Vittoradolfo Tambone

A systematic review of patient-reported outcome measures after rhinoplasty

The literature still lacks a review regarding PROs applied for rhinoplasty. Thus, we performed a systematic review of the literature to identify PROMs that assess patient satisfaction and quality of life after rhinoplasty. The aim of our study was to identify existing questionnaires and to summarize their development, psychometric properties, and content. A multi-step search of the web-based PubMed database from the National Library of Medicine was performed to identify PROMs that are designed to evaluate satisfaction and quality of life following rhinoplasty. Each potential PROM was examined by three independent reviewers for adherence to inclusion/exclusion criteria. Questionnaires included in the analysis were appraised for their adherence to international guidelines for the development and validation of health outcome questionnaires, as outlined by the Scientific Advisory Committee of the Medical Outcome Trust and the U.S. Food and Drug Administration. Our search generated a total of 457 articles, 351 that were retrieved in the primary search, and 106 that were found in the references of the first set of articles. The process of development and validation of each of the included PROMs was examined. Only ten of these were identified as surgery-specific questionnaires about rhinoplasty. These were divided into three categories: (1) functional self-assessment (Nasal Surgical Questionnaire, Nasal Obstruction Symptoms Evaluation Scale, and Nasal Obstruction Septoplasty Effectiveness); (2) aesthetic self-assessment (Utrecht Questionnaire, FACE-Q rhinoplasty module, Glasgow Benefit Inventory); and (3) aesthetic and functional self-assessment (Rhinoplasty Outcomes Evaluation), Functional Rhinoplasty Outcome Inventory 17, RHINO Scale, and Evaluation of Aesthetic Rhinoplasty Scale).

A Systematic Review of Patient-Reported Outcome Measures Following Transsexual Surgery

BackgroundThe aims of our study were to identify studies that evaluated patient satisfaction after transsexual surgery, analyze existing questionnaires, and summarize their development, psychometric properties, and content.MethodsA systematic review of the English-language literature was performed. Patient-reported outcome measures designed to assess patient satisfaction and quality of life following transsexual surgery were identified. Qualifying instruments were assessed for content and adherence to international guidelines for development and validation.ResultsFrom 796 articles, 19 studies had sufficient data and met the inclusion criteria. Included were a total of 2299 patients and 17 patient-reported outcome measures: 10 generic instruments that assessed quality of life, 4 specific for female genital or sexual satisfaction, 2 specific for transsexual body image or gender dysphoria, and 1 specific for plastic surgery. The questionnaires were analyzed by reviewers to assess the adherence to the rules of the US FDA and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 17 individual questionnaires that were included. All measures were limited by either their development, their validation, or their content.ConclusionsThere is a need for a new self-assessment tool, which should include functional, psychorelational, and cosmetic components, to measure satisfaction and quality of life of patients who have undergone transsexual surgery.Level of Evidence IIIThis 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.

Linguistic validation of the “FACE-Q Rhinoplasty Module” in Italian

Sir, We read with great interest the paper entitled ‘‘Quality of life in functional rhinoplasty: rhinoplasty outcomes evaluation German version (ROE-D)’’ published on September 2016 by Olcay Cem Bulut et al. on your journal, and we are not agree with the author to say that there are only two validated instruments to measure HRQL after rhinoplasty: ROE and FROI-17. It is a very interesting paper, but we think that the translation process they used is not described clearly. As Klassen et al. affirmed [1] United Kingdom Department of Health, systematic review of PRO measures for cosmetic surgery identified only nine specific instruments that demonstrated adequate psychometric properties and were developed with patient input. The widely used Rhinoplasty Outcomes Evaluation questionnaire was excluded from the United Kingdom review, because it was developed without patient input. The frequently used Derriford Appearance Scale, eight which is one of the nine measures in the United Kingdom Department of Health review, does not measure specific rhinoplasty concerns. In medical research, a rigorous translation and linguistic validation study is considered an essential step prior to using a PRO instrument in another language and/or culture. Following a rigorous linguistic validation, methodology helps to ensure the best possible translation which is produced. We translated FACE-Q Rhinoplasty Module following international guidelines. As the implementation of evidence-based medicine grows in everyday practice, there is increasing pressure to adopt validated survey instruments to demonstrate patientreported outcomes [2]. Surgical interventions on the face are most popular in cosmetic surgery, with nose reshaping being one of the most common procedures performed [3]. The only patient-reported outcome (PRO) instrument that we are aware of that measures how patients perceive the appearance of their nose is the FACE-Q [4]. This PRO instrument is composed of more than 40 independently functioning scales, including a 10-item scale called ‘‘Satisfaction with Nose’’ [4]. We translated and performed a linguistic validation of the FACE-Q Satisfaction with Nose scale for use in Italian patients. The translation was performed in accordance with the MAPI Research Trust [5] and the World Health Organization (WHO) recommendations. Our goal was to create a simple and clear translation understandable to all Italian patients. The steps we followed included performing two independent forward translations followed by a reconciliation process. A backward translation of the Italian version into English was then produced by a third translator. The final step involved qualitative cognitive interviews with patients to test understanding of the scale. At each step of the process, a project manager overviewed progress, coordinated committee meetings, and compiled reports. The entire translation process took approximately 3 months. This comment refers to the article available at doi:10.1007/s00405016-3920-x.

