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Mikelis F, Karamalaki D, Mikeli A, Tzanetakis GN, Koletsi D. Data sharing and transparency indicators in published RCTs in Oral Health between 2017 and 2023. J Dent 2024; 149:105263. [PMID: 39047892 DOI: 10.1016/j.jdent.2024.105263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES To record the proportion of data sharing reporting in terms of primary data and/or statistical code of Randomized Controlled Trials (RCTs), published across 12 high impact journals in Dentistry, covering 6 specialty domains. Associations with certain journal, publication and outcome characteristics were examined. Transparency indicators such as registration or funding statements were assessed. METHODS We identified and included all RCTs published from January 1st, 2017 to December 31st, 2023 in journals of high impact of the following domains: Periodontology, Endodontics, Restorative Dentistry/Prosthodontics, Orthodontics, Pediatric Dentistry, Oral/Maxillofacial Surgery. The primary outcome was the proportion of RCTs reporting their intent to share or openly shared primary data and we tested for associations with potential predictors. Funding, registration, and statistical code/script sharing practices were also examined. RESULTS A total of 752 RCTs were included, of which only 119 (15.8%) either openly provided their data or included a statement of intention to share upon request. Only one study openly provided the statistical code underlying the analysis used. RCTs in periodontology more frequently included statements about positive intent to share (57/210;27.1%), followed by Orthodontics (35/157;22.3%). Significant effects of year, dentistry domain and continent of authorship on data sharing practices were identified (p < 0.001 in all cases). There was evidence that registered RCTs had 2.04 times higher odds for intention to share data (95%confidence interval: 1.06, 3.92;p = 0.03). CONCLUSIONS Overall, in oral health RCTs, empirical evidence suggested very low prevalence of positive data sharing practices. Enhancing transparency is pivotal in promoting reproducibility and credibility of research findings. CLINICAL SIGNIFICANCE The findings of this empirical report bring attention to key transparency indicators in randomized controlled trials. These largely impact on the credibility and reproducibility of the evidence base for clinical decision making.
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Affiliation(s)
- Filippos Mikelis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Karamalaki
- School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Mikeli
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Giorgos N Tzanetakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Meta- Research Innovation Center at Stanford (METRICS), Stanford University, California, USA.
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Heymann J, Su N, Faggion CM. Differences in the reporting of conflicts of interest and sponsorships in systematic reviews with meta-analyses in dentistry: an examination of factors associated with their reporting. Res Integr Peer Rev 2024; 9:10. [PMID: 39350298 PMCID: PMC11443767 DOI: 10.1186/s41073-024-00150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/18/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Reporting conflicts of interest (COI) and sources of sponsorship are of paramount importance in adequately interpreting the results of systematic reviews. Some evidence suggests that there is an influence of COI and sponsorship on the study results. The objectives of this meta-research study were twofold: (a) to assess the reporting of COI and sponsorship statements in systematic reviews published in dentistry in three sources (abstract, journal's website and article's full text) and (b) to assess the associations between the characteristics of the systematic reviews and reporting of COI. METHODS We searched the PubMed database for dental systematic reviews published from database inception to June 2023. We assessed how COI and sponsorship statements were reported in the three sources. We performed a logistic regression analysis to assess the associations between the characteristics of the systematic reviews and the reporting of COI. RESULTS We assessed 924 abstracts published in PubMed and on the corresponding journals´ websites. Similarly, full texts associated with the 924 abstracts were also assessed. A total of 639 (69%) and 795 (88%) studies had no statement of COI in the abstracts on PubMed and the journal's website, respectively. In contrast, a COI statement was reported in 801 (87%) full texts. Sponsorship statements were not reported in 911 (99%) and 847 (93%) abstracts published in PubMed and a journal´s website, respectively. Nearly two-thirds of the full-text articles (N = 607) included sponsorship statements. Journal access was significantly associated with COI statement reporting in all three sources. Open-access journals have significantly higher odds to report COI in PubMed and full-texts, while have significantly lower odds to report COI in the websites, compared with subscription or hybrid journals. Abstract type was significantly associated with COI statement reporting on the journal's website and in the full text. Review registration based on the full text and the number of authors were significantly associated with COI statement reporting in PubMed and in the full texts. Several other variables were found to be significantly associated with COI statement reporting in one of the three sources. CONCLUSIONS COI and sponsorship statements seem to be underreported in the abstracts and homepage of the journals, compared to the full-texts. These results were particularly more pronounced in abstracts published in both the PubMed database and the journals' websites. Several characteristics of systematic reviews were associated with COI statement reporting.
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Affiliation(s)
- Jonas Heymann
- Department of Periodontology and Operative Dentistry, University Hospital Münster, Waldeyerstraße 30, 48149, Münster, Germany
| | - Naichuan Su
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA, Amsterdam, The Netherlands
| | - Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, University Hospital Münster, Waldeyerstraße 30, 48149, Münster, Germany.
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Ribeiro JP, Gluud C, Storm MRO, Storebø OJ. Should methylphenidate be included in the WHO model lists of essential medicines? Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02565-w. [PMID: 39264382 DOI: 10.1007/s00787-024-02565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Johanne Pereira Ribeiro
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Maja Rosenberg Overby Storm
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Ole Jakob Storebø
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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Hameed D, Sodhi N, Dubin J, Schneider A, Barrack RL, Mont MA. Integrating Smartphone Applications and Wearable Devices for Postoperative Rehabilitation in Total Knee Arthroplasty: A Critical Review. J Arthroplasty 2024; 39:2028-2039.e1. [PMID: 38403080 DOI: 10.1016/j.arth.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination. METHODS A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on applications, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by adherence and patient satisfaction, functional outcomes and pain scores, gait analyses and ranges of motion, and measurement and comparison tools. RESULTS A review of 24 of 25 publications related to smartphone applications used for postoperative recovery in TKA showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies used in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months. CONCLUSIONS Smartphone applications and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of TKA patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings.
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Affiliation(s)
- Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, North Shore University Hospital, Northwell Health, New York, New York
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Andrew Schneider
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Klasova J, Hussain N, Umer I, Al-Hindawi A, ElSaban M, Lahori S, D'Souza RS. Emotional and psychosocial function after dorsal column spinal cord stimulator implantation: a systematic review and meta-analysis. Reg Anesth Pain Med 2024:rapm-2024-105523. [PMID: 38942426 DOI: 10.1136/rapm-2024-105523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The efficacy of spinal cord stimulation (SCS) in chronic pain studies is traditionally assessed by pain scores, which do not reflect the multidimensional nature of pain perception. Despite the evidence of SCS's influence on emotional functioning comprehensive assessments of its effect remain lacking. OBJECTIVE To assess changes in emotional and psychosocial functioning in patients who underwent SCS implantation for chronic pain. EVIDENCE REVIEW Ovid MEDLINE, EMBASE, PsychINFO, Cochrane CENTRAL and Scopus databases were searched for original peer-reviewed publications reporting emotional functioning after SCS. The primary outcomes were a pooled mean difference (MD) in anxiety, depression, global functioning, mental well-being and pain catastrophizing at 12 months. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to determine the quality of evidence. FINDINGS Thirty-two studies were included in the primary analysis. Statistically significant improvements were observed in anxiety (MD -2.16; 95% CI -2.84 to -1.49; p<0.001), depression (MD -4.66; 95% CI -6.26 to -3.06; p<0.001), global functioning (MD 20.30; 95% CI 14.69 to 25.90; p<0.001), mental well-being (MD 4.95; 95% CI 3.60 to 6.31; p<0.001), and pain catastrophizing (MD -12.09; 95% CI -14.94 to -9.23; p<0.001). Subgroup analyses revealed differences in Global Assessment of Functioning and mental well-being based on study design and in depression based on waveform paradigm. CONCLUSION The results highlight the statistically and clinically significant improvements in emotional and psychosocial outcomes in patients with chronic pain undergoing SCS therapy. However, these results need to be interpreted with caution due to the very low certainty of evidence per the GRADE criteria. PROSPERO REGISTRATION CRD42023446326.
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Affiliation(s)
- Johana Klasova
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ibrahim Umer
- Department of Anesthesiology, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Ahmed Al-Hindawi
- Royal College of Surgeons in Ireland Medical University of Bahrain, Al Muharraq, Bahrain
| | - Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Simmy Lahori
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Kooragayala K, Moccia MC, Spitz F, Lenart A, Gandhi TV, Koneru M, Hong Y. Hepatic Ablation Technology: Assessment of Conflicts of Interest in Recent Literature. Am Surg 2024; 90:1497-1500. [PMID: 38557117 DOI: 10.1177/00031348241241714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Collaboration between the health care industry and surgeons is critical in modern medicine. Conflict of interest (COI) has the risk of introducing bias into research studies. We investigated the accuracy of self-disclosed COI for studies that researched the use of microwave ablation for liver metastasis. METHODS A literature search identified studies that investigated the use of microwave ablation for liver cancer between 2016 and 2022. We utilized the Open Payments Database to query individual authors' financial contributions from the industry. The accuracy of the disclosure statement and financial contribution for each study and author was calculated. We compared the amount of financial contribution authors received based on the accuracy of their COI statement. RESULTS Twenty-five studies of interest were identified. The mean number of authors was 8.24. A disclosure statement was present in 52% of studies. Of those, 28% had an incongruent disclosure statement. 9/25 (36%) of studies had a conflict of interest based on financial payments provided by industry. Overall, authors received an average of $440,483.41 (SD $1,889,375.34). We did not find a difference in the financial contribution's value based on the disclosure statement's accuracy (P = .55). CONCLUSIONS Over a quarter of studies in our review of microwave ablation literature had discrepancies in the reporting of conflicts of interest, highlighting the need for improved reporting of potential conflicts of interest to protect the integrity of clinical research. Compared to other fields of surgery, we found a lower rate of undisclosed COI, suggesting that the scope of cancer-directed surgery may be more resistant to industry influence.
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Affiliation(s)
| | - Matthew C Moccia
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Frank Spitz
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Austin Lenart
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Manisha Koneru
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Young Hong
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
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Fukuhara S, Kataoka Y, Aoki T, Green J, Shimizu S, Toyoda N. International Collaboration and Commercial Involvement in Randomized Controlled Trials From 10 Leading Countries, 1997 Through 2019. Cureus 2024; 16:e61205. [PMID: 38939267 PMCID: PMC11208843 DOI: 10.7759/cureus.61205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Randomized controlled trials (RCTs) affect clinical decisions and their number is increasing. However, trends in international collaboration on RCTs and involvement of healthcare-related industries, the latter of which may contribute to bias, are not known. The objectives were to identify concerns surrounding RCTs, and to quantify changes in (1) the numbers of RCT articles in journals of high clinical importance, (2) international collaboration, and (3) commercial involvement in RCTs by authors in countries that contribute the most to the scientific literature. This was not a systematic review of the medical literature. It is a descriptive study of trends during the past two decades. We extracted RCT articles from MEDLINE data (1997-2019). When grouped by authors' country, the analyses were limited to the 10 leading countries in the natural sciences, as defined by the Nature Index 2019 Annual Tables. The Core Clinical Journals (CCJ) filter in PubMed was used to identify journals that were likely to be highly relevant to clinical practice. RCT articles that included authors from multiple countries were used as examples of international collaboration, and RCTs in which at least one author's affiliation was corporate were considered to have commercial involvement. The annual number of RCT articles more than doubled (from 10,360 to 22,384), but the number published in the CCJ was essentially unchanged (from 2,245 to 2,346). The vast majority of RCT articles had US-based authors. International collaboration increased in nine of the 10 countries studied, and it was particularly common among researchers in Europe, Canada, and Australia. In contrast, international collaboration decreased in China. Regarding commercial involvement, between 1997 and 2019 the proportion of single-country RCTs with commercial involvement decreased (from 12.4% to 3.8% for the United States, and from 2.5% to 0.0% for Europe-Canada-Australia). In contrast, the proportion of international-collaborative RCTs with commercial involvement increased (from 9.2% to 17.6% for the United States, and from 17.9% to 21.3% for Europe-Canada-Australia). The largest change in commercial involvement was the 12-fold increase in Japan: from 3% to 36% (1997-2019). Japan was also noteworthy for its 28-percentage-point decrease in first-authorship of RCT articles from 2012 to 2019. In conclusion, recent increases in the number of RCT articles have occurred almost exclusively outside the CCJ. Thus, many newer RCT articles might have relatively low clinical relevance or impact. International collaboration has generally increased, along with commercial involvement. The latter has become particularly common in Japan, increasing the potential for sponsorship bias. The effects of ongoing attempts to reverse that trend should be evaluated.
