Evidence-Based Surgery

2017 ◽  
Author(s):  
Samuel R. G. Finlayson ◽  
Karl Y. Bilimoria
Keyword(s):  
External Validity ◽  
Task Force ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Type I ◽  
Levels Of Evidence ◽  
Secondary Sources ◽  
Evidence Based Surgery ◽  
Internal And External Validity

Evidence-based surgery describes the consistent and judicious use of the best available scientific evidence in making decisions about the care of surgical patients. In this chapter, guidelines and secondary sources of scientific evidence are provided. Examples include Clinical Evidence, the Cochrane Database of Systematic Reviews, and the Institute for Healthcare Improvement. Levels of evidence are defined. Appraising scientific evidence via specific study designs is described, including studies’ internal and external validity (generalizability). In evaluating the quality of a study, the properties of chance (Type I and Type II errors); bias (selection bias and measurement bias); and confounding (along with randomization, restriction and matching, instrumental variable analysis, stratification, and propensity score risk adjustment) are defined. Interpreting and applying evidence to practice (external validity) are discussed. A discussion of evidence-based surgery and quality of care is provided and focuses on how efforts to assess quality on evidence-based processes of care or clinical outcomes are as much practical as philosophical. A figure shows processes that affect the internal and external validity of a clinical study. Tables show levels of evidence, as stratified by the U.S. Preventive Services Task Force, and methods observed in published clinical studies that demonstrate efforts to minimize the effects of chance, bias, and confounding. This review contains 1 figure, 3 tables, and 42 references.

Evidence-Based Surgery

2017 ◽  
Author(s):  
Karl Y. Bilimoria ◽  
Benjamin S Brooke
Keyword(s):  
Scientific Evidence ◽  
Surgical Techniques ◽  
Internal Validity ◽  
Surgical Care ◽  
Evidence Based ◽  
Services Research ◽  
Surgical Decision ◽  
Evidence Based Surgery ◽  
Quality Of Research

The practice of surgery has undergone a dramatic evolution over the last century with the availability of new scientific evidence supporting different surgical techniques and management.  Evidence-based surgery is defined as the judicious and systematic application of scientific evidence to surgical decision making and the establishment of standards of surgical care. This includes efforts to appraise the strength of scientific evidence and evaluate the quality of research studies or evidence, as well as efforts to interpret and apply evidence to clinical practice. In this review, we discuss important methodology and approaches in surgical health services research to accomplish these goals and improve the quality of care in surgery. By providing this overview, we hope readers will be able to navigate the surgical literature and apply evidence-based science to their own surgical practice. This review contains 1 figure, 3 tables, and 43 references. Key words: bias, comparative effectiveness, confounding, evidence, external validity, implementation science, internal validity, pragmatic trials, quality, risk adjustment, surgery

Evidence-Based Surgery

2017 ◽  
Author(s):  
Karl Y. Bilimoria ◽  
Benjamin S Brooke
Keyword(s):  
Scientific Evidence ◽  
Surgical Techniques ◽  
Internal Validity ◽  
Surgical Care ◽  
Evidence Based ◽  
Services Research ◽  
Surgical Decision ◽  
Evidence Based Surgery ◽  
Quality Of Research

The practice of surgery has undergone a dramatic evolution over the last century with the availability of new scientific evidence supporting different surgical techniques and management.  Evidence-based surgery is defined as the judicious and systematic application of scientific evidence to surgical decision making and the establishment of standards of surgical care. This includes efforts to appraise the strength of scientific evidence and evaluate the quality of research studies or evidence, as well as efforts to interpret and apply evidence to clinical practice. In this review, we discuss important methodology and approaches in surgical health services research to accomplish these goals and improve the quality of care in surgery. By providing this overview, we hope readers will be able to navigate the surgical literature and apply evidence-based science to their own surgical practice. This review contains 1 figure, 3 tables, and 43 references. Key words: bias, comparative effectiveness, confounding, evidence, external validity, implementation science, internal validity, pragmatic trials, quality, risk adjustment, surgery

Evidence and Evidence-Based Practices: Are We There Yet?

2017 ◽  
Vol 55 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Robert L. Schalock ◽  
Laura E. Gomez ◽  
Miguel A. Verdugo ◽  
Claudia Claes
Keyword(s):  
Developmental Disabilities ◽  
External Validity ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Levels Of Evidence ◽  
Recent Trends ◽  
Evidence Gathering ◽  
Internal And External Validity

Abstract The purpose of this article is to move the field of intellectual and closely related developmental disabilities (IDD) towards a better understanding of evidence and evidence-based practices. To that end, we discuss (a) different perspectives on and levels of evidence, (b) commonly used evidence-gathering strategies, (c) standards to evaluate evidence, (d) the distinction between internal and external validity, and (e) guidelines for establishing evidence-based practices. We also describe how the conceptualization and use of evidence and evidence-based practices are changing to accommodate recent trends in the field.

scholarly journals The Use of Evidence-Based Acupuncture: Current Evidence

2022 ◽  
Author(s):  
Dedi Ardinata
Keyword(s):  
Clinical Evidence ◽  
Scientific Evidence ◽  
Current Evidence ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Quality

