An Update on Level of Evidence Trends in Facial Plastic Surgery Research

The level of evidence in prosthodontics in relation to author's characteristics: An analysis of three leading prosthodontics journals

Purpose

The purpose of this study was to examine the level of evidence (LOE) characteristics and associated factors that change over time in three leading prosthodontics journals.

Materials and methods

Articles published in The Journal of Prosthetic Dentistry (JPD), International Journal of Prosthodontics (IJP), and Journal of Prosthodontics (JP) in 2013 and 2020 were reviewed by eight independent reviewers. After applying exclusion and inclusion criteria, the number of authors, the corresponding author's educational degree, corresponding author's origin in each clinical research article were recorded. The included articles were rated by reviewers according to the level of evidence criteria and proposed level of evidence-associated factors. Descriptive statistics, univariable, and binary logistic regression analysis were performed to investigate dependent variables and potentially associated factors. All independent variables with a significant effect were analyzed by using a multivariable test. The entry and exit alpha level were set at αE = 0.15. The statistical significance was set at α = 0.05.

Results

A total of 439 articles from 3 selected journals for the years studied met the inclusion criteria. The percentages of level 1, 2, 3, 4, and 5 articles were 2.7 %, 11.4 %, 9.6 %, 13.4 % and 62.9 %, respectively. Univariable analysis results demonstrated significant associations related to the number of authors (P = 0.005), the corresponding author's educational degree (P = 0.022), and the corresponding author's geographic origin (P = 0.042). Multivariable analysis results demonstrated significant associations related to the number of authors (P = 0.002), and the corresponding author's geographic origin (P = 0.014).

Conclusions

The number of authors, CA degree, and CA origin had a significant association with the LOE of included prosthodontic studies. Although there was an increase in the number of publications from 2013 to 2020, the level of evidence trend shows no improvement over the years.

Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist

OBJECTIVE

This study aimed to assess the completeness of adverse event (AE) reporting in randomized control trials (RCTs) focused on rhinoplasty, using the Consolidated Standards for Reporting (CONSORT) Extension for Harms checklist.

STUDY DESIGN

A cross-sectional design was employed to review RCTs related to rhinoplasty published between January 1, 2005, and January 28, 2022.

SETTING

The study analyzed clinical trials on rhinoplasty retrieved from PubMed.

METHODS

We performed a comprehension search on PubMed, blind and duplicate screening, and data extraction. Adherence to the 18 recommendations of the CONSORT Extension for Harms was evaluated, with 1 point assigned for each adhered item. Percent adherence was calculated based on the 18 points, taking into account the multiple subcategories within some recommendations. Descriptive statistics were used to summarize adherence-including frequencies, percentages, and 95% confidence intervals.

RESULTS

Our search returned 240 articles, of which 56 met inclusion criteria. No RCTs adhered to all 18 CONSORT Extension for Harms items. Twenty-six (26/56, 46.4%) adhered to ≥50% of the items, and 30 (30/56, 53.6%) adhered to ≥33.3% of the items. Seven (7/56, 12.5%) RCTs adhered to no items. Across all RCTs, the average number of CONSORT-Harms items adhered to was 7.2 (7.2/18, 40.0%). The most adhered to item was item 10. Discussion balanced with regard to efficacy and AEs (80.4%, [70.0-90.8]).

CONCLUSION

This study highlights the inadequacy of AE reporting in rhinoplasty RCTs according to CONSORT-Harms guidelines. Urgent efforts are required to bridge this reporting gap and enhance transparency in surgical research, ultimately safeguarding patient well-being.

Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation

Patient-reported outcome metrics (PROMs) are increasingly utilized to capture data about patients' quality of life. PROMs play an important role in the value-based health care movement by providing a patient-centered metric of quality. There are many barriers to the implementation of PROMs, and widespread adoption requires buy-in from numerous stakeholders including patients, clinicians, institutions, and payers. Several validated PROMs have been utilized by facial plastic surgeons to measure both functional and aesthetic outcomes among rhinoplasty patients. These PROMs can help clinicians and rhinoplasty patients participate in shared decision making (SDM), a process via which clinicians and patients arrive at treatment decisions together through a patient-centered approach. However, widespread adoption of PROMs and SDM has not yet been achieved. Further work should focus on overcoming barriers to implementation and engaging key stakeholders to increase the utilization of PROMs in rhinoplasty.

Evaluating Strength of Evidence of Pediatric Otolaryngology Research Literature: A 20-Year Review

OBJECTIVES/HYPOTHESIS

Quantity and quality of Otolaryngology-Head and Neck Surgery (OTL-HNS) research are increasing, yet patterns within Pediatric OTL-HNS publications are unknown. This study examines trends in the level of evidence of pediatric OTL-HNS articles over a 20-year period to quantify the growth and characterize contributing factors.

STUDY DESIGN

Review article.

METHODS

A retrospective review was conducted on 12 peer-reviewed OTL-HNS journals at three time-points: 1996, 2006, and 2016. Pediatric-specific OTL-HNS journals were selected; all were among the top 10 highest impact factor journals, with one pediatric-specific and one Canadian journal. Publication details, author characteristics, and study focus were collected. Papers were classified based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence by two independent reviewers.

RESULTS

Of the 1,733 articles reviewed, 727 met inclusion criteria. A greater absolute number of pediatric OTL-HNS articles were published over the years studied: from 95 in 1996 to 359 in 2016 (P < .001). As well, the absolute number of high-quality studies has increased over the study period, from 28 articles in 1996 to 100 articles in 2016. However, the relative percentage of high-quality papers remained stable between 27.9% and 32.2% with an average of 29.7% (P = .89). Higher impact factor journals did not tend to publish higher-quality pediatric OTL-HNS articles (P = .48).

CONCLUSIONS

Over the past 20 years, there is no appreciable improvement in the proportion of high-quality publications in pediatric OTL-HNS; however, there is an overall greater number of high-quality papers within OTL-HNS literature. These findings likely relate to challenges of research within pediatric surgical specialties.

LEVEL OF EVIDENCE

NA Laryngoscope, 2021.

Evidence-Based Blepharoplasty: An Analysis of Highly Cited Research Papers

PURPOSE

The purpose of the study was to appraise the methodological quality of the highest impact blepharoplasty research and to describe prevalent research themes.

METHODS

The 100 most highly cited research papers relevant to blepharoplasty were obtained from Web of Science, with no journal or date limitations applied. Data extraction included the study design, main research topic and specialty, outcome measures, and citation count. Each paper's level of evidence was independently evaluated by 2 authors according to the Oxford Centre for Evidence-Based Medicine system.

RESULTS

Overall, the 100 most cited blepharoplasty research papers were cited by 4,194 papers. The mean number of citations for each paper was 73 (range: 42-239). Most of the papers presented level 4 (n = 51) or level 5 (n = 35) evidence, which is consistent with the predominance of case series (n = 47) and expert opinions (n = 18) amongst study designs. No papers achieved level 1 (highest) evidence. Six papers presented level 2 evidence and 8 papers presented level 3. Significant research foci included innovative surgical techniques (n = 65) and anatomical considerations (n = 10), with reconstructive and cosmetic implications. Senior authors were mainly affiliated with centers of plastic (n = 53) or ophthalmic/oculoplastic (n = 34) surgery. Only 3 papers used validated subjective or objective cosmetic outcome measures.

CONCLUSIONS

Despite a significant impact on current practice, the level of evidence of the highly cited blepharoplasty research was predominantly low. Robust research methodology, through well-designed studies and standardized outcome measures, is necessary to facilitate evidence synthesis and guide clinical practice.