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Lippert T, Schmucker E, Shukla A, Reddy R, Neerumalla P, Blanco G, Velanovich V. Publication Bias in Upper Gastrointestinal Oncology Clinical Trials. J Gastrointest Cancer 2024; 55:950-955. [PMID: 38546788 DOI: 10.1007/s12029-024-01047-1] [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] [Accepted: 03/20/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Evidence-based medicine requires evaluation of the medical literature to guide clinical reasoning and treatment recommendations. The presence of publication bias towards exclusion of non-statistically significant clinical trials may be leading to an incomplete evaluation of the literature and cause potentially incomplete guidance for patients. We aimed to compare publication rates and impact of publications of positive and negative outcome clinical trials. METHODS We queried the US National Library of Medicine Clinical Trials database identifying clinical trials with reported results on the topics of pancreatic, liver, and gastric cancer. A "positive" trial was defined as having a statistically significant difference between the treatment arms, while a "negative" did not. Data collected included termination cause, intervention, funding type, publication rates, and journal characteristics. RESULTS In total, 535 clinical trials were examined, across all pathologies clinical trials with significant findings for the primary outcome were published at a higher rate (99%) compared to those with non-significant findings (77%) (p < 0.01). Significantly, more studies with significant findings reached at least 80% of their estimated enrollment goal versus non-significant studies, 72% and 53% respectively (p < 0.01). Three of four metrics for impact of publication showed no difference between significant and non-significant studies once they reached publication. CONCLUSION These findings suggest that clinical trials of three of the most common upper gastrointestinal malignancies have a publication bias towards studies with significant primary outcome findings. This study has implications to the way evidence-based medicine is practiced as the medical literature appears to be failing to capture important data for consideration of clinical decision making.
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Affiliation(s)
- Trenton Lippert
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Erin Schmucker
- Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Clearwater, FL, USA
| | - Anchal Shukla
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ruha Reddy
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Pooja Neerumalla
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Gabriella Blanco
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Andreasen J, Nørgaard B, Draborg E, Juhl CB, Yost J, Brunnhuber K, Robinson KA, Lund H. Justification of research using systematic reviews continues to be inconsistent in clinical health science-A systematic review and meta-analysis of meta-research studies. PLoS One 2022; 17:e0276955. [PMID: 36315526 PMCID: PMC9621455 DOI: 10.1371/journal.pone.0276955] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Redundancy is an unethical, unscientific, and costly challenge in clinical health research. There is a high risk of redundancy when existing evidence is not used to justify the research question when a new study is initiated. Therefore, the aim of this study was to synthesize meta-research studies evaluating if and how authors of clinical health research studies use systematic reviews when initiating a new study. METHODS Seven electronic bibliographic databases were searched (final search June 2021). Meta-research studies assessing the use of systematic reviews when justifying new clinical health studies were included. Screening and data extraction were performed by two reviewers independently. The primary outcome was defined as the percentage of original studies within the included meta-research studies using systematic reviews of previous studies to justify a new study. Results were synthesized narratively and quantitatively using a random-effects meta-analysis. The protocol has been registered in Open Science Framework (https://osf.io/nw7ch/). RESULTS Twenty-one meta-research studies were included, representing 3,621 original studies or protocols. Nineteen of the 21 studies were included in the meta-analysis. The included studies represented different disciplines and exhibited wide variability both in how the use of previous systematic reviews was assessed, and in how this was reported. The use of systematic reviews to justify new studies varied from 16% to 87%. The mean percentage of original studies using systematic reviews to justify their study was 42% (95% CI: 36% to 48%). CONCLUSION Justification of new studies in clinical health research using systematic reviews is highly variable, and fewer than half of new clinical studies in health science were justified using a systematic review. Research redundancy is a challenge for clinical health researchers, as well as for funders, ethics committees, and journals.
