The development of reporting guidelines over the past 20 years represents a major advance in scholarly publishing with recent evidence showing positive impacts. Whilst over 350 reporting guidelines ...exist, there are few that are specific to surgery. Here we describe the development of the STROCSS guideline (Strengthening the Reporting of Cohort Studies in Surgery).
We published our protocol apriori. Current guidelines for case series (PROCESS), cohort studies (STROBE) and randomised controlled trials (CONSORT) were analysed to compile a list of items which were used as baseline material for developing a suitable checklist for surgical cohort guidelines. These were then put forward in a Delphi consensus exercise to an expert panel of 74 surgeons and academics via Google Forms.
The Delphi exercise was completed by 62% (46/74) of the participants. All the items were passed in a single round to create a STROCSS guideline consisting of 17 items.
We present the STROCSS guideline for surgical cohort, cross-sectional and case-control studies consisting of a 17-item checklist. We hope its use will increase the transparency and reporting quality of such studies. This guideline is also suitable for cross-sectional and case control studies. We encourage authors, reviewers, journal editors and publishers to adopt these guidelines.
•There are currently no guidelines specific to surgical cohort studies.•A Delphi consensus exercise was put to an expert panel of 74 surgeons and academics.•17 items were agreed critical to adequately report surgical cohort studies.
Highlights • Reporting guidelines can improve transparency and reporting quality. • No guideline exists for reporting case series. • Our objective was to develop reporting guidelines for surgical ...case series.
Restoration of function following flexor tendon repair in zone II represents a difficult clinical problem. Despite many publications on rehabilitation methods, there exists no consensus as to which ...method is superior. This study was undertaken to determine which flexor tendon rehabilitation protocol provides the best outcome after surgical repair in zone II.
Electronic databases were searched for articles published between 1970 and 2009. The population included patients aged 5 years and older who sustained a flexor tendon laceration in zone II. The primary outcome was rupture rate. Secondary outcomes were range of motion and quality of life. The following protocols and their variations were considered: passive flexion and active extension protocols (Kleinert type protocols), controlled passive motion protocols (Duran type protocols), combination of the Kleinert and Duran protocols, and early active motion protocols.
Seventy-nine articles were identified. Fifteen studies met the inclusion criteria. The mean rate of rupture was lowest in the combined Kleinert and Duran protocols (2.3 percent) and highest in the Kleinert protocols (7.1 percent). No statistically significant differences were found. The combined Kleinert and Duran protocols and the early active motion protocols exhibited the highest proportion of digits with excellent or good results using the Strickland and Buck-Gramcko systems. One study included a quality-of-life assessment-meaningful comparison was not possible.
Both early active motion protocols and combined Kleinert and Duran protocols result in low rates of tendon rupture and acceptable range of motion following flexor tendon repair in zone II. Future studies should include quality-of-life measurements using validated scales.
Objective
CLEFT-Q is a condition-specific patient-reported outcome measure (PROM) for patients with cleft lip and/or palate (CL/P). The aim of this study was to examine the cross-sectional construct ...validity of the CLEFT-Q scales.
Design
Construct validity was assessed through a prospective study that tested hypotheses regarding correlations of scores with other PROMs that measure related constructs.
Setting
Seven cleft centres in Canada, the USA, and UK were involved.
Patients/Participants
Patients were aged eight to 29 years with CL/P.
Interventions
Before undergoing rhinoplasty, orthognathic, cleft lip scar revision, and alveolar bone graft, participants were asked to complete the following PROMs: CLEFT-Q (9 scales), Child Oral Health Impact Profile (socio-emotional subscale) and Cleft Hearing Appearance and Speech Questionnaire (features 1 subscale).
Main Outcome Measure(s)
The correlation coefficients examining the relationship between the scales were the main outcome measures. Correlations (Spearman) were calculated and interpreted as follows: <0.3 weak, 0.30 to 0.50 moderate, ≥0.50 strong.