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Affiliation(s)
- Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JPN
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR) and Center for Innovative Research for Community & Clinical Experience (CiRCLE) Fukushima Medical University, Fukushima, JPN
| | - Yuki Kataoka
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JPN
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
| | - Takuya Aoki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JPN
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, JPN
| | - Joseph Green
- Graduate School of Medicine, The University of Tokyo, Tokyo, JPN
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JPN
- Department of Research, Patient Driven Academic League (PeDAL), Tokyo, JPN
| | - Nagayasu Toyoda
- Department of Obstetrics and Gynecology, Suzuka University of Medical Science, Suzuka, JPN
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Malone RE. Stop tobacco industry sponsorship of continuing medical education. BMJ 2024; 385:q950. [PMID: 38670579 DOI: 10.1136/bmj.q950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
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Wang Z, Lu C, Cui L, Fenfen E, Shang W, Wang Z, Song G, Yang K, Li X. Consumption of ultra-processed foods and multiple health outcomes: An umbrella study of meta-analyses. Food Chem 2024; 434:137460. [PMID: 37722333 DOI: 10.1016/j.foodchem.2023.137460] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
Consumption of ultra-processed foods (UPFs) is associated with various adverse health outcomes, which significantly influence the global disease burden. This umbrella review aimed to fill the knowledge gap and guide public health practices by summarizing the association between UPFs and multiple health outcomes. A total of four databases were systematically searched from inception to December 2022, and 14 eligible systematic reviews (SRs) with meta-analyses (MAs) were identified. The SRs were published in 10 journals from 2020 to 2023, with 54,147-5,750,133 participants and 5-61 studies. The overall corrected covered area (CCA) was corresponded to a slight overlap. The results showed that an increased UPFs consumption is associated with multiple health outcomes (e.g., obesity, diabetes, hypertension, mortality). Only two SRs were "Moderate" regarding the overall methodological quality, while the other twelve were "Low" or "Critically low". Therefore, well-conducted SRs with high-quality prospective cohorts with a particular focus on special populations are needed to verify these findings further.
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Affiliation(s)
- Ziyi Wang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Lu Cui
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - E Fenfen
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Wenru Shang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Guihang Song
- Gansu Healthcare Security Administration, Lanzhou 730000, China
| | - Kehu Yang
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
| | - Xiuxia Li
- Health Technology Assessment Center, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
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Randers EM, Gerdhem P, Stuge B, Diarbakerli E, Nordsletten L, Röhrl SM, Kibsgård TJ. The effect of minimally invasive sacroiliac joint fusion compared to sham operation: a double-blind randomized placebo-controlled trial. EClinicalMedicine 2024; 68:102438. [PMID: 38328752 PMCID: PMC10847054 DOI: 10.1016/j.eclinm.2024.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Background Minimally invasive fusion of the sacroiliac joint as treatment for low back pain may reduce pain and improve function compared to non-operative treatment, although clear evidence is lacking. The aim of this trial was to evaluate the effect of minimally invasive sacroiliac joint fusion compared to sham surgery on sacroiliac joint pain reduction. Methods In this double-blind randomized sham surgery-controlled trial patients with clinical diagnosis of sacroiliac joint pain confirmed with sacroiliac joint injection were included at two university hospitals in Sweden and Norway. Patients were randomized by the operating surgeon at each site to minimally invasive sacroiliac joint fusion or sham surgery. The primary endpoint was group difference in sacroiliac joint pain on the operated side at six months postoperatively, measured by the Numeric Rating Scale (0-10). Un-blinding and primary analysis were performed when all patients had completed six months follow-up. The trial is closed for new participants and was registered at clinicaltrials.gov: NCT03507049. Findings Between September 1st, 2018 and October 22nd, 2021, 63 patients were randomized, 32 to the surgical group, 31 to the sham group. Mean age was 45 years (range 26-63) and 59 of 63 (94%) patients were female. The mean reduction in the operated sacroiliac joint from baseline to six months postoperative was 2.6 Numeric Rating Scale points in the surgical group and 1.7 points in the sham group (mean between groups difference -1.0 points; 95% CI, -2.2 to 0.3; p = 0.13). Interpretation This double-blind randomized controlled trial could not prove that minimally invasive fusion of the sacroiliac joint was superior to sham surgery at six months postoperative. Funding Sophies Minde Ortopedi supported a clinical research position for Engelke Marie Randers. Region Stockholm supported the cost for the Swedish ethical application and a clinical research appointment for Paul Gerdhem.
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Affiliation(s)
- Engelke Marie Randers
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Sweden
- Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Sweden
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Elias Diarbakerli
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Stephan M. Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Thomas Johan Kibsgård
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
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Jafar U, Usama M, Hase NE, Yaseen H, Nayyar A, Rabinowitz JB, Aziz H. Analysis of Conflicts of Interest in Studies Related to Robotics in Gastrointestinal and Abdominal Wall Surgery. J Am Coll Surg 2024; 238:54-60. [PMID: 37870232 DOI: 10.1097/xcs.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Industry payments to physicians represent a potential conflict of interest (COI) and can influence the study conclusions. This study aimed to evaluate the accuracy of the COIs reported in major surgical journals. STUDY DESIGN Studies with at least one American author published between 2016 and 2021 that discussed observational and intervention studies assessing robotic surgery were included in the analysis. The Centers for Medicare & Medicaid Services' Open Payments database was used to collect the industry payments. A COI is defined as receiving funding from a robotics company while publishing research directly related to the company's products. A COI statement was defined as disclosed (or accurate) if the disclosure statement for the study in question acknowledged funding from the robotics companies. A COI was defined as undisclosed (or inaccurate) if the disclosure statement for the study in question did not acknowledge funding from the robotics companies. RESULTS A total of 314 studies and 1978 authors were analyzed. Only 13.6% of the studies had accurate COI statements, whereas the majority (86.4%) had inaccurate COI disclosures. Additionally, 48.9% of the authors who received funding of $10,000 to $100,000 failed to report this amount in their disclosures, and 18% of the authors who received funding of $100,000 or more did not report it in their disclosures. CONCLUSIONS There was a significant discordance between the self-reported COI in gastrointestinal and abdominal wall surgeries. This study calls for continued efforts to improve the definitions of what constitutes a relevant COI and encourages a standardized reporting process. It is imperative for investigators to make accurate disclosure statements.
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Affiliation(s)
- Uzair Jafar
- From the Department of Surgery, King Edward Medical University, Lahore, Pakistan (Jafar, Usama, Yaseen)
| | - Muhammad Usama
- From the Department of Surgery, King Edward Medical University, Lahore, Pakistan (Jafar, Usama, Yaseen)
| | - Niklas E Hase
- Department of Surgery, Tufts School of Medicine, Boston, MA (Hase, Rabinowitz)
| | - Haris Yaseen
- From the Department of Surgery, King Edward Medical University, Lahore, Pakistan (Jafar, Usama, Yaseen)
| | - Apoorve Nayyar
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA (Nayyar, Aziz)
| | - Judy B Rabinowitz
- Department of Surgery, Tufts School of Medicine, Boston, MA (Hase, Rabinowitz)
| | - Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA (Nayyar, Aziz)
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Thompson AA, Mayfield CK, Bashrum BS, Abu-Zahra M, Petrigliano FA, Liu JN. Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses of Ulnar Collateral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:100808. [PMID: 37965531 PMCID: PMC10641735 DOI: 10.1016/j.asmr.2023.100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/06/2023] [Indexed: 11/16/2023] Open
Abstract
Purpose To identify the quantity and types of spin present in systematic reviews and meta-analyses of ulnar collateral ligament reconstruction (UCLR) outcomes and to characterize the studies with spin to determine if any patterns exist. Methods This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In August 2022, PubMed, Scopus, and SportDiscus databases were searched using the terms "ulnar collateral ligament reconstruction" AND "systematic review" OR "meta-analysis." Each abstract was assessed for the presence of the 15 most common types of spin derived from a previously established methodology. General data that were extracted included study title, authors, publication year, journal, level of evidence, study design, funding source, reported adherence to PRISMA guidelines, preregistration of the study protocol, and methodologic quality per A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2). Results In total, 122 studies were identified during the preliminary search, of which 19 met the inclusion criteria. Each study had at least 1 form of spin. The most common type of spin identified was type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") (7/19, 36.8%). AMSTAR type 9 ("Did the review authors use a satisfactory technique for assessing the RoB [risk of bias] in individual studies that were included in the review?") was associated with both a lower Clarivate Impact Factor (P = .001) and a lower Scopus CiteScore (P = .015). Studies receiving external funding were associated with the failure to satisfy AMSTAR type 3 ("Did the review authors explain their selection of the study designs for inclusion in the review?") (P = .047). Conclusions Spin is highly prevalent in the abstracts of systematic reviews and meta-analyses that investigate the outcomes of UCLR. Clinical Relevance Spin has been identified in peer-reviewed articles published on various topics, including many in orthopaedics. Systematic reviews and meta-analyses contain the most comprehensive evidence regarding a clinical question, so it is important to identify spin that may be included in these reports. Greater efforts are needed to ensure that the abstracts of papers accurately represent the results in the full text.
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Affiliation(s)
- Ashley A. Thompson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, U.S.A
| | - Cory K. Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, U.S.A
| | - Bryan S. Bashrum
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, U.S.A
| | - Maya Abu-Zahra
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, U.S.A
| | - Frank A. Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, U.S.A
| | - Joseph N. Liu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, U.S.A
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13
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Zhu L, Yang Z, Deng H, Zhang Y, Liao X, Clarke M. Citation of updated and co-published Cochrane Methodology Reviews. Syst Rev 2023; 12:120. [PMID: 37443094 PMCID: PMC10347811 DOI: 10.1186/s13643-023-02270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND To evaluate the number of citations for Cochrane Methodology Reviews after they have been updated or co-published in another journal, and the effect of co-publishing the review on the co-publishing journal's impact factor (IF). METHODS We identified all Cochrane Methodology Reviews published in the Cochrane Database of Systematic Reviews (CDSR) before 2018 and searched for co-published versions in the Web of Science Core Collection database up to 16 August 2022. The included reviews were in two cohorts: those that had been published and updated in CDSR and those that had been published in CDSR and co-published in another journal. The primary outcome measured the citation number to updated and original reviews in the first five years after publication of the updated review, and assessed the citation number of co-published and non-co-published reviews in the first five years after publication of the co-published version. The secondary outcome was the ratio of an adjusted IF and the actual IF of the co-publishing journal. RESULTS Eight updated and six original reviews were identified for the updated cohort of reviews, and four co-published reviews were included in the co-published cohort. The original reviews continued to be cited after the update was published but the median for the total number of citations was non-significantly higher for the updated reviews than for their original version[161 (Interquartile range (IQR) 85, 198) versus 113 (IQR 15, 433)]. The median number of total citations [362 (IQR 179, 840) versus 145 (IQR 75, 445)] and the median number of citations to the review in the first five years after co-publication combined and in each of those years was higher in the co-published group than in the non-co-published group. One of the three journals that co-published Reviews in the first year and two journals in the second year had a lower IF after co-publication. CONCLUSIONS Earlier versions of Cochrane Methodology Reviews continue to be cited after an update is published, which raises doubts about whether those citing are using the most recent evidence or are aware of the update. Co-publication facilitates broader application and dissemination of Cochrane methodology evidence.
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Affiliation(s)
- Linlin Zhu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ziyu Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongyu Deng
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, Northern Ireland.
