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Bozkurt I, Holt MW, Robinson EC, Chaurasia B, Zileli M. Do we really apply evidence-based-recommendations to spine surgery? Results of an international survey. Neurosurg Rev 2024; 47:264. [PMID: 38856823 PMCID: PMC11164786 DOI: 10.1007/s10143-024-02502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/01/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE This international survey investigated Evidence-Based Medicine (EBM) in spine surgery by measuring its acceptance among spine surgeons. It assessed their understanding of EBM and how they apply it in practice by analyzing responses to various clinical scenarios.. MATERIALS AND METHODS Following the CHERRIES guidelines, an e-survey was distributed to multiple social media forums for neurosurgeons and orthopedic surgeons on Facebook, LinkedIn, and Telegram and circulated further through email via the authors' network. Three hundred participants from Africa, Asia, Europe, North America, and Oceania completed the survey. RESULTS Our study revealed that 67.7% (n = 203) of respondents used EBM in their practice, and 97.3% (n = 292) believed training in research methodology and EBM was necessary for the practice of spine surgery. Despite this endorsement of using EBM in spine surgery, we observed varied responses to how EBM is applied in practice based on example scenarios. The responders who had additional training tended to obey EBM guidelines more than those who had no additional training. Most surgeons responded as always or sometimes prescribing methylprednisolone to patients with acute spinal cord injury. Other significant differences were identified between geographical regions, training, practice settings, and other factors. CONCLUSIONS Most respondents used EBM in practice and believed training in research methodology and EBM is necessary for spine surgery; however, there were significant variations on how to use them per case. Thus, the appropriate application of EBM in clinical settings for spinal surgery must be further studied.
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Affiliation(s)
- Ismail Bozkurt
- Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey
- Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Matthew W Holt
- Department of Natural Sciences, University of South Carolina Beaufort, Bluffton, SC, USA.
| | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Mehmet Zileli
- Department of Neurosurgery, Sanko University, Gaziantep, Turkey
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Chauhan D, Ahmad HS, Hamade A, Yang AI, Wathen C, Ghenbot Y, Mannam S, Subtirelu R, Bashti M, Wang MY, Basil G, Yoon JW. Determining Differences in Perioperative Functional Mobility Patterns in Lumbar Decompression Versus Fusion Patients Using Smartphone Activity Data. Neurosurgery 2024:00006123-990000000-01010. [PMID: 38169310 DOI: 10.1227/neu.0000000000002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences. METHODS Twenty-three LF and 18 LD patients were retrospectively included. Activity data (steps per day) recorded in Apple Health, encompassing over 70 000 perioperative data points, was classified into 6 temporal epochs representing distinct functional states, including acute preoperative decline, immediate postoperative recovery, and postoperative decline. The daily rate of change of each patient's step counts was calculated for each perioperative epoch. RESULTS Patients undergoing LF demonstrated steeper preoperative declines than LD patients based on the first derivative of step count data (P = .045). In the surgical recovery phase, LF patients had slower recoveries (P = .041), and LF patients experienced steeper postoperative secondary declines than LD patients did (P = .010). The rate of change of steps per day demonstrated varying perioperative trajectories that were not explained by differences in age, comorbidities, or levels operated. CONCLUSION Patients undergoing LF and LD have distinct perioperative activity profiles characterized by the rate of change in the patient daily steps. Daily steps and their rate of change is thus a valuable metric in phenotyping patients and understanding their postsurgical outcomes. Prospective studies are needed to expand upon these data and establish causal links between preoperative patient mobility, patient characteristics, and postoperative functional outcomes.
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Affiliation(s)
- Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Hamade
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sai Mannam
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Subtirelu
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Malek Bashti
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Michael Y Wang
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Gregory Basil
- Department of Neurosurgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Estupiñan-Riberoa BD, Montaña-Gómez LM, Montaño-Guzmán JC, Ortega-Sierra MG, Elam-Eraso SAH, Lozada-Martínez ID, Narvaez-Rojas AR. Professionalism, methodological training and evidence in neurosurgery: The case of data from observational studies on unruptured aneurysms. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wolf A, McDermott MW, Hadley MN. The Value of Statistics and Evidence-Based Medicine in the Care of Neurosurgical Patients. Cureus 2022; 14:e27455. [PMID: 36060335 PMCID: PMC9420527 DOI: 10.7759/cureus.27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/22/2022] Open
Abstract
Science and the art of surgery should be anchored on evidence-based medicine. There is no room in the discipline of neurosurgery for “personal anecdotes/experience,” and the concept of “hero worship.” The construction of evidence-based medicine guidelines is essential in our continued improvement of care for neurosurgical patients.
