Global mapping of randomised trials related articles published in high-impact-factor medical journals: a cross-sectional analysis

Scientific production in sexual and reproductive health and rights research according to gender and affiliation: An analysis of publications from 1972 to 2021

INTRODUCTION

Peer-reviewed literature is commonly used to assess academic progress and research excellency. However, representation in authorship of global health publications is biased and unfair. In order to shed light on current gaps towards attaining gender equality in scientific production and shift power asymmetries in global health research, we conducted an assessment of authorship trends from 1972 to 2021 with a focus on gender and geographic representation in scientific articles authored or co-authored by researchers affiliated with UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).

METHODS

We searched PubMed, Web of Science, and HRP public reports for publications where at least one author was affiliated with HRP. Our main outcome measures were author gender and location of author affiliation, classified by region and country income group. We used descriptive statistics to characterize the publications under analysis as well as the total number of authors from the included papers. We applied a logistic regression model to explore associations between author gender and other characteristics of published articles and a time series analysis to assess how time can influence the inclusion of women as authors in a publication. Python and R were used for all analyses.

RESULTS

A total of 1,484 publications with 14,424 listed authors representing 5,950 unique authors were included in our analysis: 42.5% were female, 35.1% male, and 22.4% unknown (p<0.0001). First authorship was more likely female (56.9%) and from a high-income country (74.6%, p<0.0001) while last authorship was mostly male (53.7%) also from a high-income country (82.5%, p<0.0001). Females more frequently published papers using qualitative data (61.4%) and reviews/estimates (59.4%) while men published more case control (70.7%) and randomised controlled studies (53.0%), p<0.0001. The adjusted odds of there being a female author increased 4% for every additional year that passed.

CONCLUSION

While there are more females authoring articles as compared to the past, they are still lagging behind with regards to seniority and prestige. Likewise, female representation is closely tied to what institution they are affiliated with and where that institution is located. Global health research institutions need to actively promote change by ensuring women are included in research and research outputs, giving them opportunities to lead.

Adaptive clinical trials in surgery: A scoping review of methodological and reporting quality

IMPORTANCE

Adaptive surgical trials are scarce, but adopting these methods may help elevate the quality of surgical research when large-scale RCTs are impractical.

OBJECTIVE

Randomized-controlled trials (RCTs) are the gold standard for evidence-based healthcare. Despite an increase in the number of RCTs, the number of surgical trials remains unchanged. Adaptive clinical trials can streamline trial design and time to trial reporting. The advantages identified for ACTs may help to improve the quality of future surgical trials. We present a scoping review of the methodological and reporting quality of adaptive surgical trials.

EVIDENCE REVIEW

We performed a search of Ovid, Web of Science, and Cochrane Collaboration for all adaptive surgical RCTs performed from database inception to October 12, 2023. We included any published trials that had at least one surgical arm. All review and abstraction were performed in duplicate. Risk of bias (RoB) was assessed using the RoB 2.0 instrument and reporting quality was evaluated using CONSORT ACE 2020. All results were analyzed using descriptive methods.

FINDINGS

Of the 1338 studies identified, six trials met inclusion criteria. Trials were performed in cardiothoracic, oral, orthopedic, and urological surgery. The most common type of adaptive trial was group sequential design with pre-specified interim analyses planned for efficacy, futility, and/or sample size re-estimation. Two trials did use statistical simulations. Our risk of bias evaluation identified a high risk of bias in 50% of included trials. Reporting quality was heterogeneous regarding trial design and outcome assessment and details in relation to randomization and blinding concealment.

CONCLUSION AND RELEVANCE

Surgical trialists should consider implementing adaptive components to help improve patient recruitment and reduce trial duration. Reporting of future adaptive trials must adhere to existing CONSORT ACE 2020 guidelines. Future research is needed to optimize standardization of adaptive methods across medicine and surgery.

Does diversity beget diversity? A scientometric analysis of over 150,000 studies and 49,000 authors published in high-impact medical journals between 2007 and 2022

Background

Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMIC) have been largely underrepresented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), The Lancet, and Nature Medicine.