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Li Z, Wang Y, Xu Q, Ma J, Li X, Tian Y, Wen Y, Chen T. Ginseng and health outcomes: an umbrella review. Front Pharmacol 2023; 14:1069268. [PMID: 37465522 PMCID: PMC10351045 DOI: 10.3389/fphar.2023.1069268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/09/2023] [Indexed: 07/20/2023] Open
Abstract
Background: Ginseng consumption has been associated with various health outcomes. However, there are no review articles summarizing these reports. Methods: PubMed, Embase, the Cochrane Library of Systematic Reviews, Scopus, CNKI and Wanfang databases were searched from inception to 31 July 2022. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) systems were used to assess the methodological quality and quality of evidence in each meta-analysis, and the results were summarized in a narrative form. Results: Nineteen meta-analyses that met the eligibility criteria were identified from among 1,233 papers. The overall methodological quality was relatively poor, with only five studies being low-quality, and 14 critically low-quality. When compared with control treatments (mainly placebo), ginseng was beneficial for improving fatigue and physical function, sexual function, menopausal symptoms, metabolic indicators, inflammatory markers, unstable angina and respiratory diseases. Adverse events included gastrointestinal symptoms and potential bleeding; however, no serious adverse events were reported. Conclusion: This umbrella review suggests that ginseng intake has beneficial therapeutic effects for diverse diseases. However, the methodological quality of studies needs to be improved considerably. In addition, it is imperative to establish the clinical efficacy of ginseng through high-quality randomized controlled trials.
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Affiliation(s)
- Zhongyu Li
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Wang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qing Xu
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinxin Ma
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuan Li
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yibing Tian
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yandong Wen
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Chinese Medicine, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ting Chen
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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15
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ElSaban M, Kleppel DJ, Kubrova E, Martinez Alvarez GA, Hussain N, D'Souza RS. Physical functioning following spinal cord stimulation: a systematic review and meta-analysis. Reg Anesth Pain Med 2023; 48:302-311. [PMID: 37080578 DOI: 10.1136/rapm-2022-104295] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking. OBJECTIVE The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain. EVIDENCE REVIEW PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence. FINDINGS A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type. CONCLUSION This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
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Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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16
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McDonald A, McCausland K, Thomas L, Daube M, Jancey J. Smoke and mirrors? Conflict of interest declarations in tobacco and e-cigarette-related academic publications. Aust N Z J Public Health 2023:100055. [PMID: 37230897 DOI: 10.1016/j.anzjph.2023.100055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE This research explored international tobacco control experts' level of satisfaction with conflict of interest (COI) declaration processes; and the transparency of COI declarations of identified authors publishing in the tobacco, e-cigarette, and related novel products academic literature. METHODS This case study profiled 10 authors' (identified by expert panel) COIs pertaining to the tobacco industry; identified the 10 authors' publications (2010-2021); and assessed the transparency of the COI declarations within the publications. RESULTS All authors received indirect or direct funding from the tobacco industry. On review of the authors' 553 publications, 61% of COI and funding declarations were accessible, 33% were partially accessible and 6% were inaccessible. Overall, 33% of authors provided complete COI declarations, 51% provided incomplete declarations, and 16% provided no declaration. CONCLUSION This research demonstrates existing guidelines and recommendations for reporting COI declarations are not sufficiently robust to ensure transparency in reporting of COI declarations within the field. IMPLICATIONS FOR PUBLIC HEALTH Research outcomes have the potential to define public health discourse and influence public opinion, practices, and policy. It is critical that research remains independent and protected from the influence of the tobacco industry. Processes for monitoring and enforcing accurate reporting of COI declarations are needed.
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Affiliation(s)
- Amy McDonald
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia.
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Laura Thomas
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley, WA, 6102, Australia
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Via GG, Brueggeman DA, Lyons JG, Frommeyer TC, Froehle AW, Krishnamurthy AB. Funding has no effect on studies evaluating viscosupplementation for knee osteoarthritis: A systematic review of bibliometrics and conflicts of interest. J Orthop 2023; 39:18-29. [PMID: 37089621 PMCID: PMC10114245 DOI: 10.1016/j.jor.2023.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/11/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Background Viscosupplementation for knee osteoarthritis (OA) may raise concerns regarding conflicts of interest (COI). Evidence of inconclusive study results and publication bias in previous studies has led to concern that financial COI have influenced viscosupplementation outcomes. It is critical to ensure that clinical practice is guided by informed decision making and evidence-based medicine. Methods A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, and Web of Science databases were searched for articles pertaining to hyaluronic acid (or similarly derived) injections to native knees with primary OA only. Bibliometric data, financial COI, and study outcomes were assessed. Results 67 studies met inclusion criteria for analysis, 53 of which (79.1%) presented Level I evidence, and 21 of which (31.3%) reported at least one author with COI. All studies reporting COI also disclosed industry funding. There were no relationships between reported COI and study outcomes (Χ 2 = 0.31, P = 0.577), levels of evidence (Χ 2 = 3.48, P = 0.176), or relative citation ratio (RCR) (S = 743, P = 0.591). Studies reporting COIs/industry funding tended to be published in journals with significantly higher impact factors (IF) (reporting COI: IF = 3.5 ± 2.0; no COI: IF = 1.8 ± 1.1; S = 950, P < 0.001). Study outcomes were not related to the probability of being published in an open access journal (Χ 2 = 0.01, P = 0.960), nor to level of evidence (Χ 2 = 2.67, P = 0.263), RCR (S = 618, P = 0.835), or IF (S = 563, P = 0.655). Conclusions Investigator COIs (and commercial funding of studies) have not significantly influenced the frequency of favorable outcomes or study level of evidence regarding contemporary viscosupplementation for the treatment of knee OA. Studies reporting COIs/industry funding tended to be published in journals with significantly higher impact factors. Results overwhelmingly supported using viscosupplementation to treat knee OA. Level of evidence Level V Systematic Review.
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Affiliation(s)
- Garrhett Glenn Via
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - David Anthony Brueggeman
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - Joseph Gabriel Lyons
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - Timothy Charles Frommeyer
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
| | - Andrew William Froehle
- Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, OH, 45409, USA
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Sánchez-Iglesias I, Martín-Aguilar C. Significant Differences and Experimental Designs Do Not Necessarily Imply Clinical Relevance: Effect Sizes and Causality Claims in Antidepressant Treatments. J Clin Med 2023; 12:jcm12093181. [PMID: 37176620 PMCID: PMC10179584 DOI: 10.3390/jcm12093181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Clinical trials are the backbone of medical scientific research. However, this experimental strategy has some drawbacks. We focused on two issues: (a) The internal validity ensured by clinical trial procedures does not necessarily allow for generalization of efficacy results to causal claims about effectiveness in the population. (b) Statistical significance does not imply clinical or practical significance; p-values should be supplemented with effect size (ES) estimators and an interpretation of the magnitude of the effects found. We conducted a systematic review (from 2000 to 2020) on Scopus, PubMed, and four ProQuest databases, including PsycINFO. We searched for experimental studies with significant effects of pharmacological treatments on depressive symptoms, measured with a specific scale for depression. We assessed the claims of effectiveness, and reporting and interpreting of effect sizes in a small, unbiased sample of clinical trials (n = 10). Only 30% of the studies acknowledged that efficacy does not necessarily translate to effectiveness. Only 20% reported ES indices, and only 40% interpreted the magnitude of their findings. We encourage reflection on the applicability of results derived from clinical trials about the efficacy of antidepressant treatments, which often influence daily clinical decision-making. Comparing experimental results of antidepressants with supplementary observational studies can provide clinicians with greater flexibility in prescribing medication based on patient characteristics. Furthermore, the ES of a treatment should be considered, as treatments with a small effect may be worthwhile in certain circumstances, while treatments with a large effect may be justified despite additional costs or complications. Therefore, researchers are encouraged to report and interpret ES and explicitly discuss the suitability of their sample for the clinical population to which the antidepressant treatment will be applied.
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Affiliation(s)
- Iván Sánchez-Iglesias
- Department of Psychobiology & Behavioral Sciences Methods, Complutense University of Madrid, 28223 Madrid, Spain
| | - Celia Martín-Aguilar
- Centro Universitario San Rafael-Nebrija, Universidad Nebrija, 28036 Madrid, Spain
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Jørgensen CK, Juul S, Siddiqui F, Horowitz MA, Moncrieff J, Munkholm K, Hengartner MP, Kirsch I, Gluud C, Jakobsen JC. The risks of adverse events with venlafaxine and mirtazapine versus 'active placebo', placebo, or no intervention for adults with major depressive disorder: a protocol for two separate systematic reviews with meta-analysis and Trial Sequential Analysis. Syst Rev 2023; 12:57. [PMID: 36991504 PMCID: PMC10061867 DOI: 10.1186/s13643-023-02221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Major depressive disorder causes a great burden on patients and societies. Venlafaxine and mirtazapine are commonly prescribed as second-line treatment for patients with major depressive disorder worldwide. Previous systematic reviews have concluded that venlafaxine and mirtazapine reduce depressive symptoms, but the effects seem small and may not be important to the average patient. Moreover, previous reviews have not systematically assessed the occurrence of adverse events. Therefore, we aim to investigate the risks of adverse events with venlafaxine or mirtazapine versus 'active placebo', placebo, or no intervention for adults with major depressive disorder in two separate systematic reviews. METHODS This is a protocol for two systematic reviews with meta-analysis and Trial Sequential Analysis. The assessments of the effects of venlafaxine or mirtazapine will be reported in two separate reviews. The protocol is reported as recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, risk of bias will be assessed with the Cochrane risk-of-bias tool version 2, clinical significance will be assessed using our eight-step procedure, and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. We will search for published and unpublished trials in major medical databases and trial registers. Two review authors will independently screen the results from the literature searches, extract data, and assess risk of bias. We will include published or unpublished randomised clinical trial comparing venlafaxine or mirtazapine with 'active placebo', placebo, or no intervention for adults with major depressive disorder. The primary outcomes will be suicides or suicide attempts, serious adverse events, and non-serious adverse events. Exploratory outcomes will include depressive symptoms, quality of life, and individual adverse events. If feasible, we will assess the intervention effects using random-effects and fixed-effect meta-analyses. DISCUSSION Venlafaxine and mirtazapine are frequently used as second-line treatment of major depressive disorder worldwide. There is a need for a thorough systematic review to provide the necessary background for weighing the benefits against the harms. This review will ultimately inform best practice in the treatment of major depressive disorder. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022315395.
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Affiliation(s)
- Caroline Kamp Jørgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, Odense C, 5000 Odense, Denmark
| | - Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Stolpegaardsvej 28, 2820 Gentofte, Denmark
| | - Faiza Siddiqui
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Mark Abie Horowitz
- Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT England
- Research and Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Ilford, IG3 8XJ London, England
| | - Joanna Moncrieff
- Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT England
- Research and Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Ilford, IG3 8XJ London, England
| | - Klaus Munkholm
- Mental Health Centre Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Hovedvejen 17, 2000 Frederiksberg, Copenhagen Denmark
- Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Michael Pascal Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, 8005 Zurich, Switzerland
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, Odense C, 5000 Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, Odense C, 5000 Odense, Denmark
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Storebø OJ, Storm MRO, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, Schaug JP, Darling Rasmussen P, Huus CML, Zwi M, Kirubakaran R, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2023; 3:CD009885. [PMID: 36971690 PMCID: PMC10042435 DOI: 10.1002/14651858.cd009885.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.
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Affiliation(s)
- Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Maria Skoog
- Clinical Study Support, Clinical Studies Sweden - Forum South, Lund, Sweden
| | - Camilla Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | | | | | | | - Morris Zwi
- Islington Child and Adolescent Mental Health Service, Whittington Health, London, UK
| | - Richard Kirubakaran
- Cochrane India-CMC Vellore Affiliate, Prof. BV Moses Centre for Evidence Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Erik Simonsen
- Research Unit, Mental Health services, Region Zealand Psychiatry, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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21
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Calmy A, Wandeler G, Egger M. Need for clear inclusion criteria in reviews of antiretroviral treatments. Lancet HIV 2023; 10:e150. [PMID: 36773625 DOI: 10.1016/s2352-3018(23)00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Alexandra Calmy
- HIV/AIDS Unit, Infectious Diseases Division, Geneva University Hospitals, 1211 Geneva 14, Switzerland.
