General Surgical Journals Research Articles

Reporting on Quality of Life in Randomised Controlled Trials in Gastrointestinal Surgery

BackgroundAlthough health-related quality of life (HRQOL) has become an important outcome measure in surgical trials, questions still remain about the quality of its reporting. The aim of this study was to evaluate HRQOL assessment methodology of randomised clinical trials concerning gastrointestinal surgery. MethodsAll articles published in the calendar years 2006 and 2007 that purported to assess quality of life as end points or make some conclusion about quality of life were chosen for review from eight general surgical journals and four medical journals. Identified eligible studies were selected and then evaluated on a broad set of predetermined criteria. ResultsTwenty-four published randomised controlled clinical trials (RCTs)s with an HRQOL component were identified. Although most trials exhibited good-quality research, some methodological limitations were identified: Only 21% of the studies gave a rationale for selecting a specific HRQOL measure, 46% of the studies failed to report information about the administration of the HRQOL measure, and 37% did not give details on missing data. ConclusionsAlthough it is clear that HRQOL is an important end point in surgical RCTs because the information helps to influence treatment recommendations, a number of methodological shortcomings have to be further addressed in future studies.

Surgical research publication in a selection of research and surgical speciality journals

A prior study revealed a paucity of surgical research in the 5 top-rated general surgery journals for 1998. The hypothesis of the current study was that a large amount of surgical research was published in other journals. In all, 15 research journals and 9 surgery specialty journals were reviewed for basic research, funded clinical studies, randomized clinical trials, and drug trials. The funding sources and the surgeon's role were recorded. The findings were compared with research published in the previously studied 5 journals in 1998 and 2005. Of 6,016 papers in the research and surgery specialty journals, 19% were research, of which 76% were basic research. Funding from 1,101 sources was provided to 825 studies (70%). Seventy-four percent of funded studies were basic research. Government was the source for 46% of grants, private for 41%, and industry for 13%. A surgeon was the sole or senior author in 72% of studies. A total of 1,172 research articles were published in the research and surgery specialty journals in 1998. In comparison, 369 research papers were published in the general surgery journals in 1998 and 306 papers were published in 2005. With respect to the type of research, there were 896 basic research papers in the research and specialty journals in 1998, 200 such papers in the general surgery journals in 1998, and 164 in 2005. There were 87 randomized trials in the research and the surgery specialty journals in 1998, 46 such papers in the general surgery journals in 1998, and 29 in 2005. A 3-fold greater volume of surgical research and more than a 4-fold greater volume of basic research was found in the research and the surgical specialty journals than in the general surgical journals in 1998, and this margin is increased when compared with the data for 2005. Consideration of only the general surgical journals greatly underestimates the surgical research being conducted.

Description and reporting of surgical data — Scope for improvement?

Surgical research articles utilise a variety of descriptive and inferential methods to present and analyse data. The aim of this study was to determine the appropriateness of descriptive methods (e.g. mean, median, SD, range) and survey the use of inferential methods (statistical tests) in key general surgical journals. Articles were retrieved from the first three issues of four general surgical journals (Annals of Surgery, British Journal of Surgery, The Surgeon and the Annals of the Royal College of Surgeons of England) in the year 2005. Only original articles were included. Study characteristics, use and appropriateness of descriptive statistics and the number and types of statistical methods employed were evaluated. Of the 144 articles analysed, 119 made use of continuous data. Of these, the use of descriptive methods was inadequate or inappropriate in 50%. The use of '+/-' to describe data dispersion without further explanation occurred in 6.7% and standard error of mean (SEM) was inappropriately used in a further 9.2% of the articles. No statistical methods were described in 23% of the articles. The six most common tests used (Pearson's chi-square, Fisher's exact test, unpaired t test, Mann-Whitney test, log rank and the Cox proportional hazards) accounted for the majority (69%) of the statistical methods employed. These results highlight the need for training surgical researchers in 'data description and reporting' and for improved screening by journal reviewers/editors. Critical appraisal of surgical research can be undertaken with a comprehensive understanding of only a limited number of statistical methods.

