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Dewitt B, Persson J, Wallin A. Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals. Med Decis Making 2024; 44:335-345. [PMID: 38491851 PMCID: PMC10988987 DOI: 10.1177/0272989x241234318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/05/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Evidence-based medicine recognizes that clinical expertise gained through experience is essential to good medical practice. However, it is not known what beliefs clinicians hold about how personal clinical experience and scientific knowledge contribute to their clinical decision making and how those beliefs vary between professions, which themselves vary along relevant characteristics, such as their evidence base. DESIGN We investigate how years in the profession influence health care professionals' beliefs about science and their clinical experience through surveys administered to random samples of Swedish physicians, nurses, occupational therapists, dentists, and dental hygienists. The sampling frame was each profession's most recent occupational registry. RESULTS Participants (N = 1,627, 46% response rate) viewed science as more important for decision making, more certain, and more systematic than experience. Differences among the professions were greatest for systematicity, where physicians saw the largest gap between the 2 types of knowledge across all levels of professional experience. The effect of years in the profession varied; it had little effect on assessments of importance across all professions but otherwise tended to decrease the difference between assessments of science and experience. Physicians placed the greatest emphasis on science over clinical experience among the 5 professions surveyed. CONCLUSIONS Health care professions appear to share some attitudes toward professional knowledge, despite the variation in the age of the professions and the scientific knowledge base available to practitioners. Training and policy making about clinical decision making might improve by accounting for the ways in which knowledge is understood across the professions. HIGHLIGHTS Study participants, representing 5 health care professions-medicine, nursing, occupational therapy, dentistry, and dental hygiene-viewed science as more important for decision making, more certain, and more systematic than their personal clinical experience.Of all the professions represented in the study, physicians saw the greatest differences between the 2 types of knowledge.The effect of years of professional experience varied but tended to be small, attenuating the differences seen between science and clinical experience.
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Affiliation(s)
- Barry Dewitt
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Annika Wallin
- Department of Cognitive Science, Lund University, Lund, Sweden
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Gaudino M, Rong LQ, Baiocchi M, Dimagli A, Doenst T, Fremes SE, Gelijins AC, Kurlansky P, Sandner S, Weinsaft JW, Di Franco A. Research Concepts and Opportunities for Early-Career Investigators in Cardiac Surgery. Ann Thorac Surg 2024; 117:704-713. [PMID: 38048972 PMCID: PMC10960696 DOI: 10.1016/j.athoracsur.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/02/2023] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
Basic, translational or clinic, research is a key component of cardiac surgery. Understanding basic cellular and molecular mechanisms is key to improving patient outcomes, and cardiac surgical procedures must be compared with nonsurgical alternatives. However, guidance for early-career investigators interested in cardiac surgery research is limited. This opinion piece aims at providing basic guidance and principles based on the authors' experience.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University of Jena, Jena, Germany
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annetine C Gelijins
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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Abstract
BACKGROUND The purposes of this study were to analyze the trends in Oxford level of evidence (LOE), LOE of most-cited articles, and association between LOE and journal impact factor (IF) and SCImago Journal Rank (SJR) over a 10-year period (2009-2018) in 3 prominent hand surgery journals, specifically HAND, Journal of Hand Surgery (American Volume) (JHS), and Journal of Hand Surgery (European Volume) (JHSE). METHODS All articles published from 2009 to 2018 in HAND, JHS, and JHSE were reviewed for assigned or available LOE. Data were pooled and analyzed for trends in LOE; relationship among IF, SJR, and LOE; and citation density. RESULTS A total of 3921 total publications were tabulated from 2009 to 2018, with the majority of studies being level V (1700, 43%) and fewer studies being level I (146, 4%). Over the 10-year study period, there was no significant change in frequency of level I studies for any journal. HAND trended significantly toward higher LOE, JHS trended toward higher LOE, and JHSE trended toward decreased LOE without significance. Among all journals, the annual number of articles and the average LOE were independent significant predictors of IF and SJR. Statistically significant correlations were found between citation density and LOE for JHS and HAND. CONCLUSIONS Higher quality evidence is becoming more prevalent in the hand surgery literature over the past 10 years. Annual articles, average LOE, and level I and II and level IV articles were significant predictors of increasing IF and SJR.
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Affiliation(s)
- Reid E. Tompkins
- William Beaumont Army Medical Center, El Paso, TX, USA
- Texas Tech University Health Sciences Center, El Paso, USA
| | | | - Kyle J. Klahs
- William Beaumont Army Medical Center, El Paso, TX, USA
| | | | | | - John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
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Villeneuve LM, Evans AR, Bowen I, Gernsback J, Balsara K, Jea A, Desai VR. A systematic review of the power of standardization in pediatric neurosurgery. Neurosurg Rev 2023; 46:325. [PMID: 38049561 DOI: 10.1007/s10143-023-02218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
In the current neurosurgical field, there is a constant emphasis on providing the best care with the most value. Such work requires the constant optimization of not only surgical but also perioperative services. Recent work has demonstrated the power of standardized techniques in limiting complication while promoting optimal outcomes. In this review article, protocols addressing operative and perioperative care for common pediatric neurosurgical procedures are discussed. These articles address how various institutions have optimized procedures through standardization. Our objective is to improve patient outcomes through the optimization of protocols.
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Affiliation(s)
- Lance M Villeneuve
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA.
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA.
| | - Alexander R Evans
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Ira Bowen
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Joanna Gernsback
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Karl Balsara
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Andrew Jea
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
| | - Virendra R Desai
- Department of Neurological Surgery, University of Oklahoma College of Medicine, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
- Department of Pediatric Neurosurgery, Oklahoma Children's Hospital, Oklahoma City, OK, USA
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Ferrada P. Invited Commentary: The Power of Science: Randomized Controlled Trials in Trauma Surgery and the Need for Quality Data. J Am Coll Surg 2023; 237:737. [PMID: 37427848 DOI: 10.1097/xcs.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
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Okafor DK, Katyal G, Kaur G, Ashraf H, Bodapati AP, Hanif A, Khan S. Single-Layer or Double-Layer Intestinal Anastomosis: A Systematic Review of Randomized Controlled Trials. Cureus 2023; 15:e46697. [PMID: 38021792 PMCID: PMC10631554 DOI: 10.7759/cureus.46697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Several malignant and benign indications may necessitate bowel resection. Despite the emergence of newer techniques, the hand-sewn technique remains popular for the reestablishment of intestinal continuity after resection. This method can achieve anastomosis in one or two layers. Some studies have suggested that the single-layer technique has several potential benefits compared to its rivals while simultaneously maintaining a comparable efficacy and safety profile. Previous reviews have failed to recommend either of these methods over the other due to a lack of high-quality evidence. This review aims to establish which technique provides the best outcomes by reviewing recent relevant trials and comparing both methods. We conducted a systematic review of randomized controlled trials (RCTs) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A database search of PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) ultimately returned nine randomized trials published between 2003 and 2023 comparing single-layer intestinal anastomosis (SLIA) and double-layer intestinal anastomosis (DLIA) that fit the inclusion criteria. Overall, results show a dearth of robust trials, and the included studies displayed variable eligibility criteria and materials used for anastomosis. The available evidence, however, does suggest that neither technique is inferior in terms of preventing post-operative complications, but SLIA is less expensive and quicker to perform. The evidence is, however, limited, and further high-quality research is needed.
