1
|
Ordak M. Poor statistical reporting: do we have a reason for concern? A narrative review and recommendations. Curr Opin Allergy Clin Immunol 2024; 24:237-242. [PMID: 38236908 DOI: 10.1097/aci.0000000000000965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW The aim of the review conducted was to present recent articles indicating the need to implement statistical recommendations in the daily work of biomedical journals. RECENT FINDINGS The most recent literature shows an unchanged percentage of journals using specialized statistical review over 20 years. The problems of finding statistical reviewers, the impractical way in which biostatistics is taught and the nonimplementation of published statistical recommendations contribute to the fact that a small percentage of accepted manuscripts contain correctly performed analysis. The statistical recommendations published for authors and editorial board members in recent years contain important advice, but more emphasis should be placed on their practical and rigorous implementation. If this is not the case, we will additionally continue to experience low reproducibility of the research. SUMMARY There is a low level of statistical reporting these days. Recommendations related to the statistical review of submitted manuscripts should be followed more rigorously.
Collapse
Affiliation(s)
- Michal Ordak
- Department of Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
2
|
Yan X, Wang J, Zhou Y, Yang Z, Wang B, Jiang L, Zhang L, Kou Z, Song J, Li J. Genetically Predicted Vascular Proteins and Risk of Intracranial Aneurysms: A Mendelian Randomization Study. Mol Neurobiol 2024:10.1007/s12035-024-04393-0. [PMID: 39066975 DOI: 10.1007/s12035-024-04393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
The relationship between vascular proteins (VPs) and intracranial aneurysms (IAs) has not been fully elucidated. We used Mendelian randomization (MR) analysis to explore the effect of VPs on IAs. Dataset of aneurysmal subarachnoid hemorrhage (aSAH) [5140 cases and 71,934 controls] and unruptured intracranial aneurysm (uIA) [2070 cases and 71,934 controls] were obtained from individuals of European ancestry. Univariate MR was used to explore the associations between 90 VPs and IAs. Then, we performed multivariate MR (MVMR) to further investigate the identified VP-to-IA estimates. Two-sample MR showed that TNFSF14 was inversely associated with aSAH (odds ratio [OR] = 0.831, 95% CI: 0.713-0.969, p = 0.018). IL-16 (OR = 1.218, 95% CI: 1.032-1.438, p = 0.020) and AgRP (OR = 1.394, 95% CI: 1.048-1.855, p = 0.023) were positively associated with aSAH. HBEGF (OR = 0.642, 95% CI: 0.461-0.894, p = 0.009), MCP-1 (OR = 1.537, 95% CI: 1.007-2.344, p = 0.046), and CX3CL1 (OR = 0.762, 95% CI: 0.581-0.999, 0.049 < p < 0.050) were associated with uIA risk. The MVMR showed that the TNFSF14-to-aSAH estimate remained statistically significant after adjustment for past tobacco smoking, alcohol consumption, systolic blood pressure and body mass index. Our study indicated that low serum TNFSF14 levels might be a potential risk factor for IA rupture. Five VPs (HBEGF, MCP-1, IL-6, CX3CL1, and AgRP) are associated with the risk of IAs (both uIA and aSAH).
Collapse
Affiliation(s)
- Xinyang Yan
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jiachen Wang
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yunfei Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Zhongbo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Bo Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Liangchao Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Longxiao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Zhiyan Kou
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jinning Song
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
| | - Jiaxi Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
- Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
| |
Collapse
|
3
|
Dannehl D, von Au A, Engler T, Volmer LL, Gutsfeld R, Englisch JF, Hahn M, Hawighorst-Knapstein S, Chaudhuri A, Bauer A, Wallwiener M, Taran FA, Wallwiener D, Brucker SY, Wallwiener S, Hartkopf AD, Dijkstra TMH. Implementation and Evaluation of a Breast Cancer Disease Model Using Real-World Claims Data in Germany from 2010 to 2020. Cancers (Basel) 2024; 16:1490. [PMID: 38672572 PMCID: PMC11049278 DOI: 10.3390/cancers16081490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Breast cancer is the leading cause of cancer-related mortality among women in Germany and worldwide. This retrospective claims data analysis utilizing data from AOK Baden-Wuerttemberg, a major statutory German health insurance provider, aimed to construct and assess a real-world data breast cancer disease model. The study included 27,869 female breast cancer patients and 55,738 age-matched controls, analyzing data from 2010 to 2020. Three distinct breast cancer stages were analyzed: Stage A (early breast cancer without lymph node involvement), Stage B (early breast cancer with lymph node involvement), and Stage C (primary distant metastatic breast cancer). Tumor subtypes were estimated based on the prescription of antihormonal or HER2-targeted therapy. The study established that 77.9% of patients had HR+ breast cancer and 9.8% HER2+; HR+/HER2- was the most common subtype (70.9%). Overall survival (OS) analysis demonstrated significantly lower survival rates for stages B and C than for controls, with 5-year OS rates ranging from 79.3% for stage B to 35.4% for stage C. OS rates were further stratified by tumor subtype and stage, revealing varying prognoses. Distant recurrence-free survival (DRFS) analysis showed higher recurrence rates in stage B than in stage A, with HR-/HER2- displaying the worst DRFS. This study, the first to model breast cancer subtypes, stages, and outcomes using German claims data, provides valuable insights into real-world breast cancer epidemiology and demonstrates that this breast cancer disease model has the potential to be representative of treatment outcomes.
Collapse
Affiliation(s)
- Dominik Dannehl
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University, 69120 Heidelberg, Germany;
| | - Tobias Engler
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Léa Louise Volmer
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Raphael Gutsfeld
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Johannes Felix Englisch
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Markus Hahn
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | | | - Ariane Chaudhuri
- AOK Baden-Wuerttemberg, 70188 Stuttgart, Germany; (S.H.-K.); (A.C.)
| | - Armin Bauer
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | | | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, Freiburg University, 79106 Freiburg im Breisgau, Germany;
| | - Diethelm Wallwiener
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Stephanie Wallwiener
- Department of Obstetrics and Perinatal Medicine, Halle University, 06120 Halle, Germany;
| | - Andreas Daniel Hartkopf
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Tjeerd Maarten Hein Dijkstra
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
- Institute for Translational Bioinformatics, University Hospital Tübingen, 72076 Tübingen, Germany
| |
Collapse
|
4
|
Silva FL, Tavares SJDO, Silveira FM, Antunes LS, Antunes LAA, Assaf AV. Educational strategies for oral assistance for the disabled and their effects on dentistry students' formation: A systematic review. SPECIAL CARE IN DENTISTRY 2024; 44:339-359. [PMID: 37186236 DOI: 10.1111/scd.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/14/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
AIMS This systematic review aimed to analyze the influence of educational strategies for oral health care for Persons with disabilities (PwDs) on the technical, ethical, and social training of undergraduate dental students. METHODS AND RESULTS An extensive search was performed in the following databases: Cochrane, Embase, PubMed, Scopus, Web of Science, LILACS/BBO and OpenGrey database. Observational, nonrandomized, and quantitative comparisons before and after some type of educational strategy in undergraduate dentistry was included. The risk of bias was assessed using the risk of bias in nonrandomized intervention studies (ROBINS-I) tool. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine were included and suggested that a significant improvement was observed in the technical training of undergraduate dental students although there was no consensus on the acquisition of ethical/social competences after the application of educational strategies. The included studies presented a moderate to serious risk of bias, and the certainty of evidence for both, technical and ethical/social evaluative constructs, as very low. CONCLUSION Although studies show that awareness regarding PwD significantly increases technical skills in dental students, the evidence is poor due to the high risk of bias and inconsistency observed in both the technical and ethical/social constructs; further studies on this topic are therefore essential. Prospero: (CRD42021288463).
Collapse
Affiliation(s)
- Fernanda Luiza Silva
- Post-graduation Program in Dentistry, Federal Fluminense University (UFF), Rio de Janeiro, Brazil
| | | | - Flávia Maia Silveira
- Post-graduation Program in Dentistry, Federal Fluminense University (UFF), Rio de Janeiro, Brazil
| | - Leonardo Santos Antunes
- Post-graduation Program in Dentistry, Federal Fluminense University (UFF), Rio de Janeiro, Brazil
| | | | - Andréa Videira Assaf
- Post-graduation Program in Dentistry, Federal Fluminense University (UFF), Rio de Janeiro, Brazil
| |
Collapse
|
5
|
Luijken K, Groenwold RHH, van Smeden M, Strohmaier S, Heinze G. A comparison of full model specification and backward elimination of potential confounders when estimating marginal and conditional causal effects on binary outcomes from observational data. Biom J 2024; 66:e2100237. [PMID: 35560110 PMCID: PMC10952199 DOI: 10.1002/bimj.202100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/10/2021] [Accepted: 02/05/2022] [Indexed: 11/10/2022]
Abstract
A common view in epidemiology is that automated confounder selection methods, such as backward elimination, should be avoided as they can lead to biased effect estimates and underestimation of their variance. Nevertheless, backward elimination remains regularly applied. We investigated if and under which conditions causal effect estimation in observational studies can improve by using backward elimination on a prespecified set of potential confounders. An expression was derived that quantifies how variable omission relates to bias and variance of effect estimators. Additionally, 3960 scenarios were defined and investigated by simulations comparing bias and mean squared error (MSE) of the conditional log odds ratio, log(cOR), and the marginal log risk ratio, log(mRR), between full models including all prespecified covariates and backward elimination of these covariates. Applying backward elimination resulted in a mean bias of 0.03 for log(cOR) and 0.02 for log(mRR), compared to 0.56 and 0.52 for log(cOR) and log(mRR), respectively, for a model without any covariate adjustment, and no bias for the full model. In less than 3% of the scenarios considered, the MSE of the log(cOR) or log(mRR) was slightly lower (max 3%) when backward elimination was used compared to the full model. When an initial set of potential confounders can be specified based on background knowledge, there is minimal added value of backward elimination. We advise not to use it and otherwise to provide ample arguments supporting its use.
