answer:
archibald (archie) cochrane's most influential mark on healthcare was his 1971 publication, “effectiveness and efficiency.” this book strongly criticized the lack of reliable evidence behind many of the commonly accepted healthcare interventions at the time. his criticisms spurred rigorous evaluations of healthcare interventions and highlighted the need for evidence in medicine. his call for a collection of systematic reviews led to the creation of the cochrane collaboration. archie cochrane was a visionary person who lay down much of the foundation for evidence-based medicine. this paper will introduce evidence-based medicine to plastic surgery by tracing its history to the seminal efforts by archie cochrane.
explanation:
ebm has become increasingly important in healthcare, its relationship to surgery has been tenuous. it was estimated that 30-50% of general medicine decisions are based on rcts, only 10-20% of surgical decisions are based on rcts.34 the process of translating evidence into clinical practice is fraught with difficulties and poses special problems for the field of surgery. much of this is because of a lack of sound evidence. there is a scarcity of level i clinical evidence because rcts are quite difficult to conduct to test surgical interventions.35,36 in fact, rcts, even when conducted properly, are not infallible. for example, the inclusion criteria for rcts dramatically change the practicality of the study. rcts with stringent inclusion criteria have limited population-wide applicability, and rcts with liberal inclusion criteria lose sensitivity. moreover, it is not possible to test many surgical interventions through the use of rcts. an examination of surgical literature revealed that only 40% of surgical interventions could possibly be studied with rcts.37 often, as a result of these restrictions, physicians resort to conducting studies less stringent than rcts such as cohort studies, case-controlled studies, etc. the data from these studies have a tendency to produce artifacts, which lead physicians to “overconclude” and prescribe an inappropriate intervention.38,39 in spite of these shortcomings, ebm has benefitted surgery in many ways.40,41 if nothing else, even the sternest critic will agree that it has raised awareness of the importance of evidence and highlighted the shortcomings of many commonly performed surgical interventions. furthermore, it allows the surgeon of today to avoid unnecessary guessing. for example, a surgeon considering whether or not pre-operative hair removal prevents surgical site infections can simply reference the cochrane library to discover what the latest research shows.
like other surgical fields, the field of plastic surgery has also suffered from a dearth of level i clinical evidence. this was recently illustrated in a survey of articles published in plastic and reconstructive surgery in the years 1983, 1993, and 2003. a large portion of published studies (86.9%) remained uncontrolled in 2003. however, there was a demonstrated increase in controlled studies (7.2% of studies in 1983 versus 13.7% of studies in 2003), and the number of rcts increased from 0 in 1983 to 7 in 2003.42 due to the inherent difficulty associated with conducting rcts in surgery, it is unlikely that plastic surgery will ever enjoy having many level i clinical evidence found in other fields. as health care costs continue to rise, there will be an increasing trend towards the incorporation of ebm into practice to justify what are often costly medical interventions. organizations such as the american society of plastic surgeons (asps) have presented innovative publications to communicate up-to-date guidelines to physicians and to spur evidence-based practice.
