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CAGS coat of Arms
EVIDENCE BASED REVIEWS IN SURGERY
a joint program of the
CANADIAN ASSOCIATION OF GENERAL SURGEONS

L'ASSOCIATION CANADIENNE DES CHIRURGIENS GÉNÉRAUX
&
AMERICAN COLLEGE OF SURGEONS
 American College of Surgeons


Evidence Based Reviews in Surgery - Archives

EBRS packages are available dating back to 2000. If you would like access to any of these packages/articles, you can do so by accessing the following:

  1. Chronologically (by month and year) This allows access to the complete package, included are the questions related to the methodology, the methodological and clinical articles and the methodological and clinical reviews.

  2. Index of Methodological and Clinical Topics This allows you to access either the methodological or clinical topics of interest; a list of articles will appear. To retrieve an article on this topic you can click on it and it will bring up the article.

Display all in chronological order
April 2009

Topics
1. Clinical Topic: Lymph Node Examination Rates and Survival After Resection for Colon Ca
2. Methodological Topic: Bias - non experimental design studies
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. What is the source of the data?
  4. Are the data accurate and valid?
  5. Are the outcomes appropriate?
  6. What are the results?
  7. Is there adequate clinical information?
  8. Is there appropriate risk adjustment?
  9. Are the potential biases limiting the results of the study?
  10. State the conclusion. Have the authors addressed the question?
  11. Does the evidence support the conclusion?
  12. Are the results generalizable?
Articles

1. Lymph Node Examination Rates and Survival After Resection for Colon Ca; Wong SL, Ji H, Hollenbeck BK, et al; Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 2007;298(18):2149-54

2. STROBE: Explanation and Elaboration; Vandenbroucke JP, von Elm E, Altman DG, et al; Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Medicine 2007;4(10):1628-54
 
Reviews
Clinical Review (Can): Paul Belliveau - Queen's University
Clinical Review (US): David Rothenberger - University of Minnesota
Methodological Review: Larissa Temple - Memorial Sloan-Kettering Cancer Center
March 2009

Topics
1. Clinical Topic: Symptomatic Uncomplicated Diverticular Disease
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a represtative and well-defined sample of patients at a similar point in the course of the disease?
  3. Was follow-up sufficiently long and complete?
  4. Were objective and unbiased outcome criteria used?
  5. Was there adjustment for important prognostic factors?
  6. How large is the likelihood of the outcome event(s) in a specified period of time?
  7. How precise are the estimates of likelihood?
  8. Will the results help me in caring for my patients?
  9. Will the results lead directly to selecting or avoiding therapy?
  10. Are the results useful for reassuring or counseling patients?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Symptomatic Uncomplicated Diverticular Disease -1; Salem TA, Molloy RG, O’Dwyer PJ; Prospective, five year follow-up study of patients with symptomatic uncomplicated diverticular disease. Dis Colon Rectum 2007;50:1460-64

2. Symptomatic Uncomplicated Diverticular Disease -2; Chautems RC, Ambrosetti P, Ludwig A et al; Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory. Dis Colon Rectum 2002;45(7):962-66

3. How to Use an Article About Prognosis; Laupacis A, Wells G, Richardson WS, Tugwell P, for the Evidence-Based Working Group: Users' Guides to the Medical Literature. V. How to Use an Article About Prognosis. JAMA 1994;272:234-37
 
Reviews
Clinical Review (Can): Anthony MacLean - University of Calgary
Clinical Review (US): Michael Stamos - University of California - Irvine
Methodological Review: Nancy Baxter- University of Toronto
February 2009

Topics
1. Clinical Topic: Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit an sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probability estimates fit my patients'clinical features?
  11. Do the utilities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction; Govindarajan A, Naimark D, Coburn NG, et al; Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction: A Markov Chain Monte Carlo Decision Analysis. Dis Colon  Rectum 2007;50(11):1811-24

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995;273(16):1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995;273(20):1610-13
 
Reviews
Clinical Review (Can): John Heine - University of Calgary
Clinical Review (US): Heidi Nelson - Mayo Clinic Rochester
Methodological Review: Harry Henteleff - Dalhousie University/Suzzane Cutter - Cedars Sinai Medical Center Los Angeles
January 2009

