جراحي مبتني بر شواهد

Evidence – Based Surgery

ﮔﺰﺍﺭﺵ ﻣﺆﺳﺴﻪ ﭘﺰﺷﮑﻲ ﺁﻣﺮﻳﮑﺎ ﺩﺭ ﺳﺎﻝ 1999 ﻣﺸﺨﺺ ﺳﺎﺧﺖ ﮐﻪ ﺑﺨﺶ ﺑﺰﺭﮔﻲ ﺍﺯ ﺧﻄﺎﻫﺎﻱ ﭘﺰﺷﮑﺎﻥ ﺑﻪ ﺳﺒﺐ ﻋﺪﻡ ﺁﮔـﺎﻫ ﻲ ﺁﻧـﺎﻥ ﺍﺯ ﺑﻬﺘـﺮ ﻳﻦ ﺷـ ﻴﻮﻩ ﻃﺒﺎﺑـﺖ ﻣﻲ ﺑﺎﺷﺪ. ﺍﺳﺘﻔﺎﺩﺓ ﻫﻮﺷﻴﺎﺭﺍﻧﻪ، ﻧﻈﺎﻡ ﻣﻨﺪ ﻭ ﺷﻔﺎﻑ ﺍﺯ ﻧﺘﺎﻳﺞ ﭘﮋﻭﻫﺸﻲ ﺩﺭ ﻃﺒﺎﺑﺖ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﺎﻋﺚ ﮐﺎﻫﺶ ﺍﻳﻦ ﺧﻄﺎﻫﺎ ﮔﺮﺩﺩ. ﺍﻳﻦ ﺩﺭ ﺣﺎﻟﻲ ﺍﺳﺖ ﮐﻪ ﺟﺮﺍﺣﻲ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﺑﻪ ﻋﻠﻞ ﻣﺨﺘﻠﻒ ﮐﻤﺘﺮ ﺍﺯ ﻃﺒﺎﺑﺖ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﺩﺭ ﺗﺨﺼﺺ ﻫﺎﻱ ﻏﻴﺮﺟﺮﺍﺣﻲ ﺗﻮﺳﻌﻪ ﻳﺎﻓﺘﻪ ﺍﺳﺖ. ﺗﻤﺎﻳﻞ ﺑﻴﺸﺘﺮ ﺟﺮﺍﺣﺎﻥ ﺑﻪ ﺍﻧﺠﺎﻡ ﺟﺮﺍﺣﻲ ﻫﺎﻳﻲ ﮐـﻪ ﺩﺭ ﺁﻧﻬﺎ ﺗﺒﺤﺮ ﺩﺍﺭﻧﺪ، ﺩﺷﻮﺍﺭﻱ ﺍﻧﺠﺎﻡ ﻣﻄﺎﻟﻌﺎﺕ ﺑﺎﻟﻴﻨﻲ ﮐﻨﺘﺮﻝ ﺷﺪﻩ ﺩﻭﺳﻮﮐﻮﺭ ﺩﺭ ﻣﻮﺿﻮﻋﺎﺕ ﺟﺮﺍﺣﻲ، ﺗﻌﺪﺍﺩ ﺍﻧﺪﮎ ﻣـﺮﻭﺭﻫﺎﻱ ﻧﻈﺎﻡ ﻣﻨﺪ ﻭ ﺑﺎﻻﺧﺮﻩ ﺗﻌﺼﺐ ﺣﺮﻓـﻪ ﺍﻱ ﺳـﺒﺐ ﮔﺮﺩﻳﺪﻩ ﺍﺳﺖ ﺗﺎ ﻃﺒﺎﺑﺖ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﺍﺯ ﺟﺎﻳﮕﺎﻩ ﻣﻨﺎﺳﺒﻲ ﺩﺭ ﻣﻴﺎﻥ ﺟﺮﺍﺣﺎﻥ ﺑﺮﺧﻮﺭﺩﺍﺭ ﻧﺒﺎﺷﺪ. ﮔﺴﺘﺮﺵ ﻣﻄﺎﻟﻌﺎﺕ ﺑﺎﻟﻴﻨﻲ ﻭﺍﺟﺪ ﮐﻴﻔﻴﺖ ﻭ ﻣﻄﺎﻟﻌﺎﺕ ﺳﻨﺘﺘﻴﮏ ﺩﺭ ﺯﻣﻴﻨﻪ ﻫﺎﻱ ﺟﺮﺍﺣﻲ، ﮔﺴﺘﺮﺵ ﻓﺮﻫﻨﮓ ﻭ ﺩﺍﻧﺶ ﻃﺒﺎﺑﺖ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﺩﺭ ﻣﻴﺎﻥ ﺟﺮﺍﺣﺎﻥ، ﺗﺴﻬﻴﻞ ﻋﻤﻠﻲ ﻃﺒﺎﺑﺖ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﺩﺭ ﺟﺎﻳﮕﺎﻩ ﻫﺎﻱ .ﺟﺮﺍﺣﻲ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺟﺮﺍﺣﻲ ﻧﻤﺎ ﺩﺭ ﻣﻄﺎﻟﻌﺎﺕ ﺍﺛﺒﺎﺕ ﺍﺛﺮ ﺑﺨﺸﻲ ﻭ ﺩﺭ ﺍﻧﺘﻬﺎ ﺍﺟﺘﻨﺎﺏ ﺍﺯ ﻋﻤﻞ ﮔﺮﺍﻳﻲ ﺍﻓﺮﺍﻃﻲ ﺩﺭ ﻣﻴﺎﻥ ﺟﺮﺍﺣﺎﻥ ﺍﻗﺪﺍﻣﺎﺗﻲ ﺍﺳﺖ ﮐﻪ ﺑﻪ ﻣﻨﻈﻮﺭ ﺗﺴﻬﻴﻞ ﺟﺮﺍﺣﻲ ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮﺍﻫﺪ ﺩﺭ ﻣﻴﺎﻥ ﺟﺮﺍﺣﺎﻥ ﻣﻲ ﺗﻮﺍﻥ ﺗﻮﺻﻴﻪ ﻧﻤﻮﺩ

The report of the US institute of medicine showed that a large proportion of medical errors occurred because of poor knowledge about the best method practice. The use of careful and systematic of research results in evidence-based practice lead to less errors. Evidence-based surgery has been less developed than evidence-based practice in non-surgical disciplines because of many factors. The surgeon's willing ness to do operative procedures they are more skilled in, the problematic nature of conducting double blind randomized surgical trials, the scarcity of systematic reviews and finally professional dogmatism of surgeons, all are contributing to poor state of evidence-based practice among the surgeons. An increase in the number of quality clinical trials and synthetic studies in surgery, developing the culture of using best evidence as well as the improvement of the skills and knowledge of evidence-based practice among surgeons, provides the required supportive facilities and practicalities in the surgical settings, higher use of sham surgeries in effectiveness studies and refraining from intense pragmatism in part of surgeons are measures that can facilitate greater evidence-based practice in surgery.