1. The document discusses research design and evidence-based medicine. It provides definitions of different types of studies including observational studies, experimental studies, randomized controlled trials, and systematic reviews.
2. Guidelines for evaluating levels of evidence and grading strength of recommendations are presented. Key resources for evidence-based medicine are also listed, including the Cochrane Collaboration.
3. The use of interstitial laser hyperthermia for the treatment of solid tumors like the pancreas is explored. Studies on this technique for fibroadenomas and human pancreatic tumors are summarized.
From History to Application Procedure OF CLINICAL TRIALS IN INDIA. PHASES 0,1,2,3,4 & 5.IMPORTANCE, advantages, guidelines global and India. Types, Design & blinding technique.
4-Evidence Based Practice (EBP) is a problem-solving approach tobartholomeocoombs
4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:
Level I
Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis
Level II
Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.
Level III
Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis
Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
Includes:
- Clinical practice guidelines
- Consensus panels
Level V
Based on experiential and non-research evidence.
Includes:
- Literature reviews
- Quality improvement, program or financial evaluation
- Case reports
- Opinion of nationally recognized expert(s) based on experiential evidence.
According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:
Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a 'gold standard' for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy
Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by 'gold standard') compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy
Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation
Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).
References
Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html
Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https:// ...
Introduce IUON students to evidence-based nursing literature and effective strategies for searching for and accessing evidence-based research in nursing.
From History to Application Procedure OF CLINICAL TRIALS IN INDIA. PHASES 0,1,2,3,4 & 5.IMPORTANCE, advantages, guidelines global and India. Types, Design & blinding technique.
4-Evidence Based Practice (EBP) is a problem-solving approach tobartholomeocoombs
4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:
Level I
Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis
Level II
Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.
Level III
Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis
Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
Includes:
- Clinical practice guidelines
- Consensus panels
Level V
Based on experiential and non-research evidence.
Includes:
- Literature reviews
- Quality improvement, program or financial evaluation
- Case reports
- Opinion of nationally recognized expert(s) based on experiential evidence.
According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:
Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a 'gold standard' for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy
Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by 'gold standard') compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy
Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation
Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).
References
Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html
Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https:// ...
Introduce IUON students to evidence-based nursing literature and effective strategies for searching for and accessing evidence-based research in nursing.
3.conducting research effectively in a clinical setup with voice oversAnjali Ahuja
Informative content on types of clinical study like experimental and non-experimental studies with examples which explains what kind of study yields specific results, when to consider hypothesis, how observational study differs from experimental etc.
Most clinicians neither have enough time nor are trained to pick the best information from the enormous literature available. By practicing Evidence Based Medicine, they can give better patient care. EBM is the integration of the best research evidence with clinical expertise and patient values to make clinical decisions
What is research, Types of research, Requisites of good research, Concept in epidemiology, Epidemiologic studies , Literature search, Protocol designing, Ethical issues, Dissertation writing , Research paper writing , Reviewing a research paper
How to scientifically conduct a clinical professional research trial? In the current era of Collaborate or parish, we need to keep this design in our mind.
Enjoy
@copyLeft
3.conducting research effectively in a clinical setup with voice oversAnjali Ahuja
Informative content on types of clinical study like experimental and non-experimental studies with examples which explains what kind of study yields specific results, when to consider hypothesis, how observational study differs from experimental etc.
Most clinicians neither have enough time nor are trained to pick the best information from the enormous literature available. By practicing Evidence Based Medicine, they can give better patient care. EBM is the integration of the best research evidence with clinical expertise and patient values to make clinical decisions
What is research, Types of research, Requisites of good research, Concept in epidemiology, Epidemiologic studies , Literature search, Protocol designing, Ethical issues, Dissertation writing , Research paper writing , Reviewing a research paper
How to scientifically conduct a clinical professional research trial? In the current era of Collaborate or parish, we need to keep this design in our mind.
Enjoy
@copyLeft
Memorandum Of Association Constitution of Company.pptseri bangash
www.seribangash.com
A Memorandum of Association (MOA) is a legal document that outlines the fundamental principles and objectives upon which a company operates. It serves as the company's charter or constitution and defines the scope of its activities. Here's a detailed note on the MOA:
Contents of Memorandum of Association:
Name Clause: This clause states the name of the company, which should end with words like "Limited" or "Ltd." for a public limited company and "Private Limited" or "Pvt. Ltd." for a private limited company.
https://seribangash.com/article-of-association-is-legal-doc-of-company/
Registered Office Clause: It specifies the location where the company's registered office is situated. This office is where all official communications and notices are sent.
