Delayed publication of clinical trials in gynecologic oncology

OBJECTIVES

Delays in clinical trial publication can hinder timely implementation of evidence-based practices. We sought to determine publication rates and time to publication for clinical trials addressing gynecologic malignancies.

METHODS

All clinical trials addressing gynecologic cancers in the ClinicalTrials.gov registry with a primary completion date between 1/1/2018 and 1/1/2020 were identified. The primary outcome was publication rate. All included studies had been completed for at least 3 years. Secondary outcomes were time to publication and associations between publication rate and sponsor, cancer type, and the number and location of primary study sites.

RESULTS

Of the 290 trials included, 161 (55.5%) had a peer-reviewed publication for the primary outcome within at least 3 years after completion. Of these, 123 had positive results (76.4%) and 38 were negative (23.6%). The average duration from primary completion to manuscript publication was 23.6 months (SD 13.9; median 21.4, IQR 15.1-32.4). Only 73 had results posted on the ClinicalTrials.gov registry (25.2%). Studies with positive findings had a significantly faster time to publication than those with negative results (22.0 mo vs 29.0 mo, p = 0.009). There was no significant difference between publication rate and funding source, cancer type, or location and number of primary sites.

CONCLUSIONS

Timely publication of clinical trials addressing gynecologic cancers remains an issue. Studies with positive findings were published faster than those with negative results, but the average publication time was still almost 2 years from trial completion. Further efforts should be made to identify and address barriers to clinical trial publication.

Positive Outcome Bias in the Influential Otolaryngology Clinical Trial Literature

OBJECTIVE

To assess for the presence of positive outcome bias in the otolaryngology clinical trial literature. Specifically, we investigate the prevalence of clinical trials with positive findings (CTP) and clinical trials with negative findings (CTN), as well as their quality of evidence and subsequent impact.

STUDY DESIGN

Retrospective analysis.

SETTING

Clinical Trials in the Influential Otolaryngology Literature.

METHODS

We reviewed all clinical trials published in 4 major otolaryngology journals between 2000 and 2020. We constructed several multivariable regression models to investigate the relationship of finding direction with randomization status and citation count. Subsequently, we incorporated an interaction term between year and the primary covariate of each model to assess the temporal trajectory of these relationships. All models accounted for sample size, journal, subspecialty, and the affiliated program prestige.

RESULTS

Of the 1367 trials analyzed, 1143 (84%) were CTPs, a rate that persisted throughout the study period (aOR 1.00, 95% CI 0.98-1.03). CTPs were significantly less likely to be randomized compared to CTNs (aOR 0.25, 0.17-0.37), a relationship that persisted over time (aOR 1.05, 0.99-1.03). CTPs received significantly more citations compared to CTNs (aIRR 1.41, 1.25-1.60), a disparity that also persisted over time (aIRR 0.99, 0.97-1.01).

CONCLUSION

The otolaryngology clinical trial literature has been heavily dominated by positive findings. CTPs were more frequently cited and published even with a lower level of evidence compared to CTNs. This bias may influence the objectivity of evidence used to guide clinical practice and warrants attention when reviewing findings and changing practices.

Abstracts of randomized controlled trials in pediatric dentistry: reporting quality and spin

BACKGROUND

Abstracts provide readers a concise and readily accessible information of the trials. However, poor reporting quality and spin (misrepresentation of research findings) can lead to an overestimation in trial validity. This methodological study aimed to assess the reporting quality and spin among randomized controlled trial (RCT) abstracts in pediatric dentistry.

METHODS

We hand-searched RCTs in five leading pediatric dental journals between 2015 and 2021. Reporting quality in each abstract was assessed using the original 16-item CONSORT for abstracts checklist. Linear regression analyses were performed to identify factors associated with reporting quality. We evaluated the presence and characteristics of spin only in abstracts of parallel-group RCTs with nonsignificant primary outcomes according to pre-determined spin strategies.

RESULTS

One hundred eighty-two abstracts were included in reporting quality evaluation. The mean overall quality score was 4.57 (SD, 0.103; 95% CI, 4.36-4.77; score range, 1-10). Only interventions, objective, and conclusions were adequately reported. Use of flow diagram (P < 0.001) was the only significant factor of higher reporting quality. Of the 51 RCT abstracts included for spin analysis, spin was identified in 40 abstracts (78.4%), among which 23 abstracts (45.1%) had spin in the Results section and 39 in the Conclusions Sect. (76.5%).

CONCLUSIONS

The reporting quality of RCT abstracts in pediatric dentistry is suboptimal and the prevalence of spin is high. Joint efforts are needed to improve reporting quality and minimize spin.

Comparing Orthopaedic Randomized Control Trials Published in High-Impact Medical and Orthopaedic Journals

INTRODUCTION

Orthopaedic studies published in high-impact medical journals are often believed to have a high prevalence of negative or neutral results and possess methodological characteristics that may bias toward nonsurgical treatments. The purpose of this study was to compare study characteristics, methodologic quality, exposure, and outcome direction among orthopaedic randomized control trials (RCTs) published in high-impact medical and orthopaedic journals and to identify study attributes associated with greater impact.

METHODS

RCTs published between January 2010 and December 2020 in the five medical journals and 10 orthopaedic journals with the highest 5-year impact factors were analyzed. Inclusion criteria were RCTs reporting on orthopaedic surgical intervention compared with nonsurgical or less-invasive surgical procedures. Study characteristics, methodologic quality (Jadad scale), outcomes, and altmetric data were collected. Primary outcomes were categorized as positive (favoring surgical/more-extensive surgery), negative (favoring nonsurgical/less-extensive surgery), or neutral.

RESULTS

One hundred twenty-eight RCTs were analyzed; 26 from medical and 102 from orthopaedic journals. Studies published in medical journals included more authors ( P < 0.001), larger sample sizes ( P < 0.001), more institutions ( P < 0.001), and more often received funding ( P < 0.001). The average Jadad scale did not significantly differ between journals ( P = 0.14). The direction of the primary study outcome did not differ between journals ( P = 0.22). Average AAS and annual citation rates were higher in RCTs published in medical journals ( P < 0.001). Publication in a medical journal was the only covariate associated with higher annual citation rates ( P < 0.001) and AAS ( P < 0.001) on multivariable analyses.

