***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Correctable weaknesses in the design , conduct , and analysis of biomedical and public health research studies can produce misleading results and waste valuable re sources . Small effects can be difficult to distinguish from bias introduced by study design and analyses . An absence of detailed written protocol s and poor documentation of research is common . Information obtained might not be useful or important , and statistical precision or power is often too low or used in a misleading way . Insufficient consideration might be given to both previous and continuing studies . Arbitrary choice of analyses and an overemphasis on r and om extremes might affect the reported findings . Several problems relate to the research workforce , including failure to involve experienced statisticians and method ologists , failure to train clinical research ers and laboratory scientists in research methods and design , and the involvement of stakeholders with conflicts of interest . Inadequate emphasis is placed on recording of research decisions and on reproducibility of research . Finally , reward systems incentivise quantity more than quality , and novelty more than reliability . We propose potential solutions for these problems , including improvements in protocol s and documentation , consideration of evidence from studies in progress , st and ardisation of research efforts , optimisation and training of an experienced and non-conflicted scientific workforce , and reconsideration of scientific reward systems Background The COSMIN checklist is a tool for evaluating the method ological quality of studies on measurement properties of health-related patient-reported outcomes . The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist ( n = 114 ) . Methods 75 articles evaluating measurement properties were r and omly selected from the bibliographic data base compiled by the Patient-Reported Outcome Measurement Group , Oxford , UK . Raters were asked to assess the method ological quality of three articles , using the COSMIN checklist . In a one-way design , percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item . Results 88 raters participated . Of the 75 selected articles , 26 articles were rated by four to six participants , and 49 by two or three participants . Overall , percentage agreement was appropriate ( 68 % was above 80 % agreement ) , and the kappa coefficients for the COSMIN items were low ( 61 % was below 0.40 , 6 % was above 0.75 ) . Reasons for low inter-rater agreement were need for subjective judgement , and accustom to different st and ards , terminology and definitions . Conclusions Results indicated that raters often choose the same response option , but that it is difficult on item level to distinguish between articles . When using the COSMIN checklist in a systematic review , we recommend getting some training and experience , completing it by two independent raters , and reaching consensus on one final rating . Instructions for using the checklist are improved OBJECTIVE The Derriford Appearance Scale ( DAS ) 59 was specifically design ed to measure psychosocial adjustment in patients with appearance problems . Previous studies using the DAS59 have proven it to be a reliable method of assessing the appearance-related quality of life after plastic surgery procedures . The aim of this study was to develop a valid and reliable Italian version of the DAS59 . PATIENTS AND METHODS The first Italian translation of this question naire was conducted according to the DAS59 protocol that was design ed by the original authors of the question naire . Eight hundred patients participated in this study and filled out three question naires ( DAS59 , General Health Question naire (GHQ)12 and Beck 's Depression Inventory (BDI)-II ) . There were 400 adult patients with a history of previous plastic surgeries and 400 adult patients without any personal history of previous plastic surgery procedures . A total of 50 patients were selected r and omly for test-retest analysis . RESULTS The overall internal consistency was excellent ( α = 0.95 ) and equal to that of the original article that first described the scale . There was a good correlation between all the items . Domains demonstrated good internal consistency ( Cronbach 's alpha ) and correlation within themselves . The construct validity of the Italian DAS59 was assessed under convergent validity that confirmed the correlation with scales related to other psychological conditions . GHQ12 showed relevant correlation with DAS59 , while BDI-II did not . CONCLUSIONS A valid and reliable Italian DAS59 version was developed that can be used for research and clinical assessment of patients with appearance problems and concerns , especially before and after plastic surgery procedures Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields OBJECTIVE To assess the reliability , validity and sensitivity to change of the Derriford Scale , a quality of life instrument design ed to assess the distress and dysfunction experienced by people who are self-conscious about their physical appearance . SUBJECTS AND DESIGN Postal question naire survey of 656 cosmetic surgery patients recruited from new referral letters and plastic surgery waiting list reports . A total of 443 subjects completed and returned the question naire .  Of these respondents , 203 were sent a second question  naire to assess reproducibility , of whom 155 subjects responded . MAIN OUTCOME MEASURES Reliability was assessed in terms of internal consistency and reproducibility . Face , content and construct validity were also investigated . RESULTS The analyses led to mixed results . There was some evidence of internal consistency , but a number of items had low endorsement levels and there may be scope for reducing the overall size of the instrument . When assessed for reproducibility , the level of agreement between scores of individuals completing the question naire on two occasions was high , but an important systematic shift in responses was also detected . Correlations between the other health status measures and the Derriford Scale provided some evidence of construct validity . CONCLUSION In its present form the Derriford Scale has good descriptive value , but there are some measurement problems identified in this report that need to be addressed before the scale is taken up into general use IMPORTANCE The impact of facial defects on quality of life as perceived by society and the value society places on facial reconstruction are important outcomes measures . OBJECTIVE To measure the health state utility and dollar value of surgically reconstructing facial defects as perceived by society . DESIGN , SETTING , AND PARTICIPANTS A r and omized observational study conducted in an academic tertiary referral center using a