Methodological overview of systematic reviews to establish the evidence base for emergency general surgery

BACKGROUND: The evidence for treatment decision‐making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions. METHODS: Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non‐randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non‐surgical invasive or non‐invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist. RESULTS: The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty‐one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non‐randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty‐five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non‐surgical interventions. Fifty‐seven reviews (53·8 per cent) were rated as low risk of bias. CONCLUSION: This overview of reviews highlights the need for more and better research in this field

What are important outcomes of bariatric surgery? An in-depth analysis to inform the development of a core outcome set and a comparison between the views of surgeons and other health professionals (the BARIACT study)

BackgroundOutcome reporting in bariatric surgery needs uniformity. A core outcome set is an agreed minimum set of outcomes reported in all studies of a particular condition, but members of the bariatric multidisciplinary team might value outcomes differently. The aim of this study was to summarise existing outcome reporting in bariatric surgery, to inform the development of a core outcome set, and to compare outcomes selected as important by type of health professional.MethodsOutcomes reported in randomised controlled trials (RCTs) and large non-randomised studies, identified by a systematic review, were listed verbatim. Frequency of outcome reporting and uniformity of definition were assessed. A questionnaire to rate the importance of each outcome was completed by members of the bariatric multidisciplinary team. Responses to each item were scored as 1 (not essential) to 9 (absolutely essential). We ranked outcomes according to percentage deemed important (7–9) and according to respondents by type of health professional.FindingsWe identified 1088 individual outcomes from 90 studies (39 RCTs), grouped them into health domains, and presented them as a questionnaire with 131 items to 489 multidisciplinary team members. Most outcomes (n=920, 85%) were reported only once. The largest outcome domain was surgical complications, and 432 outcomes (42%) corresponded to an adverse event. Only a quarter of outcomes (n=461) were defined, and were often contradictory. For questionnaire responders (n=164, response rate 33·5%), most were surgeons (n=80, 48·8%), followed by dietitians (n=31, 18·9%), nurses (n=24, 14·6%), physicians (n=12, 7·3%), and others (n=16, 9·9%). Improvement in diabetes was the top outcome for all health professionals. Seven of the surgeon's top ten outcomes were adverse events, compared with three for other health professionals. Groups valued a measure of weight differently (third vs 15th for other health professionals and surgeons, respectively).InterpretationThis study shows that the assessment of bariatric surgery focuses largely on adverse events and resolution of comorbidity, but that reporting is inconsistent and ill-defined. Substantial variation between the views of surgeons and those of other health professionals was evident. The next step is to provide feedback to participants and to survey their views again before a final consensus meeting to produce a core outcome set for the Benefits and Adverse events in BARIAtric surgery Clinical Trials (BARIACT) as a solution to this problem.FundingNational Institute for Health Research (NIHR), and the NIHR Health Technology Assessment programme. This work was also undertaken with the support of the MRC ConDuCT-II Hub (Collaboration and innovation for Difficult and Complex randomised controlled Trials In Invasive procedures, MR/K025643/1)

Results from the worldwide coma morphology campaign for comet ISON (C/2012 S1)

We present the results of a global coma morphology campaign for comet C/2012 S1 (ISON), which was organized to involve both professional and amateur observers. In response to the campaign, many hundreds of images, from nearly two dozen groups were collected. Images were taken primarily in the continuum, which help to characterize the behavior of dust in the coma of comet ISON. The campaign received images from January 12 through November 22, 2013 (an interval over which the heliocentric distance decreased from 5.1 AU to 0.35 AU), allowing monitoring of the long-term evolution of coma morphology during comet ISON׳s pre-perihelion leg. Data were contributed by observers spread around the world, resulting in particularly good temporal coverage during November when comet ISON was brightest but its visibility was limited from any one location due to the small solar elongation. We analyze the northwestern sunward continuum coma feature observed in comet ISON during the first half of 2013, finding that it was likely present from at least February through May and did not show variations on diurnal time scales. From these images we constrain the grain velocities to ~10 m s−1, and we find that the grains spent 2–4 weeks in the sunward side prior to merging with the dust tail. We present a rationale for the lack of continuum coma features from September until mid-November 2013, determining that if the feature from the first half of 2013 was present, it was likely too small to be clearly detected. We also analyze the continuum coma morphology observed subsequent to the November 12 outburst, and constrain the first appearance of new features in the continuum to later than November 13.99 UT