DISCUSSION

High-impact medical journals do not publish orthopaedic RCTs with negative or neutral findings at a rate that significantly differs from orthopaedic journals. However, the higher impact and digital coverage of the studies published in medical journals may disproportionally influence the practices of nonorthopaedic providers. Raising awareness of critical findings published in orthopaedic journals may be particularly important for improving healthcare policies and orthopaedic referral patterns for musculoskeletal problems.

A large scale randomized controlled trial on herding in peer-review discussions

Peer review is the backbone of academia and humans constitute a cornerstone of this process, being responsible for reviewing submissions and making the final acceptance/rejection decisions. Given that human decision-making is known to be susceptible to various cognitive biases, it is important to understand which (if any) biases are present in the peer-review process, and design the pipeline such that the impact of these biases is minimized. In this work, we focus on the dynamics of discussions between reviewers and investigate the presence of herding behaviour therein. Specifically, we aim to understand whether reviewers and discussion chairs get disproportionately influenced by the first argument presented in the discussion when (in case of reviewers) they form an independent opinion about the paper before discussing it with others. In conjunction with the review process of a large, top tier machine learning conference, we design and execute a randomized controlled trial that involves 1,544 papers and 2,797 reviewers with the goal of testing for the conditional causal effect of the discussion initiator's opinion on the outcome of a paper. Our experiment reveals no evidence of herding in peer-review discussions. This observation is in contrast with past work that has documented an undue influence of the first piece of information on the final decision (e.g., anchoring effect) and analyzed herding behaviour in other applications (e.g., financial markets). Regarding policy implications, the absence of the herding effect suggests that the current status quo of the absence of a unified policy towards discussion initiation does not result in an increased arbitrariness of the resulting decisions.

Climate change and infectious disease: a review of evidence and research trends

BACKGROUND

Climate change presents an imminent threat to almost all biological systems across the globe. In recent years there have been a series of studies showing how changes in climate can impact infectious disease transmission. Many of these publications focus on simulations based on in silico data, shadowing empirical research based on field and laboratory data. A synthesis work of empirical climate change and infectious disease research is still lacking.

METHODS

We conducted a systemic review of research from 2015 to 2020 period on climate change and infectious diseases to identify major trends and current gaps of research. Literature was sourced from Web of Science and PubMed literary repositories using a key word search, and was reviewed using a delineated inclusion criteria by a team of reviewers.

RESULTS

Our review revealed that both taxonomic and geographic biases are present in climate and infectious disease research, specifically with regard to types of disease transmission and localities studied. Empirical investigations on vector-borne diseases associated with mosquitoes comprised the majority of research on the climate change and infectious disease literature. Furthermore, demographic trends in the institutions and individuals published revealed research bias towards research conducted across temperate, high-income countries. We also identified key trends in funding sources for most resent literature and a discrepancy in the gender identities of publishing authors which may reflect current systemic inequities in the scientific field.

CONCLUSIONS

Future research lines on climate change and infectious diseases should considered diseases of direct transmission (non-vector-borne) and more research effort in the tropics. Inclusion of local research in low- and middle-income countries was generally neglected. Research on climate change and infectious disease has failed to be socially inclusive, geographically balanced, and broad in terms of the disease systems studied, limiting our capacities to better understand the actual effects of climate change on health.

Evaluation of Spin in the Clinical Literature of Suture Tape Augmentation for Ankle Instability

Background

Spin is defined as the use of specific reporting strategies to highlight the beneficial effect of a treatment despite nonsignificant results. The presence of spin in peer-reviewed literature can negatively impact clinical and research practices. The purpose of this study was to identify the quantity and types of spin present in primary studies and systematic reviews using suture tape augmentation for ankle instability as a model.

Methods

This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Each abstract was assessed for the presence of the 15 most common types of spin. Extracted data included study title, authors, publication year, journal, level of evidence, study design, funding, reported adherence to PRISMA guidelines, and PROSPERO registration. Full texts of systematic reviews were used in the assessment of study quality per A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2).

Results

Nineteen studies were included in the final sample. At least 1 type of spin was identified in each study except one (18 of 19, 94.7%). The most common type of spin observed was type 3 ("selective reporting or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention") (6 of 19, 31.6%), The second most reported category of spin was type 4 ("the conclusion claims safety based on non-statistically significant results with a wide confidence interval") (4 of 19, 21.1%). Among systematic reviews, we identified type 5 ("the conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") in 4 out of 6 (66.7%) of the articles that were included. No significant associations were found between study characteristics and type of spin.

Conclusion

In this exploration of the introduction of a new technology, we identified spin to be highly present in the abstracts of primary studies and systematic reviews concerning suture tape augmentation for ankle instability. Steps should be taken by scientific journals to ensure that spin is minimized in the abstract to accurately reflect the quality of the intervention.

The bias for statistical significance in sport and exercise medicine

OBJECTIVES

We aimed to examine the bias for statistical significance using published confidence intervals in sport and exercise medicine research.

DESIGN

Observational study.

METHODS

The abstracts of 48,390 articles, published in 18 sports and exercise medicine journals between 2002 and 2022, were searched using a validated text-mining algorithm that identified and extracted ratio confidence intervals (odds, hazard, and risk ratios). The algorithm identified 1744 abstracts that included ratio confidence intervals, from which 4484 intervals were extracted. After excluding ineligible intervals, the analysis used 3819 intervals, reported as 95 % confidence intervals, from 1599 articles. The cumulative distributions of lower and upper confidence limits were plotted to identify any abnormal patterns, particularly around a ratio of 1 (the null hypothesis). The distributions were compared to those from unbiased reference data, which was not subjected to p-hacking or publication bias. A bias for statistical significance was further investigated using a histogram plot of z-values calculated from the extracted 95 % confidence intervals.

RESULTS

There was a marked change in the cumulative distribution of lower and upper bound intervals just over and just under a ratio of 1. The bias for statistical significance was also clear in a stark under-representation of z-values between -1.96 and +1.96, corresponding to p-values above 0.05.