Methods

Author metadata from all articles published in the selected journals between 2007 and 2022 were collected using the DimensionsAI platform. The Genderize.io API was then utilized to infer each author's likely gender based on their extracted first name. The World Bank country classification was used to map countries associated with researcher affiliations to the LMIC or the high-income country (HIC) category. We characterized the overall gender and country income category representation across the medical journals. In addition, we computed article-level diversity metrics and contrasted their distributions across the journals.

Findings

We studied 151,536 authors across 49,764 articles published in five top medical journals, over a long period spanning 15 years. On average, approximately one-third (33.1%) of the authors of a given paper were inferred to be women; this result was consistent across the journals we studied. Further, 86.6% of the teams were exclusively composed of HIC authors; in contrast, only 3.9% were exclusively composed of LMIC authors. The probability of serving as the first or last author was significantly higher if the author was inferred to be a man (18.1% vs 16.8%, P < .01) or was affiliated with an institution in a HIC (16.9% vs 15.5%, P < .01). Our primary finding reveals that having a diverse team promotes further diversity, within the same dimension (i.e., gender or geography) and across dimensions. Notably, papers with at least one woman among the authors were more likely to also involve at least two LMIC authors (11.7% versus 10.4% in baseline, P < .001; based on inferred gender); conversely, papers with at least one LMIC author were more likely to also involve at least two women (49.4% versus 37.6%, P < .001; based on inferred gender).

Conclusion

We provide a scientometric framework to assess authorship diversity. Our research suggests that the inclusiveness of high-impact medical journals is limited in terms of both gender and geography. We advocate for medical journals to adopt policies and practices that promote greater diversity and collaborative research. In addition, our findings offer a first step towards understanding the composition of teams conducting medical research globally and an opportunity for individual authors to reflect on their own collaborative research practices and possibilities to cultivate more diverse partnerships in their work.

Impact of medical technologies may be predicted using constructed graph bibliometrics

Scientific research is driven by allocation of funding to different research projects based in part on the predicted scientific impact of the work. Data-driven algorithms can inform decision-making of scarce funding resources by identifying likely high-impact studies using bibliometrics. Compared to standardized citation-based metrics alone, we utilize a machine learning pipeline that analyzes high-dimensional relationships among a range of bibliometric features to improve the accuracy of predicting high-impact research. Random forest classification models were trained using 28 bibliometric features calculated from a dataset of 1,485,958 publications in medicine to retrospectively predict whether a publication would become high-impact. For each random forest model, the balanced accuracy score was above 0.95 and the area under the receiver operating characteristic curve was above 0.99. The high performance of high impact research prediction using our proposed models show that machine learning technologies are promising algorithms that can support funding decision-making for medical research.

Publication performance and trends in bruxism research: A bibliometric analysis

BACKGROUND

Bruxism is an umbrella term that encompass a multidimensional spectrum of masticatory muscle activities.

OBJECTIVE

The purpose of this study was to do a bibliometric analysis including citation performance in the research topic of bruxism, by using an innovative method including details of article title, author keyword, KeyWords Plus and abstracts.

METHODS

The data were retrieved 2022-12-19 from the Clarivate Analytics Web of Science Core Collection, and the online version of the Science Citation Index Expanded (SCI-EXPANDED) for studies published 1992 to 2021. To evaluate research trends, the distribution of keywords in the article title and author-selected keywords were used.

RESULTS

The search yielded 3233 documents in SCI-EXPANDED, of which 2598 were of the document-type 'articles' published in 676 journals. The analysis of the articles revealed that "bruxism/sleep bruxism," "electromyography," "temporomandibular disorders" and "masticatory muscles" are the most used keywords by the authors. Further, the most frequently cited study was published 9 years ago and handles the present definition of bruxism.