Patient-Reported Satisfaction Following Post-bariatric Surgery: A Systematic Review

AbstractIntroductionThe aims of our study were to identify studies that evaluated patient satisfaction following post-bariatric surgery, analyse existing questionnaires, and summarise their development, psychometric properties, and content.Patients and MethodsA multistep search was undertaken on the web-based PubMed database from the National Library of Medicine to identify studies on patient satisfaction and quality of life following post-bariatric surgery. The authors summarised all the questionnaires used in every study and categorised them as generic, surgery specific, or ad hoc, and whether they contained either validated or unvalidated measures.ResultsOur search generated a total of 1754 articles. We performed a systematic review of the 12 remaining studies, because these had sufficient data and met the inclusion criteria. All the studies identified from the literature review were assessed to determine the type of surgery used, and whether or not the questionnaire used to analyse patient satisfaction had been validated. The questionnaires were analysed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 20 individual questionnaires that included 10 generic instruments that assessed quality of life, six instruments specific for post-bariatric surgery, three instruments specific for breast surgery.ConclusionsIn post-bariatric patients, the BODY-Q was shown to be a more objective and confident measure for evaluating the quality of life of patients following post-bariatric surgery.Level of Evidence IIIFor 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.

How You Become Who You Are: A New Concept of Beauty for Plastic Surgery

The search for beauty and its value has been a discussion topic since the ancient Greeks composed their myths. The advent of safer and more advanced modern plastic surgery techniques and the spread of aesthetic medicine have renewed the search for beauty. Today, beauty seems possible, accessible, and more democratic than ever before [1]. To be beautiful is going to become an imperative, and from this standard, new and more subtle discriminations will arise: natural beauty will become more precious than artificial beauty, so that naturally beautiful bodies are privileged [2]. With regard to clinical practice, one of the most fundamental and interesting questions in aesthetic surgery is whether an objective indication exists for such procedures.

The Role of Appearance: Definition of Appearance-Pain (App-Pain) and Systematic Review of Patient-Reported Outcome Measures Used in Literature

IntroductionThe objectives of the current study were: (1) to perform a systematic review of the existing scientific literature on appearance and any subsequently related disorders and (2) to research in the literature the correlation between the role of appearance and patient’s disease.Materials and MethodsA systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidance. A multistep search of the PubMed, MEDLINE, PreMEDLINE, Embase, Ebase, CINAHL, PsychINFO and Cochrane databases was performed to identify studies on patient satisfaction, quality of life, and body image.ResultsOur search generated a total of 347 articles. We performed a systematic review of the 18 studies, which had sufficient data and met all inclusion criteria. All studies identified from the literature review were assessed to determine the utilization of validated patient satisfaction questionnaires. The questionnaires were analyzed by reviewers to assess adherence to the rules of the US Food and Drug Administration and the Scientific Advisory Committee of the Medical Outcomes Trust. We identified 27 individual questionnaires. We summarized development and validation characteristics and content of the 27 validated measures used in the studies.ConclusionsThis is the first systematic review to identify and critically appraise patient-reported outcome measures for appearance and body image using internationally accepted criteria. DAS59 was deemed to have adequate levels of methodological and psychometric evidence. We also introduced the concept of Appearance-Pain which consists of the recomposed systematic view of the experimental indicators of suffering, linked to one of the dimensions of appearance.Level of Evidence IIIThis 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.

AN ETHICAL EVALUATION METHODOLOGY FOR CLINICAL CASES

In the present article, we introduce an ethical evaluation methodology for clinical cases. Although rejecting proceduralism as a system, we develop a procedure that eventually could be formalized as a flow chart to help carry out an ethical evaluation for clinical cases. We clarify the elements that constitute an ethical evaluation: aim (patient’s health), integration (action interconnections), and how the action is performed. We leave aside the aspect of intentions, focusing on the object of a medical action, arguing that the internal aim of a clinical action carries a moral value per se. Our evaluation system takes into account only objects and circumstances and their intrinsic morality, since we are dealing with the evaluation of a clinical case, and not with a personal and complete clinical action. DOI: 10.5294/pebi.2016.20.1.5

Etica delle cure e chirurgia plastica

La chirurgia plastica soffre di una dicotomia fondamentale tra la chirurgia ricostruttiva (spesso considerata come la parte “terapeutica” e “nobile” della specializzazione) e chirurgia estetica (spesso considerato come la parte piu commerciale). Ma la procedura medica e un processo unitario e sistematico, che puo essere considerato completato solo con l’unione dei due concetti precedenti, prima con la guarigione, poi con la restituzione dell’integrita corporea persa spesso a seguito del trattamento curativo/demolitivo. E chiaro che il punto di vista obiettivo/soggettivo o ricostruttivo/estetico sono dicotomie che devono essere superate. Esse producono incomprensioni o possono addirittura possono danneggiare il ruolo della chirurgia plastica. La ricerca della bellezza non deve essere ridotta alla sua dimensione soggettiva o a una corsa verso una perfezione ideale. Il concetto di bellezza deve migliorare la qualita della vita in generale, nel tentativo di superare i problemi fisici e relazionali del paziente. In questo senso, la chirurgia estetica non risponde esclusivamente ai desideri patologici ma contribuisce allo sviluppo ontologico della persona.