Methodological and ethical quality of randomized controlled clinical trials in gastrointestinal surgery

Pain-focused psychological interventions in women with endometriosis: A systematic review

AIMS

As a chronic inflammatory disease, endometriosis (EMS) is often associated with pain affecting different aspects of women's lives. Up to now, a wide variety of interventions have been implemented to alleviate pain in patients with this condition, including pharmacological, surgical, and rarely non-pharmacological ones. Against this background, this review aimed to investigate pain-focused psychological interventions among EMS women.

METHODS

A systematic review of the articles published in this field was conducted through a comprehensive search on the databases of Scopus, PubMed, MEDLINE, Web of Science, ScienceDirect, the Cochrane Library, PsycINFO, Google Scholar, and Scientific Information Database (SID). The quality of studies was then assessed by the Jadad Scale.

RESULTS

In total, 10 articles were entered into this systematic review. The findings further revealed that the pain-focused psychological interventions in patients with EMS were cognitive-behavioral therapy (CBT) (n = 2), mindfulness therapy (n = 4), yoga (n = 2), psychoeducation (n = 1), and progressive muscle relaxation (PMR) training (n = 1). Besides, the findings established that all the given interventions had improved and reduced pain in women living with this condition. Moreover, five articles were of good quality based on the Jadad Scale.

CONCLUSION

The study results demonstrated that all the listed psychological interventions had affected pain relief and improvement in women suffering from EMS. Considering the limited number of studies in this field and the fact that there were only five articles endowed with good quality, more high-quality studies could provide stronger evidence to support the implementation of the mentioned interventions influencing pain in patients.

Critical Appraisal of the Quality of Publications in Hepatobiliary and Pancreatic Surgery Research Using the American College of Surgeons NSQIP Database

BACKGROUND

The use of the American College of Surgeons (ACS) NSQIP has increased in hepatobiliary and pancreatic surgery (HPB) research as it provides access to high-quality surgical outcome data on a national scale. Using the ACS NSQIP database, this study examined the methodologic reporting of HPB publications.

STUDY DESIGN

Web of Science core collection (all editions) was queried for all HPB studies using the ACS NSQIP database published between 2004 and 2022. In addition, a critical appraisal was performed using the JAMA Surgery checklist, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement.

RESULTS

In total, 276 studies were included in the analysis. The median scores for the JAMA Surgery checklist, RECORD statement, and STROBE statement were 4 of 7 (interquartile range [IQR] 3 to 5), 3 of 10 (IQR 2 to 4), and 15 of 21 (IQR 13 to 17), respectively. The criteria with the highest rates of nonadherence were discussing competing risks, clear definitions of inclusion and exclusion criteria, unadjusted and adjusted outcomes, provision of supplementary data, and performing subgroup analyses. Additionally, when examining checklist fulfillment of hepatobiliary studies and pancreatic studies separately, pancreatic studies demonstrated significantly greater fulfillment of the STROBE statement checklist items.

CONCLUSIONS

Satisfactory reporting of methodology is present among HPB studies utilizing the ACS NSQIP database, with multiple opportunities for improvement. Areas for improved adherence include discussing competing risks, providing supplementary information, and performing appropriate subgroup analysis. Given the increasing role of large-scale databases in surgical research, enhanced commitment to reporting guidelines may advance HPB research and ensure quality reporting.

Risk of bias for randomized controlled trials in Journal of Clinical Monitoring and Computing

PURPOSE

Well-designed randomized controlled trials (RCTs) are considered to represent a high level of evidence and influence medical decision-making in evidence-based medicine. When biases occur in study design, processing, and reporting of RCTs, however, it is difficult to interpret results and judge the impact of interventions. Accordingly, we evaluate the quality of RCT reporting published in the Journal of Clinical Monitoring and Computing (JCMC) using three assessment tools.

METHODS

Reporting quality of RCTs published in the JCMC was evaluated through December 31, 2020, using Jadad and van Tulder scales and the Cochrane Collaboration's risk of bias tool (CCRBT). Stepwise regression analysis was performed to identify factors associated with reporting quality.