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Affiliation(s)
- Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark and Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
- * E-mail:
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark Odense, Denmark
| | - Eva Draborg
- Department of Public Health, University of Southern Denmark Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark and Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Jennifer Yost
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States of America
| | | | - Karen A. Robinson
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Hans Lund
- Department of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
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Ioannidis JP. High-cited favorable studies for COVID-19 treatments ineffective in large trials. J Clin Epidemiol 2022; 148:1-9. [PMID: 35398190 PMCID: PMC8986133 DOI: 10.1016/j.jclinepi.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 12/15/2022]
Abstract
Objectives Study Design and Setting Results Conclusion
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Leng RI. Diversity in citations to a single study: A citation context network analysis of how evidence from a prospective cohort study was cited. QUANTITATIVE SCIENCE STUDIES 2021. [DOI: 10.1162/qss_a_00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Between its origin in the 1950s and its endorsement by a consensus conference in 1984, the diet–heart hypothesis was the subject of intense controversy. Paul et al. (1963) is a highly cited prospective cohort study that reported findings inconvenient for this hypothesis, reporting no association between diet and heart disease; however, many other findings were also reported. By citation context and network analysis of 343 citing papers, I show how Paul et al. was cited in the 20 years after its publication. Generally, different findings were cited by different communities focusing on different risk factors; these communities were established by either research foci title terms or via cluster membership as established via modularity maximization. The most frequently cited findings were the significant associations between heart disease and serum cholesterol (n = 85), blood pressure (n = 57), and coffee consumption (n = 54). The lack of association between diet and heart disease was cited in just 41 papers. Yet, no single empirical finding was referred to in more than 25% of the citing papers. This raises questions about the value of inferring impact from citation counts alone and raises problems for studies using such counts to measure citation bias.
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Affiliation(s)
- Rhodri Ivor Leng
- The University of Edinburgh, Department of Science, Technology, and Innovation Studies
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5
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Chambers CD, Tzavella L. The past, present and future of Registered Reports. Nat Hum Behav 2021; 6:29-42. [PMID: 34782730 DOI: 10.1038/s41562-021-01193-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/05/2021] [Indexed: 11/09/2022]
Abstract
Registered Reports are a form of empirical publication in which study proposals are peer reviewed and pre-accepted before research is undertaken. By deciding which articles are published based on the question, theory and methods, Registered Reports offer a remedy for a range of reporting and publication biases. Here, we reflect on the history, progress and future prospects of the Registered Reports initiative and offer practical guidance for authors, reviewers and editors. We review early evidence that Registered Reports are working as intended, while at the same time acknowledging that they are not a universal solution for irreproducibility. We also consider how the policies and practices surrounding Registered Reports are changing, or must change in the future, to address limitations and adapt to new challenges. We conclude that Registered Reports are promoting reproducibility, transparency and self-correction across disciplines and may help reshape how society evaluates research and researchers.
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Affiliation(s)
- Christopher D Chambers
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK.
| | - Loukia Tzavella
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
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Hallgrimson Z, Fabiano N, Salameh JP, Treanor LM, Frank RA, Sharifabadi AD, McInnes MDF. Tweeting Bias in Diagnostic Test Accuracy Research: Does Title or Conclusion Positivity Influence Dissemination? Can Assoc Radiol J 2021; 73:49-55. [PMID: 33874758 DOI: 10.1177/08465371211006420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To examine if tweeting bias exists within imaging literature by determining if diagnostic test accuracy (DTA) studies with positive titles or conclusions are tweeted more than non-positive studies. METHODS DTA studies published between October 2011 to April 2016 were included. Positivity of titles and conclusions were assessed independently and in duplicate, with disagreements resolved by consensus. A negative binomial regression analysis controlling for confounding variables was performed to assess the relationship between title or conclusion positivity and tweets an article received in the 100 days post-publication. RESULTS 354 DTA studies were included. Twenty-four (7%) titles and 300 (85%) conclusions were positive (or positive with qualifier); 1 (0.3%) title and 23 (7%) conclusions were negative; and 329 (93%) titles and 26 (7%) conclusions were neutral. Studies with positive, negative, and neutral titles received a mean of 0.38, 0.00, and 0.45 tweets per study; while those with positive, negative, and neutral conclusions received a mean of 0.44, 0.61, and 0.38 tweets per study. Regression coefficients were -0.05 (SE 0.46) for positive relative to non-positive titles, and -0.09 (SE 0.31) for positive relative to non-positive conclusions. The positivity of the title (P = 0.91) or conclusion (P = 0.76) was not significantly associated with the number of tweets an article received. CONCLUSIONS The positivity of the title or conclusion for DTA studies does not influence the amount of tweets it receives suggesting that tweet bias is not present among imaging diagnostic accuracy studies. Study protocol available at https://osf.io/hdk2m/.
