Misconceptions about practicing evidence-based orthopedic surgery

Poolman, Rudolf W.; Petrisor, Brad; Marti, René K; Kerkhoffs, Gino M. M. J.; Zlowodzki, Michael; Bhandari, Mohit

doi:10.1080/17453670610013358

Cited by 19 publications

(9 citation statements)

References 70 publications

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“…A strong recommendation for using an intervention was given when the benefits clearly outweighed the risks for most if not all patients, with high-quality evidence supporting that recommendation. However, a strong recommendation against use may also be supported by studies of low-grade quality, such as case series that show serious adverse effects of the intervention (Poolman et al 2007b). A weak recommendation for or against use of an intervention was given where the risks and benefits were more closely balanced or were more uncertain because of the low methodological quality of the supporting studies.…”

Section: Methodsmentioning

confidence: 99%

Isolated patellofemoral osteoarthritis

Jonbergen¹,

Poolman²,

Kampen³

2010

Acta Orthopaedica

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Background and purpose The optimal treatment for isolated patellofemoral osteoarthritis is unclear at present. We systematically reviewed the highest level of available evidence on the nonoperative and operative treatment of isolated patellofemoral osteoarthritis to develop an evidenced-based discussion of treatment options.Methods A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), and EMBASE) was performed in March 2009. The quality of the studies was assessed independently by two authors using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results We extracted data from 44 articles. The best available evidence for treatment of isolated patellofemoral osteoarthritis is sparse and of generally low methodological quality. Nonoperative treatment using physiotherapy (GRADE: high quality, weak recommendation for use), taping (GRADE: moderate quality, weak recommendation for use), or injection therapy (GRADE: very low quality, weak recommendation for use) may result in short-term relief. Joint-preserving surgical treatment may result in insufficient, unpredictable, or only short-term improvement (GRADE: low quality, weak recommendation against use). Total knee replacement with patellar resurfacing results in predictable and good, durable results (GRADE: low quality, weak recommendation for use). Outcome after patellofemoral arthroplasty in selected patients is good to excellent (GRADE: low quality, weak recommendation for use).Interpretation Methodologically good quality comparative studies, preferably using a patient-relevant outcome instrument, are needed to establish the optimal treatment strategy for patients with isolated patellofemoral osteoarthritis.

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Section: Methodsmentioning

confidence: 99%

Isolated patellofemoral osteoarthritis

Jonbergen¹,

Poolman²,

Kampen³

2010

Acta Orthopaedica

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“…While localized gene transfer approaches have been developed via: direct injection of vectors with limited biodistribution, vectors with limited tissue tropism, or tissue specific promoters1–5, currently there is no technology that can site-specifically target gene expression to a limited number of cells within a particular tissue. The development of this technology would greatly facilitate gene therapies for tissue repair and regeneration, which requires a morphogenic gradient to perpetuate unidirectional growth and differentiation, such as that observed in epimorphic regeneration6,7.…”

Section: Introductionmentioning

confidence: 99%

Investigation of the peak action wavelength of light-activated gene transduction

et al. 2011

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Light-activated gene transduction (LAGT) is an approach to localize gene therapy via preactivation of cells with UV light, which facilitates transduction by recombinant adeno-associated virus vectors. Prior studies demonstrated that UVC induces LAGT secondary to pyrimidine dimer formation, while UVA induces LAGT secondary to reactive oxygen species (ROS) generation. However, the empirical UVB boundary of these UV effects is unknown. Thus, we aimed to define the action spectra for UV-induced LAGT independent of DNA damage, and determine an optimal wavelength to maximize safety and efficacy. Results: UV at 288, 311 and 320nm produced significant dose-dependent LAGT effects, of which the maximum (800-fold) was observed with 4kJ/m2 at 311nm. Consistent with its robust cytotoxicity, 288nm produced significantly high levels of DNA damage at all doses tested, while 311, 320 and 330nm did not generate pyrimidine dimers and produced low levels of DNA damage detected by comet assay. While 288nm failed to induce ROS, the other wavelengths were effective, with the maximum (10-fold) effect observed with 30 kJ/m2 at 311nm. An in vivo pilot study assessing 311nm-induced LAGT of rabbit articular chondrocytes demonstrated a significant 6.6-fold (p<0.05) increase in transduction with insignificant cytotoxicity. Conclusion: 311nm was found to be the optimal wavelength for LAGT based on its superior efficacy at the peak dose, and its broad safety range that is remarkably wider than the other UV wavelengths tested.

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“…Patients are reluctant to be randomized to procedures that may be associated with permanent consequences or scars, blinding surgeons and sham surgeries are often unfeasible, and the duration of required follow-up may be too long and impractical for RCTs. 2 As a consequence, evidence-based surgeons have relied extensively on observational studies to this point: only 3.4% of all publications in the leading surgical journals are RCTs, and more than half of these RCTs compared medical therapies in surgical patients rather than alternative surgical procedures or surgical vs medical or radiologic interventions. 3 Recent innovations in the design of surgical trials may overcome some of the limitations of traditional RCTs in surgery, provide the bias protection that randomization offers, and gain the ability to make strong inferences about the efficacy of surgical interventions.…”

Section: Using Research Evidence To Formulate Recommendationsmentioning

confidence: 99%

Methodology for clinical practice guidelines for the management of arteriovenous access

Murad

Swiglo

Sidawy³

et al. 2008

Journal of Vascular Surgery

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The Society for Vascular Surgery considers the placement and maintenance of arteriovenous hemodialysis access to be an important component of any vascular surgery practice. Therefore, the Society has long been involved in setting the standards for the management of arteriovenous access. Formulating clinical recommendations in this area is the latest effort by the Society to improve the management of arteriovenous access on a national level. To provide an unbiased study of the evidence and to help in formulating the recommendations, the Society used the Knowledge and Encounter Research (KER) Unit of the Mayo Clinic College of Medicine, Rochester, Minn, to review the available evidence and advise a multidisciplinary group of access surgeons and nephrologists in formulating the clinical recommendations. To review the evidence, randomized and observational study designs were both considered. Whenever possible, systematic reviews and meta-analyses of the literature were used because, compared with individual studies, they generate more precise estimates of treatment effects and their results are applicable to a wider range of patients. On behalf of the Society, the group issued its recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) format; this format disentangles the strength of recommendations from the quality of the evidence and encourages statements about the underlying values and preferences relevant to the particular recommendation. The recommendations are classified as strong (denoted by the phrase "we recommend") or weak (denoted by the phrase "we suggest"); and the quality of evidence is classified as high, moderate, low, or very low. These recommendations are not meant to supersede clinical judgment; rather, they should be used as a guide for the practicing surgeon and nephrologist as the decision is being made for the placement and subsequent procedures and management of arteriovenous hemodialysis access are being considered.

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Misconceptions about practicing evidence-based orthopedic surgery

Cited by 19 publications

References 70 publications

Isolated patellofemoral osteoarthritis

Isolated patellofemoral osteoarthritis

Investigation of the peak action wavelength of light-activated gene transduction

Methodology for clinical practice guidelines for the management of arteriovenous access

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