RESULTS

Database searches confirmed 132 RCTs in 1,507 original articles. The numbers of RCTs meeting criteria for high reporting quality were 97 (73.5%) using the Jadad scale, 99 (75.0%) using the van Tulder scale, and 19 (14.4%) with the CCRBT. Jadad scores [median score (interquartile range) = 3.0 (2.0-5.0), coefficients (95% CI) = 0.08 (0.04, 0.11), p < 0.001], van Tulder scores [median score (interquartile range) = 7.0 (5.0-8.75), coefficients (95% CI) = 0.15 (0.11, 0.20), p < 0.001], and CCRBT assessment [coefficients (95% CI) = 0.04 (0.02, 0.06), p < 0.001] increased significantly with publication year. The median score (interquartile range) of the last 5 years were 4.0 (3.0-5.0) in Jadad scores, and 8.0 (6.0-9.0) in van Tulder scores. Only 33.3% and 37.1% of articles described detailed blinding and allocation methods, respectively.

CONCLUSIONS

Reporting quality increased over time, with consistently high reporting quality in recently published JCMC RCTs.

Methodological and ethical quality of surgical trials from 2016 to 2020

PURPOSE

Randomized controlled trials (RCTs) are the gold standard tool used to evaluate therapeutic interventions. The published results showed that progress still needs to be made not only from a methodological point of view but also from an ethical point of view. The aim of this study was to evaluate the methodological and ethical qualities of randomized clinical trials in surgery over the last few years.

METHODS

All of the articles chosen for review reported on randomized controlled surgical trials and were published in 10 international journals between 2016 and 2020. Eligible studies were identified, selected, and then evaluated based on a broad set of predetermined criteria. Methodological quality was evaluated using the Jadad scale, and ethical quality was evaluated using the Berdeu score.

RESULTS

The methodological quality score (Jadad scale) ranged from 5 to 13, with a mean of 10.0 ± 1.54. The methodological quality was insufficient (score ≤ 9) for 162 trials (31.2%). The ethical quality score ranged from 0.25 to 1, with a mean of 0.8 ± 0.11. Fifty-two articles (10%) did not state that informed consent was requested from the participants, and 21 articles (4%) did not report either research ethics committee or institutional committee protocol approval.

CONCLUSION

The randomized clinical surgical trials analyzed showed that they had satisfactory methods in only 70% of the cases and that they had respected the fundamental ethical principles in 90% of the cases. However, less than 8% of the studies reported planned interim analysis, prospectively defined stopping rules, and independent monitoring committee.

Critically Appraising the Quality of Reporting of American College of Surgeons TQIP Studies in the Era of Large Data Research

BACKGROUND

The American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database is one of the most widely used databases for trauma research. We aimed to critically appraise the quality of the methodological reporting of ACS-TQIP studies.

STUDY DESIGN

The ACS-TQIP bibliography was queried for all studies published between January 2018 and January 2021. The quality of data reporting was assessed using the Strengthening the Reporting of Observational studies in Epidemiology-Reporting of Studies Conducted Using Observational Routinely Collected Health Data (STROBE-RECORD) statement and the JAMA Surgery checklist. Three items from each tool were not applicable and thus excluded. The quality of reporting was compared between high- and low-impact factor (IF) journals (cutoff for high IF is >90th percentile of all surgical journals).

RESULTS

A total of 118 eligible studies were included; 12 (10%) were published in high-IF journals. The median (interquartile range) number of criteria fulfilled was 5 (4-6) for the STROBE-RECORD statement (of 10 items) and 5 (5-6) for the JAMA Surgery checklist (of 7 items). Specifically, 73% of studies did not describe the patient population selection process, 61% did not address data cleaning or the implications of missing values, and 76% did not properly state inclusion/exclusion criteria and/or outcome variables. Studies published in high-IF journals had remarkably higher quality of reporting than those in low-IF journals.

CONCLUSION

The methodological reporting quality of ACS-TQIP studies remains suboptimal. Future efforts should focus on improving adherence to standard reporting guidelines to mitigate potential bias and improve the reproducibility of published studies.

