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Davies BM, Yanez Touzet A, Mowforth OD, Lee KS, Khan D, Furlan JC, Fehlings MG, Harrop JS, Zipser CM, Rodrigues-Pinto R, Milligan J, Sarewitz E, Curt A, Rahimi-Movaghar V, Aarabi B, Boerger TF, Tetreault L, Chen R, Guest JD, Kalsi-Ryan S, Sadler I, Widdop S, McNair AGK, Kwon BK, Kotter MRN. Development of a core measurement set for research in degenerative cervical myelopathy: a study protocol (AO Spine RECODE-DCM CMS). BMJ Open 2022; 12:e060436. [PMID: 35680260 PMCID: PMC9185555 DOI: 10.1136/bmjopen-2021-060436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Progress in degenerative cervical myelopathy (DCM) is hindered by inconsistent measurement and reporting. This impedes data aggregation and outcome comparison across studies. This limitation can be reversed by developing a core measurement set (CMS) for DCM research. Previously, the AO Spine Research Objectives and Common Data Elements for DCM (AO Spine RECODE-DCM) defined 'what' should be measured in DCM: the next step of this initiative is to determine 'how' to measure these features. This protocol outlines the steps necessary for the development of a CMS for DCM research and audit. METHODS AND ANALYSIS The CMS will be developed in accordance with the guidance developed by the Core Outcome Measures in Effectiveness Trials and the Consensus-based Standards for the selection of health Measurement Instruments. The process involves five phases. In phase 1, the steering committee agreed on the constructs to be measured by sourcing consensus definitions from patients, professionals and the literature. In phases 2 and 3, systematic reviews were conducted to identify tools for each construct and aggregate their evidence. Constructs with and without tools were identified, and scoping reviews were conducted for constructs without tools. Evidence on measurement properties, as well as on timing of assessments, are currently being aggregated. These will be presented in phase 4: a consensus meeting where a multi-disciplinary panel of experts will select the instruments that will form the CMS. Following selection, guidance on the implementation of the CMS will be developed and disseminated (phase 5). A preliminary CMS review scheduled at 4 years from release. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Cambridge (HBREC2019.14). Dissemination strategies will include peer-reviewed scientific publications; conference presentations; podcasts; the identification of AO Spine RECODE-DCM ambassadors; and engagement with relevant journals, funders and the DCM community.
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Affiliation(s)
- Benjamin M Davies
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Oliver D Mowforth
- Department of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Danyal Khan
- Academic Neurosurgery Unit, University College London, London, UK
| | - Julio C Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spinal Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - James S Harrop
- Thomas Jefferson University, Jefferson Health System, St Louis, Missouri, USA
| | | | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - James Milligan
- Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Armin Curt
- University Hospital Balgrist, Zürich, Switzerland
| | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran, Iran
| | - Bizhan Aarabi
- Division of Neurosurgery, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Timothy F Boerger
- Neurosurgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Lindsay Tetreault
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University College Cork, Cork, Ireland
| | - Robert Chen
- Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - James D Guest
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | | | - Angus G K McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, Avon, UK
- GI Surgery, North Bristol NHS Trust, Bristol, UK
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia, Canada
| | - Mark R N Kotter
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Ann McLaren Laboratory of Regenerative Medicine, Cambridge, UK
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Harvey KL, Sinai P, Mills N, White P, Holcombe C, Potter S. Short-term safety outcomes of mastectomy and immediate prepectoral implant-based breast reconstruction: Pre-BRA prospective multicentre cohort study. Br J Surg 2022; 109:530-538. [PMID: 35576373 PMCID: PMC10364707 DOI: 10.1093/bjs/znac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/18/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Prepectoral breast reconstruction (PPBR) has recently been introduced to reduce postoperative pain and improve cosmetic outcomes in women having implant-based procedures. High-quality evidence to support the practice of PPBR, however, is lacking. Pre-BRA is an IDEAL stage 2a/2b study that aimed to establish the safety, effectiveness, and stability of PPBR before definitive evaluation in an RCT. The short-term safety endpoints at 3 months after surgery are reported here. METHODS Consecutive patients electing to undergo immediate PPBR at participating UK centres between July 2019 and December 2020 were invited to participate. Demographic, operative, oncology, and complication data were collected. The primary outcome was implant loss at 3 months. Other outcomes of interest included readmission, reoperation, and infection. RESULTS Some 347 women underwent 424 immediate implant-based reconstructions at 40 centres. Most were single-stage direct-to-implant (357, 84.2 per cent) biological mesh-assisted (341, 80.4 per cent) procedures. Conversion to subpectoral reconstruction was necessary in four patients (0.9 per cent) owing to poor skin-flap quality. Of the 343 women who underwent PPBR, 144 (42.0 per cent) experienced at least one postoperative complication. Implant loss occurred in 28 women (8.2 per cent), 67 (19.5 per cent) experienced an infection, 60 (17.5 per cent) were readmitted for a complication, and 55 (16.0 per cent) required reoperation within 3 months of reconstruction. CONCLUSION Complication rates following PPBR are high and implant loss is comparable to that associated with subpectoral mesh-assisted implant-based techniques. These findings support the need for a well-designed RCT comparing prepectoral and subpectoral reconstruction to establish best practice for implant-based breast reconstruction.
