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Li Z, Wu J, Zhao Y, Song J, Wen Y. Natural products and dietary interventions on liver enzymes: an umbrella review and evidence map. Front Nutr 2024; 11:1300860. [PMID: 38371505 PMCID: PMC10869519 DOI: 10.3389/fnut.2024.1300860] [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: 09/25/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Background The association between natural products and dietary interventions on liver enzymes is unclear; therefore, this study aimed to examine their effects on liver enzymes in adults. Methods PubMed, Embase, and Cochrane Library of Systematic Reviews databases were searched from inception until March 2023. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) systems were used to assess the methodological and evidence quality, and the therapeutic effects were summarized in a narrative form. Results A total of 40 meta-analyses on natural products (n = 25), dietary supplements (n = 10), and dietary patterns (n = 5) were evaluated, and results were presented in a narrative form. The overall methodological quality of the included studies was relatively poor. The results indicated that positive effects were observed for nigella sativa, garlic, artichoke, curcumin, silymarin, vitamin E, vitamin D, L-carnitine, propolis, and polyunsaturated fatty acids on certain liver enzymes. The dietary patterns, including high-protein, Mediterranean, and calorie-restriction diets and evening snacks, may reduce liver enzymes; however, other supplements and herbs did not reduce liver enzyme levels or have minimal effects. The evidence quality was generally weak given the risk of bias, heterogeneity, and imprecision. Conclusion This umbrella review suggests that natural products and dietary interventions have beneficial therapeutic effects on liver enzymes levels. Further clinical trials are necessary to establish the effectiveness of supplements that reduce liver enzymes.
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Affiliation(s)
- Zhongyu Li
- Department of Chinese Medicine, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiao Wu
- Department of Oncology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yingpan Zhao
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinjie Song
- Department of Oncology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yandong Wen
- Department of Chinese Medicine, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Zhao L, Kherani J, Li PY, Zhang K, Horta A, Lin C, Li A, Eshaghpour A, Crowther MA. Primary prevention of venous thromboembolism for cancer patients in randomized controlled trials: a bibliographical analysis of funding and trial characteristics. Res Pract Thromb Haemost 2024; 8:102315. [PMID: 38404943 PMCID: PMC10884502 DOI: 10.1016/j.rpth.2024.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024] Open
Abstract
Background The majority of randomized controlled trials (RCTs) investigating venous thromboembolism (VTE) prophylaxis in patients with cancer involve commercial sponsorship. Commercial sponsorship overcomes feasibility limitations inherent in RCTs, such as recruitment and funding, but has attracted scrutiny for its potential for bias. Objectives In RCTs of VTE prophylaxis in patients with cancer, how do trial characteristics compare between commercially sponsored RCTs and noncommercially sponsored RCTs? Methods Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for RCTs that investigated at least 1 pharmacologic intervention for VTE prophylaxis in adult patients with cancer. Screening and data extraction were conducted by independent reviewers. Outcomes included trial characteristics, reporting of favorable outcomes, protocol-manuscript discrepancies, and appraisal of spin. Outcomes were compared using the independent t-test, Mann-Whitney U-test, Pearson chi-squared test, and Fisher's exact test. Logistic regression was performed to identify factors associated with possible bias. Results Of the 54 trials analyzed, 34 (63%) reported commercial sponsorship. Commercial sponsorship was not associated with the reporting of favorable outcomes, presence of spin, retrospective registration, or protocol-manuscript discrepancy. Spin was most prevalent in the abstract conclusions (9 out of 17 [53.3%]) and manuscript conclusions (8 out of 17 [46.7%]).Commercially sponsored trials had a higher rate of intention-to-treat analysis. Noncommercially sponsored trials were more likely to report retrospective registration of trial protocol and the use of composite primary outcomes. Conclusion There were few significant differences between trial characteristics, suggesting that the evidence from commercially sponsored trials investigating VTE prophylaxis in patients with cancer is unlikely to be subject to bias attributable to commercial sponsorship.
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Affiliation(s)
- Lucy Zhao
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jayhan Kherani
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pei Ye Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Zhang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angelina Horta
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Christine Lin
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Allen Li
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ali Eshaghpour
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Nagendrababu V, Faggion CM, Gopinath VK, Narasimhan S, Duncan HF, Levin L, Abbott PV, Dummer PMH. Methodological assessment and overall confidence in the results of systematic reviews with meta-analyses focusing on traumatic dental injuries: A cross-sectional study. Dent Traumatol 2023; 39:637-646. [PMID: 37594908 DOI: 10.1111/edt.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND/AIMS High methodological quality is required to interpret results of systematic reviews (SRs) in a reliable and accurate manner. The primary aim of this study was to appraise the methodologic quality of SRs with meta-analysis within the field of traumatic dental injuries using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool and assess overall confidence in their results. A secondary aim was to identify potential predictive factors associated with methodological quality. MATERIALS AND METHODS SRs with meta-analyses published in English in the field of traumatic dental injuries from inception to March 2023 were identified. The methodological quality of the included reviews was assessed using the AMSTAR 2 checklist. Two independent evaluators scored each AMSTAR 2 item as "yes" if it was adequately addressed, "partial yes" if it was partially addressed, and "no" if it was not addressed. The overall confidence in the results of each review was classified as "High," "Moderate," "Low," or "Critically low." Using multiple regression, the relationship between five predictor variables (journal impact factor, year of publication, number of authors, journal adherence to Preferred Reporting Items for Systematic reviews and Meta-analyses [PRISMA] guidelines and a priori protocol registration) and the total AMSTAR 2 scores was analyzed. The p-value was 5%. RESULTS Forty-one SRs were included. The overall confidence in the results of 13 reviews was categorized as "Critically low," 18 as "Low," 3 as "Moderate" and 7 as "High." Among the five predictor variables analyzed statistically, impact factor of the journal and year of publication significantly influenced the total AMSTAR 2 scores. The number of authors, adherence to PRISMA guidelines, and a priori protocol registration had no significant impact on AMSTAR 2 scores. CONCLUSION The overall confidence in the results of SRs with meta-analysis within the field of traumatic dental injuries was "Low" or "Critically Low" in the vast majority of studies (31 of 41). SRs with meta-analyses published in journals with higher impact factors and more recent publications had significantly higher methodological quality.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Clovis M Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
| | - Vellore Kannan Gopinath
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | | | - Henry F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Song A, Rensi SE, Tarquinio AG, Cahan E, de Ruijter VE, Wall JK. The Value of Scientific Publications in Surgical Device Innovation. Surg Innov 2023; 30:615-621. [PMID: 36511818 DOI: 10.1177/15533506221143267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Clinical trials represent a significant risk in the commercialization of surgical technologies. There is incentive for companies to mitigate their regulatory risk by targeting 510K over Premarket Approval (PMA) pathways in order to limit the scope, complexity and cost of clinical trials. As such, not all companies will publish clinical data in the scientific literature. PURPOSE We set out to investigate the relationship between scientific publication by surgical device companies and the impact it has on company valuation. We hypothesize that publishing in the scientific literature correlates with success of the surgical device companies as measured by funding. RESEARCH DESIGN We first obtained a list of surgical device startup companies and their financial deals using the Pitchbook database. Those companies were then cross referenced with the FDA database and the Dimensions database for product registrations and peer reviewed publications, respectively. Analysis was then performed using these query results. STUDY SAMPLE AND DATA COLLECTION We obtained a list of US surgical device startups financing deals closed between 2010 and 2020 from the Pitchbook database. We queried the Pitchbook for deal dates from January 1, 2010 to January 1, 2020 for deal types spanning early stage investment to IPO. Deals were limited to those conducted in the United States and to the surgical device industry. We queried the FDA database for product registration information associated with each of the companies involved in the deals. We tabulated the number of journal articles associated with surgical device companies using the Dimensions Search API as well as a manual confirmation. RESULTS Five hundred thirty five (535) deals from 222 companies were found in Pitchbook that met our criteria. Querying the FDA database resulted in 578 registrations associated with these companies. Publications per company ranged widely. CONCLUSIONS Companies that are able to generate a more numerous publications had correspondingly higher valuations during funding rounds. A subset of outstanding companies were analyzed and at least four factors affect: direct value of publications, indirect valve of publications, survivorship bias, and adoption share; each of which will be discussed in this manuscript.
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Affiliation(s)
- Alfred Song
- Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Stefano E Rensi
- Department of Bioengineering, Stanford University School of Engineering, Stanford, CA, USA
| | | | - Eli Cahan
- Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, CA, USA
| | | | - James K Wall
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford, CA, USA
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de Oliveira LC, Calixto-Lima L, Cunha GDC, Silva NFD, Souza-Silva RD, Fonseca TSM, Souza TD, Santos CDM, Santos DAD, Varea Maria Wiegert E. Effects of specialised nutritional interventions in patients with incurable cancer: a systematic review. BMJ Support Palliat Care 2022; 12:388-402. [DOI: 10.1136/spcare-2022-003893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 11/04/2022]
Abstract
ObjectiveTo evaluate current evidence of the effect of specialised nutritional interventions on nutritional status, survival, quality of life and measures of functionality in patients with incurable cancer.MethodsSystematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed/MEDLINE, EMBASE, Scopus, LILACS and Cochrane Library databases. Clinical studies that evaluated different specialised nutritional interventions, such as nutritional counselling, oral nutritional supplementation (ONS), enteral nutrition (EN) and parenteral nutrition (PN), were eligible. Only studies classified as being of high methodological quality (ie, low or moderate risk of bias) were included.ResultsA total of 22 studies reporting on 2448 patients were deemed eligible. Five types of specialised nutrition were observed: mixed (multimodal nature, ie, dietary counseling, ONS, physical activity and/or drugs) (n=12), ONS (n=5), PN (n=3), EN (n=1) and multidisciplinary team counselling (n=1). Benefits of any kind from the interventions were reported in 14 (63.6%) studies, mainly resulting from mixed intervention. Nutritional status improved in 12 (60.0%) of 20 studies and quality of life improved in eight (50.0%) of 16 studies. Few studies have evaluated the influence of nutritional interventions on survival and measure of functionality, and have not shown improvement in these outcomes.ConclusionDespite the limited evidence, specialised nutritional interventions can yield positive effects for patients with incurable cancer, mainly in their nutritional status and quality of life.
