Evidence‐based medicine in otolaryngology journals

Bentsianov, Boris; Boruk, Marina; Rosenfeld, Richard M.

doi:10.1067/mhn.2002.123859

Cited by 36 publications

(57 citation statements)

References 9 publications

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“…Those results were higher compared to orthopaedic journals (48 % level 4 studies) [2], to plastic surgery journals (40% level 4 studies) [4] and to ophthalmology journals (58% Level 4 studies) [9]. However, other surgical journals as ear, nose and throat (otolaryngology) journals present a percentage similar to JHSE and RICMA (80% Level 4 studies) [10]. The percentage of level 4 papers in JHSA was lower, as compared to the rest of the hand surgery journals investigated, and it was very close to the one published by Obremskey et al [3], who reported a 68.8% of level 4 papers, in a review of 32 articles published in the JHSA from January to June 2003.…”

Section: Discussionmentioning

confidence: 99%

Level of evidence in hand surgery

et al. 2012

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BackgroundFew investigations have been done to analyze the level of evidence in journals related to hand surgery, compared to other related research fields. The objective of this study was to assess the level of evidence of the clinical research papers published in the Ibero-american (RICMA), the European (JHSE) and American (JHSA) Journals of Hand Surgery.MethodsA total of 932 clinical research papers published between 2005 and 2009 (RICMA 60, JHSE 461, and JHSA 411) were reviewed. Two independent observers classified the level of evidence based on the Oxford International Classification, 5 being the lowest level and 1 the highest level. The observed frequencies of the level of evidence for each journal were compared with the expected frequencies by a chi-square (χ 2) test for categorical variables with a significance level of 0.05.ResultsInter-observer agreement analysis showed a Kappa of 0.617. Intra-observer agreement analysis presented a Kappa of 0.66 for the observer 1, and a Kappa of 0.751 for the observer 2. More than 80% of the papers in RICMA and JHSE and a 67.6% in the JHSA presented a level of 4. No level 1 or 2 studies were published in RICMA, compared to JHSE (0.9% level 1 and 5.0% level 2) and JHSA (8.3% level 1 and 10% level 2). The percentage of papers with level 3 published in RICMA (16.7%) was higher compared to the JHSE (11.1%) and the JHSA (14.1%). All the results were statistically significant (χ2=63.945; p<0.001).ConclusionsThe level of evidence in hand surgery is dependent on the type of journal; being the highest level evidence papers those published in the JHSA, followed by the JHSE and finally the RICMA. Knowing the status of the level of evidence published in hand surgery is the starting point to face the challenges of improving the quality of our clinical research

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Section: Discussionmentioning

confidence: 99%

Level of evidence in hand surgery

et al. 2012

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“…The initial introduction of EBM was met with concerns that EBM was a form of "cookbook" medicine based on algorithms and a threat to physician autonomy and individualized treatment decisions. 4 However, as noted by Sackett and colleagues, 1 EBM actually incorporates individual clinical expertise with understanding of the best available evidence and patient preference. EBM principles have been incorporated into medical school education now as the first step to establish a lifelong commitment to evidence-based practice.…”

Section: Barriers To Evidence-based Medicinementioning

confidence: 98%

“…A review of articles making clinical recommendations published in otolaryngology journals showed that the LOE was significantly higher in studies making medical treatment recommendations versus surgical treatment recommendations. 4 Articles making medical and surgical treatment recommendations had LOE ranging from 1 to 4, but the overwhelming majority of studies making surgical treatment recommendations used uncontrolled studies (LOE 4) (86% vs 58%). Although there is a focus on developing and publishing studies with higher LOE, it is important for those reading and evaluating studies to understand the difference between LOE and quality.…”

Section: Barriers To Evidence-based Medicinementioning

confidence: 99%

“…3 Similarly, the surgical literature has been shown to have more studies associated with lower LOE, whereas studies dealing with nonsurgical treatment modalities tend to have higher LOE. 4 Although LOE can provide insight into the quality of study design, it is important to understand that LOE does not evaluate the quality of evidence within a particular study. Similarly, LOE designation does not provide recommendations with any degree of certainty, as that decision must be made based on several factors: the clinician's background knowledge of the disease process and available treatment options, the similarities of study population characteristics to the patient, and the compatibility of patient values and circumstances with the treatment option.…”

