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Evidence-based medicine is using the best available evidence in order to make accurate and knowledgeable treatment decisions. It is not the automatic gainsay of “low quality” evidence and acceptance of randomized controlled trials (RCT's). To be able to make a sound recommendation for a therapy based on the best available evidence, it is necessary to follow steps in acquiring literature, appraising...
The evidence-based medicine (EBM) related concepts of hierarchy of evidence, meta-analyses, confidence intervals, study design, etc. are nowadays so widespread, that clinicians willing to use today's medical literature with understanding have no choice but to become familiar with EBM principles and methodologies.Although surgeons may perceive that evidence-based medicine mandates a strict adherence...
The issues concerning treatment decision-making are that often options for treatment lead to uncertain outcomes (benefits and risks) at the individual patient level and that both patients and physicians might value these outcomes differently. There are three main approaches commonly used to describe treatment decision-making including paternalistic, shared and informed decision-making. The challenge...
Teaching EBM is to impart the process of asking the question, acquiring and appraising the literature and applying it to the care of the patient, while weighing the risks, benefits and considering patient values. Teaching this process and its necessary content requires as with everything else, dedication, knowledge and practice. The best way to teach both patient care and EBM is by example.
Randomised trials top the hierarchy of evidence. To provide the best evidence to guide surgical practice, randomised trials must answer clinically important questions, have important and objective outcome measurement and be sufficiently powered to detect important differences between interventions. Investigators who adhere to these principles are more likely to succeed during the conduct of their...
We have seen an emergence of larger scale collaborative multi-center trials in surgery. These larger trials have the advantage of increased generalisability of the results and the potential for large scale and efficient recruitment (1000 patients or more). It is estimated that the average cost of bringing a new drug to market approximates 500 million dollars. The funding limitations in most national...
There are several issues that one has to take into consideration in order to avoid potential pitfalls in the design of orthopaedic studies. This article highlights how to avoid common errors and how to continue the drive towards the unattainable, but laudable, goal of perfection.
When reading an article of interest in the orthopaedic literature it is necessary to appraise the quality of the evidence therein. First, the reader should determine the design of the study. If the level of the study design in the hierarchy of evidence is lower, the inferences that are drawn from the study are weaker. Second, the article should be assessed for the quality indicators relevant to the...
Identification of information on a specific topic of interest can be a difficult and time-consuming task. The key to successful and time-efficient article identification is to use easily accessible, complete, and most up-to-date information sources and to perform a focused search that minimises hits without missing relevant articles. Pre-appraised articles and databases allowing “pre-filtering” techniques...
This paper discusses topics related to the planning and implementation of non-randomised clinical studies in orthopaedics.A well-conducted case-series is appropriate to demonstrate the safety of a surgical intervention. The case-series design involves the provision of a defined intervention to a group of patients with the ultimate objective of describing the final outcome, including such occurrences...
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