Introducing our IDEAL Lead for Physiotherapy: Dr Arsenio Paez

We are delighted to welcome Dr Arsenio Paez to the IDEAL Collaboration in the role of Specialty Lead for Physiotherapy.

Arsenio is a physiotherapist with a pediatric private practice in New York, NY. He is a Professor in the Doctoral Program in Physical Therapy in the Dept of Physical Therapy, Movement, and Rehab Sciences at Northeastern University, Boston, MA, and former Lend Fellow in Neurodevelopmental Disabilities at the Children’s Hospital, Boston. 

Arsenio recently completed the MSc in Evidence-Based Health Care at the University of Oxford, and has applied to continue to a DPhil in Evidence-Health Care for 2018.

His current area of research is in neurodevelopmental outcomes in childhood epilepsy, innovative practice in physiotherapy and clinical trial methods in complex interventions.

Arsenio states ” I am very enthusiastic about IDEAL and what IDEAL-Physio can do to improve the quality of practice and research in physiotherapy. We have had a great surge in the amount of evidence being designed and produced in physiotherapy, with over 18,500 clinical trials and 5600 systematic reviews added to the body of evidence in the last decade alone. Ideal-Physio offers us an invaluable and practical framework to help guide the innovation of new practices and improve the quality of evidence. The unique, complex nature of our interventions requires a dynamic and practicable approach to innovation and evidence gathering, and I believe IDEAL-Physio draws on these to create something truly representative of the nature of complex interventions. It also has great potential to aid us in preparing the evidence-makers and innovators of the future, with very promising applications in academic settings and clinical education”.

Arensio has led work on extending IDEAL to physiotherapy (IDEAL-Physio) recently accepted for publication in the Physical Therapy Journal:

Beard D, Hamilton D, Davies L, Cook J, Hirst A, McCulloch P and Paez A. Evidence-based evaluation of practice and innovation in Physical Therapy using the IDEAL-Physio framework. Physical Therapy Journal (In Press) DOI 10.1093/ptj/pzx103 

(Link to follow when available)







Systematic Review of key features of successful surgical registries

A breast implant“There is a clear need for surgical registry data to improve patient safety and help regulate surgical practices.The IDEAL collaborative, Department of Health (DOH), the National Institute for Health and Care Excellence (NICE), policymakers and commissioning groups have called for surgical registries that can collect prospective outcome and safety data, promote transparency as well as provide patients and the public with information on their care. However, developing and maintaining a registry faces considerable challenges with the majority of registries failing.

To help address this, we conducted a systematic review and narrative synthesis, learning from existing and previous registries, to identify the fundamentals to successful registry development. We found that the key factors for successful registry development include:  steering committee to lead and oversee the registry; clear registry objectives; planning for initial and long-term funding; strategic national collaborations among key stakeholders; dedicated registry management team; consensus meetings to agree registry dataset; established data processing systems; anticipating challenges; and implementing strategies to increase data completion. Patient involvement and awareness of legal factors should occur throughout the development process.

Our work provides robust knowledge that can be used to inform the successful development of any UK surgical registry. It also provides a methodological framework for international surgical registry development”

Mr Rishi Mandavia , NIHR Academic Clinical Fellow ENT Surgery and NICE Specialist Advisor, evidENT Team, Ear Institute, University College London

Mandavia R, Knight A, Phillips J, et al  What are the essential features of a successful surgical registry? a systematic review.

Link to the paper here:


New reporting guideline STROCSS extends STROBE for surgery-specific research studies


“For many years I saw articles compliant with the STROBE guidelines but still missing large amounts of key information relevant to surgeons.  Such key information centred around the intervention itself is paramount to understanding what’s been done in a study, critically appraising and replicating it. Readers need complete, clear and transparent reporting and we hope the STROCSS guideline goes some way towards this.”

Dr Riaz Agha, Managing and Executive Editor, International Journal of Surgery

The full guideline and checklist for reporting surgical cohort, cross-sectional and case-control studies is available on the STROCSS website:

Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP; STROCSS Group. The STROCSS statement: Strengthening the Reporting of Cohort Studies in Surgery. Int J Surg. 2017;46: 198–202

The STROCSS checklist can be downloaded here: the_strocss_statement_checklist

Peter McCulloch talks about IDEAL at Evidence Live 2017

The IDEAL team Claudia Ashton, Allison Hirst, Claire Thomson and Peter McCulloch  presented a workshop on using IDEAL to appraise the surgical literature at #EvidenceLive on 21st June 2017

Following the workshop Peter McCulloch, Chair of the IDEAL Collaboration discussed some of the challenges of surgical research with Douglas Badenoch @Mental_Elf