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Kim MM, Pound L, Steffensen I, Curtin GM. Reporting and methodological quality of systematic literature reviews evaluating the associations between e-cigarette use and cigarette smoking behaviors: a systematic quality review. Harm Reduct J 2021; 18:121. [PMID: 34838030 PMCID: PMC8627036 DOI: 10.1186/s12954-021-00570-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Several published systematic reviews have examined the potential associations between e-cigarette use and cigarette smoking, but their methodological and/or reporting quality have not yet been assessed. This systematic quality review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 to evaluate the quality of systematic reviews investigating potential associations between e-cigarette use and cigarette smoking. Materials and methods PubMed/MEDLINE, Embase, and PsycINFO were searched from 01 January 2007 to 24 June 2020. Methodological quality was assessed using AMSTAR 2, and reporting quality was assessed using PRISMA guidelines. Results Of 331 potentially relevant systematic reviews, 20 met predefined inclusion criteria. Most reviews (n = 15; 75%) reported on e-cigarette use and cigarette smoking cessation, while three reported on e-cigarette use and cigarette smoking initiation (15%); and two reported on cigarette smoking initiation and cessation (10%). According to AMSTAR 2 guidelines, 18 of the 20 reviews (90%) were “critically low” in overall confidence of the results, while two were ranked “low.” Additionally, reporting quality varied across the reviews, with only 60% reporting at least half of the PRISMA items. Discussion Methodological limitations were identified across reviews examining potential associations between e-cigarette use and cigarette smoking behaviors, indicating that findings from these reviews should be interpreted with caution. Conclusions Future systematic reviews in this field should strive to adhere to AMSTAR 2 and PRISMA guidelines, to provide high quality syntheses of the available data with transparent and complete reporting. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00570-9.
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Affiliation(s)
- Mimi M Kim
- Scientific and Regulatory Affairs, RAI Services Company, 401 North Main Street, Winston-Salem, NC, 27101, USA.
| | | | | | - Geoffrey M Curtin
- Scientific and Regulatory Affairs, RAI Services Company, 401 North Main Street, Winston-Salem, NC, 27101, USA
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Youssef M, Zani B, Olaiya O, Soliman M, Mbuagbaw L. Virological measures and factors associated with outcomes, and missing outcome data in HIV clinical trials: a methodological study. BMJ Open 2021; 11:e039462. [PMID: 34697107 PMCID: PMC8547356 DOI: 10.1136/bmjopen-2020-039462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To evaluate the definition of HIV virological outcomes in the literature and factors associated with outcomes and missing outcome data. METHODS We conducted a methodological review of HIV RCTs using a search (2009-2019) of PubMed, Embase and the Cochrane Central Register of Controlled Trials.Only full-text, peer-reviewed, randomised controlled trials (RCTs) that measured virological outcomes in people living with HIV, and published in English were included.We extracted study details and outcomes. We used logistic regression to identify factors associated with a viral threshold ≤50 copies/mL and linear regression to identify factors associated with missing outcome data. RESULTS Our search yielded 5847 articles; 180 were included. A virological outcome was the primary outcome in 73.5% of studies. 89 studies (49.4%) used virological success. The remaining used change in viral load (VL) (33 studies, 18.3%); virological failure (59 studies, 32.8%); or virological rebound (9 studies, 5.0%). 96 studies (53.3%) set the threshold at ≤50 copies/mL; and 33.1% used multiple measures.Compared with government and privately funded studies, RCTs with industry funding (adjusted OR 6.39; 95% CI 2.15 to 19.00; p<0.01) were significantly associated with higher odds of using a VL threshold of ≤50 copies/mL. Publication year, intervention type, income level and number of patients were not associated with a threshold of ≤50 copies/mL. Trials with pharmacological interventions had less missing data (β=-11.04; 95% CI -20.02 to -1.87; p=0.02). DISCUSSION Country source of funding was associated with VL threshold choice and studies with pharmacological interventions had less missing data, which may in part explain heterogeneous virological outcomes across studies. Multiple measures of VL were not associated with missing data. The development of formal guidelines on virological outcome reporting in RCTs is needed.
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Affiliation(s)
- Mark Youssef
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, South Africa
| | - Oluwatobi Olaiya
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Soliman
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
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Systematic Review and Meta-Analysis on the Effects of Astaxanthin on Human Skin Ageing. Nutrients 2021; 13:nu13092917. [PMID: 34578794 PMCID: PMC8472736 DOI: 10.3390/nu13092917] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022] Open
Abstract
Context: Astaxanthin (ASX), a xanthophyll carotenoid derived from microalgae Haematococcus pluvialis, mitigating skin photoaging and age-related skin diseases by its antioxidant and anti-inflammatory effects in animal studies. Objective: The aim was to systematically evaluate if ASX applications have anti-ageing effects in humans. Methods: A comprehensive search of PubMed, Scopus and Web of Science found a total of eleven studies. Nine randomised, controlled human studies assessed oral ASX effects and two open-label, prospective studies evaluated topical, oral-topical ASX effects on skin ageing. GetData Graph Digitizer was used to extract mean values and standard deviations of baseline and endpoint, and Cochrane Collaboration’s tool assessed RoB for all included studies. Review Manager 5.4 was used to conduct meta-analysis of RCTs; the results were reported as effect size ± 95% confidence interval. Results: Oral ASX supplementation significantly restored moisture content (SMD = 0.53; 95% CI = 0.05, 1.01; I2 = 52%; p = 0.03) and improved elasticity (SMD = 0.77; 95% CI = 0.19, 1.35; I2 = 75%; p = 0.009) but did not significantly decrease wrinkle depth (SMD = −0.26; 95% CI = −0.58, 0.06; I2 = 0%; p = 0.11) compared to placebo. Open-label, prospective studies suggested slightly protective effects of topical and oral-topical ASX applications on skin ageing. Conclusions: Ingestion and/or topical usages of ASX may be effective in reducing skin ageing and have promising cosmetical potential, as it improves moisture content and elasticity and reduces wrinkles.
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Ferrell S, Demla S, Anderson JM, Weaver M, Torgerson T, Hartwell M, Vassar M. Association between industry sponsorship and author conflicts of interest with outcomes of systematic reviews and meta-analyses of interventions for opioid use disorder. J Subst Abuse Treat 2021; 132:108598. [PMID: 34419326 DOI: 10.1016/j.jsat.2021.108598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Author conflicts of interest (COI) and industry sponsorship may lead to biased research results and conclusions. Considering the direct influence that systematic reviews have on patient care, including the management of patients being treated for opioid use disorders (OUD), these studies should be free of industry bias. Thus, we sought to determine whether a relationship exists between COI and the favorability of systematic review outcomes using a sample of systematic reviews regarding OUD interventions. METHODS We searched MEDLINE and Embase for systematic reviews and meta-analysis related to OUD treatment. The study team performed all data extraction in a masked duplicate fashion. We searched for undisclosed COI for each systematic review author in 3 databases--the CMS Open Payments database, Dollars for Profs, and the United States Patent and Trademark Office (USPTO). The research team quantified results using descriptive statistics. We evaluated associations between review characteristics using Fisher's exact tests, when possible. RESULTS This article includes seventeen systematic reviews and meta-analyses with 81 authors. We found that 25 authors (30.9%) had some form of COI, and 22 (of 25, 88.0%) authors had an undisclosed COI. However, no significant association existed between COI and favorability of results and conclusions. Notably, two systematic reviews (of 17; 11.76%) were industry-sponsored. Similarly, we found no association between the study sponsor source and the favorability of systematic review results and conclusions. CONCLUSIONS Our results suggest the favorability of systematic review results and conclusions are not influenced by author COI or industry sponsorship. However, nearly one-fourth of authors had an undisclosed COI, further emphasizing the need for standardization and adherence to COI disclosure policies within addiction medicine literature.
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Affiliation(s)
- Sydney Ferrell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Simran Demla
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - J Michael Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Michael Weaver
- Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine, Joplin, MO, United States
| | - Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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Zheng Q, Lai F, Li B, Xu J, Long J, Peng S, Li Y, Liu Y, Xiao H. Association Between Prospective Registration and Quality of Systematic Reviews in Type 2 Diabetes Mellitus: A Meta-epidemiological Study. Front Med (Lausanne) 2021; 8:639652. [PMID: 34262914 PMCID: PMC8273164 DOI: 10.3389/fmed.2021.639652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/04/2021] [Indexed: 12/01/2022] Open
Abstract
Background: We sought to investigate the methodological and reporting quality of published systematic reviews describing randomized controlled trials in type 2 diabetes mellitus and analyze their association with status of protocol registration. Methods: We searched the PubMed database and identified non-Cochrane systematic reviews, with or without meta-analysis, reporting on type 2 diabetes mellitus and published between 2005 and 2018. We then randomly selected 20% of these reviews in each year, and performed methodological and reporting quality assessment using the Assessment of Multiple Systematic Review 2 (AMSTAR-2) checklist and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We also conducted regression analyses to explore the association between characteristics of systematic reviews and AMSTAR-2 or PRISMA scores. Results: A total of 238 systematic reviews, including 33 registered and 205 non-registered articles, met the inclusion criteria and were subsequently reviewed. Analysis indicated an increase in both registered rates and quality of systematic reviews in type 2 diabetes mellitus over the recent years. With regards to methodological and reporting quality, we found higher scores in registered, relative to non-registered reviews (AMSTAR-2 mean score: 18.0 vs. 14.5, P = 0.000; PRISMA mean score: 20.4 vs. 17.6, P = 0.000). AMSTAR-2 and PRISMA scores were associated with registration status, country of the first author, and statistical results, whereas the proportion of discussing publication bias and reporting funding sources were <40% for both registered and non-registered systematic reviews. Conclusions: Methodological and reporting quality of systematic reviews in type 2 diabetes mellitus indicates an improvement in the recent years. However, the overall quality remains low, necessitating further improvement. Future studies are expected to pay more attention to prospective registration, description of publication bias and reporting of funding sources.