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Affiliation(s)
- Kate L Harvey
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Parisa Sinai
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Nicola Mills
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, UK
| | | | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Bakhbakhi D, Fraser A, Siasakos D, Hinton L, Davies A, Merriel A, Duffy JMN, Redshaw M, Lynch M, Timlin L, Flenady V, Heazell AE, Downe S, Slade P, Brookes S, Wojcieszek A, Murphy M, de Oliveira Salgado H, Pollock D, Aggarwal N, Attachie I, Leisher S, Kihusa W, Mulley K, Wimmer L, Burden C. Protocol for the development of a core outcome set for stillbirth care research (iCHOOSE Study). BMJ Open 2022; 12:e056629. [PMID: 35140161 PMCID: PMC8830254 DOI: 10.1136/bmjopen-2021-056629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stillbirth is associated with significant physical, psychosocial and economic consequences for parents, families, wider society and the healthcare system. There is emerging momentum to design and evaluate interventions for care after stillbirth and in subsequent pregnancies. However, there is insufficient evidence to inform clinical practice compounded by inconsistent outcome reporting in research studies. To address this paucity of evidence, we plan to develop a core outcome set for stillbirth care research, through an international consensus process with key stakeholders including parents, healthcare professionals and researchers. METHODS AND ANALYSIS The development of this core outcome set will be divided into five distinct phases: (1) Identifying potential outcomes from a mixed-methods systematic review and analysis of interviews with parents who have experienced stillbirth; (2) Creating a comprehensive outcome long-list and piloting of a Delphi questionnaire using think-aloud interviews; (3) Choosing the most important outcomes by conducting an international two-round Delphi survey including high-income, middle-income and low-income countries; (4) Deciding the core outcome set by consensus meetings with key stakeholders and (5) Dissemination and promotion of the core outcome set. A parent and public involvement panel and international steering committee has been convened to coproduce every stage of the development of this core outcome set. ETHICS AND DISSEMINATION Ethical approval for the qualitative interviews has been approved by Berkshire Ethics Committee REC Reference 12/SC/0495. Ethical approval for the think-aloud interviews, Delphi survey and consensus meetings has been awarded from the University of Bristol Faculty of Health Sciences Research Ethics Committee (Reference number: 116535). The dissemination strategy is being developed with the parent and public involvement panel and steering committee. Results will be published in peer-reviewed specialty journals, shared at national and international conferences and promoted through parent organisations and charities. PROSPERO REGISTRATION NUMBER CRD42018087748.
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Affiliation(s)
- Danya Bakhbakhi
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Abigail Fraser
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Abi Merriel
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - James M N Duffy
- Obstetrics and Gynaecology Department, North Middlesex University Hospital NHS Trust, London, UK
| | | | - Mary Lynch
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Laura Timlin
- Women & Children's Health Department, North Bristol NHS Trust, Bristol, UK
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | | | - Soo Downe
- Research in Childbirth and Health, University of Central Lancashire, Preston, UK
| | - Pauline Slade
- Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Sara Brookes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Aleena Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Margaret Murphy
- Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | | | - Danielle Pollock
- Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Neelam Aggarwal
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Irene Attachie
- Department of Nursing and Midwifery, University of Health and Allied Sciences School of Public Health, Hohoe, Ghana
| | | | | | | | | | - Christy Burden
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
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Implant-Based Reconstruction following Mastectomy in Patients Who Have Had a Previous Breast Augmentation: Lessons from the National Multicenter Implant Breast Reconstruction Evaluation Study. Plast Reconstr Surg 2022; 149:324-337. [PMID: 35077406 DOI: 10.1097/prs.0000000000008713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast augmentation is the most commonly performed cosmetic procedure, and increasingly women in this group present with breast cancer or request risk-reducing surgery, but their optimal management is unclear. The authors explored the clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction following previous augmentation and compared these with outcomes of patients who had not had cosmetic implants in the Implant Breast Reconstruction Evaluation (iBRA) Study. METHODS Patients undergoing immediate implant-based breast reconstruction were prospectively recruited from breast and plastic surgical units across the United Kingdom. Demographic, operative, and oncologic data, and information regarding complications within 3 postoperative months were collected. Patient-reported outcomes at 18 months were assessed using the BREAST-Q. The clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction with and without previous breast augmentation were compared. RESULTS A total of 2108 women were included in the iBRA Study, of whom 49 had undergone a previous augmentation. Women in the augmentation group were younger (median age, 45 years versus 50 years; p = 0.01), had a lower body mass index (22.8 kg/m2 versus 24.9 kg/m2; p < 0.01), and had smaller tumors (15 mm versus 25 mm; p = 0.01) than patients without augmentation. No differences were seen in operative technique between the groups. Complications at 3 months were similar in both groups and there were no significant differences in patient-reported outcomes at 18 months. CONCLUSIONS The clinical and patient-reported outcomes of patients undergoing immediate implant-based breast reconstruction following previous augmentation are consistent with those observed in the wider iBRA Study cohort, supporting the safety of this approach.