Collapse
Affiliation(s)
- Kim Luijken
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Rolf H. H. Groenwold
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Maarten van Smeden
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Susanne Strohmaier
- Section for Clinical BiometricsCenter for Medical StatisticsInformatics and Intelligent SystemsMedical University of ViennaViennaAustria
- Department of EpidemiologyCenter for Public HealthMedical University of ViennaViennaAustria
| | - Georg Heinze
- Section for Clinical BiometricsCenter for Medical StatisticsInformatics and Intelligent SystemsMedical University of ViennaViennaAustria
| |
Collapse
|
6
|
Schuster NA, Rijnhart JJM, Bosman LC, Twisk JWR, Klausch T, Heymans MW. Misspecification of confounder-exposure and confounder-outcome associations leads to bias in effect estimates. BMC Med Res Methodol 2023; 23:11. [PMID: 36635655 PMCID: PMC9835340 DOI: 10.1186/s12874-022-01817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Confounding is a common issue in epidemiological research. Commonly used confounder-adjustment methods include multivariable regression analysis and propensity score methods. Although it is common practice to assess the linearity assumption for the exposure-outcome effect, most researchers do not assess linearity of the relationship between the confounder and the exposure and between the confounder and the outcome before adjusting for the confounder in the analysis. Failing to take the true non-linear functional form of the confounder-exposure and confounder-outcome associations into account may result in an under- or overestimation of the true exposure effect. Therefore, this paper aims to demonstrate the importance of assessing the linearity assumption for confounder-exposure and confounder-outcome associations and the importance of correctly specifying these associations when the linearity assumption is violated. METHODS A Monte Carlo simulation study was used to assess and compare the performance of confounder-adjustment methods when the functional form of the confounder-exposure and confounder-outcome associations were misspecified (i.e., linearity was wrongly assumed) and correctly specified (i.e., linearity was rightly assumed) under multiple sample sizes. An empirical data example was used to illustrate that the misspecification of confounder-exposure and confounder-outcome associations leads to bias. RESULTS The simulation study illustrated that the exposure effect estimate will be biased when for propensity score (PS) methods the confounder-exposure association is misspecified. For methods in which the outcome is regressed on the confounder or the PS, the exposure effect estimate will be biased if the confounder-outcome association is misspecified. In the empirical data example, correct specification of the confounder-exposure and confounder-outcome associations resulted in smaller exposure effect estimates. CONCLUSION When attempting to remove bias by adjusting for confounding, misspecification of the confounder-exposure and confounder-outcome associations might actually introduce bias. It is therefore important that researchers not only assess the linearity of the exposure-outcome effect, but also of the confounder-exposure or confounder-outcome associations depending on the confounder-adjustment method used.
Collapse
Affiliation(s)
- Noah A. Schuster
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | | | - Lisa C. Bosman
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Thomas Klausch
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117 Amsterdam, The Netherlands
| |
Collapse
|
7
|
Grosman S, Scott IA. Quality of observational studies of clinical interventions: a meta-epidemiological review. BMC Med Res Methodol 2022; 22:313. [PMID: 36476329 PMCID: PMC9727931 DOI: 10.1186/s12874-022-01797-1] [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] [Received: 12/04/2021] [Accepted: 10/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This meta-epidemiological study aimed to assess methodological quality of a sample of contemporary non-randomised clinical studies of clinical interventions. METHODS This was a cross-sectional study of observational studies published between January 1, 2012 and December 31, 2018. Studies were identified in PubMed using search terms 'association', 'observational,' 'non-randomised' 'comparative effectiveness' within titles or abstracts. Each study was appraised against 35 quality criteria by two authors independently, with each criterion rated fully, partially or not satisfied. These quality criteria were grouped into 6 categories: justification for observational design (n = 2); minimisation of bias in study design and data collection (n = 11); use of appropriate methods to create comparable groups (n = 6); appropriate adjustment of observed effects (n = 5); validation of observed effects (n = 9); and authors interpretations (n = 2). RESULTS Of 50 unique studies, 49 (98%) were published in two US general medical journals. No study fully satisfied all applicable criteria; the mean (+/-SD) proportion of applicable criteria fully satisfied across all studies was 72% (+/- 10%). The categories of quality criteria demonstrating the lowest proportions of fully satisfied criteria were measures used to adjust observed effects (criteria 20, 23, 24) and validate observed effects (criteria 25, 27, 33). Criteria associated with ≤50% of full satisfaction across studies, where applicable, comprised: imputation methods to account for missing data (50%); justification for not performing an RCT (42%); interaction analyses in identifying independent prognostic factors potentially influencing intervention effects (42%); use of statistical correction to minimise type 1 error in multiple outcome analyses (33%); clinically significant effect sizes (30%); residual bias analyses for unmeasured or unknown confounders (14%); and falsification tests for residual confounding (8%). The proportions of fully satisfied criteria did not change over time. CONCLUSIONS Recently published observational studies fail to fully satisfy more than one in four quality criteria. Criteria that were not or only partially satisfied were identified which serve as remediable targets for researchers and journal editors.
Collapse
Affiliation(s)
- Sergei Grosman
- grid.412744.00000 0004 0380 2017Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102 Australia ,grid.413210.50000 0004 4669 2727Department of Medicine, Cairns Hospital, 165 The Esplanade, Cairns, Queensland 4870 Australia
| | - Ian A. Scott
- grid.412744.00000 0004 0380 2017Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102 Australia
| |
Collapse
|
8
|
Alghamdi NJ, Burns CT, Valdes R. The urocortin peptides: biological relevance and laboratory aspects of UCN3 and its receptor. Crit Rev Clin Lab Sci 2022; 59:573-585. [PMID: 35738909 DOI: 10.1080/10408363.2022.2080175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The urocortins are polypeptides belonging to the corticotropin-releasing hormone family, known to modulate stress responses in mammals. Stress, whether induced physically or psychologically, is an underlying cause or consequence of numerous clinical syndromes. Identifying biological markers associated with the homeostatic regulation of stress could provide a clinical laboratory approach for the management of stress-related disorders. The neuropeptide, urocortin 3 (UCN3), and the corticotropin-releasing hormone receptor 2 (CRHR2) constitute a regulatory axis known to mediate stress homeostasis. Dysregulation of this peptide/receptor axis is believed to play a role in several clinical conditions including post-traumatic stress, sleep apnea, cardiovascular disease, and other health problems related to stress. Understanding the physiology and measurement of the UCN3/CRHR2 axis is important for establishing a viable clinical laboratory diagnostic. In this article, we focus on evidence supporting the role of UCN3 and its receptor in stress-related clinical syndromes. We also provide insight into the measurements of UCN3 in blood and urine. These potential biomarkers provide new opportunities for clinical research and applications of laboratory medicine diagnostics in stress management.
Collapse
Affiliation(s)
- Norah J Alghamdi
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Roland Valdes
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| |
Collapse
|
9
|
Catalá-López F, Driver JA, Page MJ, Hutton B, Ridao M, Berrozpe-Villabona C, Alonso-Arroyo A, Fraga-Medín CA, Bernal-Delgado E, Valencia A, Tabarés-Seisdedos R. Design and methodological characteristics of studies using observational routinely collected health data for investigating the link between cancer and neurodegenerative diseases: protocol for a meta-research study. BMJ Open 2022; 12:e058738. [PMID: 35487732 PMCID: PMC9058779 DOI: 10.1136/bmjopen-2021-058738] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Health services generate large amounts of routine health data (eg, administrative databases, disease registries and electronic health records), which have important secondary uses for research. Increases in the availability and the ability to access and analyse large amounts of data represent a major opportunity for conducting studies on the possible relationships between complex diseases. The objective of this study will be to evaluate the design, methods and reporting of studies conducted using observational routinely collected health data for investigating the link between cancer and neurodegenerative diseases. METHODS AND ANALYSIS This is the protocol for a meta-research study. We registered the study protocol within the Open Science Framework: https://osf.io/h2qjg. We will evaluate observational studies (eg, cohort and case-control) conducted using routinely collected health data for investigating the associations between cancer and neurodegenerative diseases (such as Alzheimer's disease, amyotrophic lateral sclerosis/motor neuron disease, Huntington's disease, multiple sclerosis and Parkinson's disease). The following electronic databases will be searched (from their inception onwards): MEDLINE, Embase and Web of Science Core Collection. Screening and selection of articles will be conducted by at least two researchers. Potential discrepancies will be resolved via discussion. Design, methods and reporting characteristics in each article will be extracted using a standardised data extraction form. Information on general, methodological and transparency items will be reported. We will summarise our findings with tables and graphs (eg, bar charts, forest plots). ETHICS AND DISSEMINATION Due to the nature of the proposed study, no ethical approval will be required. We plan to publish the full study in an open access peer-reviewed journal and disseminate the findings at scientific conferences and via social media. All data will be deposited in a cross-disciplinary public repository.
Collapse
Affiliation(s)
- Ferrán Catalá-López
- Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and Centro de Investigación en Red de Salud Mental (CIBERSAM), Valencia, Spain
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jane A Driver
- Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Manuel Ridao
- Instituto Aragonés de Ciencias de la Salud, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Zaragoza, Spain
| | | | - Adolfo Alonso-Arroyo
- Department of History of Science and Documentation, University of Valencia, Valencia, Spain
- Unidad de Información e Investigación Social y Sanitaria, University of Valencia, Spanish National Research Council, Valencia, Spain
| | | | - Enrique Bernal-Delgado
- Instituto Aragonés de Ciencias de la Salud, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Zaragoza, Spain
| | - Alfonso Valencia
- Life Sciences Department, Barcelona Supercomputing Center, Barcelona, Spain
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and Centro de Investigación en Red de Salud Mental (CIBERSAM), Valencia, Spain
| |
Collapse
|
10
|
Petersen JM, Barrett M, Ahrens KA, Murray EJ, Bryant AS, Hogue CJ, Mumford SL, Gadupudi S, Fox MP, Trinquart L. The confounder matrix: A tool to assess confounding bias in systematic reviews of observational studies of etiology. Res Synth Methods 2022; 13:242-254. [PMID: 34954912 PMCID: PMC8965616 DOI: 10.1002/jrsm.1544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023]
Abstract
Systematic reviews and meta-analyses are essential for drawing conclusions regarding etiologic associations between exposures or interventions and health outcomes. Observational studies comprise a substantive source of the evidence base. One major threat to their validity is residual confounding, which may occur when component studies adjust for different sets of confounders, fail to control for important confounders, or have classification errors resulting in only partial control of measured confounders. We present the confounder matrix-an approach for defining and summarizing adequate confounding control in systematic reviews of observational studies and incorporating this assessment into meta-analyses. First, an expert group reaches consensus regarding the core confounders that should be controlled and the best available method for their measurement. Second, a matrix graphically depicts how each component study accounted for each confounder. Third, the assessment of control adequacy informs quantitative synthesis. We illustrate the approach with studies of the association between short interpregnancy intervals and preterm birth. Our findings suggest that uncontrolled confounding, notably by reproductive history and sociodemographics, resulted in exaggerated estimates. Moreover, no studies adequately controlled for all core confounders, so we suspect residual confounding is present, even among studies with better control. The confounder matrix serves as an extension of previously published methodological guidance for observational research synthesis, enabling transparent reporting of confounding control and directly informing meta-analysis so that conclusions are drawn from the best available evidence. Widespread application could raise awareness about gaps across a body of work and allow for more valid inference with respect to confounder control.
