Opinions and potential solutions regarding dissemination bias from funding agencies of biomedical research in Europe

RATIONALE, AIMS, AND OBJECTIVES

Several studies have found that about half of research results from clinical trials are never published. Until now, there has been little information on the views that funding agencies of biomedical research in Europe have regarding this issue and its possible solutions.

METHODS

An electronic survey was conducted among funding agencies from 34 European countries. Participants were asked about their opinions, policies, and potential solutions regarding dissemination bias. On the basis of the results of this survey and the input of the OPEN Consortium and of representatives of stakeholder groups in the knowledge generation process, we formulated recommendations for funding agencies to reduce dissemination bias.

RESULTS

We received responses from 64 funding agencies of biomedical medicine from most European countries, out of 245 that were contacted (26%). Of these, 56 funded research at the national and/or international level and were therefore eligible to participate. Policies encouraging publication increased over time: 33 (58.9%) of agencies enforced them in 2005 compared to 38 (67.6%) in 2012. However, only 13 (23.2%) had knowledge of the publications related to research funded in 2005, 23 (41.1%) were able to provide only an estimate, and 20 (35.7%) did not know at all. Regarding recommendations to control dissemination bias, we propose that funding agencies request the dissemination of research results irrespective of the direction of findings. We also call for measures that allow evaluating funded projects past the contractual period and until dissemination of results. Funding agencies should create publicly accessible databases with information on funded projects and dissemination efforts.

CONCLUSION

Despite having policies to encourage publication of results, most funding agencies fail to implement such measures or to ensure compliance. We propose recommendations that could be incorporated in the blueprint of calls for proposals and contracts agreed upon by funding agencies and grant recipients.

Transparency and public accessibility of clinical trial information in Croatia: how it affects patient participation in clinical trials

Introduction

Despite increased visibility of clinical trials through international trial registries, patients often remain uninformed of their existence, especially if they do not have access to adequate information about clinical research, including the language of the information. The aim of this study was to describe the context for transparency of clinical trials in Croatia in relation to countries in Central and Eastern Europe, and to assess how informed Croatian patients are about clinical trials and their accessibility.

Materials and methods

We assessed the transparency of clinical trials from the data available in the public domain. We also conducted an anonymous survey on a convenience sample of 257 patients visiting two family medicine offices or an oncology department in south Croatia, and members of national patients’ associations.

Results

Despite legal provisions for transparency of clinical trials in Croatia, they are still not sufficiently visible in the public domain. Among countries from Central and Eastern Europe, Croatia has the fewest number of registered trials in the EU Clinical Trials Registry. 66% of the patients in the survey were aware of the existence of clinical trials but only 15% were informed about possibilities of participating in a trial. Although 58% of the respondents were willing to try new treatments, only 6% actually participated in a clinical trial. Only 2% of the respondents were aware of publicly available trial registries.

Conclusions

Our study demonstrates that there is low transparency of clinical trials in Croatia, and that Croatian patients are not fully aware of clinical trials and the possibilities of participating in them, despite reported availability of Internet resources and good communication with their physicians. There is a need for active policy measures to increase the awareness of and access to clinical trials to patients in Croatia, particularly in their own language.

Does small equal predatory? Analysis of publication charges and transparency of editorial policies in Croatian open access journals

INTRODUCTION

We approach the problem of "predatory" journals and publishers from the perspective of small scientific communities and small journals that may sometimes be perceived as "predatory". Among other characteristics of "predatory" journals two most relevant are their business model and the quality of the editorial work.

MATERIALS AND METHODS

We analysed 444 Croatian open access (OA) journals in the Hrčak (portal of Croatian scientific journals) digital journal repository for the presence of article processing charges as a business model and the transparency of editorial policies.

RESULTS

The majority of journals do not charge authors or require submission or article processing charges, which clearly distinguishes them from "predatory" journals. Almost all Hrčak OA journals have publicly available information on editorial boards, including full names and affiliations, and detailed contact information for the editorial office at the Hrčak website. The journal names are unique and cannot be easily confused with another journal or intend to mislead about the journal's origin. While most journals provide information on peer review process, many do not provide guidelines for reviewers or other editorial and publication ethics standards.

CONCLUSION

In order to clearly differentiate themselves from predatory journals, it is not enough for journals from small research communities to operate on non-commercial bases, but also to have transparent editorial policies.

Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement

Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website.

