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Begley SL, Pelcher I, Schulder M. Topic Reviews in Neurosurgical Journals: An Analysis of Publication Trends. World Neurosurg 2023; 179:171-176. [PMID: 37648204 DOI: 10.1016/j.wneu.2023.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Topic review articles have become increasingly popular, even as the neurosurgical community looks to peer-reviewed journals as a source of discovery in basic and clinical science. In this study we quantify the prevalence of topic review articles in top neurosurgery journals. METHODS The top 20 neurosurgery journals were defined by Google Scholar metrics. The PubMed database quantified the number of topic reviews compared with the total number of articles published; data were analyzed for trends between 1945 and 2022. RESULTS All 20 journals have published topic reviews since the start of records on PubMed. Total publications have increased from <500 before 1980 to >8000 in 2022. Topic reviews have increased from <1% before 1980, to 2% by 2000, and to 3%-4% since 2010. The linear trend line equation for the total percentage of reviews in all journals shows a small increase in topic reviews per year. Three journals decreased review publication whereas 4 have reached prevalence >10%. The prevalence of topic reviews increased significantly from the first (2.13) to the last (4.76) year of publication (P = 0.003). CONCLUSIONS The increasing prevalence of topic reviews is seen in most neurosurgery journals, reflecting supply and demand. Although there are benefits to these articles, they do not contribute novel data. Actions such as defining and labeling this publication type in journals and databases will improve the transparency of research methods. Academic neurosurgeons should further expand their knowledge and not become focused only on introspection into and review of neurosurgical understanding and practice.
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Affiliation(s)
- Sabrina L Begley
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.
| | - Isabelle Pelcher
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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Shlobin NA, Sheldon M, Bernstein M. Ethics of Transitioning from Curative Care to Palliative Care: Potential Conflicts of Interest Using the Example of Neurosurgery. World Neurosurg 2022; 168:139-145. [DOI: 10.1016/j.wneu.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
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Shlobin NA, Kanmounye US, Ozair A, de Koning R, Zolo Y, Zivkovic I, Niquen-Jimenez M, Affana CK, Jogo L, Abongha GB, Garba DL, Rosseau G. Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery. World Neurosurg 2021; 155:150-159. [PMID: 34464771 DOI: 10.1016/j.wneu.2021.08.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; G4 Alliance, Chicago, Illinois, USA.
| | - Ulrick Sidney Kanmounye
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; Research Department, Association of Future African Neurosurgeons, Cameroon; Department of Neurosurgery, University of Kinsasha Faculty of Medicine, Kinsasha, Democratic Republic of the Congo
| | - Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Lucknow, India
| | | | - Yvan Zolo
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Department of Neurosurgery, University of Kinsasha Faculty of Medicine, Kinsasha, Democratic Republic of the Congo; Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Irena Zivkovic
- School of Medicine, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Milagros Niquen-Jimenez
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Leslie Jogo
- Faculty of Medicine and Biomedical Sciences, University of Ngaoundéré, Garoua, Cameroon
| | | | - Deen L Garba
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Rosseau
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; G4 Alliance, Chicago, Illinois, USA; Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Blanco-Teherán C, Quintana-Pájaro L, Narvaez-Rojas A, Martínez-Pérez R, García-Ballestas E, Moscote Salazar L, Prada-Soto S, Lozada-Martínez I. Evidence-based medicine in neurosurgery: why and how? J Neurosurg Sci 2021; 66:49-53. [PMID: 34342191 DOI: 10.23736/s0390-5616.21.05331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since its inception, medical training and practice are based primarily on the clinical experience provided by the mentors of each of the medical schools. In the 1990s, the first steps were taken for the construction of what we now know as evidence-based medicine. Evidence-based medicine is the set of studies, methods, and principles for the prevention of medical diseases, management guidelines, and algorithms used in sources of evidence. Neurosurgery based on evidence has emerged thanks to advances in neuroscience and information technology that allows the globalization of current scientific information. The results of important reviews on the levels of evidence in neurosurgery are low in percentages of high-quality evidence in this field of medicine. Based on the above, the objective of this manuscript is to describe the application of evidence in neurosurgery, the current state of the art in evidence-based medicine, and the steps needed to create evidence of the best quality in neurosurgery.