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

scholarly journals Chronic pancreatitis.Evidence based management guidelines of the Hungarian Pancreatic Study Group

2015 ◽  
Vol 156 (7) ◽  
pp. 262-288 ◽  
Author(s):  
Tamás Takács ◽  
László Czakó ◽  
Zsolt Dubravcsik ◽  
Gyula Farkas ◽  
Péter Hegyi ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Treatment Guidelines ◽  
Task Force ◽  
Correct Diagnosis ◽  
Study Group ◽  
Evidence Based ◽  
International Guidelines ◽  
Basic Reference ◽  
Evidence Based Guideline

Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading sympthoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate®grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinial questions were accepted with total or strong agreement. The present guideline is the first evidence based chronic pancreatitis guideline in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary. Orv. Hetil., 2015, 156(7), 262–288.

How to Search and Critique Scientific Evidence for Decision-Making

2017 ◽  
pp. 100-123
Author(s):  
Mayuree Tangkiatkumjai ◽  
Win Winit-Watjana ◽  
Li-Chia Chen
Keyword(s):  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Literature Search ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Evidence Based ◽  
Search Terms ◽  
Based Medicine ◽  
Complementary And Alternative

A clinical decision on the use of complementary and alternative medicine (CAM) should be made based on evidence-based medicine (EBM) together with practitioner's knowledge and experiences. This chapter describes the process of EBM, including how to address a clinical question, do a systematic search for appropriate evidence with key search terms, appraise the evidence and make a clinical decision on CAM applications. An effective literature search should be performed by using a structured search strategy in searching biomedical and CAM databases, such as the National Center for Complementary and Alternative Medicine (CAM Citation Index). Few standard tools are recommended to evaluate the quality of CAM studies, i.e. the CONSORT extension for herbal interventions and STRICTA for RCTs of acupuncture. Additionally, some guidelines for designing RCTs in Chinese herbal medicine (CHM) can also be adopted to critique CAM literature. A clinical decision on choosing optimal CAM for patient care should be based on the current best evidence emerged from the EBM process.

Improving quality of cancer care by rapid adoption of new scientific evidence.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 62-62
Author(s):  
Joanne Schottinger ◽  
Violeta Rabrenovich ◽  
David Campen ◽  
Dean Fredriks
Keyword(s):  
Cancer Care ◽  
Scientific Evidence ◽  
Care Program ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Chemotherapy Administration ◽  
Inpatient Settings ◽  
New Evidence

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.

Epidemiology 2: Study Design

2010 ◽  
pp. 47-58
Author(s):  
Muktar H. Aliyu
Keyword(s):  
Study Design ◽  
Scientific Evidence ◽  
Epidemiologic Study ◽  
Scientific Research ◽  
Time Frame ◽  
Epidemiologic Studies ◽  
Evidence Based ◽  
Study Designs ◽  
Based Medicine

The usefulness of evidence arising from scientific research is influenced by several factors, and foremost among these factors is the design of the epidemiologic study from which the findings are drawn. In evidence-based medicine, the quality of scientific evidence is often graded on the base of the type of study design and includes appraisal of methods by which studies of exposure and outcomes are planned and implemented. Several factors must be considered when designing a scientific study, including the hypothesis being tested, study cost, time frame, subject characteristics, choice of variables or measurements, and ethical concerns. In this chapter, the different types of study designs commonly encountered in clinical research, common measures of morbidity and mortality in epidemiology, and errors (random and systematic) that may threaten conclusions derived from inferences arising from epidemiologic studies are discussed.

scholarly journals EULAR evidence-based recommendations for the management of fibromyalgia syndrome

2007 ◽  
Vol 67 (4) ◽  
pp. 536-541 ◽  
Author(s):  
S F Carville ◽  
S Arendt-Nielsen ◽  
H Bliddal ◽  
F Blotman ◽  
J C Branco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Fibromyalgia Syndrome ◽  
Task Force ◽  
Fibromyalgia Impact Questionnaire ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Pharmacological Intervention ◽  
Evidence Based

Objective:To develop evidence-based recommendations for the management of fibromyalgia syndrome.Methods:A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords “fibromyalgia”, “treatment or management” and “trial”. Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation.Results:146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and “other pharmacological” and exercise, cognitive behavioural therapy, education, dietary interventions and “other non-pharmacological”. In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made.Conclusions:Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.

scholarly journals Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact, diagnosis, and treatment

2013 ◽  
Vol 39 (4) ◽  
pp. 495-512 ◽  
Author(s):  
Luiz Vicente Ribeiro Ferreira da Silva Filho ◽  
Flavia de Aguiar Ferreira ◽  
Francisco Jose Caldeira Reis ◽  
Murilo Carlos Amorim de Britto ◽  
Carlos Emilio Levy ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Scientific Evidence ◽  
Scientific Information ◽  
Clinical Impact ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Pseudomonas Aeruginosa Infection ◽  
Based Medicine

Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO–an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group.

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