Georgeson Keith
Children׳s Services, Sacred Heart Medical Center and Children׳s Hospital, 1418 North River Vista Street, Spokane, Washington 99224.
Semin Pediatr Surg. 2015 Jun;24(3):112-4. doi: 10.1053/j.sempedsurg.2015.02.007. Epub 2015 Mar 3.
Innovation is the major force for progress in pediatric surgery. Most of the progress in surgery has evolved secondary to novel approaches developed by surgeons confronted with difficult pathologic conditions. Up to the present time, most surgical innovation has been practiced with few rules for guidance. Innovation to make surgical procedures more effective and less morbid is highly desirable. However, the absence of oversight has the potential to lead to unbridled human experimentation. The quality improvement movement in medicine is attempting to improve outcomes using evidence-based clinical pathways. Quality improvement aims to decrease the variation in therapeutic approaches by scientifically defining best practices. There is a significant potential for autonomous surgical innovators to clash with well-meaning proponents of quality improvement. A suggested remedy to encourage surgical innovators while protecting patients from unintended harm is for institutions to develop Surgical Innovation Committees to evaluate and give oversight to the early application of new techniques and devices. Scientific evaluation under the auspices of an IRB should follow when feasible.
创新是小儿外科进步的主要推动力。外科手术的大多数进展都是外科医生在面对困难病理状况时开发的新方法所带来的间接成果。直到目前，大多数外科创新都是在几乎没有指导规则的情况下进行的。使手术程序更有效且并发症更少的创新非常值得期待。然而，缺乏监督有可能导致无节制的人体实验。医学领域的质量改进运动正试图通过基于证据的临床路径来改善治疗结果。质量改进旨在通过科学定义最佳实践来减少治疗方法的差异。自主的外科创新者与善意的质量改进支持者之间存在重大冲突的可能性。一种既能鼓励外科创新者又能保护患者免受意外伤害的建议补救措施是，各机构应设立外科创新委员会，以评估并监督新技术和设备的早期应用。在可行的情况下，应在机构审查委员会（IRB）的主持下进行科学评估。