Increased chemotaxis and activity of circulatory myeloid progenitor cells may contribute to enhanced osteoclastogenesis and bone loss in the C57BL/6 mouse model of collagen-induced arthritis

Our study aimed to determine the functional activity of different osteoclast progenitor (OCP) subpopulations and signals important for their migration to bone lesions, causing local and systemic bone resorption during the course of collagen-induced arthritis in C57BL/6 mice. Arthritis was induced with chicken type II collagen (CII), and assessed by clinical scoring and detection of anti-CII antibodies. We observed decreased trabecular bone volume of axial and appendicular skeleton by histomorphometry and micro-computed tomography as well as decreased bone formation and increased bone resorption rate in arthritic mice in vivo. In the affected joints, bone loss was accompanied with severe osteitis and bone marrow hypercellularity, coinciding with the areas of active osteoclasts and bone erosions. Flow cytometry analysis showed increased frequency of putative OCP cells (CD3^- B220^- NK1.1^- CD11b^-/lo CD117⁺ CD115⁺ for bone marrow and CD3^- B220^- NK1.1^- CD11b⁺ CD115⁺ Gr-1⁺ for peripheral haematopoietic tissues), which exhibited enhanced differentiation potential in vitro. Moreover, the total CD11b⁺ population was expanded in arthritic mice as well as CD11b⁺ F4/80⁺ macrophage, CD11b⁺ NK1.1⁺ natural killer cell and CD11b⁺ CD11c⁺ myeloid dendritic cell populations in both bone marrow and peripheral blood. In addition, arthritic mice had increased expression of tumour necrosis factor-α, interleukin-6, CC chemokine ligand-2 (Ccl2) and Ccl5, with increased migration and differentiation of circulatory OCPs in response to CCL2 and, particularly, CCL5 signals. Our study characterized the frequency and functional properties of OCPs under inflammatory conditions associated with arthritis, which may help to clarify crucial molecular signals provided by immune cells to mediate systemically enhanced osteoresorption.

Correction: Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement

[This corrects the article DOI: 10.1371/journal.pmed.1002056.].

Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement

Gretchen Stevens and colleagues present the GATHER statement, which seeks to promote good practice in the reporting of global health estimates.

Assembling GHERG: Could "academic crowd-sourcing" address gaps in global health estimates?

In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)'s successful work model, we would like to propose a new initiative - "Global Health Epidemiology Reference Group" (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines - a form of "academic crowd-sourcing". The main focus of GHERG will be to identify the "gap areas" where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts.

A tool to make reporting checklists work

Although the use of reporting guidelines has been demonstrated to increase the completeness and transparency of health research published in journals, there is still a long way to translate their use to the authors at the time where they are needed - during the actual research process and manuscript writing. An online tool for writing methodology section of a randomized controlled trial has been successfully tested in an experimental setting and provides a direction for the development of writing tools for health research. Writing tools should not replace original thinking and the excitement of communicating original discoveries, but make sure that all relevant data are in the manuscript so that research results can be understood, critically evaluated and used in practice. Please see related article: http://www.biomedcentral.com/1741-7015/13/221.

Time of mineralization of permanent teeth in children and adolescents in Gaborone, Botswana

The mineralization sequence of permanent dentition can be used to assess the stage of development and age of individuals. The most commonly used methods are based on the assessment of developmental stages of target groups of teeth on one side of the lower jaw. When compared with the rest of the world, fewer studies have been done on dental age in Sub-Saharan Africa, particularly in the region of Southern Africa. The aim of this study was to determine the chronology of mineralization of permanent teeth by the evaluation of developmental stages according to the Demirjian's method from 1973 and to evaluate dental age by using sex-specific self-weighted scores for dental stages and 50th percentile conversion tables of total maturity scores of seven mandibular teeth. We used a sample of panoramic radiographs (OPTs) of black African children and adolescents from the city of Gaborone, Botswana, with the aim of forming an appropriate sample to evaluate the development of the teeth in this socio-geographic environment. The final sample consisted of 1760 OPTs (807 males and 953 females) of individuals aged 6-23 years. The developmental stages of the all permanent teeth in the left side of the maxilla and the mandible were evaluated. Comparing the maxilla and the mandible, we found similar development within different stages for most of the teeth. In comparison to the average age at each stage of development, including the third molars between males and females, it is evident that females are slightly faster in developing permanent teeth, but without statistical significance for most of the developmental stages. Applying 50th percentile conversion tables for calculating the dental age for the first seven mandibular teeth, 616 OPTs of the children (299 males and 317 females), aged 6.08-16.80 years, were evaluated and their dental age was calculated. Mean dental age was overestimated in comparison to chronological age by 1.25±1.11 years and 0.72±1.02 years for males and females, respectively (p<0.001). These findings indicate that Demirjian's method from 1973 is not suitable for routine use and that there is a need for establishing specific standards for Botswana children of black African origin for dental age estimation.