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Affiliation(s)
- Qiuyi Zheng
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia Xu
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianyan Long
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihao Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Khan MS, Shahid I, Asad N, Greene SJ, Khan SU, Doukky R, Metra M, Anker SD, Filippatos GS, Fonarow GC, Butler J. Discontinuation and non-publication of heart failure randomized controlled trials: a call to publish all trial results. ESC Heart Fail 2020; 8:16-25. [PMID: 33191637 PMCID: PMC7835587 DOI: 10.1002/ehf2.13099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/17/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
Aims Discontinuation or non‐publication of trials may hinder scientific progress and violates the commitment made to research participants. We sought to identify the prevalence of discontinuation and non‐publication of heart failure (HF) clinical trials. Methods and results We conducted a cross‐sectional search of ClinicalTrials.gov to identify all completed and discontinued HF clinical trials. We limited our search to only include trials that were completed by 31 December 2017. Trials were investigated to identify reasons for discontinuation. Informative termination was defined as trial termination due to safety or efficacy concerns. Data pertaining to the trial phase, funding, intervention, enrolment, and trial completion date were extracted for each trial. A total of 572 trials were included. Of these, 21% (n = 118) were discontinued before completion. Patient accrual was the most frequently cited reason (n = 42; 36%) for trial discontinuation, followed by informative termination (n = 16; 14%) and funding (n = 14; 12%). Overall, 24 780 patients were enrolled in trials that were terminated. Of trials that were completed and not terminated, nearly one‐third (n = 131/454; 29%) were not published. Seventy‐nine (24%) trials were published within 12 months, 192 (59%) within 24 months, and 252 (78%) trials within 36 months. Conclusions Discontinuation and non‐publication of HF trials is common. This raises ethical concerns towards participants who volunteer for research and are exposed to potential risks, inconvenience, and discomfort without furthering scientific progress.
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Affiliation(s)
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Nava Asad
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos S Filippatos
- Medical School, University of Cyprus, Nicosia, Cyprus.,National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, CA, Los Angeles, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA
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Hussain N, Brull R, Sheehy BT, Kushelev M, Essandoh MK, Abdallah FW. The mornings after-periarticular liposomal bupivacaine infiltration does not improve analgesic outcomes beyond 24 hours following total knee arthroplasty: a systematic review and meta-analysis. Reg Anesth Pain Med 2020; 46:61-72. [PMID: 33106282 DOI: 10.1136/rapm-2020-101995] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
Periarticular local infiltration analgesia (LIA) is integral to multimodal analgesia following total knee arthroplasty (TKA); however, the duration of analgesia using traditional long-acting local anesthetics is often insufficient. LIA with slow-release liposomal bupivacaine may provide extended analgesia, but evidence of efficacy beyond the first 24 hours is conflicting. This meta-analysis compares the effects of periarticular liposomal and plain bupivacaine LIA on day 2 analgesic outcomes post-TKA. Trials comparing liposomal and plain bupivacaine LIA for TKA were sought. The two coprimary outcomes were (1) cumulative oral morphine equivalent consumption and (2) difference in area under the curve (AUC) of pooled rest pain scores on day 2 (24-48 hours) post-TKA. We also evaluated pain and analgesic consumption on day 3 (48-72 hours), functional recovery, length of hospital stay, patient satisfaction; and opioid-related side effects. Data were pooled using random-effects modeling. Seventeen trials (1836 patients) were analyzed. Comparing liposomal versus plain bupivacaine LIA for TKA failed to detect differences in morphine consumption and pain AUC on day 2 postoperatively, with mean differences of 0.54 mg (95% CI -5.09 to 6.18) and 0.08 cm/hour (95% CI -0.19 to 0.35), respectively (high-quality evidence). Secondary outcome analysis did not uncover any additional analgesic, functional or safety advantages to liposomal bupivacaine on postoperative day 2 or 3. Results indicate that liposomal and plain bupivacaine LIAs are not different for extended postoperative analgesic outcomes, including pain control, opioid consumption, as well as functional and safety outcomes on days 2 and 3 post-TKA. High-quality evidence does not support using liposomal bupivacaine LIA for TKA.
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Affiliation(s)
- Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Brull
- Anesthesiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Brendan T Sheehy
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Kushelev
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael K Essandoh
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Faraj W Abdallah
- Anesthesiology and Pain Medicine, University of Toronto and University of Ottawa, Ottawa, Ontario, Canada
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13
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Ng QX, De Deyn MLZQ, Loke W, Foo NX, Chan HW, Yeo WS. Effects of Astaxanthin Supplementation on Skin Health: A Systematic Review of Clinical Studies. J Diet Suppl 2020; 18:169-182. [DOI: 10.1080/19390211.2020.1739187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Qin Xiang Ng
- MOH Holdings Pte Ltd, Singapore, Singapore
- University of Essex, Colchester, United Kingdom
| | | | | | | | - Hwei Wuen Chan
- National University Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Song Yeo
- National University Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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14
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Lau VI, Rochwerg B, Xie F, Johnstone J, Basmaji J, Balakumaran J, Iansavichene A, Cook DJ. Probiotics in hospitalized adult patients: a systematic review of economic evaluations. Can J Anaesth 2020; 67:247-261. [PMID: 31721100 PMCID: PMC7222908 DOI: 10.1007/s12630-019-01525-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Probiotics may prevent healthcare-associated infections, such as ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea, and other adverse outcomes. Despite their potential benefits, there are no summative data examining the cost-effectiveness of probiotics in hospitalized patients. This systematic review summarized studies evaluating the economic impact of using probiotics in hospitalized adult patients. METHODS We searched MEDLINE, EMBASE, CENTRAL, ACP Journal Club, and other EBM reviews (inception to January 31, 2019) for health economics evaluations examining the use of probiotics in hospitalized adults. Independently and in duplicate, we extracted data study characteristics, risk of bias, effectiveness and total costs (medications, diagnostics/procedures, devices, personnel, hospital) associated with healthcare-associated infections (ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea and antibiotic-associated diarrhea). We used Grading of Recommendations Assessment, Development and Evaluation methods to assess certainty in the overall cost-effectiveness evidence. RESULTS Of 721 citations identified, we included seven studies. For the clinical outcomes of interest, there was one randomized-controlled trial (RCT)-based health economic evaluation, and six model-based health economic evaluations. Probiotics showed favourable cost-effectiveness in six of seven (86%) economic evaluations. Three of the seven studies were manufacturer-supported, all which suggested cost-effectiveness. Certainty of cost-effectiveness evidence was very low because of risk of bias, imprecision, and inconsistency. CONCLUSION Probiotics may be an economically attractive intervention for preventing ventilator-associated pneumonia, Clostridioides difficile-associated diarrhea, and antibiotic-associated diarrhea in hospitalized adult patients. Nevertheless, certainty about their cost-effectiveness evidence is very low. Future RCTs examining probiotics should incorporate cost data to inform bedside practice, clinical guidelines, and healthcare policy. TRIAL REGISTRATION PROSPERO CRD42019129929; Registered 25 April, 2019.
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Affiliation(s)
- Vincent I Lau
- Department of Medicine, Division of Critical Care Medicine, Western University, London, ON, Canada.
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
- Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, 800 Commissioners Road East, London, ON, Canada.
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Jennie Johnstone
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John Basmaji
- Department of Medicine, Division of Critical Care Medicine, Western University, London, ON, Canada
| | - Jana Balakumaran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Deborah J Cook
- Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
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15
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Vijayalaxmi, Prihoda TJ. Funding Source, Quality of Publications and Outcome in Genetic Damage in Mammalian Cells Exposed to Non-Ionizing Radiofrequency Fields. Radiat Res 2019; 192:353-362. [PMID: 31390310 DOI: 10.1667/rr15364.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There has been ongoing debate and discussion concerning whether the funding source influenced the outcome of research on human health effects from exposure to radiofrequency fields (RF, electromagnetic waves that carry energy as they propagate in air and dense media). In a study of 225 publications, in which we sought to determine a possible association between the funding source(s), quality and outcome in a total of 2,160 genetic damage assessment tests of mammalian cells exposed to RF energy, we made several observations. One finding was that a great majority of researchers had acknowledged government agencies as the funding source (53%, 120 of 225 publications), while a small number of scientists mentioned mobile phone industry as the financial source (9%, 20 of 225 publications). Numerous investigators did not mention the funding source (26%, 58 of 225 publications). Secondly, industry-funded investigations were of better quality and utilized quality control measures, i.e., blind evaluation, adequate description of dosimetry, positive controls and/or sham-exposed controls, compared to those funded by the government. Another observation was that in industry-funded studies, the d values (effect size or standardized mean difference between the cells exposed to RF energy and sham-exposed controls) were consistently lower than in government-funded studies. In addition, compared to government-funded studies, a higher percentage of industry-funded studies reported no difference in genetic damage between RF- and sham-exposed cells (80% for industry-funded studies versus 49% for government-funded studies). Finally, we observed that industry-funded studies were less likely to report an increase in genetic damage in cells exposed to RF energy (10%) compared to government-funded studies (23%). In view of the large difference between the percentage of publications funded by government and industry (53% or 122 of 225 publications for government, compared to 9% or 29 of 225 publications for industry), caution should be used when debating and discussing the above observations. Overall, it is important to include the quality control measures in the investigations, and also mention the funding source in published studies.