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Affiliation(s)
- Donatus K Okafor
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Gitika Katyal
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Gursharan Kaur
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hafsa Ashraf
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Adi Prasad Bodapati
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ayesha Hanif
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Krause F, Herrera M, Walcher M, Mahadevan D, Michels F. Quo vadis, foot & ankle research? A review. Foot Ankle Surg 2023; 29:502-505. [PMID: 37648639 DOI: 10.1016/j.fas.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
Over the last two decades, there has been a growing emphasis on the publication quality in Foot & Ankle research. A level-of-evidence rating system for clinical scientific papers has been proposed by the Centre for Evidence-based medicine in Oxford, United Kingdom. As opposed to other subspecialities, foot & ankle surgery deals with a wide variety of clinical problems and surgical solutions, which in turn leads to a generally low number of patients available for study groups. However, level III and IV studies still have a valuable place in orthopaedic research, given the challenges in running high-level studies.The measurement of outcomes in medicine from the patients' perspective (PROMS:(patient reported outcome measures) has grown almost exponentially in all surgical specialties including foot & ankle surgery. There are many PROMs available to foot & ankle surgeons, but there is little consensus on which assessment is most appropriate for a given procedure or diagnosis. Their use in research and clinical practice offers many advantages in clinical practice and research, however, besides the advantages there are also some downsides.
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Affiliation(s)
- Fabian Krause
- University of Bern, Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006 Bern, Switzerland; Sportsclinic#1, Papiermühlestrasse 73, 3006 Bern, Switzerland; Department of Orthopaedic Surgery, Inselspital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - Mario Herrera
- Foot and ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, School of Medicine, Universidad de La Laguna, Tenerife, Spain
| | - Matthias Walcher
- Orthopädie Chirurgie Würzburg, Oeggstr. 3, 97070 Würzburg, Germany; Department of Orthopedics and Traumatology, Paracelsus Medial University, Breslauer Str. 201, 90471 Nuremberg, Germany
| | - Devendra Mahadevan
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading RG1 5AN, UK
| | - Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
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Ragnhildstveit A, Li C, Zimmerman MH, Mamalakis M, Curry VN, Holle W, Baig N, Uğuralp AK, Alkhani L, Oğuz-Uğuralp Z, Romero-Garcia R, Suckling J. Intra-operative applications of augmented reality in glioma surgery: a systematic review. Front Surg 2023; 10:1245851. [PMID: 37671031 PMCID: PMC10476869 DOI: 10.3389/fsurg.2023.1245851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Background Augmented reality (AR) is increasingly being explored in neurosurgical practice. By visualizing patient-specific, three-dimensional (3D) models in real time, surgeons can improve their spatial understanding of complex anatomy and pathology, thereby optimizing intra-operative navigation, localization, and resection. Here, we aimed to capture applications of AR in glioma surgery, their current status and future potential. Methods A systematic review of the literature was conducted. This adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Embase, and Scopus electronic databases were queried from inception to October 10, 2022. Leveraging the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) framework, study eligibility was evaluated in the qualitative synthesis. Data regarding AR workflow, surgical application, and associated outcomes were then extracted. The quality of evidence was additionally examined, using hierarchical classes of evidence in neurosurgery. Results The search returned 77 articles. Forty were subject to title and abstract screening, while 25 proceeded to full text screening. Of these, 22 articles met eligibility criteria and were included in the final review. During abstraction, studies were classified as "development" or "intervention" based on primary aims. Overall, AR was qualitatively advantageous, due to enhanced visualization of gliomas and critical structures, frequently aiding in maximal safe resection. Non-rigid applications were also useful in disclosing and compensating for intra-operative brain shift. Irrespective, there was high variance in registration methods and measurements, which considerably impacted projection accuracy. Most studies were of low-level evidence, yielding heterogeneous results. Conclusions AR has increasing potential for glioma surgery, with capacity to positively influence the onco-functional balance. However, technical and design limitations are readily apparent. The field must consider the importance of consistency and replicability, as well as the level of evidence, to effectively converge on standard approaches that maximize patient benefit.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Chao Li
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, England
| | | | - Michail Mamalakis
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Victoria N. Curry
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Willis Holle
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Physics and Astronomy, The University of Utah, Salt Lake City, UT, United States
| | - Noor Baig
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | | | - Layth Alkhani
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Biology, Stanford University, Stanford, CA, United States
| | | | - Rafael Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, England
- Instituto de Biomedicina de Sevilla (IBiS) HUVR/CSIC/Universidad de Sevilla/CIBERSAM, ISCIII, Dpto. de Fisiología Médica y Biofísica
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, England
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9
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Florczynski MM, Chung KC. Choosing the Best Design in Surgical Research. Plast Reconstr Surg 2023; 151:1115-1122. [PMID: 37224338 DOI: 10.1097/prs.0000000000010173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Matthew M Florczynski
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
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Hu J, Zhu A, Vickers A, Allaf ME, Ehdaie B, Schaeffer A, Pavlovich C, Ross AE, Green DA, Wang G, Ginzburg S, Montgomery JS, George A, Graham JN, Ristau BT, Correa A, Shoag JE, Kowalczyk KJ, Zhang TR, Schaeffer EM. Protocol of a multicentre randomised controlled trial assessing transperineal prostate biopsy to reduce infectiouscomplications. BMJ Open 2023; 13:e071191. [PMID: 37208135 DOI: 10.1136/bmjopen-2022-071191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer. METHODS AND ANALYSIS We will perform a multicentre, prospective randomised clinical trial to compare transperineal versus transrectal prostate biopsy for elevated prostate-specific antigen in the first biopsy, prior negative biopsy and active surveillance biopsy setting. Prostate MRI will be performed prior to biopsy, and targeted biopsy will be conducted for suspicious MRI lesions in addition to systematic biopsy (12 cores). Approximately 1700 men will be recruited and randomised in a 1:1 ratio to transperineal versus transrectal biopsy. A streamlined design to collect data and to determine trial eligibility along with the two-stage consent process will be used to facilitate subject recruitment and retention. The primary outcome is postbiopsy infection, and secondary outcomes include other adverse events (bleeding, urinary retention), pain/discomfort/anxiety and critically, detection of non-low-grade (grade group ≥2) prostate cancer. ETHICS AND DISSEMINATION The Institutional Review Board of the Biomedical Research Alliance of New York approved the research protocol (protocol number #18-02-365, approved 20 April 2020). The results of the trial will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT04815876.
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Affiliation(s)
- Jim Hu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Alec Zhu
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Andrew Vickers
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Behfar Ehdaie
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christian Pavlovich
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David A Green
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Gerald Wang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Serge Ginzburg
- Einstein Urology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Arvin George
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - John N Graham
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Benjamin T Ristau
- Department of Surgery, Division of Urology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Andres Correa
- Department of Surgical Oncology, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jonathan E Shoag
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - E M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Constant Dit Beaufils P, Karakachoff M, Gourraud PA, Bourcier R. Management of unruptured intracranial aneurysms: How real-world evidence can help to lift off barriers. J Neuroradiol 2023; 50:206-208. [PMID: 36724868 DOI: 10.1016/j.neurad.2023.01.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/30/2023]
Affiliation(s)
- Pacôme Constant Dit Beaufils
- l'institut du thorax, Nantes Université, CHU Nantes, Service de neuroradiologie diagnostique et interventionnelle, Nantes F-44000, France
| | - Matilde Karakachoff
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, Nantes F-44000, France
| | - Pierre-Antoine Gourraud
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, Nantes F-44000, France
| | - Romain Bourcier
- l'institut du thorax, Nantes Université, CHU Nantes, Service de neuroradiologie diagnostique et interventionnelle, Nantes F-44000, France.