Decisional conflict and vaccine uptake: cross-sectional study of 2012/2013 influenza season in Croatia

INTRODUCTION

As scientific, media and individual opinions on the need for seasonal influenza vaccination differ, we explored patients' decisional conflict and perceived physician and social support when making a vaccination choice.

MATERIAL AND METHODS

We conducted a survey of patients with previous vaccination experience in a single family medicine office in Split, Croatia. The questionnaire included the Decisional Conflict Scale (DCS), perceived social support, and attitudes and knowledge concerning vaccination.

RESULTS

Out of 203 (86%) adult patients with previous vaccination experience, 182 (40.4%) opted to vaccinate in the current season, 98 (48.3%) refused, and 22 (11.3%) were undecided. The median decisional conflict score was highest among those undecided (43.8 out of the maximum 100, interquartile range (IQR) 33.2-52.3), lowest among those opting to vaccinate (17.2, IQR 9.4-26.6), and intermediate among those who refused vaccination (25.0, IQR 17.2-39.1) (p < 0.001, Kruskal-Wallis test and post-hoc Mann-Whitney U tests). The most common self-reported reasons for vaccination were previous vaccination experience (n = 85, 42%) and media information (n = 62, 30%). Those who refused vaccination felt less satisfied with the support they received from their family physician than those who decided to vaccinate (median 6.5 (IQR 0-9) vs. 9 (IQR 5-10) on a scale from 0 to 10), respectively; p = 0.001, Mann-Whitney U test).

CONCLUSIONS

Higher decisional conflict of patients who refuse influenza vaccination and those undecided, alongside their perceived low support of the family physician in making that choice, emphasize the importance family doctors play in advising and helping patients make informed decisions about seasonal influenza vaccination.

Research Integrity and Research Ethics in Professional Codes of Ethics: Survey of Terminology Used by Professional Organizations across Research Disciplines

Professional codes of ethics are social contracts among members of a professional group, which aim to instigate, encourage and nurture ethical behaviour and prevent professional misconduct, including research and publication. Despite the existence of codes of ethics, research misconduct remains a serious problem. A survey of codes of ethics from 795 professional organizations from the Illinois Institute of Technology’s Codes of Ethics Collection showed that 182 of them (23%) used research integrity and research ethics terminology in their codes, with differences across disciplines: while the terminology was common in professional organizations in social sciences (82%), mental health (71%), sciences (61%), other organizations had no statements (construction trades, fraternal social organizations, real estate) or a few of them (management, media, engineering). A subsample of 158 professional organizations we judged to be directly involved in research significantly more often had statements on research integrity/ethics terminology than the whole sample: an average of 10.4% of organizations with a statement (95% CI = 10.4-23-5%) on any of the 27 research integrity/ethics terms compared to 3.3% (95% CI = 2.1–4.6%), respectively (P<0.001). Overall, 62% of all statements addressing research integrity/ethics concepts used prescriptive language in describing the standard of practice. Professional organizations should define research integrity and research ethics issues in their ethics codes and collaborate within and across disciplines to adequately address responsible conduct of research and meet contemporary needs of their communities.

Peer Review Evaluation Process of Marie Curie Actions under EU's Seventh Framework Programme for Research