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Affiliation(s)
| | - Thomas J Prihoda
- Departments of Pathology, University of Texas Health Science Center, San Antonio, Texas 78229
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16
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Domecq JP, Prutsky G, Elraiyah T, Wang Z, Mauck KF, Brito JP, Undavalli C, Sundaresh V, Prokop LJ, Montori VM, Murad MH. Medications affecting the biochemical conversion to type 2 diabetes: A systematic review and meta-analysis. J Clin Endocrinol Metab 2019; 104:3986-3995. [PMID: 31365088 DOI: 10.1210/jc.2019-01269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND The extent to which some pharmacological interventions reduce or increase the risk of biochemical conversion to T2DM in at-risk individuals is unclear. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus through August 24, 2017, for randomized controlled trials evaluating the effect of drugs suspected to modify the risk of biochemical conversion to T2DM. RESULTS We included 43 trials with 192,156 subjects (mean age 60 years; 56% men; mean BMI 30.4 kg/m2). Alpha-glucosidase inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, metformin, orlistat, phentermine-topiramate and pioglitazone significantly reduced the risk of biochemical conversion to T2DM, whereas statins and nateglinide increased the risk. There was insufficient direct evidence regarding the effects of sulfonylureas, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter-2 inhibitors. Most trials were brief and evaluated this outcome during treatment without a withdrawal or washout period. CONCLUSIONS Several drugs modify the risk of biochemical conversation to T2DM, although whether this effect is persistent and clinically relevant is unclear. Future studies need to focus on cardiovascular disease prevention, mortality and patient-important outcomes instead of biochemical conversion to T2DM.
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Affiliation(s)
| | | | - Tarig Elraiyah
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Zhen Wang
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
| | - Karen F Mauck
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Juan Pablo Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | | | - Larry J Prokop
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
| | - Victor M Montori
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Mayo Clinic, Rochester, MN
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17
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The relationship of study and authorship characteristics on trial sponsorship and self-reported conflicts of interest among neuro-oncology clinical trials. J Neurooncol 2018; 139:195-203. [DOI: 10.1007/s11060-018-2860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/03/2018] [Indexed: 10/14/2022]
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18
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Ahmer S, Arya P, Anderson D, Faruqui R. Conflict of interest in psychiatry. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.8.302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo study the association between study support and outcome in randomised controlled trials (RCTs) of psychotropic drugs, we reviewed all RCTs published in four psychiatry journals over a 5-year period. Chi-squared tests were used to analyse the association between RCT support and outcome, and logistic regression to determine which variable best predicted outcome.ResultsA significantly higher proportion of manufacturer-supported RCTs (125/138, 91%, 95% CI 88–93) had a positive outcome than non-manufacturer-supported RCTs (39/50, 78%, 95% CI 72–84; P=0.02). Having an employee author almost guaranteed a positive outcome (56/58, 97%, 95% CI 94–99).Clinical ImplicationsOutcomes of drug RCTs have a significant association with support by the manufacturer of the experimental drug. Systematic reviews and meta-analyses based on these RCTs may be biased in favour of newer drugs.
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19
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Zheng GZ, Chang B, Lin FX, Xie D, Hu QX, Yu GY, Du SX, Li XD. Meta-analysis comparing denosumab and zoledronic acid for treatment of bone metastases in patients with advanced solid tumours. Eur J Cancer Care (Engl) 2017; 26:e12541. [PMID: 27430483 DOI: 10.1111/ecc.12541] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 02/05/2023]
Abstract
The purpose of this meta-analysis was to evaluate the efficacy of denosumab, compared with zoledronic acid (ZA), in delaying skeletal-related events (SREs) and enhancing overall survival in patients with advanced solid tumours and bone metastases. A systematic literature search of several electronic databases, including PubMed, Medline, Embase, the Cochrane Library, CKNI and Web of Science with Conference Proceedings, was performed. Only randomised controlled trials assessing denosumab in comparison with ZA, in patients with advanced solid tumours and metastatic-stage disease, were included. The primary outcome was the time to first SRE. The risk of developing subsequent on-study SREs and overall survival were also evaluated. Three randomised controlled trials with a total of 5,544 patients with advanced solid tumours and bone metastases were included in the meta-analysis. There were 2,776 patients treated with denosumab and 2,768 treated with ZA. The pooled analysis showed that denosumab was superior to ZA in delaying time to first on-study SRE (odds ratio [OR]: 0.82; 95% CI: 0.75-0.89, p < 0.0001) and multiple SREs (risk ratio: 0.81; 95% CI: 0.74-0.88, p < 0.0001). However, no significant difference was found in overall survival improvement between denosumab and ZA (OR: 1.02; 95% CI: 0.91-1.15, p = 0.71). This meta-analysis indicates that denosumab is superior to ZA in delaying SREs for patients with bone metastases. No significant difference was observed between denosumab and ZA, regarding overall survival. We support denosumab as a potential novel treatment option for the management of bone metastases in advanced solid tumours.
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Affiliation(s)
- G Z Zheng
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - B Chang
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - F X Lin
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - D Xie
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Q X Hu
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
- Department of Orthopedics, The Affiliated Luohu Hospital, Shenzhen University, Shenzhen, Guangdong, China
| | - G Y Yu
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - S X Du
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
- Department of Orthopedics, The Affiliated Luohu Hospital, Shenzhen University, Shenzhen, Guangdong, China
| | - X D Li
- Department of Orthopedics, The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
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20
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Hakoum MB, Jouni N, Abou-Jaoude EA, Hasbani DJ, Abou-Jaoude EA, Lopes LC, Khaldieh M, Hammoud MZ, Al-Gibbawi M, Anouti S, Guyatt G, Akl EA. Characteristics of funding of clinical trials: cross-sectional survey and proposed guidance. BMJ Open 2017; 7:e015997. [PMID: 28982811 PMCID: PMC5639984 DOI: 10.1136/bmjopen-2017-015997] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To provide a detailed and current characterisation of funding of a representative sample clinical trials. We also aimed to develop guidance for standardised reporting of funding information. METHODS We addressed the extent to which clinical trials published in 2015 in any of the 119 Core Clinical Journals included a statement on the funding source (eg, whether a not-for-profit organisation was supported by a private-for-profit organisation), type of funding, amount and role of funder. We used a stepwise approach to develop a guidance and an instrument for standardised reporting of funding information. RESULTS Of 200 trials, 178 (89%) included a funding statement, of which 171 (96%) reported being funded. Funding statements in the 171 funded trials indicated the source in 100%, amount in 1% and roles of funders in 50%. The most frequent sources were governmental (58%) and private-for-profit (40%). Of 54 funding statements in which the source was a not-for-profit organisation, we found evidence of undisclosed support of those from private-for-profit organisation(s) in 26 (48%). The most frequently reported roles of funders in the 171 funded trials related to study design (42%) and data analysis, interpretation or management (41%). Of 139 randomised controlled trials (RCTs) addressing pharmacological or surgical interventions, 29 (21%) reported information on the supplier of the medication or device. The proposed guidance addresses both the funding information that RCTs should report and the reporting process. Attached to the guidance is a fillable PDF document for use as an instrument for standardised reporting of funding information. CONCLUSION Although the majority of RCTs report funding, there is considerable variability in the reporting of funding source, amount and roles of funders. A standardised approach to reporting of funding information would address these limitations. Future research should explore the implications of funding by not-for-profit organisations that are supported by for-profit organisations.
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Affiliation(s)
- Maram B Hakoum
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nahla Jouni
- Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Eliane A Abou-Jaoude
- Department of Internal Medicine, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | | | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Brazil, Sorocaba, São Paulo, Brazil
| | - Mariam Khaldieh
- Faculty of Sciences, American University of Beirut, Beirut, Lebanon
| | - Mira Zein Hammoud
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Sirine Anouti
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358:j4008. [PMID: 28935701 PMCID: PMC5833365 DOI: 10.1136/bmj.j4008] [Citation(s) in RCA: 4344] [Impact Index Per Article: 620.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a range of biases and increasingly include non-randomised studies of interventions. It is important that users can distinguish high quality reviews. Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments. AMSTAR was developed to evaluate systematic reviews of randomised trials. In this paper, we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.