Results
Participants (n = 177) were mostly male (61%) and aged between eight and 11 years (42%). Overall, 38 of 52 (73%) hypotheses tested were supported. More specifically, 20 of 26 (77%) hypotheses about correlations between the appearance scales were supported, two of three (67%) hypotheses about correlations between the health-related quality of life scales were supported, and 16 of 23 (70%) hypotheses about correlations between the appearance and health-related quality of life scales were supported.
Conclusions
Cross-sectional construct validity of the CLEFT-Q scales adds further evidence of the psychometric properties of this instrument.
Surgical trials pose many methodological challenges often not present in trials of medical interventions. If not properly accounted for, these challenges may introduce significant biases and threaten ...the validity of the results.
We systematically reviewed the significance of randomized controlled trials in the evaluation of surgical interventions, discussed the methodological challenges encountered in designing and conducting randomized controlled trials of surgical treatments, and proposed possible solutions to overcome these challenges.
Many barriers and issues of surgical trials affecting internal validity can be overcome with proper methodology, and in most cases these issues do not restrict their conduct. Researchers should consider their research question carefully and design a surgical trial that contains features appropriate for the question. In doing so, they must ensure that the trial is valid, feasible, and affordable--a difficult feat, but one well worth the challenge.
Introduction Breast hypertrophy is a common condition that is often treated with breast reduction surgery. A large percentage of breast hypertrophy patients have notable asymmetry between breasts. ...Methods The purpose of this study was to investigate a method of measuring breast asymmetry, one that allows patients to determine the asymmetry of their own breasts at home with ease, and to assess its accuracy and role in a surgical practice. A retrospective chart review was conducted, wherein self-measurements of breast asymmetry using a variation of Bouman's technique were compared with the recorded intra-operative resected tissue mass. Results In total, 47 patients with asymmetry were included in the study. The difference between patient-reported measurements and resected breast tissue mass varied from 0 grams to 240 grams. Of the 47 patients, 38% were able to measure their breast difference within a remarkable 10 grams as compared to the resected breast tissue, of which four patients were accurate to less than one gram. The majority (70%) of patients accurately measured their asymmetry within 50 grams, which was determined to be a clinically significant amount based on a survey of plastic surgeons performed for the study. Conclusion The breast measurement technique presented in this study appears to be effective and accurate for most patients with suspected asymmetry undergoing reduction mammaplasty that stands to reduce pre-operative planning time. Patient-reported breast measurement may emerge as a valuable tool in clinical and research pursuits; however, further research on this topic is indicated at this time.
Systematic review of skin graft donor-site dressings Voineskos, Sophocles H; Ayeni, Olubimpe A; McKnight, Leslie ...
Plastic and reconstructive surgery (1963),
07/2009, Letnik:
124, Številka:
1
Journal Article
Recenzirano
Debate continues about what split-thickness skin graft donor-site dressing provides the best outcomes for patients at the lowest cost. The goal of this systematic review was to determine which ...donor-site dressings are associated with the best outcomes for the following: pain, infection rate, healing quality, healing rate, quality of life, and cost.
A comprehensive literature review and assessment was undertaken by two independent reviewers. Articles were selected using specific inclusion criteria. Split-thickness skin graft donor-site dressings were classified as either moist or nonmoist based on the state of the dressing upon initial application. Methodological quality of randomized controlled trials was assessed using the Jadad scale.
Seventy-five relevant articles were included in the final analysis, three of which were review articles. The most commonly measured outcome was healing rate (64 of 72), followed by pain (58 of 72), infection rate (40 of 72), healing quality (40 of 72), and cost (15 of 72). No studies measured quality of life. The majority of articles were randomized controlled trials (35 of 75), followed by observational studies (22 of 75), unsystematic clinical observations (15 of 75), and review articles (three of 75). It was difficult to compare moist and nonmoist dressings in this review because of the methodological heterogeneity of the included articles. The available evidence suggests, however, that moist dressings are superior in terms of pain.
Some weak evidence exists that supports "wet dressings." To determine the best split-thickness skin graft donor-site dressing, more methodologically sound randomized controlled trials are needed. Trials with parallel economic evaluations should be undertaken to answer this question.