The Effect of Psychological Interventions on the Quality of Life in Women with Fibromyalgia: A Systematic Review

Fibromyalgia refers to a painful type of rheumatological clinical syndrome, and its prevalence varies from 0.7% to 6.6%. This syndrome is associated with different physical and psychological symptoms, which ultimately leads to a decline in women's quality of life. A wide range of pharmacological and non-pharmacological interventions are conducted to mitigate these symptoms and improve the quality of life. Therefore, the present study aims to investigate the effect of psychological interventions on the quality of life in women with fibromyalgia. This systematic review with comprehensive search was carried out on Google Scholar, Scopus, PubMed, Web of Science, Science Direct, Cochrane Library, PsycINFO, and Scientific Information Database (SID), databases using the suitable keywords, and a total of 3125 articles from 2000 to 2019 were retrieved. Finally, the quality of 16 experimental and semi-experimental clinical trials was evaluated using the Jadad scale. The psychological interventions affecting the quality of life in women with fibromialgia included cognitive-behavioral therapy and behavioral therapy, coping strategies training, mindfulness, acceptance and commitment treatment, hypnosis, meditation, music therapy, short-term psychodynamic psychotherapy and writing emotions. The results of the study showed that except four studies, the studies generally improved the quality of life and reduced the symptoms in women with fibromyalgia. The results of the study suggest that most psychological interventions affect the quality of life in women with fibromyalgia. Therefore, besides pharmacological therapy, psychological interventions can be used by health-care providers to reduce the symptoms of fibromyalgia and improve the quality of their life.

Quality Assessment and Relevant Clinical Impact of Randomized Controlled Trials of Varicocele: Next Step to Good-Quality Randomized Controlled Trial of Varicocele Treatment

Purpose

To assess the quality of randomized controlled trials (RCTs) on varicocele published from 1979 to 2017.

Materials and Methods

We searched for original RCT on varicocele published between 1979 and 2017. Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool were used to analyze RCT quality over time. Effects on RCT quality including funding source, Institutional Review Board (IRB) approval, and intervention were assessed. Treatment parameters of varicocele were also analyzed.

Results

Blinding and allocation concealment were described in 25.9% and 9.4% of RCT, respectively. Both tended to increase and a sharp dip in allocation concealment was observed in 2010–2017. Jadad scores increased steadily from 1979 to 2017 (1.28±0.59 to 2.19±1.10, p<0.01). Van Tulder scores tended to increase from 1979 to 2017 (4.21±0.94 to 5.58±1.58, p<0.01). RCTs with funding statements had higher Jadad (Yes vs. No, 3.25±0.50 vs. 1.70±0.97; p<0.01) and van Tulder (Yes vs. No, 7.25±1.26 vs. 4.81±1.26; p<0.01) scores than unfunded RCTs. IRB approval and intervention were associated with better quality.

Conclusions

The number of RCTs on varicocele increased from 1979 to 2017. Also, quality improved over time with increasing IRB approval, funding, and multicenter trial. Most RCTs on varicocele reported the use of surgical treatment. RCTs of surgical treatments have limitations to satisfy the condition of RCT to conduct, but their quality has improved over time.

Reporting Quality Analysis of Randomized Controlled Trials in Journal of Neurosurgical Anesthesiology: A Methodological Assessment

BACKGROUND

Randomized controlled trials (RCTs) are considered to provide high levels of evidence to optimize decision-making for patient care, although there can be a risk bias in their design, conduct, and analysis. Quality assessment of RCTs is necessary to assess whether they provide reliable results with little bias.

MATERIALS AND METHODS

We assessed the reporting quality of RCTs published in the Journal of Neurosurgical Anesthesiology (JNA) between January 1, 2000 and December 31, 2017 using the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool (CCRBT).

RESULTS

We identified 130 RCTs and 570 original articles. Among the 130 RCTs, 92 (70.8%) presented an appropriate blinding method, and 70 (53.8%) described an appropriate allocation method. For the entire period, the percentages of high-quality reporting articles were 71.5%, 73.1%, and 13.8% in the Jadad scale, van Tulder scale, and CCRBT assessments, respectively. There was an improvement in the van Tulder scale over time (coefficients [95% confidence interval {CI}]=0.08 [0.01-0.15]; P=0.02). Appropriate reporting of allocation in the Jadad scale (coefficients [95% CI]=1.68 [1.28-2.07]; P<0.001) and van Tulder scale (coefficients [95% CI]=2.34 [1.97-2.70]; P<0.001), and reporting of blinding in the Jadad (coefficients [95% CI]=1.09 [0.66-1.52]; P<0.001) and van Tulder scores (coefficients [95% CI]=1.85 [1.45-2.25]; P<0.001), were associated with high-quality reporting.

CONCLUSIONS

The ratio of high-quality reporting RCTs in JNA was consistently high compared with other journals. Thorough consideration of allocation concealment during the peer review process can further improve the reporting quality of RCTs in JNA.

