Georgina Wellstead

Compliance of Systematic Reviews in Plastic Surgery With the PRISMA Statement

IMPORTANCE Systematic reviews attempt to answer research questions by synthesizing the data in primary articles. They are an increasingly important tool within evidence-based medicine, guiding clinical practice, future research, and health care policy. OBJECTIVE To determine the reporting quality of recent systematic reviews and meta-analyses in plastic surgery with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. METHODS MEDLINE and EMBASE were searched for systematic reviews published between January 1, 2013, and December 31, 2014, in 5 major plastic surgery journals. Screening, identification, and data extraction were performed independently by 2 teams. Articles were reviewed for compliance with reporting of 27 items in the PRISMA checklist. Data analysis was conducted from January 1 to July 30, 2015. MAIN OUTCOMES AND MEASURES The sum of PRISMA checklist items (1-27) per systematic review. RESULTS From an initial set of 163 articles, 79 met the inclusion criteria. The median PRISMA score was 16 of 27 items (59%) (range, 6%-26%; 95% CI, 14%-17%). Compliance varied between individual PRISMA items. It was poorest for items related to the use of review protocol (item 5; 4 articles [5%]) and presentation of data on the risk of bias of each study (item 19; 14 articles [18%]). Compliance was the highest for description of rationale (item 3; 78 articles [99%]), sources of funding and other support (item 27; 75 articles [95%]), and inclusion of a structured summary in the abstract (item 2; 75 articles [95%]). CONCLUSIONS AND RELEVANCE The reporting quality of systematic reviews in plastic surgery requires improvement. Enforcement of compliance through journal submission systems, as well as improved education, awareness, and a cohesive strategy among all stakeholders, is called for. LEVEL OF EVIDENCE NA.

The Need for Core Outcome Reporting in Autologous Fat Grafting for Breast Reconstruction.

IntroductionThere is growing interest in autologous fat grafting (AFG) for breast reconstruction. This systematic review examines the range of outcomes used across studies of AFG, their definitions and whether there is a need for a core outcome set to aid reporting. MethodsFollowing the protocol of our systematic review, a search of 20 databases (1986 to March 2014) returned 35 studies which met the inclusion criteria. These were assessed independently by two authors. Disagreements were resolved by consensus. ResultsOf the 35 studies, 27 (77%) were case series, 5 (14.3%) were cohort studies, and 3 (8.6%) were case reports. A total of 51 different outcomes were reported. These studies each reported a median of five separate outcomes (range, 2–14), of which a median of 3 outcomes were defined (range, 0–14). A median of 2 outcomes per paper were prespecified in the study methods (range, 0–12) and a median of only 2 outcomes per paper (range, 0–12) were both defined and prespecified. The most commonly reported outcome in studies of AFG was that of “operative details,” reported by 26 studies, and eight different outcome definitions were used. “Cancer recurrence” was reported by 20 studies, with the use of 10 different outcome definitions. Overall, there was a poor proportion of defined and prespecified outcomes that employed a wide range of different outcome definitions. In addition only 14/35 studies stated the number of patients lost to follow-up. ConclusionsThere is a need for a core outcomes set for AFG to the breast to minimise outcome and reporting bias and aid evidence synthesis. Our future research will focus in this direction, titled VOGUE or Valid Outcomes for the Grafting of AUtologous Fat to the BrEast study. We invite all those interested to get in touch with the lead author.

Protocol for the development of a core outcome set for autologous fat grafting to the breast

INTRODUCTION One in eight women will develop breast cancer in their lifetime. Reconstruction is routinely offered to patients and can be autologous and/or implant based. One area of growing interest in autologous fat grafting (AFG). Our group recently published a systematic review and meta-analysis of this topic which showed 51 different outcomes were being utilized in the published literature, with substantial heterogeneity in their definitions. METHODS AND ANALYSIS A Delphi consensus exercise amongst key stakeholders will be conducted using the long list of 51 outcomes generated through our previous work. We will first group these according to the six domains previously identified; oncological, clinical, aesthetic and functional, patient-reported, process and radiological. Through sequential rounds of voting, the long list of outcomes will be narrowed down using predefined rules of agreement. ETHICS AND DISSEMINATION No patients will be involved in this study and ethical approval is not required. The research will be published in a peer-reviewed journal. It will also be presented at national and international conferences in the fields of plastic, reconstructive and aesthetic surgery as well as breast surgery and at more general surgical and methodological conferences. It will be disseminated electronically and in print. Brief reports of the review findings will be disseminated directly to the appropriate audiences of surgeons and societies through email and other modes of communication.