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Woodruff TJ, Rayasam SDG, Axelrad DA, Koman PD, Chartres N, Bennett DH, Birnbaum LS, Brown P, Carignan CC, Cooper C, Cranor CF, Diamond ML, Franjevic S, Gartner EC, Hattis D, Hauser R, Heiger-Bernays W, Joglekar R, Lam J, Levy JI, MacRoy PM, Maffini MV, Marquez EC, Morello-Frosch R, Nachman KE, Nielsen GH, Oksas C, Abrahamsson DP, Patisaul HB, Patton S, Robinson JF, Rodgers KM, Rossi MS, Rudel RA, Sass JB, Sathyanarayana S, Schettler T, Shaffer RM, Shamasunder B, Shepard PM, Shrader-Frechette K, Solomon GM, Subra WA, Vandenberg LN, Varshavsky JR, White RF, Zarker K, Zeise L. A science-based agenda for health-protective chemical assessments and decisions: overview and consensus statement. Environ Health 2023; 21:132. [PMID: 36635734 PMCID: PMC9835243 DOI: 10.1186/s12940-022-00930-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
The manufacture and production of industrial chemicals continues to increase, with hundreds of thousands of chemicals and chemical mixtures used worldwide, leading to widespread population exposures and resultant health impacts. Low-wealth communities and communities of color often bear disproportionate burdens of exposure and impact; all compounded by regulatory delays to the detriment of public health. Multiple authoritative bodies and scientific consensus groups have called for actions to prevent harmful exposures via improved policy approaches. We worked across multiple disciplines to develop consensus recommendations for health-protective, scientific approaches to reduce harmful chemical exposures, which can be applied to current US policies governing industrial chemicals and environmental pollutants. This consensus identifies five principles and scientific recommendations for improving how agencies like the US Environmental Protection Agency (EPA) approach and conduct hazard and risk assessment and risk management analyses: (1) the financial burden of data generation for any given chemical on (or to be introduced to) the market should be on the chemical producers that benefit from their production and use; (2) lack of data does not equate to lack of hazard, exposure, or risk; (3) populations at greater risk, including those that are more susceptible or more highly exposed, must be better identified and protected to account for their real-world risks; (4) hazard and risk assessments should not assume existence of a "safe" or "no-risk" level of chemical exposure in the diverse general population; and (5) hazard and risk assessments must evaluate and account for financial conflicts of interest in the body of evidence. While many of these recommendations focus specifically on the EPA, they are general principles for environmental health that could be adopted by any agency or entity engaged in exposure, hazard, and risk assessment. We also detail recommendations for four priority areas in companion papers (exposure assessment methods, human variability assessment, methods for quantifying non-cancer health outcomes, and a framework for defining chemical classes). These recommendations constitute key steps for improved evidence-based environmental health decision-making and public health protection.
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Affiliation(s)
- Tracey J Woodruff
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA.
| | - Swati D G Rayasam
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | | | - Patricia D Koman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Chartres
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | - Deborah H Bennett
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Linda S Birnbaum
- National Institutes of Environmental Health Sciences and National Toxicology Program, Research Triangle Park, NC, USA
- Duke University, Durham, NC, USA
| | - Phil Brown
- Social Science Environmental Health Research Institute, Northeastern University, Boston, MA, USA
| | - Courtney C Carignan
- Department of Food Science and Human Nutrition, Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA
| | - Courtney Cooper
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | - Carl F Cranor
- Department of Philosophy, University of California, Riverside, Riverside, CA, USA
- Environmental Toxicology Graduate Program, College of Natural and Agricultural Sciences, University of California, Riverside, Riverside, CA, USA
| | - Miriam L Diamond
- Department of Earth Sciences, University of Toronto, Toronto, ON, Canada
- School of the Environment, University of Toronto, Toronto, ON, Canada
| | | | | | - Dale Hattis
- The George Perkins Marsh Institute, Clark University, Worcester, MA, USA
| | - Russ Hauser
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Wendy Heiger-Bernays
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | | | - Juleen Lam
- Department of Public Health, California State University, East Bay, Hayward, CA, USA
| | - Jonathan I Levy
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | | | | | | | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Greylin H Nielsen
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Catherine Oksas
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dimitri Panagopoulos Abrahamsson
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
| | - Heather B Patisaul
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
| | | | - Joshua F Robinson
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 490 Illinois Street, Floor 10, Box 0132, San Francisco, CA, 94143, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ted Schettler
- Science and Environmental Health Network, Ames, IA, USA
| | - Rachel M Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, USA
| | - Bhavna Shamasunder
- Department of Urban & Environmental Policy and Public Health, Occidental College, Los Angeles, CA, USA
| | | | - Kristin Shrader-Frechette
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
- Department of Philosophy, University of Notre Dame, Notre Dame, IN, USA
| | - Gina M Solomon
- School of Medicine, University of California, San Francisco, CA, USA
- Public Health Institute, Oakland, CA, USA
| | - Wilma A Subra
- Louisiana Environmental Action Network, Baton Rouge, LA, USA
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Amherst, MA, USA
| | - Julia R Varshavsky
- Department of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Roberta F White
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA
| | - Ken Zarker
- Washington State Department of Ecology, Olympia, WA, USA
| | - Lauren Zeise
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Lorenzo C, Neves F. Bioethics and sociology: the place of social studies of science and technology. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2023. [DOI: 10.1590/interface.220046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The social sciences have integrated the analytical and normative practices of bioethics. However, with some exceptions, the proposals have been epistemically limited to the methodological scope and strictly directed to biomedical care practices. Taking some data on the strategies of production of new drugs by the pharmaceutical industry, this essay intends to demonstrate the possible contributions of the social studies of science and technology to a theoretical-methodological foundation of bioethical analyzes around global health issues, such as the production and distribution of technologies. We conclude that at least three types of analyzes would benefit from this proximity: analyzes of the epistemological integrity of the health sciences; ethical-political analyzes around the access and security of new and old health technologies; and ethical-philosophical analyzes of harmful attitudes of the scientific community and health professionals in relation to health care.
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Chartres N, Sass JB, Gee D, Bălan SA, Birnbaum L, Cogliano VJ, Cooper C, Fedinick KP, Harrison RM, Kolossa-Gehring M, Mandrioli D, Mitchell MA, Norris SL, Portier CJ, Straif K, Vermeire T. Conducting evaluations of evidence that are transparent, timely and can lead to health-protective actions. Environ Health 2022; 21:123. [PMID: 36471342 PMCID: PMC9720912 DOI: 10.1186/s12940-022-00926-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In February 2021, over one hundred scientists and policy experts participated in a web-based Workshop to discuss the ways that divergent evaluations of evidence and scientific uncertainties are used to delay timely protection of human health and the environment from exposures to hazardous agents. The Workshop arose from a previous workshop organized by the European Environment Agency (EEA) in 2008 and which also drew on case studies from the EEA reports on 'Late Lessons from Early Warnings' (2001, 2013). These reports documented dozens of hazardous agents including many chemicals, for which risk reduction measures were delayed for decades after scientists and others had issued early and later warnings about the harm likely to be caused by those agents. RESULTS Workshop participants used recent case studies including Perfluorooctanoic acid (PFOA), Extremely Low Frequency - Electrical Magnetic Fields (ELF-EMF fields), glyphosate, and Bisphenol A (BPA) to explore myriad reasons for divergent outcomes of evaluations, which has led to delayed and inadequate protection of the public's health. Strategies to overcome these barriers must, therefore, at a minimum include approaches that 1) Make better use of existing data and information, 2) Ensure timeliness, 3) Increase transparency, consistency and minimize bias in evidence evaluations, and 4) Minimize the influence of financial conflicts of interest. CONCLUSION The recommendations should enhance the production of "actionable evidence," that is, reliable evaluations of the scientific evidence to support timely actions to protect health and environments from exposures to hazardous agents. The recommendations are applicable to policy and regulatory settings at the local, state, federal and international levels.
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Affiliation(s)
- Nicholas Chartres
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, 490 Illinois Street, Floor 10, San Francisco, CA, 94143, USA.
| | - Jennifer B Sass
- Natural Resources Defense Council, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | | | - Simona A Bălan
- California Department of Toxic Substances Control, Berkeley, CA, USA
- University of California at Berkeley, Berkeley, CA, USA
| | - Linda Birnbaum
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | - Courtney Cooper
- Program On Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, 490 Illinois Street, Floor 10, San Francisco, CA, 94143, USA
| | | | - Roy M Harrison
- School of Geography, Earth & Environmental Sciences, University of Birmingham, Birmingham, UK
- Department of Environmental Sciences/Centre of Excellence in Environmental Studies, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marike Kolossa-Gehring
- Department of Environmental Hygiene, Section Toxicology, Health Related Environmental Monitoring, German Federal Environmental Agency, Dessau-Roßlau, Germany
| | - Daniele Mandrioli
- Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bologna, Italy
| | - Mark A Mitchell
- George Mason University, Fairfax, VA, USA
- Connecticut Coalition for Environmental Justice, Hartford, CT, USA
| | - Susan L Norris
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Christopher J Portier
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Toxicogenomics, Maastricht University, Maastricht, Netherlands
- CJP Consulting, Seattle, WA, USA
| | - Kurt Straif
- ISGlobal, Barcelona, Spain
- Boston College, Newton, MA, USA
| | - Theo Vermeire
- Retired, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
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Stoffers-Winterling JM, Storebø OJ, Pereira Ribeiro J, Kongerslev MT, Völlm BA, Mattivi JT, Faltinsen E, Todorovac A, Jørgensen MS, Callesen HE, Sales CP, Schaug JP, Simonsen E, Lieb K. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev 2022; 11:CD012956. [PMID: 36375174 PMCID: PMC9662763 DOI: 10.1002/14651858.cd012956.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among people with a diagnosis of borderline personality disorder (BPD) who are engaged in clinical care, prescription rates of psychotropic medications are high, despite the fact that medication use is off-label as a treatment for BPD. Nevertheless, people with BPD often receive several psychotropic drugs at a time for sustained periods. OBJECTIVES To assess the effects of pharmacological treatment for people with BPD. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers up to February 2022. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA Randomised controlled trials comparing pharmacological treatment to placebo, other pharmacologic treatments or a combination of pharmacologic treatments in people of all ages with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. Secondary outcomes were individual BPD symptoms, depression, attrition and adverse events. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's risk of bias tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS We included 46 randomised controlled trials (2769 participants) in this review, 45 of which were eligible for quantitative analysis and comprised 2752 participants with BPD in total. This is 18 more trials than the 2010 review on this topic. Participants were predominantly female except for one trial that included men only. The mean age ranged from 16.2 to 39.7 years across the included trials. Twenty-nine different types of medications compared to placebo or other medications were included in the analyses. Seventeen trials were funded or partially funded by the pharmaceutical industry, 10 were funded by universities or research foundations, eight received no funding, and 11 had unclear funding. For all reported effect sizes, negative effect estimates indicate beneficial effects by active medication. Compared with placebo, no difference in effects were observed on any of the primary outcomes at the end of treatment for any medication. Compared with placebo, medication may have little to no effect on BPD symptom severity, although the evidence is of very low certainty (antipsychotics: SMD -0.18, 95% confidence interval (CI) -0.45 to 0.08; 8 trials, 951 participants; antidepressants: SMD -0.27, 95% CI -0.65 to 1.18; 2 trials, 87 participants; mood stabilisers: SMD -0.07, 95% CI -0.43 to 0.57; 4 trials, 265 participants). The evidence is very uncertain about the effect of medication compared with placebo on self-harm, indicating little to no effect (antipsychotics: RR 0.66, 95% CI 0.15 to 2.84; 2 trials, 76 participants; antidepressants: MD 0.45 points on the Overt Aggression Scale-Modified-Self-Injury item (0-5 points), 95% CI -10.55 to 11.45; 1 trial, 20 participants; mood stabilisers: RR 1.08, 95% CI 0.79 to 1.48; 1 trial, 276 participants). The evidence is also very uncertain about the effect of medication compared with placebo on suicide-related outcomes, with little to no effect (antipsychotics: SMD 0.05, 95 % CI -0.18 to 0.29; 7 trials, 854 participants; antidepressants: SMD -0.26, 95% CI -1.62 to 1.09; 2 trials, 45 participants; mood stabilisers: SMD -0.36, 95% CI -1.96 to 1.25; 2 trials, 44 participants). Very low-certainty evidence shows little to no difference between medication and placebo on psychosocial functioning (antipsychotics: SMD -0.16, 95% CI -0.33 to 0.00; 7 trials, 904 participants; antidepressants: SMD -0.25, 95% CI -0.57 to 0.06; 4 trials, 161 participants; mood stabilisers: SMD -0.01, 95% CI -0.28 to 0.26; 2 trials, 214 participants). Low-certainty evidence suggests that antipsychotics may slightly reduce interpersonal problems (SMD -0.21, 95% CI -0.34 to -0.08; 8 trials, 907 participants), and that mood stabilisers may result in a reduction in this outcome (SMD -0.58, 95% CI -1.14 to -0.02; 4 trials, 300 participants). Antidepressants may have little to no effect on interpersonal problems, but the corresponding evidence is very uncertain (SMD -0.07, 95% CI -0.69 to 0.55; 2 trials, 119 participants). The evidence is very uncertain about dropout rates compared with placebo by antipsychotics (RR 1.11, 95% CI 0.89 to 1.38; 13 trials, 1216 participants). Low-certainty evidence suggests there may be no difference in dropout rates between antidepressants (RR 1.07, 95% CI 0.65 to 1.76; 6 trials, 289 participants) and mood stabilisers (RR 0.89, 95% CI 0.69 to 1.15; 9 trials, 530 participants), compared to placebo. Reporting on adverse events was poor and mostly non-standardised. The available evidence on non-serious adverse events was of very low certainty for antipsychotics (RR 1.07, 95% CI 0.90 to 1.29; 5 trials, 814 participants) and mood stabilisers (RR 0.84, 95% CI 0.70 to 1.01; 1 trial, 276 participants). For antidepressants, no data on adverse events were identified. AUTHORS' CONCLUSIONS This review included 18 more trials than the 2010 version, so larger meta-analyses with more statistical power were feasible. We found mostly very low-certainty evidence that medication may result in no difference in any primary outcome. The rest of the secondary outcomes were inconclusive. Very limited data were available for serious adverse events. The review supports the continued understanding that no pharmacological therapy seems effective in specifically treating BPD pathology. More research is needed to understand the underlying pathophysiologic mechanisms of BPD better. Also, more trials including comorbidities such as trauma-related disorders, major depression, substance use disorders, or eating disorders are needed. Additionally, more focus should be put on male and adolescent samples.