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Affiliation(s)
| | | | - Alexis Narvaez-Rojas
- Department of General Surgery, Carlos Roberto Huembes Hospital, National Autonomous University of Nicaragua, Managua, Nicaragua
| | | | | | - Luis Moscote Salazar
- Center for Biomedical Research, University of Cartagena, Cartagena, Colombia.,Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia.,Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Cartagena, Colombia.,Latin American Council of Neurocritical Care, Cartagena, Colombia
| | - Silvia Prada-Soto
- Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia
| | - Ivan Lozada-Martínez
- Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia - .,Colombian Clinical Research Group in Neurocritical Care, University of Cartagena, Cartagena, Colombia.,Latin American Council of Neurocritical Care, Cartagena, Colombia
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Stopa BM, Yan SC, Dasenbrock HH, Kim DH, Gormley WB. Variance Reduction in Neurosurgical Practice: The Case for Analytics-Driven Decision Support in the Era of Big Data. World Neurosurg 2019; 126:e190-e195. [DOI: 10.1016/j.wneu.2019.01.292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
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Martens J, de Jong G, Rovers M, Westert G, Bartels R. Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons. Interact J Med Res 2018; 7:e16. [PMID: 30314961 PMCID: PMC6231869 DOI: 10.2196/ijmr.9617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence. OBJECTIVE The aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons. METHODS A Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. RESULTS The response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001). CONCLUSIONS According to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals.
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Affiliation(s)
- Jill Martens
- Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Guido de Jong
- Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maroeska Rovers
- Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert Westert
- Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ronald Bartels
- Neurosurgical Center Nijmegen, Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
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Esene IN, Baeesa SS, Ammar A. Evidence-based neurosurgery. Basic concepts for the appraisal and application of scientific information to patient care (Part II). ACTA ACUST UNITED AC 2017; 21:197-206. [PMID: 27356649 PMCID: PMC5107284 DOI: 10.17712/nsj.2016.3.20150553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced.
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Affiliation(s)
- Ignatius N Esene
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt. E-mail:
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8
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Evidence-based medicine in neurosurgery: an academic publication view. Neurosurg Rev 2016; 41:55-65. [DOI: 10.1007/s10143-016-0742-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
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10
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Abstract
Although it is intuitive that any neurosurgeon would seek to consistently apply the best available evidence to patient management, the application of evidence-based medicine (EBM) principles and clinical practice guidelines (CPGs) remains variable. This article reviews the origin and process of EBM, and the development, assessment, and applicability of EBM and CPGs in neurosurgical care, aiming to demonstrate that CPGs are one of the valid available options that exist to improve quality of care. CPGs are not intended to define the standard of care but to compile dynamic advisory statements, which need to be updated as new evidence emerges.
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Affiliation(s)
- Michael G Fehlings
- Department of Surgery, Spinal Program, Krembil Neuroscience Center, 399 Bathurst Street, Suite 4W-449, Toronto, Ontario, M5T 2S8, Canada.
| | - Anick Nater
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, WW 4-427, Toronto, Ontario, M5T 2S8, Canada
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Commentary on "the role of evidence based medicine in neurotrauma". J Clin Neurosci 2015; 22:617-8. [PMID: 25636831 DOI: 10.1016/j.jocn.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 11/23/2022]
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Fisher CG, Goldschlager T, Boriani S, Varga PP, Rhines LD, Fehlings MG, Luzzati A, Dekutoski MB, Reynolds JJ, Chou D, Berven SH, Williams RP, Quraishi NA, Bettegowda C, Gokaslan ZL. An evidence-based medicine model for rare and often neglected neoplastic conditions. J Neurosurg Spine 2014; 21:704-10. [DOI: 10.3171/2014.7.spine13954] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The National Institutes of Health recommends strategies to obtain evidence for the treatment of rare conditions such as primary tumors of the spine (PTSs). These tumors have a low incidence and are pathologically heterogeneous, and treatment approaches are diverse. Appropriate evidence-based care is imperative. Failure to follow validated oncological principles may lead to unnecessary mortality and profound morbidity. This paper outlines a scientific model that provides significant evidence guiding the treatment of PTSs.
Methods
A four-stage approach was used: 1) planning: data from large-volume centers were reviewed to provide insight; 2) recruitment: centers were enrolled and provided the necessary infrastructure; 3) retrospective stage: existing medical records were reviewed and completed with survival data; and 4) prospective stage: prospective data collection has been implemented. The AOSpine Knowledge Forum Tumor designed six modules: demographic, clinical, diagnostic, therapeutic, local recurrence, survival, and perioperative morbidity data fields and provided funding.