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Watts AC, Hamoodi Z, McDaid C, Hewitt C. Elbow arthroplasty research methods, outcome domains, and instruments used in clinical outcome studies : a scoping review. Bone Joint J 2022; 104-B:1148-1155. [PMID: 36177646 DOI: 10.1302/0301-620x.104b10.bjj-2022-0570.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Arthroplasties of the elbow, including total elbow arthroplasty, radial head arthroplasty, distal humeral hemiarthroplasty, and radiocapitellar arthroplasty, are rarely undertaken. This scoping review aims to outline the current research in this area to inform the development of future research. METHODS A scoping review was undertaken adhering to the Joanna Briggs Institute guidelines using Medline, Embase, CENTRAL, and trial registries, limited to studies published between 1 January 1990 and 7 February 2021. Endnote software was used for screening and selection, and included randomized trials, non-randomized controlled trials, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, and case series of ten or more patients reporting the clinical outcomes of elbow arthroplasty. The results are presented as the number of types of studies, sample size, length of follow-up, clinical outcome domains and instruments used, sources of funding, and a narrative review. RESULTS A total of 362 studies met the inclusion criteria. Most were of total elbow arthroplasty (246; 68%), followed by radial head arthroplasty (100; 28%), distal humeral hemiarthroplasty (11; 3%), and radiocapitellar arthroplasty (5; 1%). Most were retrospective (326; 90%) and observational (315; 87%). The median sample size for all types of implant across all studies was 36 (interquartile range (IQR) 21 to 75). The median length of follow-up for all studies was 56 months (IQR 36 to 81). A total of 583 unique outcome descriptors were used and were categorized into 18 domains. A total of 105 instruments were used to measure 39 outcomes. CONCLUSION We found that most of the literature dealing with elbow arthroplasty consists of retrospective observational studies with small sample sizes and short follow-up. Many outcomes have been used with many different instruments for their measurement, indicating a need to define a core set of outcomes and instruments for future research in this area.Cite this article: Bone Joint J 2022;104-B(10):1148-1155.
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Affiliation(s)
- Adam C Watts
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.,Department of Health Sciences, University of York, York, UK
| | - Zaid Hamoodi
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
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13
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Chia C, Cheung P, Wibowo J, Dubrava A, Manji J, Paddle P. Recent Levels of Evidence in Otolaryngology Journals. Ann Otol Rhinol Laryngol 2022; 132:504-510. [PMID: 35703382 DOI: 10.1177/00034894221104453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The development of evidence-based medicine has contributed to improved patient outcomes. This study aims to identify the trends in levels of evidence in otolaryngology journals over time, as represented by the 4 most widely circulated peer-reviewed otolaryngology journals. METHODS A review of all articles from 2007, 2010, 2013, 2016, and 2019, in 4 major otolaryngology journals. Data points included journal source, year of publication, country of origin, first author sex, and subspecialty category within otolaryngology. Level of evidence was determined based on the study's primary research question and was graded on a scale of 1 (strongest) to 4 (weakest) based on the Oxford Centre of Evidence-based Medicine - Levels of Evidence guideline. Comparison of levels of evidence was performed using Kruskal-Wallis analysis of variance for ordinal data. RESULTS About 4297 articles were identified over 12 years. The number of research articles remained consistent over the 12 years of this study. Clinical research increased from 78.6% to 85.1%. Female first authorship increased from 20.3% in 2007 to 31.0% in 2019. Of 3558 articles that constituted clinical research from 2007 to 2019, level 1 studies increased from 0.9% to 3.6%, with level 4 studies remaining stable at an overall rate of 60.3%. Randomized controlled trials remained stable at 4.6% of all studies. Systematic reviews increased from 3.2% to 8.4%. CONCLUSION This article provides an update on the levels of evidence to allow for an honest self-assessment of otolaryngology as a scientific field.
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Affiliation(s)
- Clemente Chia
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, VIC, Australia
| | - Priscilla Cheung
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, VIC, Australia
| | - Joshua Wibowo
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, VIC, Australia
| | - Adam Dubrava
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, VIC, Australia
| | - Jamil Manji
- Department of Otolaryngology, Head & Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Paul Paddle
- Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, VIC, Australia.,Department of Surgery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, VIC, Australia
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Andreoletti M, Bina F. A defense of surgical procedures regulation. THEORETICAL MEDICINE AND BIOETHICS 2022; 43:155-168. [PMID: 35551584 PMCID: PMC9388414 DOI: 10.1007/s11017-022-09569-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
Since the advent of drug regulation in 1962, regulatory agencies have been in the practice of using strict standards to test the safety and efficacy of medical treatments and products. Regulatory agencies, such as the FDA, demand two full-fledged Randomized Clinical Trials demonstrating the safety and effectiveness of drugs to grant its marketing authorization. On the contrary, surgical treatments are left completely unregulated. There are several reasons explaining this difference, and all of them point to the difficulty of conducting well-designed RCTs in surgery. However, we argue that none of these arguments is decisive and that, under certain conditions, surgical RCTs can be morally justified and methodologically sound. Although ethical constraints restrict the number of testable surgical procedures, and surgical trials might not be as dependable as pharmaceutical RCTs, our analysis suggests that, in certain cases, it is possible to obtain high-quality evidence about the safety and efficacy of surgical procedures. Untested surgical treatments may prove to be ineffective and harm patients. Therefore, regulation of surgical procedures seems not only morally acceptable and able to provide reliable scientific evidence, but also desirable and justified from an ethical-political standpoint.
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Affiliation(s)
- Mattia Andreoletti
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Federico Bina
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, Massachusetts United States
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Abstract
SUMMARY In 1906, George Bernard Shaw criticized the medical profession for its lack of science and compassion. Since then, advances in both medical and surgical subspecialties have improved quality of patient care. Unfortunately, the reporting of these advances is variable and is frequently biased. Such limitations lead to false claims, wasted research dollars, and inability to synthesize and apply evidence to practice. It was hoped that the introduction of evidence-based medicine would improve the quality of health care and decrease health dollar waste. For this to occur, however, credible "best evidence"-one of the components of evidence-based medicine-is required. This article provides a framework for credible research evidence in plastic surgery, as follows: (1) stating the clinical research question, (2) selecting the proper study design, (3) measuring critical (important) outcomes, (4) using the correct scale(s) to measure the outcomes, (5) including economic evaluations with clinical (effectiveness) studies, and (6) reporting a study's results using the Enhancing the Quality and Transparency of Health Research, or EQUATOR, guidelines. Surgeon investigators are encouraged to continue improving the science in plastic surgery by applying the framework outlined in this article. Improving surgical clinical research should decrease resource waste and provide patients with improved evidence-based care.
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Gaudino M, Chikwe J, Bagiella E, Bhatt DL, Doenst T, Fremes SE, Lawton J, Masterson Creber RM, Sade RM, Zwischenberger BA. Methodological Standards for the Design, Implementation, and Analysis of Randomized Trials in Cardiac Surgery: A Scientific Statement From the American Heart Association. Circulation 2021; 145:e129-e142. [PMID: 34865513 DOI: 10.1161/cir.0000000000001037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiac surgery presents specific methodological challenges in the design, implementation, and analysis of randomized controlled trials. The purposes of this scientific statement are to review key standards in cardiac surgery randomized trial design and implementation, and to provide recommendations for conducting and interpreting cardiac surgery trials. Recommendations include a careful evaluation of the suitability of the research question for a clinical trial, assessment of clinical equipoise, feasibility of enrolling a representative patient cohort, impact of practice variations on the safety and efficacy of the study intervention, likelihood and impact of crossover, and duration of follow-up. Trial interventions and study end points should be predefined, and appropriate strategies must be used to ensure adequate deliverability of the trial interventions. Every effort must be made to ensure a high completeness of follow-up; trial design and analytic techniques must be tailored to the specific research question and trial setting.
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AAPS Podium Presentations-Has the Level of Evidence Changed over the Past Decade? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3588. [PMID: 34046292 PMCID: PMC8143775 DOI: 10.1097/gox.0000000000003588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
An increase in the number and quality of randomized controlled trials (RCTs) and trends toward higher levels of evidence (LOE) in the plastic surgery literature has been reported; however, there has not been a specific focus on the LOE of presentations at scientific meetings. The purpose of this study was to ascertain trends in the LOE of studies presented at the annual meeting of the American Association of Plastic Surgeons.
