International Journal of Surgery 19 (2015) 31e32
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Editorial
Best BETS e The next chapter
Keywords: Best evidence topics Evidence based medicine Medical education
Over the last twenty years, across all medical specialities, there has been a surge of interest in evidence-based medicine (EBM): a movement committed to grounding everyday clinical practice in empiricism [1]. The benefits of EBM include making medical practice safer, more consistent, and potentially more cost-effective. Testment to this drive has been an increase in the number of systematic reviews and meta-analyses published in medical journals. Whilst it is clearly important to address the fundamental questions of medicine with high-level systematic reviews, in many respects surgical practice remains an art as opposed to a science, with numerous possible steps and nuances of technique for even the simplest operation. Many surgical approaches and techniques are therefore not amenable to being assessed by randomised controlled trials, which are in general a mandatory pre-requisite for high quality meta-analysis. As a solution to this potential lacuna in EBM for certain subjects, the concept of Best Evidence Topics, or ‘Best BETs’, was proposed in 2002 by Professor Mackway-Jones [2]. The first Best BETs concerned simple but common clinical questions arising in the Accident and Emergency department, for which high-quality, large scale evidence was lacking. Since development of Best BETs in Accident and Emergency, the format has been adopted by a number of other specialties including Cardiothoracic surgery [3], Paediatrics [4] and most recently General Surgery, with the support of the International Journal of Surgery (IJS) [5]. As demonstrated in the recent audit by Mabvuure [6], Best BETs have been enthusiastically adopted by the authorship and readership of the IJS, with high citation and download rates. Between 2011 and 2014, thirty-four Best BETs were published in IJS, which equates to approximately one Best BET per month. Of these, sixteen (47%) have addressed topics relating to upper gastrointestinal surgery, which is likely to relate to the sub-speciality interest of the senior author (OK) who originally set up Best BETs in the International Journal of Surgery. Other popular subspecialties are colorectal (14%) and hepatobiliary (9%), although topics relating to ENT, endocrine, vascular, neurosurgery, training and plastic surgery have also been published. As the evidence base for clinical
topics is constantly evolving, it is important that the publication process for Best BETs occurs rapidly, with minimum time between literature review and publication. To date, the mean time between literature search and publication of Best BETS is 38 weeks, of which the turnover between acceptance and publication is on average only 13 days. Taking as an example the Best BETs published in IJS in the month of March 2015, several of the strengths of this format are apparent. Best BETs are able to objectively assess new technologies for which there is limited or poor-quality data only, such as robotic parathyroidectomy (RP) as compared to open parathyroidectomy for patients with hyperparathyroidism [7]. Via systematic review of the available evidence, Garas et al. conclude that RP is equivalent to conventional parathyroidectomy in terms of cure, but more expensive and therefore at present only justifiable in patients with particular cultural reason to avoid a neck scar. Another strength of Best BETs is their ability to critically question standard clinical practices, with implications for delivery of cost-effective clinical care. For example, Healy et al. examined the practice of routine follow-up of infrainguinal arterial bypass vein grafts with duplex ultrasound, and have demonstrated that there is to-date no good evidence that such routine surveillance improves patient outcomes [8]. Bets BETs also allow closer scrutiny of surgical technique, improving the safety and efficacy of clinical care. For example Bashar et al. have recently used the Best BET methodology to demonstrate that use of a vein with diameter of
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Editorial
Best BETS e The next chapter
Keywords: Best evidence topics Evidence based medicine Medical education
Over the last twenty years, across all medical specialities, there has been a surge of interest in evidence-based medicine (EBM): a movement committed to grounding everyday clinical practice in empiricism [1]. The benefits of EBM include making medical practice safer, more consistent, and potentially more cost-effective. Testment to this drive has been an increase in the number of systematic reviews and meta-analyses published in medical journals. Whilst it is clearly important to address the fundamental questions of medicine with high-level systematic reviews, in many respects surgical practice remains an art as opposed to a science, with numerous possible steps and nuances of technique for even the simplest operation. Many surgical approaches and techniques are therefore not amenable to being assessed by randomised controlled trials, which are in general a mandatory pre-requisite for high quality meta-analysis. As a solution to this potential lacuna in EBM for certain subjects, the concept of Best Evidence Topics, or ‘Best BETs’, was proposed in 2002 by Professor Mackway-Jones [2]. The first Best BETs concerned simple but common clinical questions arising in the Accident and Emergency department, for which high-quality, large scale evidence was lacking. Since development of Best BETs in Accident and Emergency, the format has been adopted by a number of other specialties including Cardiothoracic surgery [3], Paediatrics [4] and most recently General Surgery, with the support of the International Journal of Surgery (IJS) [5]. As demonstrated in the recent audit by Mabvuure [6], Best BETs have been enthusiastically adopted by the authorship and readership of the IJS, with high citation and download rates. Between 2011 and 2014, thirty-four Best BETs were published in IJS, which equates to approximately one Best BET per month. Of these, sixteen (47%) have addressed topics relating to upper gastrointestinal surgery, which is likely to relate to the sub-speciality interest of the senior author (OK) who originally set up Best BETs in the International Journal of Surgery. Other popular subspecialties are colorectal (14%) and hepatobiliary (9%), although topics relating to ENT, endocrine, vascular, neurosurgery, training and plastic surgery have also been published. As the evidence base for clinical
topics is constantly evolving, it is important that the publication process for Best BETs occurs rapidly, with minimum time between literature review and publication. To date, the mean time between literature search and publication of Best BETS is 38 weeks, of which the turnover between acceptance and publication is on average only 13 days. Taking as an example the Best BETs published in IJS in the month of March 2015, several of the strengths of this format are apparent. Best BETs are able to objectively assess new technologies for which there is limited or poor-quality data only, such as robotic parathyroidectomy (RP) as compared to open parathyroidectomy for patients with hyperparathyroidism [7]. Via systematic review of the available evidence, Garas et al. conclude that RP is equivalent to conventional parathyroidectomy in terms of cure, but more expensive and therefore at present only justifiable in patients with particular cultural reason to avoid a neck scar. Another strength of Best BETs is their ability to critically question standard clinical practices, with implications for delivery of cost-effective clinical care. For example, Healy et al. examined the practice of routine follow-up of infrainguinal arterial bypass vein grafts with duplex ultrasound, and have demonstrated that there is to-date no good evidence that such routine surveillance improves patient outcomes [8]. Bets BETs also allow closer scrutiny of surgical technique, improving the safety and efficacy of clinical care. For example Bashar et al. have recently used the Best BET methodology to demonstrate that use of a vein with diameter of