CONCLUSION

The most productive authors and those with the highest performance have some common features; they have several national and international collaborations; and they have published articles about the definition, aetiology/pathophysiology and prevalence of bruxism, all senior researchers in the field of TMD. Hopefully, based on this study, researchers and clinicians will have information to be stimulated to outline future research projects on bruxism-related aspects, and to initiate new international or multinational collaborations.

Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review

BACKGROUND

The status of randomised controlled trials (RCTs) as the 'gold standard' for evaluating efficacy in healthcare interventions is increasingly debated among the research community, due to often insufficient consideration for implementation. Normalisation Process Theory (NPT), which focuses on the work required to embed processes into practice, offers a potentially useful framework for addressing these concerns. While the theory has been deployed in numerous RCTs to date, more work is needed to consolidate understanding of if, and how, NPT may aid implementation planning and processes within RCTs. Therefore, this review seeks to understand how NPT contributes to understanding the dynamics of implementation processes within RCTs. Specifically, this review will identify and characterise NPT operationalisation, benefits and reported challenges and limitations in RCTs.

METHODS

A qualitative systematic review with narrative synthesis of peer-reviewed journal articles from eight databases was conducted. Studies were eligible for inclusion if they reported sufficient detail on the use of NPT within RCTs in a healthcare domain. A pre-specified data extraction template was developed based on the research questions of this review. A narrative synthesis was performed to identify recurrent findings.

RESULTS

Searches identified 48 articles reporting 42 studies eligible for inclusion. Findings suggest that NPT is primarily operationalised prospectively during the data collection stage, with limited sub-construct utilisation overall. NPT is beneficial in understanding implementation processes by aiding the identification and analysis of key factors, such as understanding intervention fidelity in real-world settings. Nearly three-quarters of studies failed to report the challenges and limitations of utilising NPT, though coding difficulties and data falling outside the NPT framework are most common.

CONCLUSIONS

NPT appears to be a consistent and generalisable framework for explaining the dynamics of implementation processes within RCTs. However, operationalisation of the theory to its full extent is necessary to improve its use in practice, as it is currently deployed in varying capacities. Recommendations for future research include investigation of NPT alongside other frameworks, as well as earlier operationalisation and greater use of NPT sub-constructs.

TRIAL REGISTRATION

The protocol for this systematic review was accepted for public registration on PROSPERO (registration number: CRD42022345427) on 26 July 2022.

The paucity of high-level evidence for therapy in pediatric cardiology

Introduction

Clinical practice should be based on the highest quality of evidence available. Therefore, we aimed to classify publications in the field of pediatric cardiology in the year 2021 based on the level of scientific evidence.

Materials and Methods

A PubMed search was performed to identify pediatric cardiology articles published in the calendar year 2021. The abstract or manuscript of each study was reviewed. Each study was categorized as high, medium, or low level of evidence based on the study design. Disease investigated, treatment studied, and country of publication were recorded. Randomized control trials (RCTs) in similar fields of neonatology and adult cardiology were identified for comparison. Descriptive statistics were performed on the level of evidence, type of disease, country of publication, and therapeutic intervention.

Results

In 2021, 731 studies were identified. A decrease in prevalence for the level of evidence as a function of low, medium, and high was found (50.1%, 44.2%, and 5.8%, respectively). A low level of evidence studies was the majority for all types of cardiac disease identified, including acquired heart disease, arrhythmias, congenital heart disease, and heart failure, and for treatment modalities, including circulatory support, defibrillator, percutaneous intervention, medicine, and surgery. In a subgroup analysis, most high-level evidence studies were from the USA (31%), followed by China (26.2%) and India (14.3%). Comparing RCTs, 21 RCTs were identified in pediatric cardiology compared to 178 in neonatology and 413 in adult ischemic heart disease.

Conclusions

There is a great need for the conduct of studies that offer a high level of evidence in the discipline of pediatric cardiology.