UPDATE: SYSTEMATIC REVIEWS AND META‐ANALYSES

UPDATE: SYSTEMATIC REVIEWS AND META‐ANALYSES

Accuracy of references in general surgical journals — An old problem revisited

Reference errors in biomedicals journals are well documented. Increasing use of electronic databases and bibliographic software may change the nature and frequency of errors. To study the current incidence of reference errors in four major general surgical journals. Seventy-five references were randomly selected from original articles published in one issue of each of four general surgical journals. For each reference, ease of retrieval on PubMed and the presence of citation errors were noted. Two observers independently reviewed each reference for quotation errors. Of the 300 selected references, 261 from indexed English language biomedical journals were analysed. Retrieval from PubMed was impossible or difficult in six instances, giving a major citation error rate of 2.3%. Overall (major and minor) citation error rate was 11.1%. Of the 258 references that could be retrieved, 20 (7.8%) had quotation errors, 80% of which were considered major. The overall citation error rate was significantly different across the four journals. There was moderate correlation between quotation error rate and number of references in each original article. Errors in references still appear in current surgical literature. Solutions to address this problem have been discussed.

Randomized, Controlled Trials

Randomized, Controlled Trials

Comparison of reports of randomized controlled trials and systematic reviews in surgical journals: literature review

Randomized controlled trials and systematic reviews of such trials are the gold standard for assessing the effectiveness of interventions. There have been concerns about the anecdotal evidence underpinning many of the interventions used and introduced into surgical care. The American College of Surgeons has prioritized the need for more trials and systematic reviews of trials. To investigate the assertion that the methodological quality of studies conducted in surgery is in general poor and to assess the possible impact of new policy developments in the US, we sought to compare the number and proportion of published randomized controlled trials and systematic reviews in the leading two US and UK general surgical journals. Two reviewers systematically and independently hand searched all issues of these journals over a 12-month period to identify randomised controlled trials and systematic reviews. Systematic searching and independent abstraction of data from all volumes of the top two general surgical journals published in the USA and the UK in 2004. 519 original reports in UK journals and 616 original reports in USA journals. Number and proportion of randomized controlled trials and systematic reviews. Overall, the proportion of randomized controlled trials in all four journals was 5.6% (95% confidence interval [CI] 4.4-7.0) and 5.2% (95% CI 4.1-6.7) for systematic reviews. For journals published in the UK 29/519 (5.6%) of the publications were reports of randomized controlled trials, and for the USA journals this figure was 34/616 (5.5%); odds ratio [OR]=0.99, 95%CI 0.6-1.6; P=0.96. Systematic reviews were significantly more commonly reported in the UK journals: UK 37/519 (7.1%) versus USA 22/616 (3.6%); OR=0.48, 95%CI 0.3-0.8; P<0.01. The concerns expressed almost a decade ago remain valid: there are still very few reports of randomized controlled trials and systematic reviews published in leading USA and UK surgical journals, with relatively little difference between these countries in the proportion of reported studies employing these designs. The American College of Surgeons initiative has yet to make an impact.

Comparison of reports of randomized controlled trials and systematic reviews in surgical journals: literature review.

Randomized controlled trials and systematic reviews of such trials are the gold standard for assessing the effectiveness of interventions. There have been concerns about the anecdotal evidence underpinning many of the interventions used and introduced into surgical care. The American College of Surgeons has prioritized the need for more trials and systematic reviews of trials. To investigate the assertion that the methodological quality of studies conducted in surgery is in general poor and to assess the possible impact of new policy developments in the US, we sought to compare the number and proportion of published randomized controlled trials and systematic reviews in the leading two US and UK general surgical journals. Two reviewers systematically and independently hand searched all issues of these journals over a 12-month period to identify randomised controlled trials and systematic reviews. Systematic searching and independent abstraction of data from all volumes of the top two general surgical journals published in the USA and the UK in 2004. 519 original reports in UK journals and 616 original reports in USA journals. Number and proportion of randomized controlled trials and systematic reviews. Overall, the proportion of randomized controlled trials in all four journals was 5.6% (95% confidence interval [CI] 4.4-7.0) and 5.2% (95% CI 4.1-6.7) for systematic reviews. For journals published in the UK 29/519 (5.6%) of the publications were reports of randomized controlled trials, and for the USA journals this figure was 34/616 (5.5%); odds ratio [OR]=0.99, 95%CI 0.6-1.6; P=0.96. Systematic reviews were significantly more commonly reported in the UK journals: UK 37/519 (7.1%) versus USA 22/616 (3.6%); OR=0.48, 95%CI 0.3-0.8; P<0.01. The concerns expressed almost a decade ago remain valid: there are still very few reports of randomized controlled trials and systematic reviews published in leading USA and UK surgical journals, with relatively little difference between these countries in the proportion of reported studies employing these designs. The American College of Surgeons initiative has yet to make an impact.