Collapse
Affiliation(s)
- Julie M. Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Malcolm Barrett
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Katherine A. Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Eleanor J. Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Vincent Obstetric Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carol J. Hogue
- Departments of Epidemiology and Behavioral Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sunni L. Mumford
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Salini Gadupudi
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Matthew P. Fox
- Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Mouffak A, Lepelley M, Revol B, Bernardeau C, Salvo F, Pariente A, Roustit M, Cracowski JL, Khouri C. High prevalence of spin was found in pharmacovigilance studies using disproportionality analyses to detect safety signals: a meta-epidemiological study. J Clin Epidemiol 2021; 138:73-79. [PMID: 34186195 DOI: 10.1016/j.jclinepi.2021.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To systematically review and appraise misinterpretation of pharmacovigilance disproportionality analysis results in published studies. STUDY DESIGN AND SETTING We randomly selected 100 studies that performed disproportionality analyses and indexed in Medline identified during a systematic literature search. Titles, abstracts and main texts (results, discussion and conclusion) were evaluated for spin independently by two reviewers. Spin in pharmacovigilance studies was classified according to three main categories: inappropriate interpretation, inappropriate extrapolations and misleading reporting. RESULTS Of the 100 studies evaluated, we found that 63%, 56% and 51% had at least one type of spin in their abstract, main text or conclusion respectively, and 40% used causal language to interpret their results in the abstract or conclusion. Spin in titles and results were exclusively represented by inappropriate interpretations of findings (12% and 21% respectively), with terms such as "risk of" or "risks associated with" or results erroneously presented as regular Odds Ratios. Spin in discussion sections mostly concerned inappropriate interpretations (38%)and misleading reporting (12%). Misleading reporting, notably failing to acknowledge the limitations of disproportionality analyses, was the most frequent type of spin in abstracts (55%) and conclusion sections (37%). CONCLUSION We found that spin is frequent in publications of pharmacovigilance disproportionality analyses, notably in abstracts. This consisted notably in an over-interpretation of the results suggesting a proven causative link between a drug use and the risk of an event.
Collapse
Affiliation(s)
- Amelle Mouffak
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble F-38000, France
| | - Marion Lepelley
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble F-38000, France
| | - Bruno Revol
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble F-38000, France; HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble F-38000, France
| | - Claire Bernardeau
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble F-38000, France
| | - Francesco Salvo
- Pharmacoepidemiology Team Bordeaux Population Health INSERM U1219, University of Bordeaux, Bordeaux F-33000, France; Medical Pharmacology Unit, Public Health division, Bordeaux University Hospital (CHU), Bordeaux 33000, France
| | - Antoine Pariente
- Pharmacoepidemiology Team Bordeaux Population Health INSERM U1219, University of Bordeaux, Bordeaux F-33000, France; Medical Pharmacology Unit, Public Health division, Bordeaux University Hospital (CHU), Bordeaux 33000, France
| | - Matthieu Roustit
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble F-38000, France; Clinical Pharmacology Department INSERM CIC 1406, Grenoble Alpes University Hospital, Grenoble F-38000, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble F-38000, France; HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble F-38000, France
| | - Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble F-38000, France; HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble F-38000, France; Clinical Pharmacology Department INSERM CIC 1406, Grenoble Alpes University Hospital, Grenoble F-38000, France.
| |
Collapse
|
12
|
Torp-Pedersen C, Goette A, Nielsen PB, Potpara T, Fauchier L, John Camm A, Arbelo E, Boriani G, Skjoeth F, Rumsfeld J, Masoudi F, Guo Y, Joung B, Refaat MM, Kim YH, Albert CM, Piccini J, Avezum A, Lip GYH. 'Real-world' observational studies in arrhythmia research: data sources, methodology, and interpretation. A position document from European Heart Rhythm Association (EHRA), endorsed by Heart Rhythm Society (HRS), Asia-Pacific HRS (APHRS), and Latin America HRS (LAHRS). Europace 2021; 22:831-832. [PMID: 31725156 DOI: 10.1093/europace/euz210] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
The field of observational studies or "real world studies" is in rapid development with many new techniques introduced and increased understanding of traditional methods. For this reason the current paper provides an overview of current methods with focus on new techniques. Some highlights can be emphasized: We provide an overview of sources of data for observational studies. There is an overview of sources of bias and confounding. Next There is an overview of causal inference techniques that are increasingly used. The most commonly used techniques for statistical modelling are reviewed with focus on the important distinction of risk versus prediction. The final section provides examples of common problems with reporting observational data.
Collapse
Affiliation(s)
| | | | | | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Alan John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Flemming Skjoeth
- Aalborg University, Health Science and Technology, Aalborg, Denmark
| | - John Rumsfeld
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Frederick Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yutao Guo
- Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Boyoung Joung
- Cardiology Department, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marwan M Refaat
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Young-Hoon Kim
- Cardiology Department, Korea University Medical Center, Seoul, Republic of Korea
| | | | - Jonathan Piccini
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | |
Collapse
|
13
|
Groenwold RHH. Commentary: Quantifying the unknown unknowns. Int J Epidemiol 2020; 49:1503-1505. [PMID: 32594115 PMCID: PMC7746407 DOI: 10.1093/ije/dyaa092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
14
|
Chu L, Wallach JD. Consideration of confounding in epidemiologic studies assessing alcohol consumption on the risk of breast cancer: A brief report. Chem Biol Interact 2020; 322:109060. [PMID: 32171849 DOI: 10.1016/j.cbi.2020.109060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Individual observational studies have suggested null, weak, linear, and J-shaped associations between alcohol consumption and breast cancer risk. However, observational studies are susceptible to confounders, which can obscure the true impact of an exposure on an outcome. Given the uncertainty regarding the association between alcohol consumption and breast cancer, and the challenges of identifying, measuring, and accounting for all potential confounders, we assessed whether and how authors of observational studies evaluating the impact of alcohol consumption on the risk of breast cancer considered bias when interpreting their main study findings. METHODS We identified all observational studies included in a recent alcohol-breast cancer meta-analysis. The Abstract and/or Discussion sections were reviewed to determine whether authors considered confounding. RESULTS Among 101 eligible studies, 73 (72.3%) mentioned confounding explicitly in the Abstract and Discussion sections. There were 33 (32.7%) studies that included statements regarding specific confounders that were not adjusted for in the analyses and 60 (59.4%) studies without any statements about the impact of residual confounding on their main findings. Although none of the studies outlined that their main findings were "likely" to be affected by residual confounding, 25 (24.8%) mentioned a "possible" impact and 16 (15.8%) claimed an "unlikely" impact. Only one (1.0%) article explicitly stated that caution was needed when interpreting their findings due to confounding. CONCLUSION These results highlight the need for more adequate consideration of the potential impact of residual confounding in observational studies evaluating the impact of alcohol consumption on the risk of breast cancer.
Collapse
Affiliation(s)
- Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, 411, New Haven, CT, 06510, USA
| | - Joshua D Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, 411, New Haven, CT, 06510, USA; Collaboration for Research Integrity and Transparency (CRIT), Yale School of Medicine, 157 Church Street, 17th Floor, Suite 1, New Haven, CT, 06510, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA.
| |
Collapse
|
15
|
Wallach JD, Serghiou S, Chu L, Egilman AC, Vasiliou V, Ross JS, Ioannidis JPA. Evaluation of confounding in epidemiologic studies assessing alcohol consumption on the risk of ischemic heart disease. BMC Med Res Methodol 2020; 20:64. [PMID: 32171256 PMCID: PMC7071725 DOI: 10.1186/s12874-020-0914-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/27/2020] [Indexed: 01/22/2023] Open
Abstract
Background Among different investigators studying the same exposures and outcomes, there may be a lack of consensus about potential confounders that should be considered as matching, adjustment, or stratification variables in observational studies. Concerns have been raised that confounding factors may affect the results obtained for the alcohol-ischemic heart disease relationship, as well as their consistency and reproducibility across different studies. Therefore, we assessed how confounders are defined, operationalized, and discussed across individual studies evaluating the impact of alcohol on ischemic heart disease risk. Methods For observational studies included in a recent alcohol-ischemic heart disease meta-analysis, we identified all variables adjusted, matched, or stratified for in the largest reported multivariate model (i.e. potential confounders). We recorded how the variables were measured and grouped them into higher-level confounder domains. Abstracts and Discussion sections were then assessed to determine whether authors considered confounding when interpreting their study findings. Results 85 of 87 (97.7%) studies reported multivariate analyses for an alcohol-ischemic heart disease relationship. The most common higher-level confounder domains included were smoking (79, 92.9%), age (74, 87.1%), and BMI, height, and/or weight (57, 67.1%). However, no two models adjusted, matched, or stratified for the same higher-level confounder domains. Most (74/87, 85.1%) articles mentioned or alluded to “confounding” in their Abstract or Discussion sections, but only one stated that their main findings were likely to be affected by residual confounding. There were five (5/87, 5.7%) authors that explicitly asked for caution when interpreting results. Conclusion There is large variation in the confounders considered across observational studies evaluating the impact of alcohol on ischemic heart disease risk and almost all studies spuriously ignore or eventually dismiss confounding in their conclusions. Given that study results and interpretations may be affected by the mix of potential confounders included within multivariate models, efforts are necessary to standardize approaches for selecting and accounting for confounders in observational studies.