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The 100 Most-cited Articles in Abdominoplasty: A Bibliometric Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3426. [PMID: 33786256 PMCID: PMC7997088 DOI: 10.1097/gox.0000000000003426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Background: Abdominoplasty is one of the most common aesthetic procedures performed globally. Research in this field is evolving, with recent emphasis on evidence-based surgery optimizing informed consent. This bibliometric analysis aimed to characterize emerging research trends and to assess the methodological quality of the highest impact abdominoplasty research. Methods: The 100 most-cited articles in abdominoplasty were identified on Web of Science, across all available journals and years (1950–2019). Study details, including the citation count, main subject, and outcome measures, were extracted from each article by 2 independent reviewers. The level of evidence of each study was also assessed. Results: The 100 most-cited articles in abdominoplasty were cited by a total of 2545 articles. Citations per article ranged from 206 to 34 (mean 65). Overall, 50 articles were assessed to be level of evidence 3, which is representative of the large number of cohort studies (n = 59) on the list. Similar numbers achieved levels 2, 4, and 5 (n = 16, 20, and 14), though none reached level 1. The main subject was operative technique in 50 articles, followed by outcomes in 34 articles. Only 7 articles utilized objective cosmetic outcome measures. Patient-reported outcome measures were employed in 25 articles, though only 5 incorporated validated questionnaires. Conclusions: The most-cited research in abdominoplasty largely comprised low-to-moderate quality studies, with no article achieving the highest level of evidence. Contemporary high-quality evidence incorporating validated outcome measures is crucial to enhance shared decision-making, particularly in aesthetic procedures.
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Jain M, Mohnaty CR, Sahoo J, Radhakrishnan RV, Biswas M. A bibliometric analysis of the spine journals. J Clin Orthop Trauma 2021; 16:219-225. [PMID: 33717958 PMCID: PMC7920116 DOI: 10.1016/j.jcot.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Spine is a rapidly growing branch with fully-dedicated peer-reviewed journals. Journal impact factor (JIF), speed of publication, and readership are some critical factors affecting the author's choice for submission. This study aimed to find the bibliometric data of spine journals. METHOD Fourteen Spine journals in NCBI (National centre for Biotechnology information, USA) database, meeting the inclusion criterion were analyzed for original articles, collected via stratified sampling from each issue of the journal. The dates to submission (DS), acceptance (DA), and publication (DP), study design, corresponding author's details like-subject specialization and country of affiliation were recorded for each original article. Data on JIF, number of issues/years, open access availability (OA), article processing charges (APC) were also retrieved. Correlation and geographic plot were used to display the findings. RESULTS The median (interquartile range) time for submission to publication/total time (TT) in spine journals was 175 (120-313) days with a submission to acceptance time of 107 (66-168) days and acceptance to publication time of 54 (20-170). Fifty-seven percent of the journals had APC, and all had options for OA. A significant correlation was noted between all determinants of publication speed and the Scimago Journal rankings (SJR) (AT: r = 0.238, PT: r = 0.074, TT: r = 0.288, p < 0.001). Amongst the author affiliations, the USA (37.5%) and Japan (18.6%) had the maximum contributions. Furthermore, 57.4% of authors were orthopaedicians, and 14.4% were neurosurgeons. Retrospective and prospective cohort studies were the standard study designs (48% vs. 20.9%), while clinical trials accounted for 5.8%. CONCLUSION Spine journals had comparable publication speed with other biomedical journals; all spine journals had OA options. Observational study dominates the pattern in spine research. The contribution is mainly from orthopaedician, but the trend is changing towards collaborative research with neurosurgeons.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, 751019, India,Corresponding author. 106 Mahdev Orchid, Cosmopolis Road, Dumduma, Bhubaneswar, Odisha, 751019, India.
| | | | - Jagannatha Sahoo
- Department of Physical Medicine and Rehabilitation, AIIMS, Bhubaneswar, 751019, India
| | | | - Mridul Biswas
- Department of Orthopedics, AIIMS, Bhubaneswar, 751019, India
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Challenges to randomized trials in adult and congenital cardiac and thoracic surgery. Ann Thorac Surg 2021; 113:1409-1418. [PMID: 33412133 PMCID: PMC9425119 DOI: 10.1016/j.athoracsur.2020.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
Randomized trials in surgery face additional challenges compared to those in medicine. Some of the challenges are intrinsic to the nature of the field (such as issues with blinding, learning curve and surgeons experience and difficulties in defining the appropriate timing for comparative trials). Other issues are due to the surgical culture, the attitude of surgeons toward randomized trials and the lack of support by professional and national bodies. In this review a group with experience in trials in congenital and adult cardiac and thoracic surgery discusses the key issues with surgical trials and suggest potential solutions.
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21
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Nabil S, Samman N. Levels of evidence and journal impact factor in oral and maxillofacial surgery: a 15-year follow-up. Int J Oral Maxillofac Surg 2020; 50:1394-1399. [PMID: 33384235 DOI: 10.1016/j.ijom.2020.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 01/08/2023]
Abstract
This study was performed to assess changes over time in the quality of research in oral and maxillofacial surgery (OMS) by examining the level of evidence of published articles. A secondary aim was to determine the relationship of the journal impact factor to these levels of evidence. The four major OMS journals with an impact factor were assessed. Articles published in 2017 and 2018 were categorized based on their level of evidence, and their correlation with the 2019 journal impact factor was investigated using Spearman's rank correlation coefficient (rho). The total number of published articles increased by a factor of 2.4 over a 15-year period, from 932 in 2002-2003 to 2253 in 2017-2018. The percentage of articles increased by 1.0% for level I evidence, 3.4% for level II, 8.2% for level III, and 4.1% for level IV. Non-evidence articles reduced by 16.7%. All journals showed an increase in impact factor, and a significant correlation was noted between the proportion of published higher-level evidence articles and the impact factor over time (rho=0.811, P=0.001). It is concluded that OMS journals currently display a higher proportion of good quality articles leading to a better impact factor than 15 years ago.
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Affiliation(s)
- S Nabil
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The National University of Malaysia, Malaysia.
| | - N Samman
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong; Dental Implant and Maxillofacial Centre, Hong Kong.
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22
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Gaudino M, Kappetein AP, Di Franco A, Bagiella E, Bhatt DL, Boening A, Charlson ME, Flather M, Gelijns AC, Grover F, Head SJ, Jüni P, Lamy A, Miller M, Moskowitz A, Reents W, Shroyer AL, Taggart DP, Tam DY, Zenati MA, Fremes SE. Randomized Trials in Cardiac Surgery: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 75:1593-1604. [PMID: 32241376 DOI: 10.1016/j.jacc.2020.01.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
Compared with randomized controlled trials (RCTs) in medical specialties, RCTs in cardiac surgery face specific issues. Individual and collective equipoise, rapid evolution of the surgical techniques, as well as difficulties in obtaining funding, and limited education in clinical epidemiology in the surgical community are among the most important challenges in the design phase of the trial. Use of complex interventions and learning curve effect, differences in individual operators' expertise, difficulties in blinding, and slow recruitment make the successful completion of cardiac surgery RCTs particularly challenging. In fact, over the course of the last 20 years, the number of cardiac surgery RCTs has declined significantly. In this review, a team of surgeons, trialists, and epidemiologists discusses the most important challenges faced by RCTs in cardiac surgery and provides a list of suggestions for the successful design and completion of cardiac surgery RCTs.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. https://twitter.com/AKappetein
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Andreas Boening
- Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany
| | - Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Science Research, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Marcus Flather
- Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Frederick Grover
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andre Lamy
- Population Health Research Institute, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marissa Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alan Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wilko Reents
- Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt/Saale, Germany
| | | | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/MarcoZenatiMD
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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23
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Bell PRF. Open Surgery has not had its Day. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Michel LA. Evidence-Based Medicine, Cost-Containment, Care Effectiveness : Is it a new trilogy aimed at transforming the surgical mystique or the reality of double standards? Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- L. A. Michel
- Chief of Surgical Services, Mont-Godinne University Hospital, Universite Catholique de Louvain (U.C.L.) - Medical School
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25
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Gaudino M, Bagiella E, Chang HL, Kurlansky P. Randomized trials, observational studies, and the illusive search for the source of truth. J Thorac Cardiovasc Surg 2020; 163:757-762. [PMID: 33277031 DOI: 10.1016/j.jtcvs.2020.10.120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Emilia Bagiella
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Helena L Chang
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY.