ASSESSMENT OF THE FREQUENCY OF REPORTING DENTAL PATIENT-REPORTED OUTCOMES (dPROs) IN A SAMPLE OF RANDOMIZED CONTROLLED TRIALS ON ROOT COVERAGE PROCEDURES

OBJECTIVE

Dental patient-reported outcomes (dPROs) are important for understanding the impact of proposed therapies on patients' oral health. The aims of the present study were to investigate the frequency of the reporting of dPROs in randomized controlled trials (RCTs) of root coverage procedures and to assess associations between the study/article characteristics and the reporting level of the dPROs.

METHODS

The PubMed database was searched for RCTs of root coverage procedures in March 16, 2022 and articles published up to March 2022 were included. Information on the types of outcomes and the characteristics of the studies/articles were extracted and reported as frequencies and percentages. Univariate and multivariate binary logistic regression analyses were performed to investigate the associations between the study/article characteristics and the reporting level of dPROs.

RESULTS

The search initially identified 387 articles, and after applying the eligibility criteria, 135 articles reporting 135 RCTs were included. A combination of dPROs and non-dPROs was reported in 61.5% of the selected trials, while 37.8% of the trials reported only non-dPROs. Pain or discomfort was the most frequently reported dPRO (n = 58, 43% of the RCTs). More recently published RCTs reported more dPROs. The country of the first author (odds ratio [OR]: 4.39; 95% CI: 1.76-10.95; P < .01), protocol registration (OR: 0.36; 95% CI: 0.16-0.83; P = .02), and RCT type (OR: 0.38; 95% CI: 0.17-0.83; P = .02) were significantly associated with the reporting level of the dPROs.

CONCLUSIONS

Researchers in recent years seem to be paying more attention to the importance of dPROs. RCTs in which the first authors were from developed countries, registered trials, and RCTs with a parallel design were more likely to report dPROs than RCTs with first authors from developing countries, unregistered trials, and RCTs with a split-mouth design.

Evaluating the online impact of reporting guidelines for randomised trial reports and protocols: a cross-sectional web-based data analysis of CONSORT and SPIRIT initiatives

Reporting guidelines are tools to help improve the transparency, completeness, and clarity of published articles in health research. Specifically, the CONSORT (Consolidated Standards of Reporting Trials) and SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statements provide evidence-based guidance on what to include in randomised trial articles and protocols to guarantee the efficacy of interventions. These guidelines are subsequently described and discussed in journal articles and used to produce checklists. Determining the online impact (i.e., number and type of links received) of these articles can provide insights into the dissemination of reporting guidelines in broader environments (web-at-large) than simply that of the scientific publications that cite them. To address the technical limitations of link analysis, here the Debug-Validate-Access-Find (DVAF) method is designed and implemented to measure different facets of the guidelines' online impact. A total of 65 articles related to 38 reporting guidelines are taken as a baseline, providing 240,128 URL citations, which are then refined, analysed, and categorised using the DVAF method. A total of 15,582 links to journal articles related to the CONSORT and SPIRIT initiatives were identified. CONSORT 2010 and SPIRIT 2013 were the reporting guidelines that received most links (URL citations) from other online objects (5328 and 2190, respectively). Overall, the online impact obtained is scattered (URL citations are received by different article URL IDs, mainly from link-based DOIs), narrow (limited number of linking domain names, half of articles are linked from fewer than 29 domain names), concentrated (links come from just a few academic publishers, around 60% from publishers), non-reputed (84% of links come from dubious websites and fake domain names) and highly decayed (89% of linking domain names were not accessible at the time of the analysis). In light of these results, it is concluded that the online impact of these guidelines could be improved, and a set of recommendations are proposed to this end.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11192-022-04542-z.

Randomised controlled trials in women's health in the last two decades: A meta-review

OBJECTIVES

Obstetric and gynaecological conditions represent a significant burden of disease, requiring clinical research. We aimed to study trends in the publication of randomised controlled trials (RCTs) in women's health over the last two decades. The primary objective was to describe longitudinal trends in the geographical distribution of RCTs in obstetrics and gynaecology. We also described trends in trial funding, publication sources and separately published trial protocols.