Topics
1. Clinical Topic: Nonsurgical Treatment of Appendiceal Abscess or Phlegmon
2. Methodological Topic: Meta-analysis - non experimental design
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicity address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Was there a qualitative and/or quantitative assessment of heterogeneity?
  5. Are the interventions adequately described?
  6. Were the clinically important outcomes considered?
  7. Was there adequate reporting of results including descriptive information of each study?
  8. What are the overall results of the review?
  9. Was there an assessment of potential biases?
  10. Was there a discussion of what future research is required?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Nonsurgical Treatment of Appendiceal Abscess; Andersson RE, Petzold MG; Nonsurgical Treatment of Appendiceal Abscess or Phlegmon. A Systematic Review and Meta-analysis. Ann Surg. 2007;246(5):741-48

2. How to Use an Article Evlauting Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR et al; Users’ Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions. Can J Surg 2001;44(2):95-100
 
Reviews
Clinical Review (Can): Susan Reid - McMaster University
Clinical Review (US): Neil Hyman - University of Vermont
Methodological Review: Steve Latosinsky - University of Manitoba
November 2008

Topics
1. Clinical Topic: Mortality Rates in Patients With and Without Colectomy for Ulcerative Colitis and Crohn's Disease
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were the groups similar at the start of the trial?
  5. Aside from the experimental interventions, were the groups treated equally?
  6. How large and precise was the treatment effect?
  7. Were the study patients similar to my patients?
  8. Were the measured outcomes clinically relevant?
  9. Were all clinically important outcomes considered?
  10. Are my surgical skills similar to those of the study surgeons?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?
Articles

1. Mortality rates in patients with and without colectomy for Ulcerative Colitis and Crohn's Disease; Roberts SE, Williams JG, Yates D, Goldacre MJ; Mortality in Patients With and Without Colectomy Admitted to Hospital for Ulcerative Colitis and Crohn's Disease: Record Linkage Studies. BMJ 2007;335:1033-40

2. How to Use an Article Evlauting Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR et al; Users’ Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions. Can J Surg 2001;44(2):95-100
 
Reviews
Clinical Review (Can): Wes Stephen - McMaster University
Clinical Review (US): Lisa Poritz - University of Pennsylvania
Methodological Review: Carl Brown - University of British Columbia
October 2008

Topics
1. Clinical Topic: Comparison of Starion and Ligasure Hemorrhoidectomy for Prolapsed Hemhorroids
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all the patients who entered the trial properly accounted for and attraibuted for at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence support the conclusion?
Articles

1. Comparison of Starion and Ligasure Hemorrhoidectomy for Prolapsed Hemorrhoidectomy; Wang JY, Tsai HL, Chen FM, et al; Prospective, Randomized Controlled Trial of Starion vs. Ligasure Hemorrhoidectomy for Prolapsed Hemorrhoids. Dis Colon Rectum 2007;50:1146-51

2. How to Use an Article Evlauting Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR et al; Users’ Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions. Can J Surg 2001;44(2):95-100
 
Reviews
Clinical Review (Can): Ken Woolfson - Oshawa Clinic
Clinical Review (US): Randolph Bailey - University of Texas
Methodological Review: Arden Morris - University of Michigan
April 2008

Topics
1. Clinical Topic: ASCO guidelines for colorectal cancer surveillance
2. Methodological Topic: Guidelines
 
Questions
  1. What is the clinical question being asked?
  2. Were all important options and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of different outcomes?
  5. Is the guideline likely to account for important recent developments?
  6. Has the guideline been subjected to peer review and testing?
  7. Are practical clinically important recommendations made?
  8. How strong are the recommendations?
  9. What is the impact of uncertainty associated with the evidence and values used in the guidelines?
  10. Is the primary objective of the guidelines consistent with your objective?
  11. Are the recommendations applicable to your patients?
  12. State the conclusion. Have the authors addressed the clinical question?
  13. Does the evidence support the conclusion?
Articles

1. ASCO guidelines for colorectal cancer surveillance; Desch CE, Benson III AB, Somerfield MR et al. Colorectal Cancer Surveillance: 2005 Update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol 2005;23(33):8512-19

2. How to use clinical practice guidelines (a); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. How to Use Clinical Practice Guidelines (A). JAMA 1995;274(7):570-74

3. How to use clinical practice guidelines (b); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. How to Use Clinical Practice Guidelines (B). JAMA 1995;274(20):1630-32
 
Reviews
Clinical Review (Can): Marko Simunovic - McMaster University
Clinical Review (US): Neil Hyman - University of Vermont
Methodological Review: Larissa Temple - Memorial Sloan-Kettering Cancer Center
March 2008

Topics
1. Clinical Topic: Use of sacral nerve stimulation for fecal incontinence
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatments randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel “blind” to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside form the experimental intervention were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. How precise was the estimate of the treatment effect?
  9. Were all measured outcomes clinically relevant?
  10. Are the likely treatment benefits worth the potential harms and costs?
  11.  State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence support the conclusion?
Articles

