Evaluation and stages of surgical innovations

Barkun, Jeffrey; Aronson, Jeffrey K; Feldman, Liane S.; Maddern, Guy J.; Strasberg, Steven M.

doi:10.1016/s0140-6736(09)61083-7

Cited by 496 publications

(379 citation statements)

References 54 publications

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“…[1][2][3] Accordingly, it is not uncommon for diffusion of surgical innovation to outpace the generation of evidence supporting its safety and effectiveness in diverse clinical settings. 1,4 In some cases, this paradox can expose patients to unanticipated risks associated with widespread implementation of new surgical techniques. Illustrating this point, evaluation of patient outcomes following the widespread adoption of laparoscopic cholecystectomy revealed higher than expected rates of potentially lethal bile duct injuries.…”

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confidence: 99%

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Tan

Wolf

et al. 2011

Cancer

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BACKGROUND:Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of 4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P ¼ .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;117:4184-93.

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confidence: 99%

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Tan

Wolf

et al. 2011

Cancer

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“…Although there is a large degree of overlap, it is misleading to suggest that translational medicine is all that pharmacology is, or that pharmacology is all that translational medicine is (there is, after all, translation in non-pharmacological areas, such as surgery [18]). However, I do have a real difficulty with the way in which the idea of translational medicine has been widely interpreted, in that it seems to have been generally assumed that it is a process that begins with omics rather than functional ologies and proceeds in a linear fashion to practical outcomes.…”

Section: Lost or Found In Translation?mentioning

confidence: 99%

Integrating pharmacology and clinical pharmacology

Aronson¹

2011

Brit J Clinical Pharma

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I here reaffirm some of the points that I made in the manifesto for UK clinical pharmacology [1] [3,4], and indeed the manifesto itself, where I wrote that 'the importance of integrating pharmacology and clinical pharmacology cannot be overestimated' .In relation to this, I strongly believe that the distinction that many make between basic and applied science is a false dichotomy. As I wrote in the manifesto, 'functions in biology emerge . . . as a result of integration of different components of relevant systems at different levels.' This is true of pharmacology and clinical pharmacology. Although it is sometimes useful to refer separately to basic and applied science, it is the crosstalk between them, at all levels and from one level to another, that is important. I have recently had the opportunity to make these views known more widely, in my opening plenary lecture at WorldPharma 2010, the 16th World Congress of the International Union of Basic and Clinical Pharmacology (IUPHAR). The contents of that lecture have been posted on the BPS's website [5]. Clinical pharmacology and clinical pharmacologistsAs the manifesto again makes clear, I believe that it is important to distinguish between the discipline of clinical pharmacology, to which many can contribute, whatever their qualifications, and the practitioners of the discipline, who should be medically qualified practitioners. My definition of a clinical pharmacologist has two distinct parts:1 A statement that a clinical pharmacologist is a medically qualified practitioner. A medical qualification is essential, as I argued in the manifesto and shall argue further here. 2 An outline of the main categories of activities that clinical pharmacologists undertake: teaching, research, the framing of medicines policy, the purveying of information and advice about the actions and proper uses of medicines in humans, and implementation of that knowledge in clinical practice.Professors Tucker and Miners [6] suggest that as there are five categories in this list, clinical practice forms only 20% of the whole, the implication being that it is but a small part of the discipline. That is not so. Clinical knowledge, experience, practice, and above all, insight permeate all of the activities of a clinical pharmacologist, and there can be no simple division of attributes such as they suggest.It is undoubtedly true, as Professor Page asserts, that one does not have to be medically qualified or clinically experienced to contribute work that is of relevance to drug action in humans, and many who are not medically qualified practitioners have made major contributions to the discipline of clinical pharmacology. When I suggested that some of those 'could be described as, say, "applied pharmacologists" ' , I was thinking specifically of the small British Journal of Clinical Pharmacology DOI:10.1111DOI:10. /j.1365DOI:10. -2125DOI:10. .2011 Br J Clin Pharmacol / 71:5 / 787-790 / 787

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“…Laparoscopic cholecystectomy (LC) is widely accepted as the treatment of choice for acute cholecystitis [1][2][3]. However, patients with acute cholecystitis demonstrate a wide spectrum of clinical manifestations.…”

Section: Introductionmentioning

confidence: 99%

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

Iwashita

Hibi

Ohyama

et al. 2017

J Hepatobiliary Pancreat Sci

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Background We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. Methods Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median AE 1 after stratification by workplace and LC experience level. Results Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. 'Diffuse scarring in the Calot's triangle area' in the 'Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. Conclusions A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

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Evaluation and stages of surgical innovations

Cited by 496 publications

References 54 publications

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Integrating pharmacology and clinical pharmacology

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

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