Collapse
Affiliation(s)
- Joshua D Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, Room 411, New Haven, CT, 06510, USA. .,Collaboration for Research Integrity and Transparency (CRIT), Yale School of Medicine, New Haven, CT, 06510, USA. .,Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA.
| | - Stylianos Serghiou
- Meta-Research Innovation Center at Stanford (METRICS), Stanford School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA, 94305, USA.,Department of Epidemiology & Population Health, Stanford School of Medicine, 150 Governor's Lane, Stanford, CA, 94305, USA
| | - Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, Room 411, New Haven, CT, 06510, USA
| | - Alexander C Egilman
- Collaboration for Research Integrity and Transparency (CRIT), Yale School of Medicine, New Haven, CT, 06510, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, 4th Floor, Room 411, New Haven, CT, 06510, USA
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, 06510, USA.,Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Ste 405B, New Haven, CT, 06510, USA.,National Clinician Scholars Program, Yale School of Medicine, 367 Cedar Street, Ste 405B, New Haven, CT, 06510, USA.,Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA, 94305, USA.,Department of Epidemiology & Population Health, Stanford School of Medicine, 150 Governor's Lane, Stanford, CA, 94305, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Rd, MSOB X306, Stanford, CA, 94305, USA.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, 94305, USA
| |
Collapse
|
16
|
Consideration of confounding was suboptimal in the reporting of observational studies in psychiatry: a meta-epidemiological study. J Clin Epidemiol 2020; 119:75-84. [DOI: 10.1016/j.jclinepi.2019.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/12/2019] [Accepted: 12/02/2019] [Indexed: 01/17/2023]
|
17
|
Rahmani N, Salehi A, Molavi Vardanjani H, Marzban M, Behbood A. Using STROBE checklist to assess the reporting quality of observational studies affiliated with Shiraz University of Medical Sciences, and its correlates: a scientometric study from Iran. Scientometrics 2019. [DOI: 10.1007/s11192-019-03317-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
18
|
Zeraatkar D, Cheung K, Milio K, Zworth M, Gupta A, Bhasin A, Bartoszko JJ, Kiflen M, Morassut RE, Noor ST, Lawson DO, Johnston BC, Bangdiwala SI, de Souza RJ. Methods for the Selection of Covariates in Nutritional Epidemiology Studies: A Meta-Epidemiological Review. Curr Dev Nutr 2019; 3:nzz104. [PMID: 31598577 PMCID: PMC6778415 DOI: 10.1093/cdn/nzz104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Observational studies provide important information about the effects of exposures that cannot be easily studied in clinical trials, such as nutritional exposures, but are subject to confounding. Investigators adjust for confounders by entering them as covariates in analytic models. OBJECTIVE The aim of this study was to evaluate the reporting and credibility of methods for selection of covariates in nutritional epidemiology studies. METHODS We sampled 150 nutritional epidemiology studies published in 2007/2008 and 2017/2018 from the top 5 high-impact nutrition and medical journals and extracted information on methods for selection of covariates. RESULTS Most studies did not report selecting covariates a priori (94.0%) or criteria for selection of covariates (63.3%). There was general inconsistency in choice of covariates, even among studies investigating similar questions. One-third of studies did not acknowledge potential for residual confounding in their discussion. CONCLUSION Studies often do not report methods for selection of covariates, follow available guidance for selection of covariates, nor discuss potential for residual confounding.
Collapse
Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Cheung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kirolos Milio
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Max Zworth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arrti Bhasin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michel Kiflen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Salmi T Noor
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
19
|
Elshafay A, Omran ES, Abdelkhalek M, El-Badry MO, Eisa HG, Fala SY, Dang T, Ghanem MAT, Elbadawy M, Elhady MT, Vuong NL, Hirayama K, Huy NT. Reporting quality in systematic reviews of in vitro studies: a systematic review. Curr Med Res Opin 2019; 35:1631-1641. [PMID: 30977685 DOI: 10.1080/03007995.2019.1607270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Systematic reviews (SRs) and/or meta-analyses of in vitro research have an important role in establishing the foundation for clinical studies. In this study, we aimed to evaluate the reporting quality of SRs of in vitro studies using the PRISMA checklist.Method: Four databases were searched including PubMed, Virtual Health Library (VHL), Web of Science (ISI) and Scopus. The search was limited from 2006 to 2016 to include all SRs and/or meta-analyses (MAs) of pure in vitro studies. The evaluation of reporting quality was done using the PRISMA checklist.Results: Out of 7702 search results, 65 SRs were included and evaluated with the PRISMA checklist. Overall, the mean overall quality score of reported items of the PRISMA checklist was 68%. We have noticed an increasing pattern in the numbers of published SRs of in vitro studies over the last 10 years. In contrast, the reporting quality was not significantly improved over the same period (p = .363). There was a positive but not significant correlation between the overall quality score and the journal impact factor of the included studies.Conclusions: The adherence of SRs of in vitro studies to the PRISMA guidelines was poor. Therefore, we believe that using reporting guidelines and journals paying attention to this fact will improve the quality of SRs of in vitro studies.
Collapse
Affiliation(s)
- Abdelrahman Elshafay
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Online Research Club (http://www.onlineresearchclub.org/)
| | - Esraa Salah Omran
- Online Research Club (http://www.onlineresearchclub.org/)
- Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mariam Abdelkhalek
- Online Research Club (http://www.onlineresearchclub.org/)
- Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Omar El-Badry
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Online Research Club (http://www.onlineresearchclub.org/)
| | - Heba Gamal Eisa
- Online Research Club (http://www.onlineresearchclub.org/)
- Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Salma Y Fala
- Online Research Club (http://www.onlineresearchclub.org/)
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Thao Dang
- Online Research Club (http://www.onlineresearchclub.org/)
- Surgery Department School of Medicine, Tan Tao University, Tan Duc Ecity, Vietnam
| | - Mohammad A T Ghanem
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Vascular Surgery, Uniklinik Magdeburg, Magdeburg, Germany
| | - Maha Elbadawy
- Online Research Club (http://www.onlineresearchclub.org/)
- Ministry of Health, Cairo, Egypt
| | - Mohamed Tamer Elhady
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Pediatrics, Zagazig University Hospitals, Faculty of Medicine, Sharkia, Egypt
| | - Nguyen Lam Vuong
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
20
|
Shanahan DR, Lopes de Sousa I, Marshall DM. Simple decision-tree tool to facilitate author identification of reporting guidelines during submission: a before-after study. Res Integr Peer Rev 2017; 2:20. [PMID: 29451534 PMCID: PMC5803581 DOI: 10.1186/s41073-017-0044-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/17/2017] [Indexed: 12/23/2022] Open
Abstract
Background There is evidence that direct journal endorsement of reporting guidelines can lead to important improvements in the quality and reliability of the published research. However, over the last 20 years, there has been a proliferation of reporting guidelines for different study designs, making it impractical for a journal to explicitly endorse them all. The objective of this study was to investigate whether a decision tree tool made available during the submission process facilitates author identification of the relevant reporting guideline. Methods This was a prospective 14-week before–after study across four speciality medical research journals. During the submission process, authors were prompted to follow the relevant reporting guideline from the EQUATOR Network and asked to confirm that they followed the guideline (‘before’). After 7 weeks, this prompt was updated to include a direct link to the decision-tree tool and an additional prompt for those authors who stated that ‘no guidelines were applicable’ (‘after’). For each article submitted, the authors’ response, what guideline they followed (if any) and what reporting guideline they should have followed (including none relevant) were recorded. Results Overall, 590 manuscripts were included in this analysis—300 in the before cohort and 290 in the after. There were relevant reporting guidelines for 75% of manuscripts in each group; STROBE was the most commonly applicable reporting guideline, relevant for 35% (n = 106) and 37% (n = 106) of manuscripts, respectively. Use of the tool was associated with an 8.4% improvement in the number of authors correctly identifying the relevant reporting guideline for their study (p < 0.0001), a 14% reduction in the number of authors incorrectly stating that there were no relevant reporting guidelines (p < 0.0001), and a 1.7% reduction in authors choosing a guideline (p = 0.10). However, the ‘after’ cohort also saw a significant increase in the number of authors stating that there were relevant reporting guidelines for their study, but not specifying which (34 vs 29%; p = 0.04). Conclusion This study suggests that use of a decision-tree tool during submission of a manuscript is associated with improved author identification of the relevant reporting guidelines for their study type; however, the majority of authors still failed to correctly identify the relevant guidelines. Electronic supplementary material The online version of this article (10.1186/s41073-017-0044-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Daniel R Shanahan
- 1Faculty of 1000 Ltd., Middlesex House, 34-42 Cleveland Street, London, W1T 4LB UK.,2BioMed Central Ltd., 236 Gray's Inn Road, London, WC1X 8HB UK
| | | | - Diana M Marshall
- 2BioMed Central Ltd., 236 Gray's Inn Road, London, WC1X 8HB UK.,Taylor & Francis Group, 2&4 Park Square, Milton Park, Abingdon, OX14 4RN UK
| |
Collapse
|
21
|
Hemkens LG, Ewald H, Naudet F, Ladanie A, Shaw JG, Sajeev G, Ioannidis JPA. Interpretation of epidemiologic studies very often lacked adequate consideration of confounding. J Clin Epidemiol 2017; 93:94-102. [PMID: 28943377 DOI: 10.1016/j.jclinepi.2017.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/19/2017] [Accepted: 09/18/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Confounding bias is a most pervasive threat to validity of observational epidemiologic research. We assessed whether authors of observational epidemiologic studies consider confounding bias when interpreting the findings. STUDY DESIGN AND SETTING We randomly selected 120 cohort or case-control studies published in 2011 and 2012 by the general medical, epidemiologic, and specialty journals with the highest impact factors. We used Web of Science to assess citation metrics through January 2017. RESULTS Sixty-eight studies (56.7%, 95% confidence interval: 47.8-65.5%) mentioned "confounding" in the Abstract or Discussion sections, another 20 (16.7%; 10.0-23.3%) alluded to it, and there was no mention or allusion at all in 32 studies (26.7%; 18.8-34.6%). Authors often acknowledged that for specific confounders, there was no adjustment (34 studies; 28.3%) or deem it possible or likely that confounding affected their main findings (29 studies; 24.2%). However, only two studies (1.7%; 0-4.0%) specifically used the words "caution" or "cautious" for the interpretation because of confounding-related reasons and eventually only four studies (3.3%; 0.1-6.5%) had limitations related to confounding or any other bias in their Conclusions. Studies mentioning that the findings were possibly or likely affected by confounding were more frequently cited than studies with a statement that findings were unlikely affected (median 6.3 vs. 4.0 citations per year, P = 0.04). CONCLUSIONS Many observational studies lack satisfactory discussion of confounding bias. Even when confounding bias is mentioned, authors are typically confident that it is rather irrelevant to their findings and they rarely call for cautious interpretation. More careful acknowledgment of possible impact of confounding is not associated with lower citation impact.