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Eggerstedt M, Shay AD, Brown HJ, Ganti A, Varelas E, Smith RM, Revenaugh PC. An Update on Level of Evidence Trends in Facial Plastic Surgery Research. Facial Plast Surg Aesthet Med 2020; 22:105-109. [PMID: 32130061 DOI: 10.1089/fpsam.2019.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Knowledge of the quality of evidence in facial plastic surgery research is essential for the implementation of evidence-based practices. The purpose of this study is to provide an update over the past decade as to whether the level of evidence in leading journals featuring topics in facial plastic surgery has changed in comparison with prior reports. Materials and Methods: This study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature over time. Five journals were queried using facial plastic surgery keywords for four selected years for a 10-year period. After screening, articles were assessed for the presence of various methodological traits and were evaluated for overall level of evidence. These variables were compared across the years studied to evaluate trends in level of evidence. Results: A total of 826 articles were included for final review. For all selected years, level IV or level V evidence was the most prevalent level of evidence. Over time, significantly less level IV (p = 0.009) and significantly more level II (p = 0.007) evidence was published. The proportion of studies reporting confidence intervals (p < 0.001) and p-values (p = 0.02) were significantly greater in later years. Conclusions: The level of evidence of facial plastic surgery literature has increased over time, as demonstrated by an increased proportion of level II evidence, decreased proportion of level IV evidence, and increased use of p-values and confidence intervals. The absolute number of randomized controlled trials continues to remain low.
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Affiliation(s)
- Michael Eggerstedt
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Aryan D Shay
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Ashwin Ganti
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Eleni Varelas
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Ryan M Smith
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Peter C Revenaugh
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
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Mitigating Biases in a Cohort Study: A Critical Examination of the Silicone Arthroplasty in Rheumatoid Arthritis Study. Plast Reconstr Surg 2020; 145:746-754. [PMID: 32097319 DOI: 10.1097/prs.0000000000006602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research bias, or the systematic errors of a study, can arise before, during, or after a trial ends. These biases hinder the internal validity of the study, which is the accuracy of a study's conclusions regarding the effects of an intervention on a given group of subjects. With the growing use of evidence-based medicine, there is a demand for high-quality evidence from the research community. Systematic reviews and meta-analyses of randomized controlled trials are considered the highest level of evidence, followed by individual randomized controlled trials. However, most surgical trials cannot be conducted as randomized controlled trials because of factors such as patient preferences and lack of equipoise among surgeons. Therefore, surgical trials may lack features that are held as important standards for high-quality evidence, such as randomization and blinding. To demonstrate the biases that surgical trials may encounter, the authors examined a prospective cohort study, the Silicone Arthroplasty in Rheumatoid Arthritis study. The authors focus on the challenges that arise during a surgical trial, including the design, implementation, and methods used to report the clinical evidence. By recognizing and addressing obstacles that exist in research, investigators will provide health care providers with high-quality evidence needed to make well-informed, evidence-based clinical decisions.
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Reading between the Lines: A Plastic Surgeon's Guide to Evaluating the Quality of Evidence in Research Publications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2311. [PMID: 31624694 PMCID: PMC6635181 DOI: 10.1097/gox.0000000000002311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022]
Abstract
An important component of practicing evidence-based medicine (EBM) in plastic surgery is staying current with published research, an increasingly difficult task given the rapid growth of the literature. This article reviews the methodological aspects specific to the aesthetic surgery field that should be considered when evaluating the quality of evidence in research publications in the context of the level of evidence (LOE) grading scales that are currently used by plastic surgery journals. Reporting the LOE in a research publication can help to highlight the quality of the research and the potential for bias so that the reader may prioritize information accordingly. However, LOE classifications are not an absolute index of the quality of evidence and do not preclude careful evaluation of the study’s methods and results in the context of the authors’ conclusions. As the application of evidence-based medicine expands in the plastic surgery community, surgeons must be mindful of how to appropriately interpret research findings and assess the utility of applying results to their practice.
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Park J, Gil JA, Kleiner J, Eltorai AEM, Daniels AH. Publication characteristics of studies published in The Spine Journal from 2005 to 2015. Orthop Rev (Pavia) 2019; 11:7786. [PMID: 31588255 PMCID: PMC6776923 DOI: 10.4081/or.2019.7786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 06/08/2019] [Indexed: 11/29/2022] Open
Abstract
There is a growing demand for evidence- based practices and informed clinical decision making supported by reliable, high-quality research. The aim of the study is to analyze trends in the level of evidence of publications and to evaluate the publication characteristics that influence the quality of research in The Spine Journal (TSJ). This is a comprehensive publication assessment that reviews and analyses all studies published in TSJ from the years 2005, 2007, 2009, 2011, 2013, and 2015. Level of evidence, study type, funding source, author country, author department, number of citations were considered as the outcome measures. Multivariable logistic regression, multivariable linear regression analyses, and chi square tests were used to analyze the trends of published studies level of evidence, study type, the specialties of authors, author countries, number of citations, and funding sources. A total of 1456 articles were evaluated. There was a decrease in the percentage of high-level evidence (level 1 and 2) studies from 73.6% in 2005 to 49.8% in 2015 (P=0.0045). There was a significant increase in the percentage studies with reporting funding support (P<0.0001). Funded studies were more likely to have a higher level of evidence (P<0.0001). The percentage of studies from international authors increased from 17.8% in 2005 to 69.1% in 2015 (P<0.0001). The percentage of studies with orthopedic authors decreased from 67% in 2005 to 44.9% in 2015 with a corresponding increase in the percentage of studies with neurosurgeon authors from 14.4% in 2005 to 23.2% by 2015, as well as an increase in the percentage of studies with a collaboration of authors from both specialties from 5.1% in 2005 to 8.7% in 2015 (P=0.0007). Orthopedic and neurosurgery collaboration in authorship did not affect the level of evidence of the studies nor the number of citations of the studies (P=0.7583). Earlier studies had a higher Scopus citation number but were not affected by the level of evidence (P=0.2515) nor the department of the author(s) (P=0.9107). We can conclude that the publication characteristics of articles in TSJ have evolved between 2005 and 2015 with a 3.9-fold increase in international authorship and a 32% decrease in the proportion of Level I and Level II studies. Inter-departmental collaboration, funding source, and country of origin may affect level of evidence and number of citations. Continued efforts to increase level of evidence should be considered.
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Affiliation(s)
- Joseph Park
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph A Gil
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Justin Kleiner
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adam E M Eltorai
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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de Morais TB, Veiga DF, Veiga-Filho J, do Carmo ACF, de Fátima Pellizzon R, Juliano Y, Sabino-Neto M, Ferreira LM. Quality of Randomized Controlled Trials Published By Plastic Surgeons: Long-Term Follow-Up. Aesthetic Plast Surg 2019; 43:866-873. [PMID: 30968210 DOI: 10.1007/s00266-019-01335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/15/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In two previous studies, the quality of randomized controlled trials (RCTs) with the participation of at least one plastic surgeon was evaluated in two periods: 1966-2003 and 2004-2008. OBJECTIVE To evaluate the evolution of the quality of RCT publications by plastic surgeons in the subsequent 5-year period, from 2009 to 2013. METHODS RCTs published from 2009 to 2013 in English with the participation of at least one plastic surgeon were identified by electronic search and classified for concealment of allocation by two independent evaluators. The studies with adequate allocation concealment had their quality evaluated by two evaluators using the Delphi List and the Jadad Quality Scale. RESULTS Of the 6997 identified studies, 261 were classified as to concealment of allocation. Of these, 43 (16.47%) had adequate allocation concealment. According to the evaluation in the Delphi List, there was an improvement, in relation to 1966-2003, in the items "most important characteristics of the prognosis" (p < 0.001), "use of independent evaluator" (p = 0.0029), and "measures of variability and point estimate for the primary variable" (p = 0.0057); there was no difference in relation to 2004-2008. Regarding the Jadad Quality Scale, there was an increase in scores in relation to 1966-2003 (p < 0.0004) but not in relation to the 2004-2008 period. CONCLUSION There was no difference in the quality of publications of RCTs by plastic surgeons in the period 2009-2013 compared to the previous 5 years (2004-2008), but both periods presented higher quality than the period 1966-2003. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Thiago Bezerra de Morais
- Graduate Program in Translational Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 2nd floor, Vila Clementino, São Paulo, SP, CEP 04023-900, Brazil
| | - Daniela Francescato Veiga
- Graduate Program in Translational Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 2nd floor, Vila Clementino, São Paulo, SP, CEP 04023-900, Brazil.
