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EVIDENCE BASED REVIEWS IN SURGERY
a program of the
CANADIAN ASSOCIATION OF GENERAL SURGEONS

L'ASSOCIATION CANADIENNE DES CHIRURGIENS GÉNÉRAUX


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
May 2014

Topics
1. Clinical Topic: Blood transfusion and prognosis in colorectal cancer
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 and attributed 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 form the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence support the conclusion?
Articles

1. Prognosis of colorectal cancer following patients receiving a blood transfusion; Harlaar JJ, Gosselink MP, Hop WDJ, et al. Blood transfuion and prognosis in colorectal cancer. Long term results of a randomized controlled trial. Ann Surg 2012;256:681-87

2. How to use an article about therapy or prevention;
Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to use an article about therapy or prevention (2);
Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Andrew McFadden - University of British Columbia
Clinical Review (US): Mary Kwaan - University of Minnesota
Methodological Review: Tara Mastracci - Cleveland Clinic

March 2014

Topics
1. Clinical Topic: Routine leak testing in colorectal surgery
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design? Is it appropriate?
  3. What are the sources of data?
  4. Are data accurate and valid?
  5. What was the intervention and how was it assessed?
  6. What outcomes are considered?
  7. How large and precise was the difference in the outcome?
  8. Are there any factors (confounders) that might explain the differences in the results?
  9. State the conclusion. Have the authors addressed the clinical question posed?
  10. Does the evidence support the conclusion?
Articles

1. Routine leak testing in colorectal surgery; Kwon S, Morris A, Billingham R, et al. Routine leak testing in colorectal surgery in the surgical care and outcomes assessment program. Arch Surg 2012;147(4):345-351

2. Reader's Guide to Criticial Appraisal of Cohor Studies 1; Rochon PA, Gurwitz JH, Sykora K et al. Reader’s guide to critical appraisal of cohort studies: 1. Role and design.  BMJ 2005;330:895-897

3. Reader's Guide to Critical Appraisal of Cohort Studies 2; Mamdani M, Sykora K, Li P et al. Reader’s guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005;330:960-2
 
Reviews
Clinical Review (Can): Neel Datta - University of Calgary
Clinical Review (US): Elisa Birnbaum - University of Washington
Methodological Review: Karen Brasel - Medical College of Wisconsin

February 2014

Topics
1. Clinical Topic: Loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for C difficile
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 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 adjustments?
  9. Are the results generalizable?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for C difficle; Neal MD, Alverdy JC, Hall DE, et al. Diverting loop ileostomy and colonic lavage. An alternative to total abdominal colectomy for the treatment of severe, complicated Colistridium difficile associated diseae. Ann Surg 2011;254:423-429

2. Bias in surgical research; Paradis C. Bias in surgical research. Ann Surg 2008;248(2):180-188
 
Reviews
Clinical Review (Can): Marylise Boutros - McGill University
Clinical Review (Can): Andrew Morris/Nisha Thampi - University of Toronto
Clinical Review (US): Celia Divino - Mount Sinai School of Medicine
Methodological Review: Carl Brown - University of British Columbia

January 2014

Topics
1. Clinical Topic: Patients' expectations about effects of chemo for advanced cancer
2. Methodological Topic: Survey/Ethics
 
Questions
  1. What is the clinical question being addressed?
  2. Werer the participants relevant to the research question and was their selection well reasoned?
  3. Were the data collection methods appropriate for the research objectives and settings?
  4. Was the data collection comprehensive enough to support the rich and robust descriptions of the observed events?
  5. Were the data appropriately analyzed and the findings adequately corroborated?
  6. How evocative and thorough is the description?
  7. How comprehensive and relevant are the theoretical conclusions?
  8. Does this study help me understand my practice? Does it help me understand my relationship with my patients and their families?
Articles

1. Patients' expectations about effects of chemotherapy for advanced cancer; Weeks JC, Ctalano PJ, Cronin A, et al. Patients' expectaions about effect of chemotherapy for advanced cancer. New Engl J Med. 2012;367:1616-1625

2. Qulaitative research in health care A. Are the results of the study valid?; Giacomini MK, Cook DJ; for the Evidence-Based Medicine Working Group. Users' guides to the medical literature XXIII. Qualitative research in health care A. Are the results of the study valid? JAMA 2000;284(3):357-62

