How Does One Learn Medicine? LISTS; OOOTTAFAGVAH. NLTPGMCH ALGORITHMS; MOST DAMP MENTORING Critical Objective Appraisal of the Evidence?. No, that’s too tough, even for old farts like me.

How Does One Learn Medicine? LISTS; OOOTTAFAGVAH. NLTPGMCH ALGORITHMS; MOST DAMP MENTORING Critical Objective Appraisal of the Evidence?. No, that’s too tough, even for old farts like me.

Why use prophylactic post-operative nasogastric decompression? Hasten the return of gastrointestinal function Diminish the risk of emesis and pulmonary aspiration Decrease the risk of wound dehiscence.

Does Anybody Still Do It? Standard of Care; Montgomery, 1996 Traditionally used by most Surgeons; Lee, 2002 Common Practice; Sakamandis, 1999;. Manning, 2001,.. Cunningham, 1992 Unquestioned; Savassi-Rocha, 1992 Routine; Wolff, 1989

What did they do? See, touch, play with a Salem Sump Tube What is a clinical trial? Where is the library? Find out about Pub Med. Download Cochrane Software, Epi-info, Hepima Learn about quality assessment/ data abstraction Develop a data abstraction form Do literature search ……………..and so on

NASOGASTRIC TUBES DOGMA: Prophylactic nasogastric decompression after abdominal surgery diminishes the duration of ileus and lessens the risk of pulmonary complications COCHRANE REVIEW 1 st AUTHOR: Nelson & Honors 201 STATUS: Published review RESULTS: Patients receiving no tube had shorter duration of ileus and less risk of pulmonary complications. NUMBER RCTs: 29

Types of Surgery in the Review Colorectal Hepatobiliary Gastric Gynecological Oncology Major Vascular Abdominal Trauma

TIME TO FLATUS; only studies presenting precise odds ratios and standard deviations

TIME TO FLATUS adding studies that imputed odds ratios and confidence intervals from “p” values

PULMONARY COMPLICATIONS

ANASTOMOTIC LEAK

WOUND INFECTION

HERNIA

WHO CAN DO COCHRANE REVIEWS? Anybody But it helps to have your feet on the ground clinically.

What still needs to be Reviewed? Everything Think of something you do in your practice, and you’re sure it’s for a good reason, but you can’t remember why. Many common practices have been shown to be ineffective through systematic review of randomized studies. Practice based upon evidence.

ANASTOMOTIC LEAK

WOUND INFECTION