Chapter 9 – Evidence-Based Surgery Critically Assessing Surgical Literature

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1、CHAPTER9EVIDENCE-BASEDSURGERY:CRITICALLYASSESSINGSURGICALLITERATUREDavidR.Flum,FarhoodFarjah,andNaderMassarwehregulatoryoversightandadriveformoreaccountablecare,itiswhatisthepurposeofthestudy?essentialthatsurgeonsunderstandandembracetheapproachofwhatisbeingcompare

2、d?evidence-basedsurgerysotheycanimprovethecareoftheirwhatistheoutcomeofinterest?patientsandmaintainaleadershiproleinhealthpolicyandwhatisthestudydesign?qualityimprovementactivities.Thegoalofthischapteristohelpwhatisthesourceofdata?thereaderbecomeamorecriticalevalu

3、atorofthesurgicallit-aretherenonanalyticissuesworthyofconsideration?eratureandadvancetheuseofbetterevidenceinsurgicalprac-howwerethedataanalyzed?tice.Tothatend,thischapterisframedthroughquestionsthatarethereethicalconsiderations?acriticalreadershouldaskwhenreading

4、aresearchstudy.conclusionsWHATISTHEPURPOSEOFTHESTUDY?Assessingthevalueofastudyrequiresanunderstandingoftheinvestigator’sintendedpurpose.MoststudiescanbeplacedintoNotlongago,caseseriespublishedbyasinglesurgeonorgrouponeoftwogeneralcategories,descriptive(orexplorato

5、ry)andofsurgeonsreportingtheresultsofanovelmanagementstrategyanalytic(Fig.9-1).Mostdescriptivestudiesshouldbeconsid-ornewtechniquewerethemainstayofcommunicationintheeredhypothesis-generatingratherthancausality-focusedwhereassurgicalcommunity.Thesereportshighlighte

6、dsurgicaladvancesanalyticstudiestestaprespecifiedhypothesis.Astudy’spurposethatcouldbeappliedtopatients,butoftenreflectedthebestshoulddrivetheselectionofstudygroups,outcomesofinterest,surgeonsreportingtheirbestresults.Suchreportsrepresenteddatasources,studydesign,

7、andanalyticplan.Unfortunately,muchoftheevidencebasethatguidedsurgicalpractice.However,manystudiesfallshortinlinkingstudypurposeandmethodol-withgrowingrecognitionthatalmosteveryonewillrequireogy;investigatorsmaysometimestrytoestablishcausalityfromsurgeryatsomepoint

8、intheirlives,surgicaldiseaseisbeingdescriptivestudies.Forexample,inastudydescribingtrendsinincreasinglyconsideredinthecontextofthepublic’shealth.themisd