3. Qualitative research in health care B. What are the results and how do they help me care for my patient?; Giacomini MK, Cook DJ; for the Evidence-Based Medicine Working Group. Users' guides to the medical literature XXIII. Qualitative research in health care B. What are the results and how to they help me care for my patients? JAMA 2000;284(4):478-482
 
Reviews
Clinical Review (Can): Karen Devon - University of Toronto
Clinical Review (Can): Anthony Fields - University of Alberta
Clinical Review (US): Daniel Hinshaw - University of Michigan
Methodological Review: Tim Pawlik - John Hopkins Medical School

November 2013

Topics
1. Clinical Topic: Development of validated instrument to assess rectal function after LAR
2. Methodological Topic: Quality of Life
 
Questions
  1. What is the purpose of the HRQL instrument?
  2. What type of HRQL instrument is this?
  3. Was the patient group appropriate for developing this instrument?
  4. What does it measure?
  5. Are there any important aspects of HRQL that have been omitted?
  6. Was the instrument tested to determine its validity, realiability and responsiveness? If so, what are the results?
  7. Will the instrument be useful in assessing quality of life in your patients?
Articles

1. Development of validated instrument to assess rectal function after LAR; Temple LK, Bacik J, Savatt SG, et al. The developoment of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 2005;48:1353-1365

2. Measuring health-related quality of life; Gyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Int Med. 1993;118:622-629
 
Reviews
Clinical Review (Can): Darlene Fenech - University of Toronto
Clinical Review (US): David Dietz - Cleveland Clinic
Methodological Review: Arden Morris - University of Michigan

October 2013

Topics
1. Clinical Topic: LIFT procedure vs. advancement flap for complex fistula
2. Methodological Topic: Bias - non experimental design studies
 
Questions
  1. Was a sample size calculated?
  2. Was the sample size calculation detailed for the primary outcomes?
  3. Is the effect size clinically relevant and realistic?
  4. Would the stated difference in treatment effect result in a change in your practice?
  5. Is the effect size consistent with your clinical experience and previous published trials?
  6. If no power analysis was completed, are the results reported appropriately to estimate power?
  7. Are confidence intervals included so that estimation of the treatment effect can be determined?
Articles

1. LIFT procedcure vs. advancement flap for complex fistula; Mushaya C, Barlett L, Shuulze B, et al. Ligation of intersphicteric fistual tract compred with advancement flap for complex anorectal fistulas requiring intial seton drainage. Amer J Sug. 2012;204:283-289

2. How to assess power and sample size; Caddeddu M, Farrokhyar R, Thoma A, et al; for the Evidence-Based Surgery Working Group. Users' guide to the surgical literature: how to assess power and sample size. Can J Surg 2008;51(6):476-482
 
Reviews
Clinical Review (Can): Husein Moloo/Joshua Bleier- University of Ottawa/University of Pennsylvania, Perelman School of Medicine
Clinical Review (US): Bradley Champagne - Case Western University
Methodological Review: Nancy Baxter - University of Toronto

May 2013

Topics
1. Clinical Topic: Strategies for the prevention of postoperative recurrence in Crohn's disease
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the analysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all relevant clinical strategies compared?
  5. Was clinical effectiveness established?
  6. Were costs measured accurately?
  7. Were data on costs and outcomes appropriately integrated?
  8. Was appropriate allowances made for uncertaninties in the analysis?
  9. What were the incremental costs and outcomes of each strategy?
  10. Do incremental costs and outcomes differ between subgroups?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Strategies for prevention of postoperative recurrence of Crohn's disease;
Naanthakrishnan AN, et al. Strategies for the prevention of postoperative recurrence in Crohn’s disease: Results of a decision analysis. Am J Gastroenterol 2011;106:2009-17

2. How to use an article on economic analysis;
Thoma A, Sprague S, Tandan V; for the Evidence-Based Surgery Working Group Users’ Guide to the Surgical Literature: How to Use an Article on Economic Analysis. CJS 2001;44(5):347-54
 
Reviews
Clinical Review (Can): Brian Bressler - University of British Columbia
Clinical Review (Can): Tony MacLean - University of Calgary
Clinical Review (US): Feza Remzi/Jean Paul Achkar - Cleveland Clinic
Methodological Review: Carl Brown - University of British Columbia