STUDY DESIGN

RCTs were identified by searching the Web of Science alone, due to the large number of results and descriptive nature of analyses. Using the filter tool, only studies labelled as "Clinical trial" or "Article" were included; all other document types were excluded. Trial protocols were identified and analysed separately. Indexing data were extracted using the Web of Science selection tools. As we aimed simply to describe research trends using a single platform, we did not check for duplicates. No process for data pooling was necessary. Correlation of GDP, funding and number of RCTs was calculated using Pearson's r test.

RESULTS

We identified 39,071 RCTs. The number of annual publications globally increased from 1,406 in 2001 to 1,979 in 2020. The US (n = 12,479) and the UK (n = 3,745) were responsible for the most RCTs, followed by Italy (n = 2,676) and China (n = 2,338). The largest percentage increase in annual publications was seen in Iran (n = 5 to n = 113, +2,160 %) and the Western Pacific Region (n = 16 to n = 171, +968.8 %). GDP was significantly correlated with the number of published RCTs in 2019 for the 25 most prolific countries (p < 0.001), but not with the proportion of RCTs funded.

CONCLUSIONS

Despite growing contributions from the Western Pacific and Eastern Mediterranean regions, most RCTs are still produced in a small nucleus of high-income countries. Increased international collaboration may benefit both high- and low-income countries.

Adherence in leading medical journals to the CONSORT 2010 statement for reporting of binary outcomes in randomised controlled trials: cross-sectional analysis

Clinicians and lay people tend to overestimate the effectiveness of a treatment when only the relative effect is presented, particularly if the relative effect is large, but the absolute effect is small. In recognition of this problem, item 17b of The Consolidated Standards of Reporting Trials (CONSORT) 2010 statement stipulates authors present both absolute and relative effects for binary outcomes in randomised controlled trials (RCTs). Adherence to item 17b and the effect of differing levels of CONSORT endorsement by journals on adherence is not well known. We assessed the extent to which item 17b is adhered to in 258 RCTs published in five leading medical journals (Annals of Internal Medicine, BMJ, JAMA, The Lancet and The New England Journal of Medicine) between January and December 2019 that all endorsed the CONSORT statement to varying degrees. Only 53 of 258 (20.5%; 95% CI 15.8% to 26.0%) included studies adhered fully to item 17b. Proportional adherence was higher in journals that endorsed the statement more strictly (BMJ and JAMA, 47.4% [34.0% to 61.0%]) compared with journals less strict in their endorsement (NEJM and Ann Intern Med, 12.2% [7.0% to 19.3%]; The Lancet, 14.1% [7.3% to 23.8%]). Journals that only recommend author adherence to CONSORT had a greater proportion of studies reporting only relative effects in the main results section (62.6%) and abstract (64.2%) compared with journals that require authors to submit a completed checklist (24.6% and 29.8%, respectively). The majority of RCTs (79.5%) with binary primary outcomes published in five leading medical journals during 2019 do not report both absolute and relative effect estimates as per item 17b of the CONSORT guideline despite its universal endorsement. Differences in adherence were observed between journals that endorsed the CONSORT statement to differing extents.

Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review

Background

There is increasing recognition of the importance of undertaking process evaluations alongside implementation of health interventions by examining mechanisms of impact and contextual factors. However, a comprehensive synthesis of process evaluations undertaken alongside clinical trials in hospital settings is lacking. We undertook a scoping review to address this gap.

Methods

This review was guided by the methodological framework for scoping studies. Studies were identified using four databases; Ovid Medline, EBSCO CINAHL, EMBASE and Scopus. Two authors independently screened all titles and available abstracts, with a third author available to adjudicate. Studies were eligible for inclusion if they described a process evaluation undertaken alongside a randomised controlled trial in the hospital setting. Data were abstracted by one author and checked by two others and analysed both descriptively and using inductive content analysis.

Results

Data were extracted from 30 articles reporting on 15 trials, most of which were cluster randomised trials (c-RTs) (n = 12). The most common data collection methods used in process evaluations were interviews, questionnaires or surveys, and records or logs. Data analysis revealed three themes relative to how authors: use process data to interpret, understand and explain trial outcomes; evaluate responses to the intervention; and consider the implementation context.