socioeconomically diverse group of 200 casual observers . MAIN OUTCOMES AND MEASURES Observers  viewed images of faces with defects of varying sizes and locations before and after surgical reconstruction . Observers imagined if the defect in each image were on their own face and rated ( 1 ) their health state utility with the defect and ( 2 ) how much they would be willing to pay to have the defect surgically repaired to normal ( perfect repair ) . Established health state utility and contingent valuation metrics were used . RESULTS Data from 200 observers were analyzed . Facial defects significantly decreased perceived health state utility with the greatest penalty attributed to large and central ly located defects . Surgical reconstruction of the facial defects increased health state utility to near-normal ranges for all groups except large central defects . Participants were willing to pay an average of $ 1170 ( 95 % CI , $ 767-$1572 ) to repair a de novo small peripheral defect ; they were willing to pay $ 4274 more than the average ( 95 % CI , $ 3296-$5251 ) to repair a large defect and $ 2372 more ( 95 % CI , $ 1379-$3366 ) to repair a central defect . Using these valuation and health utility data , we calculated willingness to pay per quality -adjusted life-year ( WTP/QALY ) , a value-related metric . Mean WTP/QALY ratios ranged from $ 639/QALY for repairing small peripheral defects to $ 2838/QALY for repairing large central defects , well below all cost-effectiveness thresholds . CONCLUSIONS AND RELEVANCE Casual observers perceived that facial defects significantly decrease quality of life , an effect improved by reconstructive surgery . Measuring WTP and calculating WTP/QALY provides novel data to assess the social importance and value of facial reconstructive surgery . To our knowledge , these are the first data demonstrating that surgical reconstruction of facial defects is a high-value intervention as perceived by society . These findings have implication s for a broad range of stakeholders , including patients , surgeons , health policy makers , and payers . LEVEL OF EVIDENCE NA Background : The FACE-Q is a new patient-reported outcome instrument to evaluate a range of outcomes for patients undergoing any type of facial cosmetic operation , minimally invasive cosmetic procedure , or facial injectable . This article describes the development and validation of FACE-Q scales relevant to face-lift patients . Methods : The FACE-Q was developed by following international guidelines for patient-reported outcome instrument development . For outcomes following a face lift , the authors developed five  appearance appraisal scales ( i.e. , Satisfaction with Cheeks , Satisfaction with Lower Face and Jawline , Appraisal of Nasolabial Folds , Appraisal of Area Under the Chin  , and Appraisal of the Neck ) and an adverse effects checklist . A field test of these scales was performed in a sample of 225 face-lift patients , and were evaluated using both modern and traditional psychometric methods . Results : The five FACE-Q appearance appraisal scales were found to be clinical ly meaningful , reliable , valid , and responsive to clinical change . These findings were supported by Rasch measurement theory analysis ( e.g. , overall chi-square values of p ≥ 0.18 ; Person Separation Index ≥ 0.88 ) . Responsiveness analyses showed that patient scores for facial appearance improved significantly after treatment ( p < 0.001 ) ; changes in scores were associated with moderate effect sizes ( range effect size , 0.40 to 0.79 ; range st and ardized response mean , 0.37 to 0.69 ) . Traditional psychometric statistics provided further support ( e.g. , Cronbach ’s alpha values ≥0.94 ) Conclusions : The FACE-Q appearance appraisal scales are scientifically sound and clinical ly meaningful and can be used with the adverse effects checklist to measure patient-reported outcomes following a face lift . CLINICAL QUESTION /LEVEL OF EVIDENCE : Diagnostic , III OBJECTIVE To establish the clinical responsiveness of the Skin Cancer Index ( SCI ) , a new disease-specific quality of life ( QOL ) instrument , and to assess demographic and clinical factors which impact QOL in patients with nonmelanoma skin cancer ( NMSC ) . STUDY DESIGN Prospect i ve study of 183 patients with NMSC of the face and neck referred to a tertiary care Mohs surgery clinic . METHODS The SCI is a 15 item , vali date d , disease-specific QOL instrument with 3 distinct subscales , Emotion , Social , and Appearance . Higher scores reflect better QOL . The  SCI  and the  Dermatology Life Quality Index ( DLQI ) , a general dermatology instrument , was administered at initial consultation and 4 months after surgical treatment . Multivariate analysis was conducted to assess demographic and clinical factors predictive of QOL for both instruments . RESULTS The SCI total score and all three subscale scores increased with treatment , demonstrating strong evidence of responsiveness over time ( P < .001 ) in contrast with the DLQI ( P = .46 ) . Predictors of poorer QOL for the SCI included female sex and cancers located on the lip . Patients who demonstrated greatest improvement in QOL with treatment included those who were younger ( < 50 yr ) and had lower reported household income . Also , first time NMSC patients and those patients who underwent less extensive reconstructions demonstrated greater improvements in QOL . CONCLUSION The SCI is a sensitive and responsive QOL instrument for patients with NMSC . Distinct demographic and clinical variables that impact QOL have been demonstrated using this multidimensional , disease-specific instrument OBJECTIVE To test 4 previously published outcomes instruments ( the  Facelift Outcomes Evaluation , the Rhinoplasty Outcomes Evaluation , the Blepharoplasty Outcomes Evaluation , and the  Skin Rejuvenation Outcomes Evaluation ) in terms of their reliability and validity in assessing patient-related outcomes of surgical intervention . DESIGN A prospect i ve pilot study of 78 patients in 3 similar private cosmetic surgery centers undergoing a total of 100 face-lift , rhinoplasty , blepharoplasty , and skin rejuvenation procedures .  Patients were evaluated at 2 preoperative and 1 postoperative time points and the instruments were analyzed with regard to their test-retest reliability , internal consistency , and responsiveness to change . RES 
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Conclusions : This is the first systematic review to identify and critically appraise patient-reported outcome measures for soft-tissue facial reconstruction using internationally accepted criteria .
Through the use of psychometrically well-vali date d question naires , it is hoped that patients ’ concerns can be truly appreciated , the level of care improved , and the quality of reconstructive options offered advanced