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Yanez Touzet A, Bhatti A, Dohle E, Bhatti F, Lee KS, Furlan JC, Fehlings MG, Harrop JS, Zipser CM, Rodrigues-Pinto R, Milligan J, Sarewitz E, Curt A, Rahimi-Movaghar V, Aarabi B, Boerger TF, Tetreault L, Chen R, Guest JD, Kalsi-Ryan S, McNair AG, Kotter M, Davies B. Clinical outcome measures and their evidence base in degenerative cervical myelopathy: a systematic review to inform a core measurement set (AO Spine RECODE-DCM). BMJ Open 2022; 12:e057650. [PMID: 35046007 PMCID: PMC8772430 DOI: 10.1136/bmjopen-2021-057650] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/22/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To evaluate the measurement properties of outcome measures currently used in the assessment of degenerative cervical myelopathy (DCM) for clinical research. DESIGN Systematic review DATA SOURCES: MEDLINE and EMBASE were searched through 4 August 2020. ELIGIBILITY CRITERIA Primary clinical research published in English and whose primary purpose was to evaluate the measurement properties or clinically important differences of instruments used in DCM. DATA EXTRACTION AND SYNTHESIS Psychometric properties and clinically important differences were both extracted from each study, assessed for risk of bias and presented in accordance with the Consensus-based Standards for the selection of health Measurement Instruments criteria. RESULTS Twenty-nine outcome instruments were identified from 52 studies published between 1999 and 2020. They measured neuromuscular function (16 instruments), life impact (five instruments), pain (five instruments) and radiological scoring (five instruments). No instrument had evaluations for all 10 measurement properties and <50% had assessments for all three domains (ie, reliability, validity and responsiveness). There was a paucity of high-quality evidence. Notably, there were no studies that reported on structural validity and no high-quality evidence that discussed content validity. In this context, we identified nine instruments that are interpretable by clinicians: the arm and neck pain scores; the 12-item and 36-item short form health surveys; the Japanese Orthopaedic Association (JOA) score, modified JOA and JOA Cervical Myelopathy Evaluation Questionnaire; the neck disability index; and the visual analogue scale for pain. These include six scores with barriers to application and one score with insufficient criterion and construct validity. CONCLUSIONS This review aggregates studies evaluating outcome measures used to assess patients with DCM. Overall, there is a need for a set of agreed tools to measure outcomes in DCM. These findings will be used to inform the development of a core measurement set as part of AO Spine RECODE-DCM.
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Affiliation(s)
- Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Manchester, UK
| | - Aniqah Bhatti
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Esmee Dohle
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Faheem Bhatti
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Julio C Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilita, University of Toronto, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James S Harrop
- Thomas Jefferson University, Jefferson Health System, St Louis, Philadelphia, USA
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Bizhan Aarabi
- Division of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay Tetreault
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert Chen
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - James D Guest
- Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Angus Gk McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, Avon, UK
- GI Surgery, North Bristol NHS Trust, Bristol, UK
| | - Mark Kotter
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, Ann McLaren Laboratory of Regenerative Medicine, Cambridge, UK
| | - Benjamin Davies
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Roberts K, Mills N, Metcalfe C, Lane A, Clement C, Hollingworth W, Taylor J, Holcombe C, Skillman J, Fairhurst K, Whisker L, Cutress R, Thrush S, Fairbrother P, Potter S. Best-BRA (Is subpectoral or prepectoral implant placement best in immediate breast reconstruction?): a protocol for a pilot randomised controlled trial of subpectoral versus prepectoral immediate implant-based breast reconstruction in women following mastectomy. BMJ Open 2021; 11:e050886. [PMID: 34848516 PMCID: PMC8634330 DOI: 10.1136/bmjopen-2021-050886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure following mastectomy. IBBR techniques are evolving rapidly, with mesh-assisted subpectoral reconstruction becoming the standard of care and more recently, prepectoral techniques being introduced. These muscle-sparing techniques may reduce postoperative pain, avoid implant animation and improve cosmetic outcomes and have been widely adopted into practice. Although small observational studies have failed to demonstrate any differences in the clinical or patient-reported outcomes of prepectoral or subpectoral reconstruction, high-quality comparative evidence of clinical or cost-effectiveness is lacking. A well-designed, adequately powered randomised controlled trial (RCT) is needed to compare the techniques, but breast reconstruction RCTs are challenging. We, therefore, aim to undertake an external pilot RCT (Best-BRA) with an embedded QuinteT Recruitment Intervention (QRI) to determine the feasibility of undertaking a trial comparing prepectoral and subpectoral techniques. METHODS AND ANALYSIS Best-BRA is a pragmatic, two-arm, external pilot RCT with an embedded QRI and economic scoping for resource use. Women who require a mastectomy for either breast cancer or risk reduction, elect to have an IBBR and are considered suitable for both prepectoral and subpectoral reconstruction will be recruited and randomised 1:1 between the techniques.The QRI will be implemented in two phases: phase 1, in which sources of recruitment difficulties are rapidly investigated to inform the delivery in phase 2 of tailored interventions to optimise recruitment of patients.Primary outcomes will be (1) recruitment of patients, (2) adherence to trial allocation and (3) outcome completion rates. Outcomes will be reviewed at 12 months to determine the feasibility of a definitive trial. ETHICS AND DISSEMINATION The study has been approved by the National Health Service (NHS) Wales REC 6 (20/WA/0338). Findings will be presented at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN10081873.