Conclusions

Findings from this review demonstrate the complex nature of intervention implementation in the hospital setting. Overall, there is need for standardised reporting of process evaluations and more explicit descriptions of how authors use frameworks to guide their evaluation.

Endodontic Microbiology: A Bibliometric Analysis of the Top 50 Classics

Background

Citation analysis has emerged to play a significant role in recognition of the most useful areas of research. Endodontic microbiology has been a topic of interest for endodontists as well as periodontists and oral surgeons. This bibliometric analysis is aimed at identifying and reporting the characteristics of the top 50 cited articles on endodontic microbiology.

Methods

The articles were identified through a search on Web of Science (WoS), property of Clarivate Analytics database published on endodontic microbiology. The citation information of the selected articles was recorded. The Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Dental Traumatology, and Australian Endodontic Journal were searched in the search title. Descriptive and bivariate analyses were performed using a statistical software package SPSS. Statistical analysis was performed using Shapiro-Wilk, Kruskal-Wallis, Post hoc, Mann-Kendall trend, and Spearman-rank tests.

Results

The 50 most cited articles were published from 1965 to 2012 with citation count varying from 1065 to 103 times. The total citation counts of articles recorded were 11,525 (WoS), 12,602 (Elseviers' Scopus), and 28,871 (Google Scholar). The most prolific years in terms of publications were 2001, 2002, and 2003, with five publications each, followed by 2005 with four. The year with most citations was 1998, with 1,330 citations, followed by 1965 and 2001, with 1,065 and 1,015 citations, respectively. A total of 136 authors contributed to the top 50 most cited articles with 27 corresponding institutions from 12 different countries. The most common methodological design was in vitro study, followed by clinic-laboratory study, literature review, systematic review and meta-analysis, and animal study.

Conclusions

The present study provided a detailed list of the top 50 most cited and classic articles on microbiology in endodontics. This will help researchers, students, and clinicians in the field of endodontics as an impressive source of information.

Number and quality of randomized controlled trials in obstetrics published in the top general medical and obstetrics and gynecology journals

BACKGROUND

There has been an increasing number of randomized controlled trials published in obstetrics and maternal-fetal medicine to reduce biases of treatment effect and to provide insights on the cause-effect of the relationship between treatment and outcomes.

OBJECTIVE

This study aimed to identify obstetrical randomized controlled trials published in top weekly general medical journals and monthly obstetrics and gynecology journals, to assess their quality in reporting and identify factors associated with publication in different journals.

STUDY DESIGN

The 4 weekly medical journals with the highest 2019 impact factor (New England Journal of Medicine, The Lancet, The Journal of the American Medical Association, and British Medical Journal), the top 4 monthly obstetrics and gynecology journals with obstetrics-related research (American Journal of Obstetrics & Gynecology, Ultrasound in Obstetrics & Gynecology, Obstetrics & Gynecology, and the British Journal of Obstetrics and Gynaecology), and the American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine were searched for obstetrical randomized controlled trials in the years 2018 to 2020. The primary outcome was the number of obstetrical randomized controlled trials published in the obstetrics and gynecology journals vs the weekly medical journals and the percentage of trials published, overall and per journal. The secondary outcomes included the proportion of positive vs negative trials overall and per journal and the assessment of the study characteristics of published trials, including quality assessment criteria.

