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• W2215308116 abstract "In this issue, we once again present letters from readers, along with the authors’ reply. The sentiments and concerns raised by Drs. Wu and Fellner in their Letters to the Editor, as well as Dr. Dayton’s reply, are much appreciated. In my opinion, moreover, these letters demonstrate the importance of bias reduction measures and determining levels of clinical evidence as these concepts apply to the medical literature. It is important for surgeons to feel strongly about the operations that they carry out on their patients because so much is at stake when we resort to surgical methods as treatment. The decision as to which procedures to perform is typically based on the individual surgeon’s past experience and training, his or her understanding of the current literature, and that surgeon’s appreciation of the specific needs of the individual patient. Combined, these factors make up the evidence base. Unfortunately, the evidence base often lacks quality scientific information that surgeons can use in the decision-making process. In particular, scientific evidence comparing one procedure to another in an unbiased fashion, namely a randomized controlled trial (usually designated as Level of Clinical Evidence 1 or 2), is often absent because it is difficult to design and execute a meaningful randomized controlled trial and far easier to analyze and describe outcomes observed in a series of patients. For these reasons, we resort to systematic reviews of existing information to aid us in our selection of a particular surgical procedure. However, if the existing pool of information consists only of case reports and series, cohort and cross-sectional studies, and case-control studies, then biases and personal opinions will permeate the evidence base and limit our ability to select a scientifically grounded treatment option. Yet paradoxically, in our commitment to our patients’ well-being, we must strongly believe that the interventions we choose are the best for that particular patient. The letters that we present in this issue of The Journal of Foot & Ankle Surgery® illustrate this dilemma clearly. The authors’ reply makes clear the lack of unbiased, scientific clinical information on this topic, and thus the need for well-designed and executed randomized controlled trials to provide a sound scientific foundation on which to base our choices." @default.
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• W2215308116 date "2016-01-01" @default.
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• W2215308116 title "Show Me the Evidence" @default.
• W2215308116 doi "https://doi.org/10.1053/j.jfas.2015.11.004" @default.
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