Objective Clause: This clause delineates the main objectives for which the company is formed. It's important to define these objectives clearly, as the company cannot undertake activities beyond those mentioned in this clause.
www.seribangash.com
Liability Clause: It outlines the extent of liability of the company's members. In the case of companies limited by shares, the liability of members is limited to the amount unpaid on their shares. For companies limited by guarantee, members' liability is limited to the amount they undertake to contribute if the company is wound up.
https://seribangash.com/promotors-is-person-conceived-formation-company/
Capital Clause: This clause specifies the authorized capital of the company, i.e., the maximum amount of share capital the company is authorized to issue. It also mentions the division of this capital into shares and their respective nominal value.
Association Clause: It simply states that the subscribers wish to form a company and agree to become members of it, in accordance with the terms of the MOA.
Importance of Memorandum of Association:
Legal Requirement: The MOA is a legal requirement for the formation of a company. It must be filed with the Registrar of Companies during the incorporation process.
Constitutional Document: It serves as the company's constitutional document, defining its scope, powers, and limitations.
Protection of Members: It protects the interests of the company's members by clearly defining the objectives and limiting their liability.
External Communication: It provides clarity to external parties, such as investors, creditors, and regulatory authorities, regarding the company's objectives and powers.
https://seribangash.com/difference-public-and-private-company-law/
Binding Authority: The company and its members are bound by the provisions of the MOA. Any action taken beyond its scope may be considered ultra vires (beyond the powers) of the company and therefore void.
Amendment of MOA:
While the MOA lays down the company's fundamental principles, it is not entirely immutable. It can be amended, but only under specific circumstances and in compliance with legal procedures. Amendments typically require shareholder
Taurus Zodiac Sign_ Personality Traits and Sign Dates.pptxmy Pandit
Explore the world of the Taurus zodiac sign. Learn about their stability, determination, and appreciation for beauty. Discover how Taureans' grounded nature and hardworking mindset define their unique personality.
Unveiling the Secrets How Does Generative AI Work.pdfSam H
At its core, generative artificial intelligence relies on the concept of generative models, which serve as engines that churn out entirely new data resembling their training data. It is like a sculptor who has studied so many forms found in nature and then uses this knowledge to create sculptures from his imagination that have never been seen before anywhere else. If taken to cyberspace, gans work almost the same way.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
RMD24 | Debunking the non-endemic revenue myth Marvin Vacquier Droop | First ...BBPMedia1
Marvin neemt je in deze presentatie mee in de voordelen van non-endemic advertising op retail media netwerken. Hij brengt ook de uitdagingen in beeld die de markt op dit moment heeft op het gebied van retail media voor niet-leveranciers.
Retail media wordt gezien als het nieuwe advertising-medium en ook mediabureaus richten massaal retail media-afdelingen op. Merken die niet in de betreffende winkel liggen staan ook nog niet in de rij om op de retail media netwerken te adverteren. Marvin belicht de uitdagingen die er zijn om echt aansluiting te vinden op die markt van non-endemic advertising.
Enterprise Excellence is Inclusive Excellence.pdfKaiNexus
Enterprise excellence and inclusive excellence are closely linked, and real-world challenges have shown that both are essential to the success of any organization. To achieve enterprise excellence, organizations must focus on improving their operations and processes while creating an inclusive environment that engages everyone. In this interactive session, the facilitator will highlight commonly established business practices and how they limit our ability to engage everyone every day. More importantly, though, participants will likely gain increased awareness of what we can do differently to maximize enterprise excellence through deliberate inclusion.
What is Enterprise Excellence?
Enterprise Excellence is a holistic approach that's aimed at achieving world-class performance across all aspects of the organization.
What might I learn?
A way to engage all in creating Inclusive Excellence. Lessons from the US military and their parallels to the story of Harry Potter. How belt systems and CI teams can destroy inclusive practices. How leadership language invites people to the party. There are three things leaders can do to engage everyone every day: maximizing psychological safety to create environments where folks learn, contribute, and challenge the status quo.
Who might benefit? Anyone and everyone leading folks from the shop floor to top floor.