Collapse
Affiliation(s)
- Lars G Hemkens
- Department of Clincial Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Medicine, Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hannah Ewald
- Department of Clincial Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Naudet
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA
| | - Aviv Ladanie
- Department of Clincial Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Gautam Sajeev
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA.
| |
Collapse
|
22
|
Sargeant JM, O'Connor AM, Dohoo IR, Erb HN, Cevallos M, Egger M, Ersbøll AK, Martin SW, Nielsen LR, Pearl DL, Pfeiffer DU, Sanchez J, Torrence ME, Vigre H, Waldner C, Ward MP. Methods and processes of developing the strengthening the reporting of observational studies in epidemiology - veterinary (STROBE-Vet) statement. Prev Vet Med 2017; 134:188-196. [PMID: 27836042 DOI: 10.1016/j.prevetmed.2016.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The reporting of observational studies in veterinary research presents many challenges that often are not adequately addressed in published reporting guidelines. OBJECTIVE To develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. DESIGN A consensus meeting of experts was organized to develop an extension of the STROBE statement to address observational studies in veterinary medicine with respect to animal health, animal production, animal welfare, and food safety outcomes. SETTING Consensus meeting May 11-13, 2014 in Mississauga, Ontario, Canada. PARTICIPANTS Seventeen experts from North America, Europe, and Australia attended the meeting. The experts were epidemiologists and biostatisticians, many of whom hold or have held editorial positions with relevant journals. METHODS Prior to the meeting, 19 experts completed a survey about whether they felt any of the 22 items of the STROBE statement should be modified and if items should be added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. At the meeting, the participants were provided with the survey responses and relevant literature concerning the reporting of veterinary observational studies. During the meeting, each STROBE item was discussed to determine whether or not re-wording was recommended, and whether additions were warranted. Anonymous voting was used to determine whether there was consensus for each item change or addition. RESULTS The consensus was that six items needed no modifications or additions. Modifications or additions were made to the STROBE items numbered: 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). LIMITATION Published literature was not always available to support modification to, or inclusion of, an item. CONCLUSION The methods and processes used in the development of this statement were similar to those used for other extensions of the STROBE statement. The use of this extension to the STROBE statement should improve the reporting of observational studies in veterinary research related to animal health, production, welfare, or food safety outcomes by recognizing the unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.
Collapse
Affiliation(s)
- J M Sargeant
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada; Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada.
| | - A M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
| | - I R Dohoo
- Centre for Veterinary Epidemiological Research, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - H N Erb
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - M Cevallos
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - S W Martin
- Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - L R Nielsen
- Section for Animal Welfare and Disease Control, University of Copenhagen, Copenhagen, Denmark
| | - D L Pearl
- Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - D U Pfeiffer
- Department of Production and Population Health, Royal Veterinary College, London, United Kingdom
| | - J Sanchez
- Department of Health Management, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - M E Torrence
- Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - H Vigre
- Unit for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - C Waldner
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - M P Ward
- Faculty of Veterinary Science, The University of Sydney, Sydney, Australia
| |
Collapse
|
23
|
Sargeant JM, O'Connor AM, Dohoo IR, Erb HN, Cevallos M, Egger M, Ersbøll AK, Martin SW, Nielsen LR, Pearl DL, Pfeiffer DU, Sanchez J, Torrence ME, Vigre H, Waldner C, Ward MP. Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary (STROBE-Vet) Statement. J Food Prot 2016; 79:2211-2219. [PMID: 28221964 DOI: 10.4315/0362-028x.jfp-16-016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines. Our objective was to develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. We conducted a consensus meeting with 17 experts in Mississauga, Canada. Experts completed a premeeting survey about whether items in the STROBE statement should be modified or added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. During the meeting, each STROBE item was discussed to determine whether or not rewording was recommended, and whether additions were warranted. Anonymous voting was used to determine consensus. Six items required no modifications or additions. Modifications or additions were made to the STROBE items 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources and measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). The methods and processes used were similar to those used for other extensions of the STROBE statement. The use of this STROBE statement extension should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.
Collapse
Affiliation(s)
- J M Sargeant
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada N1G 2W1.,Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1
| | - A M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, Iowa 50011, USA
| | - I R Dohoo
- Centre for Veterinary Epidemiological Research, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - H N Erb
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York 14853, USA
| | - M Cevallos
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, DK-1353, Copenhagen, Denmark
| | - S W Martin
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1
| | - L R Nielsen
- Section for Animal Welfare and Disease Control, University of Copenhagen, 1017 Copenhagen, Denmark
| | - D L Pearl
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1
| | - D U Pfeiffer
- Department of Production and Population Health, Royal Veterinary College, University of London, London NW1 0TU, UK
| | - J Sanchez
- Department of Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - M E Torrence
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, Maryland 20740, USA
| | - H Vigre
- Unit for Genomic Epidemiology, National Food Institute, Technical University of Denmark, 2800 Lyngby, Denmark
| | - C Waldner
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B4
| | - M P Ward
- Faculty of Veterinary Science, The University of Sydney, Sydney, Australia 2006
| |
Collapse
|
24
|
Sargeant JM, O'Connor AM, Dohoo IR, Erb HN, Cevallos M, Egger M, Ersbøll AK, Martin SW, Nielsen LR, Pearl DL, Pfeiffer DU, Sanchez J, Torrence ME, Vigre H, Waldner C, Ward MP. Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology – Veterinary (
STROBE
‐Vet) Statement. Zoonoses Public Health 2016; 63:651-661. [DOI: 10.1111/zph.12314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Indexed: 12/12/2022]
Affiliation(s)
- J. M. Sargeant
- Centre for Public Health and Zoonoses University of Guelph Guelph ON Canada
- Department of Population Medicine Ontario Veterinary College Guelph ON Canada
| | - A. M. O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine Iowa State University Ames IA USA
| | - I. R. Dohoo
- Centre for Veterinary Epidemiological Research University of Prince Edward Island Charlottetown PEI Canada
| | - H. N. Erb
- Department of Population Medicine and Diagnostic Sciences Cornell University Ithaca NY USA
| | - M. Cevallos
- Institute of Social and Preventive Medicine University of Bern BernSwitzerland
| | - M. Egger
- Institute of Social and Preventive Medicine University of Bern BernSwitzerland
| | - A. K. Ersbøll
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - S. W. Martin
- Department of Population Medicine Ontario Veterinary College Guelph ON Canada
| | - L. R. Nielsen
- Section for Animal Welfare and Disease Control University of Copenhagen Copenhagen Denmark
| | - D. L. Pearl
- Department of Population Medicine Ontario Veterinary College Guelph ON Canada
| | - D. U. Pfeiffer
- Department of Production and Population Health Royal Veterinary College London UK
| | - J. Sanchez
- Department of Health Management University of Prince Edward Island Charlottetown PEI Canada
| | - M. E. Torrence
- Food and Drug Administration Center for Food Safety and Applied Nutrition College Park MD USA
| | - H. Vigre
- Unit for Genomic Epidemiology National Food Institute Technical University of Denmark Lyngby Denmark
| | - C. Waldner
- Department of Large Animal Clinical Sciences Western College of Veterinary Medicine University of Saskatchewan Saskatoon SK Canada
| | - M. P. Ward
- Faculty of Veterinary Science The University of Sydney Sydney NSWAustralia
| |
Collapse
|
25
|
Sargeant JM, O'Connor AM, Dohoo IR, Erb HN, Cevallos M, Egger M, Ersbøll AK, Martin SW, Nielsen LR, Pearl DL, Pfeiffer DU, Sanchez J, Torrence ME, Vigre H, Waldner C, Ward MP. Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology - Veterinary (STROBE-Vet) Statement. J Vet Intern Med 2016; 30:1887-1895. [PMID: 27859753 PMCID: PMC5115188 DOI: 10.1111/jvim.14574] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 06/24/2016] [Accepted: 08/10/2016] [Indexed: 12/29/2022] Open
Abstract
Background Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines. Objective To develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. Design Consensus meeting of experts. Setting Mississauga, Canada. Participants Seventeen experts from North America, Europe, and Australia. Methods Experts completed a pre‐meeting survey about whether items in the STROBE statement should be modified or added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. During the meeting, each STROBE item was discussed to determine whether or not rewording was recommended and whether additions were warranted. Anonymous voting was used to determine consensus. Results Six items required no modifications or additions. Modifications or additions were made to the STROBE items 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). Conclusion The methods and processes used were similar to those used for other extensions of the STROBE statement. The use of this STROBE statement extension should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food‐producing and companion animals, products of animal origin, aquaculture, and wildlife.
Collapse
Affiliation(s)
- J M Sargeant
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada.,Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - A M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA
| | - I R Dohoo
- Centre for Veterinary Epidemiological Research, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - H N Erb
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY
| | - M Cevallos
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - S W Martin
- Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - L R Nielsen
- Section for Animal Welfare and Disease Control, University of Copenhagen, Copenhagen, Denmark
| | - D L Pearl
- Department of Population Medicine, Ontario Veterinary College, Guelph, ON, Canada
| | - D U Pfeiffer
- Department of Production and Population Health, Royal Veterinary College, London, UK
| | - J Sanchez
- Department of Health Management, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - M E Torrence
- Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD
| | - H Vigre
- Unit for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - C Waldner
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - M P Ward
- Faculty of Veterinary Science, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
26
|
Orkin AM, Phillips WR, Stange KC. Research Reporting Guidelines and the New Annals Instructions for Authors. Ann Fam Med 2016; 14:500-501. [PMID: 28376434 PMCID: PMC5389391 DOI: 10.1370/afm.2008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 11/09/2022] Open
|
27
|
Hemkens LG, Benchimol EI, Langan SM, Briel M, Kasenda B, Januel JM, Herrett E, von Elm E. The reporting of studies using routinely collected health data was often insufficient. J Clin Epidemiol 2016; 79:104-111. [PMID: 27343981 PMCID: PMC5152936 DOI: 10.1016/j.jclinepi.2016.06.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/28/2016] [Accepted: 06/06/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess reporting quality of studies using routinely collected health data (RCD) to inform the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) guideline development. STUDY DESIGN AND SETTING PubMed search for observational studies using RCD on any epidemiologic or clinical topic. Sample of studies published in 2012. Evaluation of five items based on the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guideline and eight newly developed items for RCD studies. RESULTS Of 124 included studies, 39 (31.5%) clearly described its design in title or abstract. Complete information to frame a focused research question, that is, on the population, intervention/exposure, and outcome, was provided for 51 studies (41.1%). In 44 studies where definitions of codes or classification algorithms would be necessary to operationalize such a research question, only nine (20.5%) reported all items adequately. In 81 studies describing multivariable analyses, 54 (66.7%) reported all variables used for modeling and 34 (42.0%) reported basic details required for replication. Database linkage was reported adequately in 12 of 41 studies (29.3%). Statements about data sharing/availability were rare (5/124; 4%). CONCLUSION Most RCD studies are insufficiently reported. Specific reporting guidelines and more awareness and education on their use are urgently needed.