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Affiliation(s)
- Beverley J Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - George Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Micere Thuku
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - Candyce Hamel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Julian Moran
- The Hospital for Sick Children, the Genetics and Genome Biology Program, Toronto, Canada
| | - David Moher
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Vivian Welch
- Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Elizabeth Kristjansson
- Centre for Research in Educational and Community Services, School of Psychology, Faculty of Social Sciences, University of Ottawa, Canada
| | - David A Henry
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
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A Systematic Appraisal of Neurosurgical Seizure Prophylaxis: Guidance for Critical Care Management. J Neurosurg Anesthesiol 2017; 28:233-49. [PMID: 26192247 DOI: 10.1097/ana.0000000000000206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Clinical decisions are often made in the presence of some uncertainty. Health care should be based on a combination of scientific evidence, clinical experience, economics, patient value judgments, and preferences. Seizures are not uncommon following brain injury, surgical trauma, hemorrhage, altered brain metabolism, hypoxia, or ischemic events. The impact of seizures in the immediate aftermath of injury may be a prolonged intensive care stay or compounding of the primary injury. The aim of brain injury management is to limit the consequences of the secondary damage. The original intention of seizure prophylaxis was to limit the incidence of early-onset seizures. However, clinical trials have been equivocal on this point, and there is concern about the adverse effects of antiepileptic drug therapy. This review of the literature raises concerns regarding the arbitrary division of seizures into early onset (7 d) and late onset (8 d and beyond). In many cases it would appear that seizures present within 24 hours of the injury or after 7 days, which would be outside of the scope of current seizure prophylaxis guidance. There also does not appear to be a pathophysiological reason to divide brain injury-related seizures into these timeframes. Therefore, a solution to the conundrum is to reevaluate current practice. Prophylaxis could be offered to those receiving intensive care for the primary brain injury, where the impact of seizure would be detrimental to the management of the brain injury, or other clinical judgments where prophylaxis is prudent. Neurosurgical seizure management can then focus attention on which agent has the best adverse effect profile and the duration of therapy. The evidence seems to support levetiracetam as the most appropriate agent. Although previous reviews have identified an increase cost associated with the use of levetiracetam, current cost comparisons with phenytoin demonstrate a marginal price differential. The aim of this review is to assimilate the applicable literature regarding seizure prophylaxis. The final guidance is a forum upon which further clinical research could evaluate a new seizure prophylaxis paradigm.
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Abstract
BACKGROUND Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have found that pharmaceutical-industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. A similar association between sponsorship and outcomes have been found for device studies, but the body of evidence is not as strong as for sponsorship of drug studies. This review is an update of a previous Cochrane review and includes empirical studies on the association between sponsorship and research outcome. OBJECTIVES To investigate whether industry sponsored drug and device studies have more favorable outcomes and differ in risk of bias, compared with studies having other sources of sponsorship. SEARCH METHODS In this update we searched MEDLINE (2010 to February 2015), Embase (2010 to February 2015), the Cochrane Methodology Register (2015, Issue 2) and Web of Science (June 2015). In addition, we searched reference lists of included papers, previous systematic reviews and author files. SELECTION CRITERIA Cross-sectional studies, cohort studies, systematic reviews and meta-analyses that quantitatively compared primary research studies of drugs or medical devices sponsored by industry with studies with other sources of sponsorship. We had no language restrictions. DATA COLLECTION AND ANALYSIS Two assessors screened abstracts and identified and included relevant papers. Two assessors extracted data, and we contacted authors of included papers for additional unpublished data. Outcomes included favorable results, favorable conclusions, effect size, risk of bias and whether the conclusions agreed with the study results. Two assessors assessed risk of bias of included papers. We calculated pooled risk ratios (RR) for dichotomous data (with 95% confidence intervals (CIs)). MAIN RESULTS Twenty-seven new papers were included in this update and in total the review contains 75 included papers. Industry sponsored studies more often had favorable efficacy results, RR: 1.27 (95% CI: 1.17 to 1.37) (25 papers) (moderate quality evidence), similar harms results RR: 1.37 (95% CI: 0.64 to 2.93) (four papers) (very low quality evidence) and more often favorable conclusions RR: 1.34 (95% CI: 1.19 to 1.51) (29 papers) (low quality evidence) compared with non-industry sponsored studies. Nineteen papers reported on sponsorship and efficacy effect size, but could not be pooled due to differences in their reporting of data and the results were heterogeneous. We did not find a difference between drug and device studies in the association between sponsorship and conclusions (test for interaction, P = 0.98) (four papers). Comparing industry and non-industry sponsored studies, we did not find a difference in risk of bias from sequence generation, allocation concealment, follow-up and selective outcome reporting. However, industry sponsored studies more often had low risk of bias from blinding, RR: 1.25 (95% CI: 1.05 to 1.50) (13 papers), compared with non-industry sponsored studies. In industry sponsored studies, there was less agreement between the results and the conclusions than in non-industry sponsored studies, RR: 0.83 (95% CI: 0.70 to 0.98) (six papers). AUTHORS' CONCLUSIONS Sponsorship of drug and device studies by the manufacturing company leads to more favorable efficacy results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments.
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Affiliation(s)
- Andreas Lundh
- Odense University Hospital and University of Southern DenmarkCenter for Evidence‐Based MedicineSdr. Boulevard 29, Entrance 50 (Videncentret)OdenseDenmark5000
| | - Joel Lexchin
- York UniversitySchool of Health Policy and Management121 Walmer RdTorontoONCanadaM5R 2X8
| | - Barbara Mintzes
- The University of SydneyCharles Perkins Centre and Faculty of PharmacyRoom 6W75, 6th FloorThe Hub, Charles Perkins Centre D17SydneyNSWAustralia2006
| | - Jeppe B Schroll
- Herlev HospitalDepartment of Obstetrics and GynaecologyHerlev Ringvej 75HerlevDenmark2730
| | - Lisa Bero
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney6th Floor (6W76)The University of SydneySydneyNew South Wales 2006Australia
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Ahn R, Woodbridge A, Abraham A, Saba S, Korenstein D, Madden E, Boscardin WJ, Keyhani S. Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study. BMJ 2017; 356:i6770. [PMID: 28096109 PMCID: PMC5241252 DOI: 10.1136/bmj.i6770] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the association between the presence of individual principal investigators' financial ties to the manufacturer of the study drug and the trial's outcomes after accounting for source of research funding. DESIGN Cross sectional study of randomized controlled trials (RCTs). SETTING Studies published in "core clinical" journals, as identified by Medline, between 1 January 2013 and 31 December 2013. PARTICIPANTS Random sample of RCTs focused on drug efficacy. MAIN OUTCOME MEASURE Association between financial ties of principal investigators and study outcome. RESULTS A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers' fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1.4 to 7.9). CONCLUSIONS Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base.
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Affiliation(s)
- Rosa Ahn
- Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Ann Abraham
- San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - Susan Saba
- Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | | | - Erin Madden
- San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - W John Boscardin
- San Francisco VA Medical Center, San Francisco, CA 94121, USA
- University of California, San Francisco, San Francisco, CA 94121, USA
| | - Salomeh Keyhani
- San Francisco VA Medical Center, San Francisco, CA 94121, USA
- University of California, San Francisco, San Francisco, CA 94121, USA
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Hannon CP, Chalmers PN, Carpiniello MF, Cvetanovich GL, Cole BJ, Bach BR. Inconsistencies Between Physician-Reported Disclosures at the AAOS Annual Meeting and Industry-Reported Financial Disclosures in the Open Payments Database. J Bone Joint Surg Am 2016; 98:e90. [PMID: 27869631 DOI: 10.2106/jbjs.15.01119] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the rate and type of inconsistencies between disclosures self-reported by physicians at a major academic meeting in the United States and industry-reported disclosures in the Open Payments database for a concordant time period. METHODS Disclosures for every first and last author from the United States with a medical degree of a podium or poster presentation at the 2014 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting were collected and were compared with the disclosures reported in the Open Payments database to determine if any inconsistencies were present and, if so, within which category. RESULTS In total, 1,925 total AAOS presenters were identified, and 1,113 met the inclusion criteria. Based on AAOS disclosures, 432 (39%) should have been listed within the Open Payments database. There were 125 presenters (11%) who reported an AAOS disclosure and thus should have been included in the Open Payments database, but were not included. An additional 259 presenters (23%) had ≥1 AAOS disclosures that were not reported or were improperly categorized in the Open Payments database. Inconsistencies were more common for authors who had significantly more poster presentations (p < 0.001), podium presentations (p = 0.01), total presentations (p < 0.001), and AAOS disclosures (p < 0.001) and a significantly higher value of payments in the Open Payments database (p < 0.001). CONCLUSIONS In this sample, there was a 35% rate of inconsistency between physician-reported financial relationships for presenters at the AAOS Annual Meeting and industry-reported relationships published in the Open Payments database.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Matthew F Carpiniello
- Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital Center, New York, NY
| | - Gregory L Cvetanovich
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Maas E, Maher C, Moseley A, Annevelink R, Jagersma J, Ostelo R. Funding is related to the quality, conduct, and reporting of trial reports in musculoskeletal physical therapy: A survey of 210 published trials. Physiother Theory Pract 2016; 32:628-635. [DOI: 10.1080/09593985.2016.1222472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Esther Maas
- Health Sciences, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Christopher Maher
- The George Institute for Global Health and Professor, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Anne Moseley
- The George Institute for Global Health and Professor, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Renske Annevelink
- Health Sciences, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Jurgen Jagersma
- Health Sciences, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Raymond Ostelo
- Health Sciences, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
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Maharaj SVM. A new method for scoring financial conflicts of interest. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 21:49-52. [PMID: 25633929 DOI: 10.1179/2049396714y.0000000097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is a large and consistent body of evidence showing that research sponsored by for-profit industries tends to have pro-industry conclusions in comparison with similar research or re-analyses not funded by industry. Disclosure of financial conflicts via statements is presently the standard method for notification of potential biases. However, many journals are not consistent in publishing financial conflicts of interest (FCoI) statements. Furthermore, even when divulged, disclosure merely shifts the burden of evaluating conflicts to readers and the general public. Moreover, there has been an absence of a means of quantifying FCoI. OBJECTIVES To propose a solution for the question: What are we doing about FCoI that continue to compromise the integrity of the scientific enterprise? METHODS The FCoI Scale was developed for scoring and comparing FCoI and describing potential biases. RESULTS The FCoI Scale consists of a score that may be expressed in whole numbers and decimal fractions, correlated to descriptive terms for potential biases and examples of financial conflicts at 11 levels. CONCLUSIONS The FCoI score (FCoIS) provides a means for a more uniform and concise method of disclosure compared to statements, while at the same time permitting flexibility. It encourages the disclosure of relevant information and transparency in the reporting of financial conflicts. The FCoI Scale has the potential to become the standard basis for measuring, reporting, and comparing financial conflicts, suitable for disciplines in science, medicine, and beyond.
