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  1. Article: Patient-Reported Measurement of Breast Asymmetry Using Archimedes' Principle in Breast Reduction Mammaplasty: A Retrospective Study.

    Waltho, Daniel / McRae, Mark / Thoma, Achilleas

    Cureus

    2020  Volume 12, Issue 1, Page(s) e6536

    Abstract: Introduction Breast hypertrophy is a common condition that is often treated with breast reduction surgery. A large percentage of breast hypertrophy patients have notable asymmetry between breasts. Methods The purpose of this study was to investigate a ... ...

    Abstract Introduction Breast hypertrophy is a common condition that is often treated with breast reduction surgery. A large percentage of breast hypertrophy patients have notable asymmetry between breasts. Methods The purpose of this study was to investigate a method of measuring breast asymmetry, one that allows patients to determine the asymmetry of their own breasts at home with ease, and to assess its accuracy and role in a surgical practice. A retrospective chart review was conducted, wherein self-measurements of breast asymmetry using a variation of Bouman's technique were compared with the recorded intra-operative resected tissue mass. Results In total, 47 patients with asymmetry were included in the study. The difference between patient-reported measurements and resected breast tissue mass varied from 0 grams to 240 grams. Of the 47 patients, 38% were able to measure their breast difference within a remarkable 10 grams as compared to the resected breast tissue, of which four patients were accurate to less than one gram. The majority (70%) of patients accurately measured their asymmetry within 50 grams, which was determined to be a clinically significant amount based on a survey of plastic surgeons performed for the study. Conclusion The breast measurement technique presented in this study appears to be effective and accurate for most patients with suspected asymmetry undergoing reduction mammaplasty that stands to reduce pre-operative planning time. Patient-reported breast measurement may emerge as a valuable tool in clinical and research pursuits; however, further research on this topic is indicated at this time.
    Language English
    Publishing date 2020-01-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.6536
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Post-breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach - a review of the literature and discussion.

    Waltho, Daniel / Rockwell, Gloria

    Canadian journal of surgery. Journal canadien de chirurgie

    2016  Volume 59, Issue 5, Page(s) 342–350

    Abstract: Background: Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by ... ...

    Abstract Background: Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by identifying the various elements included in the definitions and how they vary across the literature, determining how these definitions affect the methodological components therein, and proposing a definition that appropriately encompasses all of the appropriate elements.
    Methods: We searched PubMed to retrieve all studies and case reports on PMPS, and we analyzed definitions of PMPS, inclusion/exclusion criteria, and methods of measuring PMPS.
    Results: Twenty-three studies were included in this review. We identified 7 independent domains for defining PMPS: surgical breast procedure, neuropathic nature, pain of at least moderate intensity, protracted duration, frequent symptoms, appropriate location of the symptoms and exacerbation with movement. These domains were used with varying frequency. Inclusion/exclusion criteria and methods for assessing PMPS also varied markedly.
    Conclusion: To prevent future discrepancies in both the clinical and research settings, we propose a new and complete definition based on the results of our review: PMPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50% of the time; and may be exacerbated by movements of the shoulder girdle.
    MeSH term(s) Consensus ; Humans ; Mastectomy/adverse effects ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology
    Language English
    Publishing date 2016-09-25
    Publishing country Canada
    Document type Journal Article ; Review
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.000716
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Reply: Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.

    Waltho, Daniel / Hatchell, Alexandra / Thoma, Achilleas

    Plastic and reconstructive surgery

    2017  Volume 140, Issue 4, Page(s) 621e

    MeSH term(s) Gynecomastia/classification ; Humans ; Male
    Language English
    Publishing date 2017-05-23
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 208012-6
    ISSN 1529-4242 ; 0032-1052 ; 0096-8501
    ISSN (online) 1529-4242
    ISSN 0032-1052 ; 0096-8501
    DOI 10.1097/PRS.0000000000003733
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.

    Waltho, Daniel / Hatchell, Alexandra / Thoma, Achilleas

    Plastic and reconstructive surgery

    2017  Volume 139, Issue 3, Page(s) 638e–648e

    Abstract: Background: Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several ... ...