Nipple sparing versus skin sparing mastectomy: a systematic review protocol

Introduction Breast cancer has a lifetime incidence of one in eight women. Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy (NSM). However, oncological safety remains unproven, and the benefits and indications have not been clearly identified. The objective of this systematic review will be to determine the safety and efficacy of NSM as compared with skin sparing mastectomy (SSM). Methods and analysis All original comparative studies including; randomised controlled trials, cohort studies and case–control studies involving women undergoing either NSM or SSM for breast cancer will be included. Outcomes are primary—relating to oncological outcomes and secondary—relating to clinical, aesthetic, patient reported and quality of life outcomes. A comprehensive electronic literature search, designed by a search specialist, will be undertaken. Grey literature searches will also be conducted. Eligibility assessment will occur in two stages; title and abstract screening and then full text assessment. Each step will be conducted by two trained teams acting independently. Data will then be extracted and stored in a database with standardised extraction fields to facilitate easy and consistent data entry. Data analysis will be undertaken to explore the relationship between NSM or SSM and preselected outcomes, heterogeneity will be assessed using the Cochrane tests. Ethics and dissemination This systematic review requires no ethical approval. It will be published in a peer-reviewed journal. It will also be presented at national and international conferences. Updates of the review will be conducted to inform and guide healthcare practice and policy.

The Academic Surgical Collaborative: Launching a new trainee research collaborative

The first trainee research collaborative (TRC) in medicine began in 1986, when General Practitioners orchestrated a research project for regional trainees [1]. Whilst there has been a proliferation of research collaboratives across the UK, and an increase in the proportion of publications written by collaborative groups [2], TRCs have only become more widespread relatively recently. Multicentre surgical research projects led by trainees [3,4] have firmly cemented the resurgence of the TRC and its role within the surgical profession [5]. The National Research Collaborative website is dominated by the surgical disciplines and at present twenty-nine out of the thirty-seven collaboratives listed are surgically themed [6]. Surgical TRCs are an opportunity for trainees at all levels of experience to develop their research involvement [7]. Junior trainees are supported as their exposure to research and audit increases [8] by more senior colleagues who are able to offer advice and experience. As trainees mature, TRCs can help to identify research questions, assist networking, offer academic support and mentoring, provide motivation to finish work [8] and improve access to funding [9]. TRCs are an educational tool, promote future collaboration, and increase the exposure of trainees at all levels to research and audit [1]. Finally, TRCs allow trainees to learn basic research methodology, to assist in the co-ordination of multi-centre studies, and to recruit willing collaborators from other centres who may otherwise be inaccessible [7]. Bhangu identifies that surgical trainees are highly suited to the delivery of collaborative work; they are regularly in contact with each other, are motivated and desire evidence of involvement in research [10]. However, now we find medical students are leading national audit projects (STARSurg) [10], giving them an early taste of collaborative research. International level, trainee led surgical collaborative projects have also begun to establish [10], with GlobalSurg announcing it had completed patient recruitment for its first endeavour in January 2015 [11]. This short paper describes the establishment of the Academic Surgical Collaborative (ASC); a new TRC. We describe the ASCs positioning within TRCs and its guiding philosophies.

How to organize a medical elective.

The medical elective is often considered a major highlight of the medical school experience. However, organizing an elective can be a daunting experience. From selecting a destination, to securing bursaries, the road is fraught with uncertainty. In this article, we provide some guidance on how to successfully organize a medical elective. This includes the selection of the destination; options for research or clinical practice and tips for budgeting and acquiring travel bursaries.