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Cullum N, Buckley H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Goncalves PS, Soares M, Stubbs N. Wounds research for patient benefit: a 5-year programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04130] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Nicky Cullum
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Hannah Buckley
- Department of Health Sciences, University of York, York, UK
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | - Richard Morley
- Department of Health Sciences, University of York, York, UK
| | - Susan O’Meara
- Department of Health Sciences, University of York, York, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
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Koletsi D, Valla K, Fleming PS, Chaimani A, Pandis N. Assessment of publication bias required improvement in oral health systematic reviews. J Clin Epidemiol 2016; 76:118-24. [DOI: 10.1016/j.jclinepi.2016.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/26/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
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Ahmed AA, Holliday EB, Fakhreddine M, Yoo SK, Deville C, Jagsi R. Trends in Disclosures of Industry Sponsorship. Int J Radiat Oncol Biol Phys 2016; 95:1093-101. [PMID: 27130795 DOI: 10.1016/j.ijrobp.2016.02.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/11/2016] [Accepted: 02/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine trends in the reporting of industry funding of oncology trials by primary therapeutic intervention studied: local, targeted, or nontargeted systemic. METHODS AND MATERIALS We reviewed oncologic trials published in 10 journals for the years 1994, 2004, and 2014 to determine the frequency of declarations of industry funding for cancer research. Logistic modeling was used to assess associations between reported industry funding and investigation characteristics, such as type of primary intervention, cancer site, study endpoint, number of participants, geographic location of corresponding author, journal impact factor, trial phase, and year of publication. RESULTS Reporting of industry funding increased over time (odds ratio [OR] 6.8; 95% confidence interval [CI] 3.82-12.35). Compared with systemic trials, those investigating local therapies were less likely to report industry funding (OR 0.08; 95% CI 0.14-0.15), whereas studies examining targeted interventions were more likely to report industry funding (OR 2.24; 95% CI 1.38-3.66). Studies investigating gynecologic (OR 0.37; 95% CI 0.15-0.88) and pediatric cancers (OR 0.08; 95% CI 0.02-0.27) were less likely to report funding by industry when compared with hematologic cancers. Phase 2 (OR 0.32, 95% CI 0.19-0.52) and phase 3 (OR 0.39, 95% CI 0.17-0.37) studies were less likely to report industry funding than phase 1 studies. Trials investigating interventions for metastatic disease (OR 2.55; 95% CI 1.73-3.79) were more likely to have reported industry funding compared with studies examining the primary/definitive disease setting. CONCLUSION Industry funding was reported in more than one-third of oncology trials examined in this study, and the proportion of trials reporting industry funding increased over time. The potential ramifications for these patterns of funding for the future direction of cancer research should be examined, especially given the disproportionate distribution of industry funding among therapeutic intentions, cancer types, and treatment modalities.
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Affiliation(s)
- Awad A Ahmed
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Emma B Holliday
- Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Mohamad Fakhreddine
- Department of Radiation Oncology, University of San Antonio, San Antonio, Texas
| | - Stella K Yoo
- Department of Radiation Oncology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Wilson C, Kerr D, Noel-Storr A, Quinn TJ. Associations with publication and assessing publication bias in dementia diagnostic test accuracy studies. Int J Geriatr Psychiatry 2015; 30:1250-6. [PMID: 25779466 DOI: 10.1002/gps.4283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/14/2015] [Accepted: 02/16/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Biomarkers are of increasing interest in dementia research. Studies describing favourable accuracy of various dementia tests have influenced research, guidelines and diagnostic criteria. Publication bias is known to compromise reports on efficacy of therapeutic interventions. Traditional methods of quantifying publication bias are not suited to reviews of diagnostic tests. We aimed to describe rates and predictors of publication of dementia test accuracy studies presented at scientific meetings. METHODS We chose three exemplar scientific meetings from 2009. Two independent researchers assessed conference proceedings and selected all abstracts relating to dementia diagnostics. We recorded basic descriptors and dichotomised results as 'positive' or 'neutral'. We assessed publication status using electronic literature databases and contacting lead authors. We described univariate and multivariate predictors of publication status using logistic regression modelling. RESULTS From n = 2257 abstracts, we identified n = 250 (11%) abstracts relating to dementia diagnostics. The majority n = 209 (84%) reported positive results. Only 97 (39%) of these studies are published. Univariate predictors of publication status included positive result (p = 0.042), North American or European authors (p = 0.047), higher number of participants (p = 0.008) and use of a 'biomarker' test (p = 0.035). On multivariate analysis, only increasing number of participants was independently associated with publication (p = 0.034). CONCLUSIONS Our strategy did not prove or disprove a publication bias effect in dementia test accuracy studies. The substantial proportion of 'positive' studies may point to a downstream 'submission bias' effect on decision to submit data to meetings. Modest rate of publication of dementia test accuracy studies is concerning, and publication bias remains possible.
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Affiliation(s)
- Claire Wilson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Anna Noel-Storr
- Cochrane Dementia and Cognitive Improvement Group, Oxford, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Reporting of sources of funding in systematic reviews in periodontology and implant dentistry. Br Dent J 2015; 216:109-12. [PMID: 24504292 DOI: 10.1038/sj.bdj.2014.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 01/08/2023]
Abstract
Industry-supported clinical trials may present better outcomes than those supported by other sources. The aim of this paper was to assess whether systematic reviews (SRs) published in periodontology and implant dentistry report and discuss the influence of funding sources on study results. Two reviewers conducted a comprehensive search in PubMed and the Cochrane Database of Systematic Reviews independently and in duplicate to identify SRs published up to 11 November 2012. Speciality dental journals and the reference lists of included SRs were also scrutinised. Information on the reporting and discussion of funding sources of primary studies included in the SRs was extracted independently and in duplicate. Any disagreement regarding SR selection or data extraction was discussed until consensus was achieved. Of 146 SRs included in the assessment, only 45 (31%) reported the funding sources of primary studies. Fourteen (10%) SRs discussed the potential influence of funding sources on study results, that is, sponsorship bias. Funding sources are inadequately reported and discussed in SRs in periodontology and implant dentistry. Assessment, reporting, and critical appraisal of potential sponsorship bias of meta-analytic estimates are paramount to provide proper guidance for clinical treatments.
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Pang WK, Yeter KC, Torralba KD, Spencer HJ, Khan NA. Financial conflicts of interest and their association with outcome and quality of fibromyalgia drug therapy randomized controlled trials. Int J Rheum Dis 2015; 18:606-15. [PMID: 26012523 DOI: 10.1111/1756-185x.12607] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the association of financial conflicts of interest (FCOI) with the characteristics, outcome and reported methodological quality of fibromyalgia drug therapy randomized controlled trials (FM-RCTs). METHODS A cross-sectional study of original, parallel-group, drug therapy FM-RCTs published between 1997 and 2011 from Medline and Cochrane Central Register of Controlled Trials was conducted. Two reviewers independently assessed each RCT for funding source, authors' FCOI(s), study characteristics, reporting of methodological measures important for internal validity and outcome (positive [statistically significant result favoring experimental drug for the primary outcome] or non-positive). RESULTS Forty-seven RCTs were eligible with funding source as: 26 (55.3%) industry; eight (17%) non-profit source(s); five (10.6%) mixed; and eight (17%) unspecified. Industry-funded RCTs were more likely to be multicenter and enroll greater number of patients. Reporting of key methodological measures was suboptimal; however, industry and non-profit funded RCTs did not differ in their reporting. Thirty (63.8%) RCTs had ≥ one author who disclosed an FCOI (receipt of research grant [21, 44.7%], industry sponsor employee [20, 42.6%], receipt of consultancy fee/honorarium [16, 34%] and stock ownership [11, 23.4%]). Although industry funding and certain authors' FCOIs (employment and receipt of consultancy fee/honorarium) were univariately associated with positive outcome, such association was not observed after adjusting for study sample size. CONCLUSIONS The majority of FM-RCTs were industry-sponsored, and had at least one author with an FCOI. Reporting of key methodological measures was suboptimal. After adjusting for study sample size, no association of industry funding or author's FCOI with study outcome was seen.
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Affiliation(s)
- Winnie K Pang
- University of Southern California-Los Angeles County Medical Center, Los Angeles, CA, USA
| | - Karen C Yeter
- University of Southern California-Los Angeles County Medical Center, Los Angeles, CA, USA
| | | | - Horace J Spencer
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nasim A Khan
- Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Every-Palmer S, Howick J. How evidence-based medicine is failing due to biased trials and selective publication. J Eval Clin Pract 2014; 20:908-14. [PMID: 24819404 DOI: 10.1111/jep.12147] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
Abstract
Evidence-based medicine (EBM) was announced in the early 1990s as a 'new paradigm' for improving patient care. Yet there is currently little evidence that EBM has achieved its aim. Since its introduction, health care costs have increased while there remains a lack of high-quality evidence suggesting EBM has resulted in substantial population-level health gains. In this paper we suggest that EBM's potential for improving patients' health care has been thwarted by bias in the choice of hypotheses tested, manipulation of study design and selective publication. Evidence for these flaws is clearest in industry-funded studies. We argue EBM's indiscriminate acceptance of industry-generated 'evidence' is akin to letting politicians count their own votes. Given that most intervention studies are industry funded, this is a serious problem for the overall evidence base. Clinical decisions based on such evidence are likely to be misinformed, with patients given less effective, harmful or more expensive treatments. More investment in independent research is urgently required. Independent bodies, informed democratically, need to set research priorities. We also propose that evidence rating schemes are formally modified so research with conflict of interest bias is explicitly downgraded in value.
