Dear Caroline,
Your research question:
I would be very interested to hear your views about the importance of traditionally viewed 'gold standard' evidence (eg. RCTs) in surgical research and the need for blinding in this setting, where it is often difficult to achieve (due to attitude as much as logistics!). I have lots of references on this topic, but if you are aware of any particularly good ones you think would be of use to me that would be greatly appreciated!!
I would suggest following approach to get comprehensive understanding of this topic:
As you know, Systematic Reviews/Meta-analysis are at top of the evidence hierarchy and evidence obtained from systematic reviews is considered to be of highest quality.
You can undertake systematic review of RCTs in surgical research and can identify all relevant RCTs on this topic. You can then check blinding in individual study methodologies.
For this you will require to make a precise search strategy for individual literature databases like: MEDLINE, EMBASE, Cochrane Library etc.
You can screen the retrieved references to check whether they answer your question.
Hope this makes sense?
Thanks
Kind Regards
Javed
...........................................................................
Javed Shaikh, M.S.(Pharm)
Analyst: Systematic Reviews
Knowledge Services: CRC, Healthcare
Capita India
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-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Caroline Boulind
Sent: Thursday, November 25, 2010 1:02 PM
To: [log in to unmask]
Subject: Re: Surgical research
Dear all,
Thank you for your responses. Philipp, I didn't have that reference, though I have another by Devereaux, I will search it out. Thank you also, Tom, I have that reference but it was interesting to hear what Peter McCulloch had to say. I agree. My thesis talks a lot about non-pharmacological trials rather than surgical trials per se because I completely agree with him that many trials of non-drug interventions face similar methodological issues. You might be interested to read the following paper about an alternative way to think about evidence as apposed to our traditional hierarchy, which places the RCT (and meta-analyses) firmly at the top.
http://www.biomedcentral.com/1471-2288-6-29
Walach et al; Circular instead of hierarchical: methodological principles for the evaluation of complex interventions; Medical Research Methodology 2006; 6, 29
Best wishes,
Caroline
Dr. Caroline Boulind
Clinical Research Fellow
01935 384559
>>> "Sensky, Tom" <[log in to unmask]> 23/11/2010 17:16 >>>
Dear Caroline
You might be interested in the following:
P. McCulloch, I. Taylor, M. Sasako, B. Lovett, and D. Griffin. Randomised trials in surgery: problems and possible solutions. BMJ 324 (7351):1448-1451, 2002.
I met Peter McCulloch (the first author) at one of the Oxford EBM workshops. I was trying to make the case that psychotherapy research was unique, but Peter persuaded me that surgery and psychotherapy had a great deal in common in terms of gathering evidence - difficulties with control groups, design of placebos, great expense because of the need for clinician time, the complicating effects of clinician experience, etc. The parallels are striking!
While we have to accept that RCTs continue to be regarded as the gold standard as far as evidence goes, I sometimes wonder whether we shouldn't try harder to argue for a more nuanced approach, particularly with complex interventions (I include surgery and psychotherapy here). RCTs are useful in providing evidence on medications for regulatory authorities. However, while such evidence determines precisely how a particular medication is to be used, complex interventions never have such discrete end-points. In psychotherapy, by the time the results are published of the first RCT, the therapy has inevitably been further developed and moved on. I suspect that surgery is similar - interventions develop all the time and not in a step-wise manner of the kind that lends itself to testing with RCTs.
Kind regards
Yours
Tom
Tom Sensky BSc PhD MB BS FRCPsych
Emeritus Professor of Psychological Medicine
Imperial College
Consultant Psychiatrist
West London Mental Health NHS Trust
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Caroline Boulind
Sent: 23 November 2010 15:39
To: [log in to unmask]
Subject: Surgical research
Dear all,
I have been receiving emails from this list for some time now. I always enjoy the discussion and invariably learn something important and/or useful! I am a surgery trainee currently doing a research fellowship in Yeovil (UK) and I am particularly interested in methodology, especially blinding and the assessment of its success in surgical trials. I appreciate that this is not strictly an evidence based health topic, but I have seen some interesting discussions loosely around methodogy and I would be very interested to hear your views about the importance of traditionally viewed 'gold standard' evidence (eg. RCTs) in surgical research and the need for blinding in this setting, where it is often difficult to achieve (due to attitude as much as logistcs!). I have lots of references on this topic, but if you are aware of any particularly good ones you think would be of use to me that would be greatly appreciated!!
I look forward to hearing your views.
Best wishes,
Caroline
Dr. Caroline Boulind
Clinical Research Fellow
01935 384559
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