March 2013

Topics
1. Clinical Topic: HPV vaccine against anal HPV infection and anal cancer
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomoized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicans and study personnel "blind" to treatment?
  5. Were the groupls 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 all clinically important outcomes considered?
  9. Should routine vaccination with qHPV be instituted and if so, who should be the target population?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence supoprt the conclusion?
Articles

1. A HPV vaccine against anal HPV infection and anal cancer;
Palefsky JM, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia NEJM 2011;365(17):1576-85

2. Supplementary Appendix: HPV vaccine against anal HPV infection and anal cancer;
Supplementary Appendix: Palefsky JM, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia NEJM 2011;365(17):1576-85

3. How to use an article about therapy or prevention;
Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

4. How to use an article about therapy or prevention (2);
Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Manoj Raval - University of British Columbia
Clinical Review (Can): Irving Salit - University of Toronto
Clinical Review (US): Mark Welton - Stanford University
Methodological Review: Elijah Dixon - University of Calgary

February 2013

Topics
1. Clinical Topic: Use of MRI to identify good prognosis in stage I, II, III rectal cancer
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being posed?
  2. Was there a representative 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 porgnositc factors?
  6. How lare is the liklihood of the outome 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 clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Use of MRI to identify good prognosis in stage I, II, III rectal cancer;
Taylor FGM, Quirke P, Heald RJ, et al. Preoperative high –resolution magnetic resoncance imaging can identify good prognosis stage I, II and III rectal cancer best managed by surgery alone. Ann Surg 2011;253:711-719 

2. How to use an article about prognosis;
Hansebout RR, Cornacchi SD, Haines T, et al. Users’ guide to the surgical literature. How to use an article about prognosis. Can J Surg 2009;52(4):328-36
 
Reviews
Clinical Review (Can): Erin Kennedy - University of Toronto
Clinical Review (Can): Blair Macdonald - University of Ottawa
Clinical Review (US): Heidi Nelson - Mayo Clinic Rochester
Methodological Review: Arden Morris - University of Michigan

January 2013

Topics
1. Clinical Topic: Effect of stitch length on wound complications
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 al patients who entered into the trial properly accounted for and attributed for at its conclusion?
  4. Were patients, their clinicians and study peronnel "blind" to treamtent?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. Were the measured outcomes clinically relevant?
  8. How large and precise was the treamtent effect?
  9. Were the study patients similar to your patients?
  10. Are your surgical skills similar to those of the study surgeons?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Effect of stitch length on wound complications;
Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009;144(11):1056-59 

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): Fred Brenneman - University of Toronto
Clinical Review (Can): Ori Rotstein - University of Toronto
Clinical Review (US): Parag Bhanot - Georgetown University
Methodological Review: Robin McLeod - University of Toronto

November 2012

Topics
1. Clinical Topic: Effect of ASA on long-term risk of death due to colorectal cancer
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. What is the study design and how does it differ from a meta-analysis?
  4. Was the search for relevant studies detailed and exhaustive?
  5. Were the primary studies of high methodologic quality?
  6. Were assessments of the studies reproducible?
  7. Were the results similar from study to study?
  8. How were the results combined?
  9. Are the benefits worth the costs and potential risks?
  10. What are the overall resutls of the review?
  11. How precise were the resutls?
  12. Were all clinically important outcomes considered?
  13. State the conclusion. Have the authors addressed the clinical question posed?
  14. Should patietns be advised to take ASA on a regular basis?
Articles

1. Effect of ASA on long-term risk of death due to colorecal cancer;
Rothwell, PM et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomized trials. Lancet 2011;377:31-41 

2. How to use an article about therapy or prevention;
Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to use an article about therapy or prevention (2);
Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Wes Stephen - McMaster University
Clinical Review (US): Eric Dozois - Mayo Clinic Rochester
Methodological Review: Prosanto Chaudhury - McGill University

October 2012

Topics
1. Clinical Topic: Once only flexible sigmoidoscopy in prevention of colorectal cancer
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Was the comparator intervention in the control group appropriate?
  4. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  5. Were patients, their clinicians and study personnel "blind" to treatment?
  6. Were the groups similar at the start of the trial?"
  7. Aside from the experimental intervention, were the groups treated equally?
  8. How large and precise was the treatment effect?
  9. Were all clinically important outcomes considered?
  10. Should the results of this study change practice?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Once only flexible sigmoidoscopy in prevention of colorectal cancer;
Atkin, WS et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multientre randomized controlled trial. Lancet 2010;375:1624-33