CONCLUSIONS

There was an excess of published research with statistically significant results just below the standard significance threshold of 0.05, which is indicative of publication bias. Transparent research practices, including the use of registered reports, are needed to reduce the bias in published research.

'Spin' among abstracts of randomised controlled trials in sleep medicine: A research-on-research study

STUDY OBJECTIVES

'Spin', using reporting strategies to distort study results, can mislead readers of medical research. This study aimed to evaluate the prevalence and characteristics of 'spin' among randomised controlled trial (RCT) abstracts published in sleep medicine journals, and to identify factors associated with its presence and severity.

METHODS

The search for RCTs published between 2010 and 2020 were conducted in seven reputable journals of sleep medicine. Abstracts of RCTs with statistically nonsignificant primary outcomes were included and analysed for 'spin', according to pre-determined 'spin' strategies. Chi-square tests or logistic regression analyses were performed to detect the association between characteristics of included abstracts and the presence and severity of 'spin'.

RESULTS

A total of 114 RCT abstracts were included in this study, of which 89 (78.1%) were identified as having at least one type of 'spin' strategy. Sixty-six abstracts (57.9%) had 'spin' in the Results section, 82 (71.9%) abstracts presented with 'spin' in the Conclusions section. The presence of 'spin' varied significantly among RCTs based on the different categories of research area (P=0.047) and the statistician involvement (P=0.045). Furthermore, research area (P=0.019) and funding status (P=0.033) were significant factors associated with the severity of 'spin'.

CONCLUSIONS

The prevalence of 'spin' is high among RCT abstracts in sleep medicine. This raise the need for researchers, editors and other stakeholders to be aware of the issue of 'spin' and make joint efforts to eliminate it in future publications.

Factors relating to nonpublication and publication bias in clinical trials in Canada: A qualitative interview study

AIMS

This study aims to understand factors contributing to nonpublication and publication bias in clinical trials in Canada.

METHODS

Qualitative interviews were conducted between March 2019 and April 2021 with 34 participants from the Canadian provinces of Alberta, British Columbia and Ontario, including 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators, 3 research ethics board members and 10 clinical trial participants. We conducted a thematic analysis involving coding of interview transcripts and memo-writing to identify key themes.

RESULTS

Several factors contribute to nonpublication and publication bias in clinical trial research. A core theme was that reporting practices are shaped by incentives within the research system taht favour publication of positive over negative trials. Investigators are discouraged from reporting by experiences or perceptions of difficulty in publishing negative findings but rewarded for publishing positive findings in various ways. Trial investigators more strongly associated positive clinical trials than negative trials with opportunities for industry and nonindustry funding and with academic promotion, bonuses and recognition. Research institutions and ethics boards tended to lack well-resourced, proactive policies and practices to ensure trial findings are reported in registries or journals.

CONCLUSION

Clinical trial reporting practices in Canada are shaped by incentives favouring reporting of positive over negative trials, such as funding opportunities and academic promotion, bonuses and recognition. Research institutions could help change incentives by adopting performance metrics that emphasize full reporting of results in journals or registries.

Robust Randomized Controlled Data Is Lacking in Total Joint Arthroplasty

INTRODUCTION

 Randomized controlled trials (RCTs)are regarded as highest level of scientific evidence. There is belief that while prospective randomized control trials (PRCTs) are the gold standard for evaluating efficacy of interventions, there are very few conducted on lower extremity joint arthroplasty. However, there was a more than adequate amount (n=197) of published RCTs in knee arthroplasty during the 2021 calendar year. Therefore, we studied RCTs on knee arthroplasties for 2021 and assessed them for overall study topic reasons (i.e., devices as well as prostheses, rehabilitation, pain control, blood loss [tranexamic acid], and other), which were then subcategorized by: (1) country of origin; (2) sample size; and (3)whether or not they were follow-up studies. After this, we specifically focused on the studies (n=26) concerning devices or prostheses.

METHODS

 A search of PubMed on "knee arthroplasty" specifying "RCT" using their search function and dates between January 1, 2021 to December 24, 2021 resulted in the analyzed reports. A total of 17.3% reports analyzed rehabilitation methods while 28.4% studied pain control. A total of 20.3% examined blood loss topics and 20.8% investigated other topics.

RESULTS

 We found that 26 studies (13.2%) involved prosthetic design and implantation. Overall, only 15% knee arthroplasty RCTs were conducted in the United States, the mean total final sample size was 133±146 patients, and 7% were follow-up studies. None of the prostheses studies were performed in the United States, and the mean total final sample size of all of these studies was 86±54 patients, and 23% were follow-up studies. Total knee arthroplasty prospective RCTs were not performed in the United States.

CONCLUSION

 The authors believe that other study designs, such as database or registry analyses, are also appropriate in this rapidly advancing field of joint arthroplasty for the continuing evaluation and approval of new prostheses and techniques, while we await more PRCTs in our field.

Spin and reporting in systematic reviews with meta-analysis of randomized clinical trials in restorative dentistry

OBJECTIVE

To estimate the prevalence of spin and completeness of reporting of systematic reviews with metanalysis (SRMAs) in restorative dentistry.

METHODS

Inclusion criteria were SRMAs of randomized clinical trials of restorative dentistry on survival, success, or failure rates of treatment in humans, with no language or year restriction. SRMAs performed with non-RCTs were excluded. PubMed/MEDLINE, Web of Science, Scopus, Embase, and Cochrane Collaboration Library were searched from inception to April 2022. Outcomes were the prevalence of spin (primary outcome) and completeness of reporting (secondary outcome) in the abstract and full text. Data were reported through means and standard deviations or absolute and relative frequencies. Spin in each item was considered low when occurring in less than 25% of the papers, moderate (25 to 75%), or high (more than 75%).

RESULTS

We identified 7029 studies and 49 unique manuscripts were included. There was a moderate presence of spin in the abstracts and low in full texts. In the abstracts, 65.9% did not report adverse events; while in the abstract and full text, more than 16% reported a conclusion containing recommendations for clinical practice not supported by the findings. Regarding completeness of reporting, there was poor reporting for most items in the abstract while there was an adequate report in full texts, except for register name and registration number (not reported in 32.7%).

