scholarly journals Defining the Inframammary Fold by Liposuction: An Essential Tool in Aesthetic Shaping of the Reconstructed Breast. Technique and Long-term Results in a Series of Patients

2021 ◽  
Author(s):  
Valentina Pinto ◽  
Marco Pignatti ◽  
Luca Contu ◽  
Riccardo Cipriani
Keyword(s):  
Evidence Based Medicine ◽  
Experimental Studies ◽  
Long Term Results ◽  
Inframammary Fold ◽  
Full Description ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Definition Of ◽  
Based Medicine

Abstract Background A good inframammary fold (IMF) definition and position is essential to achieve a satisfactory and natural result in breast surgery. This structure can be damaged, especially during mastectomies. Multiple methods are reported in the literature to restore IMF or improve its definition. In this study, we present the results achieved in a series of patients treated with subdermal liposuction. Methods We report on all our patients who underwent IMF liposuction between January 2016 and June 2020. Subdermal liposuction was performed with a blunt 3 mm cannula along the new IMF to promote skin retraction and adherence between skin and fascia. Results were evaluated subjectively by the patients and objectively by 8 individuals not involved with the treatment. Results We performed IMF liposuction in 88 breasts (69 patients), aged 21–74 (mean 52) years for 82 implant-based reconstructions, 2 tuberous breasts, and 4 contralateral breast augmentations. Mean follow-up was 28 months (6–64). Subjective results: the overall result evaluated with the VAS scale reached 86.6/100. All the 22 patients interviewed judged as well defined the new inframammary fold. Objective results: in 83% of cases the definition of the inframammary fold was judged as good or excellent, while symmetry with contralateral IMF, natural appearance, and overall aesthetic outcome were judged as good. Conclusion Based on our long-term satisfactory results, we recommend the technique of subdermal liposuction to improve the definition of IMF in breast reconstruction after mastectomy and other breast procedures. It is effective, easy to perform, minimally invasive, and durable. Level of Evidence IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.

scholarly journals Guiding Nipple-Areola Complex Reconstruction: Literature Review and Proposal of a New Decision-Making Algorithm

2020 ◽  
Author(s):  
Guido Paolini ◽  
Guido Firmani ◽  
Francesca Briganti ◽  
Michail Sorotos ◽  
Fabio Santanelli di Pompeo
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Patient Selection ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Patient Factors ◽  
Level Of Evidence ◽  
Areola Complex ◽  
Complex Reconstruction ◽  
Based Medicine

Abstract Background Nipple-areola complex reconstruction (NAR) most commonly represents the finishing touch to breast reconstruction (BR). Nipple presence is particularly relevant to the patient’s psyche, beyond any shadow of doubt. Many reconstructive options have been described in time. Surgery is easy, but final result is often disappointing on the long run. Methods The goal of this manuscript is to analyze and classify knowledge concerning NAR techniques and the factors that influence success, and then to elaborate a practical evidence-based algorithm. Out of the 3136 available articles as of August 8th, 2020, we selected 172 manuscripts that met inclusion criteria, which we subdivided into 5 main topics of discussion, being the various NAR techniques; patient factors (including patient selection, timing and ideal position); dressings; potential complications and finally, outcomes/patient satisfaction. Results We found 92 articles describing NAR techniques, 41 addressing patient factors (out of which 17 discussed patient selection, 14 described ideal NAC location, 10 described appropriate timing), 10 comparing dressings, 7 studying NAR complications, and 22 addressing outcomes and patient satisfaction. We elaborated a comprehensive decision-making algorithm to help narrow down the choice among NAR techniques, and choose the correct strategy according to the various scenarios, and particularly the BR technique and skin envelope. Conclusions No single NAR technique provides definitive results, which is why we believe there is no “end-all be-all solution”. NAR must be approached as a case-by-case situation. Furthermore, despite NAR being such a widely discussed topic in scientific literature, we still found a lack of clinical trials to allow for more thorough recommendations to be elaborated. Level of Evidence III This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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

Evidence-based causation in toxicology

2015 ◽  
Vol 34 (12) ◽  
pp. 1245-1252 ◽  
Author(s):  
RC James ◽  
JK Britt ◽  
NC Halmes ◽  
PS Guzelian
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Weight Of Evidence ◽  
Evidence Based ◽  
Definition Of ◽  
Evidence Based Guidelines ◽  
Available Information ◽  
Based Medicine ◽  
Lay Public ◽  
Reproducible Manner