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Affiliation(s)
- Zachary Hallgrimson
- Department of Radiology, Faculty of Medicine, 6363University of Ottawa, Ontario, Canada
| | - Nicholas Fabiano
- Department of Radiology, Faculty of Medicine, 6363University of Ottawa, Ontario, Canada
| | - Jean-Paul Salameh
- Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada
| | - Lee M Treanor
- Department of Radiology, Faculty of Medicine, 6363University of Ottawa, Ontario, Canada
| | - Robert A Frank
- Department of Radiology, Faculty of Medicine, 6363University of Ottawa, Ontario, Canada
| | | | - Matthew D F McInnes
- Department of Radiology, Faculty of Medicine, 6363University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, Ontario, Canada
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Affiliation(s)
- Laura Bennet
- The Department of Physiology, University of Auckland, Auckland, New Zealand
| | - David A Eisner
- Unit of Cardiac Physiology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alistair Jan Gunn
- The Department of Physiology, University of Auckland, Auckland, New Zealand
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Evidence for Citation Networks in Studies of Free-Roaming Cats: A Case Study Using Literature on Trap-Neuter-Return (TNR). Animals (Basel) 2020; 10:ani10060993. [PMID: 32517234 PMCID: PMC7341228 DOI: 10.3390/ani10060993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022] Open
Abstract
Simple Summary All aspects of an argument need to be evaluated in evidence-based scientific pursuit to prevent the development of self-reinforcing cohorts of studies through the cross-referencing of selected subsets of studies (citation bias). Controling populations of unowned cats using Trap–Neuter–Return and its variants (hereafter TNR) is an example of how a scientific topic develops and is communicated academically and publicly. We found 145 TNR publications between 2002–2019, with the last two years seeing a rapid increase in studies. Publication clusters occur, focusing on: population control, interactions with wildlife, disease transmission (including implications for pet cats, wildlife and humans), free-roaming cats, and feral and domestic cat management. A quarter of all studies were published in Open Access formats, which have the highest potential social impact because they are free to download, share and read. While it is encouraging that diverse views are expressed, the development of clusters of introspective topics risks reduced dialogue between groups of authors with differing views. Journal editors could encourage exchanges between groups by choosing reviewers from different camps to assess manuscripts and by asking authors to acknowledge alternative views. Abstract Trap–Neuter–Return and its variants (hereafter TNR) aims to control unowned cat populations. Papers on this topic form a useful case study of how how an area of literature grows, papers become influential, and citation networks form, influencing future study as well as public perceptions of the science. We analysed 145 TNR studies published 2002–2019. Common topics, identified by frequently used language, were population control, interactions with wildlife, disease transmission (including implications for pets, wildlife and humans), free-roaming cats, and feral and domestic cat management. One or more papers on each of these topics was judged influential because of high citations overall, high average citations/year, or frequent mentions in social media. Open Access papers were more influential in social media, raising greater public awareness than studies published in journals that were less accessible. While divergent views exist on a range of topics, the network analysis of the TNR literature indicated potential for forming self-reinforcing groups of authors. While it is encouraging that diverse views are expressed, there is a risk of reduced dialogue interactions between groups, potentially constraining dialogue to refine arguments, share information, or plan research. Journal editors could encourage communication by choosing reviewers from different camps to assess manuscripts and by asking authors to acknowledge alternative views.
