What kind of Evidence do we need in Surgery?

In percutaneous coronary intervention, the key to stent patency and therefore prevention of clinical events is inhibition of platelet function. Aspirin is the best know inhibitor of platelet function & has been around forever. Over the past 10 years, we have had many more - clopidogrel, abciximab, ticlopidine, pasugrel and now ticagrelor - each one shown to be superior to the last in good quality randomised controlled studies.

Endoscopic Vein Harvesting and the Disingenuity of NICE.

In the coronary artery bypass (CABG) operation, saphenous vein is harvested from the leg for use as a conduit to bypass stenoses in coronary arteries. This harvesting can be done in 2 ways - open harvest i.e. using an incision that is as long as the length of vein required or endoscopic harvest using a 3cm incision above the knee to harvest any length of vein.

RUNNING TO KEEP STILL

The results of an unprecedented number of trials involving cardiac surgical ops have been published recently. Most have been in the NEJM here, here and here. Many, including the results of the Partner Cohort A trial  were announced for the first time at the recent annual meeting of the American College of Cardiology. I have commented on the results of the Partner trial in my last post. Many of these trials have

CRITICAL APPRAISAL

I read a lot of cardiothoracic and cardiac related abstracts every week. Occasionally I may read the whole paper. When I do this, I critically appraise the paper in my head and usually summarise on the blog. I have decided therefore that I ought to start a formal journal club. Every week I will pick a paper and formally critically appraise it. There are a number of formal critical appraisal sheets available on various Evidence Based Medicine websites. Examples include the excellent BestBet topics, and the authoritative centre for evidence based medicine at Oxford University and the new NHS public health website.
So watch this space.

IT'S OK TO SCREW UP, NO REALLY !

Why Letting Yourself Make Mistakes Means Making Fewer of Them | Psychology Today In this paper a psychologist explains how if we mentally give ourselves permission to screw up, we are less likely to do so.

NUDGE NUDGE

Secondary Prevention After Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation Into Practice -- Williams et al., 10.1161/CIRCULATIONAHA.110.981068 -- Circulation
Until relatively recently, reporting of outcomes (especially in cardiac surgery) was perceived as being the key towards quality improvement. The past 6 to 12 months has seen a shift towards ensuring that the

EVIDENCE

JAMA -- Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer: A Randomized Trial, November 24, 2010, Annema et al. 304 (20): 2245

I used to practice both cardiac and thoracic surgery until August 2007. After the appointment of 2 purely thoracic surgeons to our department, 2 of us who practiced both disciplines had to give up thoracic surgery. For various reasons that I won't go into now, I decided to give up thoracic surgery and stick to cardiac. Although this paper will not affect my practice, it still gives me great pleasure to see a well conducted surgical trial that produces good evidence that surgeons can use in their everyday practice - even though the results of the study means less surgery. We need more of these.