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): Chris Vinden - University of Western Ontario
Clinical Review (Can): Bob Hilsden - University of Calgary
Clinical Review (US): Elin Sigurdson - Fox Chase Cancer Center
Methodological Review: Andy Kirkpatrick - University of Calgary

May 2012

Topics
1. Clinical Topic: Rectopexy or No Rectopexy for Rectal Prolapse
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Were the surgical techniques adequately described?
  7. Was the expertise of the surgeons entering patients into the trial adequately described?
  8. Aside from the experimental intervention, were the groups treated equally?
  9. Howe large and precise ws the treatment effect?
  10. Were all clinically important outcomes considered?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Rectopexy or No Rectopexy for Retal Prolapse; Karas JR, Uranues S, Altomare DR, et al. No rectopexy versus rectopexy following rectal mobilization for full-thickness rectal prolapse: a randomized controlled trial. Dis Colon & Rectum 2011;54(1):29-34

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): Marcus Burnstein - University of Toronto
Clinical Review (US): Tracy Hull - Cleveland Clinic
Methodological Review: Morad Hameed - University of British Columbia

March 2012

Topics
1. Clinical Topic: Qualtiy Initiative in Rectal Cancer Surgery
2. Methodological Topic: Knowledge Transfer
 
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 and attributed 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 fromt he experimental intervention, werer 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. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the clinical question posed?
  13. Does the evidence support the conclusion?
Articles

1. Quality Initiative in Rectal Cancer Surgery; Simunovic M, Coates A, Goldsmith CH, et al. The cluster-randomized quality initiative in rectal cancer trial: evaluating a quality-improvement strategy in surgery. CMAJ 2010;182(12):1301-06

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

3. Knowledge Translation Research; Simunovic M, Baxter NN. Knowledge translation research: a review and new concepts from a surgical case study. Surgery 2009;145(6):639-44
 
Reviews
Clinical Review (Can): Terry Phang - University of British Columbia
Clinical Review (US): Conor Delaney - University Hospital Case Medical Center
Methodological Review: Arden Morris - University of Michigan
Methodological Review: Lars Pahlman - Uppsala University Sweden

February 2012

Topics
1. Clinical Topic: Long-term Effect of ASA on Colorectal Cancer
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 qualtiy?
  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. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Long-term Effect of ASA on Colorectal Cancer; Rothwell PM, Wilson M, elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomized trials. Lancet 2010;376:1741-50

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): Steve Gallinger - University of Toronto
Clinical Review (US): James Church - Cleveland Clinic
Methodological Review: Carl Brown - University of British Columbia

January 2012

Topics
1. Clinical Topic: Sleep Deprication in Surgeons
2. Methodological Topic: Administrative Data
 
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 2 cohorts adequately matched?
  6. What outcomes were assessed and are they clinically relevant and sensitive?
  7. What are the potential biases?
  8. How precise is the estimate of risk?
  9. What are the results?
  10. Should the results of this study be used to implement etc. or are futher studies required?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Sleep Deprivation in Surgeons; Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA 2009;302(14):1565-72

2. Reader's Guide to Criticial Appraisal of Cohor Studies 1; Rochon PA, Gurwitz JH, Sykora K et al. Reader’s guide to critical appraisal of cohort studies: 1. Role and design.  BMJ 2005;330:895-897

3. Reader's Guide to Critical Appraisal of Cohort Studies 2; Mamdani M, Sykora K, Li P et al. Reader’s guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005;330:960-2

4. Reader's Guide to Critical Appraisal of Cohort Studies 3; Normand SLT, Sykora K, Li P, et al. Reader’s guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding. BMJ 2005;330:1021-3
 
Reviews
Clinical Review (Can): Garth Warnock - University of British Columbia
Clinical Review (US): Thomas Whalen - Lehigh Valley Health Network
Methodological Review: Prosanto Chaudhury - McGill University