Results
It took 18 months to implement Stages 1–3, while Stage 4 is ongoing. A total of 1495 tumor cases were captured and diagnosed as one of 18 PTS histotypes. In addition, a PTS biobank network has been created to link clinical data with tumor pathology and molecular analysis.
Conclusions
This scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. Access to large volumes of data will generate further research to guide and enhance PTS clinical management. This model could be applied to other rare neoplastic conditions. Clinical trial registration no.: NCT01643174 (ClinicalTrials.gov).
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Affiliation(s)
- Charles G. Fisher
- 1Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver CoastalHealth, Vancouver, British Columbia
| | - Tony Goldschlager
- 1Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver CoastalHealth, Vancouver, British Columbia
- 14Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia; and
| | - Stefano Boriani
- 2Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna
| | - Peter Paul Varga
- 3National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Laurence D. Rhines
- 4Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Michael G. Fehlings
- 5Division of Neurosurgery, Department of Surgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alessandro Luzzati
- 6Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milano, Italy
| | | | | | - Dean Chou
- Departments of 9Neurological Surgery and
| | - Sigurd H. Berven
- 10Orthopaedic Surgery, University of California, San Francisco, California
| | - Richard P. Williams
- 11Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland
| | - Nasir A. Quraishi
- 12Center for Spine Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom;
| | - Chetan Bettegowda
- 13Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 13Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Goldschlager T, Härtl R, Greenfield JP, Anand VK, Schwartz TH. The endoscopic endonasal approach to the odontoid and its impact on early extubation and feeding. J Neurosurg 2014; 122:511-8. [PMID: 25361480 DOI: 10.3171/2014.9.jns14733] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The gold-standard surgical approach to the odontoid is via the transoral route. This approach necessitates opening of the oropharynx and is associated with risks of infection, and swallowing and breathing complications. The endoscopic endonasal approach has the potential to reduce these complications as the oral cavity is avoided. There are fewer than 25 such cases reported to date. The authors present a consecutive, single-institution series of 9 patients who underwent the endonasal endoscopic approach to the odontoid. METHODS The charts of 9 patients who underwent endonasal endoscopic surgery to the odontoid between January 2005 and August 2013 were reviewed. The clinical presentation, radiographic findings, surgical management, complications, and outcome, particularly with respect to time to extubation and feeding, were analyzed. Radiographic measurements of the distance between the back of the odontoid and the front of the cervicomedullary junction (CMJ) were calculated, as well as the location of any residual bone fragments. RESULTS There were 7 adult and 2 pediatric patients in this series. The mean age of the adults was 54.8 years; the pediatric patients were 7 and 14 years. There were 5 females and 4 males. The mean follow-up was 42.9 months. Symptoms were resolved or improved in all but 1 patient, who had concurrent polyneuropathy. The distance between the odontoid and CMJ increased by 2.34 ± 0.43 mm (p = 0.03). A small, clinically insignificant fragment remained after surgery, always on the left side, in 57% of patients. Mean times to extubation and oral feeding were on postoperative Days 0.3 and 1, respectively. There was one posterior cervical wound infection; there were 2 cases of epistaxis requiring repacking of the nose and no instances of breathing or swallowing complications or velopharyngeal insufficiency. CONCLUSIONS This series of 9 cases of endonasal endoscopic odontoidectomy highlights the advantages of the approach in permitting early extubation and early feeding and minimizing complications compared with transoral surgery. Special attention must be given to bone on the left side of the odontoid if the surgeon is standing on the right side.