Who Publishes in Leading General Surgical Journals? The Divide Between the Developed and Developing Worlds

Most articles in top general surgical journals seem to originate from a limited few developed countries. The purpose of this study was to establish which countries publish the most in leading general surgical journals. We analysed all the studies, reviews and case reports published in 2003-2004 in 10 leading English-language general surgical journals with the highest impact factors to obtain country-wise data with regard to the origin of articles. Editorials, historical articles, commentaries, guidelines, biographies, interviews and letters to editors were excluded from the analysis. A total of 5,081 articles were reviewed. Out of these, 834 were excluded as detailed above and the remaining 4,247 articles were analysed. Most of these were from USA, European countries, Japan, and Australia. It seems that the vast majority of the world's population living in the developing countries do not find adequate representation in leading general surgical journals. Very few articles are published from developing countries in leading general surgical journals. Both developing countries and medical journals need to take steps to curb this trend. Steps are suggested to improve the situation so that the developing world is also adequately represented in the surgical literature.

Citation Characteristics of Basic Science Research Publications in General Surgical Journals 1, 2

Basic science research (BSR) publications in general surgical (GS) journals are an important "translational bridge" for practicing surgeons and surgical trainees. The purpose of this study is to characterize the BSR publications in GS journals and to analyze their citation frequencies. In 1996, all (224) BSR publications in the five highest rated U.S. GS journals (by impact factor) were reviewed, characterized, and their citation frequencies were compared to BSR publications in non-GS journals. On average, a BSR publication from these journals is cited 32 times (range 1-141, median 11). Half of the publications were cited more than 10 times in 6 years and 22% were cited twice, or more, within 1 year of publication. One in four publications were cited twice or more in journals with an impact factor greater than five. Citation frequencies of BSR publications in GS journals were related to the journal impact factor (P = 0.07), and to having a basic scientist (i.e., Ph.D.) as one of the authors (P < 0.01). Citation characteristics of BSR publications in GS journals were similar to those of BSR publications in non-GS journals with similar impact factors. We found that BSR publications in the U.S. GS journals studied had significant citation frequencies.

Basic science research publications in general surgical journals: are they obsolete?

Introduction: Basic science research (BSR) publications in general surgical journals are an important ‘translational bridge’ for practicing surgeons and surgical trainees. However, these articles are considered by some as left-over from higher impact basic science journals, and perhaps as obsolete. The purpose of this study is to characterize BSR articles published in general surgical journals and to analyze their citation frequencies. Methods: All BSR articles published in the five highest rated US general surgical journals (by Impact Factor, ISI Journal Citation reports) in the year 1996 were reviewed, characterized and their citation frequencies analyzed (total citations, citations within a year of publication, and citations in journals with impact factor greater than 5). The Wilcoxon rank-sum test was used to compare citation rates in different groups. Results: In 1996, 226 BSR articles were published in the five general surgical journals studied (10–43% of the total articles in each journal). Three fourths of BSR articles were from the USA (12% of total BSR articles by US surgeons in 1996), 12% from Europe and 8% from Japan. In 58% of the BSR articles, one of the authors was a basic scientist (PhD). Fifty-six percent of the publications were presented at a society conference. One in two US BSR publications was funded by the government (14% by private non-profit, 3% industry). On average a BSR article from these journals is cited 32 times (range 1–141, median 11). Half of the articles were cited more than ten times in six years (1–5: 24%; 6–10: 23%; >10: 52%) and 22% were cited twice or more within a year of publication. One in four publications were cited twice or more in journals with an impact factor greater than five (0: 35%; 1: 23%; 2: 17%; >2: 25%). Citation frequencies of BSR publications in general surgical journals were related to the journal impact factor (p = 0.07), to having a basic scientist (i.e. PhD) as one of the authors (p < 0.01) and to the research having been presented at a conference. Conclusions: Basic science research articles in US general surgical journals in the year studied have significant citation frequencies and were not obsolete.

One hundred citation classics in general surgical journals.