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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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Lepard JR, Walters BC. In Reply: A Bibliometric Analysis of Neurosurgical Practice Guidelines. Neurosurgery 2020; 86:E405-E406. [PMID: 31814019 DOI: 10.1093/neuros/nyz539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jacob R Lepard
- Department of Neurological Surgery The University of Alabama at Birmingham Birmingham, Alabama
| | - Beverly C Walters
- Department of Neurological Surgery The University of Alabama at Birmingham Birmingham, Alabama
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Arana E, Kovacs FM, Royuela A, Asenjo B, Nagib F, Pérez-Aguilera S, Dejoz M, Cabrera-Zubizarreta A, García-Hidalgo Y, Estremera A. Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation. J Natl Compr Canc Netw 2020; 18:267-273. [PMID: 32135511 DOI: 10.6004/jnccn.2019.7367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND MRI is assumed to be valid for distinguishing metastatic vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). This study assessed (1) concordance between the image-based diagnosis of MVF versus OVF and the reference (biopsy or follow-up of >6 months), (2) interobserver and intraobserver agreement on key imaging findings and the diagnosis of MVF versus OVF, and (3) whether disclosing a patient's history of cancer leads to variations in diagnosis, concordance, or agreement. PATIENTS AND METHODS This retrospective cohort study included clinical data and imaging from 203 patients with confirmed MVF or OVF provided to 25 clinicians (neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists). From January 2018 through October 2018, the clinicians interpreted images in conditions as close as possible to routine practice. Each specialist assessed data twice, with a minimum 6-week interval, blinded to assessments made by other clinicians and to their own previous assessments. The kappa statistic was used to assess interobserver and intraobserver agreement on key imaging findings, diagnosis (MVF vs OVF), and concordance with the reference. Subgroup analyses were based on clinicians' specialty, years of experience, and complexity of the hospital where they worked. RESULTS For diagnosis of MVF versus OVF, interobserver agreement was fair, whereas intraobserver agreement was substantial. Only the latter improved to almost perfect when a patient's history of cancer was disclosed. Interobserver agreement for key imaging findings was fair or moderate, whereas intraobserver agreement on key imaging findings was moderate or substantial. Concordance between the diagnosis of MVF versus OVF and the reference was moderate. Results were similar regardless of clinicians' specialty, experience, and hospital category. CONCLUSIONS When MRI is used to distinguish MVF versus OVF, interobserver agreement and concordance with the reference were moderate. These results cast doubt on the reliability of basing such a diagnosis on MRI in routine practice.
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Affiliation(s)
- Estanislao Arana
- aDepartment of Radiology, Fundación Instituto Valenciano de Oncología, Valencia.,bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca
| | - Francisco M Kovacs
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,cUnidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa, Madrid
| | - Ana Royuela
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,dClinical Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid; CIBERESP
| | - Beatriz Asenjo
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,eDepartment of Radiology, Hospital Universitario Regional de Málaga, Málaga
| | - Fatima Nagib
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,eDepartment of Radiology, Hospital Universitario Regional de Málaga, Málaga
| | - Sandra Pérez-Aguilera
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,fDepartment of Radiology, Hospital de Manacor, Mallorca
| | - María Dejoz
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,gSchool of Biomedical Engineering, Universitat Politècnica de Valencia, Valencia
| | - Alberto Cabrera-Zubizarreta
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,hDepartment of Radiology, Hospital de Galdakao, Galdakao, Bizkaia
| | - Yolanda García-Hidalgo
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,iDepartment of Radiology, Hospital Universitario Puerta de Hierro, Madrid; and
| | - Ana Estremera
- bSpanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca.,jDepartment of Radiology, Hospital Son Llàtzer, Palma de Mallorca, Spain
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Lu VM, Graffeo CS, Perry A, Link MJ, Meyer FB, Dawood HY, Mekary RA, Smith TR. Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort. Neurosurgery 2020; 87:435-441. [DOI: 10.1093/neuros/nyaa027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/28/2019] [Indexed: 01/11/2023] Open
Abstract
Abstract
Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.
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Affiliation(s)
- Victor M Lu
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Avital Perry
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Fredric B Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Hassan Y Dawood
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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