Dr. William Harvey is a seasoned Operations Leader with extensive experience in chemical processing, manufacturing, and operations management. At Michelman, he currently oversees multiple sites, leading teams in strategic planning and coaching/practicing continuous improvement. William is set to start his eighth year of teaching at the University of Cincinnati where he teaches marketing, finance, and management. William holds various certifications in change management, quality, leadership, operational excellence, team building, and DiSC, among others.
3.0 Project 2_ Developing My Brand Identity Kit.pptxtanyjahb
A personal brand exploration presentation summarizes an individual's unique qualities and goals, covering strengths, values, passions, and target audience. It helps individuals understand what makes them stand out, their desired image, and how they aim to achieve it.
Affordable Stationery Printing Services in Jaipur | Navpack n PrintNavpack & Print
Looking for professional printing services in Jaipur? Navpack n Print offers high-quality and affordable stationery printing for all your business needs. Stand out with custom stationery designs and fast turnaround times. Contact us today for a quote!
Discover the innovative and creative projects that highlight my journey throu...dylandmeas
Discover the innovative and creative projects that highlight my journey through Full Sail University. Below, you’ll find a collection of my work showcasing my skills and expertise in digital marketing, event planning, and media production.
Cracking the Workplace Discipline Code Main.pptxWorkforce Group
Cultivating and maintaining discipline within teams is a critical differentiator for successful organisations.
Forward-thinking leaders and business managers understand the impact that discipline has on organisational success. A disciplined workforce operates with clarity, focus, and a shared understanding of expectations, ultimately driving better results, optimising productivity, and facilitating seamless collaboration.
Although discipline is not a one-size-fits-all approach, it can help create a work environment that encourages personal growth and accountability rather than solely relying on punitive measures.
In this deck, you will learn the significance of workplace discipline for organisational success. You’ll also learn
• Four (4) workplace discipline methods you should consider
• The best and most practical approach to implementing workplace discipline.
• Three (3) key tips to maintain a disciplined workplace.
Explore our most comprehensive guide on lookback analysis at SafePaaS, covering access governance and how it can transform modern ERP audits. Browse now!
1. 1
Research Design & EBM
Ravi Kant
MS, DNB, FAMS, FRCS (Edin), FRCS (Glasg), FRCS
(Engl.), FRCS (Irel.), FACS, FICS, FAIS
Professor of Surgery
2. 2
Science
Intelligent Hypothesis
Experiments & analysis of results prove
that hypothesis is correct.
Replicable universally= Most Important
3. 3
Evidence based medicine:
what it is and what it isn't
Integrating individual clinical
expertise and the best external
evidence
BMJ 1996;312:71-72 (13 January)
Editorial
7. 7
Type of study Definition
Observational
Evaluating results of condition or treatment in a defined
population
Retrospective: analyzing past events
Prospective: collecting data contemporaneously
Case-control
Series of patients with a particular disease or condition contrasted
with matched control patients
Cross-sectional
Measurements mode on a single occasion, not looking at whole
population but selecting small similar group & expanding results
Longitudinal
Measurements are taken over a period of time, not looking at
whole population but selecting small similar group & expanding
results
Experimental
Two or more treatments are compared. Allocation to treatment
groups is under the control of the researcher
Randomized Two randomly allocated treatments
Randomized controlled Includes control group with no treatment
13. 13
Longitudinal
Measurements are taken over
a period of time, not looking at
whole population but selecting
small similar group &
expanding results
14. 14
Experimental
Two or more treatments are
compared. Allocation to
treatment groups is under the
control of the researcher
23. 23
Levels of evidence
1= Meta-analyses of Prospective Double
blind randomized controlled trials
2=Prospective Randomized Controlled study/
Meta-analyses of retrospective studies
3= Case series/ Cohort study
4= Case report/ observational
5= Expert opinion
24. 24
Evidence grade: I
I (High): the described effect is
plausible, precisely quantified and not
vulnerable to bias
25. 25
Evidence grade: I
II (Intermediate): the described effect is
plausible but is not quantified precisely or
may be vulnerable to bias
26. 26
Evidence grade : III
III (Low): concerns about plausibility or
vulnerability to bias severely limit the value
of the effect being described and
quantified
29. 29
Strength of recommendation
Definition C
C=Recommendation based on consensus,
usual practice, opinion, disease-oriented
evidence or case series for studies of
diagnosis, treatment, prevention, or
screening.
