[Contribution of the Study Center of the German Surgical Society to evidence based surgery]

[Evidence-based surgery - The Study Center of the German Surgical Society]

The Study Center of the German Surgical Society (SDGC) assists surgeons to develop research questions and conduct clinical trials. Development (sample size calculation, protocol, funding application), implementation (submission to ethics committee, data management, monitoring) and analysis (statistical analysis, publication) are supported by SDGC specialists such as biometricians and project managers. Currently approximately 4,800 patients have been included in 15 trials. Systematic reviews with meta-analyses are the basis of valid sample size calculation by aggregating the results of existing studies systematically. In 2005, a work group for the development of systematic reviews has been established at the SDGC. Sixteen publications have so far been completed, and eight more are underway. Using clinical trials and systematic reviews as the fundamental cornerstones in evidence-based medicine, the SDGC has developed an effective network for clinical research in surgery.

Evidence-based medicine in daily surgical decision making: a survey-based comparison between the UK and Germany

BACKGROUND

Evidence-based medicine (EbM) is a vital part of reasonable and conclusive decision making for clinicians in daily clinical work. To analyze the knowledge and the attitude of surgeons towards EbM, a survey was performed in the UK and Germany.

METHODS

A web-based questionnaire was distributed via mailing lists from the Royal College of Surgeons of England (RCSE) and the Berufsverband Deutscher Chirurgen (BDC). Our primary aim was to get information about knowledge of EbM amongst German and British surgeons.

RESULTS

A total of 549 individuals opened the questionnaire, but only 198 questionnaires were complete and valid for analysis. In total, 40,000 recipients were approached via the mailing lists of the BDC and RCSE. The response rate was equally low in both countries. On a scale from 1 (unimportant) to 10 (very important), all participants rated EbM as very important for daily clinical decision making (7.3 ± 1.9) as well as for patients (7.8 ± 1.9) and the national health system (7.8 ± 1.9). On a scale from 1 (unimportant) to 5 (very important), systematic reviews (4.6 ± 0.6) and randomized controlled trials (4.6 ± 0.6) were identified as the highest levels of study designs to enhance evidence in medicine. British surgeons considered EbM to be more important in daily clinical work when compared to data from German surgeons (7.9 ± 1.6 vs. 6.7 ± 2.1, p < 0.001). Subgroup analysis showed different results in some categories; however, a pattern to explain the differences was not evident. Personal requirements expressed in a free text field emphasized the results and reflected concerns such as broad unwillingness and lack of interdisciplinary approaches for patients (n = 59: 25 in the UK and 34 in Germany).

CONCLUSION

The overall results show that EbM is believed to be important by surgeons in the UK and Germany. However, perception of EbM in the respective health system (UK vs. Germany) may be different. Nonetheless, EbM is an important tool to navigate through daily clinical problems although a discrepancy between the knowledge of theoretical abstract terms and difficulties in implementing EbM in daily clinical work has been detected. The provision of infrastructure, courses and structured education as a permanent instrument will advance the knowledge, application and improvement of EbM in the future.

[Abstracts at congresses of the German Society of Urology. Trends and quality]

BACKGROUND

The congress of the German Society of Urology is the third biggest urology congress worldwide and reflects the scientific landscape of urology in Germany. In the congress abstracts, detailed data regarding study design, current trends in urologic research and the cooperation of authors are lacking. We wanted to identify factors contributing to the likelihood of an abstract being followed by a publication in a peer-reviewed journal.

MATERIAL AND METHODS

The two congresses of the years 2002 and 2009 were exemplarily analyzed. Various aspects regarding study design and cooperations were retrieved from the abstracts and trends were determined. Subsequent publications in peer-reviewed journals were searched for in MEDLINE and potential factors influencing publication success were identified. Significance was tested for using the χ (2) and Mann-Whitney-U statistical tests.

RESULTS

A total of 732 abstracts (2002: 352, 2009: 380) were analyzed, one third of which contained prospective, retrospective or preclinical/experimental studies. Internal (28.7 %) and national (27.6 %) cooperations were most frequent. Significant trends towards more retrospective studies (p=0.008) and national cooperations (p=0.019) were found. Of the abstracts 49.2 % (2002) and 56.3% (2009) were followed by publication in peer-reviewed journals (median 15.1 months) with a significantly higher mean impact factor in 2009 (3.4 vs. 2.1, respectively p>0.0001). Therapeutic studies and those including statistics or national cooperations were significantly more likely to be published.

CONCLUSION

In the future urologic research should focus on prospective studies. Many abstracts are not followed by a publication in a peer-reviewed journal. This is especially true for abstracts containing no statistics. As national collaborations are correlated with successful publication, an early national networking of young researching urologists should be promoted.

[Barriers to clinical studies involving medical devices]

Clinical trials with medical devices need to be considered in terms of the complexity of surgical procedures. Creating the proper environment for the conduct of trials includes improved academic career opportunities in the field of clinical research, methodological competence, and established structures. The challenges and pitfalls in the design of clinical trials involving medical devices are based on aspects such as blinding, placebo, learning curves and surgeons' expertise. Surgical procedures should be standardised, and a study hypothesis needs to be established which is answerable by a relevant and feasible sample size. Besides the above-mentioned challenges, efficient interactions between authorities, universities, hospitals, and medical device manufacturers are mandatory to allow for quality and relevance of clinical studies in this field.