Surgical practice is evidence based

Howes, Noah; Chagla, Leena; Thorpe, Matthew; McCulloch, Peter

doi:10.1046/j.1365-2168.1997.00513.x

Cited by 110 publications

(84 citation statements)

References 20 publications

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“…[4][5][6]69 We found that two-thirds of interventions were based on the highest level of evidence and that routine practice in our unit is supported by good quality of evidence. Using similar classification, Kingston et al, 8 in a retrospective audit, found that 45% of interventions in surgical practice were based on randomised-controlled trials or better evidence.…”

Section: Discussionmentioning

confidence: 99%

“…In their retrospective study they found that 82% of patients received evidence-based interventions. Jemec et al 5 found that threequarters of dermatologic outpatient therapy is based on scientific evidence and Howes et al 6 concluded that in-patient general surgery is evidence based, but the proportion of surgical treatments supported by randomised-controlled trials is much smaller than that found in general medicine. In 2003, a clinical audit was conducted at Hong Kong eye hospital to determine the proportion of evidence-based interventions in their emergency unit.…”

Section: Introductionmentioning

confidence: 99%

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Evidence-based practice in acute ophthalmology

Bhatt¹,

Sandramouli²

2006

Eye

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Aim To study the overall level of evidencebased practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs). Methods The case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and its intervention was ascertained. A literature search using Medline and Cochrane library was performed to assess the level of evidence provided for each diagnosis-intervention pair. Each diagnosisintervention pair was evaluated and graded to assess the best level of evidence provided. Results A total of 474 new patients attended the eye casualty during the study period. No diagnosis was made in 27 cases and they were excluded from the analysis. Out of 447 patients, 308 (68.9%) cases were managed by NPs and 139 (31.1%) by doctors. A total of 294 (65.8%) patient interventions were based on evidence from systematic reviews, metaanalysis and randomised-controlled trials, of which 223 were managed by NPs and 71 by ophthalmologists. This difference was statistically significant with Po0.001. One hundred and seven (23.9%) interventions were supported by evidence from prospective and retrospective trials. Conclusion This study demonstrated that two-thirds of interventions were based on the highest level of evidence and was comparable to studies performed in other specialities. It also highlights the advanced role of trained NPs in acute ophthalmology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evidence-based practice in acute ophthalmology

Bhatt¹,

Sandramouli²

2006

Eye

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“…This is associated on the one hand with the degree of difficulty in conducting this type of study and on the other essentially with the following facts: the need to work with numerous and comparable groups of patients, therefore considerable sample sizes if what is desired is to obtain results with appropriate power and the problem of administering placebos to the "control group", a group that is sometimes the one compared to a group that was operated on Howes et al, 1997;Sondenaa et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Literature with Different Types of Designs

et al. 2009

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SUMMARY:In certain situations, which occur with particular frequency in the field of surgery and its related disciplines (where what predominates are observational-type studies), the management of randomized controlled clinical trials (RCT) is very difficult and as such, conducting a systematic review (SR) based on RCT and realice a meta-analysis is even more difficult. Therefore, we have generated a methodology for implementing a SR with different types of designs (including observational studies) as an alternative in order to clarify the uncertainty in the field of therapy when there are few RCT and the evidence relies so heavily on descriptive and observational studies. The aim of this study, was to set out a methodology that leads to a SR with various types of designs. Methodologycally, this is based on consideration of the different primary studies through the application of a methodological quality score made up of 3 items (type of study design, size of the population studied and methodology used in the study). Once assigned a point score, a calculation of weighted averages with their respective confidence intervals of 95% is applied to each variable to be studied, which finally enables to apply a metaanalysis and compare groups. A methodological proposal leading to a SR with various types of designs.

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“…Adequately powered head-tohead studies are warranted in order to clarify these issues. These trials should have a rigorous design with participants being randomised to clinicians who will only undertake the intervention they are expert in (Howes, 1997). …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

et al. 2010

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SUMMARY:The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately.

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Surgical practice is evidence based

Cited by 110 publications

References 20 publications

Evidence-based practice in acute ophthalmology

Evidence-based practice in acute ophthalmology

Systematic Review of Literature with Different Types of Designs

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

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