Use of Implants
genital organ prolapse
Sweden 2006 - 2013
National Quality Registry
for Gynecological Surgery
www.gynop.org
How did we decide ?
IMPLANT
yes / no ?
if yes
”FIRST TIME” / RECURRENCES?
Why do we decide as we do?
INPLANT: YES / NO ?
MEMO
 IMPLANT Yes / No:
Most of us must be wrong
and have been so for 6 years
COUNTIES – individual decisions ?
REGIONS – individual decisions ?
MEMO
IMPLANT Yes/No:
Most of us must be wrong and have been so for 6 years
we do like our neighbours do
FIRST TIME or RECURRENCE ?
MEMO
yes/no - first time/recurrence
Most of us make the wrong decisions
We have done so persistently for 6 years
We do like our neighbours do
Increasing evidence since 2005
had no impact on our decisions
Why do we do as we do?
Why did we not improve
after 6 years + 4000 implants?
ILLUSION of VALIDITY............
”more evidence” … yes
but it will not solve our problems
We must change the way
we make decisions
thank you for listening to me
Back up for the diskussion
new implants / year:
mean operations / dr / year:
5-6-7…
2-3-4
6 or more new implants / year…
EBM:
the conscientious integration of individual clinical expertise
with the best available external clinical evidence from systematic research
to make decisions about the care of individual patients
and the use of mathematical estimates
to predict whether a treatment will do more good than harm
Evidence-based medicine is mainly concerned with ensuring
that strategies of proven clinical effectiveness are adopted.
The Gynop family …
adnex
intrauterin
hyst
Databas
tumör
prolaps
inkont