CONCLUSIONS

Abstract of SRMAs in restorative dentistry should be better reported. Spin and poor reporting were more frequent in the abstracts, which misleads readers and could lead to inadequate clinical recommendations.

CLINICAL SIGNIFICANCE

Spin and incomplete reporting are a threat to evidence-based practice, especially in systematic reviews. Therefore, care providers, researchers, and other stakeholders should be aware of the possibility of spin in systematic reviews and other sources to prevent misinterpretation, which could lead to inadequate decisions and treatments.

Self-report measures of secure attachment in adulthood: A systematic review

BACKGROUND

Secure attachment in adulthood is associated with many markers of adaptive functioning. Valid and reliable self-report measures of attachment security could provide a practical tool to help advance strengths-based research and clinical work. Previous reviews have not specifically examined the psychometric properties of self-report instruments with respect to secure attachment or systematically appraised the methodological quality of relevant validation studies.

METHOD

A systematic review was completed in accordance with the COSMIN guidelines for reviews of patient-reported outcome measures. The methodological quality of individual studies was evaluated, and results were rated against criteria for good measurement properties.

RESULTS

A total of 40 studies were included in the review, which collectively reported on 24 self-report instruments. The methodological quality of individual studies was variable, and no single instrument was identified as having sufficient evidence of a range of psychometric properties. However, the Attachment Style Questionnaire-Short Form (ASQ-SF), the Cartes-Modèles Individuels de Relations (CAMIR), Cartes-Modèles Individuels de Relations-Reduced (CAMIR-R), and the Psychological Treatment Inventory-Attachment Style Scales (PTI-ASS) had the most robust evidence for the properties assessed.

CONCLUSION

Existing self-report measures assessing adult secure attachment have limited psychometric support. More methodologically robust studies of content validity, reliability, measurement invariance, and construct validity in particular are needed.

COVID-19 and the eye: alternative facts The 2022 Bowman Club, David L. Easty lecture

In addition to catastrophic loss of life, and dramatic and unwanted alterations to the daily lives of those left behind, the COVID-19 pandemic has fostered the publication and dissemination of an unprecedented quantity of peer-reviewed medical and scientific publications on a single subject. In particular, the ophthalmic literature is now replete with clinical and laboratory studies on putative eye involvement by SARS-CoV-2, the aetiologic agent of COVID-19. In this review, we critically appraise the published literature on COVID-19, and suggest that the quality of scientific peer review and editorial decision-making also suffered during the COVID-19 pandemic.

Spin in the Abstracts of Randomized Controlled Trials in Operative Dentistry: A Cross-sectional Analysis

OBJECTIVE

To assess the presence and characteristics of spin in recently published RCT abstracts in operative dentistry and to investigate potential factors associated with the presence of spin.

METHODS AND MATERIALS

The PubMed database was searched to identify parallel-group RCTs published between 2015 and 2019 in the field of operative dentistry, which compared two or more groups and had nonsignificant results for the primary outcome. Two authors evaluated independently the presence and characteristics of spin among these abstracts. Multivariable logistic regression analyses were conducted to identify factors associated with the presence of spin in the Results and the Conclusions sections, respectively.

RESULTS

A total of 77 RCT abstracts were included, among which 58 (75.3%) showed at least one type of spin. Spin was identified in the Results and Conclusions sections of 32 (41.6%) and 45 (58.4%) abstracts, respectively. 19 RCTs (24.7%) presented spin in both the Results and the Conclusions section of abstracts. The presence of spin in the Results section of abstracts was significantly associated with source of funding (OR=8.10; p=0.025) and number of treatment arms was associated with the presence of spin in the Conclusions section of abstracts (OR=5.66; p=0.005).

CONCLUSION

The occurrence rate of spin in the sample of operative dentistry RCTs abstracts is high.

Transparent, Open, and Reproducible Prevention Science

The field of prevention science aims to understand societal problems, identify effective interventions, and translate scientific evidence into policy and practice. There is growing interest among prevention scientists in the potential for transparency, openness, and reproducibility to facilitate this mission by providing opportunities to align scientific practice with scientific ideals, accelerate scientific discovery, and broaden access to scientific knowledge. The overarching goal of this manuscript is to serve as a primer introducing and providing an overview of open science for prevention researchers. In this paper, we discuss factors motivating interest in transparency and reproducibility, research practices associated with open science, and stakeholders engaged in and impacted by open science reform efforts. In addition, we discuss how and why different types of prevention research could incorporate open science practices, as well as ways that prevention science tools and methods could be leveraged to advance the wider open science movement. To promote further discussion, we conclude with potential reservations and challenges for the field of prevention science to address as it transitions to greater transparency, openness, and reproducibility. Throughout, we identify activities that aim to strengthen the reliability and efficiency of prevention science, facilitate access to its products and outputs, and promote collaborative and inclusive participation in research activities. By embracing principles of transparency, openness, and reproducibility, prevention science can better achieve its mission to advance evidence-based solutions to promote individual and collective well-being.

Spin is present in the majority of articles evaluating robot-assisted groin hernia repair: a systematic review

BACKGROUND

The number of scientific articles published each year is increasing, resulting in greater competition to get work published. Spin is defined as specific reporting strategies used to distort the readers' interpretation of results so that they are viewed more favorable. However, prevalence of spin in studies comparing robot-assisted groin hernia repair with traditional methods is unknown.

OBJECTIVES/AIM

To determine the frequency and extent of spin in studies assessing robot-assisted groin hernia repair.

METHODS

This systematic review was reported according to PRISMA guidelines, and a protocol was registered at PROSPERO before data extraction. Database search included PubMed, EMBASE, and Cochrane Central.

RESULTS

Of 35 included studies, spin was present in 57%. Within these, 95% had spin present in the abstract and 80% in the conclusion of the article. There was no association between study size and spin (p > 0.05). However, presence of spin in studies positively minded towards robot-assisted hernia repair was higher (p < 0.001) compared with those against or being neutral in their view of the procedure. Furthermore, being funded by or receiving grants from Intuitive Surgical were associated with a higher prevalence of spin (p < 0.05) compared with those who were not.

