Notice bibliographique
Résumé
Sir:FigureWe appreciate the comments by Drs. Nikkhah, Rodrigues, Saleh, and Jeffers regarding our article, “Comparison of Trapeziectomy and Trapeziectomy with Ligament Reconstruction and Tendon Interposition: A Systematic Literature Review” (Plast Reconstr Surg. 2011;128:199–207). Our systematic review and meta-analysis attempted to answer the crucial question of whether trapeziectomy and ligament reconstruction and tendon interposition is superior to trapeziectomy alone for a number of clinically important outcomes. The meta-analysis component of this systematic review has shown that in terms of the specific outcomes of tip and key pinch strength, there was no difference in the two procedures. We are confident of the veracity of this conclusion, as the pooled results had enough power to answer this question. Although we found no difference between the two techniques regarding the other outcomes (i.e., grip strength, pain, adverse events, and function), we have concerns that type II error may be at play here. In other words, there may be a difference but even the pooling of the data did not have enough power to “tell us the truth.” For these variables, the results were inconclusive. Quality of life and cost-effectiveness remain largely unknown, as previous investigators did not pay particular attention to these very important outcomes.1,2 Dr. Nikkhah and colleagues state that they prefer trapeziectomy with ligament reconstruction and tendon interposition because it maintains thumb height. Although maintenance of trapezial height is theoretically important, it has been shown to not be associated with postoperative subjective and objective outcomes, particularly strength outcomes. The impact of marginal or greater decrease in trapezial height with trapeziectomy alone remains questionable. In general, this systematic review questions the general acceptance of trapeziectomy with ligament reconstruction and tendon interposition as a definitive solution to the osteoarthritis of the carpometacarpal joint of the thumb. To find the definitive answer, we need to compare the two procedures side-by-side in a methodologically sound randomized controlled trial with a large sample size with unbiased assessors in which the following outcomes are measured: quality of life, pain control, cost-effectiveness, grip strength, radial and palmar abduction, and adverse events. The time horizon for measuring the outcomes should be decided by a panel of expert hand surgeons and should include an early, intermediate, and long-term follow-up.3,4 We agree with Dr. Nikkhah and colleagues that it would also be appropriate to compare the two procedures in different patient groups. Such a definitive study will require contribution of multiple centers to achieve the necessary sample size with adequate power to address this clinical question. Failure to do so will lead to additional multiple smaller studies in the future with inadequate power, thus wasting resources and possibly preventing future patients from undergoing the most effective procedure. Achilleas Thoma, M.D., M.Sc. Yu Kit Li, B.H.Sc. Colin White, M.D. Teegan A. Ignacy, B.Sc. McMaster University, Hamilton, Ontario, Canada
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,044 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,003 | 0,005 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,012 | 0,017 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,076 | 0,046 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».