Collapse
Affiliation(s)
- Lars G Hemkens
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031 Basel, Switzerland.
| | - Eric I Benchimol
- Department of Pediatrics, Children's Hospital of Eastern Ontario, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada; Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Sinéad M Langan
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031 Basel, Switzerland; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Benjamin Kasenda
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031 Basel, Switzerland
| | - Jean-Marie Januel
- University Institute of Higher Education and Research in Health Care (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Biopole 2, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Emily Herrett
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| |
Collapse
|
28
|
Minnaard MC, van der Zand J, van de Pol AC, de Wit NJ, Schierenberg A, Hopstaken RM, van Delft S, Verheij TJM, Broekhuizen BDL. Analysis of recruitment in a pragmatic observational study on C-reactive protein point-of-care testing in primary care. Eur J Gen Pract 2016; 22:219-224. [PMID: 27485531 DOI: 10.1080/13814788.2016.1208167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Failure to recruit all eligible study patients can lead to biased results. Little is known on selective patient recruitment in studies on implementation of diagnostic devices. OBJECTIVES The aim of this observational study was to measure recruitment of patients in an implementation study in primary care on use of point-of-care (POC) C-reactive protein (CRP) and to evaluate recruitment bias and its impact on the study endpoint. METHODS In a cross-sectional observational study on POC CRP implementation and related antibiotics prescribing, we compared included patients with all eligible patients to assess the representativeness of the included subjects. Eligible patients were adults presenting with acute cough in primary care between March and September 2012. The frequency of POC CRP testing and the proportion of prescribed antibiotics were compared between recruited and non-recruited patients. As measure of bias, odds ratios (ORs) with accompanying 95% confidence intervals (CIs) for the association between CRP level (<20 mg/l or not) and antibiotic prescribing were computed. RESULTS Of all 1473 eligible patients 348 (24%) were recruited. In recruited patients, POC CRP tests were conducted and antibiotics prescribed more frequently as compared to non-recruited patients (81% versus 6% and 44% versus 29%, respectively). The ORs were 18.2 (95%CI: 9.6-34.3), 30.5 (95%CI: 13.2-70.3) and 3.8 (95%CI: 0.9-14.8) respectively in all eligible patients, the recruited and the non-recruited patients. CONCLUSION Selective recruitment resulted in an overestimation of POC CRP test use and antibiotic prescribing.
Collapse
Affiliation(s)
- Margaretha C Minnaard
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Janna van der Zand
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Alma C van de Pol
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Niek J de Wit
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Alwin Schierenberg
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Rogier M Hopstaken
- b Saltro, Diagnostic Center for Primary Care , Utrecht , the Netherlands
| | - Sanne van Delft
- b Saltro, Diagnostic Center for Primary Care , Utrecht , the Netherlands
| | - Theo J M Verheij
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Berna D L Broekhuizen
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| |
Collapse
|
29
|
Real J, Forné C, Roso-Llorach A, Martínez-Sánchez JM. Quality Reporting of Multivariable Regression Models in Observational Studies: Review of a Representative Sample of Articles Published in Biomedical Journals. Medicine (Baltimore) 2016; 95:e3653. [PMID: 27196467 PMCID: PMC4902409 DOI: 10.1097/md.0000000000003653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/07/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022] Open
Abstract
Controlling for confounders is a crucial step in analytical observational studies, and multivariable models are widely used as statistical adjustment techniques. However, the validation of the assumptions of the multivariable regression models (MRMs) should be made clear in scientific reporting. The objective of this study is to review the quality of statistical reporting of the most commonly used MRMs (logistic, linear, and Cox regression) that were applied in analytical observational studies published between 2003 and 2014 by journals indexed in MEDLINE.Review of a representative sample of articles indexed in MEDLINE (n = 428) with observational design and use of MRMs (logistic, linear, and Cox regression). We assessed the quality of reporting about: model assumptions and goodness-of-fit, interactions, sensitivity analysis, crude and adjusted effect estimate, and specification of more than 1 adjusted model.The tests of underlying assumptions or goodness-of-fit of the MRMs used were described in 26.2% (95% CI: 22.0-30.3) of the articles and 18.5% (95% CI: 14.8-22.1) reported the interaction analysis. Reporting of all items assessed was higher in articles published in journals with a higher impact factor.A low percentage of articles indexed in MEDLINE that used multivariable techniques provided information demonstrating rigorous application of the model selected as an adjustment method. Given the importance of these methods to the final results and conclusions of observational studies, greater rigor is required in reporting the use of MRMs in the scientific literature.
Collapse
Affiliation(s)
- Jordi Real
- From the Unitat de Suport a la Recerca-Lleida, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona (JR); Universitat International de Catalunya, Facultat de Medicina i Ciències de la Salut, Sant Cugat (JR, JMM-S); Department of Basic Medical Sciences, Universitat de Lleida, Lleida (CF); Oblikue Consulting (CF); Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona (AR-L); and Tobacco Control Unit, Catalan Istitute of Oncology, Hospitalet de Llobregat (JMM-S), Spain
| | | | | | | |
Collapse
|
30
|
Pouwels KB, Widyakusuma NN, Groenwold RH, Hak E. Quality of reporting of confounding remained suboptimal after the STROBE guideline. J Clin Epidemiol 2016; 69:217-24. [DOI: 10.1016/j.jclinepi.2015.08.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/06/2015] [Accepted: 08/24/2015] [Indexed: 12/27/2022]
|
31
|
Zhang ZW, Cheng J, Liu Z, Ma JC, Li JL, Wang J, Yang KH. Epidemiology, quality and reporting characteristics of meta-analyses of observational studies published in Chinese journals. BMJ Open 2015; 5:e008066. [PMID: 26644119 PMCID: PMC4680011 DOI: 10.1136/bmjopen-2015-008066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine the epidemiological and reporting characteristics as well as the methodological quality of meta-analyses (MAs) of observational studies published in Chinese journals. METHODS 5 Chinese databases were searched for MAs of observational studies published from January 1978 to May 2014. Data were extracted into Excel spreadsheets, and Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Assessment of Multiple Systematic Reviews (AMSTAR) checklists were used to assess reporting characteristics and methodological quality, respectively. RESULTS A total of 607 MAs were included. Only 52.2% of the MAs assessed the quality of the included primary studies, and the retrieval information was not comprehensive in more than half (85.8%) of the MAs. In addition, 50 (8.2%) MAs did not search any Chinese databases, while 126 (20.8%) studies did not search any English databases. Approximately 41.2% of the MAs did not describe the statistical methods in sufficient details, and most (95.5%) MAs did not report on conflicts of interest. However, compared with the before publication of the MOOSE Checklist, the quality of reporting improved significantly for 20 subitems after publication of the MOOSE Checklist, and 7 items of the included MAs demonstrated significant improvement after publication of the AMSTAR Checklist (p<0.05). CONCLUSIONS Although many MAs of observational studies have been published in Chinese journals, the reporting quality is questionable. Thus, there is an urgent need to increase the use of reporting guidelines and methodological tools in China; we recommend that Chinese journals adopt the MOOSE and AMSTAR criteria.
Collapse
Affiliation(s)
- Zhe-wen Zhang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Juan Cheng
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhuan Liu
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ji-chun Ma
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Jin-long Li
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Jing Wang
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Ke-hu Yang
- Evidence-Based Medicine Center, Institute of Traditional Chinese and Western Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| |
Collapse
|
32
|
Norström F. Poor quality in the reporting and use of statistical methods in public health - the case of unemployment and health. Arch Public Health 2015; 73:56. [PMID: 26576268 PMCID: PMC4645480 DOI: 10.1186/s13690-015-0096-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 09/14/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It has previously been reported that many research articles fail to fulfill important criteria for statistical analyses, but, to date, these reports have not focused on public health problems. The aim of this study was to investigate the quality of reporting and use of statistical methods in articles analyzing the effect of unemployment on health. METHODS Forty-one articles were identified and evaluated in terms of how they addressed 12 specified criteria. RESULTS For most of these criteria, the majority of articles were inadequate. These criteria were conformity with a linear gradient (100 % of the articles), validation of the statistical model (100 %), collinearity of independent variables (97 %), fitting procedure (93 %), goodness of fit test (78 %), selection of variables (68 % for the candidate model; 88 % for the final model), and interactions between independent variables (66 %). Fewer, but still alarmingly many articles, failed to fulfill the criteria coefficients presented in statistical models (48 %), coding of variables (34 %) and discussion of methodological concerns (24 %). There was a lack of explicit reporting of statistical significance/confidence intervals; 34 % of the articles only presented p-values as being above or below the significance level, and 42 % did not present confidence intervals. Events per variable was the only criterion met at an undoubtedly acceptable level (2.5 %). CONCLUSIONS There were critical methodological shortcomings in the reviewed studies. It is difficult to obtain unbiased estimates, but there clearly needs to be some improvement in the quality of documentation on the use and performance of statistical methods. A suggestion here is that journals not only demand that articles fulfill the criteria within the STROBE statement, but that they include additional criteria to decrease the risk of incorrect conclusions being drawn.