RESULTS

Of the 4024 original research articles published in the 9 journals during the 3-year study period, 1221 (30.3%) were randomized controlled trials, with 137 (11.2%) randomized controlled trials being in obstetrics (46 in 2018, 47 in 2019, and 44 studies in 2020). Furthermore, 33 (24.1%) were published in weekly medical journals, and 104 (75.9%) were published in obstetrics and gynecology journals. The percentage of obstetrical randomized controlled trials published ranged from 1.5% to 9.6% per journal. Overall, 34.3% of obstetrical trials were statistically significant or "positive" for the primary outcome. Notably, 24.8% of the trials were retrospectively registered after the enrollment of the first study patient. Trials published in the 4 weekly medical journals enrolled significantly more patients (1801 vs 180; P<.001), received more often funding from the federal government (78.8% vs 35.6%; P<.001), and were more likely to be multicenter (90.9% vs 42.3%; P<.001), non-United States based (69.7% vs 49.0%; P=.03), and double blinded (45.5% vs 18.3%; P=.003) than trials published in the obstetrics and gynecology journals. There was no difference in study type (noninferiority vs superiority) and trial quality characteristics, including pretrial registration, ethics approval statement, informed consent statement, and adherence to the Consolidated Standards of Reporting Trials guidelines statement between studies published in weekly medical journals and studies published in obstetrics and gynecology journals.

CONCLUSION

Approximately 45 trials in obstetrics are being published every year in the highest impact journals, with one-fourth being in the weekly medical journals and the remainder in the obstetrics and gynecology journals. Only about a third of published obstetrical trials are positive. Trials published in weekly medical journals are larger, more likely to be funded by the government, multicenter, international, and double blinded. Quality metrics are similar between weekly medical journals and obstetrics and gynecology journals.

A review of pragmatic trials found a high degree of diversity in design and scope, deficiencies in reporting and trial registry data, and poor indexing

OBJECTIVE

We established a large database of trials to serve as a resource for future methodological and ethical analyses. Here, we use meta-data to describe the broad landscape of pragmatic trials including research areas, identification as pragmatic, quality of trial registry data and enrolment.

STUDY DESIGN AND SETTING

Trials were identified by a validated search filter and included if a primary report of a health-related randomized trial published January 2014-April 2019. Data were collated from MEDLINE, Web of Science, ClinicalTrials.gov, and full text.

RESULTS

4337 eligible trials were identified from 13,065 records, of which 1988 were registered in ClinicalTrials.gov. Research areas were diverse, with the most common being general and internal medicine; public, environmental and occupational health; and health care sciences and services. The term "pragmatic" was seldom used in titles or abstracts. Several domains in ClinicalTrials.gov had questionable data quality. We estimated that one-fifth of trials under-accrued by at least 15%.

CONCLUSION

There is a need to improve reporting of pragmatic trials and quality of trial registry data. Under accrual remains a challenge in pragmatic RCTs despite calls for more streamlined recruitment approaches. The diversity of pragmatic trials should be reflected in future ethical analyses.

Defining Common Features in High Impact and Highly Cited Journal Articles on Pancreatic Tumors: An Analysis of 1044 Studies over the Past Decade

INTRODUCTION

Surgical researchers seek to publish their findings in esteemed surgical journals to advance science and their careers. A detailed investigation of study and manuscript attributes in a specific research area, like pancreatic neoplasia, may yield informative insights for researchers looking to maximize research impact.

OBJECTIVES

We analyzed publications related to pancreatic surgery primarily focused on pancreatic and periampullary tumors in order to identify elements associated with acceptance into high impact journals and a high likelihood of future citations.

METHODS

A comprehensive review of nine surgical journals was performed between 2010-19. Journals were grouped based on impact factor into high (>3), medium (1-3) and low (<1) impact categories. Each publication was annotated to identify study topic, methodology and statistical approach. Findings were compared according to journal impact and number of citations to identify predictors of success across these two domains.

RESULTS

A total of 1,044 out of 21,536 (4.8%) articles published in the index journals were related to pancreatic tumors. The most common focus of study was perioperative outcomes and complications (46.7%). There was significantly more number of authors, participating institutions, countries, and randomized clinical trials in higher impact journals as well as high-cited articles (p<0.05). Though advanced statistical analysis was used more commonly in high-impact journals (p<0.05), it did not translate to higher citations (p>0.05).

CONCLUSION

Pancreatic neoplasia continues to be extensively studied in surgical literature. Specific elements of study methodology and design were identified as potentially key attributes to acceptance in high impact journals and citation success.