Randomised trials in surgery

doi:10.1136/bmj.325.7365.658/a

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ comment articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Integrated approach is needed

Rajan Madhok (rajan.madhok@neynlha.nhs.uk), medical director,
Helen H G Handoll, research fellow

North and East Yorkshire and Northern Lincolnshire Health Authority, York Science Park, York YO10 5DG
University of Hull c/o University Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SU
School of Medicine, University of Keele, Stoke on Trent ST4 7QB

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 …