Vol 1 | Issue 1 | July – Sep 2015 | page: 3 | Ashok Shyam.
Author: Dr. Ashok Shyam.
Editor – International journal of surgical cases
Case Reports and Clinical Practice: What is the Evidence?
In the era of evidence based medicine where everyone is talking about randomised controlled trials, what impact will a new journal of surgical case reports will have?
This is a question that will arise in minds of many and it did arose in my mind several years back when we started the Journal of Orthopaedic Case Reports (JOCR). JOCR is in its fifth year and is indexed with pubmed. The phenomenal success of JOCR has led us to believe that case reports have returned with great vigour especially since the clinicians are now looking for solutions for cases that are difficult to treat and also wish to learn about rare cases. As pointed in the editorial of this issue, case reports provide a blueprint of protocol and decision making for management of a unique or rare case. This is an excellent clinical material which is almost as if every reader gets the personalised clinical experience of treating the patient described in the report. Case reports can provide great insights to the readers and can help them enrich their clinical expertise. This is opposition to evidence based medicine which has severe restrictions especially in surgical field. There has been consistent and valid criticism of the paradigm of evidence based medicine specifically related to surgical fields which are more depended on the surgical skills of the surgeon and patient factors as compared to the purely pharmaceutical fields. Specific point of criticism would be how EBM treats the observational studies as much inferior as compared to comparative experimental studies.
Looking historically, observational studies have formed the core of our clinical knowledge and expertise and these have served us well for a long time. Comparative experimental studies do play important role specifically in development of new pharmaceuticals but then application of those same principles to surgical concepts like surgeons experience, infrastructure availability, patient preferences are not possible. These factors combined with huge infrastructural and financial cost that the experimental studies warrant, EBM seems to be a difficult pathway for surgical field. In the same line do observational studies have enough value to provide us with valid conclusions? It has been stated that a well conducted observational study is as good as a randomised trial. This International Journal of Surgical Cases aims to provide platform for all forms of observational studies including case series, case reports, case images etc. We believe this will help us generate good strong observational data and studies and will be useful to enrich the subject of surgery.
I would like to thank and congratulate the new team of editors that have taken over this responsibility of starting and running this Journal and I wish them the very best.
Dr Ashok Shyam
Editor- International journal of surgical cases.
|How to Cite this Article: Shyam A. Case Reports and Clinical Practice: What is the Evidence?. International Journal of Surgical Cases 2015 July-Sep;1(1): 3.