Educational Workshop 4th May 2017, NY: Critical appraisal using IDEAL

As part of our 2017 Conference in New York, 4th-5th May 2017, we are holding a half day educational workshop. Please select this at the time of registration for the conference at

Early registration discount available until April 1st   Registration fees include breakfast and lunch each day of the conference, and CME credits will be available for physicians. For further information, contact: or visit

Workshop 4th May 2017

Critical appraisal using the IDEAL Framework (provisional timetable)

8.30—9.15AM (JH)  History of EBM; Inherent difficulties of surgical evaluation; lack of formal education among trainees in US

9.15—10.00AM (JF)  Group workshop – Systematic approach to the Critical Appraisal of a Surgical Paper

  • Short lecture explaining the approach to appraising a surgical paper using GATE framework
  • Using an RCT – group(s) will appraise the paper

10.00—10.30AM               Coffee/Tea

10.30—11.00AM (CP)  IDEAL: Framework and How to utilize it

  • Describe the purpose of IDEAL and why it is necessary
  • Explain each stage and the relevant questions at each stage

11.00AM – 11.30AM  Group workshop – Identifying the IDEAL stage of innovation

  • Group given a surgical article and asked to identify the IDEAL stage described in the paper

11.30 – 12.00PM (PM)  Using IDEAL: Progressing through the life-cycle of surgical Innovation

  • As a large group, we take a surgical procedure through the IDEAL stages of innovation and display how each stage would be designed

12.00—12.15PM (JF)  IDEAL: Current status and future

  • Update since conference last year
  • Applications to devices and other sectors

12:15 – 12.30 (JF)  Assessment of participants’ comprehension of IDEAL

  • Short questionnaire asking participants about Framework & Recommendations
  • Will provide handouts on IDEAL and critical appraisal

Teaching Faculty

JH – Joel Horovitz, Vice Chair of Surgery, Maimonides Medical Center

JF – Joshua Feinberg, Maimonides Medical Center

CP – Christopher Pennell, Maimonides Medical Center

PM – Peter McCulloch, Chair IDEAL Collaboration, University of Oxford

Where is the evidence for novel surgical devices?

This question was recently addressed and the findings published in the British Journal of Surgery

Two of the authors describe what they did and what they found;


Stephen J Chapman, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK




Aneel Bhangu, Dept of ColorectalSurgery, University of Birmingham, Birmingham, UK


Innovation in surgery is important to ensure the treatment of surgical disease continues to advance. The role of industry is paramount in driving this forward, but must be matched by robust clinical evidence and dedicated regulation.

Whilst regulatory bodies in the U.K. work to ensure safe introduction of surgical devices, many are supported by minimal or no evidence of safety or effectiveness. We are acutely aware of this problem; new surgical devices are introduced every day yet these may be unfamiliar or unproven. Whilst regulatory bodies are often satisfied with evidence of “equivalence”, the true clinical impacts of these are unclear.

Our study, published in the British Journal of Surgery, demonstrated the extent of this problem (1). We systematically compiled a list of implantable devices used in gastrointestinal surgery and set out to find evidence to support their use. Alarmingly, only 1 in 10 of these devices was supported by evidence from high quality randomised controlled trials (RCT).

Whilst RCTs are perceived to slow the rate of innovation, dedicated networks of surgeons have proven their ability to evaluate surgical interventions quickly and effectively (2). Additionally, whilst RCTs are not always the most appropriate design to test novel interventions, they provide high quality evidence when undertaken by dedicated clinical and academic networks.

In line with proposals from the IDEAL Collaboration, we encourage a standardised, step-wise approach to the assessment of novel surgical technology. This should begin with first in man studies, progress through stages of randomised assessment, and culminate in long term surveillance in dedicated devices registries.


  1. Chapman SJ. Shelton B. Maruthappu M. Singh P. McCulloch P. Bhangu A. Cross-sectional observational study of the availability of evidence supporting novel implantable devices used in gastrointestinal surgery. Br J Surg 2017 [Epub ahead of print]. doi: 10.1002/bjs.10485
  2. Bhangu A. Kolias AG. Pinkney T. Hall NJ. Fitzgerald JE. Surgical research collaboratives in the UK. Lancet 2013;382:1091-2.

Opportunities to develop collaborative surgical projects at IDEAL 2017 Conference



Would you like to participate in the development of major new scientific studies to evaluate your work?