Artificial Intelligence-Aided Colonoscopy for Polyp Detection: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background: This study aimed to compare artificial intelligence (AI)-aided colonoscopy with conventional colonoscopy for polyp detection. Methods: A systematic literature search was performed in PubMed and Ovid for randomized clinical trials (RCTs) comparing AI-aided colonoscopy with conventional colonoscopy for polyp detection. The last search was performed on July 22, 2020. The primary outcome was polyp detection rate (PDR) and adenoma detection rate (ADR). Results: Seven RCTs published between 2019 and 2020 with a total of 5427 individuals were included. When compared with conventional colonoscopy, AI-aided colonoscopy significantly improved PDR (P < .001, odds ratio [OR] = 1.95, 95% confidence interval [CI]: 1.75 to 2.19, I² = 0%) and ADR (P < .001, OR = 1.72, 95% CI: 1.52 to 1.95, I² = 33%). Besides, polyps in the AI-aided group were significantly smaller in size than those in conventional group (P = .004, weighted mean difference = -0.48, 95% CI: -0.81 to -0.15, I² = 0%). In addition, AI-aided group detected significantly less proportion of advanced adenoma (P = .03, OR = 0.70, 95% CI: 0.50 to 0.97, I² = 46%), pedicle polyps (P < .001, OR = 0.64, 95% CI: 0.49 to 0.83, I² = 0%), and pedicle adenomas (P < .001, OR = 0.60, 95% CI: 0.44 to 0.80, I² = 0%). Conclusion: AI-aided colonoscopy could significantly increase the PDR and ADR, especially for those with small size. Besides, the shape and pathology recognition of the AI technique should be further improved in the future.

Low-residual diet versus clear-liquid diet for bowel preparation before colonoscopy: meta-analysis and trial sequential analysis of randomized controlled trials

BACKGROUND AND AIMS

The aim of this study was to compare a low-residual diet (LRD) with a clear-liquid diet (CLD) for bowel preparation before colonoscopy.

METHODS

A systematic literature search was performed in PubMed, Ovid, and Cochrane databases for randomized clinical trials comparing LRD with CLD for bowel preparation before colonoscopy. The last search was performed on September 20, 2019. The primary outcome was adequate bowel preparation. The outcomes were compared using systematic review with meta-analysis and trial sequential analysis (TSA).

RESULTS

Twenty randomized controlled trials published between 2005 and 2019 with 4323 participants were included. LRD was comparable with CLD for adequate bowel preparation (P = .79; odds ratio [OR], 0.96; 95% confidence interval [CI], 0.72-1.29). The detection rates for polyps (P = .68; OR, 1.04; 95% CI, 0.86-1.27) or adenomas (P = .78; OR, 1.03; 95% CI, 0.86-1.23) were similar between the groups. There were significantly fewer advents in individuals in the LRD group: nausea (P = .02; OR, 0.72; 95% CI, 0.56-0.94), vomiting (P = .04; OR, 0.61; 95% CI, 0.38-0.98), hunger (P < .001; OR, 0.36; 95% CI, 0.24-0.53), and headache (P = .02; OR ,0.64; 95% CI, 0.44-0.93). In addition, significantly more individuals in the LRD group found it easy to complete the diet (P = .01; OR, 1.86; 95% CI, 1.15-3.00) and showed willingness to repeat it (P = .005; OR, 2.23; 95% CI, 1.28-3.89). TSA demonstrated that the cumulative Z curve crossed both the traditional boundary and the trial sequential monitoring boundary for adequate bowel preparation.

CONCLUSION

The present study demonstrated that LRD was comparable with CLD in the quality of bowel preparation before colonoscopy. More clinical trials are needed to confirm other outcomes.