December 2011

Topics
1. Clinical Topic: Trends in Crohn's Disease Surgery and Infliximab
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinical question being addressed?
  2. Is the validity of the database described adequately?
  3. What is the exposure?
  4. Are all the clinically relevant outcomes reported?
  5. What are the potential sources of bias?
  6. Are there potential confounders?
  7. What are the results?
  8. Are the results of this study generalizable or are further studies required?
  9. State the conclusion. Have the authors addressed the clinical question?
  10. Does the evidence support the conclusion?
Articles

1. Trends in Crohn's Disease Surgery and Infliximab; Jones DW, Finlayson SRG. Trends in surgery for Crohn’s disease in the era of infliximab Ann Surg. 2010;252(2):307-12

2. Good Research Practices for Comparitive Effectiveness Research; Cox E, Bradley C, Martin C et al. Good research practices for comparative effectiveness research: approaches to mitigate bias and confounding in the design of nonrandomized studies of treatment effects using secondary data sources: the international society for pharmacoeconomics and outcomes research good research practices for retrospective database analysis task force report-part II ISPOR 2009;12(8):1053-61
 
Reviews
Clinical Review (Can): Helen MacRae - University of Toronto
Clinical Review (Can): Charles Bernstein - University of Manitoba
Clinical Review (Can): Walter Koltun - Penn State University
Methodological Review: Nancy Baxter - University of Toronto

October 2011

Topics
1. Clinical Topic: Bowel Prep Yes or No in Rectal Cancer Surgery
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who  entered the trial properly accounted for and attributed at its conclusions?
  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 all clinically important outcomes considered?
  9. Are the likely treatment benefits worth the potential harm and costs?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Bowel Prep Yes or No Rectal Cancer Surgery; Bretagnol F, Panis Y, Rullier E, et al. Rectal cancer surgery with or without bowel preparation. The French Greccar III multicenter single-blinded randomized trial. Ann Surg. 2010;252(5):863-68

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): Shawn Forbes - McMaster University
Clinical Review (US): Patricia Roberts - Lahey Clinic
Methodological Review: Larissa Temple - Memorial Sloan Kettering Cancer Center

April 2011

Topics
1. Clinical Topic: Accuracy of CT Colonography
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. Will patients be better off as a result of the test?
  9. State the conclusion.  Have the authors addressed the clinical question posed?
  10. Does the evidence support the conclusion?   
Articles

1. Accuracy of CT Colonography; Regge D, Laudi C, Galatola G et al; Diagnostic Accuracy of Computed Tomographic Colonography for the Detection of Advanced Neoplasia in Individuals at Increased Risk of Colorectal Cancer. JAMA 2009;301(23):2453-61

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): Robert Gryfe - University of Toronto
Clinical Review (US): Elena M. Stoffel - Brigham and Womens's Hospital
Clinical Review (US): Alan G. Thorson - University of Nebraska
Methodological Review: Arden M. Morris - University of Michigan

March 2011

Topics
1. Clinical Topic: Complete Response - Rectal Cancer
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. State the conclusion.  Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?    
Articles

1. Complete Response - Rectal Cancer; Neuman HB, Elkin EB, Guillem JG et al; Treatment for Patients with Rectal Cancer and a Clinical Complete Response to Neoadjuvant Therapy: A Decision Analysis. Dis Col & Rectum 2009;52(5):863-71

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): Carol J. Swallow - University of Toronto
Clinical Review (US): Julio E. Garcia-Aguilar - City of Hope
Methodological Review: Nancy N. Baxter - University of Toronto

February 2011

Topics
1. Clinical Topic: Prevention of Parastomal Hernia
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel “blind” to treatment?
  5. Were the groups similar at the start of the trial?
  6. Were the surgical techniques adequately described?
  7. Was the expertise of the surgeons entering the patients into the trial adequately described?
  8. Aside from the experimental intervention, were the groups treated equally?
  9. How large and precise was the treatment effect?
  10. Were all clinically important outcomes considered?
  11. State the conclusion.  Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?       
Articles

1. Prevention of Parastomal Hernia; Serra-Accil X, Bobardo-Junca J, Moreno-Matias J et al; Randomized, Controlled Trial of the Use of a Mesh to Prevent Parastomal Hernia. Ann of Surg. 2009;249(4):583-87

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): W. Donald Buie - University of Calgary
Clinical Review (Can): Christopher M. Schlachta - University of Western Ontario
Clinical Review (US): C. Neal Ellis - West Penn Allegheny Health System
Methodological Review: Larissa K. Temple - Memorial Sloan-Kettering Cancer Center