We analysed the peer review of grant proposals under Marie Curie Actions, a major EU research funding instrument, which involves two steps: an independent assessment (Individual Evaluation Report, IER) performed remotely by 3 raters, and a consensus opinion reached during a meeting by the same raters (Consensus Report, CR). For 24,897 proposals evaluated from 2007 to 2013, the association between average IER and CR scores was very high across different panels, grant calls and years. Median average deviation (AD) index, used as a measure of inter-rater agreement, was 5.4 points on a 0-100 scale (interquartile range 3.4-8.3), overall, demonstrating a good general agreement among raters. For proposals where one rater disagreed with the other two raters (n=1424; 5.7%), or where all 3 raters disagreed (n=2075; 8.3%), the average IER and CR scores were still highly associated. Disagreement was more frequent for proposals from Economics/Social Sciences and Humanities panels. Greater disagreement was observed for proposals with lower average IER scores. CR scores for proposals with initial disagreement were also significantly lower. Proposals with a large absolute difference between the average IER and CR scores (≥10 points; n=368, 1.5%) generally had lower CR scores. An inter-correlation matrix of individual raters' scores of evaluation criteria of proposals indicated that these scores were, in general, a reflection of raters’ overall scores. Our analysis demonstrated a good internal consistency and general high agreement among raters. Consensus meetings appear to be relevant for particular panels and subsets of proposals with large differences among raters’ scores.

Evidence-informed recommendations to reduce dissemination bias in clinical research: conclusions from the OPEN (Overcome failure to Publish nEgative fiNdings) project based on an international consensus meeting

BACKGROUND

Dissemination bias in clinical research severely impedes informed decision-making not only for healthcare professionals and patients, but also for funders, research ethics committees, regulatory bodies and other stakeholder groups that make health-related decisions. Decisions based on incomplete and biased evidence cannot only harm people, but may also have huge financial implications by wasting resources on ineffective or harmful diagnostic and therapeutic measures, and unnecessary research. Owing to involvement of multiple stakeholders, it remains easy for any single group to assign responsibility for resolving the problem to others.

OBJECTIVE

To develop evidence-informed general and targeted recommendations addressing the various stakeholders involved in knowledge generation and dissemination to help overcome the problem of dissemination bias on the basis of previously collated evidence.

METHODS

Based on findings from systematic reviews, document analyses and surveys, we developed general and targeted draft recommendations. During a 2-day workshop in summer 2013, these draft recommendations were discussed with external experts and key stakeholders, and refined following a rigorous and transparent methodological approach.

RESULTS

Four general, overarching recommendations applicable to all or most stakeholder groups were formulated, addressing (1) awareness raising, (2) implementation of targeted recommendations, (3) trial registration and results posting, and (4) systematic approaches to evidence synthesis. These general recommendations are complemented and specified by 47 targeted recommendations tailored towards funding agencies, pharmaceutical and device companies, research institutions, researchers (systematic reviewers and trialists), research ethics committees, trial registries, journal editors and publishers, regulatory agencies, benefit (health technology) assessment institutions and legislators.

CONCLUSIONS

Despite various recent examples of dissemination bias and several initiatives to reduce it, the problem of dissemination bias has not been resolved. Tailored recommendations based on a comprehensive approach will hopefully help increase transparency in biomedical research by overcoming the failure to disseminate negative findings.

Research Integrity and Research Ethics in Professional Codes of Ethics: Survey of Terminology Used by Professional Organizations across Research Disciplines

Professional codes of ethics are social contracts among members of a professional group, which aim to instigate, encourage and nurture ethical behaviour and prevent professional misconduct, including research and publication. Despite the existence of codes of ethics, research misconduct remains a serious problem. A survey of codes of ethics from 795 professional organizations from the Illinois Institute of Technology's Codes of Ethics Collection showed that 182 of them (23%) used research integrity and research ethics terminology in their codes, with differences across disciplines: while the terminology was common in professional organizations in social sciences (82%), mental health (71%), sciences (61%), other organizations had no statements (construction trades, fraternal social organizations, real estate) or a few of them (management, media, engineering). A subsample of 158 professional organizations we judged to be directly involved in research significantly more often had statements on research integrity/ethics terminology than the whole sample: an average of 10.4% of organizations with a statement (95% CI = 10.4-23-5%) on any of the 27 research integrity/ethics terms compared to 3.3% (95% CI = 2.1-4.6%), respectively (P<0.001). Overall, 62% of all statements addressing research integrity/ethics concepts used prescriptive language in describing the standard of practice. Professional organizations should define research integrity and research ethics issues in their ethics codes and collaborate within and across disciplines to adequately address responsible conduct of research and meet contemporary needs of their communities.

Who would students ask for help in academic cheating? Cross-sectional study of medical students in Croatia

BACKGROUND

Academic cheating does not happen as an isolated action of an individual but is most often a collaborative practice. As there are few studies that looked at who are collaborators in cheating, we investigated medical students' readiness to engage others in academic dishonest behaviours.