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Affiliation(s)
- Kirsty Roberts
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Athene Lane
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Clare Clement
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Jodi Taylor
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Katherine Fairhurst
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Lisa Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ramsey Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Steven Thrush
- Breast Unit, Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
| | | | - Shelley Potter
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury on Trym, UK
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Sewart E, Turner NL, Conroy EJ, Cutress RI, Skillman J, Whisker L, Thrush S, Barnes N, Holcombe C, Potter S. Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh. BJS Open 2021; 5:6145787. [PMID: 33609398 PMCID: PMC7896806 DOI: 10.1093/bjsopen/zraa063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Biological and synthetic meshes may improve the outcomes of immediate implant-based breast reconstruction (IBBR) by facilitating single-stage procedures and improving cosmesis. Supporting evidence is, however, limited. The aim of this study was to explore the impact of biological and synthetic mesh on patient-reported outcomes (PROs) of IBBR 18 months after surgery. METHODS Consecutive women undergoing immediate IBBR between February 2014 and June 2016 were recruited to the study. Demographic, operative, oncological and 3-month complication data were collected, and patients received validated BREAST-Q questionnaires at 18 months. The impact of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically relevant confounders, and including a random effect to account for clustering by centre. RESULTS A total of 1470 participants consented to receive the questionnaire and 891 completed it. Of these, 67 women underwent two-stage submuscular reconstructions. Some 764 patients had a submuscular reconstruction with biological mesh (495 women), synthetic mesh (95) or dermal sling (174). Fourteen patients had a prepectoral reconstruction. Compared with two-stage submuscular reconstructions, no significant differences in PROs were seen in biological or synthetic mesh-assisted or dermal sling procedures. However, patients undergoing prepectoral IBBR reported better satisfaction with breasts (adjusted mean difference +6.63, 95 per cent c.i. 1.65 to11.61; P = 0.009). PROs were similar to those in the National Mastectomy and Breast Reconstruction Audit 2008-2009 cohort, which included two-stage submuscular procedures only. CONCLUSION This study found no difference in PROs of subpectoral IBBR with or without biological or synthetic mesh, but provides early data to suggest improved satisfaction with breasts following prepectoral reconstruction. Robust evaluation is required before this approach can be adopted as standard practice.
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Affiliation(s)
- E Sewart
- Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK
| | - N L Turner
- Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK
| | - E J Conroy
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - R I Cutress
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, UK
| | - J Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Thrush
- Breast Unit, Worcester Royal Hospital, Worcester, UK
| | - N Barnes
- Nightingale Breast Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - S Potter
- Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Davies CF, Macefield R, Avery K, Blazeby JM, Potter S. Patient-Reported Outcome Measures for Post-mastectomy Breast Reconstruction: A Systematic Review of Development and Measurement Properties. Ann Surg Oncol 2021; 28:386-404. [PMID: 32602063 PMCID: PMC7752876 DOI: 10.1245/s10434-020-08736-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Breast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set be robustly developed and validated so data are reliable and accurate. The aim of this systematic review is to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies. METHODS A PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using three steps: (1) the methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist; (2) criteria were applied for assessing good measurement properties; and (3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach. RESULTS Fourteen articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality. CONCLUSIONS BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.
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Affiliation(s)
- C F Davies
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.
| | - R Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - K Avery
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- University Hospitals Bristol Foundation NHS Trust, Bristol, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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