Timing of Cholecystectomy after Biliary Pancreatitis

2017 ◽  
Author(s):  
Michael P. Catanzaro ◽  
Rachel J. Kwon
Keyword(s):  
Hospital Admission ◽  
Randomized Study ◽  
Historical Study ◽  
Evidence Based ◽  
Biliary Pancreatitis ◽  
Increased Risk ◽  
History Of ◽  
Timing Of Cholecystectomy ◽  
Based Medicine ◽  
Current Guidelines

This chapter provides a summary of a landmark historical study in surgery related to timing of cholecystectomy after biliary pancreatitis. It describes the history of the disease, a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: systematic reviews. This study was the first prospective randomized study to show that early removal of impacted gallstones did not prevent the progression of pancreatitis but did put patients at increased risk for other complications. Current guidelines, informed by this and subsequent studies, recommend that surgery be performed after pancreatic inflammation has subsided but ideally during the same hospital admission.

Internal Mammary Artery Ligation versus Sham Sternotomy for Angina Pectoris

2017 ◽  
Author(s):  
Michael P. Catanzaro
Keyword(s):  
Angina Pectoris ◽  
Internal Mammary Artery ◽  
Historical Study ◽  
Evidence Based ◽  
Artery Ligation ◽  
Sham Surgery ◽  
Internal Mammary ◽  
History Of ◽  
Clinical Questions ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in cardiac surgery related to internal mammary artery ligation versus sham sternotomy for angina pectoris. It describes the history of the procedure and a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: blinding and sham surgery. Whether or not sham surgery is ethical remains under debate. Proponents for sham surgery agree that it should be used only when a question cannot be answered adequately by other methods. Cobb and his colleagues were among the first to demonstrate the value of sham studies in addressing important clinical questions.

Acute Appendicitis

2017 ◽  
Author(s):  
Michael P. Catanzaro ◽  
Rachel J. Kwon
Keyword(s):  
Acute Appendicitis ◽  
Study Design ◽  
Observational Studies ◽  
Surgical Intervention ◽  
Case Series ◽  
Historical Study ◽  
Evidence Based ◽  
Broad Spectrum Antibiotic ◽  
History Of ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in surgery involving management and treatment of acute appendicitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: observational studies in study design. Reginald H. Fitz’s insights over a century ago in a seminal case series regarding the nature of appendicitis, its potential sequelae, and the value of urgent surgical intervention changed the disease from a deadly one into one that can be easily cured by surgery. However, with the advent of modern broad spectrum antibiotic therapy, Fitz’s assertion that immediate surgical therapy is always mandated has recently come under question.

Hinchey Classification of Acute Diverticulitis

2017 ◽  
Author(s):  
Michael P. Catanzaro ◽  
Rachel J. Kwon
Keyword(s):  
Evidence Based Medicine ◽  
Paradigm Shift ◽  
Acute Diverticulitis ◽  
Scoring Systems ◽  
Historical Study ◽  
Evidence Based ◽  
Hinchey Classification ◽  
History Of ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in surgery: the Hinchey classification of acute diverticulitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: validation of scoring systems. Hinchey’s classification of diverticulitis has become the most widespread system and while the Hinchey score may currently have less clinical relevance as it did in his time, its publication and eventual adoption marked a practice-changing paradigm shift in the way diverticulitis is viewed and managed today.

Child-Pugh Score for Mortality in Cirrhosis

2017 ◽  
Author(s):  
Rachel J. Kwon
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Intervention ◽  
Meld Score ◽  
Historical Study ◽  
Evidence Based ◽  
End Stage Liver Disease ◽  
History Of ◽  
End Stage ◽  
Based Medicine ◽  
Objective Tool

This chapter provides a summary of a landmark historical study in surgery deriving the Child-Pugh score for mortality in cirrhosis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: prognosis studies. There is a critical need for prognostic tools for selecting appropriate patients with liver cirrhosis and portal hypertension for surgical intervention. The development of the Child-Pugh score, and now the Model for End-Stage Liver Disease (MELD) score, has provided surgeons with an evidence-based objective tool for informing these decisions.

Ranson’s Criteria for Acute Pancreatitis

2017 ◽  
Author(s):  
Michael P. Catanzaro
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Management ◽  
Evidence Based Medicine ◽  
Decision Rules ◽  
Clinical Decision ◽  
Historical Study ◽  
Evidence Based ◽  
Surgical Disease ◽  
History Of ◽  
Based Medicine

This chapter provides a summary of a landmark historical study in surgery. It describes the history of pancreatitis, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: clinical decision rules. The management of pancreatitis has evolved from primarily a surgical disease to one in which operation is rarely undertaken, in part because stratification tools such as Ranson’s criteria have enabled more conservative management of those likely to have favorable outcomes. The development of Ranson’s criteria also paved the way for newer clinical scores that may have more discriminatory power.

