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Covone J, ElHawary H, Abdulkarim S, Janis JE. Revisiting Level of Evidence Ratings in Plastic Surgery: A Call to Action. Aesthet Surg J 2024; 44:NP421-NP426. [PMID: 38377406 DOI: 10.1093/asj/sjae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Evidence-based medicine underpins medical and surgical practice, with level of evidence (LOE) being a key aspect that allows clinicians and researchers to better discriminate the methodological context by which studies are conducted and appropriately interpret their conclusions, and more specifically the strength of their recommendations. OBJECTIVES The aim of this study was to reassess the LOE of articles published in plastic surgery journals. METHODS To assess the overall LOE of publications from January 1 to December 31, 2021, a review of the following plastic surgery journals was performed: Aesthetic Surgery Journal (ASJ), Annals of Plastic Surgery (Annals), Journal of Plastic Reconstructive and Aesthetic Surgery (JRPAS), Plastic and Reconstructive Surgery (PRS), and Plastic and Reconstructive Surgery Global Open (PRS GO). RESULTS Of 3698 PUBMED articles, 1649 original articles and systematic reviews were analyzed. The average LOE for each journal was: ASJ 3.02 ± 0.94, Annals 3.49 ± 0.62, JPRAS 3.33 ± 0.77, PRS 2.91 ± 0.77, and PRS GO 3.45 ± 0.70. The collective average LOE was 3.28 ± 0.78. Only 4.4% were LOE 1 and 7.3% were LOE 2. Compared to past studies, PRS showed a significant LOE improvement (P = .0254), while ASJ and JPRAS saw nonsignificant changes; Annals experienced a significant decrease (P = .0092). CONCLUSIONS ASJ and PRS showed the highest LOE among the journals analyzed. Despite this, low LOE studies remain prevalent in plastic surgery. This paper serves as a call to action for both researchers and academic journals to elevate the standard, offering several strategies to help improve the LOE in plastic surgery.
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Bijlard E, Oflazoglu K, Hommes J, Leereveld D, Young-Afat DA, Horbach S, Guitton TG, Hoogbergen MM, Rakhorst HA. Towards evidence based plastic surgery; how a national research agenda can unite research. J Plast Reconstr Aesthet Surg 2021; 75:439-488. [PMID: 34838498 DOI: 10.1016/j.bjps.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
We describe the development of the Research Agenda of the Dutch Society for Plastic Surgery, supported and democratically created by plastic surgeons, patients, and other stakeholders. The agenda contains the 10 most relevant knowledge gaps encountered in clinical practice, as prioritized by the abovementioned groups. The aim is to stimulate national collaborations and research networks to initiate trials to answer these knowledge gaps. The agenda will be renewed periodically to stay relevant. We encourage other national and international associations to develop a research agenda within their field, and intensify their research network and improve research quality.
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Affiliation(s)
- E Bijlard
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands.
| | - K Oflazoglu
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - J Hommes
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - D Leereveld
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - D A Young-Afat
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - Ser Horbach
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - T G Guitton
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - M M Hoogbergen
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
| | - H A Rakhorst
- Bureau Nederlandse Vereniging voor Plastische Chirurgie (Dutch Society for Plastic Surgery) - Wetenschappelijke Koepel NVPC (Scientific Committee NVPC), Orteliuslaan 1, 3528 BA Utrecht, Netherlands
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Dissemination and Implementation Science in Plastic and Reconstructive Surgery: Perfecting, Protecting, and Promoting the Innovation That Defines Our Specialty. Plast Reconstr Surg 2021; 147:303e-313e. [PMID: 33009331 DOI: 10.1097/prs.0000000000007492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
SUMMARY Plastic and reconstructive surgery has an illustrious history of innovation. The advancement, if not the survival, of the specialty depends on the continual development and improvement of procedures, practices, and technologies. It follows that the safe adoption of innovation into clinical practice is also paramount. Traditionally, adoption has relied on the diffusion of new knowledge, which is a consistent but slow and passive process. The emerging field of dissemination and implementation science promises to expedite the spread and adoption of evidence-based interventions into clinical practice. The field is increasingly recognized as an important function of academia and is a growing priority for major health-related funding institutions. The authors discuss the contemporary challenges of the safe implementation and dissemination of new innovations in plastic and reconstructive surgery, and call on their colleagues to engage in this growing field of dissemination and implementation science.
