Towards evidence-based medicine in cardiothoracic surgery: best BETS

Cardiothoracic surgeons are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the 'best practice' from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research and current resources that collate evidence for clinicians have few if any resources for cardiothoracic surgeons. We have adopted an approach pioneered in emergency medicine, namely the Best Evidence Topic or BestBET. Clinicians select a clinical scenario from their daily practice that highlighted an area of controversy. From this, a three-part question is generated and this is used to search Medline for relevant papers. Once the relevant papers are found, these papers are critically appraised using validated checklists and the results are summarized. A clinical bottom line is reached after this process. To add confidence to the quality of the search a second author and then an Evidence Based Journal Club checks the BET to ensure that no relevant evidence is missed. These BETs will then be posted on the ICVTS website prior to publication for widespread commentary. The resulting BETs, written by practising cardiothoracic surgeons, will then provide robust evidence-based answers to important clinical questions asked during our daily practice.