PDF(Pubmed)
Abstract：
BACKGROUND: In 2015, the results of the \'Small bites versus large bites for closure of abdominal midline incisions (STITCH) Trial\' were published in The Lancet. This demonstrated the superiority of small bite laparotomy closure over mass closure for the reduction of incisional hernias; despite this most surgeons have not changed their practice. Previous research has shown the time taken for the implementation of evidenced based practise within medicine takes an average of 17 years. This study aims to understand the reasons why surgeons have and have not changed their practice with regards to closure of midline laparotomy.
METHODS: Semi-structured interviews were completed with surgical consultants and registrars at a single institution in South West England. The interview topic guide was informed by a review of the published literature, which identified barriers to adopting evidence into surgical practice. Interview transcripts underwent thematic analysis with themes identified following discussions within the research team, exploring views on published data and clinical practise.
RESULTS: Nine interviews with general surgical and urological consultants as well as registrars in training were performed. Three themes were identified; \'Trusting the Evidence & Critical Appraisal\', \'Surgical Attitude to Risk\' and \'Adopting Evidence in Practise\', that reflected barriers to the introduction of evidenced based practise to clinical work.
CONCLUSIONS: Identification of the themes highlights possible areas for intervention to decrease the adoption time for evidence, for example from randomised controlled trials. The continued updating of clinical practise allows clinicians to provide best evidenced based care for patients and improve their outcomes.
METHODS: Semi-structured interviews were completed with surgical consultants and registrars at a single institution in South West England. The interview topic guide was informed by a review of the published literature, which identified barriers to adopting evidence into surgical practice. Interview transcripts underwent thematic analysis with themes identified following discussions within the research team, exploring views on published data and clinical practise.
RESULTS: Nine interviews with general surgical and urological consultants as well as registrars in training were performed. Three themes were identified; \'Trusting the Evidence & Critical Appraisal\', \'Surgical Attitude to Risk\' and \'Adopting Evidence in Practise\', that reflected barriers to the introduction of evidenced based practise to clinical work.
CONCLUSIONS: Identification of the themes highlights possible areas for intervention to decrease the adoption time for evidence, for example from randomised controlled trials. The continued updating of clinical practise allows clinicians to provide best evidenced based care for patients and improve their outcomes.
摘要：
背景：2015年，“小咬伤与大咬伤闭合腹部中线切口（STITCH）试验”的结果发表在《柳叶刀》杂志上。这证明了小切口剖腹术闭合术在减少切口疝方面优于大量闭合术；尽管如此，大多数外科医生并没有改变他们的做法。先前的研究表明，在医学中实施基于证据的实践所需的时间平均为17年。这项研究旨在了解外科医生在闭合中线剖腹手术方面已经和没有改变其做法的原因。
方法：在英格兰西南部的一个机构中与外科顾问和注册师进行了半结构化访谈。采访主题指南是通过对已发表文献的回顾得出的，确定了将证据应用于外科实践的障碍。访谈笔录进行了主题分析，主题是在研究团队内部讨论后确定的，探索对已发表数据和临床实践的看法。
结果：对普外科和泌尿外科顾问以及培训注册人员进行了9次访谈。确定了三个主题；“信任证据和关键评估”，\“对风险的手术态度\”和\“在实践中采用证据\”，这反映了将证据基础实践引入临床工作的障碍。
结论：主题的确定突出了干预的可能领域，以减少采用证据的时间，例如来自随机对照试验。临床实践的不断更新使临床医生能够为患者提供最佳的循证护理并改善其结果。
方法：在英格兰西南部的一个机构中与外科顾问和注册师进行了半结构化访谈。采访主题指南是通过对已发表文献的回顾得出的，确定了将证据应用于外科实践的障碍。访谈笔录进行了主题分析，主题是在研究团队内部讨论后确定的，探索对已发表数据和临床实践的看法。
结果：对普外科和泌尿外科顾问以及培训注册人员进行了9次访谈。确定了三个主题；“信任证据和关键评估”，\“对风险的手术态度\”和\“在实践中采用证据\”，这反映了将证据基础实践引入临床工作的障碍。
结论：主题的确定突出了干预的可能领域，以减少采用证据的时间，例如来自随机对照试验。临床实践的不断更新使临床医生能够为患者提供最佳的循证护理并改善其结果。