1. Use of sacral nerve stimulation for fecal incontinence; Leroi AM, Parc Y, Lehur PA, et al. Efficacy of Sacral Nerve Stimulation for Fecal Incontinence. Results of a Multicenter Double-Blind Crossover Study. Ann Surg 2005;242(5):662-69

2. How to use an article about therapy or prevention (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA1995;273(20):1292-95

3. How to use an article about therapy and prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. How to Use an Article about Therapy or Prevention (B). JAMA 1994;271(1):59-63
 
Reviews
Clinical Review (Can): Marcus Burnstein - University of Toronto
Clinical Review (US): Anne Lowry - University of Minnesota
Methodological Review: Nancy Baxter - University of Toronto
February 2008

Topics
1. Clinical Topic: Workup of Rectal Bleeding
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6.  Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probability estimates fit my patients' clinical features?
  11. Do the utilities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the clinical question?
  13. Does the evidence support the conclusion?  
Articles

1. Workup of rectal bleeding; Allen E, Nicolaidis C, Helfand M; The Evaluation of Rectal Bleeding in Adults. A cost-effectiveness Analysis Comparing Four Diagnostic Strategies. JGen Intern Med 2005; 20: 81-90 

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995;273(16):1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users’ Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995;273(20):1610-13
 
Reviews
Clinical Review (Can): Paul Johnson - Dalhousie University
Clinical Review (US): George Chang - University of Texas M.D. Anderson Cancer Center
Methodological Review: Mark Taylor - Lakeridgehealth Centre
January 2008

Topics
1. Clinical Topic: Fast track surgery
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. How precise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence support the conclusion?        
Articles

1. Fast track surgery; Wind J, Polle SW, Fung Kon Jin PHP, et al; Systematic review of enhanced recovery programmes in colonic surgery. Br. J. Surg 2006; 93: 800-09

2. How to use a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Users’ Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004;47(1):60-67 
 
Reviews
Clinical Review (Can): Zane Cohen - University of Toronto
Clinical Review (US): Anthony Senagore - Michigan State University
Methodological Review: Tara Mastracci - McMaster University
November 2007

Topics
1. Clinical Topic: Need for surgery in relation to Nod2/CARD 15 genotype in Crohn's patients
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical question being addressed?
  2. Were there clearly identified comparison groups that were similar with respect to important determinants of outcome other than the one of interest?
  3. Were the exposures and outcomes measured in the same way in the groups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationship correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome?
  8. How precise is the estimate of the risk?
  9. Are the results applicable to my practice?
  10. What is the magnitude of the risk?
  11. Should I attempt to stop the exposure?
  12. State the conclusion. Have the authors addressed the clinical question posed?
  13. Does the evidence support the conclusion?
Articles

1. Need for surgery in relation ot Nod2/CARD 15 genotype in Crohn's disease patients; Lobos-Alvarez M, Arostegui J, Sans M, et al; Crohn’s Disease Patients Carrying Nod2/CARD 15 Gene Variants Have an Increased and Early Need for First Surgery due to Stricturing Disease and Higher Rate of Surgical Recurrence. Ann Surg 2005;242(5):693-700

2. How to use an article about harm; Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. IV. How to Use an Article about Harm. JAMA 1994; 271(20): 1615-1619
 
Reviews
Clinical Review (Can): Tom Walters - University of Toronto
Clinical Review (US): Susan Galandiuk - University of Louisville
Methodological Review: Arden Morris - University of Michigan
October 2007

Topics
1. Clinical Topic: Pre-operative staging of rectal ca with MRI
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. Is there an independent, blind comparison with a reference standard?
  3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is to be applied?
  4. Do the results of the test being evaluated influence the decision to perform the reference standard test?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Are likelihood ratios for the test results, presented or is the data necessary for their calculation included?
  7. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
  8. Are the results applicable to my patient?
  9. Will the results change my mangement?
  10. Will patients be better off as a result of the test?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence support the conclusion?
Articles

1. Diagnostic accuracy of pre-operative MRI in rectal cancer; MERCURY Study Group. Diagnostic Accuracy of Preoperative Magnetic Resonance Imaging in Predicting Curative Resection of Rectal Cancer: Prospective Observational Study. BMJ 2006;333(7572):779-84

2. How to use an article about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Users’ Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001;44(1):17-23
 
Reviews
Clinical Review (Can): Terry Phang - University of British Columbia
Clinical Review (US): Julio Garcia-Aguilar - University of California, San Francisco
Methodological Review: Carl Brown - University of British Columbia
   
   
   
     
 
     
 
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