Collapse
Affiliation(s)
- Fredrik Norström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| |
Collapse
|
33
|
Johnson SP, Malay S, Chung KC. The quality of control groups in nonrandomized studies published in the Journal of Hand Surgery. J Hand Surg Am 2015; 40:133-9. [PMID: 25447000 PMCID: PMC4791587 DOI: 10.1016/j.jhsa.2014.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/11/2014] [Accepted: 09/15/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate control group selection in nonrandomized studies published in the Journal of Hand Surgery American (JHS). METHODS We reviewed all papers published in JHS in 2013 to identify studies that used nonrandomized control groups. Data collected included type of study design and control group characteristics. We then appraised studies to determine whether authors discussed confounding and selection bias and how they controlled for confounding. RESULTS Thirty-seven nonrandomized studies were published in JHS in 2013. The source of control was either the same institution as the study group, a different institution, a database, or not provided in the manuscript. Twenty-nine (78%) studies statistically compared key characteristics between control and study group. Confounding was controlled with matching, exclusion criteria, or regression analysis. Twenty-two (59%) papers explicitly discussed the threat of confounding and 18 (49%) identified sources of selection bias. CONCLUSIONS In our review of nonrandomized studies published in JHS, papers had well-defined controls that were similar to the study group, allowing for reasonable comparisons. However, we identified substantial confounding and bias that were not addressed as explicit limitations, which might lead the reader to overestimate the scientific validity of the data. CLINICAL RELEVANCE Incorporating a brief discussion of control group selection in scientific manuscripts should help readers interpret the study more appropriately. Authors, reviewers, and editors should strive to address this component of clinical importance.
Collapse
Affiliation(s)
- Shepard P Johnson
- Department of Surgery, Saint Joseph Mercy Hospital, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Sunitha Malay
- Department of Surgery, Saint Joseph Mercy Hospital, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Department of Surgery, Saint Joseph Mercy Hospital, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI.
| |
Collapse
|
34
|
Meta-analyses including data from observational studies. Prev Vet Med 2014; 113:313-22. [DOI: 10.1016/j.prevetmed.2013.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 10/09/2013] [Accepted: 10/19/2013] [Indexed: 11/23/2022]
|
35
|
Glasziou P, Altman DG, Bossuyt P, Boutron I, Clarke M, Julious S, Michie S, Moher D, Wager E. Reducing waste from incomplete or unusable reports of biomedical research. Lancet 2014; 383:267-76. [PMID: 24411647 DOI: 10.1016/s0140-6736(13)62228-x] [Citation(s) in RCA: 828] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Research publication can both communicate and miscommunicate. Unless research is adequately reported, the time and resources invested in the conduct of research is wasted. Reporting guidelines such as CONSORT, STARD, PRISMA, and ARRIVE aim to improve the quality of research reports, but all are much less adopted and adhered to than they should be. Adequate reports of research should clearly describe which questions were addressed and why, what was done, what was shown, and what the findings mean. However, substantial failures occur in each of these elements. For example, studies of published trial reports showed that the poor description of interventions meant that 40-89% were non-replicable; comparisons of protocols with publications showed that most studies had at least one primary outcome changed, introduced, or omitted; and investigators of new trials rarely set their findings in the context of a systematic review, and cited a very small and biased selection of previous relevant trials. Although best documented in reports of controlled trials, inadequate reporting occurs in all types of studies-animal and other preclinical studies, diagnostic studies, epidemiological studies, clinical prediction research, surveys, and qualitative studies. In this report, and in the Series more generally, we point to a waste at all stages in medical research. Although a more nuanced understanding of the complex systems involved in the conduct, writing, and publication of research is desirable, some immediate action can be taken to improve the reporting of research. Evidence for some recommendations is clear: change the current system of research rewards and regulations to encourage better and more complete reporting, and fund the development and maintenance of infrastructure to support better reporting, linkage, and archiving of all elements of research. However, the high amount of waste also warrants future investment in the monitoring of and research into reporting of research, and active implementation of the findings to ensure that research reports better address the needs of the range of research users.
Collapse
Affiliation(s)
- Paul Glasziou
- Centre for Research in Evidence Based Practice, Bond University, Robina, QLD, Australia.
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Patrick Bossuyt
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Steven Julious
- Medical Statistics Group, University of Sheffield, Sheffield, UK
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, London, UK
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | |
Collapse
|
36
|
Alemayehu D, Cappelleri JC. Evaluating methodological assumptions in comparative effectiveness research: overcoming pitfalls. J Comp Eff Res 2014; 3:79-93. [DOI: 10.2217/cer.13.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The scope of comparative effectiveness research (CER) is wide and therefore requires the application of complex statistical tools and nonstandard procedures. The commonly used methods presuppose the realization of important, and often untestable, assumptions pertaining to the underlying distribution, study heterogeneity and targeted population. Accordingly, the value of the results obtained based on such tools is in large part dependent on the validity of the underlying assumptions relating to the operating characteristics of the procedures. In this article, we elucidate some of the pitfalls that may arise with use of the most commonly used techniques, including those that are applied in network meta-analysis, observational data analysis and patient-reported outcome evaluation. In addition, reference is made to the impact of data quality and database heterogeneity on the performance of commonly used CER tools and the need for standards in order to inform researchers engaged in CER.
Collapse
|
37
|
Sargeant JM, O'Connor AM. Issues of reporting in observational studies in veterinary medicine. Prev Vet Med 2013; 113:323-30. [PMID: 24139690 DOI: 10.1016/j.prevetmed.2013.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 08/30/2013] [Accepted: 09/13/2013] [Indexed: 11/16/2022]
Abstract
Observational studies are common in veterinary medicine; the results may be used to inform decision-making, future research, or as inputs to systematic reviews or risk assessment. To be of use, the results must be published, all of the outcomes that were assessed must be included in the publication, and the research (methods and results) must be reported in sufficient detail that the reader can evaluate the internal and external validity. In human healthcare, concerns about the completeness of reporting - and evidence that poor reporting is associated with study results - have led to the creation of reporting guidelines; these include the STROBE statement for observational studies. There is evidence from a limited body of research that there also are reporting inadequacies in veterinary observational studies. There are differences between human and veterinary observational studies that might be relevant to recommendations for reporting. Such differences include: the use of observational studies in animal populations for simultaneously estimating disease frequency and risk-factor identification; the distinction between the animal owners who consent to participate and the animals that are the study subjects; and the complexity of organizational levels inherent in animal research (in particular, for studies in livestock species). In veterinary medicine, it is common to have clustering within outcomes (due to animal grouping) and clustering of predictor variables. We argue that there is a compelling need for the scientific community involved in veterinary observational studies to use the STROBE statement, use an amended version of STROBE, or to develop and use reporting guidelines that are specific to veterinary medicine to improve reporting of these studies.
Collapse
Affiliation(s)
- Jan M Sargeant
- Centre for Public Health and Zoonoses and Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
| | - Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| |
Collapse
|
38
|
The teacher, the physician and the person: exploring causal connections between teaching performance and role model types using directed acyclic graphs. PLoS One 2013; 8:e69449. [PMID: 23936020 PMCID: PMC3720648 DOI: 10.1371/journal.pone.0069449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background In fledgling areas of research, evidence supporting causal assumptions is often scarce due to the small number of empirical studies conducted. In many studies it remains unclear what impact explicit and implicit causal assumptions have on the research findings; only the primary assumptions of the researchers are often presented. This is particularly true for research on the effect of faculty’s teaching performance on their role modeling. Therefore, there is a need for robust frameworks and methods for transparent formal presentation of the underlying causal assumptions used in assessing the causal effects of teaching performance on role modeling. This study explores the effects of different (plausible) causal assumptions on research outcomes. Methods This study revisits a previously published study about the influence of faculty’s teaching performance on their role modeling (as teacher-supervisor, physician and person). We drew eight directed acyclic graphs (DAGs) to visually represent different plausible causal relationships between the variables under study. These DAGs were subsequently translated into corresponding statistical models, and regression analyses were performed to estimate the associations between teaching performance and role modeling. Results The different causal models were compatible with major differences in the magnitude of the relationship between faculty’s teaching performance and their role modeling. Odds ratios for the associations between teaching performance and the three role model types ranged from 31.1 to 73.6 for the teacher-supervisor role, from 3.7 to 15.5 for the physician role, and from 2.8 to 13.8 for the person role. Conclusions Different sets of assumptions about causal relationships in role modeling research can be visually depicted using DAGs, which are then used to guide both statistical analysis and interpretation of results. Since study conclusions can be sensitive to different causal assumptions, results should be interpreted in the light of causal assumptions made in each study.
Collapse
|
39
|
Is weight-bearing asymmetry associated with postural instability after stroke? A systematic review. Stroke Res Treat 2013; 2013:692137. [PMID: 23738232 PMCID: PMC3655651 DOI: 10.1155/2013/692137] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/28/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. Improvement of postural stability is an important goal during poststroke rehabilitation. Since weight-bearing asymmetry (WBA) towards the nonparetic leg is common, training of weight-bearing symmetry has been a major focus in post-stroke balance rehabilitation. It is assumed that restoration of a more symmetrical weight distribution is associated with improved postural stability. Objective. To determine to what extent WBA is associated with postural instability in people after stroke. Methods. Electronic databases were searched (Cochrane, MEDLINE, EMBASE, and CINAHL) until March 2012. Main Eligibility Criteria. (1) Participants were people after stroke. (2) The association between WBA and postural stability was reported. Quality of reporting was assessed with the STROBE checklist and a related tool for reporting of confounding. Results. Nine observational studies met all criteria. Greater spontaneous WBA was associated with higher center of pressure (COP) velocity and with poorer synchronization of COP trajectories between the legs (two and one studies, resp.). Evidence for associations between WBA and performance on clinical balance tests or falls was weak. Conclusion. Greater WBA after stroke was associated with increased postural sway, but the current literature does not provide evidence for a causal relationship. Further studies should investigate whether reducing WBA would improve postural stability.
