Colorectal Endometriosis: Ample data without definitive recommendations.

The preoperative work-up and optimal surgical approach to colorectal endometriosis is a highly studied topic lacking definitive recommendations. Synthesis of the available data can be extremely challenging for surgeons due to the heterogeneity of existing comparisons, a variety of studied surgical outcomes, and a predominant focus on operative complications. While these considerations are extremely important for surgeons performing such complex gynecologic surgery there is still much to be desired with regards to evidence based guidelines for the preoperative assessment and surgical technique for colorectal endometriosis. Having an established guideline stating in which clinical situations endometriosis surgeons should performing rectovaginal shaving, versus discoid excision, versus segmental resection would be extremely important for all pelvic surgeons, even those operating in high-volume centers dedicated to the surgical management of complex endometriosis. This perspective highlights the shortcomings of the available data and attempts to create an algorithm surgeons can follow when performing surgery for colorectal endometriosis. This algorithm is based on our expert opinion after synthesising available data.

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Adherence to Evidence-Based Guidelines for Preoperative Testing in Women Undergoing Gynecologic Surgery

Obstetrics and Gynecology ◽

10.1097/aog.0b013e3181ec448d ◽

2010 ◽

Vol 116 (3) ◽

pp. 694-700 ◽

Cited By ~ 16

Author(s):

Caryn M. St. Clair ◽

Monjri Shah ◽

Elisabeth J. Diver ◽

Sharyn N. Lewin ◽

William M. Burke ◽

...

Keyword(s):

Gynecologic Surgery ◽

Evidence Based ◽

Preoperative Testing ◽

Evidence Based Guidelines

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Do physicians follow evidence-based guidelines in the diagnostic work-up of IBS?

Nature Clinical Practice Gastroenterology &#38 Hepatology ◽

10.1038/ncpgasthep0820 ◽

2007 ◽

Vol 4 (6) ◽

pp. 296-297 ◽

Cited By ~ 13

Author(s):

Brennan MR Spiegel

Keyword(s):

Evidence Based ◽

Diagnostic Work ◽

Evidence Based Guidelines ◽

Work Up ◽

Diagnostic Work Up

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Hot and Bothered

Pediatric Medical Emergencies ◽

10.1093/med/9780190946678.003.0007 ◽

2020 ◽

pp. 59-72

Author(s):

Christopher Perry ◽

Nechama Sonenthal

Keyword(s):

Emergency Medicine ◽

Treatment Plan ◽

Febrile Child ◽

Clinical Judgement ◽

Evidence Based ◽

Immune Systems ◽

Life Threatening ◽

Evidence Based Guidelines ◽

High Degree ◽

Work Up

Pediatric fever is both an extremely common and yet highly challenging scenario faced regularly by emergency medicine physicians. A high degree of concern must always exist for the presence of a serious bacterial infection (SBI). This is especially true for infants due to their immature immune systems as well as to the limitations involved in obtaining a reliable history and physical exam. Evidence-based guidelines can assist the clinician in performing an appropriate work-up and treatment plan. However, clinical judgement always remains the physician’s most valuable tool. In areas where the guidelines are not clear, clinicians should exercise the highest degree of caution that a febrile child may have an SBI or other potentially life-threatening infectious pathology.

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The Influence of Evidence-Based Surgical Indications and Techniques on Failure Rates After Arthroscopic Shoulder Stabilization in the Contact or Collision Athlete With Anterior Shoulder Instability

The American Journal of Sports Medicine ◽

10.1177/0363546516663716 ◽

2016 ◽

Vol 45 (5) ◽

pp. 1218-1225 ◽

Cited By ~ 31

Author(s):

Timothy S. Leroux ◽

Bryan M. Saltzman ◽

Maximilian Meyer ◽

Rachel M. Frank ◽

Bernard R. Bach ◽

...

Keyword(s):

Surgical Technique ◽

Failure Rate ◽

Shoulder Instability ◽

Preoperative Assessment ◽

Anterior Shoulder Instability ◽

Evidence Based ◽

Failure Rates ◽

Surgical Indications ◽

Shoulder Stabilization ◽

Arthroscopic Shoulder Stabilization

Background: It has been reported that arthroscopic shoulder stabilization yields higher rates of failure in contact or collision athletes as compared with open shoulder stabilization; however, this is largely based upon studies that do not employ modern, evidence-based surgical indications and techniques for arthroscopic shoulder stabilization. Purpose: To (1) determine the pooled failure rate across all studies reporting failure after primary arthroscopic shoulder stabilization for anterior shoulder instability in contact or collision athletes and (2) stratify failure rates according to studies that use evidence-based surgical indications and techniques. Study Design: Systematic review. Methods: A review of PubMed, Medline, and Embase was performed to identify all clinical studies with a minimum of 1-year follow-up that reported failure rates after arthroscopic shoulder stabilization for anterior shoulder instability in contact or collision athletes. Data pertaining to patient demographics, clinical and radiographic preoperative assessment, surgical indications, surgical technique, rehabilitation, and outcome were collected from each included study. An overall failure rate was determined across all included studies. After this, a secondary literature review was performed to identify factors related to patient selection and surgical technique that significantly influence failure after primary arthroscopic shoulder stabilization. Failure rates were then determined among included studies that used these evidence-based indications and techniques. Results: Overall, 26 studies reporting on 779 contact or collision athletes met the inclusion criteria. The mean patient age was 19.9 years, 90.3% were male, and the most common sport was rugby. There was considerable variability in the reporting of patient demographics, preoperative assessment, surgical indications, surgical technique, and patient outcomes. Across all included studies, the pooled failure rate after arthroscopic shoulder stabilization in the contact or collision athlete was 17.8%; however, among studies that excluded patients with significant bone loss, used a minimum of 3 suture anchors, and performed the stabilization in the lateral decubitus position, the failure rate was 7.9%. Conclusion: The rate of failure after arthroscopic shoulder stabilization in contact or collision athletes decreases from 17.8% to 7.9% after the use of evidence-based surgical indications and techniques.

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