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Affiliation(s)
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Johanne Pereira Ribeiro
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- District Psychiatric Services Roskilde, Region Zealand Mental Health Services, Roskilde, Denmark
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Jessica T Mattivi
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Erlend Faltinsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Mie S Jørgensen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | | | - Christian P Sales
- Duncan MacMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Institute of Mental Health, Department of Psychiatry & Applied Psychology, Nottingham, UK
| | - Julie Perrine Schaug
- Region Zealand Psychiatry, Center for Evidence Based Psychiatry, Slagelse, Denmark
| | - Erik Simonsen
- Research Unit, Mental Health Services, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Via GG, Brueggeman DA, Lyons JG, Ely IC, Froehle AW, Krishnamurthy AB. Funding has no effect on clinical outcomes of total joint arthroplasty emerging technologies: a systematic review of bibliometrics and conflicts of interest. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:45. [PMID: 36316729 PMCID: PMC9623935 DOI: 10.1186/s42836-022-00146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/14/2022] [Indexed: 11/06/2022]
Abstract
Background The use of new total joint arthroplasty technologies, including patient-specific implants/instrumentation (PSI), computer-assisted (CA), and robotic-assisted (RA) techniques, is increasing. There is an ongoing debate regarding the value provided and potential concerns about conflicts of interest (COI). Methods PRISMA guidelines were followed. PubMed, MEDLINE, and Web of Science databases were searched for total hip and knee arthroplasties, unicompartmental knee arthroplasties (UKA), PSI, CA, and RA. Bibliometric data, financial COI, clinical/functional scores, and patient-reported outcomes were assessed. Results Eighty-seven studies were evaluated, with 35 (40.2%) including at least one author reporting COI, and 13 (14.9%) disclosing industry funding. COI and industry funding had no significant effects on outcomes (P = 0.682, P = 0.447), and there were no significant effects of conflicts or funding on level of evidence (P = 0.508, P = 0.826). Studies in which author(s) disclosed COI had significantly higher relative citation ratio (RCR) and impact factor (IF) than those without (P < 0.001, P = 0.032). Subanalysis demonstrated RA and PSI studies were more likely to report COI or industry funding (P = 0.045). RA (OR = 6.31, 95% CI: 1.61–24.68) and UKA (OR = 9.14, 95% CI: 1.43–58.53) had higher odds of reporting favorable outcomes than PSI. Conclusions Author COIs (about 40%) may be lower than previously reported in orthopedic technologies/techniques reviews. Studies utilizing RA and PSI were more likely to report COI, while RA and UKA studies were more likely to report favorable outcomes than PSI. No statistically significant association between the presence of COIs and/or industry funding and the frequency of favorable outcomes or study level of evidence was found. Level of evidence Level V Systematic Review Supplementary Information The online version contains supplementary material available at 10.1186/s42836-022-00146-3.
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Affiliation(s)
- Garrhett G. Via
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - David A. Brueggeman
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Joseph G. Lyons
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Isabelle C. Ely
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Andrew W. Froehle
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Anil B. Krishnamurthy
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
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Zhong CCW, Zhao J, Wong CHL, Wu IXY, Mao C, Yeung JWF, Chung VCH. Methodological quality of systematic reviews on treatments for Alzheimer's disease: a cross-sectional study. Alzheimers Res Ther 2022; 14:159. [PMID: 36309725 PMCID: PMC9617345 DOI: 10.1186/s13195-022-01100-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/30/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Carefully conducted systematic reviews (SRs) can provide reliable evidence on the effectiveness of treatment strategies for Alzheimer's disease (AD). Nevertheless, the reliability of SR results can be limited by methodological flaws. This cross-sectional study aimed to examine the methodological quality of SRs on AD treatments, along with potentially relevant factors. METHODS To identify eligible SRs on AD treatments, four databases including the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, and PsycINFO were searched. The Assessing the Methodological Quality of Systematic Reviews 2 instrument was used for quality appraisal of SRs. Multivariable regression analyses were used to examine factors related to methodological quality. RESULTS A total of 102 SRs were appraised. Four (3.90%) SRs were considered as high quality; 14 (13.7%), 48 (47.1%), and 36 (35.3%) were as moderate, low, and critically low quality, respectively. The following significant methodological limitations were identified: only 22.5% of SRs registered protocols a priori, 6.9% discussed the rationales of chosen study designs, 21.6% gave a list of excluded studies with reasons, and 23.5% documented funding sources of primary studies. Cochrane SRs (adjusted odds ratio (AOR): 31.9, 95% confidence interval (CI): 3.81-266.9) and SRs of pharmacological treatments (AOR: 3.96, 95%CI: 1.27-12.3) were related to the higher overall methodological quality of SRs. CONCLUSION Methodological quality of SRs on AD treatments is unsatisfactory, especially among non-Cochrane SRs and SRs of non-pharmacological interventions. Improvement in the following methodological domains requires particular attention due to poor performance: registering and publishing protocols a priori, justifying study design selection, providing a list of excluded studies, and reporting funding sources of primary studies.
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Affiliation(s)
- Claire C. W. Zhong
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jinglun Zhao
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charlene H. L. Wong
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X. Y. Wu
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, 5/F, No. 238, Shang ma Yuan ling Alley, Kaifu District, Changsha, Hunan China
| | - Chen Mao
- grid.284723.80000 0000 8877 7471Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jerry W. F. Yeung
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Vincent C. H. Chung
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong ,grid.10784.3a0000 0004 1937 0482School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Petersen JJ, Juul S, Jørgensen CK, Gluud C, Jakobsen JC. Deep brain stimulation for neurological disorders: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. Syst Rev 2022; 11:218. [PMID: 36229825 PMCID: PMC9558400 DOI: 10.1186/s13643-022-02095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deep brain stimulation has been used since the 1980s for neurological disorders and the USA and Europe have now approved it for Parkinson's disease, essential tremor, dystonia, and epilepsy. Previous reviews have assessed the effects of deep brain stimulation on different neurological disorders. These reviews all had methodological limitations. METHODS This is a protocol for a systematic review based on searches of major medical databases (e.g. MEDLINE, EMBASE, CENTRAL) and clinical trial registries. Two review authors will independently extract data and conduct risk of bias assessment. We will include published and unpublished randomised clinical trial comparing deep brain stimulation versus no intervention, usual care, sham stimulation, medical treatment, or resective surgery for Parkinson's disease, essential tremor, dystonia, or epilepsy. The effects of deep brain stimulation will be analysed separately for each of the different diagnoses. Primary outcomes will be all-cause mortality, disease-specific symptoms, and serious adverse events. Secondary outcomes will be quality of life, depressive symptoms, executive functioning, level of functioning, and non-serious adverse events. Data will be analysed using fixed-effect and random-effects meta-analyses and Trial Sequential Analysis. Risk of bias will be assessed with the Cochrane Risk of Bias tool-version 2, an eight-step procedure to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DISCUSSION Deep brain stimulation is increasingly being used for different neurological diseases, and the effects are unclear based on previous evidence. There is a need for a comprehensive systematic review of the current evidence. This review will provide the necessary background for weighing the benefits against the harms when assessing deep brain stimulation as intervention for individual neurological disorders. SYSTEMATIC REVIEW REGISTRATION PROSPERO 306,556.
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Affiliation(s)
- Johanne Juul Petersen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Copenhagen, Denmark
| | - Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Copenhagen, Denmark
| | - Caroline Kamp Jørgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, Odense C, 5000 Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100 Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 3, Odense C, 5000 Odense, Denmark
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The undisclosed disclosures: Conflicts of interest in studies related to robotics in hepatobiliary and pancreatic surgery. Surgery 2022; 172:1429-1433. [PMID: 36096965 DOI: 10.1016/j.surg.2022.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of robotics in hepatobiliary and pancreatic surgery has increased. With this increased collaboration, there has also been a push toward improving the transparency of conflicts of interest in terms of funding provided by robotics companies. METHODS Studies with ≥1 American author published between 2016 and 2020 discussing robotic hepatobiliary and pancreatic surgery were included in the analysis. The Centers for Medicare and Medicaid Services Open Payments Program was used to evaluate the accuracy of industry payment disclosures. Conflict of interest was defined as a lack of disclosure of ≥$100 funding from any robotics company in the United States. The primary outcome of this study was to determine the efficacy of the current standard conflict of interest reporting in surgery. RESULTS A total of 355 studies (2,413 authors) were included. Of the studies that received robotics funding (n = 133), 20.3% did not disclose their conflicts of interest, whereas 79.7% had a conflict of interest disclosure. However, most of the disclosures (76.5%) were inaccurate. CONCLUSION The findings of this study require an update in journal policies to ensure the accurate disclosure of conflicts of interest in robotic hepatobiliary and pancreatic surgery studies. Similarly, the investigators should ensure that their disclosures are accurate. Finally, surgeons must be more on top of their relationships with these companies and consider their vulnerability to bias.
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Lu C, Wu S, Ke L, Liu F, Shang W, Deng X, Huang Y, Zhang Q, Cui X, Mentis AFA, Xie Y, Wang Z. Kanglaite (Coix Seed Extract) as Adjunctive Therapy in Cancer: Evidence Mapping Overview Based on Systematic Reviews With Meta-Analyses. Front Pharmacol 2022; 13:901875. [PMID: 36034785 PMCID: PMC9413959 DOI: 10.3389/fphar.2022.901875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Several quantitative systematic reviews of Kanglaite (KLT), an herb preparation used to treat cancer and malignant pleural effusion, have been published in recent years. However, the clinical evidence reported in these studies has not been pursued further and the methodological quality of these meta-analyses remains unknown. Therefore, an overview was designed to map the evidence landscape based on the published meta-analyses on KLT in cancer treatment. Methods: Two bibliographic databases (PubMed and Embase) were searched from inception to 25 November 2021. Two independent reviewers were involved in study selection, data abstraction, and methodological quality assessment using AMSTAR 2. The principal features of publications and the clinical outcomes of efficacy and safety were synthesized narratively, and results of methodological quality were reported as frequencies and percentages with the corresponding 95% confidence intervals. The evidence map was used to visualize the overall quality. Excel 2016 and Stata 17/SE were used for data analysis. Results: Thirteen meta-analyses published in English were included for in-depth analysis. Among them, the year of publication ranged from 2008 to 2021, and the number of included patients ranged from 488 to 2,964. Regarding the cancer type, seven articles focused on non-small cell lung cancer, two on malignant pleural effusion, and four reviews on digestive system malignancies, such as hepatocellular carcinoma and pancreatic cancer. Almost all included meta-analyses reported that KLT as adjunctive therapy could improve various efficacy outcomes (such as disease response rates, quality of life, immune indicators) and reduce the rate of occurrence of adverse reactions, such as nausea and vomiting, leukopenia, and anemia. In terms of their methodological quality, three meta-analyses were of low quality, whereas 10 studies were critically low in quality. The methodological flaws main involved items 2 ("predesigned protocol and registration informatio''), 3 ("rationale of study design for inclusion"), 4 ("comprehensive search strategy''), 5 ("literature selection in duplicate''), 7 ("list of excluded studies with reasons''), 8 ("adequate information on included studies''), 10 ("funding support for included primary studies''), and 12 ("evaluation of the potential impact of risk of bias'') based on the AMSTAR 2 tool. Conclusion: Current evidence reveals that KLT is effective and safe as an adjunctive treatment for non-small cell lung cancer, malignant pleural effusion, and digestive system malignancies (such as hepatocellular carcinoma). However, the results assessed in this overview should be further verified using well-designed and clearly reported clinical trials and meta-analyses of KLT.
