Harkiran Sagoo

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.

Systematic review of the methodological and reporting quality of case series in surgery

Case series are an important and common study type. No guideline exists for reporting case series and there is evidence of key data being missed from such reports. The first step in the process of developing a methodologically sound reporting guideline is a systematic review of literature relevant to the reporting deficiencies of case series.

An assessment of the compliance of systematic review articles published in craniofacial surgery with the PRISMA statement guidelines: A systematic review

CONTEXT Systematic review evidence is increasing within craniofacial surgery. Compliance with recognised reporting guidelines for systematic review evidence has not been assessed. OBJECTIVE To assess the compliance of systematic reviews published in craniofacial journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting criteria. DATA SOURCES, SEARCH TERMS AND STUDY SELECTION Thomson Reuters impact factor was used to identify three top craniofacial journals. A search for all systematic review articles published in these journals from 1st May 2010 to 30th April 2015 was conducted using MEDLINE PubMed. DATA EXTRACTION Two independent researchers assessed each study for inclusion and performed the data extraction. Data included the article reference information; the pathology and interventions examined and compliance of each review article with the PRISMA checklist. DATA SYNTHESIS AND RESULTS 97 studies were returned by the search. 62 studies proceeded to data extraction. The mean percentage of applicable PRISMA items that were met across all studies was 72.5% (range 28.6-96.2%). The area of poorest compliance was with the declaration of a study protocol (19.4% of studies). Only 37.1% of studies declared their source of funding. CONCLUSIONS Compliance of systematic review articles within craniofacial surgery with areas of the PRISMA checklist could be improved.

Serum Calcium and the Risk of Breast Cancer: Findings from the Swedish AMORIS Study and a Meta-Analysis of Prospective Studies

To investigate the association between serum calcium and risk of breast cancer using a large cohort and a systematic review with meta-analysis. From the Swedish Apolipoprotein Mortality Risk (AMORIS) Study we included 229,674 women who had baseline measurements of serum total calcium and albumin. Multivariable Cox regression was used to assess the association between total and albumin-corrected calcium and breast cancer risk. For the systematic review, an electronic search of MEDLINE and EMBASE databases was performed to identify other prospective cohorts assessing the relationship between serum calcium and breast cancer risk. We pooled the results of our AMORIS cohort with other eligible studies in a meta-analysis using a random effects model. I2 test was used to assess heterogeneity. In the AMORIS study, 10,863 women were diagnosed with breast cancer (mean follow-up: 19 years). We found an inverse association between total serum calcium and breast cancer when comparing the fourth quartile to the first quartile (HR: 0.94, 95% CI: 0.88–0.99, p value for trend 0.04) and similar results using albumin-corrected calcium. In the systematic review, we identified another two prospective cohorts evaluating pre-diagnostic serum total calcium and breast cancer. Combining these studies and our findings in AMORIS in a meta-analysis showed a protective effect of serum calcium against breast cancer, with a summary RR of 0.80 (95% CI: 0.66–0.97). No substantial heterogeneity was observed. Our findings in AMORIS and the meta-analysis support an inverse association between serum calcium and breast cancer risk, which warrants mechanistic investigations.

The First 500 Registrations to the Research Registry®: Advancing Registration of Under-Registered Study Types

Introduction The Declaration of Helsinki 2013 encourages the registration of all research studies involving human participants. However, emphasis has been placed on prospective clinical trials, and it is estimated that only 10% of observational studies are registered. In response, Research Registry®1 was launched in February 2015; a retrospectively curated registry that is free and easy to use. Research Registry® enables prospective or retrospective registration of studies, including those study types that cannot be registered on existing registries. In this study, we describe the first 500 registrations on Research Registry®. Methods Since the launch of Research Registry® in February 2015, data of registrations have been collected, including type of studies registered, country of origin, and data curation activity. Inappropriate registrations, such as duplicates, were identified by the data curation process. These were removed from the database or modified as required. A quality score was assigned for each registration, based on Sir Austin Bradford Hill’s criteria on what research studies should convey. Changes in quality scores over time were assessed. Results A total of 500 studies were registered on Research Registry® from February 2015 to October 2015, with a total of 1.7 million patients enrolled. The most common study types were retrospective cohort studies (37.2%), case series (14.8%), and first-in-man case reports (10.4%). Registrations were received from 57 different countries; the most submissions were received from Turkey, followed by China and the United Kingdom. Retrospective data curation identified 80 studies that were initially registered as the incorrect study type, and were subsequently correct. The Kruskal–Wallis test identified a significant improvement in quality scores for registrations from February 2015 to October 2015 (p < 0.0001). Conclusions Since its conception in February 2015, Research Registry® has established itself as a new registry that is free, easy to use, and enables the registration of various study types, including observational studies and first-in-man case reports. Going forward, our plan is to continue developing Research Registry® in line with user feedback and usability studies. We plan to further promote Research Registry® to advance the cause of registration of research, to increase compliance with the Declaration of Helsinki 2013.

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.