Polypectomy During Both Insertion and Withdrawal Phase Versus During Withdrawal Phase Only: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background: This study aimed to compare polypectomy during both insertion and withdrawal phase versus during withdrawal phase only. Method: We performed literature searching in PubMed and Ovid for randomized clinical trials (RCTs) that compared polypectomy during both insertion and withdrawal phase versus during withdrawal phase only on April 3, 2020. The primary outcome was adenoma detection rate (ADR). Results: Five RCTs published between 2012 and 2020 with a total of 2694 individuals were included in this meta-analysis. No significant difference was observed between the two groups for ADR (P = .99, odds ratio = 1.00, 95% confidence interval [CI] 0.84-1.19, I² = 0%), or average number of adenomas per individuals (P = .53, weighted mean difference [WMD] = 0.04, 95% CI -0.09 to 0.17, I² = 30%). Besides, polypectomy during both insertion and withdrawal group showed significantly longer time for insertion phase (P = .01, WMD = 2.16, 95% CI 0.47-3.84, I² = 95%), and shorter time for withdrawal phase (P = .010, WMD = -2.32, 95% CI -4.09 to -0.56, I² = 94%), although the total procedure time was not significantly different between the two groups. Conclusion: No obvious advantages were observed for polypectomy during both insertion and withdrawal phase. We are looking forward to the long-term outcomes of these studies. More studies are warranted in the future for further exploration, especially the detection rate of small lesions.

Coping Strategies-Oriented Interventions in Breast Cancer Women: A Systematic Scoping Review of the Quantitative Evidence

Context: Coping strategies can predict breast cancer patients’ emotional well-being. Objectives: The aim of this systematic scoping review was to investigate the effect of coping strategies-oriented interventions on coping skills in breast cancer women. Data Sources: A systematic scoping review was conducted using a broad search across PubMed, Scopus, Springer, Elsevier, Cochrane Library, Science Direct, Web of Science, Magiran, Scientific Information Database, and Google scholar from 2009 - 2018. Study Selection: Clinical or quasi-experimental trials using interventions and control groups on the coping strategies-oriented interventions in breast cancer women in English or Persian were included. Data Extraction: Two independent researchers selected the final papers. In the case of a disagreement, the third researcher made the final decision. The quality of the included studies was assessed using the Jadad scale. Results: The coping strategies-oriented interventions were classified into four main categories: psychological interventions, such as cognitive-behavioral therapy, mindfulness, coping therapy, self-management, and psychoeducation; spiritual-religious interventions; social interventions, such as family therapy; and complementary interventions, such as acupuncture. Most interventions improved the coping skills of the studied women. Based on the Jadad scale, only two studies had good quality. Conclusions: Considering that most interventions improved the coping skills of breast cancer women, it is suggested that healthcare providers be proficient in examination techniques that maximize the patient’s coping skills. However, there remains a need for further culture-based research to adopt the best interventions and make changes in policy.

Trustworthiness of randomized trials in endocrinology-A systematic survey

Background

Trustworthy (i.e. low risk of bias) randomized clinical trials (RCTs) play an important role in evidence-based decision making. We aimed to systematically assess the risk of bias of trials published in high-impact endocrinology journals.

Methods

We searched the MEDLINE/PubMed database between 2014 and 2016 for phase 2–4 RCTs evaluating endocrine-related therapies. Reviewers working independently and in duplicate used the Cochrane Risk of Bias Tool (CCRBT) to determine the extent to which the methods reported protected the results of each RCT from bias.

Results

We assessed 292 eligible RCTs, of which 40% (116) were judged to be at low risk, 43% (126) at moderate, and 17% (50) at high risk of bias. Blinding of outcome assessment was the least common domain reported 43% (125), while selective reporting of outcomes was the most common 97% (282). In multivariable analysis, RCTs with a parallel design (OR 2.4; 95% CI; 1.2–4.6) and funded by for-profit sources (OR 2.2; 95% CI; 1.3–3.6) were more likely to be at low risk of bias.

Conclusions

Trustworthy evidence should ultimately shape care to improve the likelihood of desirable patient outcomes. Six out-of 10 RCTs published in top endocrine journals are at moderate/high-risk of bias. Improving this should be a priority in endocrine research.

Psychological interventions for nausea and vomiting of pregnancy: A systematic review

Various studies have investigated the role that psychological factors play in the etiology of nausea and vomiting during pregnancy. The current research was aimed at reviewing the psychological interventions that are implemented to treat the aforementioned conditions. Vocabulary from the Medical Subject Headings database was used as basis for identifying search keywords, which were then employed to search for relevant articles in PubMed, Web of Science, Google Scholar, PsycINFO, Scopus, the Scientific Information Database, IranMedex, Magiran, and IranDoc. A total of 174,270 articles published in the period between 1985 and 2017 were obtained. After the elimination of repetitive and unrelated articles, six clinical trials were evaluated using the Oxford quality scoring system or Jadad scale. Psychological interventions for nausea and vomiting during pregnancy fall into four categories, namely, behavioral therapy, mindfulness-based cognitive therapy, hypnosis, and progressive muscle relaxation. On the basis of the Jadad scale, all the reviewed studies were evaluated as being of poor methodological quality. Further studies are needed to obtain strong evidence on the effectiveness of psychological interventions for the treatment of women suffering from nausea and vomiting during pregnancy.