scholarly journals Electronic Record Linkage cohort study of evidence-based management and outcomes in patients with ischaemic heart disease and atrial fibrillation

2021 ◽  
Author(s):  
◽  
Edward Daniel Harris
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Evidence Based Medicine ◽  
Lipid Lowering ◽  
Evidence Based ◽  
Lipid Lowering Therapy ◽  
Lipid Levels ◽  
Increased Risk ◽  
Based Medicine

BACKGROUND Implementation of evidence-based medicine is often suboptimal. The objectives of this thesis are to explore the delivery of evidence-based medicine and outcomes in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF). METHODS Retrospective observational cohort studies were conducted using linked anonymised data from the secure anonymised information linkage (SAIL) databank. Patients included (i) those undergoing percutaneous coronary intervention, (ii) patients prescribed vitamin K antagonist (VKA) for AF, and (iii) patients with AF who had undergone successful PCI. RESULTS Amongst patients directed to take clopidogrel for one-year post-PCI, discontinuation was far lower (~6%) than in previous studies where the treatment duration was not known. Despite this, early discontinuation and/or bleeding was associated with an increased risk of adverse events. In a national cohort of PCI patients, we observed a low rate of achievement of international guideline target lipid levels (<25%) and low prescribing of intensive lipid lowering therapy amongst those not at target. Females and patients who had undergone elective PCI were least likely to have their lipid levels documented and be at target. In patients prescribed VKA for AF guideline defined poor anticoagulation control was common and associated with significantly higher bleeding event rates, independent of common comorbidities that are recognised as risk factors for stroke and bleeding. In patients with AF who had undergone PCI outcomes were poor: approximately 1 in 5 had either a stroke, acute coronary syndrome (ACS) or died in the year follow-up. Bleeding events were also common and associated with a five, three and four-fold increased risk of stroke, ACS, and death. CONCLUSION This thesis has characterised the nature of multiple therapeutic gaps and associated adverse outcomes with common clinical conditions. Thus, identifying opportunities to improve outcomes in individual patients and at population level.

scholarly journals Miasmas, mental models and preventive public health: some philosophical reflections on science in the COVID-19 pandemic

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Trisha Greenhalgh
Keyword(s):  
Mental Models ◽  
Relative Weight ◽  
Evidence Based ◽  
Science And Policy ◽  
Hierarchy Of Evidence ◽  
John Snow ◽  
History Of ◽  
Support Policy ◽  
Preventive Public Health ◽  
Based Medicine

When the history of the COVID-19 pandemic is written, it is likely to show that the mental models held by scientists sometimes facilitated their thinking, thereby leading to lives saved, and at other times constrained their thinking, thereby leading to lives lost. This paper explores some competing mental models of how infectious diseases spread and shows how these models influenced the scientific process and the kinds of facts that were generated, legitimized and used to support policy. A central theme in the paper is the relative weight given by dominant scientific voices to probabilistic arguments based on experimental measurements versus mechanistic arguments based on theory. Two examples are explored: the cholera epidemic in nineteenth century London—in which the story of John Snow and the Broad Street pump is retold—and the unfolding of the COVID-19 pandemic in 2020 and early 2021—in which the evidence-based medicine movement and its hierarchy of evidence features prominently. In each case, it is shown that prevailing mental models—which were assumed by some to transcend theory but were actually heavily theory-laden—powerfully shaped both science and policy, with fatal consequences for some.

Evidence-Based Medicine

2016 ◽  
Author(s):  
Emily R. Winslow
Keyword(s):  
Evidence Based Medicine ◽  
Critical Appraisal ◽  
Reporting Guidelines ◽  
Evidence Based ◽  
Treatment Benefits ◽  
Therapeutic Decisions ◽  
History Of ◽  
Evidence Based Surgery ◽  
Key Resources ◽  
Based Medicine

Descriptions of “evidence-based” approaches to medical care are now ubiquitous in both the popular press and medical journals. The term evidence-based medicine (EBM) was first coined in 1992, and over the last two decades, the field has experienced rapid growth, and its principles now permeate both graduate medical education and clinical practice. The field of EBM has been in constant evolution since its introduction and continues to undergo refinements as its principles are tested and applied in a wide variety of clinical circumstances. This review presents a brief history of EBM, EBM: fundamental tenets, a critical appraisal of a single study, reporting guidelines for single studies, a critical appraisal of a body of evidence, evidence-based surgery, and limitations in EBM. Tables list strength of evidence for treatment decisions (EBM working group), Oxford Centre for Evidence-Based Medicine revised levels of evidence for treatment benefits , “4S” approach to finding resources for EBM, critical appraisal of individual studies examining therapeutic decisions, reporting guidelines by study design, and key resources for evidence-based surgery. This review contains 6 tables and 85 references

Sign in / Sign up

Export Citation Format

Share Document