We introduced Evidence-based Toxicology (EBT) in 2005 to address the disparities that exist between the various Weight-of-Evidence (WOE) methods typically applied in the regulatory hazard decision-making arena and urged toxicologists to adopt the evidence-based guidelines long-utilized in medicine (i.e., Evidence-Based Medicine or EBM). This review of the activities leading to the adoption of evidence-based methods and EBT during the last decade demonstrates how fundamental concepts that form EBT, such as the use of systematic reviews to capture and consider all available information, are improving toxicological evaluations performed by various groups and agencies. We reiterate how the EBT framework, a process that provides a method for performing human chemical causation analyses in an objective, transparent and reproducible manner, differs significantly from past and current regulatory WOE approaches. We also discuss why the uncertainties associated with regulatory WOE schemes lead to a definition of the term “risk” that contains unquantifiable uncertainties not present in this term as it is used in epidemiology and medicine. We believe this distinctly different meaning of “risk” should be clearly conveyed to those not familiar with this difference (e.g., the lay public), when theoretical/nomologic risks associated with chemical-induced toxicities are presented outside of regulatory and related scientific parlance.

scholarly journals Uncomfortable treatment without diagnosis

2021 ◽  
Vol LIII (1) ◽  
pp. 69-70
Author(s):  
Nikita A. Zorin
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Epidemiology ◽  
Natural Process ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Holistic View ◽  
Theory Of Evidence ◽  
Based Medicine

One explanation for breakdown of the traditional medical connection of diagnosis and treatment is presented. It is suggested that it was a natural process brought to life by the results of the development of genetics and the results of the application of clinical epidemiology (the theory of evidence-based medicine), which led to the beginning of the downfall of the nosological concept, so far de facto, and in the long term de jure. Medicine is painfully returning to a holistic view of a patient.

scholarly journals Relationship between Journal Impact Factor and Levels of Evidence in Anaesthesia

2005 ◽  
Vol 33 (5) ◽  
pp. 567-570 ◽  
Author(s):  
C. R. Bain ◽  
P. S. Myles
Keyword(s):  
Impact Factor ◽  
Evidence Based Medicine ◽  
Citation Rate ◽  
Journal Ranking ◽  
Evidence Based ◽  
Publication Type ◽  
Level Of Evidence ◽  
Level 1 ◽  
Number Of Publications ◽  
Based Medicine

Evidence-based medicine uses a hierarchy of publication types according to their vulnerability to bias. A widely used measure of journal “quality” is its impact factor, which describes the citation rate of its publications. We investigated the relationship between impact factor for eight anaesthesia journals and publication type with respect to their level of evidence 1-4 using Spearman rank correlation (rho). There were 1418 original publications during 2001 included in the analysis. The number (%) of publication types according to evidence-based medicine level were: level 1: 6 (0.4%), level 2: 533 (38%) level 3: 329 (23%), level 4: 550 (39%). There was no correlation between journal ranking according to impact factor and publication type (rho=–0.03, P=0.25). The correlation between journal rank and the proportion of publications that were randomized trials was –0.35 (P<0.001). The correlation between journal rank and number of publications was 0.65 (P<0.001). The correlation between journal rank and number of level 1 or 2 studies was 0.58 (P<0.001). The overall level of evidence published in anaesthesia journals was high. Journal rank according to impact factor is related to the number of publications, but not the proportion of publications that are evidence-based medicine level 1 or 2.

scholarly journals THE MAIN FEATURES OF EVIDENCE-BASED MEDICINE IN THE TREATMENT AND REHABILITATION OF PATIENTS IN MAXILLOFACIAL SURGERY

ASJ. ◽  
2020 ◽  
Vol 1 (43) ◽  
pp. 30-33
Author(s):  
S. Тemirbolatova ◽  
A. Shogenov
Keyword(s):  
Evidence Based Medicine ◽  
Maxillofacial Surgery ◽  
Scientific Data ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Key Skills ◽  
Assessment Of Evidence ◽  
Based Medicine ◽  
Methods Of Treatment

The paper considers the features of modern evidence-based medicine, its role and place in modern clinical practice, the role of assessing the effectiveness of drug therapy, the principles of conducting clinical trials of drugs. The results obtained will find wide application in the choice of methods of treatment and rehabilitation of patients in the Department of Maxillofacial Surgery, which will contribute to the development of this branch of medicine. Introduced modern scientific data into practice, which includes 5 key skills: study of questions and problems, with a detailed detailed answer to them, to conclude a method of treating a patient, a conservative approach or the degree of effectiveness of surgery; a detailed analysis of electronic literature of the corresponding type and level of evidence; selection of research methods and assessment of evidence of their necessity; the ability to implement the final results, and use them in the process of treating patients.

scholarly journals Anti-D-immunoprophylaxis

2015 ◽  
Vol 64 (3) ◽  
pp. 52-57
Author(s):  
Nataliya Grigor’yevna Pavlova
Keyword(s):  
Evidence Based Medicine ◽  
Point Of View ◽  
European Countries ◽  
Evidence Based ◽  
Federal Programs ◽  
Foreign Countries ◽  
Economic Advisability ◽  
Based Medicine ◽  
Working Out

The working out and introducing of anti-D-immunoprofylaxis program in the time of pregnancy in foreign countries and Russia are discussed, effectiveness of its long-term using on the base of the federal programs in developed European countries and America is analyzed; necessity and economic advisability of its introducing on the base of the federal and municipal programs in Russia from the evidence-based medicine point of view are considered, indications and arguable points of the program are discussed.

