structures and relationships that facilitate a joint approach to delivering high-quality systematic clinical care should be developed. The culture that supports these aims is also one in which patients can rely on safely receiving up-to-date and effective treatments from well-trained and trusted surgeons.
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Affiliation(s)
- Martin J R Lee
- University Hospitals, Coventry and Warwickshire National Health Service Trust, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2 2DX, England, UK.
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Krahn J, Sauerland S, Rixen D, Gregor S, Bouillon B, Neugebauer EAM. Applying evidence-based surgery in daily clinical routine: a feasibility study. Arch Orthop Trauma Surg 2006; 126:88-92. [PMID: 16402196 DOI: 10.1007/s00402-005-0095-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although the word evidence-based medicine (EBM) has gained wide popularity, only a few studies have evaluated how EBM works in clinical practice. METHODS We have prospectively evaluated the feasibility of evidence-based trauma surgery. Orthopaedic trauma surgeons were asked to produce clinical questions related to the treatment of current patients. An informaticist searched the literature (Medline, Cochrane Library, practice guidelines and textbooks) and reported the findings on every following day. The study's main endpoints were the rate of questions for which relevant evidence (>level V) was available and the time necessary to find and critically appraise medical evidence. RESULTS In total, 44 EBM questions were formulated, mainly concerning treatment options. PubMed was searched for 39 questions, textbooks for 14, the Cochrane Library for 11, online guidelines for 9 and other sources were used for 4 questions. On average, 157 text items (three per questions) were identified as potentially relevant. Journal articles predominated (83%) over textbooks (10%). Sixty-eight percent of the questions (30 of 44) were answered, either on the basis level 1 (n=13 questions), level 2 (n=6), or level 4 evidence (n=14). Trying to answer a question required 53 min on average, split up between 39 min of database searches and 25 min of obtaining full text articles. In four cases, the evidence suggested a change in clinical management. The physicians were very appreciative of our project and found the provided evidence very helpful for their clinical decisions. CONCLUSIONS Time will be the main barrier against the introduction of clinical EBM. It is likely that clinicians reduce EBM to those situations where evidence is likely to be found. Although the impact of EBM on patient-care was limited, the concept of EBM was successfully implemented.
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Affiliation(s)
- Jan Krahn
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, Cologne, Germany
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Shahar R, Milgram J. Biomechanics of Tibial Plateau Leveling of the Canine Cruciate-Deficient Stifle Joint: A Theoretical Model. Vet Surg 2006; 35:144-9. [PMID: 16472294 DOI: 10.1111/j.1532-950x.2006.00125.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of tibial plateau leveling on the biomechanics of the canine stifle. STUDY DESIGN Analysis of a 3-dimensional (3-D) anatomically accurate theoretical model of the canine stifle. METHODS A 3-D, 3-segment mathematical model of the normal canine stifle was modified to simulate the effect of rotation of the tibial plateau during tibial plateau leveling osteotomy (TPLO). The model examined the normal stifle, the stifle with a tibial plateau angle (TPA) of 0 degrees, and the stifle with a TPA of 5 degrees. Analysis of the models at 10 consecutive equally spaced positions during the stance phase yielded data such as ligament forces and joint reaction forces at each position. RESULTS Rotation of the tibial plateau to a TPA of 0 degrees almost eliminates forces in the cranial cruciate ligament (CCL) throughout the stance phase. Rotation to a TPA of 5 degrees did not, however, substantially decrease the load in the CCL. Both procedures increased the load in the caudal cruciate ligament (CaCL). CONCLUSIONS Cranial tibial thrust (CTT) is converted into caudal tibial thrust when the TPA is 0 degrees ; however, rotating the plateau to a TPA of 5 degrees does not eliminate the CTT. CLINICAL RELEVANCE The TPLO procedure performed as currently recommended (rotating the tibial plateau to a TPA of 5 degrees) may not eliminate the CTT, but only reduce it. Both TPLO procedures evaluated here were found to increase the load in the CaCL.
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Affiliation(s)
- Ron Shahar
- Laboratory of Biomechanics and Applied Anatomy, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel.
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Brophy RH, Gardner MJ, Saleem O, Marx RG. An assessment of the methodological quality of research published in The American Journal of Sports Medicine. Am J Sports Med 2005; 33:1812-5. [PMID: 16157847 DOI: 10.1177/0363546505278304] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. HYPOTHESIS Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. STUDY DESIGN Systematic review. METHODS All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. RESULTS Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P = .00003) and from 11.9% to 5.6% (P = .001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P = .000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P = .04). More studies tested an explicit hypothesis (P = .0000002), used prospective data collection (P = .000003), and used blinding (P = .02), and more studies identified a funding source (P = .004). CONCLUSIONS Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.
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Affiliation(s)
- Robert H Brophy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Antes G, Sauerland S, Seiler CM. Evidence-based medicine—from best research evidence to a better surgical practice and health care. Langenbecks Arch Surg 2005; 391:61-7. [PMID: 16292684 DOI: 10.1007/s00423-005-0006-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 09/20/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of the terms evidence-based medicine (EBM) and healthcare (EBHC) has become commonplace in the medical as well as in the surgical literature. Using the best available evidence, however, is not yet a working routine among surgeons because of the large amount and complexity of published research and the lack of user-friendly tools and necessary skills for the use of research results. DISCUSSION This article encourages to formulate surgically relevant questions and to answer them on the basis of high-quality research, preferably by using systematic reviews which are based on the quality criteria of the Cochrane Collaboration. CONCLUSIONS As currently only 77 Cochrane reviews address surgical procedures; much work remains to be done to enlarge the number of high-quality and relevant reviews. Similarly, the number and quality of randomized controlled trials need to be increased in all surgical specialties.
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Affiliation(s)
- G Antes
- German Cochrane Centre, Department of Medical Biometrics and Informatics, Division of Medical Biometrics and Statistics, University of Freiburg, Stefan-Meier-Street 26, 79104, Freiburg, Germany.
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Klomp HM, Steyerberg EW. Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia (Br J Surg 2004; 91: 948-955). Br J Surg 2005; 92:120; author reply 120-1. [PMID: 15635617 DOI: 10.1002/bjs.4921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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