Fistula in Cleft Lip and Palate Patients—A Systematic Scoping Review
Bibliographic record
Abstract
AIMS: (1) Assess the level of available evidence regarding fistula occurrence in cleft lip and palate patients, (2) identify main research areas in the original studies, (3) evaluate the quality of original studies, and (4) summarize the evidence. METHODS: Two independent researchers searched the Cochrane Database of Systematic Reviews, Medline, Web of Knowledge, Web of Science and EMBASE, the Grey literature, and the reference lists of main references. The level of evidence was assessed based on study design and according to the Hierarchy of Evidence. The quality assessment was done using the adapted Consolidated Standards of Reporting Trials and Strengthening the Reporting of Observational Studies in Epidemiology checklists and a validity scoring system. Main findings were summarized, and fistula rates were compared between early and more recent articles, also between high-quality and low-quality studies. RESULTS: The systematic search and relevance assessment identified a total of 127 sources of evidence. The overall level of evidence was weak because it was dominated by small studies (<30 subjects), retrospective cohort studies, and case series. Main research areas were either: (1) focused on surgeries or (2) focused on risk determinants associated with fistula occurrence. Recent reports were of higher quality than the older ones, but the overall quality in the majority of reports was low. Knowledge synthesis demonstrated a wide range of rates for primary fistula (0-78%). No significant difference was found in the fistula rates of older studies compared with more recent studies or among different quality studies. Multiple risk determinants were studied and age at surgery, surgeon's experience, type and severity of cleft were the most frequently examined risk determinants. However, findings concerning different risk determinants and fistula occurrence were not consistent. CONCLUSIONS: The research mainly focused on surgeries and fistula-related risk determinants. The available evidence was low level and of poor quality. No consistent pattern between fistula occurrence and any of the risk determinants could be detected. Reported fistula rates did not differ significantly when comparing older studies with more recent studies or when high-quality studies were compared with low-quality studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.082 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.027 | 0.020 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".