Journal of Pharmaceutical and Biomedical Sciences

Evidence-based Medicine in Biliary Surgery: A Model of Applicability

Loudjedi Salim, Bereksi Amiana, Khemis Kamila, Dib Fadel, Toaba Toaba, Taouagh Nacereddine, Kherbouche Mouffok

Abstract


Background Evidence-based medicine (EBM) is the conscientious and judicious use of the best data in the literature for optimal care of patients. This must go through four steps: (1) formulation of a clear clinical question, (2) research documented facts, (3) analysis of results and (4) application of results in clinical practice.

Methods Our choice of application was gallstones and complications because it is a frequent and complex pathology that requires several clinical questions. The experimental design was considered to be a non-comparative cohort study (patients were exposed to evidence-based medicine). It can also be considered as a feasibility study. In our application we took the following steps: (1) formulation of several clinical questions, (2) literature search in medline using MeSH and Cochrane library, (3) analysis of results through critical reading of collected articles, (4) calculation of percentage of patients for each clinical
situation and correlating it with the levels of evidence. Then we estimated the matching of our application with EBM by calculating the number of positive responses.

Conclusion As a conclusion we were able to apply EBM with some degrees of confidence. However, some limitations related to environmental factors are still present. We can overcome this problem by introducing an educational learning model.


Keywords


evidence-based medicine, gallstones, non-comparative, cohort, education

Full Text:

References


Hayward RS, Guyatt GH, Moore KA, et al. Canadian physicians’ attitudes about and preferences regarding clinical practice guidelines. CMAJ. 1997;156:(12):1715–23.

O’Donnell MJ. A skeptic’s Medical dictionary. London: BMJ Publishing Group; 1997.

Sackett D, Rosenberg W, Gray M, et al. Evidence-based medicine: what it is and what it isn’t. BMJ. 1996;312:71.

A. Perrier, T. Similowski. A series of evidence-based medicine (evidence-based medicine) but for what? Rev Mal Respir. 2002;19:395–8.

Bongala DS, Santos RMF, Panaligan MM, Anastacio et al. Evidence- Based clinical practice guidelines on the diagnosis and treatment of cholecystitis. Committee on Surgical Infections, Philippine College of Surgeons, Epifanio de los Santos Avenue, Quezon City, Philippines; 2004.

Duncan CB, Riall TS. Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg. 2012; 16(11):2011–25.

du Prel JB, Röhrig B, Blettner M. Critical appraisal of scientific articles: part 1 of a series on evaluation of scientific publications. Dtsch Arztebl Int. Feb 2009;106(7):100–5.

Wheeler, Dr. L. Kip. Critical Reading of an Essay’s Argument. Wheeler’s Website; 12 Oct 2004.

Deborah K. Critical Reading Towards Critical Writing. Available at http:// www.writing.utoronto.ca/advice/reading-and-researching/critical

Ford JA, Soop M, Du J, et al. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg. 2011;99(2):160–7.

Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile ductstones (CBDS). Gut. 2008;57(7):1004–21.

Kanamaru T, Sakata K, Nakamura Y, Yamamoto M, Ueno N, Takeyama Y. Laparoscopic choledochotomy in management of choledocholithiasis. Surg Laparosc Endosc Percutan Tech. 2007 Aug;17(4):262–6.

Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl. 2008 Jan;90(1):29–35.

Siddiqui FG, Memon AA, Abro AH, et al. Routine histopathology of gallbladder after elective cholecystectomy for gallstones:waste of resources or a justified act? BMC Surg. 2013 Jul;13:26.

Romero-González RJ, Garza-Flores A, L Martínez-PérezMaldonado, et al. Gallbladder selection for histopathological analysis based on a simple method: a prospective comparative study. Ann R Coll Surg Engl. 2012 Apr;94(3):159–64.

Sqn Ldr A Gaur, Gp Capt AK Pujahari. Role of prophylactic antibiotics in laparoscopic cholecystectomy. MJAFI. 2010;66:228–30.

Hobart W. Harris. Open Ventral Hernia Repair. UCSF Postgraduate Course in General Surgery Maui, HI March 21, 2011.

Salim Loudjedi. Application de la médecine factuelle à la chirurgie de la lithiase biliaire. Edilivre, Essai/Etude autres ISBN 9782332516862;2012.


Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 Journal of Pharmaceutical and Biomedical Sciences

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.