31. 31
Recommendation grade : B
B (Provisional recommendation): on
balance of evidence, a pattern of care is
recommended with caution
32. 32
Recommendation grade : C
C (Consensus opinion): evidence being
inadequate, a pattern of care is
recommended by consensus
33. 33
US Government Agency for
Health Care Policy and Research
(AHCPR):A
A: requires at least one randomized
controlled trial as part of the body of
evidence.
34. 34
US Government Agency for
Health Care Policy and Research
(AHCPR):B
B: requires availability of well-
conducted clinical studies but no
randomized controlled trials in the body
of evidence.
35. 35
US Government Agency for
Health Care Policy and Research
(AHCPR):C
C: requires evidence from expert
committee reports or opinions and/ or
clinical experience of respected
authorities. Indicates absence of
directly applicable studies of good
quality
37. 37
Grading of evidence
Ia: Systematic review or meta-analysis of
randomized controlled trials
Ib: at least one randomized controlled trial
IIa: at least one well-designed controlled study
without randomization
IIb: at least one well-designed quasi-experimental
study, such as a cohort study
III: well-designed non-experimental descriptive
studies, such as comparative studies, correlation
studies, case–control studies and case series
IV: expert committee reports, opinions and/or
clinical experience of respected authorities
38. 38
Grading of
recommendations
A: based on hierarchy I evidence
B: based on hierarchy II evidence or
extrapolated from hierarchy I evidence
C: based on hierarchy III evidence or
extrapolated from hierarchy I or II evidence
D: directly based on hierarchy IV evidence or
extrapolated from hierarchy I, II or III
evidence
40. 40
Research can be Quantitative:
A medical condition is analyzed
systematically using hard, objective end
point such as death or amputation.
41. 41
Research can be Qualitative
Data come from patient narratives, and
the psychosocial impact of the disease
and its treatment are analyzed, for
example narratives of breast cancer.
43. 43
Sample size
An incorrect sample size is probably the
most frequent reason for research to be
invalid.
Never forget that more patients will
need to be randomized than the final
sample size to take into account
patients who die, drop out or are lost to
follow up.
47. 47
Eliminating bias: Single blind
The observers or recorders who do not
know which treatment has been used.
48. 48
Eliminating bias: Double blind
Neither patient nor researcher is aware
of which therapy has been used until
after study has finished, & these are
the best randomized studies.
49. 49
The Cochrane Collaboration
Best evidence
an international not-for-profit and independent
organization,
It produces and disseminates systematic
reviews of healthcare interventions and
promotes the search for evidence in the form
of clinical trials and other studies of
interventions.
The Cochrane Collaboration was founded in
1993 and named after the British
epidemiologist, Archie Cochrane.
50. 50
Current reliable evidence-
based medicine resources for
the busy clinician -1
American College of Physicians Journal Club
http://www.acpj.org
American Family Physician
http://www.aafp.org/afp
Bandolier http://www.rj2.ox.ac.uk/bandolie
Clinical Evidence
http://www.clinicalevidence.com
51. 51
Current reliable evidence-
based medicine resources for
the busy clinician -2
Cochrane Database of Systematic Reviews
http://www.cochrane.org/reviews/en/
Database of Abstracts of Reviews of Effects (DARE)
http://www.york.ac.uk/inst/crd/crddatabases.htm
Dr. Alper's Useful Links
http://www.myhq.com/public/a/l/alperDynaMed http:
//www.dynamicmedical.com
Family Practitioners Inquiries Network (FPIN) Clinical
Inquiries http://www.fpin.org
FIRSTConsult http://www.firstconsult.comInfoPOEMs
– The Clinical Awareness
Systemhttp://www.infopoems.com
52. 52
Current reliable evidence-
based medicine resources for
the busy clinician -3
Institute for Clinical Systems Improvement
(ISCI) http://www.icsi.org/knowledge
Journal of Family Practice
http://www.jfponline.org
SUM Search http://sumsearch.uthscsa.edu
TRIP Database
http://www.tripdatabase.comUpToDate http://
www.uptodate.com
53. 53
Current reliable evidence-
based medicine resources for
the busy clinician -4
US National Guideline Clearinghouse
http://www.guidelines.gov
U.S. Preventive Services Task Force (USPSTF)
Recommendations
http://www.ahrq.gov/clinic/uspstfix.htm
54. 54
Current reliable evidence-
based medicine resources for
the busy clinician -5
Bandolier
Evidence based thinking about healthcare
Cochrane Library Database of Systematic Reviews
Full text systematic reviews of health care interventions, prepared by The Cochrane
Collaboration.