Background:
Evaluation of research productivity among plastic surgeons can be complex. The Hirsch index (h-index) was recently introduced to evaluate both the quality and quantity of one’s research ...activity. It has been proposed to be valuable in assessing promotions and grant funding within academic medicine, including plastic surgery. Our objective is to evaluate research productivity among Canadian academic plastic surgeons using the h-index.
Methods:
A list of Canadian academic plastic surgeons was obtained from websites of academic training programs. The h-index was retrieved using the Scopus database. Relevant demographic and academic factors were collected and their effects on the h-index were analyzed using the t test and Wilcoxon Mann-Whitney U test. Nominal and categorical variables were analyzed using χ2 test and 1-way analysis of variance. Univariate and multivariate models were built a priori. All P values were 2 sided, and P < .05 was considered to be significant.
Results:
Our study on Canadian plastic surgeons involved 175 surgeons with an average h-index of 7.6. Over 80% of the surgeons were male. Both univariable and multivariable analysis showed that graduate degree (P < .0001), academic rank (P = .03), and years in practice (P < .0001) were positively correlated with h-index. Limitations of the study include that the Scopus database and the websites of training programs were not always up-to-date.
Conclusion:
The h-index is a novel tool for evaluating research productivity in academic medicine, and this study shows that the h-index can also serve as a useful metric for measuring research productivity in the Canadian plastic surgery community. Plastic surgeons would be wise to familiarize themselves with the h-index concept and should consider using it as an adjunct to existing metrics such as total publication number.
Hydrofluoric acid (HF) causes a unique chemical burn. Much of the current treatment knowledge of HF burns is derived from case reports, small case series, animal studies and anecdotal evidence. The ...management can be challenging because clinical presentation and severity of these burns vary widely. Plastic surgeons managing burn patients must have a basic understanding of the pathophysiology, the range of severity in presentation and the current treatment options available for HF burns.
The present article reviews the current understanding of the pathophysiology and systemic effects associated with severe HF burns. Furthermore, it distinguishes between minor and life-threatening HF burns and describes several of the basic techniques that are available to treat patients with HF burns.
Cleft lip and/or palate (CL/P) is a common congenital craniofacial anomaly that may negatively affect an individual's appearance, health-related quality of life, or speech. In Spain, Colombia, and ...Chile the overall prevalence of CL/P ranges from 0.53 to 1.59 cases per 1000 live births. Currently, there is no patient-reported outcome (PRO) instrument that is specific for patients with CL/P. The CLEFT-Q is a new PRO instrument developed to measure outcomes of treatment in patients 8 to 29 years of age with CL/P. The aim of this study was to translate and culturally adapt the CLEFT-Q for use in Colombia, Chile, and Spain.
The CLEFT-Q was translated from English to 3 Spanish language varieties (Colombian, Chilean, and Spanish (Spain)) and Catalan. Translation and cultural adaptation guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research were followed.
The field- test version of the CLEFT-Q consisted of 13 scales (total 154 items) measuring appearance, health-related quality of life, and facial function. Forward translations revealed 10 (7%) items that were difficult to translate into Chilean, and back translations identified 34 (22%) and 21 (13%) items whose meaning differed from the English version in at least 1 of the 3 Spanish varieties and Catalan respectively. Twenty-one participants took part in cognitive debriefing interviews. Participants were recruited from plastic surgery centres in Bogotá, Colombia (n = 4), Santiago, Chile (n = 7), and Barcelona, Spain (n = 10). Most participants were males (n = 14, 67%) and were diagnosed with CL/P (n = 17, 81%). Participants reported difficulty understanding 1 item in the Colombian, 1 item in the Spanish (Spain), and 11 items from the Catalan version. Comparison of the 3 Spanish varieties revealed 61 (40%) of the 154 items whose wording differed across the 3 Spanish versions.
Translation and cultural adaptation processes provided evidence of transferability of the CLEFT-Q scales into 3 Spanish varieties and Catalan, as semantic, idiomatic, experiential, and conceptual equivalence of the items, instructions, and response options were achieved.
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