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Bespalov A, Steckler T, Skolnick P. Be positive about negatives-recommendations for the publication of negative (or null) results. Eur Neuropsychopharmacol 2019; 29:1312-1320. [PMID: 31753777 DOI: 10.1016/j.euroneuro.2019.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 01/29/2023]
Abstract
Both positive and negative (null or neutral) results are essential for the progress of science and its self-correcting nature. However, there is general reluctance to publish negative results, and this may be due a range of factors (e.g., the widely held perception that negative results are more difficult to publish, the preference to publish positive findings that are more likely to generate citations and funding for additional research). It is particularly challenging to disclose negative results that are not consistent with previously published positive data, especially if the initial publication appeared in a high impact journal. Ideally, there should be both incentives and support to reduce the costs associated with investing efforts into preparing publications with negative results. We describe here a set of criteria that can help scientists, reviewers and editors to publish technically sound, scientifically high-impact negative (or null) results originating from rigorously designed and executed studies. Proposed criteria emphasize the importance of collaborative efforts and communication among scientists (also including the authors of original publications with positive results).
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Affiliation(s)
- Anton Bespalov
- Partnership for Assessment and Accreditation of Scientific Practice, Heidelberg, Germany.
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Juergens AL, Barney J, Julakanti M, Allen L, Shaver C. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Proc (Bayl Univ Med Cent) 2019; 32:485-489. [PMID: 31656402 DOI: 10.1080/08998280.2019.1632779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
Abstract
An increased emphasis on stroke care has led to a proliferation of specialized stroke teams despite relatively few trials demonstrating their efficacy. Our academic stroke center incorporated a unique setup allowing for the comparison between stroke teams and emergency physicians. During weekday working hours, a stroke team would respond to the emergency department for stroke activations. During all other times, the emergency physician caring for the patient would make all treatment decisions. We sought to determine whether there was any difference in treatment and outcomes between these two groups. We conducted a retrospective review of all stroke activations from January 2015 to June 2016 and compared the thrombolytic administration rates, modified Rankin Scale (mRS) at discharge, and change in National Institutes of Health Stroke Scale (NIHSS). A total of 415 stroke activations were identified. Of those, 69 of 262 patients (26.3%) seen by emergency physicians and 60 of 153 patients (39.2%) seen by neurologists received thrombolysis (P = 0.006). No significant difference was found in the discharge mRS or change in NIHSS between the two groups. Emergency physicians administered significantly less thrombolytics than did neurologists. No significant difference was observed in outcomes, including mRS and admission-to-discharge change in NIHSS.
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Affiliation(s)
- Andrew L Juergens
- Department of Emergency Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Jacob Barney
- Department of Emergency Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | | | - Leigh Allen
- Department of Neurology, Baylor Scott & White Medical Center-TempleTempleTexas
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Selective Citation Practices in Imaging Research: Are Diagnostic Accuracy Studies With Positive Titles and Conclusions Cited More Often? AJR Am J Roentgenol 2019; 213:397-403. [DOI: 10.2214/ajr.18.20977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Frank RA, Sharifabadi AD, Salameh JP, McGrath TA, Kraaijpoel N, Dang W, Li N, Gauthier ID, Wu MZ, Bossuyt PM, Levine D, McInnes MDF. Citation bias in imaging research: are studies with higher diagnostic accuracy estimates cited more often? Eur Radiol 2018; 29:1657-1664. [DOI: 10.1007/s00330-018-5801-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
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Darsaut TE, Fahed R, Raymond J. Reporting Interim Results Can Show the Feasibility of Practicing Outcome-Based Neurovascular Care Within Randomized Trials: An Opinion. World Neurosurg 2018; 122:e955-e960. [PMID: 30404058 DOI: 10.1016/j.wneu.2018.10.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Randomized trials of commonly performed surgical interventions are notoriously difficult to conduct. The trial methodology may nevertheless be the best way to offer outcome-based neurovascular care in the presence of uncertainty. One obstacle to promoting such trials is the conventional prohibition of publication and dissemination of interim results as the trial progresses. METHODS We review the scientific and statistical reasons against the publication of interim analyses as well as exceptions that can occur when 1 treatment is unexpectedly shown to be harmful or when the results of other trials have convincingly shown the comparative benefits of a new intervention. We also discuss the promotion of difficult surgical trials. RESULTS Reasons to support the conventional ban on publication of interim results include control of statistical errors, prevention of invalid conclusions, and dissemination of false claims of equivalence of rival interventions. In the early phases of a trial, usually 1 treatment cannot be shown superior to the other. We believe, contrary to the received view, that a transparent report of the early progress of certain trials can be justified, even when interim results are inconclusive, to promote the recruitment of participating centers and the practice of a novel way to offer neurovascular care in the presence of uncertainty in the best medical interest of patients. CONCLUSIONS In our opinion, the early publication of inconclusive interim results may increase awareness of the feasibility of surgical care trials.
