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-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.

CEU chief awarded professorship

2008 ◽  
Vol 90 (9) ◽  
pp. 299-299
Author(s):  
Matthew Worrall
Keyword(s):  
Health Services Research ◽  
Clinical Epidemiology ◽  
Surgical Care ◽  
Clinical Effectiveness ◽  
London School ◽  
Services Research ◽  
Senior Lecturer ◽  
The Uk ◽  
Key Staff

Since 1998 the College has been working in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) to understand better the quality of surgical care in the UK, through our Clinical Effectiveness Unit (CEU). Now the unit has gained further recognition through the promotion of key staff by the LSHTM as Jan van der Meulen, CEU head, has been appointed professor of clinical epidemiology (a new chair) and David Cromwell promoted to senior lecturer in health services research. To mark this, I interviewed Jan on the achievements of the department and on what challenges lie ahead.

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.

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.

Article Commentary: Optimizing Surgical Care: A Contemporary Assessment of Temperature, Oxygen, and Glucose

2010 ◽  
Vol 76 (6) ◽  
pp. 571-577 ◽  
Author(s):  
Ashley Dickinson ◽  
Motaz Qadan ◽  
Hiram C. Polk
Keyword(s):  
Immune Response ◽  
Quality Of Care ◽  
Innate Immune Response ◽  
Surgical Care ◽  
Innate Immune ◽  
Surgical Patients ◽  
Evidence Based

Factors such as temperature, oxygen, and glucose have recently been implicated in the development of surgical sepsis by either promoting or attenuating protective components of the innate immune response. Reducing infective sequelae and the improvement of the quality of care of surgical patients is a top practice priority today. These factors and their associated effects are discussed through the examination of recent clinical and scientific studies to provide an up-to-date evidence-based review.

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.

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

2015 ◽  
Vol 156 (8) ◽  
pp. 326-339 ◽  
Author(s):  
Richárd Szmola ◽  
Gyula Farkas ◽  
Péter Hegyi ◽  
László Czakó ◽  
Zsolt Dubravcsik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Scientific Evidence ◽  
Surgical Care ◽  
Study Group ◽  
Evidence Based ◽  
Management Guidelines ◽  
International Guidelines ◽  
Evidence Based Guideline ◽  
Cancer Network

Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference in everyday patient care and guides patient financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary. Orv. Hetil., 2015, 156(8), 326–339.

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.

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