    Abstract Background: Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed.
    Methods: A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making.
    Results: The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features.
    Conclusions: Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.
    MeSH term(s) Gynecomastia/classification ; Gynecomastia/surgery ; Humans ; Male ; Mammaplasty/methods ; Mastectomy/methods
    Language English
    Publishing date 2017-02-15
    Publishing country United States
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 208012-6
    ISSN 1529-4242 ; 0032-1052 ; 0096-8501
    ISSN (online) 1529-4242
    ISSN 0032-1052 ; 0096-8501
    DOI 10.1097/PRS.0000000000003059
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Reporting Outcomes and Outcome Measures in Cubital Tunnel Syndrome: A Systematic Review.

    Gallo, Lucas / Gallo, Matteo / Murphy, Jessica / Waltho, Daniel / Baxter, Charmaine / Karpinski, Marta / Mowakket, Sadek / Copeland, Andrea / Thoma, Achilleas

    The Journal of hand surgery

    2020  Volume 45, Issue 8, Page(s) 707–728.e9

    Abstract: Purpose: Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to ... ...

    Abstract Purpose: Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to evaluate postoperative results for CuTS.
    Methods: We performed computerized database searches of MEDLINE and EMBASE. Studies with 20 or more patients aged 18 and older who were undergoing medial epicondylectomy, endoscopic decompression, open simple decompression, or decompression with subcutaneous, submuscular, or intramuscular transposition for ulnar neuropathy at the elbow were included. Outcomes and outcome measures were extracted and tabulated.
    Results: Of the 101 studies included, 45 unique outcomes and 31 postoperative outcome measures were identified. These included 7 condition-specific, clinician-reported instruments; 4 condition-specific, clinician-reported instruments; 8 patient-reported, generic instruments; 11 clinician-generated instruments; and one utility measure. Outcome measures were divided into 6 unique domains. Overall, 60% of studies used condition-specific outcome measures. The frequency of any condition-specific outcome measure ranged from 1% to 37% of included studies.
    Conclusions: There is marked heterogeneity in outcomes and outcome measures used to assess CuTS. A standardized core outcome set is needed to compare results of various techniques of cubital tunnel decompression.
    Clinical relevance: This study builds on the existing literature to support the notion that there is marked heterogeneity in outcomes and outcome measures used to assess CuTS. The authors believe that a future standardized set of core outcomes is needed to limit heterogeneity among studies assessing postoperative outcomes in CuTS to compare these interventions more easily and pool results in the form of systematic reviews and meta-analyses.
    MeSH term(s) Humans ; Cubital Tunnel Syndrome/surgery ; Decompression, Surgical ; Lumbar Vertebrae ; Outcome Assessment, Health Care ; Treatment Outcome ; Ulnar Nerve/surgery
    Language English
    Publishing date 2020-06-24
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 605716-0
    ISSN 1531-6564 ; 0363-5023
    ISSN (online) 1531-6564
    ISSN 0363-5023
    DOI 10.1016/j.jhsa.2020.04.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Outcomes and Outcome Measures in Breast Reduction Mammaplasty: A Systematic Review.

    Waltho, Daniel / Gallo, Lucas / Gallo, Matteo / Murphy, Jessica / Copeland, Andrea / Mowakket, Sadek / Moltaji, Syena / Baxter, Charmaine / Karpinski, Marta / Thoma, Achilleas

    Aesthetic surgery journal

    2019  Volume 40, Issue 4, Page(s) 383–391

    MeSH term(s) Breast/surgery ; Female ; Humans ; Hypertrophy/surgery ; Mammaplasty/adverse effects ; Outcome Assessment, Health Care ; Quality of Life
    Language English
    Publishing date 2019-10-18
    Publishing country England
    Document type Journal Article ; Systematic Review
    ZDB-ID 2087022-X
    ISSN 1527-330X ; 1090-820X ; 1084-0761
    ISSN (online) 1527-330X
    ISSN 1090-820X ; 1084-0761
    DOI 10.1093/asj/sjz308
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Users' guide to the surgical literature: how to assess a noninferiority trial.

    Thoma, Achilleas / Farrokhyar, Forough / Waltho, Daniel / Braga, Luis H / Sprague, Sheila / Goldsmith, Charlie H

    Canadian journal of surgery. Journal canadien de chirurgie

    2017  Volume 60, Issue 6, Page(s) 426–432

    Abstract: Summary: A well-planned randomized controlled trial (RCT) is the most optimal study design to determine if a novel surgical intervention is any different than a prevailing one. Traditionally, when we want to show that a new surgical intervention is ... ...