If so, the 2017 IDEAL MEETING in New York offers a unique opportunity.  During the SURGICAL SPECIALITY THINK TANKS ON 4TH MAY IDEAL 2017 Provisional Agenda  we’ll be seeking to initiate multi-centre prospective collaborative studies of one new cutting edge technique in each workshop.  These will use the IDEAL 2b PROSPECTIVE COHORT format and the intention is that the initial study will form the basis for a subsequent major RCT.  If you would like to get in on the ground floor of one of these collaborative studies by surgical innovators, register for the meeting and send your ideas to:

Registration is now open at – early registration discount available until April 1st 2017! Registration fees include breakfast and lunch each day of the conference, and CME credits will be available for physicians. For further information, contact: or visit

This is an opportunity to help plan important studies which will shape the direction of future practice in your speciality.  The IDEAL Collaboration contains expert methodologists, statisticians and others who can help guide the development of research groups and reduce the burden of participation on clinicians to a minimum. 

We look forward to meeting you and working together on these exciting projects.

Prof Peter McCulloch, IDEAL Chair, Oxford (left)


  Prof Art Sedrakyan, IDEAL    Vice-Chair, New York (right)

Abstracts from our 2016 Conference now published in International Journal of Surgery

Abstracts from our 2016 Conference are now available in  the International Journal of Surgery

December 2016 Volume 36, Supplement 2, S133-S144

Access to innovative treatments and device support during IDEAL stages 2b-4 K. Hutchison

Advancing the cause of research registration: The first 500 registrations of the R. Agha, A.J. Fowler, C. Limb, Y. Al Omran, H. Sagoo, K. Koshy, D.J. Jafree, M.O. Anwar, Peter McCulloch, D.P. Orgill

Surgical trainee research collaboratives in the United Kingdom A.G. Kolias, A.A.B. Jamjoom, P.N.H. Phan, P.J.A. Hutchinson

The merits of decision modeling in the earliest stages of the IDEAL framework – The case of innovative bilateral DIEP flap surgery J. Grutters, J. Gerrits, L. Schultze Kool, D. Ulrich, M. Rovers, S. Hummelink

Evaluation of innovation in radiation oncology: R-IDEAL H. Verkooijen, L. Kerkmeijer, D. Fuller, Robbert Huddart, C. Faivre-Finn, M. Verheij, A. Sahgal, E. Hall, M. van Vulpen

Small simple trials: A strategy to study rare surgical condition J.G. Wright

Short-term cost-effectiveness of colonic stenting is lost at 90-day follow-up in patients with malignant large bowel obstruction  H. Yeo, J. Abelson, J. Milsom, S. Sharma, A. Sedrakyan

3-Year outcomes and cost-savings of combined endoscopic laparoscopic surgery (CELS) for benign colon polyps M. Kiely, S. Sharma, A. Sedrakyan, J. Yoo, H. Yeo, J. Abelson, J. Milsom

Stereotactic body radiotherapy followed by surgery for unstable spinal metastases: Technical feasibility and safety study according to the IDEAL stages 1 and 2a.  A. Versteeg, J. van der Velden, H. Verkooijen, W. Eppinga, N. Kasperts, S. Gerlich, C. Oner, M. van Vulpen, J.-J. Verlaan

Perioperative outcomes, health care costs and survival after robotic-assisted versus open radical cystectomy: A national comparative effectiveness study  J. Hu, B. Chughtai, P. O’Malley, J. Halpern, J. Mao, D. Scherr, D. Hershman, J. Wright, A. Sedrakyan

Comparative effectiveness of cancer control and survival after robotic assisted versus open radical prostatectomy J. Hu, B. Chughtai, P. O’Malley, A. Isaacs, J. Wright, D. Hershman, A. Sedrakyan

Reconstruction of bladder defects with amniotic membrane – IDEAL-D Stage 0-1  D. Barski, H. Gerullis, A. Winter, I. Pintelon, J.-P. Timmermans, A. Ramon, M. Boros, G. Varga, T. Otto

Is more evidence always better? The value of adding decision analytical modeling to the IDEAL framework C. Tax, P.H.M. Govaert, M. Stommel, M.G.H. Besselink, H.G. Gooszen, J. Grutters, M.M. Rovers

Progressing through IDEAL: When is the right time to move from observational to randomised studies? – A case study of REBOA J.O. Jansen, M.K. Campbell

MiCollar – A novel iPhone application to analyse cervical spine motion restriction with different size and type of cervical orthoses R. Ingleton, C. Ashton, J. Bull, V.N. Vakhari

The X-Bolt dynamic hip plating system: Evaluating a novel surgical device for hip fracture surgery  M. Fernandez, J. Achten, N. Parsons, X.L. Griffin, M.L. Costa