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Falavigna A, Botelho RV, Teles AR, Guarise da Silva P, Martins D, Guyot JP, Gonzalez AS, Avila JMJ, Defino HLA. Twelve years of scientific production on Medline by Latin American spine surgeons. PLoS One 2014; 9:e87945. [PMID: 24505336 PMCID: PMC3914870 DOI: 10.1371/journal.pone.0087945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/01/2014] [Indexed: 11/19/2022] Open
Abstract
Background Despite the small contribution of LA in the Science Citation Index (SCI), a growing contribution by LA research to international literature has been observed in recent years. Study Design Systematic review. Purpose To evaluate the scientific contribution of Latin American (LA) Spine Surgeons in the last decade. Methods A literature search of publications by LA spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. The quality of the publication was evaluated with the journal impact factor (IF), Oxford classification and number of citations. Results This study comprised 320 articles published in the Medline database by LA spine surgeons from 2000 to 2011. In recent years, there has been an increase in the number of publications by LA spine surgeons. It was observed that 38.4% of LA papers were published in LA journals. 46.6% of the articles were published in journals with an IF lower than 1, and there was no statistically significant difference in the number of articles published in journals with a higher IF during the period. Linear-by-linear association analysis demonstrated an improvement in the level of evidence provided by LA articles published in recent years. Conclusions This study showed a growth in the number of publications in last 12 years by LA spinal surgeons. It is necessary to discuss a way to increase quantity and quality of scientific publications, mainly through a better education in research.
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Affiliation(s)
- Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, RS, Brazil
- * E-mail:
| | - Ricardo Vieira Botelho
- Department of Neurosurgery, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP, Brazil
| | - Alisson Roberto Teles
- Department of Neurosurgery, Hospital São José of the Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Delio Martins
- Department of Orthopedics, Federal University of São Paulo, Sao Paulo, SP, Brazil
| | - Juan Pablo Guyot
- Department of Orthopedics, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
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Weber C, Jakola AS, Gulati S, Nygaard ØP, Solheim O. Evidence-based clinical management and utilization of new technology in European neurosurgery. Acta Neurochir (Wien) 2013; 155:747-54. [PMID: 23440373 DOI: 10.1007/s00701-013-1640-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. METHODS We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. RESULTS A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals. CONCLUSIONS Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.
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Yarascavitch BA, Chuback JE, Almenawer SA, Reddy K, Bhandari M. Levels of Evidence in the Neurosurgical Literature. Neurosurgery 2012; 71:1131-7; discussion 1137-8. [DOI: 10.1227/neu.0b013e318271bc99] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Statement of Ethics in Neurosurgery of the World Federation of Neurosurgical Societies. World Neurosurg 2011; 76:239-47. [DOI: 10.1016/j.wneu.2011.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 06/01/2011] [Indexed: 11/21/2022]
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Izu BS, Monson B, Little AG, Termuhlen PM. Surgical practice: evidence or anecdote. JOURNAL OF SURGICAL EDUCATION 2009; 66:281-284. [PMID: 20005501 DOI: 10.1016/j.jsurg.2009.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 05/01/2009] [Accepted: 07/20/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Our objective is to highlight a few surgical practices that are not based on evidence but are still taught in surgical education, and to assess our experience with these practices. DESIGN We identified 3 practices (clamping of nasogastric tubes before removal, bowel preparation before elective colon resection, and elective sigmoid colectomy following 2 bouts of diverticulitis), identified the data supporting each practice, and administered a survey to faculty and residents at our institution. SETTING Wright State University Department of Surgery, Boonshoft School of Medicine, Dayton, Ohio. PARTICIPANTS Twenty-one faculty and 35 residents responded to the survey. RESULTS No studies were found relating to clamping nasogastric tubes before removal. Seven faculty (33%) and 11 residents (31%) used this practice. Two faculty (10%) and 0 residents felt this was an evidence-based practice. Faculty were more likely to have reviewed the evidence (85% vs 40%, p < 0.001). Level 2 evidence has shown bowel preparation did not improve outcomes relating to anastomotic leak, wound infection, or septic complications in elective colon resection. Twenty faculty (95%) and 34 residents (97%) used this practice. Faculty were more likely to believe this to be evidence-based (85% vs 49%, p = 0.01). There has been no level 1 or 2 evidence showing that sigmoid colectomy following 2 bouts of diverticulitis improves morbidity or mortality. Fourteen faculty (70%) and 26 residents (76%) reported using this practice. Twelve faculty (60%) and 21 residents (60%) felt this was evidence-based. CONCLUSIONS Frequent use of surgical practices without evidence support can create a misperception that such practices are evidence-based. Faculty are more likely to change a practice after obtaining continuing medical education, suggesting that residents may need validation by faculty practice of evidence-based procedures before incorporation into their clinical care.
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Affiliation(s)
- Brent S Izu
- Department of Surgery, Wright State University, Boonshoft School of Medicine, One Wyoming Street, Dayton, OH 45409, USA.
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