CONCLUSION

Spin was found to be common in articles reporting on robot-assisted groin hernia repair, and presence of spin was higher in studies funded by or receiving grants from the robot company. This suggests that readers should be cautious when reading similar literature.

Evaluation of the Quick Wee method of inducing faster clean catch urine collection in pre-continent infants: a randomized controlled trial

INTRODUCTION

The acquisition of non-contaminated urine samples in pre-continent infants remains a challenge. The Quick Wee method uses bladder stimulation to induce voiding. A previous randomized trial showed a higher rate of voiding within 5 minutes using this method. We evaluated this method in an Irish hospital providing secondary care.

METHODS

A non-blinded, randomized, controlled trial was carried out. Eligible infants were between 1 and 12 months of age, who required urine sampling as part of clinical care. Participants were randomly allocated to receive the intervention (Quick Wee Method-supra-pubic stimulation with cold saline) or the control (usual care-clean catch with no bladder stimulation) for 5 min. Primary outcome was voiding of urine within 5 min.

RESULTS

A total of 140 infants were included in this study (73 in intervention group; 67 in control group). Baseline characteristics were similar. 25% in the intervention group passed urine in the 5-min trial period compared with 18% in the control group [P = 0.4, absolute difference 7% (95% confidence interval: - 7% to + 20%)].

CONCLUSION

The Quick Wee method is a simple and inexpensive intervention that did not show a statistically significant increase in urine samples obtained in pre-continent infants.

Industry Sponsor Influence in Clinical Trial Reporting in Canada: A Qualitative Interview Study

PURPOSE

Approximately 40% of randomized controlled trials are not published, leading to publication bias and less informed clinical decision-making. Qualitative interviews were conducted to understand whether and how industry sponsors of clinical trials of drugs and biologics in Canada influence decisions to report trial results.

METHODS

Participants eligible for an interview included clinical trial investigators and research coordinators with experience in drug research, research ethics board members with at least 1 year of experience in ethical review of trials, research administrators with knowledge of dissemination of clinical trial findings or relations with trial sponsors, and trial participants who had taken part in a drug trial as an adult in the 5 years before their interview. Semi-structured interviews were held in person or by telephone between March 2019 and April 2021 with participants in Alberta, British Columbia, and Ontario, Canada. Qualitative analysis included coding of interview transcripts and identification of key themes.

FINDINGS

Interviews were conducted with 34 participants, including 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators, 3 research ethics board members, and 10 clinical trial participants. Participants involved in the conduct, administration, or ethical review of trials represented a range of medical disciplines. Interview participant accounts indicated that in some cases, industry sponsors influence whether results are reported. A core theme was that companies have a weaker incentive to publish trials with unfavorable findings and trials for products that they have decided not to develop further. Companies may influence reporting in various ways, including stopping trials early and not reporting results of stopped trials, owning and controlling access to data, and negotiating clinical trial agreements in multicenter trials that do not fully protect the ability of investigators to publish. Internal company trials represent an additional source of unpublished trials. More broadly, the research system creates a dependency on funding from industry sponsors that may weaken the ability of researchers and research institutions to negotiate terms with industry sponsors that would fully protect publication rights.

IMPLICATIONS

Interviews with trial investigators and others connected to trial research indicate that in some cases, industry sponsors of clinical trial research in Canada influence whether results are reported. Policies aiming to bring about full reporting of trials could benefit from considering the commercial incentives of companies and the ways in which industry sponsors may influence clinical trial reporting. Future research could examine the generalizability of these findings to other jurisdictions.

Predicting life expectancy after geriatric hip fracture: A systematic review

Background

Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration.

Methods

Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables.

Results

There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies.

Discussion

There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.

Physician Interpretation of Data of Uncertain Clinical Utility in Oncology Prescription Drug Promotion

BACKGROUND

Little is known about how physicians interpret data displays that depict preliminary or exploratory clinical data in physician-targeted sales aids for oncology drugs. Using three factorial experiments, we examined whether disclosures of data limitations and clinical uncertainty adequately communicate the limitations and practical utility of this type of data.

SUBJECTS, MATERIALS, AND METHODS

The studies used a 2 (disclosure of data limitations: technical, nontechnical) × 2 (disclosure of clinical uncertainty: present, absent) + 1 (control: no disclosure) between-subjects experimental design to examine the impact of disclosures as they relate to presentations of preliminary or exploratory data in promotional communications for oncology products. In each experiment, we randomized oncologists and primary care physicians with oncology experience to view one version of a two-page sales aid. Following this exposure, physicians completed a web-based survey. The design was replicated in three concurrently conducted experiments using sales aids for different fictitious oncology drugs, each featuring one of three common data displays: a forest plot (n = 495), a Kaplan-Meier curve (n = 504), or a bar chart (n = 532).

RESULTS

Results provide initial evidence that in some contexts disclosures can improve understanding of the clinical utility of certain information about a drug and the limitations of results presented in a data display. Disclosures can also temper perceptions of how much evidence is presented that supports a conclusion that the drug is an appropriate treatment. In terms of the language used in the disclosure of data limitations, physicians in all three experiments strongly preferred the nontechnical disclosures.

CONCLUSION

The findings from the three experiments in this study suggest that disclosures have the potential to increase relevant knowledge, but more research is needed to establish best practice recommendations for using disclosures to convey contextual information relevant for interpreting data displays in promotional communications.

IMPLICATIONS FOR PRACTICE

This article reports the results from three large, online experimental studies that address a growing concern that drug companies often share favorable clinical trial results with physicians in promotional materials that lack important context for physicians to interpret the data. This series of studies investigates whether strategic use of two types of disclosures (disclosure of data limitations and a disclosure of clinical uncertainty) improves understanding and reduces misinterpretations among physicians. The results from these studies help identify communication factors that impact how physicians critically appraise preliminary or exploratory clinical trial data to inform policy and regulatory efforts.

The presence and characteristics of 'spin' among randomized controlled trial abstracts in orthodontics

OBJECTIVES

To identify the presence and characteristics of spin (using reporting strategies to distort study results and mislead readers) within randomized controlled trial (RCT) abstracts published in orthodontic journals, and to explore the association between spin and potentially related factors.