Comparison of self-care in non-cardiac diabetic patients

BACKGROUND

In general, the majority of diabetic patients suffering from a lack of capability in controlling different aspects of self-care have likely been prone to cardiovascular disease. To reduce the economic burden in societies and the rate of death on one hand, and improve life expectancy, on the other hand, it seems necessary to emphasize self-care training in diabetic patients. The purpose of this study was to determine comparison of self-care in cardiac and non-cardiac diabetic patients.

METHODS

This descriptive-analytic study was carried out with 136 diabetic participants selected using random sampling and divided into two groups of 68 non-cardiac diabetic patients. Data were collected using a demographic and diabetic patient's self-management questionnaire (DSMQ). For the analysis of the data, SPSS16 was employed to check the significance test at the level of P<0.05.

RESULTS

In this study, twenty-eight (41.2%) and forty (58.8%) of the participants in each group were male and female, respectively. Their ages spanned from (61.35±13.34) in non-cardiac diabetic group to (65.94±8.74) in cardiac diabetic participants. There were significant differences between two groups, specifically in patients with cardiac diabetic disease in different aspects, for instance, including glucose monitoring (F=4.977, P=0.027, η²=0.036), diet control (F=9.125, P=0.003, η²=0.064), physical activity (F=22.954, P=0.0001, η²=0.146) and health care awareness (F=31.366, P=0.0001, η²=0.19).

CONCLUSION

According to DSMQ questionnaire in the present study, glucose monitoring, diet control, physical activity, and health care awareness in diabetic patients with heart disease were significantly reported to have been better than the other group with no cardiac problem. Due to insufficient self-care in diabetic patients and some consequences such as poor health, heart disease as one of the complications of diabetes, hospital re-admission and heavy costs, the therapeutic team should be alerted to self-care training.

Recommendations for Randomised Trials in Surgical Oncology

Trials of surgical procedures in the treatment of malignant disease face a unique set of challenges. This review aimed to describe recommendations for the design, delivery and reporting of randomised trials in surgical oncology. A literature search was carried out without date limits to identify articles related to trial methodology research in surgery and surgical oncology. A narrative review was framed around two open National Institute of Health Research portfolio trials in colon and rectal cancer: the STAR-TREC trial (ISRCTN14240288) and the ROCCS trial (ISRCTN46330337). Twelve specific challenges were highlighted: standardisation of technique; pilot and feasibility studies; balancing treatments; the recruitment pathway; outcome measures; patient and public representation; trainee-led networks; randomisation; novel techniques and training; learning curves; blinding; follow-up. Evidence-based recommendations were made for the future design and conduct of surgical oncology trials. Better understanding of the challenges facing trials in the surgical treatment of cancer will accelerate high-quality evaluation and rapid adoption of innovation for the benefit of patient care.

Research in Nursing and Nutrition: Is Randomized Clinical Trial the Actual Gold Standard?

The aim of this study was to assess the quality of reporting of nurse-driven randomized controlled trials involving a direct nutritional intervention. A bibliometric search for randomized controlled trials involving a direct nutritional intervention from 1991 to 2011 in nursing research was conducted. Both quality of the study and design aspects were evaluated. The prevalent randomized controlled trial design used is 2-arm parallel, individual, and randomized with a continuous primary endpoint. Global numbers of randomized controlled trials and the proportion of good-quality randomized controlled trials began a steady and marked rise, more than doubling, from the 1990s to about 2001 and increased slowly thereafter. Studies are overall sufficiently well designed, although there is still room for quality improvement. Additionally, implementation of new randomized controlled trial designs exists and should be advocated.

The relationship between external and internal validity of randomized controlled trials: A sample of hypertension trials from China

Objective

To explore the relationship between the external validity and the internal validity of hypertension RCTs conducted in China.

