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Best evidence, but does it really change practice?
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  1. Richard N de Steiger
  1. Department of Surgery, Epworth Health Care, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Professor Richard N de Steiger; Richard.Desteiger{at}epworth.org.au

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Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.1 Though it is generally accepted that properly conducted randomised trials (and subsequent meta-analyses) provide the best evidence to answer a clinical question, these are not always possible and they have been less frequently performed in surgery. If there are randomised trials, and good evidence is thus available, this should guide therapeutic and diagnostic choices but also still requires clinical judgement to translate the results from these trials to an individual patient in daily practice, for instance because some subgroups of patients may have been excluded from these trials.2

In this issue of BMJ Quality & Safety, an interesting and informative article by Reeves et al entitled ‘Implementation of research evidence in orthopaedics: a tale of three trials’3 seeks to examine the impact of three widely known orthopaedic trauma randomised controlled trials (RCTs) and the subsequent Health Technology Assessment (HTA) reports and their uptake in clinical practice. The two key questions were whether, and when surgeons followed the recommendations of the trial. In two cases, a change of practice in line with the trial conclusions actually preceded publication, and in the third case there was no evidence of a change of practice, either during or after the trial.

There are many sources of information that surgeons may consider when trying to adopt best practice apart from clinical trials, including clinical quality registries, peer-reviewed cohort …

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