METHODS

A manual search was conducted to identify abstracts of RCTs with statistically non-significant primary outcomes published in five leading orthodontic journals between 2015 and 2020. Spin in the Results and Conclusions sections of each included abstract was evaluated and categorized according to pre-determined spin strategies. Logistic regression analyses were employed to explore the association between spin and relevant factors.

RESULTS

A total of 111 RCT abstracts were included, of which 69 (62.2 per cent) were identified with spin. In the Results section, 47 (42.3 per cent) abstracts had spin, and 'focusing on significant within-group comparison for primary outcomes' was the most frequent spin strategy. In the Conclusions section, 57 (51.4 per cent) abstracts presented spin, with the most common strategy being 'claiming equivalence or non-inferiority for statistically nonsignificant results'. According to multivariable logistic regression analysis, a significantly lower presence of spin was found in studies with international collaboration (odds ratio [OR]: 0.331, 95 per cent confidence interval [CI]: 0.120-0.912, P = 0.033) and trial registration (OR: 0.336, 95 per cent CI: 0.117-0.962, P = 0.042).

CONCLUSION

The prevalence of spin is high among RCT abstracts in orthodontics. Clinicians need to be aware of the definition and presence of spin. Concerted efforts are needed from researchers and other stakeholders to address this issue.

Reimagining the peer-review system for translational health science journals

Retractions of coronavirus disease 2019 (COVID-19) papers in high impact journals, such as The Lancet and the New England Journal of Medicine, have been panned as major scientific fraud in public media. The initial reaction to this news was to seek out scapegoats and blame individual authors, peer-reviewers, editors, and journals for wrong doing. This paper suggests that scapegoating a few individuals for faulty science is a myopic approach to the more profound problem with peer-review. Peer-review in its current limited form cannot be expected to adequately address the scope and complexity of large interdisciplinary science research collaboration, which is central in translational research. In addition, empirical studies on the effectiveness of traditional peer-review reveal its very real potential for bias and groupthink; as such, expectations regarding the capacity and effectiveness of the current peer review process are unrealistic. This paper proposes a new vision of peer-review in translational science that, on the one hand, would allow for early release of a manuscript to ensure expediency, whereas also creating a forum or a collective of various experts to actively comment, scrutinize, and even build on the research under review. The aim would be to not only generate open discussion and oversight respecting the quality and limitations of the research, but also to assess the extent and the means for that knowledge to translate into social benefit.

Neglect of publication bias compromises meta-analyses of educational research

Because negative findings have less chance of getting published, available studies tend to be a biased sample. This leads to an inflation of effect size estimates to an unknown degree. To see how meta-analyses in education account for publication bias, we surveyed all meta-analyses published in the last five years in the Review of Educational Research and Educational Research Review. The results show that meta-analyses usually neglect publication bias adjustment. In the minority of meta-analyses adjusting for bias, mostly non-principled adjustment methods were used, and only rarely were the conclusions based on corrected estimates, rendering the adjustment inconsequential. It is argued that appropriate state-of-the-art adjustment (e.g., selection models) should be attempted by default, yet one needs to take into account the uncertainty inherent in any meta-analytic inference under bias. We conclude by providing practical recommendations on dealing with publication bias.

Evaluation of Oncology Trial Results Reporting Over a 10-Year Period

IMPORTANCE

Unreported clinical trial results represent a violation of human rights. Oncology trials account for nearly 30% of interventional biopharmaceutical clinical studies registered on ClinicalTrials.gov and are the most numerous among all disciplines.

OBJECTIVE

To analyze the reporting of results among all interventional oncology trials registered on ClinicalTrials.gov from 2007 through 2017.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed all clinical studies registered between June 1, 2007, and May 8, 2017, on ClinicalTrials.gov, the largest public clinical trial registry in the world. Trials with a recruitment status of completed or terminated and a primary completion date of on or before September 30, 2017, were selected. Data were analyzed between February 20, 2021, and February 26, 2021.

MAIN OUTCOMES AND MEASURES

The main outcome was the percentage of trials that reported results either on ClinicalTrials.gov or in journal publications within 24 months of the primary completion date. Journal publication was ascertained by searching ClinicalTrials.gov for a link to the publication, PubMed using national clinical trial number, and Embase using national clinical trial number and filters.

RESULTS

Of the 12 240 clinical trials registered in ClinicalTrials.gov, 7425 trials (60.7%; 95% CI, 60.0%-61.5%) reported results, with a 34.0% (95% CI, 30.3%-37.7%) increase in 24-month reporting rate from 2007 to 2017. Multivariable analyses confirmed that more recent trials (adjusted hazard ratio [HR], 1.11 per year increase; 95% CI, 1.10-1.13) and trials with larger sample sizes (51-100 patients: adjusted HR, 1.17 [95% CI, 1.09-1.24]; >100 patients: adjusted HR, 1.43 [95% CI, 1.33-1.54]) were more likely to report results. Terminated trials were less likely to report results compared with completed trials (adjusted HR, 0.88; 95% CI, 0.83-0.93). Compared with trials funded by industry, those funded by the National Institutes of Health were more likely to report results (adjusted HR, 1.39; 95% CI, 1.29-1.49), whereas those funded by other academic or nonprofit organizations were less likely to report results (adjusted HR, 0.66; 95% CI, 0.62-0.70). Among all 7425 trials, the results of 2807 trials (37.8%; 95% CI, 36.7%-38.9%) were posted only on ClinicalTrials.gov. These trials tended to be terminated early and to have small sample sizes (≤50 patients) compared with trials that published results in journals.

CONCLUSIONS AND RELEVANCE

This study found a gradual improvement in results reporting among oncology trials over a 10-year period. Trial registries could serve as a results reporting platform for unpublished trials and as a data source of trial outcomes for future studies.

Enhancing Older Adults' Well-Being and Quality of Life through Purposeful Activity: A Systematic Review of Intervention Studies

BACKGROUND AND OBJECTIVES

Population aging represents a significant challenge for health and social care services. Older adults who engage in activities that offer a sense of purpose have significantly better physical and psychological health outcomes. However, age-related functional limitations and losses of social roles can present barriers to engaging in purposeful activity, especially for those older adults within the 'oldest old' age range (i.e. 80 years and over). This review aimed to determine the nature and effectiveness of purposeful activity interventions in older adults, aged ≥80 years, with respect to well-being and quality of life outcomes.