- Division of Plastic Surgery, Universidade do Vale do Sapucaí (UNIVAS), Pouso Alegre, MG, Brazil.
| | - Joel Veiga-Filho
- Division of Plastic Surgery, Universidade do Vale do Sapucaí (UNIVAS), Pouso Alegre, MG, Brazil
| | | | | | - Yara Juliano
- Department of Biostatistics, UNIVAS, Pouso Alegre, MG, Brazil
- Universidade de Santo Amaro (UNISA), Santo Amaro, SP, Brazil
| | - Miguel Sabino-Neto
- Graduate Program in Translational Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 2nd floor, Vila Clementino, São Paulo, SP, CEP 04023-900, Brazil
- Division of Plastic Surgery, UNIFESP, São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Graduate Program in Translational Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 2nd floor, Vila Clementino, São Paulo, SP, CEP 04023-900, Brazil
- Division of Plastic Surgery, UNIFESP, São Paulo, SP, Brazil
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Evidence-based recommendations for blinding in surgical trials. Langenbecks Arch Surg 2019; 404:273-284. [DOI: 10.1007/s00423-019-01761-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/05/2019] [Indexed: 12/15/2022]
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Never put equipoise in appendix! Final results of ASAA (antibiotics vs. surgery for uncomplicated acute appendicitis in adults) randomized controlled trial. Updates Surg 2018; 71:381-387. [PMID: 30560527 DOI: 10.1007/s13304-018-00614-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022]
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Huang HF, Tian JL, Yang XT, Sun L, Hu RY, Yan ZH, Li SS, Xie Q, Tian XB. Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis. PLoS One 2018; 13:e0197868. [PMID: 29927930 PMCID: PMC6013230 DOI: 10.1371/journal.pone.0197868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background Venous thromboembolism (VTE) is considered a potentially serious complication of knee arthroscopy and leads to conditions such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Low-molecular-weight heparin (LMWH) is widely employed in knee arthroscopy to reduce perioperative thromboembolic complications. However, the efficacy and safety of LMWH in knee arthroscopy remains unclear. Methods Seven randomized controlled clinical trials on LMWH in knee arthroscopy were identified and included in this meta-analysis. The main outcomes of the effectiveness (prevention of DVT and PE) and complications (death, major bleeding, and minor bleeding) of LMWH in knee arthroscopic surgery were assessed using Review Manager 5.3 software. Results The meta-analysis indicated that LMWH prophylaxis comprised 79% of asymptomatic DVT. No association was found in symptomatic VTE (RR: 0.90; 95% confidence interval [CI]: 0.39–2.08; P = 0.80), symptomatic DVT (RR: 0.79; 95% CI: 0.28–2.23; P = 0.66), symptomatic PE (RR: 1.36; 95% CI: 0.37–4.97; P = 0.64) and major bleeding (RR: 0.70; 95% CI: 0.12–3.95; P = 0.68) risk during LMWH prophylaxis were identified. Death was not reported in these studies. Moreover, there was a lower incidence of minor bleeding (RR: 0.64; 95% CI: 0.49 to 0.83; P = 0.001) in the control group than in the LMWH group. Conclusion Compared with the control group, the group treated with LMWH after knee arthroscopy was no association in reducing the symptomatic VTE rate, symptomatic DVT rate or symptomatic PE rate. The symptomatic VTE rate was 0.5% (11/2,166) in the LMWH group versus 0.6% (10/1,713) in the control group. Although the limitations of this meta-analysis cannot be ignored, the results of our study show that LMWH after knee arthroscopy is ineffective. We recommend that LMWH should not be routinely provided for knee arthroscopy. Trial registration ClinicalTrials.gov NCT03164746
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Affiliation(s)
- Hai-Feng Huang
- Medical College, Guizhou University, Guiyang, Guizhou, China
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Jia-Liang Tian
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Xian-Teng Yang
- Medical College, Guizhou University, Guiyang, Guizhou, China
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Li Sun
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Ru-Yin Hu
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Zhi-Hui Yan
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Shan-Shan Li
- Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Quan Xie
- College of Big Data and Information Engineering, Guizhou University, Guiyang, Guizhou, China
- * E-mail: (XBT); (QX)
| | - Xiao-Bin Tian
- Department of Orthopaedics, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
- * E-mail: (XBT); (QX)
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Judy RP, Shin JJ, McCrum C, Ayeni OR, Samuelsson K, Musahl V. Level of evidence and authorship trends of clinical studies in knee surgery, sports traumatology, arthroscopy, 1995-2015. Knee Surg Sports Traumatol Arthrosc 2018; 26:9-14. [PMID: 29138917 DOI: 10.1007/s00167-017-4801-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/08/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE There is increasing emphasis on publication quality and internationalization of author groups in orthopaedic literature. The purpose of this review was to evaluate the type of studies and the level of evidence (LOE) published in knee surgery, sports traumatology, arthroscopy (KSSTA) from 1995 to 2015. The secondary aim was to analyze trends in authorship characteristics in KSSTA. METHODS Two reviewers reviewed the table of contents of KSSTA and identified original papers from 1995, 2000, 2005, 2010, and 2015. The reviewers graded LOE from Levels I to IV using guidelines from the University of Oxford's Centre for Evidence-Based Medicine. For each article, the total number of authors and country of author group were also analyzed. RESULTS A total of 880 papers were analyzed. The proportions in LOE have stayed consistent throughout the study period (n.s.). There has been a significant increase in the number of published articles and the number of Level I and II studies (P < 0.01). Therapeutic articles were the most common type. The mean number of authors per KSSTA article significantly increased from 3.9 to 5.7 over the 20-year period (P < 0.01). The number of represented countries increased yearly and academic institutions from 40 different nationalities published articles in the Journal. Of the examined years, the percent of articles with international collaboration was 17.6%. CONCLUSION The proportion of LOE I and II articles published in KSSTA remains consistently high. Therapeutic studies are the most frequently published articles. There is an increase in international groups publishing in KSSTA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ryan P Judy
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. .,University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.
| | - Jason J Shin
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher McCrum
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kristian Samuelsson
- Department of Orthopaedics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Middleton R, Price A. Levels of evidence in orthopaedics. J ISAKOS 2017. [DOI: 10.1136/jisakos-2017-000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Evidence-Based Medicine in Aesthetic Surgery: The Significance of Level to Aesthetic Surgery. Plast Reconstr Surg 2017; 139:1195e-1202e. [PMID: 28445382 DOI: 10.1097/prs.0000000000003269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Since its popularization in the 1980s, evidence-based medicine has become the cornerstone of American health care. Many specialties rapidly adapted to the paradigm shift of health care by delivering treatment using the evidence-based guidelines. However, the field of plastic surgery has been slow to implement evidence-based medicine compared with the other specialties because of the challenges of performing randomized controlled trials, such as funding, variability in surgical skills, and difficulty with standardization of techniques. To date, aesthetic surgery has been at the forefront of evidence-based medicine in plastic surgery by having the most randomized controlled trials. Nevertheless, a detailed analysis of these studies has not been previously performed. In this article, the level I and II articles of aesthetic surgery are discussed to increase awareness of high-quality evidence-based medicine in aesthetic surgery.