January 2011

Topics
1. Clinical Topic: Antibiotics to Prevent UTI after Catheter Removal
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  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 all clinically important outcomes considered?
  9. Are the likely treatment benefits worth the potential harm and costs?
  10. State the conclusion.  Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?     
Articles

1. Antibiotics to Prevent UTI After Catheter Removal; Pfefferkron U, Sanlav L, Moldenhauer J et al; Antibiotic Prophylaxis at Urinary Catheter Removal Prevents Urinary Tract Infections. A Prospective Randomized Trial. Ann of Surg. 2009;249(4):573-75

2. How to Use an Article about Therapy or Prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to Use an Article about Therapy or Prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Stephen R. Kelly - McMaster University
Clinical Review (Can): John E. Mahoney - University of Ottawa
Clinical Review (Can): Lindsay E. Nicolle -University of Manitoba
Clinical Review (US): Peter W. Marcello - Lahey Clinic
Methodological Review: C. Suzanne Cutter - Los Angeles; Robin S. McLeod - University of Toronto

November 2010

Topics
1. Clinical Topic: Hyperoxygenation to Prevent SSI
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3.  Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  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. State the estimates upon which the sample size was calculated. In retrospect, were they accurate?
  9. Is there adequate power to conclude the risk of a SSI is the same if 80% or 30% oxygen is administered?
  10. Were all clinically important outcomes considered?
  11. State the conclusion.  Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?        
Articles

1. Hyperoxygenation to Prevent SSI; Meyhoff CS, Wtterslev J, Jorgensen LN, et al; Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complication after Abdominal Surgery. The PROXI Randomized Clinical Trial. JAMA 2009;302(14):1543-50

2. Measures of Precision (Confidence Intervals); Montori VM, Kleinbart J, Newman TB et al; Tips For Learners of Evidence-Based Medicine; 2 Measures of Precision (Confidence Intervals). Can Med Assoc J 2004;171(6):611-15
 
Reviews
Clinical Review (Can): Stuart A. McCluskey - University of Toronto
Clinical Review (Can): Giuseppe Papia - University of Toronto
Clinical Review (US): Hiram C. Polk; Ozan Akca; Motaz Qadan - University of Louisville
Methodological Review: Andrew W. Kirkpatrick - University of Calgary

October 2010

Topics
1. Clinical Topic: Skin Preparation in the OR
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  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 all clinically important outcomes considered?
  9. State the conclusion.  Have the authors addressed the clinical question posed?
  10. Does the evidence support the conclusion?       
Articles

1. Skin Preparation in the OR; Darouiche RO, Wall MJ, Itani KMF et al; Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical Site Antisepsis. New Eng J Med 2010;362(1):18-26

2. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to Use an Article about Therapy or Prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Users’ Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Rachel G. Khadaroo - University of Alberta
Clinical Review (US): William G. Cheadle - University of Louisville
Methodological Review: Elijah Dixon - University of Calgary

April 2010

Topics
1. Clinical Topic: Does Stapled Side-to-Side Anastomosis Descrease the Risk of Recurrence of Crohn’s Disease after Ileocolic Resection
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question beign addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed 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: Calculate the 95% CI around the difference in 30 day mortalty rates between groups?
  8. State the estimates upon which the sample size was calculated? In retrospect, were they accurate?
  9. Can the results be applied to my patient care?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Does Stapled Side-to-Side Anastomosis Descrease the Risk of Recurrence of Crohn’s Disease after Ileocolic Resection; McLeod RS, Wolff BG, Ross S, et al. Recurrencre of Crohn's Disease After Ileocolic Resection is not Affected by Anastomotic Type: Results of Multicenter Randomized Controlled Trial. Dis Colon Rectum 2009;52(5):919-27

2. Measures of Precision (Confidence Intervals); Montori VM, Kleinbart J, Newman TB et al; Tips For Learners of Evidence-Based Medicine; 2 Measures of Precision (Confidence Intervals). Can Med Assoc J 2004;171(6):611-15
 
Reviews
Clinical Review (Can): Paul Johnson - Dalhousie University
Clinical Review (US): Mary Otterson - Medical College of Wisconsin
Methodological Review: Nancy Baxter - University of Toronto

March 2010

Topics
1. Clinical Topic: Does Colonoscopy Decrease the Risk of Colon Cancer
2. Methodological Topic: Screening
 