The Database of Abstracts of Reviews of Effects (DARE)
Critical appraisal of systematic reviews published in the medical literature.
Health Technology Assessment Database (HTA)
Completed and on-going health technology assessments from around the world
NHS Economic Evaluation Database (NHS EED)
Reliable information about the costs as well as the effects of drugs, treatments and
procedures, to inform decisions.
UK Database of Uncertainties about the Effects of Treatments
Publishes those patients' and clinicians' questions about the effects of treatments
which cannot currently be answered reliably by referring to up-to-date systematic
reviews of existing research.
55. 55
Web search-6
Clinical evidence.com
Cochrane.org
Consolidated Standards of Reporting
trials= consort-statement.htm
National Institute for Health & Clinical
excellence (NICE.org.uk
Scottish Intercollegiate Guideline
Network (SIGN) www.sign.ac.uk
65. 65
POEMS
Journals with highest frequency of
articles that contain patient
oriented evidence
that matters (POEMs)
66. 66
Impact factor
= average number of citations
to those papers that were
published during the two
preceding years.
67. 67
Impact factor
For example, the 2008 impact factor of a
journal would be calculated as follows:
A = the number of times articles published in
2006 and 2007 were cited by indexed journals
during 2008
B = the total number of "citable items" published
in 2006 and 2007. ("Citable items" are usually
articles, reviews, proceedings, or notes; not
editorials or Letters-to-the-Editor.)
2008 impact factor = A/B
68. 68
High-impact journals (those
cited most frequently by others)
Annals of Internal Medicine
British Medical Journal
Journal of the American Medical
Association
Lancet
New England Journal of Medicine
70. 70
Preclinical studies
Even animal studies need ethical
clearance in Europe
Efficacy, toxicity and pharmacokinetic
data
71. 71
Phase 0
Human microdosing
Distinctive features of Phase 0 trials include
the administration of single subtherapeutic
doses of the study drug to a small number of
subjects (10 to 15) to gather preliminary data
on the agent's pharmacokinetics (how the
body processes the drug)
and pharmacodynamics (how the drug works
in the body)
73. 73
SAD
Single Ascending Dose studies
MAD
Multiple Ascending Dose studies
Crossover study
A short trial designed to investigate any differences in
absorption of the drug by the body, caused by eating before
the drug is given. These studies are usually run as
a crossover study, with volunteers being given two identical
doses of the drug on different occasions; one while fasted,
and one after being fed.
74. 74
Phase II
Larger group
Phase IIA is specifically designed to
assess dosing requirements (how much
drug should be given).
Phase IIB is specifically designed to
study efficacy (how well the drug works
at the prescribed dose(s)).
76. 76
Phase III
Phase III studies are randomized
controlled multicenter trials on large
patient groups (300–3,000 or more
depending upon the disease/medical
condition studied)
77. 77
Phase IV
Phase IV trial is also known as Post
Marketing Surveillance Trial
= Pharmacovigilance
78. 78
Research Design
It's always easier to explain design
notation through examples than it is to
describe it in words. The figure shows
the design notation for apretest-
posttest (or before-after)
treatment versus comparison
group randomized
81. 81
Experimental study- steps
Animal model
Induce tumor by viral inoculation
Treat tumor by various laser
wavelength
Correct wavelength applied in incurable
humans
Regular Clinical approach
82. 82
Pilot study
Somprakas Basu, Bina Ravi & Ravi
Kant: Interstitial laser Hyperthermia, a
New Method in the Management of
Fibroadenoma of the Breast: A Pilot
Study. Lasers in Surgery and
Medicine, 1999: Vol. 25: p 148-152.
91. 91
ILH & Pancreas
Kant Ravi, Masters A, Lees WR, Bown
SG: Interstitial Laser Hyperthermia in
Human pancreas tumors: GUT,
supplement 1992. Vol. 33 No 1 W69,
p S18.
92. 92
Lab studies► need
infrastructure
Hedau S, Jain N, Husain SA, Mandal AK, Ray
G, Shahid M, Kant R, Gupta V, Shukla NK,
Deo SS, & Das BC. Novel germ line
mutations in breast cancer susceptibility
genes BRCA1, BRCA2 and p53 gene in
breast cancer patients from India. Breast
Cancer Research Treat 2004 Nov,
88(2):177-86.
