BMJ 2002;325:658 ( 21 September )

Letters

Randomised trials in surgery

    Integrated approach is needed
    Employment of academic and evidence based surgeons and epidemiologists may be the answer

Integrated approach is needed

The first 150 words of the full text of this article appear below.

EDITOR---As Cochrane reviewers appraising randomised controlled trials on surgical interventions for orthopaedic trauma and through our involvement with the promotion of evidence based orthopaedic surgery in Teesside, we would like to endorse and extend the observations of McCulloch et al on randomised controlled trials in surgery.1

Although issues specific to surgical trials mentioned by McCulloch et al also apply, most of the trials we have reviewed have methodological defects that could have been avoided. For example, concealment of study allocation is always possible, yet this was confirmed in just two of the 44 trials included in a review of surgical treatment of wrist fractures in adults.2

Tackling any "lack of education in clinical epidemiology," and various other measures proposed by McCulloch et al will go some way towards addressing the current state of affairs in research in surgery, but more is needed. Surgeons should realise that using the right . . . [Full text of this article]
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Relevant Article

Randomised trials in surgery: problems and possible solutions
Peter McCulloch, Irving Taylor, Mitsuru Sasako, Bryony Lovett, and Damian Griffin
BMJ 2002 324: 1448-1451. [Extract] [Full Text] [PDF]

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