evidence based surgery hospital

Medical guidelines should insists on proof that time-honored medical practices and procedures that cost money and may harm or kill patients are actually effective. This Forum is about how to force organized veterinary medicine to issue Evidence Based Guidelines.

evidence based surgery hospital

Postby malernee » Fri Jun 11, 2004 5:46 am

BMJ 2004;328:1396 (12 June), doi:10.1136/bmj.328.7453.1396-b
New centre is set up to promote evidence based surgery in the United Kingdom
London Zosia Kmietowicz

What is thought to be the world’s first centre to help coordinate clinical trials into surgical interventions opened this week in the United Kingdom.

The de Lotbinière Facial Surgery Research Centre is the brainchild of Mr Iain Hutchison, consultant in oral and maxillofacial surgery at St Bartholomew’s Hospital and the Royal London Hospital.

The centre aims to stimulate research and provide rapid answers to important questions about the value of surgical techniques for treating conditions affecting the mouth and face. Unlike drug interventions, surgical treatments—:for a number of reasons—:are rarely covered by randomised trials, said Mr Hutchison,

One of the problems is that surgeons tend to work on their own and may in their working life see just a handful of patients with rare conditions requiring surgery. By providing surgeons with the infrastructure to carry out research, the centre will help bring together the experiences of surgeons around the country into meaningful research.

"No one surgeon sees enough patients to run a randomised controlled trial. But as new surgical treatments come on board we need to find out if they are any good, which means we need to organise effective collaborative clinical trials," said Mr Hutchison.

The new centre will also tackle the lack of funding for research into surgical treatments by employing 14 research assistants to support surgeons taking part in studies.

Although studies into the effectiveness of drug treatments are often paid for by drug companies, surgical treatments do not carry the same potential profits and fail to attract the same sponsorship.

The centre will help surgeons to gain ethical approval for research and with data gathering and input, statistical analysis, and the general administration involved in carrying out a trial.

Iain Chalmers, coordinator of the James Lind Library, a web based information resource on medical treatments, said: "Differences of opinion among surgeons about which treatments to offer patients have too rarely been addressed in well controlled comparative studies. The launch of a centre committed to improving the evidence needed to inform decisions in the challenging sphere of head and neck surgery is an important development."

The centre is named after the barrister Henry de Lotbinière, who died in 2002 after a 15 year battle with cancer of the salivary gland. His chambers raised £150 000 ($276 100 ; €224 900) and donated the money to the charity the Facial Surgery Research Foundation—:Saving Faces, which is funding the centre. Mr Hutchison, who founded the charity in 2000, removed and remodelled many parts of Mr de Lotbinière’s face during his illness.

One study that the centre will be supporting will look into the value of radiotherapy after surgery for cancer of the salivary glands. On average a surgeon sees a patient with this type of cancer every three to four years. But by using the collaborative efforts of 40 surgeons in the United Kingdom the centre hopes to have results from enough patients to be statistically meaningful in five years.

For the time being the centre will just be supporting research into surgical interventions to treat conditions that affect the mouth and face, but in the future the scheme could be rolled out to cover other conditions, said Mr Hutchison.

"If it works it will be a model for other surgical groupings," he said.
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