93. 93
The Liver: The drains do not
offer any benefit after
elective liver resections.
Marcello Spampinato Hassan Elberm & Colin D
Johnson in Recent Advances in Surgery # 31, by
Irving Taylor & Colin Johnson, The Royal Society
of Medicine Press, 2008 page 189-
Gurusamy KS, Samraj K, Davidson BR. Routine
abdominal drainage for uncomplicated liver
resections. Cochrane Database Systemic Rev
2007; CD006232
94. 94
GB
The Gall Bladder: The drains do not
offer any benefit after routine
uncomplicated laparoscopic
cholecystectomy.
Marcello Spampinato Hassan Elberm & Colin D
Johnson in Recent Advances in Surgery # 31, by
Irving Taylor & Colin Johnson, The Royal Society
of Medicine Press, 2008 page 196-
Gurusamy KS, Samraj K, Mullerat P et al.
Routine abdominal drainage for uncomplicated
laparoscopic cholecystectomy. Cochrane
Database Systemic Rev 2007; CD006004
95. 95
The Thyroid: No drain is
required following
thyroidectomy.
Khanna J, Mohil RS, Chintamani, Bhatnagar D, Mittal MK,
Sahoo M, Mehrotra M. Is the routine drainage after
surgery for thyroid necessary? A prospective randomized
clinical study [ISRCTN63623153]. BMC Surg. 2005 May
19; 5:11.
Suslu N, Vural S, Oncel M, Demirca B, Gezen FC, Tuzun B,
Erginel T, Dalkilic G. Is the insertion of drains after
uncomplicated thyroid surgery always necessary? Surg
Today. 2006; 36(3):215-8.
Lee SW, Choi EC, Lee YM et al. Is lack of placement of
drains after thyroidectomy with central neck dissections
safe? A prospective randomized study. Laryngoscope
2006;116:1632-1635
96. 96
The Breast: No drain is
required after conservation
surgery for breast cancer
Stojkovic C, Smeulders MJ, Van der Horst
CM. Wound drainage after plastic and
reconstructive surgery of the breast
(Protocol). Cochrane Database of
Systematic Reviews 2008, Issue 3. Art.
No.: CD007258. DOI:
10.1002/14651858.CD007258.
97. 97
Rectal Surgery: The pelvic
drainage after rectal surgery adds
no benefit.
Urbach DR, Kennedy ED, Cohen MM.
Colon and rectal anastomosis donot
require routine drainage: a systemic
review and meta-analysis. Ann Surg
1999; 229:174-180.
98. 98
Incision by electrocautery heal as
well as incision by knife. No
difference in either postoperative
results or in cosmesis.
Kears SR, Connolly EM, Mc Nally S,
McNamara DA, Deasy J. Randomized
clinical trial of diathermy versus scalpel
incision in elective midline laparotomy.
Br J Surg 2001; 88:41-44.
100. 100
Evidence-Based surgery
Evidence-base study is a move to find out the
best ways of managing patients using clinical
evidence from collected studies.
Collecting published evidence together and
analyzing it often requires review of multiple
randomized trials.
These meta-analysis involve complex
statistical analysis designed to interpret
multiple findings and synthesize the results of
multiple studies.
101. 101
Important advantages of
evidence-based medicine
Has the potential to improve quality of patient care
Identifies and promotes practices that are proven
scientifically to be effective
Identifies practices that are ineffective or harmful
Promotes critical thinking
Requires clinicians to be open-minded
Encourages researchers to focus on evidence and
outcomes that are important to clinicians and
patients
102. 102
Type of study Definition
Observational
Evaluating results of condition or treatment in a defined
population
Retrospective: analyzing past events
Prospective: collecting data contemporaneously
Case-control
Series of patients with a particular disease or condition contrasted
with matched control patients
Cross-sectional
Measurements mode on a single occasion, not looking at whole
population but selecting small similar group & expanding results
Longitudinal
Measurements are taken over a period of time, not looking at
whole population but selecting small similar group & expanding
results
Experimental
Two or more treatments are compared. Allocation to treatment
groups is under the control of the researcher
Randomized Two randomly allocated treatments
Randomized controlled Includes control group with no treatment