Levels of evidence of articles in podiatric medical journals

2000 ◽  
Vol 90 (6) ◽  
pp. 300-302 ◽  
Author(s):  
MA Turlik ◽  
D Kushner
Keyword(s):  
Randomized Controlled Trials ◽  
Evidence Based Medicine ◽  
Medical Profession ◽  
Controlled Trials ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Medical Journals ◽  
Levels Of Evidence ◽  
Randomized Controlled ◽  
Based Medicine

The authors reviewed 322 articles in podiatric medical journals to determine their level of evidence. Only 1% of the articles reviewed were randomized controlled trials. The authors concluded that if the podiatric medical profession wishes to become a participant in evidence-based medicine, greater emphasis must be placed on studies that assess hypotheses.

Disease specificity and evidence-based medicine: a historical perspective

2020 ◽  
Vol 8 (3) ◽  
pp. 308
Author(s):  
Timo Bolt ◽  
F G Huisman
Keyword(s):  
Evidence Based Medicine ◽  
Historical Perspective ◽  
Clinical Epidemiology ◽  
Unintended Consequences ◽  
Current Debate ◽  
Evidence Based ◽  
Negative Consequences ◽  
Based Medicine ◽  
Ontological Concept

This paper seeks to inform the current debate on an alleged ‘crisis’ and the ‘unintended negative consequences’ of evidence-based medicine (EBM) from a historical perspective. EBM can be placed against the background of a long term process of medical quantification and objectification. This long term process was accompanied by a ‘specificity revolution’, which made the ontological concept of diseases as specific entities the central ordering and regulatory principle in healthcare (as well as in clinical epidemiology and EBM). To a certain extent, the debate about EBM’s alleged crisis can be understood as resulting from this specificity revolution. When the ontological concept of disease is applied too rigidly, this will contribute to ‘negative unintended consequences’ of EBM such as ‘poor mapping of multimorbidity’ and medical practice ‘that is management-driven rather than patient-centered’.

Evidence-based medicine in otolaryngology journals

2002 ◽  
Vol 126 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Boris L. Bentsianov ◽  
Marina Boruk ◽  
Richard M. Rosenfeld
Keyword(s):  
Clinical Research ◽  
Internal Control ◽  
Evidence Based Medicine ◽  
Research Articles ◽  
Control Group ◽  
Evidence Based ◽  
Supporting Evidence ◽  
Level Of Evidence ◽  
Therapeutic Recommendations ◽  
Based Medicine

OBJECTIVE: We set out to assess, within the context of evidence-based medicine, the levels of supporting evidence for therapeutic recommendations made in leading otolaryngology journals. DESIGN: We used a cross-sectional survey of clinical research articles published in 1999 in 4 high-circulation otolaryngology journals. OUTCOME MEASURES: We used study design methodology and level of evidence for clinical research articles with therapeutic recommendations. Outcomes were stratified by type of recommendation (positive vs negative) and by study focus (medical vs surgical therapy). RESULTS: Of the 1019 articles identified, 737 (72%) were clinical research and 268 (36%) made therapeutic recommendations. Median sample size was modest (27 subjects), with only 38% of studies reflecting planned research and 22% including an internal control or comparison group. positive studies were 20 times more prevalent than negative ones, but were 69% less likely to have an internal control group ( P = .042) and 93% less likely to include confidence intervals ( P = .020). Moreover, the level of evidence for positive studies was lower than for negative studies ( P = .037), with twice as many negative recommendations supported by analytic research. Similarly, the level of evidence for operation was lower than for medical therapy ( P < .001), with 3 times as many medical recommendations supported by analytic research. CONCLUSIONS: Most therapeutic recommendations in otolaryngology journals are on the basis of descriptive case series (80%) and least often on randomized controlled trials (7%). A dual standard appears to exist for negative versus positive studies and for medical versus surgical recommendations. Greater scrutiny of the breadth and quality of evidence levels supporting therapeutic recommendations is likely to occur as the popularity of—and demand for—evidence-based medicine increases. SIGNIFICANCE: Evaluation of levels of evidence in otolaryngology decision making.

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