    Abstract Summary: A well-planned randomized controlled trial (RCT) is the most optimal study design to determine if a novel surgical intervention is any different than a prevailing one. Traditionally, when we want to show that a new surgical intervention is superior to a standard one, we analyze data from an RCT to see if the null hypothesis of "no difference" can be rejected (i.e., the 2 surgical interventions have the same effect). A noninferiority RCT design seeks to determine whether a new intervention is not worse than a prevailing (standard) one within an acceptable margin of risk or benefit, referred to as the "noninferiority margin." In the last decade, we have observed an increase in the publication of noninferiority RCTs. This article explores this type of study design and discusses the tools that can be used to appraise such a study.
    MeSH term(s) Equivalence Trials as Topic ; Guidelines as Topic ; Humans ; Research Design/standards ; Review Literature as Topic ; Surgical Procedures, Operative
    Language English
    Publishing date 2017-11-27
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.000317
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review.

    Moltaji, Syena / Gallo, Matteo / Wong, Chloe / Murphy, Jessica / Gallo, Lucas / Waltho, Daniel / Copeland, Andrea / Karpinski, Marta / Mowakket, Sadek / Duku, Eric / Thoma, Achilleas

    Journal of hand and microsurgery

    2020  Volume 12, Issue 2, Page(s) 85–94

    Abstract: ... ...

    Abstract Introduction
    Language English
    Publishing date 2020-04-09
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 0974-3227
    ISSN 0974-3227
    DOI 10.1055/s-0040-1701324
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery: A Systematic Review.

    Mowakket, Sadek / Karpinski, Marta / Gallo, Lucas / Gallo, Matteo / Banfield, Laura / Murphy, Jessica / Waltho, Daniel / Copeland, Andrea / Moltaji, Syena / Thoma, Achilleas

    Plastic and reconstructive surgery

    2018  Volume 142, Issue 6, Page(s) 947e–957e

    Abstract: Background: Current guidelines for randomized controlled trial reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the ... ...

    Abstract Background: Current guidelines for randomized controlled trial reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature.
    Methods: This is a systematic review of plastic surgery randomized controlled trials published within the past 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, nonpharmaceutical randomized controlled trials, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizon, was extracted.
    Results: The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, or a follow-up duration range, or were not reported at all. Although most studies (85.4 percent) reported a standardized time horizon, the majority (85.4 percent) failed to provide a valid justification to support their selection of time horizon.
    Conclusions: Clinical investigators failed to justify their choice of time horizon in the majority of published randomized controlled trials. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency.
    MeSH term(s) Humans ; Practice Guidelines as Topic ; Randomized Controlled Trials as Topic/methods ; Reconstructive Surgical Procedures/methods ; Research Design/standards ; Time Factors
    Language English
    Publishing date 2018-09-10
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 208012-6
    ISSN 1529-4242 ; 0032-1052 ; 0096-8501
    ISSN (online) 1529-4242
    ISSN 0032-1052 ; 0096-8501
    DOI 10.1097/PRS.0000000000005040
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Users' guide to the surgical literature: how to perform a high-quality literature search.

    Waltho, Daniel / Kaur, Manraj Nirmal / Haynes, R Brian / Farrokhyar, Forough / Thoma, Achilleas

    Canadian journal of surgery. Journal canadien de chirurgie

    2015  Volume 58, Issue 5, Page(s) 349–358

    Abstract: The article "Users" guide to the surgical literature: how to perform a "literature search" was published in 2003, but the continuing technological developments in databases and search filters have rendered that guide out of date. The present guide fills ... ...

    Abstract The article "Users" guide to the surgical literature: how to perform a "literature search" was published in 2003, but the continuing technological developments in databases and search filters have rendered that guide out of date. The present guide fills an existing gap in this area; it provides the reader with strategies for developing a searchable clinical question, creating an efficient search strategy,accessing appropriate databases, and skillfully retrieving the best evidence to address the research question.
    MeSH term(s) Bibliography of Medicine ; Databases, Bibliographic ; General Surgery/methods ; Humans
    Language English
    Publishing date 2015-09-18
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.017314
    Database MEDical Literature Analysis and Retrieval System OnLINE

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