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Aesthetic Contouring of the Chest wall with Rib Resection. Aesthetic Plast Surg 2021; 45:1099-1104. [PMID: 33037473 DOI: 10.1007/s00266-020-01988-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes. METHODS A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details. CONCLUSIONS Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes. 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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Eggerstedt M, Brown HJ, Shay AD, Westrick J, Ritz EM, Smith RM, Revenaugh PC. Level of Evidence in Facial Plastic Surgery Research: A Procedure-Level Analysis. Aesthetic Plast Surg 2020; 44:1531-1536. [PMID: 32328745 DOI: 10.1007/s00266-020-01720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND As evidence-based medicine has taken hold across medical specialties, the level of evidence within the facial plastic surgery literature has risen, but remains weak in comparison. There has not yet been a systematic, critical appraisal of the relative strength of evidence among subsets of the practice of facial plastic surgery. METHODS The current study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature. Five journals were queried using facial plastic surgery terms for four selected years over a 10-year period. Following screening, articles were assigned to a category regarding subject matter, assessed for the presence of various methodological traits, and evaluated for overall level of evidence. Comparisons were made in regard to level of evidence across the breadth of facial plastic surgery subject matter. RESULTS A total of 826 articles were included for final review. Studies on operative facial rejuvenation and rhinoplasty had significantly fewer authors on average than studies on cancer reconstruction or craniofacial topics. Craniofacial studies demonstrated higher levels of evidence relative to all other categories, with the exception of facial paralysis and facial trauma studies, from which there was no significant difference. In general, reconstructive studies had significantly more authors and higher levels of evidence than did articles with an aesthetic focus. CONCLUSION Level of evidence in facial plastic surgery remains relatively weak overall. Reconstructive and particularly craniofacial studies demonstrate higher mean level of evidence, relative to other subsets of facial plastic surgery. 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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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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Boyd CJ, Patel JJ, Soto E, Kurapati S, Martin KD, King TW. Differences in Highly-Cited and Lowly-Cited Manuscripts in Plastic Surgery. J Surg Res 2020; 255:641-646. [PMID: 32279891 DOI: 10.1016/j.jss.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of research comparing journal articles that accrue numerous citations with those that accrue few citations over time. Understanding differences between journal articles can help direct investigators in designing and conducting their research. METHODS Using advanced bibliometric tools, we queried four plastic surgery journals (Journal of Reconstructive Microsurgery, Annals of Plastic Surgery, Plastic and Reconstructive Surgery, and Microsurgery) for primary research articles published between 1998 and 2008 accruing zero or one citations with at least a 10-y lag time. Forty-seven articles were identified as low citation and were compared with an equal number of articles in the same journals that accrued the highest number of citations in the same period as high citation (HC). The data were analyzed using Student t-tests, Wilcoxon rank sum tests, chi-square tests, and Fisher exact tests. The level of significance was established at P < 0.05. RESULTS When compared with the HC cohort, the low citation articles were more likely to be nonclinical (P < 0.001), have no plastic surgery authors (P = 0.0026), and focus on the field of microsurgery (P = 0.003). The HC cohort was more likely to have higher sample sizes (P = 0.0339), focus on aesthetic/cosmetic surgery (P = 0.003), have a higher number of other disciplines included on authorship (P < 0.001), references (P = 0.0451), manuscript pages (P < 0.001), and words in the abstract (P < 0.001). CONCLUSIONS A small number of articles published in four plastic surgery journals were uncited during a 10-y period. There are qualitative and quantitative differences between highly and lowly cited articles in the plastic surgery literature. Investigators should consider these differences when designing and conducting studies.
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Affiliation(s)
- Carter J Boyd
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason J Patel
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Edgar Soto
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Srikanth Kurapati
- Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly D Martin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy W King
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Department of Biomedical Engineering, University of Alabama at Birmingham, Alabama; Division of Plastic Surgery, Birmingham VA Medical Center, Birmingham, Alabama.
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Losco L, Roxo AC, Roxo CW, Lo Torto F, Bolletta A, de Sire A, Aksoyler D, Ribuffo D, Cigna E, Roxo CP. Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience. Aesthetic Plast Surg 2020; 44:421-432. [PMID: 31748908 DOI: 10.1007/s00266-019-01543-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lower body lift is a widespread procedure for massive weight loss patients aimed to improve the contour of the lower trunk, gluteal region and proximal lower extremity. The data about complications are confusing, and there is a lack of uniform studies for massive weight loss patients. A simple formula to carry out a reliable procedure in a short time with a low complication rate should be advocated. METHODS This retrospective study analyzed data of 323 patients undergoing lower body lift after bariatric surgery over a 10-year period. Selection criteria, careful preoperative marking, reliable intra- and postoperative care and a few surgical tips are discussed. All the complications (both major and minor) and the aesthetic satisfaction were evaluated. Risk factors assessed were patient age, tobacco consumption, current BMI, operative time and combined surgery. RESULTS The overall complication rate was 42%. We recorded a lower rate of major complications and skin dehiscence; no infection and no skin necrosis were observed. The most frequent complication was seroma (35%). A complication development was straight related to age (p = 0.0177) and tobacco use (p = 0.0336). Patients' satisfaction about overall aesthetic was high. CONCLUSIONS We present our case load and describe an easy recipe to perform a safe surgery without undermining and liposuction in short operative times. The reasonable overall complication rate and the surprisingly lower rate of dehiscence and skin necrosis combined with a pleasant aesthetic result make the lower body lift an easy and safe procedure, when applied to the appropriate patient population. LEVEL OF EVIDENCE IV 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)
- Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56125, Pisa, Italy.
| | - Ana Claudia Roxo
- Plastic Surgery Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Carlos W Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Alberto Bolletta
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro de Sire
- Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Dicle Aksoyler
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Diego Ribuffo
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56125, Pisa, Italy
| | - Carlos P Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
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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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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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