Establishing and integrating datasets beyond instilling a culture of capture
Whilst the double-blind, randomised clinical trial has established itself at the apex of the evidence pyramid for modern medicine, surgical research has always suffered from a degree of epistemological elitism and snobbery by the medical disciplines.1 This is because the majority of surgical progress has been made as a result of the lowly surgical audit rather than the double-blind, randomised control trial (RCT). This is unfair as the benefits of clinical audit in surgery are manifest. Ambrose Pare was an early example of a surgeon who, out of necessity, applied his mind and came up with a pragmatic but radical solution to a pressing clinical problem. During the interminable internecine wars of the Renaissance period, he began to apply linen dressings to wounds rather than cautery, and so changed the practice of surgery for the better.2 The same can be said of Semmelweis, an early adopter of surgical asepsis, at a time when the germ theory was still not conceived. Without any theory to support his praxis, he advocated hand washing for medical students returning from their morning post mortem session, before beginning work in the maternity wards. His simple intervention radically reduced hospital- related maternal mortality rates. Semmelweis paid a heavy professional price for his radical disruption of vested interests. He was drives from Vienna and ended his days working far from the major hospitals of Vienna. He is posthumously referred to as the Saviour of the Mother.3
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