Questions
  1. What is the clinical question being addressed?
  2. Comment on the appropriateness of the study design.
  3. Comment on the definition and selection of cases.
  4. Comment on the definition and selection of controls.
  5. How were data on colonoscopy ascertained?
  6. Was the period of time during which colonoscopy was performed appropriate?
  7. Was there control of confounding variables?
  8. What are the results?
  9. How precise are the results?
  10. State the conclusion. Have the authors addressed the question posed?
  11. Does the evidence support the conclusion?
Articles

1. Does Colonoscopy Decrease the Risk of Colon Cancer; Baxter NN, Goldwasser MA, Paszat LF, et al. Association of Colonoscopy and Death from Colorectal Cancer. Ann Int Med 2009;150:1-8

2. Critical Appraisal Skills Program (CASP); Critical Appraisal Skills Program (CASP) Making Sense of Evidence. Public Health Resource Unit, England 2006:1-6
 
Reviews
Clinical Review (Can): Guillaume Martel /Robin Boushey- University of Ottawa
Clinical Review (US): James Church - Cleveland Clinic
Methodological Review: Elijah Dixon - University of Calgary

February 2010

Topics
1. Clinical Topic: Primary Closure vs. Open Healing for Pilonidal Sinus
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical quetion being addressed?
  2. Did the review explicityly 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 posed?
  12. Does the evidence support the conclusion?
Articles

1. Primary Closure vs Open Healing for Pilonidal Sinus; McCallum IJD, King PM, Bruce J. Healing by Primary Closure versus Open Healing after Surgery for Pilonidal Sinus: Systematic Review and Meta-analysis. BMJ 2008;336(7649):868-71

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): Carol-Ann Vasilevsky - McGill University
Clinical Review (US): Lester Gottesman - Columbia University
Methodological Review: Karen Brasel - Medical College of Wisconsin

January 2010

Topics
1. Clinical Topic: Nut, Corn and Popcorn Consumption and the Incidence of Diverticulitis
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical quetion 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 gorups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationshop correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome and how precise is the estimate of risk?
  8. Are the results applicable to my practice?
  9. What is the magnitude of the risk?
  10. Should I attempt to stop the exposure? Or should I encourage "the exposure"?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Nut, Corn, Popcorn Consumption and the Incidence of Diverticulitis;

State LL, Liu YL, Synagal S, et al. Nut, Corn and Popcorn Consumption and the Incidence of Diverticular Diseae. JAMA 2008;300(8):907-14


2. How to Use an Article About Harm; Mitchell L, 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): Stan Feinberg - North York General Hospital
Clinical Review (US): Rooco Ricciardi - Lahey Clinic
Methodological Review: Carl Brown - University of British Columbia

November 2009

Topics
1. Clinical Topic: Meta-analyis of Quality of Life for APR vs. AR for Rectal Cancer
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 posed?
  12. Does the evidence support the conclusion?
Articles

1. Meta-analysis of Quality of Life for APR vs. AR for Rectal Cancer; Cornish JA, Tilney HS, Heriot AG, Lavery IC, et al. Meta-analysis of Quality of Life for Abdominalperineal Excision of Rectum versus Anterior Resection for Rectal Cancer. Ann Surg Ocolg 2007;14(7):2056-68

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): Erin Kennedy - University of Toronto
Clinical Review (US): Clifford Ko - UCLA
Methodological Review: Larissa Temple - Memorial Sloan Kettering Cancer Center

October 2009

Topics
1. Clinical Topic: Defunctiong Stoma Reduces Anastomotic Leakage after Low Anterior Resection of Rectum for Cancer
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 attributed 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 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 clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Defunctiong Stoma Reduces Anastomotic Leak after Low Anterior Resection of Rectum for Cancer; Matthiessen P, Hallbook O, Rutegard J, et al. Defunctiong Stoma Reduces Symptomatic Anastomotic Leakage after Low Anterior Resection of the Rectum for Cancer. Ann Surg 2007;246(2):207-14

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): Manoj Raval - University of British Columbia
Clinical Review (US): Steven Wexner - Cleveland Clinic
Methodological Review: Suzanne Cutter - Cedars Sinai Medical Center Los Angeles/Arden Morris - Unviersity of Michigan

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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