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Systematic reviews rank at the top of the evidence hierarchy. Concise writing implies drafting the systematic review article succinctly, i.e. using as few words to express as full an extent of the research effort as possible. Precise writing means drafting the text with accuracy especially with respect to the methodological and statistical aspects. The Abstract ought to be succinct and structured to allow for editors, peer reviewers and readers to get the gist of the key aspects of the systematic review with a quick read. The readership needs to be able to critically appraisal systematic reviews for their internal and external validity rapidly. The Abstract also needs to be standalone, representing an independent summary that can be fully understood without the need for reading the full paper. The standard structure of the main text of a scientific article called IMRaD (Introduction, Methods, Results and Discussion) applies equally to systematic reviews in the same way as it does to any other kinds of research manuscripts whether related to laboratory experiments or clinical trials. Restricting the word count limits to those imposed by journals may at first seem difficult, even unfair, to systematic reviewers. However, with the availability of online appendices to transparently and fully report the details of the methods, results and other aspects of the work undertaken allows for a succinct print or PDF article. Writing a shorter manuscript is more effortful than writing a longer report. This commentary is aimed at novice systematic reviewers to help them learn the written and unwritten writing rules in order to assist them in producing impactful publications to support evidence-based medicine., Spanish Government

Background: The trustworthiness of randomised clinical trials (RCTs) is suffering a crisis of confidence. Objectives: We undertook an umbrella review of the research integrity literature concerning RCTs. Search strategy and selection criteria: Following prospective registration (https://osf.io/3ursn), two reviewers independently searched PubMed, Scopus, Cochrane Library and Google Scholar, without language or time restrictions until November 2021. We included systematic reviews covering any aspect of research integrity throughout the RCT lifecycle. Data collection and analysis: We assessed methodological quality using a modified AMSTAR-2 tool and collated the main findings. Main results: There were 55 relevant reviews summarising a total of 6001 studies (median per review 63; range 8-1106 studies). The overall quality of 53 (96.4%) reviews was critically low. Eight (14.6%) reviews focused on the general aspects of a RCT, 12 (21.8%) on the design and approval, 6 (10.9%) on the conduct and monitoring, 21 (38.2%) on the reporting of protocols and findings, one (1.8%) on post-publication concerns and 7 (12.7%) on future research and development. The integrity issues covered were varied, the most common being the importance of ethics (10/55, 18.2%) and transparency (10/55, 18.2%). Conclusions: Various research integrity issues covering RCT lifecycle, captured from mostly low-quality reviews, provided a broad overview emphasising the need for high level of ethical standards and professionalism. Many gaps in the RCT integrity landscape were also identified. There is a need to generate multistakeholder consensus to create specific RCT integrity standards.

Background and aim Gestational trophoblastic disease (GTD) is a heterogeneous group of disorders characterised by abnormal proliferation of trophoblastic tissue. Since GTD and its malignant sequel gestational trophoblastic neoplasia (GTN) are rare diseases, little evidence is available from randomised controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centres within countries. One of the goals of the ‘European Organisation for Treatment of Trophoblastic Diseases’ (EOTTD) is to harmonise treatment in Europe. To provide a basis for European standardisation of definitions, treatment and follow-up protocols in GTD, we composed a set of guidelines for minimal requirements and optimal management of GTD. Methods Members from each EOTTD country attended multiple workshops during annual EOTTD meetings. Clinical guidelines were formulated by consensus and evidence where available. The following guidelines were discussed: diagnostics of GTD and GTN, treatment of low-risk GTN, high-risk GTN, ultra-high-risk GTN, placental site and epithelioid trophoblastic tumours and follow-up. Results Between 40 and 65 EOTTD members from 17 European countries and 7 non-European countries attended the clinical workshops held on 6 occasions. Flow diagrams for patient management were composed to display minimum and best practice for most treatment situations. New agreed definitions of recurrence and chemotherapy resistance were formulated. Conclusions Despite the many differences between and within the participating countries, an important step in uniform treatment of GTD and GTN within Europe was made by the Clinical Working Party of the EOTTD. This is an example on how guidelines and harmonisation can be achieved within international networks.

Concern over contamination of groundwater resources in areas impacted by anthropogenic activities has led to an increasing number of baseline groundwater quality surveys intended to provide context for interpreting water quality data. Flexible screening tools that can parse through these large, regional datasets to identify spatial or temporal changes in water quality are becoming more important to groundwater scientists. One such tool, developed from previous work by the authors, makes use of linear discriminant analysis (LDA) to identify the most probable source of chloride salinity in groundwater samples based on their geochemical fingerprints. Here, we applied the model to a dataset of shallow groundwater with known sources of contamination compiled from two studies of groundwater quality in Illinois: Panno et al. (2005) and Hwang et al. (2015). By predicting the source of salinity in groundwater samples for which the sources of contamination are known, we validated model prediction-accuracy. Results show high classification accuracy for groundwater samples impacted by basin brines (e.g. deep saline groundwater) and road salt (> 80%), with diminishing success for those impacted by organic sources of chloride, such as septic effluent and animal waste. Posterior probabilities, a statistic inherent to LDA, provide a proxy for prediction confidence that enables the model to be used for assessment and accountability measures, such as identifying parties responsible for contamination. LDA is complementary to fingerprinting using halogen ratios (e.g. Cl/Br) because it implicitly relies on halogen ratios for classification decisions while providing a clearer, more quantitative classification of contamination sources. Our model is ideal for regional assessment or initial screening of salinity sources in groundwater because it makes use of commonly measured solute concentrations in publicly available water quality databases.

F. Fatima, S. Banik & L. HaqueAberdeen Maternity Hospital, AberdeenIntroduction: Venous Thromboembolism (VTE) is the leading cause of maternal mortality and morbidity. The risk is increased 60 fold...

That a 6-hour drug administration interval has similar efficacy and greater patient satisfaction as a 36- to 48-hour interval.Four hundred and fifty patients.A two-arm parallel design unblended randomised controlled trial in a single hospital. Eligible women up to 63 days of gestation will be invited to participate. Those willing will be randomised to either the experimental group (6 hours administration of misoprostol) or the control group (36-48 hours administration of misoprostol). All participants will take 200 mg mifepristone orally. At the time determined by study group allocation 800 microg misoprostol will be given intravaginally together with 100 mg diclofenac pr. Antibiotic prophylaxis as per the usual protocol will be given to each group. The control group will remain in hospital for 6 hours as per current policy and the study group will return home in 1 to 3 hours.Complete medical abortion without need for further misoprostol or surgical evacuation.Duration of bleeding, side effects and acceptability based on questionnaire.None.