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Affiliation(s)
- Cuncun Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuilin Wu
- Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lixin Ke
- Hepatobiliary and Pancreatic Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fumei Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenru Shang
- Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiuxiu Deng
- Department of Gastroenterology, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Yanli Huang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiang Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xin Cui
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Alexios-Fotios A. Mentis
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Yanming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Vellekoop H, Versteegh M, Huygens S, Corro Ramos I, Szilberhorn L, Zelei T, Nagy B, Tsiachristas A, Koleva-Kolarova R, Wordsworth S, Rutten-van Mölken M. The Net Benefit of Personalized Medicine: A Systematic Literature Review and Regression Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1428-1438. [PMID: 35248467 DOI: 10.1016/j.jval.2022.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Amidst conflicting expectations about the benefits of personalized medicine (PM) and the potentially high implementation costs, we reviewed the available evidence on the cost-effectiveness of PM relative to non-PM. METHODS We conducted a systematic literature review of economic evaluations of PM and extracted data, including incremental quality-adjusted life-years (ΔQALYs) and incremental costs (Δcosts). ΔQALYs and Δcosts were combined with estimates of national cost-effectiveness thresholds to calculate incremental net monetary benefit (ΔNMB). Regression analyses were performed with these variables as dependent variables and PM intervention characteristics as independent variables. Random intercepts were used to cluster studies according to country. RESULTS Of 4774 studies reviewed, 128 were selected, providing cost-effectiveness data for 279 PM interventions. Most studies were set in the United States (48%) and the United Kingdom (16%) and adopted a healthcare perspective (82%). Cancer treatments (60%) and pharmaceutical interventions (72%) occurred frequently. Prognostic tests (19%) and tests to identify (non)responders (37%) were least and most common, respectively. Industry sponsorship occurred in 32%. Median ΔQALYs, Δcosts, and ΔNMB per individual were 0.03, Int$575, and Int$18, respectively. We found large heterogeneity in cost-effectiveness. Regression analysis showed that gene therapies were associated with higher ΔQALYs than other interventions. PM interventions for neoplasms brought higher ΔNMB than PM interventions for other conditions. Nonetheless, average ΔNMB in the 'neoplasm' group was found to be negative. CONCLUSIONS PM brings improvements in health but often at a high cost, resulting in 0 to negative ΔNMB on average. Pricing policies may be needed to reduce the costs of interventions with negative ΔNMB.
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Affiliation(s)
- Heleen Vellekoop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Matthijs Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Simone Huygens
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | - Balázs Nagy
- Syreon Research Institute, Budapest, Hungary
| | | | | | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Maureen Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Saunders H, Pham B, Loong D, Mishra S, Ashoor HM, Antony J, Darvesh N, Bains SK, Jamieson M, Plett D, Trivedi S, Yu CH, Straus SE, Tricco AC, Isaranuwatchai W. The Cost-Effectiveness of Intermediate-Acting, Long-Acting, Ultralong-Acting, and Biosimilar Insulins for Type 1 Diabetes Mellitus: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1235-1252. [PMID: 35341688 DOI: 10.1016/j.jval.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The incidence of type 1 diabetes mellitus is increasing every year requiring substantial expenditure on treatment and complications. A systematic review was conducted on the cost-effectiveness of insulin formulations, including ultralong-, long-, or intermediate-acting insulin, and their biosimilar insulin equivalents. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, HTA, and NHS EED were searched from inception to June 11, 2021. Cost-effectiveness and cost-utility analyses were included if insulin formulations in adults (≥ 16 years) with type 1 diabetes mellitus were evaluated. Two reviewers independently screened titles, abstracts, and full-text articles, extracted study data, and appraised their quality using the Drummond 10-item checklist. Costs were converted to 2020 US dollars adjusting for inflation and purchasing power parity across currencies. RESULTS A total of 27 studies were included. Incremental cost-effectiveness ratios ranged widely across the studies. All pairwise comparisons (11 of 11, 100%) found that ultralong-acting insulin was cost-effective compared with other long-acting insulins, including a long-acting biosimilar. Most pairwise comparisons (24 of 27, 89%) concluded that long-acting insulin was cost-effective compared with intermediate-acting insulin. Few studies compared long-acting insulins with one another. CONCLUSIONS Long-acting insulin may be cost-effective compared with intermediate-acting insulin. Future studies should directly compare biosimilar options and long-acting insulin options and evaluate the long-term consequences of ultralong-acting insulins.
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Affiliation(s)
- Hailey Saunders
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Desmond Loong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Huda M Ashoor
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Silkan K Bains
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna Plett
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Srushhti Trivedi
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Catherine H Yu
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Stoll M, Hubenschmid L, Koch C, Lieb K, Egloff B. Physicians' attitudes towards disclosure of payments from pharmaceutical companies in a nationwide voluntary transparency database: a cross-sectional survey. BMJ Open 2022; 12:e055963. [PMID: 35750457 PMCID: PMC9234799 DOI: 10.1136/bmjopen-2021-055963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate German physicians' attitudes towards and experiences with voluntary disclosure of payments by pharmaceutical companies in a public database and their impact on future decisions for or against disclosure. DESIGN A national cross-sectional survey conducted in 2018 among physicians who voluntarily disclosed at least one payment in the German transparency regulation. SETTING Retrospective paper-pencil questionnaire about attitudes towards and experiences with voluntary payment disclosures in the first (2015) and second (2016) years of the German transparency regulation. PARTICIPANTS German physicians who disclosed either in the first year only, the second year only, or in both years of the transparency regulation. PRIMARY OUTCOMES (1) The probability to disclose in 2016, predicted by physicians' experience of reactions from others in 2015, descriptive norms and attitudes towards transparency; (2) Frequency and (3) Content of reactions from others in 2015 compared with 2016. RESULTS Data of 234 respondents were analysed (n=42, 45 and 147 physicians who disclosed in 2015, 2016 or both years, respectively). The probability to disclose in 2016 was not predicted by perceived reactions, norms or attitudes towards transparency (p>0.01). Most participants reported not to have received any reactions by patients (190/234, 81%), colleagues (128/234, 55%) or the private environment (153/234, 65%). Neither frequency nor content of reactions differed between the first and second years (scale 1-5; frequency: Mdn2015,2016 = 1.33 vs 1.00, rb=-0.17, p>0.01; content: Mdn2015,2016 = 3.00 vs 3.00, rb=0.19, p>0.01). However, media reporting, fear of reputational damage and a feeling of being defamed were mentioned as reasons for non-disclosure. CONCLUSIONS While confirmatory analyses did not provide significant results, descriptive analyses showed that participants who voluntarily disclose payments mainly do not experience any reactions towards their disclosures but report fears about losing their reputation due to disclosures.
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Affiliation(s)
- Marlene Stoll
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Cora Koch
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Boris Egloff
- Department of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
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Phillips MC. Metabolic Strategies in Healthcare: A New Era. Aging Dis 2022; 13:655-672. [PMID: 35656107 PMCID: PMC9116908 DOI: 10.14336/ad.2021.1018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Modern healthcare systems are founded on a disease-centric paradigm, which has conferred many notable successes against infectious disorders in the past. However, today's leading causes of death are dominated by non-infectious "lifestyle" disorders, broadly represented by the metabolic syndrome, atherosclerosis, cancer, and neurodegeneration. Our disease-centric paradigm regards these disorders as distinct disease processes, caused and driven by disease targets that must be suppressed or eliminated to clear the disease. By contrast, a health-centric paradigm recognizes the lifestyle disorders as a series of hormonal and metabolic responses to a singular, lifestyle-induced disease of mitochondria dysfunction, a disease target that must be restored to improve health, which may be defined as optimized mitochondria function. Seen from a health-centric perspective, most drugs target a response rather than the disease, whereas metabolic strategies, such as fasting and carbohydrate-restricted diets, aim to restore mitochondria function, mitigating the impetus that underlies and drives the lifestyle disorders. Substantial human evidence indicates either strategy can effectively mitigate the metabolic syndrome. Preliminary evidence also indicates potential benefits in atherosclerosis, cancer, and neurodegeneration. Given the existing evidence, integrating metabolic strategies into modern healthcare systems should be identified as a global health priority.
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Cosgrove L, Herrawi F, Shaughnessy AF. Conflicts of Interest in Psychopharmacology Textbooks. Community Ment Health J 2022; 58:619-623. [PMID: 34748149 DOI: 10.1007/s10597-021-00906-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
While most medical journals require disclosures of industry payments to authors and editors, there is no requirement for textbooks. In this study we evaluated nine well-known psychopharmacology textbooks to identify payments to their writers and editors. Two-thirds of the textbooks had at least one editor or author who received personal payments from one or more pharmaceutical companies, for a total of 11,021,409 USD paid to 11 of 21 editors/authors over a seven-year period. Much of this money was paid to a single author but 24% of the writers received over 75,000 USD each over this time period. There are several psychopharmacology textbooks authored by writers without apparent financial conflicts of interest. Just as with medical journals, medical textbooks should be transparent about payments made to their authors and editors.
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Affiliation(s)
- Lisa Cosgrove
- Counseling Psychology Department, Applied Ethics Center, University of Massachusetts-Boston, 100 William T Morrissey Blvd, Boston, USA.
| | - Farahdeba Herrawi
- Counseling Psychology Department, Applied Ethics Center, University of Massachusetts-Boston, 100 William T Morrissey Blvd, Boston, USA
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, 195 Canal Street, Malden, MA, 02148, USA
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Tornese P, Lalli S, Cocco A, Albanese A. Review of disease-modifying drug trials in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:521-529. [PMID: 35228271 DOI: 10.1136/jnnp-2021-328470] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 01/22/2023]
Abstract
We analysed clinical trials of pharmacological interventions on patients with amyotrophic lateral sclerosis (ALS), and compared study quality and design features. The systematic review included articles published in PubMed and trials registered in ClinicalTrials.gov. Included studies were randomised double-blind placebo-controlled clinical trials assessing a disease-modifying pharmacological intervention. Studies were excluded if primary end points were safety or dose finding. A total of 28 735 articles and 721 current trials were identified. 76 published articles and 23 ongoing trials met inclusion criteria; they referred to distinct populations comprising 22 817 participants with ALS. Most articles and all current trials had parallel group design; few articles had cross-over design. A run-in observation period was included in about 20% of published studies and ongoing trials. Primary end points included functional assessment, survival, muscle strength, respiratory function, biomarkers and composite measures. Most recent trials had only functional assessment and survival. Risk of bias was high in 23 articles, moderate in 35, low in 18. A disease modification effect was observed for 10 interventions in phase II studies, two of which were confirmed in phase III. Three confirmatory phase III studies are currently underway. The present review provides cues for the design of future trials. Functional decline and survival, as single or composite measures, stand as the reference end points. Post hoc analyses should not be performed, particularly in studies using composite end points. There is a general agreement on diagnostic criteria; but eligibility criteria must be improved. Run-in observations may be used for censoring patients but are discouraged for refining participants' eligibility. The ALS Functional Rating Scale-Revised needs improvement for use as an ordinal measure of functional decline.