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Affiliation(s)
- Susanna Every-Palmer
- Te Korowai Whariki, Capital and Coast District Health Board, Porirua, New Zealand
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Babor TF, Miller PG. McCarthyism, conflict of interest and addiction's new transparency declaration procedures. Addiction 2014; 109:341-4. [PMID: 24524311 DOI: 10.1111/add.12384] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Thomas F Babor
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT, USA.
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Faggion CM. Are there guidelines for reporting clinical research findings in oral lectures and seminars in dental meetings? Br Dent J 2014; 214:281-3. [PMID: 23518971 DOI: 10.1038/sj.bdj.2013.272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/09/2022]
Abstract
Dental meetings are one of the most important resources for disseminating knowledge to dental practitioners. Therefore, the information provided in such meetings should be as unbiased as possible. This paper assessed whether major general dentistry and periodontology/implant dentistry meetings have guidelines for reporting scientific evidence in oral lectures and seminars. The homepages of seven dental meetings (EUROPERIO, AAP, EAO, AO, IADR, ADA, and FDI) were assessed to check for guidelines for presenting scientific data in oral lectures and seminars, according to defined criteria. Only three of these dental meetings reported information for presentations on their homepages, although these guidelines were related to technical issues rather than recommendations for the presentation of scientific data. The present paper suggests guidelines for reporting scientific evidence in oral lectures and seminars in dental meetings to improve the current standards of reporting. High standards of reporting may provide less biased information, which is necessary for dental practitioners and clinicians to make accurate judgements on the efficacy/effectiveness of therapies.
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Affiliation(s)
- C M Faggion
- Department of Oral Sciences, University of Otago, 310 great King Street, Dunedin, 9016, New Zealand.
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Hodgson R, Allen R, Broderick E, Bland JM, Dumville JC, Ashby R, Bell-Syer S, Foxlee R, Hall J, Lamb K, Madden M, O'Meara S, Stubbs N, Cullum N. Funding source and the quality of reports of chronic wounds trials: 2004 to 2011. Trials 2014; 15:19. [PMID: 24422753 PMCID: PMC3896781 DOI: 10.1186/1745-6215-15-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Critical commentaries suggest that wound care randomised controlled trials (RCTs) are often poorly reported with many methodological flaws. Furthermore, interventions in chronic wounds, rather than being drugs, are often medical devices for which there are no requirements for RCTs to bring products to market. RCTs in wounds trials therefore potentially represent a form of marketing. This study presents a methodological overview of chronic wound trials published between 2004 and 2011 and investigates the influence of industry funding on methodological quality. METHODS A systematic search for RCTs for the treatment of chronic wounds published in the English language between 2004 and 2011 (inclusive) in the Cochrane Wounds Group Specialised Register of Trials was carried out.Data were extracted on aspects of trial design, conduct and quality including sample size, duration of follow-up, specification of a primary outcome, use of surrogate outcomes, and risks of bias. In addition, the prevalence of industry funding was assessed and its influence on the above aspects of trial design, conduct and quality was assessed. RESULTS A total of 167 RCTs met our inclusion criteria. We found chronic wound trials often have short durations of follow-up (median 12 weeks), small sample sizes (median 63), fail to define a primary outcome in 41% of cases, and those that do define a primary outcome, use surrogate measures of healing in 40% of cases. Only 40% of trials used appropriate methods of randomisation, 25% concealed allocation and 34% blinded outcome assessors. Of the included trials, 41% were wholly or partially funded by industry, 33% declared non-commercial funding and 26% did not report a funding source. Industry funding was not statistically significantly associated with any measure of methodological quality, though this analysis was probably underpowered. CONCLUSIONS This overview confirms concerns raised about the methodological quality of RCTs in wound care and illustrates that greater efforts must be made to follow international standards for conducting and reporting RCTs. There is currently minimal evidence of an influence of industry funding on methodological quality although analyses had limited power and funding source was not reported for a quarter of studies.
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Affiliation(s)
| | | | | | | | - Jo C Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Jean McFarlane Building, Oxford Road, M13 9PL Manchester, England.
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Dieterich S, Keall PJ, Orton CG. Increasing dependence on industry-funded research creates higher risk of biased reporting in medical physics. Med Phys 2013; 40:100601. [DOI: 10.1118/1.4812894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013; 346:e7586. [PMID: 23303884 PMCID: PMC3541470 DOI: 10.1136/bmj.e7586] [Citation(s) in RCA: 3228] [Impact Index Per Article: 293.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 02/06/2023]
Abstract
High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.
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Affiliation(s)
- An-Wen Chan
- Women's College Research Institute at Women's College Hospital, Department of Medicine, University of Toronto, Toronto, Canada M5G 1N8
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Abstract
BACKGROUND Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have found that pharmaceutical industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. This review is an update using more stringent methodology and also investigating sponsorship of device studies. OBJECTIVES To investigate whether industry sponsored drug and device studies have more favorable outcomes and differ in risk of bias, compared with studies having other sources of sponsorship. SEARCH METHODS We searched MEDLINE (1948 to September 2010), EMBASE (1980 to September 2010), the Cochrane Methodology Register (Issue 4, 2010) and Web of Science (August 2011). In addition, we searched reference lists of included papers, previous systematic reviews and author files. SELECTION CRITERIA Cross-sectional studies, cohort studies, systematic reviews and meta-analyses that quantitatively compared primary research studies of drugs or medical devices sponsored by industry with studies with other sources of sponsorship. We had no language restrictions. DATA COLLECTION AND ANALYSIS Two assessors identified potentially relevant papers, and a decision about final inclusion was made by all authors. Two assessors extracted data, and we contacted authors of included papers for additional unpublished data. Outcomes included favorable results, favorable conclusions, effect size, risk of bias and whether the conclusions agreed with the study results. Two assessors assessed risk of bias of included papers. We calculated pooled risk ratios (RR) for dichotomous data (with 95% confidence intervals). MAIN RESULTS Forty-eight papers were included. Industry sponsored studies more often had favorable efficacy results, risk ratio (RR): 1.24 (95% confidence interval (CI): 1.14 to 1.35), harms results RR: 1.87 (95% CI: 1.54 to 2.27) and conclusions RR: 1.31 (95% CI: 1.20 to 1.44) compared with non-industry sponsored studies. Ten papers reported on sponsorship and effect size, but could not be pooled due to differences in their reporting of data. The results were heterogeneous; five papers found larger effect sizes in industry sponsored studies compared with non-industry sponsored studies and five papers did not find a difference in effect size. Only two papers (including 120 device studies) reported separate data for devices and we did not find a difference between drug and device studies on the association between sponsorship and conclusions (test for interaction, P = 0.23). Comparing industry and non-industry sponsored studies, we did not find a difference in risk of bias from sequence generation, allocation concealment and follow-up. However, industry sponsored studies more often had low risk of bias from blinding, RR: 1.32 (95% CI: 1.05 to 1.65), compared with non-industry sponsored studies. In industry sponsored studies, there was less agreement between the results and the conclusions than in non-industry sponsored studies, RR: 0.84 (95% CI: 0.70 to 1.01). AUTHORS' CONCLUSIONS Sponsorship of drug and device studies by the manufacturing company leads to more favorable results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments.
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Affiliation(s)
- Andreas Lundh
- The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark.
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Khan NA, Lombeida JI, Singh M, Spencer HJ, Torralba KD. Association of industry funding with the outcome and quality of randomized controlled trials of drug therapy for rheumatoid arthritis. ACTA ACUST UNITED AC 2012; 64:2059-67. [PMID: 22275179 DOI: 10.1002/art.34393] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the association of industry funding with the characteristics, outcome, and reported quality of randomized controlled trials (RCTs) of drug therapy for rheumatoid arthritis (RA). METHODS The Medline and Cochrane Central Register of Controlled Trials databases were searched to identify original RA drug therapy RCTs published in 2002-2003 and 2006-2007. Two reviewers independently assessed each RCT for the funding source, characteristics, outcome (positive [statistically significant result favoring experimental drug for the primary outcome] or not positive), and reporting of methodologic measures whose inadequate performance may have biased the assessment of treatment effect. RCTs that were registered at ClinicalTrials.gov and completed during the study years were assessed for publication bias. RESULTS Of the 103 eligible RCTs identified, 58 (56.3%) were funded by industry, 19 (18.4%) were funded by nonprofit sources, 6 (5.8%) had mixed funding, and funding for 20 (19.4%) was not specified. Industry-funded RCTs had significantly more study centers and subjects, while nonprofit agency-funded RCTs had longer duration and were more likely to study different treatment strategies. Outcome could be assessed for 86 (83.5%) of the 103 RCTs studied. The funding source was not associated with a higher likelihood of positive outcomes favoring the sponsored experimental drug (75.5% of industry-funded RCTs had a positive outcome, compared with 68.8% of non-industry-funded RCTs, 40% of RCTs with mixed funding, and 81.2% of RCTs for which funding was not specified). Industry-funded RCTs showed a trend toward a higher likelihood of nonpublication (P=0.093). Industry-funded RCTs were more frequently associated with double-blinding, an adequate description of participant flow, and performance of an intent-to-treat analysis. CONCLUSION Industry funding was not associated with a higher likelihood of positive outcomes of published RCTs of drug therapy for RA, and industry-funded RCTs performed significantly better than non-industry-funded RCTs in terms of reporting the use of some key methodologic quality measures.
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Affiliation(s)
- Nasim A Khan
- University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA.