The number of times an article is cited in scientific journals reflects its impact on a specific biomedical field or specialty and reflects the impact of the authors' creativity. Our objective was to identify and analyze the characteristics of the 100 most frequently cited articles published in journals dedicated to general surgery and its close subspecialties. Using the database (1945-1995) of the Science Citation Index of the Institute for Scientific Information, 1500 articles cited 100 times and more were identified and the top 100 articles selected for further analysis. The 100 articles were published between 1931 and 1990, with more than two-thirds of them published after 1960. The mean number of citations per article was 405, (range 278-1013). Altogether, 84 of the articles originated from North America (USA 78, Canada 6) and the UK (12). New York State led the list of U.S. states with 14, and Harvard and Columbia University led the list of institutions with 6 articles each. The 100 articles were published in 10 surgical journals led by the Annals of Surgery (n = 40), followed by Surgery (n = 15), Archives of Surgery (n = 12), Surgery, Gynecology and Obstetrics (n = 11), and British Journal of Surgery (n = 10). A total of 80 of the articles reported clinical experiences, 6 were clinical review articles, and 14 dealt with basic science. Eighteen articles reported a new surgical technique and six a prosthetic device. Gastrointestinal surgery and trauma and critical care led the list of the surgical fields, each with 25 articles, followed by vascular surgery (n = 15). Thirty-four persons authored two or more of the top-cited articles. This list of the top-cited papers identifies seminal contributions and their originators, facilitating the understanding and discourse of modern surgical history and offering surgeons hints about what makes a contribution a "top-cited classic." To produce such a "classic" the surgeon and his or her group must come up with a clinical or nonclinical innovation, observation, or discovery that has a long-standing effect on the way we practice-be it operative or nonoperative. Based on our findings, to be well cited such a contribution should be published in the English language in a high-impact journal. Moreover, it is more likely to resonant loudly if it originates from a North American or British "ivory tower."

Internationalization of general surgical journals: origin and content of articles published in North America and Great Britain from 1983 to 1998.

The origin and characteristics of articles published in the 6 highest rated (Institute for Scientific Information classification) English-language general surgical journals have changed significantly during the past 15 years. All articles published in 1983, 1988, 1993, and 1998 in 5 US surgical journals and 1 British surgical journal were reviewed and characterized. Absolute numbers and proportions of national and international articles published in each journal. Articles reviewed included 4868 in US journals and 1380 in the British journal. The total number of US journal articles decreased by 15.1%. The total number of British journal articles increased by 58.9%. The percentage of national articles decreased from 87.5% to 68.8% in US journals (P<.001) and constituted the minority of freely submitted articles in 1998 in 3 of 5 US journals. The percentage of national articles also decreased from 74.8% to 47.1% in the British journal (P<.001). Articles by European and Asian authors showed the most striking increases in all journals. The percentage of basic research articles declined in US journals from 23.3% to 17.9% (P =.001) owing to a 14.9% decline in national basic research articles. The percentage of clinical randomized studies increased from 2.2% to 4.1% (P<.008), but the increase was attributable to international articles. Government funding alone decreased from 13.6% to 11.2%, and government plus another source of funding decreased from 19.2% to 16.7% for national articles in US journals. Internationalization of the highly rated British and the 5 highest rated US general surgical journals has occurred. The decrease in the number of national articles in the US journals has been accompanied by significant decreases in government funding and basic research articles and a static output of clinical randomized studies from North America.

Internationalization of General Surgical Journals—Invited Critique

Internationalization of General Surgical Journals—Invited Critique

Internationalization of General Surgical Journals--Invited Critique

Internationalization of General Surgical Journals--Invited Critique

The quality of quality of life studies in general surgical journals

Background: There has been a tremendous increase in interest on quality of life in surgical research. An increase in interest does not necessarily translate into better research. This study evaluates surgical articles that claim to measure or make some conclusion on quality of life. Study Design: All articles published in the calendar years 1996 and 1999 that purported to assess quality of life as end points or make some conclusion about quality of life were chosen for review from eight general surgical journals. Articles were assessed for use of a quality of life instrument, type of instrument, validation of the instrument, appropriateness of the instrument for the hypothesis, quality of statistical analysis, and adherence to the Gill and Feinstein criteria. Results: Of the 18 articles published in 1996, 72% used a quality of life instrument. Eighteen instruments were used in 13 studies: 7 generic, 10 disease-specific, and 1 ad hoc. Forty-three percent were validated, 39% were appropriate for the study hypothesis, 39% had correct statistical analysis. The majority did not meet the Gill and Feinstein criteria. Of the 24 studies published in 1999, 63% used a quality of life instrument. Twenty-two instruments were used in 15 studies: 11 generic, 5 disease-specific, and 6 ad hoc. Fifty-five percent were validated, 45% were appropriate, 45% had correct statistical analysis. Once again, the majority did not meet the Gill and Feinstein criteria. Conclusions: Despite the emphasis on quality of life outcomes, a substantial number of studies made errors in conceptually defining quality of life and in use of quality of life instruments. Researchers and journal reviewers need to be better versed on the techniques of quality of life research.

