The term “evidence-based medicine” was first coined by Sackett and colleagues as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”1 The key to practising evidencebased medicine is applying the best current knowledge to decisions in individual patients. Medical knowledge is continually and rapidly expanding. For clinicians to practise evidence-based medicine, they must have the skills to read and interpret the medical literature so that they can determine the validity, reliability, credibility and utility of individual articles. These skills are known as critical appraisal skills, and they require some knowledge of biostatistics, clinical epidemiology, decision analysis and economics, and clinical knowledge.
Evidence Based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS) and is supported by an educational grant from ETHICON and ETHICON ENDO-SURGERY, both units of Johnson & Johnson Medical Products, a division of Johnson & Johnson and ETHICON Inc. and ETHICON ENDO-SURGERY Inc., divisions of Johnson & Johnson Inc. The primary objective of EBRS is to help practising surgeons improve their critical appraisal skills. During the academic year, 8 clinical articles are chosen for review and discussion. They are selected for their clinical relevance to general surgeons and because they cover a spectrum of issues important to surgeons, including causation or risk factors for disease, natural history or prognosis of disease, how to quantify disease, diagnostic tests, early diagnosis and the effectiveness of treatment. A methodological article guides the reader in critical appraisal of the clinical article. Methodological and clinical reviews of the article are performed by experts in the relevant areas and posted on the EBRS website, where they are archived indefinitely. In addition, a listserv allows participants to discuss the monthly article. Surgeons who participate in the monthly packages can obtain Royal College of Physicians and Surgeons of Canada Maintenance of Certification credits and/or continuing medical education credits for the current article only by reading the monthly articles, participating in the listserv discussion, reading the methodological and clinical reviews and completing the monthly online evaluation and multiple choice questions.
We hope readers will find EBRS useful in improving their critical appraisal skills and in keeping abreast of new developments in general surgery. Four reviews are published in condensed versions in the Canadian Journal of Surgery and 4 are published in the Journal of the American College of Surgeons. For further information about EBRS, please refer to the CAGS or ACS websites. Questions and comments can be directed to the program administrator, Marg McKenzie, at mmckenzie@mtsinai.on.ca.
Reference
- Evidence-Based Medicine Working Group. Evidence-based medicine. JAMA 1992;268:2420-5.
Published Articles
48. What is the effect of screening mammography on breast cancer incidence?
47. Does the long-term use of aspirin decrease the risk of death due to cancer?
46. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes
45. Impact of the 80-hour resident work week on mortality and morbidity in trauma patients
42. Risks of complications by attending physicians after performing nighttime procedures
41. Cost–utility analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis
38. Guidelines for the management of Barrett esophagus with high-grade dysplasia?
36. Effect of high perioperative oxygen fraction on surgical site infection
35. Efficacy and safety of low-dose hydrocortisone therapy in the treatment of septic shock
34. Effects of ß-blockers in patients undergoing noncardiac surgery
33. The association between colonoscopy and deaths from colorectal cancer
32. Use of a surgical safety checklist to reduce morbidity and mortality
31. The use of intensive insulin therapy and penta-starch resuscitation in patients with severe sepsis
30. Prophylactic antibiotics for mesh inguinal hernioplasty
29. Computed tomographic angiography for the diagnosis of blunt cervical vascular injury
28. Comparison of on-demand and planned relaparotomy for secondary peritonitis
26. Watchful waiting versus repair of inguinal hernia in minimally symptomatic men
25. Perioperative chemotherapy and surgery versus surgery alone for resectable gastric cancer
24. Fast-track programs in colonic surgery
23. ASCO recommended guidelines for sentinal lymph node biopsy for early-stage breast cancer
22. The use of PET/CT scanning on the management of resectable pancreatic cancer
21. The risk of surgical site infection is reduced with perioperative oxygen
19. The effect of a decision aid on knowledge and treatment decision making for breast cancer
18. Treatment of occult pneumothoraces from blunt trauma
17. The timing of elective colectomy in diverticulitis: a decision analysis
16. Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism
15. Biphasic computed tomography with mesenteric evaluation of acute mesenteric ischemia
14. Preoperative fasting for adults to prevent perioperative complications
12. Primary repair for penetrating colon injuries
11. Evidence-based guidelines for children with isolated spleen or liver injury
9. Risk factors for retained foreign bodies after surgery
8. Efficacy and safety of recombinant human activated protein C for severe sepsis
7. Quality of life after bile duct injury during laparoscopic cholecystectomy
6. “GERD” as a risk factor for esophageal cancer
5. Need for preoperative radiation in rectal cancer
3. Helical computed tomography versus pulmonary arteriography in pulmonary embolism