Collapse
|
40
|
Groenwold RHH, Klungel OH, Altman DG, van der Graaf Y, Hoes AW, Moons KGM. Adjustment for continuous confounders: an example of how to prevent residual confounding. CMAJ 2013; 185:401-6. [PMID: 23401401 PMCID: PMC3602256 DOI: 10.1503/cmaj.120592] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Rolf H H Groenwold
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | | | | | | | | | | |
Collapse
|
41
|
Couto ATR, Silva DT, Silvestre CC, Lyra DP, Quintans LJ. Quality analysis of research on the use of benzodiazepines by elderly patients in the emergency room:a systematic review. Eur J Clin Pharmacol 2013; 69:1343-50. [DOI: 10.1007/s00228-012-1439-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
|
42
|
Manchikanti L, Cash KA, McManus CD, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis. Int J Med Sci 2012; 10:50-9. [PMID: 23289005 PMCID: PMC3534877 DOI: 10.7150/ijms.5303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/13/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied. STUDY DESIGN A prospective evaluation. SETTING An interventional pain management practice, a specialty referral center, a private practice setting in the United States. OBJECTIVE To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis. METHODS Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter. OUTCOMES ASSESSMENT Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more improvement in pain scores and ODI scores. RESULTS Overall, a primary outcome or significant pain relief and functional status improvement of 50% or more was seen in 71% of patients at the end of 2 years. The overall number of procedures over a period of 2 years were 5.7 ± 2.73. LIMITATIONS The lack of a control group and a prospective design. CONCLUSIONS Significant relief and functional status improvement as seen in 71% of the 70 patients with percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic function limiting low back and lower extremity pain with central spinal stenosis after failure of conservatie management and fluoroscopically directed epidural injections.
Collapse
Affiliation(s)
- Laxmaiah Manchikanti
- 1. Pain Management Center of Paducah, Paducah, Kentucky, USA
- 2. University of Louisville, Louisville, Kentucky, USA
| | | | | | | |
Collapse
|
43
|
Nurmatov U, Nwaru BI, Devereux G, Sheikh A. Confounding and effect modification in studies of diet and childhood asthma and allergies. Allergy 2012; 67:1041-59. [PMID: 22712878 DOI: 10.1111/j.1398-9995.2012.02858.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2012] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To propose a comprehensive set of confounders and effect modifiers that should be considered in epidemiologic investigations. METHODS Two reviewers independently critiqued studies included in a recent systematic review and extracted data on the confounders and effect modifiers that were considered and the approaches used to justify inclusion. RESULTS Of the 62 studies reviewed, 20 were cohort, 16 case-control, 25 cross-sectional studies, and one ecologic study. All cohort, cross-sectional, and ecologic studies had some adjustment for confounding or consideration of effect modification, but this was only the case for 7/16 (44%) case-control studies. Of the 53 studies that considered confounding or effect modification, 39/53 (74%) gave no justification for the inclusion of the variables considered. Studies that justified the inclusion of the variables did so based on empirical evidence (n = 10), conceptual justification (n = 7), or a combination of the two (n = 3). Confounding was handled mainly by using regression modeling, but some case-control studies utilized matching and anova. Ten studies handled effect modification by stratification, eight tested for interaction, and five used both strategies. CONCLUSIONS We have found substantial shortcomings in the handling of confounding and effect modification in studies of diet and development of childhood asthma/allergies. Selection of variables should be based on conceptual considerations and empirical evidence. Using this approach, we have proposed a comprehensive set of confounders and effect modifiers that need to be considered in future studies.
Collapse
Affiliation(s)
- U. Nurmatov
- Allergy & Respiratory Research Group; Centre for Population Health Sciences, Medical School; The University of Edinburgh; Edinburgh; UK
| | - B. I. Nwaru
- School of Health Sciences; University of Tampere; Tampere; Finland
| | - G. Devereux
- Department of Child Health; Royal Aberdeen Children's Hospital, University of Aberdeen; Aberdeen; UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences, Medical School; The University of Edinburgh; Edinburgh; UK
| |
Collapse
|
44
|
Scott IA, Glasziou PP. Improving the effectiveness of clinical medicine: the need for better science. Med J Aust 2012; 196:304-8. [PMID: 22432658 DOI: 10.5694/mja11.10364] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/29/2011] [Indexed: 11/17/2022]
Abstract
Effective clinical practice is predicated on valid and relevant clinical science - a commodity in increasingly short supply. The pre-eminent place of clinical research has become tainted by methodological shortcomings, commercial influences and neglect of the needs of patients and clinicians. Researchers need to be more proactive in evaluating clinical interventions in terms of patient-important benefit, wide applicability and comparative effectiveness, and in adopting study designs and reporting standards that ensure accurate and transparent research outputs. Funders of research need to be more supportive of applied clinical research that rigorously evaluates effectiveness of new treatments and synthesis existing knowledge into clinically useful systematic reviews. Several strategies for improving the state of the science are possible but their implementation requires collective action of all those undertaking and reporting clinical research.
Collapse
Affiliation(s)
- Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | | |
Collapse
|
45
|
Anderson GH, Foreyt J, Sigman-Grant M, Allison DB. The use of low-calorie sweeteners by adults: impact on weight management. J Nutr 2012; 142:1163S-9S. [PMID: 22573781 DOI: 10.3945/jn.111.149617] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The application of low-calorie sweeteners (LCS) in foods and beverages has increased over the past 35 y. At the same time, many characteristics of the American diet have changed, including variations in fat and carbohydrate content and composition, increased nutrient additions, and new dietary patterns due to changing lifestyles and attitudes toward food and the changing cost of food. During this same time period, the prevalence of overweight and obesity has increased from ~30 to 70% of adults in the United States. Clearly, these trends lead to a variety of hypotheses and efforts to explain the role of LCS in this association. The aim of this review is to gain clarity on the role of LCS in weight management and their impact on diet quality. In addition, because the majority of studies aimed at identifying associations between LCS and these outcomes are based on observational data, the pitfalls in designing and evaluating data from observational studies are also discussed. We conclude that there is no evidence that LCS can be claimed to be a cause of higher body weights in adults. Similarly, evidence supporting a role for LCS in weight management is lacking. Due to the confounders in most observational studies, randomized controlled trials are needed to advance understanding.
Collapse
Affiliation(s)
- G Harvey Anderson
- University of Toronto, Department of Nutritional Sciences, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
46
|
Tomasi C, Derks J. Clinical research of peri-implant diseases - quality of reporting, case definitions and methods to study incidence, prevalence and risk factors of peri-implant diseases. J Clin Periodontol 2012; 39 Suppl 12:207-23. [DOI: 10.1111/j.1600-051x.2011.01831.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Cristiano Tomasi
- Department of Periodontology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - Jan Derks
- Department of Periodontology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| |
Collapse
|
47
|
Groenwold RHH, Klungel OH, Grobbee DE, Hoes AW. Selection of confounding variables should not be based on observed associations with exposure. Eur J Epidemiol 2011; 26:589-93. [PMID: 21796419 PMCID: PMC3168755 DOI: 10.1007/s10654-011-9606-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 07/07/2011] [Indexed: 12/03/2022]
Abstract
In observational studies, selection of confounding variables for adjustment is often based on observed baseline incomparability. The aim of this study was to evaluate this selection strategy. We used clinical data on the effects of inhaled long-acting beta-agonist (LABA) use on the risk of mortality among patients with obstructive pulmonary disease to illustrate the impact of selection of confounding variables for adjustment based on baseline comparisons. Among 2,394 asthma and COPD patients included in the analyses, the LABA ever-users were considerably older than never-users, but cardiovascular co-morbidity was equally prevalent (19.9% vs. 19.9%). Adjustment for cardiovascular co-morbidity status did not affect the crude risk ratio (RR) for mortality: crude RR 1.19 (95% CI 0.93–1.51) versus RR 1.19 (95% CI 0.94–1.50) after adjustment for cardiovascular co-morbidity. However, after adjustment for age (RR 0.95, 95% CI 0.76–1.19), additional adjustment for cardiovascular co-morbidity status did affect the association between LABA use and mortality (RR 1.01, 95% CI 0.80–1.26). Confounding variables should not be discarded based on balanced distributions among exposure groups, because residual confounding due to the omission of confounding variables from the adjustment model can be relevant.
Collapse
Affiliation(s)
- Rolf H H Groenwold
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, The Netherlands,
| | | | | | | |
Collapse
|
48
|
Cook DA, Levinson AJ, Garside S. Method and reporting quality in health professions education research: a systematic review. MEDICAL EDUCATION 2011; 45:227-38. [PMID: 21299598 DOI: 10.1111/j.1365-2923.2010.03890.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
CONTEXT Studies evaluating reporting quality in health professions education (HPE) research have demonstrated deficiencies, but none have used comprehensive reporting standards. Additionally, the relationship between study methods and effect size (ES) in HPE research is unknown. OBJECTIVES This review aimed to evaluate, in a sample of experimental studies of Internet-based instruction, the quality of reporting, the relationship between reporting and methodological quality, and associations between ES and study methods. METHODS We conducted a systematic search of databases including MEDLINE, Scopus, CINAHL, EMBASE and ERIC, for articles published during 1990-2008. Studies (in any language) quantifying the effect of Internet-based instruction in HPE compared with no intervention or other instruction were included. Working independently and in duplicate, we coded reporting quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and coded study methods using a modified Newcastle-Ottawa Scale (m-NOS), the Medical Education Research Study Quality Instrument (MERSQI), and the Best Evidence in Medical Education (BEME) global scale. RESULTS For reporting quality, articles scored a mean±standard deviation (SD) of 51±25% of STROBE elements for the Introduction, 58±20% for the Methods, 50±18% for the Results and 41±26% for the Discussion sections. We found positive associations (all p<0.0001) between reporting quality and MERSQI (ρ=0.64), m-NOS (ρ=0.57) and BEME (ρ=0.58) scores. We explored associations between study methods and knowledge ES by subtracting each study's ES from the pooled ES for studies using that method and comparing these differences between subgroups. Effect sizes in single-group pretest/post-test studies differed from the pooled estimate more than ESs in two-group studies (p=0.013). No difference was found between other study methods (yes/no: representative sample, comparison group from same community, randomised, allocation concealed, participants blinded, assessor blinded, objective assessment, high follow-up). CONCLUSIONS Information is missing from all sections of reports of HPE experiments. Single-group pre-/post-test studies may overestimate ES compared with two-group designs. Other methodological variations did not bias study results in this sample.
Collapse
Affiliation(s)
- David A Cook
- Division of General Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | |
Collapse
|
49
|
Reporting of methodological features in observational studies of pre-harvest food safety. Prev Vet Med 2011; 98:88-98. [DOI: 10.1016/j.prevetmed.2010.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 10/02/2010] [Accepted: 10/16/2010] [Indexed: 11/24/2022]
|
50
|
Groenwold RHH, Rovers MM. The Catch-22 of appraisals on the quality of observational studies. J Clin Epidemiol 2010; 63:1059-60. [PMID: 20728044 DOI: 10.1016/j.jclinepi.2010.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/24/2010] [Indexed: 11/19/2022]
Affiliation(s)
- R H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | | |
Collapse
|