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Affiliation(s)
- Tim E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - Robert Fahed
- Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada; Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Jean Raymond
- Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada.
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Leng RI. A network analysis of the propagation of evidence regarding the effectiveness of fat-controlled diets in the secondary prevention of coronary heart disease (CHD): Selective citation in reviews. PLoS One 2018; 13:e0197716. [PMID: 29795624 PMCID: PMC5968408 DOI: 10.1371/journal.pone.0197716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine how the first randomised controlled trials (RCTs) evaluating the efficacy of cholesterol-lowering diets in the secondary prevention of coronary heart disease were interpreted in reviews of the literature prior to the National Institutes of Health consensus conference in 1984. DESIGN Claim-specific citation network analysis was used to study the network of citations between reviews and RCTs over a defined period (1969-1984). RCTs were identified and classified according to whether their conclusions supported or opposed the use of dietary fat modification/restriction in the secondary prevention of coronary heart disease. Each review published in this period that cited any of the RCTs was classified as supportive, neutral, or unsupportive to the use of dietary fat modification based on a quotation analysis of its evaluation of the findings of these RCTs. Citation bias and underutilisation were detected by applying a comparative density measure, in-degree centrality, and out-degree in a series of sub-graph analyses. RESULTS In total, 66 unique publications were identified (four RCTs-one supportive, three unsupportive; 62 reviews-28 supportive, 17 neutral, 17 unsupportive). On average, supportive reviews underutilised the available RCTs to a greater degree than other reviews. Amongst the supportive group, citation bias was common-23 (82%) reviews cited only the one RCT that was supportive. CONCLUSION Most reviews that disseminated a supportive evaluation of the results of RCTs in the context of secondary prevention cited only data that supported this position.
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Affiliation(s)
- Rhodri Ivor Leng
- Department of Science, Technology and Innovation Studies, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
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Duyx B, Urlings MJ, Swaen GM, Bouter LM, Zeegers MP. Scientific citations favor positive results: a systematic review and meta-analysis. J Clin Epidemiol 2017; 88:92-101. [DOI: 10.1016/j.jclinepi.2017.06.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/15/2017] [Accepted: 06/03/2017] [Indexed: 10/19/2022]
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Abstract
Cerebellar strokes account for less than 10% of all strokes but lead to significantly poor outcomes. Cerebellar strokes that are initially missed have a mortality rate of 40%, and half of the patients who survive have long-term deficits. The patient's history may provide clues that point to a cerebellar stroke. Signs and symptoms include vertigo, headache, vomiting and ataxia. It is important to note the presence of stroke risk factors, such as a history of strokes or transient ischemic attacks, diabetes mellitus, hypertension, hypercholesterolemia, advanced age, atrial fibrillation, and cigarette smoking. The importance of early and correct diagnosis is imperative to reduce morbidity and mortality.
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Affiliation(s)
- Diane C Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Berry); School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Platt-Mills); Emergency Department, University of North Carolina Health Care, Chapel Hill, North Carolina (Drs Berry and Platt-Mills and Mss Rafferty and Tiu)
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