RESUMEN
The purpose of this study was to compare the use of evidence based medicine in the guidelines published by the American College of Obstetrician and Gynecologists (ACOG) and Trauma Surgery (Eastern Association for Trauma Surgery [East]). We compared the references and the types of recommendations in ACOG and EAST guidelines. Odds ratio (OR), along with 95% confidence intervals (CI) were calculated and 95% CI not crossing the integer 1 were considered significant. Over eight years (1998-2005), ACOG published 58 guidelines and EAST, 23. Among the references cited, randomized clinical trials (RCT) were noted in 17% (714/4225) for ACOG versus 9% (165/1850) among trauma surgery guidelines (OR 2.07; 95% 1.74, 2.48). ACOG guidelines were also significantly more likely to have recommendations based on RCT (29%; 135/464) than EAST (10%, 24/242; OR 3.73, 95% CI 2.34, 5.94). East and ACOG guidelines have significantly fewer RCT and recommendations based on them than previously thought.
Asunto(s)
Ginecología/métodos , Obstetricia/métodos , Guías de Práctica Clínica como Asunto , Procedimientos Quirúrgicos Operativos/métodos , Heridas y Lesiones/cirugía , Medicina Basada en la Evidencia , Femenino , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Various techniques for basilic vein transposition have been described, including endovascular, 1-stage, and 2-stage transposition. However, none of these 2-stage techniques include a new arteriovenous anastomosis during the second stage. This study adds to the current literature as well as introducing a new and innovative technique for hemodialysis access. METHODS: Forty-nine basilic vein transpositions were performed. Data were collected retrospectively. Primary and secondary patency was calculated using life table methods. Complications and interventions were recorded. RESULTS: Primary patency was 72% at 1 year, 54% at 2 years, and 54% at 3 years. Secondary patency was 95%, 80% and 65% at 1, 2, and 3 years, respectively. Twenty-nine patients experienced complications related to the fistula, and 15 required intervention to maintain patency. Patency was achieved in 100% of the procedures using percutaneous techniques. CONCLUSIONS: This 2-stage procedure should be strongly considered when planning brachial basilic fistulas for hemodialysis access.