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Here's the blog version of the video Juan by @methodsmanmd: http://methodsman.com/you-operate-on-appendicitis-right-right/ Regards, Ash Sent from Yahoo Mail on Android From:"Juan Gérvas" <[log in to unmask]> Date:Sun, 21 Jun, 2015 at 17:50 Subject:Re: EBM of appendicectomy -thanks, Ash -very clear -still, no definitive answer -and no comment about the abuse of CT scan -un saludo -juan gérvas 2015-06-21 18:44 GMT+02:00 Ash Paul <[log in to unmask]>: Dear Juan, Here's a video critique of the trial: http://www.medpagetoday.com/Surgery/GeneralSurgery/52153 The critiquer F Perry Wilson from Yale tweets under the name of @methodsman Regards, Ash Sent from Yahoo Mail on Android From:"Juan Gérvas" <[log in to unmask]> Date:Sun, 21 Jun, 2015 at 17:27 Subject:Re: Fw: EBM of appendicectomy -excellent critique, Ash -we are still in the Cochrane conclusion, in 2011 Therefore we conclude that appendectomy remains the standard treatment for acute appendicitis . Antibiotic treatment might be used as an alternative treatment in a good quality RCT or in specific patients or conditions were surgery is contraindicated. http://www.cochrane.org/CD008359/COLOCA_antibiotic-therapy-compared-to-appendectomy-in-the-treatment-of-acute-appendicitis. -about laparoscopci surgery, also Cochrane, in 2000 In summary, laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery. However, conventional appendectomy should not be considered 'wrong', because the difference between the two techniques is rather small and strongly depends on patient characteristics and the treating surgeon's expertise. http://www.cochrane.org/CD001546/COLOCA_laparoscopic-key-hole-surgery-for-appendicitis -but no one comment about the overuse of CTscan in children and young adults (thinks in females, and their ovaries) when the standard of uncomplicated appendicitis is via radiology -un saludo -juan gérvas 2015-06-21 18:02 GMT+02:00 Ash Paul <[log in to unmask]>: Dear colleagues, Here's a recent critique of the Finnish trial: http://skepticalscalpel.blogspot.co.uk/2015/06/antibiotics-for-appendicitis-no-thanks.html?m=1 Regards, Ash Sent from Yahoo Mail on Android From:"Mayer, Dan" <[log in to unmask]> Date:Sun, 21 Jun, 2015 at 16:12 Subject:Re: Fw: EBM of appendicectomy Hi Barry and list. Not sure what 24% refers to. If this is the non-inferiority margin, it seems HUGE. The bigger the margin, the more likely to find that the two treatments are non-inferior. Is the 24% the difference between surgically treated and non-treated (without antibiotics) cases of appendicitis? That would make no sense. Perhaps it would make sense to select as the non-inferiority margin the difference between prompt and delayed surgical treatment. The problem with non-inferiority trials is that there has to be some reasonable treatment to use as a comparitor and some difference that makes clinical sense. Would you be happy with a NNT of 4 corresponding to a difference of 24% in absolute mortality (or whatever is being measured)? This seems very important, and I'd probably go for a NNT of 40 or 50 as a reasonable place to start. This would mean that the non-inferiority margin should be 2 - 2.5%. Hope this helps, Best wishes Dan Dan Mayer, MD, FAAEM, FACEP (ret.) Professor of Emergency Medicine Albany Medical College From: Evidence based health (EBH) [[log in to unmask]] on behalf of Barry Diner [[log in to unmask]] Sent: Sunday, June 21, 2015 10:28 AM To: [log in to unmask] Subject: Re: Fw: EBM of appendicectomy any comments on 24% used for inferiority trails. Is that standard Barry Diner, MD, MPH, FACEP, FAAEM Baylor College of Medicine On Sun, Jun 21, 2015 at 9:18 AM, Bewley, Susan <[log in to unmask]> wrote: From: Susan <[log in to unmask]> Sent: 21 June 2015 12:11:41 To: Bewley, Susan Subject: RE: EBM of appendicectomy This is of interest, and is another trial that can be added to the body of work. However, it begs a question about ‘what counts as evidence’ and who/what is being excluded? When I was clinical director of NHS London, I was unlucky enough to realise we’d had two maternal deaths from appendicitis within a short time in London. Coincidence? Or ‘canary in the mine’? I don’t know, but please see the enclosed letter about the failed treatment of appendicitis with antibiotics in pregnancy we wrote in response to a metaanalysis of same subject. Maternal death is very rare, but the CEMD has a surveillance function. I did a look back using the Confidential Enquiry into Maternal Deaths (now reinstated in a different form as MBBRACE). Susan From: Evidence based health (EBH) <[log in to unmask]> on behalf of Juan Gérvas <[log in to unmask]> Sent: 20 June 2015 11:02:35 To: [log in to unmask] Subject: EBM of appendicectomy -hope it will of interest -un saludo -juan gérvas Contra la percepción de "lo evidente". Efectos positivos beneficiosos de tratar la apendicitis sin apendicectomía. Against the perceived evidence. Positive benefits of treating appendicitys without appendicetomy. http://jama.jamanetwork.com/article.aspx?articleid=2320296 ¿Apendicitis no complicada? Antibióticos en primer término, cirugía si acaso. Ensayo clínico aleatorizado. Uncomplicated appendicitis? Try antibiotic treatment, delay appendectomy. Randomised clinical trial. http://jama.jamanetwork.com/article.aspx?articleid=2320315 ----------------------------------------- CONFIDENTIALITY NOTICE: This email and any attachments may contain confidential information that is protected by law and is for the sole use of the individuals or entities to which it is addressed. If you are not the intended recipient, please notify the sender by replying to this email and destroying all copies of the communication and attachments. Further use, disclosure, copying, distribution of, or reliance upon the contents of this email and attachments is strictly prohibited. To contact Albany Medical Center, or for a copy of our privacy practices, please visit us on the Internet at www.amc.edu.