Methods

Comprehensive literature searches were performed in Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR), CBMdisc (Chinese biomedical literature database), CNKI (China National Knowledge Infrastructure/China Academic Journals Full-text Database) and VIP (Chinese scientific journals database) as well as advanced search strategies were used to locate hypertension RCTs. The risk of bias in RCTs was assessed by a modified scale, Jadad scale respectively, and then studies with 3 or more grading scores were included for the purpose of evaluating of external validity. A data extract form including 4 domains and 25 items was used to explore relationship of the external validity and the internal validity. Statistic analyses were performed by using SPSS software, version 21.0 (SPSS, Chicago, IL).

Results

226 hypertension RCTs were included for final analysis. RCTs conducted in university affiliated hospitals (P < 0.001) or secondary/tertiary hospitals (P < 0.001) were scored at higher internal validity. Multi-center studies (median = 4.0, IQR = 2.0) were scored higher internal validity score than single-center studies (median = 3.0, IQR = 1.0) (P < 0.001). Funding-supported trials had better methodological quality (P < 0.001). In addition, the reporting of inclusion criteria also leads to better internal validity (P = 0.004). Multivariate regression indicated sample size, industry-funding, quality of life (QOL) taken as measure and the university affiliated hospital as trial setting had statistical significance (P < 0.001, P < 0.001, P = 0.001, P = 0.006 respectively).

Conclusion

Several components relate to the external validity of RCTs do associate with the internal validity, that do not stand in an easy relationship to each other. Regarding the poor reporting, other possible links between two variables need to trace in the future methodological researches.

Conflicts of Interest, Selective Inertia, and Research Malpractice in Randomized Clinical Trials: An Unholy Trinity

Recently a great deal of attention has been paid to conflicts of interest in medical research, and the Institute of Medicine has called for more research into this important area. One research question that has not received sufficient attention concerns the mechanisms of action by which conflicts of interest can result in biased and/or flawed research. What discretion do conflicted researchers have to sway the results one way or the other? We address this issue from the perspective of selective inertia, or an unnatural selection of research methods based on which are most likely to establish the preferred conclusions, rather than on which are most valid. In many cases it is abundantly clear that a method that is not being used in practice is superior to the one that is being used in practice, at least from the perspective of validity, and that it is only inertia, as opposed to any serious suggestion that the incumbent method is superior (or even comparable), that keeps the inferior procedure in use, to the exclusion of the superior one. By focusing on these flawed research methods we can go beyond statements of potential harm from real conflicts of interest, and can more directly assess actual (not potential) harm.

Tiny tweaks, big changes: An alternative strategy to empower ethical culture of human research in anesthesia (A Taiwan Acta Anesthesiologica Taiwanica-Ethics Review Task Force Report)

For this guidance article, the Ethics Review Task Force (ERTF) of the Journal reviewed and discussed the ethics issues related to publication of human research in the field of anesthesia. ERTF first introduced international ethics principles and minimal requirements of reporting of ethics practices, followed by discussing the universal problems of publication ethics. ERTF then compared the accountability and methodology of several medical journals in assuring authors' ethics compliance. Using the Taiwan Institutional Review Board system as an example, ERTF expressed the importance of institutional review board registration and accreditation to assure human participant protection. ERTF presented four major human research misconducts in the field of anesthesia in recent years. ERTF finally proposed a flow-chart to guide journal peer reviewers and editors in ethics review during the editorial process in publishing. Examples of template languages applied in the Ethics statement section in the manuscript are expected to strengthen the ethics compliance of the authors and to set an ethical culture for all the stakeholders involved in human research.

Strategies to improve clinical research in surgery through international collaboration

More than 235 million patients undergo surgery every year worldwide, but less than 1% are enrolled in surgical clinical trials--few of which are international collaborations. Several levels of action are needed to improve this situation. International research collaborations in surgery between developed and developing countries could encourage capacity building and quality improvement, and mutually enhance care for patients with surgical disorders. Low-income and middle-income countries increasingly report much the same range of surgical diseases as do high-income countries (eg, cancer, cardiovascular disease, and the surgical sequelae of metabolic syndrome); collaboration is therefore of mutual interest. Large multinational trials that cross cultures and levels of socioeconomic development might have faster results and wider applicability than do single-country trials. Surgeons educated in research methods, and aided by research networks and trial centres, are needed to foster these international collaborations. Barriers to collaboration could be overcome by adoption of global strategies for regulation, health insurance, ethical approval, and indemnity coverage for doctors.