RESEARCH DESIGN AND METHODS

Three databases were searched from their inception to April 2020. The search yielded 8,916 records, which resulted in eight eligible studies.

RESULTS

The interventions were divided into two groups: (1) interventions that gave participants a specific functional role, such as volunteer or mentor (n=5); (2) interventions that supported participants to develop a new skill (n=3). The quality of the evidence was variable. The strongest evidence was for interventions that assigned a functional role, which appeared to be somewhat effective in improving well-being outcomes.

DISCUSSION AND IMPLICATIONS

There is preliminary evidence that purposeful activity interventions, particularly those that involved taking on a functional role, can improve well-being and quality of life outcomes in older adults aged 80 years and over. These findings have implications for professionals and carers to support older adults to access more purposeful social roles and create opportunities for helping and reciprocation.

Bias in Medicine: Lessons Learned and Mitigation Strategies

Cognitive bias consists of systematic errors in thinking due to human processing limitations or inappropriate mental models. Cognitive bias occurs when intuitive thinking is used to reach conclusions about information rather than analytic (mindful) thinking. Scientific progress is delayed when bias influences the dissemination of new scientific knowledge, as it has with the role of human leucocyte antigen antibodies and antibody-mediated rejection in cardiac transplantation. Mitigating strategies can be successful but involve concerted action by investigators, peer reviewers, and editors to consider how we think as well as what we think.

Postoperative Quality of Life after Open Transinguinal Preperitoneal Inguinal Hernia Repair Using Memory Ring or Three-dimensional Devices

A transinguinal preperitoneal (TIPP) approach has become a common technique for inguinal hernia repair. Our goal was to compare the impact of the two mesh designs for this operation: a flat mesh with a memory ring device (MRD) or a three-dimensional device (3DD) containing both onlay and preperitoneal mesh components. The prospective International Hernia Mesh Registry (2007 to 2012) was queried for MRD and 3DD inguinal hernia repairs. Outcomes and patient quality of life (QOL), using the Carolinas Comfort Scale (CCS), were examined at 1, 6, 12, and 24 months. Standard statistical methods were used, and multivariate logistic regression was performed using a forward stepwise selection method. TIPP was performed in 956 patients. Their average age 57.4 ± 15.3 years, 94.0 per cent were male, and mean body mass index was 25.7 ± 3.2 kg/m2. MRD was used in 131 and 3DD in 825. Follow-up was 97, 82, 87, and 80 per cent at 1, 6, 12, and 24 months, respectively. Complications were not significantly different ( P > 0.05). Recurrence was 0.8 per cent for MRD and 2.1 per cent for 3DD ( P = 0.45). Comparing patient outcomes of MRD with 3DD at 1 month, 18.9 versus 11.5 per cent had symptoms of mesh sensation ( P = 0.02); 28.7 versus 14.8 per cent had movement limitations ( P < 0.01). MRD use was a significant independent predictor of movement limitation (odds ratio, 2.3; confidence interval, 1.4 to 3.7). No significant differences in CCS scores were seen at 6, 12, and 24 months. TIPP repair is safe and has a low recurrence rate. Early postoperative QOL is significantly improved with a 3DD mesh compared with MRD.

Perspective on Systematic Medical Literature Reviews and Meta-Analyses

PURPOSE

This study sought to identify factors contributing to the inadequacies of systematic reviews and meta-analyses (SRMAs) published in the ophthalmology literature.

DESIGN

Perspective.

METHODS

Review and synthesis of selective literature, with interpretation and perspective.

RESULTS

Although recommendations for the design, conduct, assessment of quality, and risk of bias of systematic reviews have been widely available, some recent publications illustrate a serious potential failing in this domain: inclusion of refuted science, lack of citation of post-publication correspondence and failure to use ≥1 alternative search strategy.

CONCLUSIONS

Examples of inadequacies of peer review in medical literature and perpetuation of erroneous science by unfiltered inclusion in subsequent systematic reviews have been identified, and the problem can be traced to authors, peer reviewers, and editors of journals. This perspective identifies and analyzes several possible causes of the problem and recommends some specific corrective actions to improve the quality and accuracy of such reviews.

Metascience on Peer Review: Testing the Effects of a Study’s Originality and Statistical Significance in a Field Experiment

Peer review has become the gold standard in scientific publishing as a selection method and a refinement scheme for research reports. However, despite its pervasiveness and conferred importance, relatively little empirical research has been conducted to document its effectiveness. Further, there is evidence that factors other than a submission’s merits can substantially influence peer reviewers’ evaluations. We report the results of a metascientific field experiment on the effect of the originality of a study and the statistical significance of its primary outcome on reviewers’ evaluations. The general aim of this experiment, which was carried out in the peer-review process for a conference, was to demonstrate the feasibility and value of metascientific experiments on the peer-review process and thereby encourage research that will lead to understanding its mechanisms and determinants, effectively contextualizing it in psychological theories of various biases, and developing practical procedures to increase its utility.

Gray (Literature) Matters: Evidence of Selective Hypothesis Reporting in Social Psychological Research

Selective reporting practices (SRPs)—adding, dropping, or altering study elements when preparing reports for publication—are thought to increase false positives in scientific research. Yet analyses of SRPs have been limited to self-reports or analyses of pre-registered and published studies. To assess SRPs in social psychological research more broadly, we compared doctoral dissertations defended between 1999 and 2017 with the publications based on those dissertations. Selective reporting occurred in nearly 50% of studies. Fully supported dissertation hypotheses were 3 times more likely to be published than unsupported hypotheses, while unsupported hypotheses were nearly 4 times more likely to be dropped from publications. Few hypotheses were found to be altered or added post hoc. Dissertation studies with fewer supported hypotheses were more likely to remove participants or measures from publications. Selective hypothesis reporting and dropped measures significantly predicted greater hypothesis support in published studies, supporting concerns that SRPs may increase Type 1 error risk.