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Affiliation(s)
- Paolo Tornese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefania Lalli
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Antoniangela Cocco
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy .,Department of Neuroscience, Catholic University, Milan, Italy
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Özdemir V, Springer S. Decolonizing Knowledge Upstream: New Ways to Deconstruct and Fight Disinformation in an Era of COVID-19, Extreme Digital Transformation, and Climate Emergency. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2022; 26:247-269. [PMID: 35544326 DOI: 10.1089/omi.2022.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lies and disinformation have always existed throughout human history. However, disinformation has become a "pandemic within a pandemic" with convergence of COVID-19 and digital transformation of health care, climate emergency, and pervasive human-computer interaction in all facets of life. We are living through an era of post-truth. New approaches to fight disinformation are urgently needed and of paramount importance for systems science and planetary health. In this study, we discuss the ways in which extractive and entrenched epistemologies such as technocracy and neoliberalism co-produce disinformation. We draw from the works of David Collingridge in technology entrenchment and the literature on digital health, international affairs, climate emergency, degrowth, and decolonializing methodologies. We expand the vocabulary on and interventions against disinformation, and propose the following: (1) rapid epistemic disobedience as a critical governance tool to resist the cultural hegemony of neoliberalism and its master narrative infinite growth that is damaging the planetary ecosystems, while creating echo chambers overflowing with disinformation, and (2) a two-tiered taxonomy of reflexivity, a state of self-cognizance by knowledge actors, for example, scientists, engineers, and physicians (type 1 reflexivity), as well as by chroniclers of former actors, for example, civil society organizations, journalists, social sciences, and humanities scholars (type 2 reflexivity). This article takes seriously the role of master narratives in quotidian life in production of disinformation and ecological breakdown. The infinite growth narrative does not ask critical questions such as "growth in what, at what costs to society and environment?," and is a dangerous game of brinkmanship that has been testing the planetary ecological boundaries and putting at risk the veracity of knowledge. There is a need for scholars and systems scientists who break ranks with entrenched narratives that pose existential threats to planetary sustainability and are harmful to knowledge veracity. Scholars who resist the obvious recklessness and juggernaut of the pursuit of neoliberal infinite growth would be rooting for living responsibly and in solidarity on a planet with finite resources. The interventions proposed in this study, rapid epistemic disobedience and the expanded reflexivity taxonomy, can advance progressive policies for a good life for all within planetary boundaries, and decolonize knowledge from disinformation in ways that are necessarily upstream, radical, rapid, and emancipatory.
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Affiliation(s)
- Vural Özdemir
- OMICS: A Journal of Integrative Biology, New Rochelle, New York, USA
| | - Simon Springer
- Centre for Urban and Regional Studies, Discipline of Geography and Environmental Studies, School of Environmental and Life Sciences, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
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Wang X, Long Y, Yang L, Huang J, Du L. Results Reporting and Early Termination of Childhood Obesity Trials Registered on ClinicalTrials.gov. Front Pediatr 2022; 10:860610. [PMID: 35402346 PMCID: PMC8987712 DOI: 10.3389/fped.2022.860610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Childhood obesity is one of the most severe challenges of public health in the twenty-first century and may increase the risk of various physical and psychological diseases in adulthood. The prevalence and predictors of unreported results and premature termination in pediatric obesity research are not clear. We aimed to characterize childhood obesity trials registered on ClinicalTrials.gov and identify features associated with early termination and lack of results reporting. Methods Records were downloaded and screened for all childhood obesity trials from the inception of ClinicalTrials.gov to July 29, 2021. We performed descriptive analyses of characteristics, Cox regression for early termination, and logistic regression for lack of results reporting. Results We identified 1,312 trials registered at ClinicalTrials.gov. Among clinicalTrials.gov registered childhood obesity-related intervention trials, trial unreported results were 88.5 and 4.3% of trials were prematurely terminated. Additionally, the factors that reduced the risk of unreported outcomes were US-registered clinical studies and drug intervention trials. Factors associated with a reduced risk of early termination are National Institutes of Health (NIH) or other federal agency funding and large trials. Conclusion The problem of unreported results in clinical trials of childhood obesity is serious. Therefore, timely bulletin of the results and reasons for termination remain urgent aims for childhood obesity trials.
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Affiliation(s)
- Xinyi Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Youlin Long
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Liu Yang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, China
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Cheung AKL, Wong CHL, Ho L, Wu IXY, Ke FYT, Chung VCH. Methodological quality of systematic reviews on Chinese herbal medicine: a methodological survey. BMC Complement Med Ther 2022; 22:48. [PMID: 35197038 PMCID: PMC8867833 DOI: 10.1186/s12906-022-03529-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) synthesise the best evidence of effectiveness and safety on Chinese herbal medicine (CHM). Decision-making should be supported by the high-quality evidence of prudently conducted SRs, but the trustworthiness of conclusions may be limited by poor methodological rigour. METHODS This survey aimed to examine the methodological quality of a representative sample of SRs on CHM published during January 2018 to March 2020. We conducted literature search in Cochrane Database of Systematic Reviews, MEDLINE via Ovid, and EMBASE via Ovid. Eligible SRs must be in Chinese or English with at least one meta-analysis on the treatment effect of any CHM documented in the 2015 Chinese Pharmacopoeia. Two reviewers extracted the bibliographical characteristics of SRs and appraised their methodological quality using AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews 2). The associations between bibliographical characteristics and methodological quality were investigated using Kruskal-Wallis tests and Spearman's rank correlation coefficients. RESULTS We sampled and appraised one hundred forty-eight SRs. Overall, one (0.7%) was of high methodological quality; zero (0%), four (2.7%), and one-hundred forty-three (96.6%) SRs were of moderate, low, and critically-low quality. Only thirteen SRs (8.8%) provided a pre-defined protocol; none (0%) provided justifications for including particular primary study designs; six (4.1%) conducted a comprehensive literature search; two (1.4%) provided a list of excluded studies; nine (6.1%) undertook meta-analysis with appropriate methods; and seven (4.7%) reported funding sources of included primary studies. Cochrane reviews had higher overall quality than non-Cochrane reviews (P < 0.001). SRs with European funding support were less likely to have critically-low quality when compared with their counterparts (P = 0.020). SRs conducted by more authors (rs = 0.23; P = 0.006) and published in higher impact factor journals (rs = 0.20; P = 0.044) were associated with higher methodological quality. CONCLUSIONS Our results indicated that the methodological quality of SRs on CHM is low. Future authors should enhance the methodological quality through registering a priori protocols, justifying selection of study designs, conducting comprehensive literature search, providing a list of excluded studies with rationales, using appropriate method for meta-analyses, and reporting funding sources among primary studies.
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Affiliation(s)
- Andy K L Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charlene H L Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leonard Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X Y Wu
- 5/F, Xiangya School of Public Health, Central South University, 238 Shang-Ma-Yuan-Ling Alley, Kai-Fu District, Changsha, Hunan, China.
| | - Fiona Y T Ke
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Liu X, Liu H, Wang L, Zhang L, Xu Q. Role of sacubitril-valsartan in the prevention of atrial fibrillation occurrence in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0263131. [PMID: 35081164 PMCID: PMC8791471 DOI: 10.1371/journal.pone.0263131] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/12/2022] [Indexed: 12/11/2022] Open
Abstract
Objective Heart failure (HF) and atrial fibrillation (AF) are often coexisting. They have common risk factors and pathophysiologic mechanisms. Sacubitril/valsartan has shown efficacy and tolerability in patients with HF. Thus, the study was performed to evaluate the impact of sacubitril/valsartan on AF occurrence in patients with HF. Methods The Embase and PubMed were searched from their inception date to June 2021 for all relevant randomized controlled trials (RCTs) evaluating the efficacy of sacubitril/valsartan in HF. The outcome of interest was the AF occurrence during the follow-up. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results Six trials involving a total of 15,512 patients were included (7,750 randomized to sacubitril/valsartan and 7,762 to control). All trials were randomized, double-blind, and active-control. There was no significant difference in the prevention of AF occurrence between the sacubitril/valsartan group and the control group (enalapril or valsartan) in patients with HF (RR 1.07, 95%CI 0.95 to 1.19; I2 4%). Conclusions Sacubitril/valsartan was similar to either enalapril or valsartan in preventing the occurrence of AF in patients with HF.
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Affiliation(s)
- Xuehui Liu
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
| | - Hongjun Liu
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
| | - Lijun Wang
- Clinical Medical College of Traditional Chinese Medicine, China Three Gorges University, Yichang, China
| | - Lei Zhang
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
| | - Qiang Xu
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
- * E-mail:
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Maziarz M. Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions? STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2022; 91:159-167. [PMID: 34922183 DOI: 10.1016/j.shpsa.2021.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Literature-based meta-analysis is a standard technique applied to pool results of individual studies used in medicine and social sciences. It has been criticized for being too malleable to constrain results, averaging incomparable values, lacking a measure of evidence's strength, and problems with a systematic bias of individual studies. We argue against using literature-based meta-analysis of RCTs to assess treatment efficacy and show that therapeutic decisions based on meta-analytic average are not optimal given the full scope of existing evidence. The argument proceeds with discussing examples and analyzing the properties of some standard meta-analytic techniques. First, we demonstrate that meta-analysis can lead to reporting statistically significant results despite the treatment's limited efficacy. Second, we show that meta-analytic confidence intervals are too narrow compared to the variability of treatment outcomes reported by individual studies. Third, we argue that literature-based meta-analysis is not a reliable measurement instrument. Finally, we show that meta-analysis averages out the differences among studies and leads to a loss of information. Despite these problems, literature-based meta-analysis is useful for the assessment of harms. We support two alternative approaches to evidence amalgamation: meta-analysis of individual patient data (IPD) and qualitative review employing mechanistic evidence.
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Affiliation(s)
- Mariusz Maziarz
- Interdisciplinary Centre for Ethics, Jagiellonian University, Kraków, Poland; Institute of Philosophy, Jagiellonian University, Grodzka 52, Kraków, Poland.
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Osugo M, Whitehurst T, Shatalina E, Townsend L, O’Brien O, Mak TLA, McCutcheon R, Howes O. Dopamine partial agonists and prodopaminergic drugs for schizophrenia: systematic review and meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2022; 135:104568. [DOI: 10.1016/j.neubiorev.2022.104568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
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Lu C, Ke L, Li J, Wu S, Feng L, Wang Y, Mentis AFA, Xu P, Zhao X, Yang K. Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map. Front Pharmacol 2022; 12:797753. [PMID: 35082677 PMCID: PMC8784830 DOI: 10.3389/fphar.2021.797753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Many meta-analyses (MAs) on Chinese medicine (CM) as an adjunctive treatment for gastric cancer have been published in recent years. However, the pooled evidence reported in MAs and their methodological quality remain unknown. Therefore, we designed a study to comprehensively evaluate and summarize the current evidence of CMs for gastric cancer in published MAs. Methods: A systematic search on MAs published in English from inception to 1st September 2021 was conducted in PubMed and Embase. The AMSTAR-2 tool was used to evaluate the methodological quality of the included MAs, and the results of the quality assessment were visualized using the evidence mapping method. Stata 17/SE was used for statistical analysis (Registration number: INPLASY202190005). Results: A total of 20 MAs (16 pairwise and 4 network MAs) were included from 118 records. These MAs were published in 14 journals from 2013 to 2021, with the number of patients and trials ranging from 688 to 6,857, and from 10 to 85, respectively. A large number of CMs (e.g., AiDi, FuFangKuShen, and HuaChanSu) in combination with chemotherapy for gastric cancer were identified among the included MAs. According to the pooled results reported in MAs, when compared to chemotherapy alone, CMs in combination with chemotherapy not only improve various outcomes on efficacy (e.g., objective response rate, quality of life) but also reduce various adverse reactions (e.g., leucopenia, nausea and vomiting). Only 2 MAs were low in terms of the overall methodological quality, while the other 18 MAs were all critically low. The methodology was required to be advanced significantly, mainly involving: study protocol and registration, explanation for the inclusion of study design, list of excluded studies with justifications, adequate details of included studies, reporting on funding sources of primary studies, and evaluation of the potential impact of risk of bias. In addition, MAs that received funds support (β = 2.68; 95%CI: 0.40 to 4.96; p = 0.024) or were published in journals with higher impact factor (β = 2.81; 95%CI: 0.69 to 4.92; p = 0.012) had a higher score on the overall methodological quality in the univariate analysis, but the results were not statistically significant according to the multivariate analysis. Conclusion: Combining CMs with chemotherapy can potentially improve clinical outcomes and reduce the relevant adverse effects in patients with gastric cancer. However, the methodological quality of relevant MAs requires significant improvement, and the current evidence needs to be validated through multinational trials that are well-designed and have a large sample size.