The quality of “quality of life” studies in general surgical journals

Abstract Background: There has been a tremendous increase in interest on quality of life in surgical research. An increase in interest does not necessarily translate into better research. This study evaluates surgical articles that claim to measure or make some conclusion on quality of life. Study Design: All articles published in the calendar years 1996 and 1999 that purported to assess quality of life as end points or make some conclusion about quality of life were chosen for review from eight general surgical journals. Articles were assessed for use of a quality of life instrument, type of instrument, validation of the instrument, appropriateness of the instrument for the hypothesis, quality of statistical analysis, and adherence to the Gill and Feinstein criteria. Results: Of the 18 articles published in 1996, 72% used a quality of life instrument. Eighteen instruments were used in 13 studies: 7 generic, 10 disease-specific, and 1 ad hoc. Forty-three percent were validated, 39% were appropriate for the study hypothesis, 39% had correct statistical analysis. The majority did not meet the Gill and Feinstein criteria. Of the 24 studies published in 1999, 63% used a quality of life instrument. Twenty-two instruments were used in 15 studies: 11 generic, 5 disease-specific, and 6 ad hoc. Fifty-five percent were validated, 45% were appropriate, 45% had correct statistical analysis. Once again, the majority did not meet the Gill and Feinstein criteria. Conclusions: Despite the emphasis on quality of life outcomes, a substantial number of studies made errors in conceptually defining quality of life and in use of quality of life instruments. Researchers and journal reviewers need to be better versed on the techniques of quality of life research.

Clinical trials in general surgical journals: Are methods better reported?

Background: Reports of clinical trials often lack adequate descriptions of their design and analysis. Thus readers cannot properly assess the strength of the findings and are limited in their ability to draw their own conclusions. A review of 6 surgical journals in 1984 revealed that the frequency of reporting 11 basic elements of design and analysis in clinical trials was only 59%. This study attempted to identify areas that still need improvement. Methods: Eligible studies published from July 1995 through June 1996 included all reports of comparative clinical trials on human subjects that were prospective and had at least 2 treatment arms. A total of 68 articles published in 6 general surgery journals were reviewed. The frequency that the previously identified 11 basic elements of design and analysis were reported was determined. Results: Seventy-four percent of all items were reported accurately (a 15% increase from the previous study), 4% were reported ambiguously, and 23% were not reported; improvement was seen in every journal. The reporting of eligibility criteria and statistical power improved the most. For 3 items, reporting was still not adequate; 32% of reports provided information about statistical power, 40% about the method of randomization, and 49% about whether the person assessing outcomes was blind to the treatment assignment. Conclusions: Improvements have been made in reporting surgical clinical trials, but in general methodologic questions poorly answered in the 1980s continue to be answered poorly in the 1990s. Editors of surgical journals are urged to provide authors with guidelines on how to report clinical trial design and analysis. (Surgery 1999;125:41-5.)

Clinical trials in general surgical journals: Are methods better reported?

Background: Reports of clinical trials often lack adequate descriptions of their design and analysis. Thus readers cannot properly assess the strength of the findings and are limited in their ability to draw their own conclusions. A review of 6 surgical journals in 1984 revealed that the frequency of reporting 11 basic elements of design and analysis in clinical trials was only 59%. This study attempted to identify areas that still need improvement. Methods: Eligible studies published from July 1995 through June 1996 included all reports of comparative clinical trials on human subjects that were prospective and had at least 2 treatment arms. A total of 68 articles published in 6 general surgery journals were reviewed. The frequency that the previously identified 11 basic elements of design and analysis were reported was determined. Results: Seventy-four percent of all items were reported accurately (a 15% increase from the previous study), 4% were reported ambiguously, and 23% were not reported; improvement was seen in every journal. The reporting of eligibility criteria and statistical power improved the most. For 3 items, reporting was still not adequate; 32% of reports provided information about statistical power, 40% about the method of randomization, and 49% about whether the person assessing outcomes was blind to the treatment assignment. Conclusions: Improvements have been made in reporting surgical clinical trials, but in general methodologic questions poorly answered in the 1980s continue to be answered poorly in the 1990s. Editors of surgical journals are urged to provide authors with guidelines on how to report clinical trial design and analysis. (Surgery 1999;125:41-5.)

Publish or Perish Revisited

A 1-PAGE commentary titled Surgical Research or Comic Opera: Questions, but Few Answers, recently published in Lancet , 1 concluded as follows: Only when the quality of publications in the surgical literature has improved will surgeons reasonably be able to rebut the charge that as much as half of the research they undertake is misconceived. This serious indictment followed a review of the first 1996 issues of 9 of the most widely read general surgical journals. The immediate reaction of many, if not most, surgeons will be to reject completely the veracity of these accusations. The charge, however, is of such great import to the academic surgical community that heed should be paid to a reasoned examination of the genesis of such a position. First, there are far too many surgical journals for the number of studies of excellence currently emanating from surgical departments around the world. New journals dealing with