Evidence-Based Surgery, An Issue of Surgical Clinics

Table of contents :
Ethical Issues in Evidence-Based Surgery……Page 1
Professional ethics and evidence-based medicine……Page 2
A short history of evidence-based medicine, US regulations, and ethics……Page 3
When a procedure should be formally evaluated……Page 5
Choosing the most appropriate research design……Page 7
Choosing a control group: the ethics of sham surgery……Page 12
The role of equipoise……Page 13
Implications for informed consent……Page 14
Summary……Page 15
References……Page 16
What is evidence-based surgery?……Page 19
Is surgical practice evidence-based?……Page 22
Evidence-based surgical practice: why is it so difficult?……Page 24
What would be the face of evidence-based surgical practice?……Page 26
Are there external drivers?……Page 27
How should surgical innovation be assessed?……Page 28
What are some of the solutions?……Page 31
References……Page 32
Systematic Reviews of Surgical Interventions……Page 35
Developing a focused clinical question……Page 36
Identifying relevant studies……Page 37
What is the validity of the individual study?……Page 39
Dealing with the included studies……Page 41
Statistical methods……Page 42
The Cochrane Collaboration……Page 43
Preparation, maintenance, and accessibility of Cochrane reviews……Page 44
Systematic reviews of surgical interventions: challenges and examples……Page 46
References……Page 47
The changing expectations of patients……Page 49
The need for better access to information for doctors……Page 50
Surgeons’ attitudes to information technology……Page 51
Educational support……Page 52
Bringing together patient information and consent……Page 53
The importance of knowing your results……Page 54
Clinical governance: organization versus freedom?……Page 55
How do we find the time to do all this?……Page 56
References……Page 57
Outcomes as a measure of quality……Page 59
Traditional outcomes and their limitations……Page 60
Morbidity and mortality……Page 62
Return to normal activity/return to work……Page 64
Health-related quality of life……Page 65
Functional outcomes: activities, disability, and measuring recovery……Page 71
Pain……Page 73
Patient satisfaction……Page 74
Composite measures……Page 75
References……Page 76
Understanding the decision-making process……Page 80
Influences on decision-making in medicine……Page 81
External influences……Page 82
Availability of evidence……Page 83
Use of heuristics……Page 84
Compiling a list of sources of evidence……Page 85
Influences on decision-making and role of evidence……Page 86
Discuss tactics on how to acquire evidence at appropriate level……Page 87
Principles of teaching evidence-based decision-making: teaching methods and tactics……Page 88
References……Page 90
Surgical Decision-Making: Integrating Evidence, Inference, and Experience……Page 92
Inductive science and the methodologic basis of evidence-based medicine……Page 93
An evidence-based approach to the management of perforated diverticulitis……Page 96
Deductive science and inferential decision-making……Page 99
Are there consistent mechanistic data from studies in animal models?……Page 100
What are the potential complications of our plan of action?……Page 102
Experience: integrating subjectivity into surgical decision-making……Page 103
Integrating evidence, inference, and experience……Page 104
References……Page 105
Evaluating New Surgical Techniques in Australia: The Australian Safety and Efficacy Register of New Interventional ………Page 107
The process……Page 108
Systematic reviews……Page 110
Acceptance of the process……Page 114
Horizon scanning……Page 115
Future……Page 117
2001……Page 118
2003……Page 119
References……Page 120
Managing the Evidence Flood……Page 121
Managing the flood……Page 123
Filtering the flood……Page 125
An evidence-based surgery journal?……Page 126
References……Page 127
Relative Contributions of Surgeons and Decision Support Systems……Page 128
Problems for surgeons and evidence-based surgery……Page 129
Approaches to the problem……Page 130
Getting best evidence into practice……Page 131
Outcomes……Page 133
American College of Surgeons centers for surgical care: development of care systems……Page 135
Summary……Page 137
References……Page 138
Developing Skills for Evidence-Based Surgery: Ensuring that Patients Make Informed Decisions……Page 139
Practice variation and implications for informed surgical decisions……Page 140
Professional uncertainty and unwarranted variation……Page 141
Benign prostatic hyperplasia and the importance of patients’ preferences……Page 142
Applying the lessons learned in benign prostatic hyperplasia more broadly……Page 145
Informing patients about risks of death and other bad outcomes……Page 146
Integrating decision support and clinical trials to improve relevant knowledge……Page 147
References……Page 148
Finding and Appraising Evidence……Page 151
Finding the best evidence……Page 152
Prioritizing your questions……Page 153
Secondary sources……Page 155
Primary sources……Page 156
Which database?……Page 157
Sample search from PubMed……Page 158
PubMed clinical queries……Page 159
Search engines……Page 160
Critical appraisal……Page 161
Where does bias come from?……Page 162
What matters most in checking for bias?……Page 163
Sample size……Page 164
Deciding on relevance……Page 165
References……Page 166
Librarians, Surgeons, and Knowledge……Page 168
Authentication and e-license barriers……Page 169
What is the role of the information specialist in twenty-first century health care?……Page 170
The “informationist” debate……Page 171
Eskind Biomedical Library case study……Page 172
A systemic approach to knowledge management……Page 173
What kinds of knowledge do surgeons need?……Page 175
Keeping professionally updated……Page 177
Support for knowledge management services……Page 178
Support for work-based and lifelong learning, training, and research……Page 179
Information literacy and access to knowledge……Page 180
References……Page 183
Knowledge Management: A Core Skill for Surgeons Who Manage……Page 188
Three types of generalizable knowledge……Page 190
Choosing criteria and developing systems……Page 191
Comparative and public knowledge about performance……Page 193
Knowledge from research……Page 194
Rose-tinted spectacles; the unreliability of prepublication peer review……Page 195
The twenty-first century evidence paradigm……Page 196
Knowledge from experience……Page 197
Learning from one’s own experience: reflective practitioners……Page 198
Learning from the experience of others……Page 199
Knowledge derived from patient experience……Page 201
Integrating the three types of knowledge……Page 202
Organizing and mobilizing knowledge……Page 203
Push: delivering urgent knowledge……Page 204
Prompt: delivering just-in-time knowledge……Page 205
Localization……Page 206
Personalization……Page 207
Allocating responsibility for knowledge management……Page 208
The knowing-doing gap……Page 209
References……Page 210
tlink2……Page 211
tlink2……Page 215
Defining our terms……Page 217
Defining words by their usage……Page 218
Word euthanasia……Page 219
Defining words by numbers……Page 220
Indefinite definitions……Page 221
Further readings……Page 222
tlink2……Page 223