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New Paradigm for Progress in Surgery Proposed

Last Updated: September 25, 2009.

In a series of articles in the Sept. 26 issue of The Lancet, a cohort of surgical-thought leaders proposes a new paradigm for innovation, research, and evidence-based advancement in the field of surgery.

FRIDAY, Sept. 25 (HealthDay News) -- In a series of articles in the Sept. 26 issue of The Lancet, a cohort of surgical-thought leaders proposes a new paradigm for innovation, research, and evidence-based advancement in the field of surgery.

In the initial article, Jeffrey S. Barkun, M.D., of McGill University Health Centre in Montreal, and colleagues discuss the steps in surgical innovation, including the first use of a procedure, development of technical details, early dispersion among practitioners, initial assessment as the innovation becomes widespread, and long-term monitoring. In the second article, Patrick L. Ergina, M.D., also of McGill University Health Centre, and colleagues survey the challenges to research in the surgical sphere, such as the difficulty of randomizing in the surgical setting, interdependence of surgical care components, surgeon knowledge and experience variability, and poorly defined outcomes.

In the final article, Peter McCulloch, M.D., of the University of Oxford in the United Kingdom, and colleagues propose a rigorous five-stage development process, similar to drug development, that makes use of databases and clearly-defined prospective studies, including randomized trials. The stages encompass: 1) innovation, or initial use of a procedure; 2a) development, entailing the planned use of a new procedure in a group usually not larger than 30 patients; 2b) exploration with a larger number of patients (up to a few hundred); 3) assessment against current standards; and 4) long-term study to identify rare and long-term outcomes.

"We believe surgical science can be greatly improved, and progress in surgical care and interventions will become safer, more efficient, and better," McCulloch and colleagues conclude.

Abstract - Barkun
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Abstract - Ergina
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Abstract - McCulloch
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