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McBride KE, Young JM, Bannon PG, Solomon MJ. Assessing surgical research at the teaching hospital level. ANZ J Surg 2016; 87:70-75. [DOI: 10.1111/ans.13863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/05/2016] [Accepted: 10/26/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Kate E. McBride
- RPA Institute of Academic Surgery (IAS); Royal Prince Alfred Hospital; Sydney New South Wales Australia
- The University of Sydney; Sydney New South Wales Australia
| | - Jane M. Young
- RPA Institute of Academic Surgery (IAS); Royal Prince Alfred Hospital; Sydney New South Wales Australia
- The University of Sydney; Sydney New South Wales Australia
- Surgical Outcomes Research Centre (SOuRCe); Sydney New South Wales Australia
| | - Paul G. Bannon
- RPA Institute of Academic Surgery (IAS); Royal Prince Alfred Hospital; Sydney New South Wales Australia
- The University of Sydney; Sydney New South Wales Australia
- The Baird Institute; Sydney New South Wales Australia
| | - Michael J. Solomon
- RPA Institute of Academic Surgery (IAS); Royal Prince Alfred Hospital; Sydney New South Wales Australia
- The University of Sydney; Sydney New South Wales Australia
- Surgical Outcomes Research Centre (SOuRCe); Sydney New South Wales Australia
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Potter S, Conroy EJ, Williamson PR, Thrush S, Whisker LJ, Skillman JM, Barnes NLP, Cutress RI, Teasdale EM, Mills N, Mylvaganam S, Branford OA, McEvoy K, Jain A, Gardiner MD, Blazeby JM, Holcombe C. The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction. Pilot Feasibility Stud 2016; 2:41. [PMID: 27965859 PMCID: PMC5154059 DOI: 10.1186/s40814-016-0085-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the procedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these techniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are challenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design and conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR. METHODS/DESIGN The iBRA study is a trainee-led research collaborative project with four phases:Phase 1 - a national practice questionnaire (NPQ) to survey current practicePhase 2 - a multi-centre prospective cohort study of patients undergoing IBBR to evaluate the clinical and patient-reported outcomesPhase 3- an IBBR-RCT acceptability survey and qualitative work to explore patients' and surgeons' views of proposed trial designs and candidate outcomes.Phase 4 - phases 1 to 3 will inform the design and conduct of the future RCT All centres offering IBBR will be encouraged to participate by the breast and plastic surgical professional associations (Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons). Data collected will inform the feasibility of undertaking an RCT by defining current practice and exploring issues surrounding recruitment, selection of comparator arms, choice of primary outcome, sample size, selection criteria, trial conduct, methods of data collection and feasibility of using the trainee collaborative model to recruit patients and collect data. DISCUSSION The preliminary work undertaken within the iBRA study will determine the feasibility, design and conduct of a definitive RCT in IBBR. It will work with the trainee collaborative to build capacity by creating an infrastructure of research-active breast and plastic surgeons which will facilitate future high-quality research that will ultimately improve outcomes for all women seeking reconstructive surgery. TRIAL REGISTRATION ISRCTN37664281.
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Affiliation(s)
- Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Elizabeth J. Conroy
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool, Liverpool, L69 3GS UK
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool, Liverpool, L69 3GS UK
| | - Steven Thrush
- Breast Unit, Worcester Royal Hospital. Charles Hastings Way, Worcester, WR5 1DD UK
| | - Lisa J. Whisker
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB UK
| | - Joanna M Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Nicola L. P. Barnes
- The Nightingale Centre Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
| | - Ramsey I. Cutress
- Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Elizabeth M. Teasdale
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - Nicola Mills
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Senthurun Mylvaganam
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP UK
| | - Olivier A. Branford
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | | | - Abhilash Jain
- Imperial College London NHS Trust, London, SW7 2AZ UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE UK
| | - Matthew D. Gardiner
- Imperial College London NHS Trust, London, SW7 2AZ UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE UK
| | - Jane M. Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Christopher Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - on behalf of the Breast Reconstruction Research Collaborative
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Room 3.12 Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool, Liverpool, L69 3GS UK
- Breast Unit, Worcester Royal Hospital. Charles Hastings Way, Worcester, WR5 1DD UK
- Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB UK
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
- The Nightingale Centre Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT UK
- Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire SO16 6YD UK
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ UK
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP UK
- New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP UK
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- City Hospital, Dudley Road, West Midlands, B18 7QH UK
- Imperial College London NHS Trust, London, SW7 2AZ UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE UK
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Tanis E, Caballero C, Collette L, Verleye L, den Dulk M, Lacombe D, Schuhmacher C, Werutsky G. The European Organization for Research and Treatment for Cancer (EORTC) strategy for quality assurance in surgical clinical research: Assessment of the past and moving towards the future. Eur J Surg Oncol 2016; 42:1115-22. [DOI: 10.1016/j.ejso.2016.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/31/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022] Open
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Abstract
BACKGROUND The application of evidence-based medicine (EBM) to the practice of hand surgery has been limited. Production of high-quality research is an integral component of EBM. With considerable improvements in the quality evidence in both orthopedic and plastic and reconstructive surgery, it is imperative that hand surgery research emulates this trend. METHODS A systematic review was performed on all hand surgery articles published in 6 journals over a 20-year period. The journals included Plastic and Reconstruction Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, Journal of Hand Surgery-European Volume, Journal of Hand Surgery-American Volume, Journal of Bone & Joint Surgery, and the Bone & Joint Journal. The level of evidence of each article was determined using the Oxford level of evidence. The quality of methodology of randomized controlled trials (RCTs) was assessed using Jadad scale. Statistical analysis involved chi-squares and Student t test (P < .05). RESULTS A total of 972 original hand surgery research articles were reviewed. There was a significant increase in the average level of evidence of articles published between1993 and 2013. High-quality evidence only accounted for 11.2% of evidence published, with a significant increase over the study period (P = 0.001). Quantitative evaluation of the 26 published RCTs, using Jadad scale, revealed a progressive improvement in study design from 0.3 in 1993 to 3.33 in 2013. CONCLUSIONS Hand surgery research has mirrored trends seen in other surgical specialties, with a significant increase in quality of evidence over time. Yet, high-quality evidence still remains infrequent.
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Affiliation(s)
- Conor M. Sugrue
- St Vincent’s University Hospital, Dublin, Ireland,Conor M. Sugrue, Department of Plastic & Reconstructive Surgery, St Vincent’s University Hospital, Dublin, Ireland.
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Vemulakonda VM, Jones J. Barriers to participation in surgical randomized controlled trials in pediatric urology: A qualitative study of key stakeholder perspectives. J Pediatr Urol 2016; 12:180.e1-7. [PMID: 26455638 DOI: 10.1016/j.jpurol.2015.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) are considered the gold standard for assessing treatment efficacy. However, pediatric surgical RCTs have been limited in their ability to recruit patients. The purpose of this study was to identify barriers and motivators to pediatric participation in surgical RCTs. METHODS We conducted a series of two focus groups with parents and one focus group with urology providers for children aged <2 years of age with a diagnosis of Society for Fetal Urology grade 3 or 4 hydronephrosis. We then administered a survey to referring pediatricians based on the initial analysis of focus group findings. Theme analysis was used for all qualitative transcribed text data obtained from focus groups and open-ended survey questions using team-based inductive approaches. Descriptive statistics were obtained for the remainder of the provider survey. RESULTS Using qualitative text from stakeholders (n = 38) we identified four key themes across the data: responsibility to my child; responsibility to my patient; responsibility to the field; and irreversibility of surgery. Participants felt there was an obligation to be informed of relevant scientific research within a clinic research culture. However, there remains a disconnect for parents between randomized research studies that may ultimately benefit their child, depending on their age and concern their child is being treated as a 'guinea pig'. Some parents were willing to participate in RCTs but all were more open to participate in an observational study where the treatment decisions were felt to be under their control even when there was no "right answer" or multiple equivalent options for treatment. There was mixed opinion across the parents and providers whether research trial education and enrollment should be provided by the pediatrician or urologist. Active physician decisions were seen as critical within the context of a long term clinical relationship and provision of information of risks and benefits without pressure were considered essential for ethical research by both parents and providers. CONCLUSION While some parents are open to participation in surgical RCTs, providers and parents of children with hydronephrosis feel discomfort with the element of chance in surgical randomized trials. Parents and providers are more likely to participate in observational studies where treatment decisions may be made jointly by the physician and the parent. These findings suggest that pragmatic trial strategies with the option for participation in an observational cohort may improve recruitment of pediatric patients into surgical clinical trials.
