[Evidence-based surgery]. / Chirurgie op basis van wetenschap.

Authority-based surgery is slowly being replaced by evidence-based surgery. New and existing interventions are increasingly being studied in randomised controlled trials (RCTs). RCTs allow not only for comparison of different types of surgical interventions but also for comparison with non-surgical interventions and adjuvant therapies. Surgical RCTs have many methodological limitations, such as inherent difficulties with randomisation and blinding, and ethical limitations in using placebo controls. Choosing appropriate intervention groups, providing adequate training for participating surgeons and ensuring a high volume per surgeon reduces the risk of complications due to inexperience. Unplanned cross-over is a potential source of bias in explanatory RCTs comparing surgical interventions. Conducting a surgical RCT requires good collaboration between large and small hospitals due to organisational complexity, ethical limitations, funding and long term follow-up. Acceptance and implementation of the results from surgical RCTs through evidence-based guidelines depends heavily on local opinion leaders and the training of surgical residents.

[From the Cochrane Library: the use of peer review is still under discussion]. / Uit de Cochrane Library: nut van 'peer review' nog steeds ter discussie.

Peer review is generally considered to be an invaluable part of the editorial process of biomedical journals. It is widely assumed that peer review has positive effects on the quality of submitted papers and of biomedical research. This is why improvements in peer reviewing have been studied for some years. According to the authors of a recent Cochrane methodology review, peer review does improve the quality of papers, but there is insufficient evidence that it also improves the quality of biomedical research. A major study on this subject is called for, since its results could have implications for patient care and scientific research.