Radical cystectomy in epidural anaesthesia – Feasibility analysis using a new reporting method following the IDEAL recommendations H. Gerullis, T.H. Ecke, C. Bantel, A. Weyland, D. Barski, T. Jansen, J. Uphoff, F. Wawroschek, A. Winter

Applying IDEAL: Early stage surgical innovation of a novel bio-wrap-assisted vasectomy reversal technique  A. Gudeloglu, J. Brahmbhatt, S. Parekattil

Matching trial design decisions to the needs of those you hope will use the results: The PRECIS-2 tool  K. Loudon, M. Zwarenstein, F. Sullivan, P. Donnan, S. Treweek

The GASTROS Study: Standardising outcome reporting in gastric cancer surgery research  Bilal Alkhaffaf, Anne-Marie Glenny, Jane Blazeby, Paula Williamson, Iain Bruce

Support for reporting guidelines in surgical journals needs improvement: A systematic review  R. Agha, I. Barai, S. Rajmohan, S.Y. Lee, M. Anwar, A.J. Fowler, D. Orgill, D. Altman

Compliance of systematic reviews in plastic surgery with the PRISMA statement: A systematic review  S.Y. Lee, H. Sagoo, K. Whitehurst, G. Wellstead, A.J. Fowler, R. Agha, D. Orgill

A systematic review of the methodological and reporting quality of case series in surgery  R. Agha, A.J. Fowler, S.Y. Lee, B. Gundogan, K. Whitehurst, H. Sagoo, K.J.L. Jeong, D. Altman, D. Orgill

An assessment of the compliance of systematic review articles published in craniofacial surgery with the PRISMA statement guidelines: A systematic review  T.E. Pidgeon, G. Wellstead, H. Sagoo, D.J. Jafree, A.J. Fowler, R. Agha

The use of study registration and protocols in plastic surgery research: A systematic review  T.E. Pidgeon, C. Limb, R. Agha, K. Whitehurst, C. Chandrakumar, G. Wellstead, A.J. Fowler, D. Orgill

Twist-drill craniostomy with hollow screws for evacuation of chronic subdural haematoma  A.G. Kolias, A. Chari, S.J. Bond, P.J.A. Hutchinson

Intra-operative hyperspectral imaging for brain tumour detection and delineation: Current progress on the HELICoid project S. Kabwama, D. Bulters, H. Bulstrode, H. Fabelo, S. Ortega, G.M. Callico, B. Stanciulescu, R. Kiran, D. Ravi, A. Szolna, J.F. Piñeiro

Developing a patient and public involvement intervention to enhance recruitment and retention in UK surgical trials (PIRRIST)  J.C. Crocker, S. Rees, L. Locock, S. Petit-Zeman, A. Chant, S. Treweek, J.A. Cook, N. Farrar, K. Woolfall, J. Bostock, L. Bowman, R. Bulbulia

Osseointegrated joint replacement connected to a lower limb prosthesis: An IDEAL stage 1 proof of concept study with 7 cases  A. Khemka, S. Lord, M. Al Muderis

The East Grinstead Consent Collaborative (EGCC) online consent creator J. Dhanda, M. Dungarwalla

Development of an online platform for registration and outcome measurement of urogynecological implants according to IDEAL-system D. Barski, H. Gerullis, T. Ecke, R. Joukhadar, J. Kranz, R. Tahbaz, F. Queissert, L. Schneidewind, S. Mühlstädt, M. Grabbert, N. Huppertz, A.E. Pelzer, U. Klinge, M. Boros, W. Bader, F. Puppe, T. Otto

Bringing laparoscopy to your own home M. Vella-Baldacchino, M. Vella Baldacchino, M. Schembri, R. Bugeja

Autologous plasma coating improves the biocompatibility of mesh implants. On the IDEAL way from bench to bedside  H. Gerullis, D. Barski, T.H. Ecke, C. Eimer, M. Boros, B. Klosterhalfen, A. Ramon, T. Otto

Percutaneous nephrolithotomy (PCNL) under local infiltrative anesthesia with and without stand-by anesthesia – Complication rates and clinical outcome for a method at the exploration stage according to IDEAL T.H. Ecke, G. Weingart, C. Lange, S. Hallmann, F. Wawroschek, D. Barski, J. Ruttloff, H. Gerullis

The landscape of surgical innovation in robotic microsurgery A. Gudeloglu, B. Ozdemir, S.R. Fleischman, P. Dahm

Awareness of the ideal recommendations among the members of the Robotic-Assisted Microsurgery and Endoscopic Society (RAMSES)  A. Gudeloglu, S.R. Fleischman, P. Dahm