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Signori A, Baccino A, Sormani MP. The quality of reports of randomized trials in multiple sclerosis: a review. Mult Scler 2012; 18:776-81. [DOI: 10.1177/1352458512444327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Randomized clinical trials (RCT) in multiple sclerosis (MS) have a recent tradition, but their number has been exponentially increasing since the first study detecting the efficacy of a disease modifying drug in MS. To examine the methodological details of reports of RCT in MS, we extracted from five leading journals all the reports of RCT published between 1993 and 2010. Trial reports were compared for different periods (1993–2001, 2002–2006, 2007–2010) for a set of indicator variables reflecting methodological quality (including details about randomization and blinding, statistical methods, results reporting, subgroup analyses). Fifty-three reports were included in the analysis. All of the methodological items indicated an improvement over time in the quality of reporting, the main weaknesses being frequent and inappropriate use of significance testing for assessing baseline imbalances and the statistical approach to subgroup analysis. A complete and transparent reporting of trial methodology is becoming even more important in an era when new design strategies are required for the feasibility of future trials in MS.
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Affiliation(s)
| | - Alice Baccino
- Department of Health Sciences, University of Genoa, Italy
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Thirugnanam S, Pinto R, Cook DJ, Geerts WH, Fowler RA. Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R43. [PMID: 25927574 PMCID: PMC3964799 DOI: 10.1186/cc11241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/11/2011] [Accepted: 03/09/2012] [Indexed: 11/14/2022]
Abstract
Introduction Despite evidence-based guidelines for venous thromboembolism prevention, substantial variability is found in practice. Many economic evaluations of new drugs for thromboembolism prevention do not occur prospectively with efficacy studies and are sponsored by the manufacturers, raising the possibility of bias. We performed a systematic review of economic analyses of venous thromboembolism prevention in hospitalized patients to inform clinicians and policy makers about cost-effectiveness and the potential influence of sponsorship. Methods We searched MEDLINE, EMBASE, Cochrane Databases, ACP Journal Club, and Database of Abstracts of Reviews of Effects, from 1946 to September 2011. We extracted data on study characteristics, quality, costs, and efficacy. Results From 5,180 identified studies, 39 met eligibility and quality criteria. Each addressed pharmacologic prevention: low-molecular-weight heparins versus placebo (five), unfractionated heparin (12), warfarin (eight), one or another agents (five); fondaparinux versus enoxaparin (11); and rivaroxaban and dabigatran versus enoxaparin (two). Low-molecular-weight heparins were most economically attractive among most medical and surgical patients, whereas fondaparinux was favored for orthopedic patients. Fondaparinux was associated with increased bleeding events. Newer agents rivaroxaban and dabigatran may offer additional value. Of all economic evaluations, 64% were supported by manufacturers of a "new" agent. The new agent had a favorable outcome in 38 (97.4%) of 39 evaluations [95% confidence interval [CI] (86.5 to 99.9)]. Among studies supported by a pharmaceutical company, the sponsored medication was economically attractive in 24 (96.0%) of 25 [95% CI, 80.0 to 99.9)]. We could not detect a consistent bias in outcome based on sponsorship; however, only a minority of studies were unsponsored. Conclusion Low-molecular-weight heparins and fondaparinux are the most economically attractive drugs for venous thromboembolism prevention in hospitalized patients. Approximately two thirds of evaluations were supported by the manufacturer of the new agent; such drugs were likely to be reported as economically favorable.
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Affiliation(s)
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Deborah J Cook
- Department of Medicine, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada.
| | - William H Geerts
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Robert A Fowler
- Department of Medicine, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada. .,Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Wright NMJ, Sheard L, Adams CE, Rushforth BJ, Harrison W, Bound N, Hart R, Tompkins CNE. Comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): a randomised controlled trial. Br J Gen Pract 2011; 61:e772-80. [PMID: 22137413 PMCID: PMC3223774 DOI: 10.3399/bjgp11x613106] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 08/19/2011] [Accepted: 09/15/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Many opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification. AIM To evaluate whether buprenorphine or methadone help to achieve drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification. DESIGN Open-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England. METHOD Prisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded. RESULTS Abstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point. CONCLUSION There is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence from opiates at 8 days post detoxification within prison.
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Chung KC, Kotsis SV, Berger RA, Van Ummersen G. The relationship between industry and surgery. J Hand Surg Am 2011; 36:1352-9. [PMID: 21664768 DOI: 10.1016/j.jhsa.2011.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/20/2011] [Accepted: 05/01/2011] [Indexed: 02/02/2023]
Abstract
This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and disadvantages of collaborating with industry and provide practical guides for interactions with industry in terms of clinical research, continuing medical education, and clinical practice. With careful consideration to protect all parties involved, collaboration with industry can be advantageous to surgeons, industry, and patients.
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Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-0340, USA.
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Polychronopoulou A, Pandis N, Eliades T. Assessment of publication bias in dental specialty journals. J Evid Based Dent Pract 2010; 10:207-11. [PMID: 21093801 DOI: 10.1016/j.jebdp.2010.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/09/2010] [Accepted: 09/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the presence of publication bias (acceptance of articles indicating statistically significant results). METHODS The journals possessing the highest impact factor (2008 data) in each dental specialty were included in the study. The content of the 6 most recent issues of each journal was hand searched and research articles were classified into 4 type categories: cross-sectional, case-control, cohort, and interventional (nonrandomized clinical trials and randomized controlled trials). In total, 396 articles were included in the analysis. Descriptive statistics and univariate and multivariate logistic regression was used to examine the association between article-reported statistical significance (dependent variable) and journal impact factor and article study type subject area (independent variables). RESULTS A statistically significant acceptance rate of positive result was found, ranging from 75% to 90%, whereas the value of impact factor was not related to publication bias among leading dental journals. Compared with other research designs, clinical intervention studies (randomized or nonrandomized) presented the highest percentage of nonsignificant findings (20%); RCTs represented 6% of the examined investigations. CONCLUSIONS Compared with the Journal of Clinical Periodontology, all other subspecialty journals, except the Journal of Oral and Maxillofacial Surgery, showed significantly decreased odds of publishing an RCT, which ranged from 60% to 93% (P < .05).
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Jones R, Younie S, Macallister A, Thornton J. A comparison of the scientific quality of publicly and privately funded randomized controlled drug trials. J Eval Clin Pract 2010; 16:1322-5. [PMID: 20738476 DOI: 10.1111/j.1365-2753.2009.01335.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is disagreement but few objective data on the relative quality of publicly or privately funded research. Cochrane reviews of randomized trials provide a good comparison opportunity because there is widespread agreement on how trial quality should be assessed and the Cochrane reviewers routinely do this. AIMS To compare the quality of publicly or privately funded randomized controlled trials. METHODS A total of 105 trials included in two Cochrane reviews were studied. Their quality assessments were abstracted from the relevant review and information about their funding source was collected from the original trial publications. MAIN RESULTS Funding information was obtained for 87 trials. Of these, trials funded by pharmaceutical companies were larger (median sample size 126 vs. 45, P<0.001), more likely to have avoided ascertainment bias 11/14 vs. 15/41 (P=0.05). Non-significant trends in avoiding entry bias 19/19 vs. 35/37 and performance bias 13/22 vs. 14/48 also favoured the commercial trials. Commercial trials also had higher recorded attrition rates (median 6% vs. 1%, P=0.007), but this difference was entirely caused by more non-commercial trials reporting a zero attrition rate. DISCUSSION The apparently lower attrition rate in the non-commercial trials should be interpreted with caution. Zero attrition in clinical trials with follow-up of many months is somewhat implausible. MAIN CONCLUSION Commercially funded randomized trials tend to be of higher methodological quality than government-funded ones.
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Affiliation(s)
- Richard Jones
- Foundation Year 2, Trent Deanery, School of Human Development, Nottingham University, Nottingham, UK
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Allan GM, Korownyk C, LaSalle K, Vandermeer B, Ma V, Klein D, Manca D. Do randomized controlled trials discuss healthcare costs? PLoS One 2010; 5:e12318. [PMID: 20808794 PMCID: PMC2925897 DOI: 10.1371/journal.pone.0012318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 07/28/2010] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare costs, particularly pharmaceutical costs, are a dominant issue for most healthcare organizations, but it is unclear if randomized controlled trials (RCTs) routinely discuss costs. Our objective was to assess the frequency and factors associated with the inclusion of costs in RCTs. Methods and Findings We randomly sampled 188 RCTs spanning three years (2003-2005) from six high impact journals. The sample size for RCTs was based on a calculation to estimate the inclusion of actual drug costs with a precision of +/−3%. Two reviewers independently extracted cost data and study characteristics. Frequencies were calculated and potential characteristics associated with the inclusion of costs were explored. Actual drug costs were included in 4.7% (9/188) of RCTs; any actual costs were included in 7.4% (14/188) of RCTs; and any mention of costs was included in 27.7% (52/188) of RCTs. As the amount of industry funding increased across RCTs, from non-profit to mixed to fully industry funded RCTs, there was a statistically significant reduction in the number of RCTs with any actual costs (Cochran-Armitage test, p = 0.005) and any mention of costs (Cochran-Armitage test, p = 0.02). Logistic regression analysis also indicated funding was associated with the inclusion of any actual cost (OR = 0.34, p = 0.009) or any mention of costs (OR = 0.63, p = 0.02). Journal, study conclusions, study location, primary author's country and product age were not associated with inclusion of cost information. Conclusion While physicians are encouraged to consider costs when prescribing drugs for their patients, actual drug costs were provided in only 5% of RCTs and were not mentioned at all in 72% of RCTs. Industry funded trials were less likely to include cost information. No other factors were associated with the inclusion of cost information.
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Affiliation(s)
- G Michael Allan
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
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