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Affiliation(s)
| | - Jacqueline Jones
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
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Grotenhuis A. If it can be done, it should be done,…or not? Acta Neurochir (Wien) 2016; 158:649-653. [PMID: 26875089 DOI: 10.1007/s00701-016-2735-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Affiliation(s)
- André Grotenhuis
- Department of Neurosurgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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Probst P, Grummich K, Harnoss JC, Hüttner FJ, Jensen K, Braun S, Kieser M, Ulrich A, Büchler MW, Diener MK. Placebo-Controlled Trials in Surgery: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e3516. [PMID: 27124060 PMCID: PMC4998723 DOI: 10.1097/md.0000000000003516] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This systematic review was performed to investigate the ethical justification, methodological quality, validity and safety of placebo controls in randomized placebo-controlled surgical trials.Central, MEDLINE, and EMBASE were systematically searched to identify randomized controlled trials comparing a surgical procedure to a placebo. "Surgical procedure" was defined as a medical procedure involving an incision with instruments. Placebo was defined as a blinded sham operation involving no change to the structural anatomy and without an expectable physiological response in the target body compartment.Ten randomized placebo-controlled controlled surgical trials were included, all of them published in high-ranking medical journals (mean impact factor: 20.1). Eight of 10 failed to show statistical superiority of the experimental intervention. Serious adverse events did not differ between the groups (rate ratio [RR] 1.38, 95% confidence interval [CI]: 0.92-2.06, P = 0.46). None of the trials had a high risk of bias in any domain. The ethical justification for the use of a placebo control remained unclear in 2 trials.Placebo-controlled surgical trials are feasible and provide high-quality data on efficacy of surgical treatments. The surgical placebo entails a considerable risk for study participants. Consequently, a placebo should be used only if justified by the clinical question and by methodological necessity. Based on the current evidence, a pragmatic proposal for the use of placebo controls in future randomized controlled surgical trials is made.
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Affiliation(s)
- Pascal Probst
- From the Department of General, Visceral and Transplantation Surgery (PP, JCH, FJH, AU, MWB, MKD), University of Heidelberg; The Study Center of the German Surgical Society (SDGC); University of Heidelberg (PP, KG, JCH, SB, MKD); and Institute of Medical Biometry and Informatics (KJ, MK), University of Heidelberg, Heidelberg, Germany
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Probst P, Grummich K, Heger P, Zaschke S, Knebel P, Ulrich A, Büchler MW, Diener MK. Blinding in randomized controlled trials in general and abdominal surgery: protocol for a systematic review and empirical study. Syst Rev 2016; 5:48. [PMID: 27012940 PMCID: PMC4806514 DOI: 10.1186/s13643-016-0226-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/18/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Blinding is a measure in randomized controlled trials (RCT) to reduce detection and performance bias. There is evidence that lack of blinding leads to overestimated treatment effects. Because of the physical component of interventions, blinding is not easily applicable in surgical trials. This is a protocol for a systematic review and empirical study about actual impact on outcomes and future potential of blinding in general and abdominal surgery RCT. METHODS/DESIGN A systematic literature search in CENTRAL, MEDLINE and Web of Science will be conducted to locate RCT between 1996 and 2015 with a surgical intervention. General study characteristics and information on blinding methods will be extracted. The risk of performance and detection bias will be rated as low, unclear or high according to the Cochrane Collaboration's tool for assessing risk of bias. The main outcome of interest will be the association of a high risk of performance or detection bias with significant trial results and will be tested at a level of significance of 5 %. Further, trials will be meta-analysed in a Mantel-Haenszel model comparing trials with high risk of bias to other trials at a level of significance of 5 %. DISCUSSION Detection and performance bias distort treatment effects. The degree of such bias in general and abdominal surgery is unknown. Evidence on influence of missing blinding would improve critical appraisal and conduct of general and abdominal surgery RCT. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2015: CRD42015026837.
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Affiliation(s)
- Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Kathrin Grummich
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Steffen Zaschke
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Sharma A, Hasan K, Carter A, Zaidi R, Cro S, Briggs T, Goldberg A. Knee surgery and its evidence base. Ann R Coll Surg Engl 2016; 98:170-6. [PMID: 26890835 PMCID: PMC5226166 DOI: 10.1308/rcsann.2016.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. METHODS Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. RESULTS The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. CONCLUSIONS Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.
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Affiliation(s)
- A Sharma
- Royal National Orthopaedic Hospital NHS Trust , UK
| | | | - A Carter
- South Warwickshire NHS Foundation Trust , UK
| | - R Zaidi
- Royal National Orthopaedic Hospital NHS Trust , UK
| | - S Cro
- Medical Research Council , UK
| | - T Briggs
- Royal National Orthopaedic Hospital NHS Trust , UK
| | - A Goldberg
- Royal National Orthopaedic Hospital NHS Trust , UK
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Swanson E. Level 2 Observational Studies: A Practical Alternative to Randomized Trials in Plastic Surgery. Aesthet Surg J 2016; 36:NP87-8. [PMID: 26374809 DOI: 10.1093/asj/sjv153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, KS
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Surgeon Willingness to Participate in Randomized Controlled Trials for the Treatment of Femoroacetabular Impingement. Arthroscopy 2016; 32:20-4.e23. [PMID: 26395410 DOI: 10.1016/j.arthro.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/23/2015] [Accepted: 07/09/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To define surgeon willingness to participate in large, multicenter randomized controlled trials (RCTs) to address common treatment decisions for the management of femoroacetabular impingement (FAI) and to define the feasibility of executing these RCTs. METHODS Thirty case vignettes of consecutive, symptomatic FAI patients who underwent FAI corrective surgery by a single surgeon were provided to members of the Academic Network of Conservational Hip Outcomes Research (ANCHOR). Each surgeon (n = 10) completed a questionnaire in a blinded fashion to determine willingness to participate and enroll the patient in 6 different potential RCTs. The proportion of yes/no ratings were blindly assessed for all 6 RCTs. Differences were tested with χ(2)-tests, and odds ratios were calculated. RESULTS Seventy-seven percent and 42% of surgeons were willing to enroll patients in a surgical versus nonoperative FAI RCT with 6-month and 12-month crossover arms, respectively. Only 25% and 53% of surgeons were willing to consider randomization of operative versus nonoperative treatment for femoral and acetabular sided osseous deformities, respectively. Regarding the capsulolabral complex, 63% and 78% were amenable to randomization of labral refixation versus debridement and capsular closure versus no closure, respectively. Statistically, surgeon ratings differed significantly (Pearson χ(2) = 246.302; P < .001). CONCLUSIONS Surgeons are willing to participate in surgical versus nonsurgical trials with a 6-month crossover endpoint, yet surgeons are reluctant to offer surgical treatment of FAI without correction of osseous deformity, particularly for cam-type pathomorphology. RCTs to address management of the capsulolabral structures may be more feasible and generalizable based on the willingness of hip preservation surgeons to enroll patients. CLINICAL RELEVANCE The feasibility of completing RCTs for the management of FAI is limited even among high-volume hip preservation surgeons; however, surgeons are willing to participate.
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