METHODS

In a cross-sectional survey study in Zagreb, Croatia, 592 medical students from the first, 3rd and 6th (final) study year anonymously answered a survey of readiness to ask family, friends, colleagues or strangers for help in 4 different forms of academic cheating or for 2 personal material favours. Stepwise multiple linear regression models (MLR) were used to evaluate potential factors influencing propensity for engaging others in these two types of behaviour.

RESULTS

Many students would ask another person for help in academic cheating, from 88.8% to 26.9% depending on a cheating behaviour. Students would most often ask a family member or friend for help in academic cheating. The same "helpers" were identified for non-academic related behaviour - asking for personal material favours. More respondents, however, would include three or four persons for asking help in academic cheating than for routine material favours. Score on material favours survey was the strongest positive predictor of readiness for asking help in academic cheating (stepwise MLR model; beta = 0.308, P < 0.0001) followed by extrinsic motivation (compensation) and male gender, whereas intrinsic motivation, year of study and grade point average were weak negative predictors.

CONCLUSIONS

Our study indicates that medical students are willing to engage more than one person in either close or distant relationships in academic cheating. In order to develop effective preventive measures to deter cheating at medical academic institutions, factors surrounding students' preference towards academic cheating rather than routine favours should be further investigated.

Five-step authorship framework to improve transparency in disclosing contributors to industry-sponsored clinical trial publications

Authorship guidelines have established criteria to guide author selection based on significance of contribution and helped to define associated responsibilities and accountabilities for the published findings. However, low awareness, variable interpretation, and inconsistent application of these guidelines can lead to confusion and a lack of transparency when recognizing those who merit authorship. This article describes a research project led by the Medical Publishing Insights and Practices (MPIP) Initiative to identify current challenges when determining authorship for industry-sponsored clinical trials and develop an improved approach to facilitate decision-making when recognizing authors from related publications. A total of 498 clinical investigators, journal editors, publication professionals and medical writers were surveyed to understand better how they would adjudicate challenging, real-world authorship case scenarios, determine the perceived frequency of each scenario and rate their confidence in the responses provided. Multiple rounds of discussions about these results with journal editors, clinical investigators and industry representatives led to the development of key recommendations intended to enhance transparency when determining authorship. These included forming a representative group to establish authorship criteria early in a trial, having all trial contributors agree to these criteria and documenting trial contributions to objectively determine who warrants an invitation to participate in the manuscript development process. The resulting Five-step Authorship Framework is designed to create a more standardized approach when determining authorship for clinical trial publications. Overall, these recommendations aim to facilitate more transparent authorship decisions and help readers better assess the credibility of results and perspectives of the authors for medical research more broadly. Please see related article: http://www.biomedcentral.com/1741-7015/12/214.

Using the WHO essential medicines list to assess the appropriateness of insurance coverage decisions: a case study of the Croatian national medicine reimbursement list

Purpose

To investigate the use of the WHO EML as a tool with which to evaluate the evidence base for the medicines on the national insurance coverage list of the Croatian Institute of Health Insurance (CIHI).

Methods

Medicines from 9 ATC categories with highest expenditures from 2012 CIHI Basic List (n = 509) were compared with 2011 WHO EML for adults (n = 359). For medicines with specific indication listed only in CIHI Basic List we assessed whether there was evidence in Cochrane Database of Systematic Reviews questioning their efficacy and safety.

Results

The two lists shared 188 medicines (52.4% of WHO EML and 32.0% of CIHI list). CIHI Basic List had 254 medicines and 33 combinations of these medicines which were not on the WHO EML, plus 14 medicines rejected and 20 deleted from WHO EML by its Evaluation Committee. For deleted medicines, we could obtain data that showed 2,965,378 prescriptions issued to 617,684 insured patients, and the cost of approximately € 41.2 million for 2012 and the first half of 2013, when the CIHI Basic List was in effect. For CIHI List-only medicines with a specific indication (n = 164 or 57.1% of the analyzed set), fewer benefits or more serious side-effects than other medicines were found for 17 (10.4%) and not enough evidence for recommendations for specific indication for 21 (12.8%) medicines in Cochrane systematic reviews.

Conclusions

National health care policy should use high-quality evidence in deciding on adding new medicines and reassessing those already present on national medicines lists, in order to rationalize expenditures and ensure wider and better access to medicines. The WHO EML and recommendations from its Evaluation Committee may be useful tools in this quality assurance process.