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Affiliation(s)
- Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lixin Ke
- Hepatobiliary and Pancreatic Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieyun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Shuilin Wu
- Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lufang Feng
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Youyou Wang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Alexios Fotios A Mentis
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Peng Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxiao Zhao
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Kwee RM, Kwee TC. Health Care Industry Payments to Editorial Board Members of Imaging-related Journals. Radiology 2022; 303:399-403. [PMID: 35076298 DOI: 10.1148/radiol.212527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Editorial board members may be biased due to conflicts of interest (COIs). Purpose To investigate the frequency and amount of payments from industry to editorial board members of imaging-related journals and whether they are in agreement with the disclosure status as provided by the journal. Materials and Methods Editorial board members of 15 U.S.-based imaging-related journals who were listed in the Open Payments database (OPD) were included. Payments from industry to editorial board members in the year 2020 were extracted from the OPD and compared with publicly available COI disclosure data as provided by the journals. The Kruskal-Wallis test was used for statistical analysis. Results A total of 519 editorial board members were included, of whom 214 (41%) received industry payment and 305 (59%) did not. Payments to editorial board members by the industry ranged from $12.63 to $404 625.47 (median, $2397.48). Most payments from industry (59%) were ascribed to consulting. Editorial board members of the journals JACC: Cardiovascular Imaging and Journal of Vascular and Interventional Radiology received significantly higher amounts of individual payments from industry than editorial board members of most other journals. Financial COI disclosures were not publicly listed for 413 of the 519 (80%) editorial board members, 169 of whom received payments from industry according to the OPD. Of the 106 editorial board members whose financial COI disclosures were publicly listed, 36 (34%) were discordant with the OPD. Conclusion Payments from industry to Open Payments database-listed editorial board members of imaging-related journals are prevalent. Imaging-related journals often do not report or do not accurately report payments from industry to their editorial board members © RSNA, 2022.
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Affiliation(s)
- Robert M Kwee
- From the Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands (R.M.K.); and Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (T.C.K.)
| | - Thomas C Kwee
- From the Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands (R.M.K.); and Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (T.C.K.)
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Müller-Vahl KR, Szejko N, Verdellen C, Roessner V, Hoekstra PJ, Hartmann A, Cath DC. European clinical guidelines for Tourette syndrome and other tic disorders: summary statement. Eur Child Adolesc Psychiatry 2022; 31:377-382. [PMID: 34244849 PMCID: PMC8940881 DOI: 10.1007/s00787-021-01832-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022]
Abstract
In 2011 a working group of the European Society for the Study of Tourette syndrome (ESSTS) developed the first European Guidelines for Tourette syndrome (TS) published in the ECAP journal. After a decade ESSTS now presents updated guidelines, divided into four sections: Part I: assessment, Part II: psychological interventions, Part III: pharmacological treatment and Part IV: deep brain stimulation (DBS). In this paper, we summarise new developments described in the guidelines with respect to assessment and treatment of tics. Further, summary findings from a recent survey conducted amongst TS experts on these same topics are presented, as well as the first European patient representative statement on research. Finally, an updated decision tree is introduced providing a practical algorithm for the treatment of patients with TS. Interestingly, in the last decade there has been a significant shift in assessment and treatment of tics, with more emphasis on non-pharmacological treatments.
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Affiliation(s)
- Kirsten R. Müller-Vahl
- grid.10423.340000 0000 9529 9877Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Natalia Szejko
- grid.13339.3b0000000113287408Department of Neurology, Medical University of Warsaw, Warsaw, Poland ,grid.13339.3b0000000113287408Department of Bioethics, Medical University of Warsaw, Warsaw, Poland ,grid.47100.320000000419368710Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA
| | - Cara Verdellen
- PsyQ Nijmegen, Parnassia Group, Nijmegen, The Netherlands ,TicXperts, Heteren, The Netherlands
| | - Veit Roessner
- grid.4488.00000 0001 2111 7257Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Pieter J. Hoekstra
- grid.4830.f0000 0004 0407 1981Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andreas Hartmann
- grid.411439.a0000 0001 2150 9058Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Danielle C. Cath
- grid.468637.80000 0004 0465 6592Department of Specialist Trainings, GGZ Drenthe Mental Health Institution, Assen, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of Psychiatry, University Medical Center Groningen, Rijks University Groningen, Groningen, The Netherlands
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Saghy E, Mulinari S, Ozieranski P. Drug company payments to General Practices in England: Cross-sectional and social network analysis. PLoS One 2021; 16:e0261077. [PMID: 34874975 PMCID: PMC8651134 DOI: 10.1371/journal.pone.0261077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
Although there has been extensive research on pharmaceutical industry payments to healthcare professionals, healthcare organisations with key roles in health systems have received little attention. We seek to contribute to addressing this gap in research by examining drug company payments to General Practices in England in 2015. We combine a publicly available payments database managed by the pharmaceutical industry with datasets covering key practice characteristics. We find that practices were an important target of company payments, receiving £2,726,018, equivalent to 6.5% of the value of payments to all healthcare organisations in England. Payments to practices were highly concentrated and specific companies were also highly dominant. The top 10 donors and the top 10 recipients amassed 87.9% and 13.6% of the value of payments, respectively. Practices with more patients, a greater proportion of elderly patients, and those in more affluent areas received significantly more payments on average. However, the patterns of payments were similar across England's regions. We also found that company networks-established by making payments to the same practices-were largely dominated by a single company, which was also by far the biggest donor. Greater policy attention is required to the risk of financial dependency and conflicts of interests that might arise from payments to practices and to organisational conflicts of interests more broadly. Our research also demonstrates that the comprehensiveness and quality of payment data disclosed via industry self-regulatory arrangements needs improvement. More interconnectivity between payment data and other datasets is needed to capture company marketing strategies systematically.
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Affiliation(s)
- Eszter Saghy
- Faculty of Pharmacy, Division of Pharmacoeconomics, University of Pecs, Pecs, Hungary
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
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Trinh M, Kalloniatis M, Nivison-Smith L. Should clinical automated perimetry be considered for routine functional assessment of early/intermediate age-related macular degeneration (AMD)? A systematic review of current literature. Ophthalmic Physiol Opt 2021; 42:161-177. [PMID: 34843120 PMCID: PMC9300202 DOI: 10.1111/opo.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
Purpose There is growing interest in functional testing for early/intermediate age‐related macular degeneration (iAMD). However, systematic evaluation of existing clinical functional tests is lacking. This systematic review examines evidence for using clinical automated perimetry in routine assessment of early/iAMD. Recent findings PubMed, Web of Science Core Collection, and Embase were searched from inception to October 2020 to answer, is there evidence of visual field defects in early/iAMD, and if so, are early/iAMD visual field defects linked to real‐world patient outcomes? Articles using clinical automated perimetry (commercially accessible and non‐modified devices/protocols) were included. Microperimetry was excluded as this has yet to be incorporated into clinical guidelines. The primary outcome was global visual field indices including mean deviation (MD), pattern standard deviation (PSD), mean sensitivity (MS) and frequency of defects. The secondary outcome was any real‐world patient outcome including quality of life and/or activities of daily living indices. Twenty‐six studies were eligible for inclusion and all studies were observational. There was consistent evidence of worsened MD, PSD, MS and frequency of defects for early/iAMD compared to normal eyes under photopic, low‐photopic and scotopic conditions. Meta‐analysis of studies using standard automated perimetry (SAP) under photopic conditions revealed worsened MD (−1.52dB [−2.27, −0.78 dB]) and MS (−1.47dB [−2, −0.94 dB]) in early/iAMD compared to normal eyes, representing large statistical effect sizes but non‐clinically meaningful reductions. There was insufficient data for meta‐analyses regarding other clinical automated perimetry protocols. Only one study assessed a real‐world patient outcome (on‐road driving performance), with no significant link to visual field outcomes in early/iAMD. Summary Significant reduction of global visual field indices is present in early/iAMD, but not clinically meaningful using SAP under photopic conditions. Translational relevance of visual field outcomes to patient outcomes in early/iAMD remains unclear. Thus, SAP under photopic conditions is unlikely to be useful for routine assessment of early/iAMD.
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Affiliation(s)
- Matt Trinh
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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McGauran N, Wieseler B. Centralised Full Access to Clinical Study Data Can Support Unbiased Guideline Development, Continuing Medical Education, and Patient Information. J Eur CME 2021; 10:1989172. [PMID: 34868731 PMCID: PMC8635651 DOI: 10.1080/21614083.2021.1989172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/24/2021] [Indexed: 10/25/2022] Open
Affiliation(s)
- Natalie McGauran
- Communications Department, Institute for Quality and Efficiency in Health Care (IQWIG), Cologne, Germany
| | - Beate Wieseler
- Drug Assessment Department, Institute for Quality and Efficiency in Health Care (IQWIG), Cologne, Germany
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Skrivankova VW, Richmond RC, Woolf BAR, Davies NM, Swanson SA, VanderWeele TJ, Timpson NJ, Higgins JPT, Dimou N, Langenberg C, Loder EW, Golub RM, Egger M, Davey Smith G, Richards JB. Strengthening the reporting of observational studies in epidemiology using mendelian randomisation (STROBE-MR): explanation and elaboration. BMJ 2021; 375:n2233. [PMID: 34702754 PMCID: PMC8546498 DOI: 10.1136/bmj.n2233] [Citation(s) in RCA: 509] [Impact Index Per Article: 169.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Affiliation(s)
| | - Rebecca C Richmond
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Benjamin A R Woolf
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Psychological Science, University of Bristol, Bristol, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- K G Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sonja A Swanson
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Nicholas J Timpson
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Niki Dimou
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Claudia Langenberg
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Robert M Golub
- JAMA, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - J Brent Richards
- Departments of Medicine, Human Genetics, Epidemiology & Biostatistics, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Department of Twin Research and Genetic Epidemiology, King's College London, University of London, London, UK
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Lu C, Ke L, Li J, Zhao H, Lu T, Mentis AFA, Wang Y, Wang Z, Polissiou MG, Tang L, Tang H, Yang K. Saffron (Crocus sativus L.) and health outcomes: a meta-research review of meta-analyses and an evidence mapping study. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 91:153699. [PMID: 34419735 DOI: 10.1016/j.phymed.2021.153699] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/31/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although a number of systematic reviews and meta-analyses of saffron (Crocus sativus L.) have been published, no study has comprehensively summarized the clinical evidence from meta-analyses, or assessed the reporting or methodological quality of these reviews. PURPOSE The present meta-research study was designed to fill the gaps in knowledge to inform future studies and allow enhanced clinical decision-making on saffron. METHODS The PubMed, Cochrane Library, Embase, and CNKI databases were systematically searched from inception to April 3 rd, 2021, for meta-analyses of clinical trials that assessed the efficacy and safety of saffron. PRISMA 2009 and AMSTAR-2 were employed to assess the reporting and methodological quality of meta-analyses identified in the search, respectively. The present study was registered on PROSPERO with registration number CRD42020220274. RESULTS Nineteen eligible systematic reviews with meta-analyses published in English were identified from 235 records. These meta-analyses were published in 12 peer-reviewed journals from 2013 to 2021. The heterogeneous results indicated that saffron significantly reduced fasting blood glucose, waist circumference, diastolic blood pressure, concentrations of total cholesterol and low-density lipoprotein cholesterol, and improved symptoms of depression, cognitive function and sexual dysfunction compared with controls (mainly placebos). Common side effects of saffron consumption included nausea, dry mouth, poor appetite, and headache, but no serious adverse reactions were reported. Primary analysis and sensitivity analysis confirmed that the reporting and methodological quality of reviews included in the study were highly correlated (p < 0.001). The quality of meta-analyses of saffron requires improvement by including a structured abstract, a prospective protocol and registration, explanation of the study designs within each study that is reviewed, the searches, risk of bias assessment, literature selection, and reporting of funding sources. CONCLUSION The available evidence indicates that saffron is a safe plant for administration as a medicine and can improve diverse clinical outcomes, but the scientific quality of the published systematic reviews needs to be improved. Moreover, the clinical effects of saffron need to be confirmed through high-quality randomized trials in multiple countries with large sample sizes.
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Affiliation(s)
- Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Lixin Ke
- Hepatobiliary and pancreatic center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jieyun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Haitong Zhao
- Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Tingting Lu
- Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, China
| | - Alexios Fotios A Mentis
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens 10183, Greece
| | - Youyou Wang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Moschos G Polissiou
- Laboratory of Chemistry, Department of Science, Agricultural University of Athens, Athens 10183, Greece
| | - Liyao Tang
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Hao Tang
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China.
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