Supporting robust, rigorous, and reliable reviewing as the cornerstone of our profession: Introducing a competency framework for peer review

Peer review is a critical component toward facilitating a robust science in industrial and organizational (I-O) psychology. Peer review exists beyond academic publishing in organizations, university departments, grant agencies, classrooms, and many more work contexts. Reviewers are responsible for judging the quality of research conducted and submitted for evaluation. Furthermore, they are responsible for treating authors and their work with respect, in a supportive and developmental manner. Given its central role in our profession, it is curious that we do not have formalized review guidelines or standards and that most of us never receive formal training in peer reviewing. To support this endeavor, we are proposing a competency framework for peer review. The purpose of the competency framework is to provide a definition of excellent peer reviewing and guidelines to reviewers for which types of behaviors will lead to good peer reviews. By defining these competencies, we create clarity around expectations for peer review, standards for good peer reviews, and opportunities for training the behaviors required to deliver good peer reviews. We further discuss how the competency framework can be used to improve peer reviewing and suggest additional steps forward that involve suggestions for how stakeholders can get involved in fostering high-quality peer reviewing.

Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences

Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations also affect biological psychiatry and are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. Moreover, journalists are unaware that initial studies, even when positive and promising, are inherently uncertain. Journalists preferentially cover them and almost never inform the public when those studies are disconfirmed by subsequent research. This explains why reductionist theories about mental health often persist in mass media even though the scientific claims that have been put forward to support them have long been contradicted. These misrepresentations affect the care of patients. Indeed, studies show that a neuro-essentialist conceptualization of mental disorders negatively affects several aspects of stigmatization, reduces the chances of patients' healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering. Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.

Examination of CIs in health and medical journals from 1976 to 2019: an observational study

OBJECTIVES

Previous research has shown clear biases in the distribution of published p values, with an excess below the 0.05 threshold due to a combination of p-hacking and publication bias. We aimed to examine the bias for statistical significance using published confidence intervals.

DESIGN

Observational study.

SETTING

Papers published in Medline since 1976.

PARTICIPANTS

Over 968 000 confidence intervals extracted from abstracts and over 350 000 intervals extracted from the full-text.

OUTCOME MEASURES

Cumulative distributions of lower and upper confidence interval limits for ratio estimates.

RESULTS

We found an excess of statistically significant results with a glut of lower intervals just above one and upper intervals just below 1. These excesses have not improved in recent years. The excesses did not appear in a set of over 100 000 confidence intervals that were not subject to p-hacking or publication bias.

CONCLUSIONS

The huge excesses of published confidence intervals that are just below the statistically significant threshold are not statistically plausible. Large improvements in research practice are needed to provide more results that better reflect the truth.

Current State in Scientific Publishing: AOA Critical Issues Symposium

Orthopaedic surgery has a rich history of publication of the science that supports the practice of our specialty, which dates from 1887. Orthopaedic publishing has evolved since that time, expanding from print to online access, with increasing variation in publication models, including open-access journals and article repositories, and methods of information delivery that include video, data archives, and commentary. This symposium provides an overview of the changes and challenges in the publication of orthopaedic science.

The effects of industry funding and positive outcomes in the interpretation of clinical trial results: a randomized trial among Dutch psychiatrists

BACKGROUND

Most studies are inclined to report positive rather than negative or inconclusive results. It is currently unknown how clinicians appraise the results of a randomized clinical trial. For example, how does the study funding source influence the appraisal of an RCT, and do positive findings influence perceived credibility and clinical relevance? This study investigates whether psychiatrists' appraisal of a scientific abstract is influenced by industry funding disclosures and a positive outcome.

METHODS

Dutch psychiatrists were randomized to evaluate a scientific abstract describing a fictitious RCT for a novel antipsychotic drug. Four different abstracts were created reporting either absence or presence of industry funding disclosure as well as a positive or a negative outcome. Primary outcomes were the perceived credibility and clinical relevance of the study results (10-point Likert scale). Secondary outcomes were the assessment of methodological quality and interest in reading the full article.

RESULTS

Three hundred ninety-five psychiatrists completed the survey (completion rate 45%). Industry funding disclosure was found not to influence perceived credibility (Mean Difference MD 0.12; 95% CI - 0.28 to 0.47, p?) nor interpretation of its clinical relevance (MD 0.14; 95% CI - 0.54 to 0.27, p?). A negative outcome was perceived as more credible than a positive outcome (MD 0.81 points; 95% Confidence Interval (CI) 0.43 to 1.18, p?), but did not affect clinical relevance scores (MD -0.14; 95% CI - 0.54 to 0.27).

CONCLUSIONS

In this study, industry funding disclosure was not associated with the perceived credibility nor judgement of clinical relevance of a fictional RCT by psychiatrists. Positive study outcomes were found to be less credible compared to negative outcomes, but industry funding had no significant effects. Psychiatrists may underestimate the influence of funding sources on research results. The fact that physicians indicated negative outcomes to be more credible may point to more awareness of existing publication bias in the scientific literature.

Clinical Trial Publication Trends Within Neurology

Timely dissemination of results from clinical studies is crucial for the advancement of knowledge and clinical decision making. A large body of research has shown that up to half of clinical trials do not publish their findings. In this study, we sought to determine whether clinical trial publication rates within neurology have increased over time. Focusing on neurology clinical trials completed between 2008 to 2014, we found that while the overall percentage of published trials has not changed (remaining at approximately 50%), time to publication has significantly decreased. Our findings suggest that clinical trials within neurology are being published in a more timely manner.

A kinked meta-regression model for publication bias correction

Publication bias distorts the available empirical evidence and misinforms policymaking. Evidence of publication bias is mounting in virtually all fields of empirical research. This paper proposes the endogenous kink (EK) meta-regression model as a novel method of publication bias correction. The EK method fits a piecewise linear meta-regression of the primary estimates on their standard errors, with a kink at the cutoff value of the standard error below which publication selection is unlikely. We provide a simple method of endogenously determining this cutoff value as a function of a first-stage estimate of the true effect and an assumed threshold of statistical significance. Our Monte Carlo simulations show that EK is less biased and more efficient than other related regression-based methods of publication bias correction in a variety of research conditions.