Section: Levels Of Evidencementioning

confidence: 99%

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Early Practice Focus

Teng

Christophel

2015

Facial Plastic Surgery Clinics of North America

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“…¿Cómo determinar con rigor científico qué acciones comportan más beneficios clínicos o sanitarios en comparación con sus daños o inconvenientes? La Medicina Basada en Evidencias (MBE) es una propuesta para responder a estas interrogantes (8).…”

Section: Sr Directorunclassified

Dificultad diagnóstica y Medicina Basada en la Evidencia

Hombre

Solano

2006

An. Med. Interna (Madrid)

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Con cierta frecuencia tenemos el llamado "caso raro" que comparte sintomatología con varias especialidades y es difícil el manejo y seguimiento por una sola especialidad. En lo referente a nuestra especialidad la otitis externa maligna del diabético es una alteración grave y que exige actuación inmediata para evitar complicaciones mayores (1-4).Hemos hecho seguimiento durante 12 años de una enferma diabética tipo 1, que de manera espontánea y recurrente tiene episodios de inflamación con rubor y calor del pabellón auricular derecho que se extiende a la base del cuello; acompañado de fiebre y malestar general. Lo anterior acaece unas veces con correcto control metabólico y otras veces cuando ha estado descompensada. No hemos podido demostrar de forma objetiva una causa local infecciosa, disfunción inmunológica u otra etiología responsable de este trastorno. La hemos englobado dentro del diagnósti-co de dermopatía sin filiación. El tratamiento ha sido tan variado como el uso tópico de antinflamatorio, corticoide y antibióticos o empleo sistémico de antibióticos y corticoides, todo ello con el correspondiente uso de insulina (5-7). Estos cuadros son autolimitados y con independencia de la variante terapéutica empleada el curso y la duración de los mismos no varían Es sorprendente, e incluso alarmante que, según diversas estimaciones, un alto porcentaje de las decisiones clínicas que se toman no tiene un buen fundamento científico. Pero, ¿cómo distinguir lo que es eficaz de aquello que no lo es? ¿Cómo determinar con rigor científico qué acciones comportan más beneficios clínicos o sanitarios en comparación con sus daños o inconvenientes? La Medicina Basada en Evidencias (MBE) es una propuesta para responder a estas interrogantes (8).¿Qué es la Medicina Basada en Evidencias? Es el uso sensato y a conciencia, de la mejor evidencia actualmente disponible a partir de la investigación clínica, en beneficio del manejo de los pacientes individuales. La práctica de la MBE significa la integración de la maestría clínica individual con las mejores evidencias clínicas disponibles a partir de la exploración sistemática. Internet ocupa también un puesto importante en la tarea de "explorar sistemáticamente", ofreciendo a los profesionales los últimos avances de esta metodología de apoyo a la prác-tica clínica.La puesta en práctica de la MBE requiere de algunas habilidades, como realizar búsquedas bibliográficas y aplicar reglas formales para evaluar la literatura, que permitan afrontar el desafío de la actualización profesional médica. Se trata de integrar la experiencia clínica personal con la mejor "evidence" o pruebas externas obtenidas a través de una investigación sistemática. Por tanto la MBE consiste en el uso consciente, explícito y juicioso de las mejores pruebas actuales en la toma de decisiones sobre la atención de cada paciente individual en su enfermedad o proceso.La MBE implica una actitud vital, de búsqueda y actualización permanente. Es innegable que ha provocado cambios en la utilización de los resultados de la i...

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Evidence‐based medicine in otolaryngology journals

Abstract: Evaluation of levels of evidence in otolaryngology decision making.

Cited by 36 publications

References 9 publications

Level of evidence in hand surgery

Level of evidence in hand surgery

Early Practice Focus

Dificultad diagnóstica y Medicina Basada en la Evidencia

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