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Mathur MB. Assessing robustness to worst case publication bias using a simple subset meta-analysis. BMJ 2024; 384:e076851. [PMID: 38490665 PMCID: PMC10941077 DOI: 10.1136/bmj-2023-076851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Maya B Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA
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Wade SWT, Velan GM, Tedla N, Briggs N, Moscova M. What works in radiology education for medical students: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2024; 24:51. [PMID: 38200489 PMCID: PMC10782640 DOI: 10.1186/s12909-023-04981-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Medical imaging related knowledge and skills are widely used in clinical practice. However, radiology teaching methods and resultant knowledge among medical students and junior doctors is variable. A systematic review and meta-analysis was performed to compare the impact of different components of radiology teaching methods (active versus passive teaching, eLearning versus traditional face-to-face teaching) on radiology knowledge / skills of medical students. METHODS PubMed and Scopus databases were searched for articles published in English over a 15-year period ending in June 2021 quantitatively comparing the effectiveness of undergraduate medical radiology education programs regarding acquisition of knowledge and/or skills. Study quality was appraised by the Medical Education Research Study Quality Instrument (MERSQI) scoring and analyses performed to assess for risk of bias. A random effects meta-analysis was performed to pool weighted effect sizes across studies and I2 statistics quantified heterogeneity. A meta-regression analysis was performed to assess for sources of heterogeneity. RESULTS From 3,052 articles, 40 articles involving 6,242 medical students met inclusion criteria. Median MERSQI score of the included articles was 13 out of 18 possible with moderate degree of heterogeneity (I2 = 93.42%). Thematic analysis suggests trends toward synergisms between radiology and anatomy teaching, active learning producing superior knowledge gains compared with passive learning and eLearning producing equivalent learning gains to face-to-face teaching. No significant differences were detected in the effectiveness of methods of radiology education. However, when considered with the thematic analysis, eLearning is at least equivalent to traditional face-to-face teaching and could be synergistic. CONCLUSIONS Studies of educational interventions are inherently heterogeneous and contextual, typically tailored to specific groups of students. Thus, we could not draw definitive conclusion about effectiveness of the various radiology education interventions based on the currently available data. Better standardisation in the design and implementation of radiology educational interventions and design of radiology education research are needed to understand aspects of educational design and delivery that are optimal for learning. TRIAL REGISTRATION Prospero registration number CRD42022298607.
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Affiliation(s)
- Stuart W T Wade
- Westmead Hospital, Sydney, Australia
- School of Biomedical Sciences, Faculty of Medicine & Health, The University of New South Wales, Sydney, Australia
| | - Gary M Velan
- School of Biomedical Sciences, Faculty of Medicine & Health, The University of New South Wales, Sydney, Australia
- Office of Medical Education, The University of New South Wales, Sydney, Australia
| | - Nicodemus Tedla
- School of Biomedical Sciences, Faculty of Medicine & Health, The University of New South Wales, Sydney, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, The University of New South Wales, Sydney, Australia
| | - Michelle Moscova
- Office of Medical Education, The University of New South Wales, Sydney, Australia.
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Prasad N, Yadav B. Editorial: Be positive about the negative in pharmacology: clinical studies in renal pharmacology 2022. Front Pharmacol 2023; 14:1236750. [PMID: 37397482 PMCID: PMC10313126 DOI: 10.3389/fphar.2023.1236750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
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Ropovik I, Martončik M, Babinčák P, Baník G, Vargová L, Adamkovič M. Risk and protective factors for (internet) gaming disorder: A meta-analysis of pre-COVID studies. Addict Behav 2023; 139:107590. [PMID: 36571943 DOI: 10.1016/j.addbeh.2022.107590] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/28/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
This large-scale meta-analysis aimed to provide the most comprehensive synthesis to date of the available evidence from the pre-COVID period on risk and protective factors for (internet) gaming disorder (as defined in the DSM-5 or ICD-11) across all studied populations. The risk/protective factors included demographic characteristics, psychological, psychopathological, social, and gaming-related factors. In total, we have included 1,586 effects from 253 different studies, summarizing data from 210,557 participants. Apart from estimating these predictive associations and relevant moderating effects, we implemented state-of-the-art adjustments for publication bias, psychometric artifacts, and other forms of bias arising from the publication process. Additionally, we carried out an in-depth assessment of the quality of underlying evidence by examining indications of selective reporting, statistical inconsistencies, the typical power of utilized study designs to detect theoretically relevant effects, and performed various sensitivity analyses. The available evidence suggests the existence of numerous moderately strong and highly heterogeneous risk factors (e.g., male gender, depression, impulsivity, anxiety, stress, gaming time, escape motivation, or excessive use of social networks) but only a few empirically robust protective factors (self-esteem, intelligence, life satisfaction, and education; all having markedly smaller effect sizes). We discuss the theoretical implications of our results for prominent theoretical models of gaming disorder and for the existing and future prevention strategies. The impact of various examined biasing factors on the available evidence seemed to be modest, yet we identified shortcomings in the measurement and reporting practices.
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Affiliation(s)
- Ivan Ropovik
- Institute for Research and Development of Education, Faculty of Education, Charles University, Czechia; Faculty of Education, University of Presov, Slovakia
| | - Marcel Martončik
- Faculty of Arts, University of Presov, Slovakia; Institute of Social Sciences CSPS SAS, Slovakia; Department of Music, Art and Culture Studies, Faculty of Humanities and Social Sciences, University of Jyväskylä, Finland.
| | | | - Gabriel Baník
- Institute for Research and Development of Education, Faculty of Education, Charles University, Czechia; Faculty of Arts, University of Presov, Slovakia
| | | | - Matúš Adamkovič
- Faculty of Arts, University of Presov, Slovakia; Institute of Social Sciences CSPS SAS, Slovakia; Department of Music, Art and Culture Studies, Faculty of Humanities and Social Sciences, University of Jyväskylä, Finland
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Edge D, Watkins ER, Limond J, Mugadza J. The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression - A systematic review and meta-analysis. Behav Res Ther 2023; 164:104292. [PMID: 37003138 DOI: 10.1016/j.brat.2023.104292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. METHOD A systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. RESULTS After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p = .79) and 0.67 (95% CI [0.48, 0.93], p = .02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of -0.27 (95% CI [ -0.37, -0.17], p < .001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of -0.21 (95% CI [-0.31, -0.10], p < .001). CONCLUSIONS Self-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity.
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Affiliation(s)
- Daniel Edge
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom.
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jenny Limond
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jane Mugadza
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
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An artificial neural network (ANN) model for publication bias: a machine learning-based study on PubMed meta-analyses. ASLIB J INFORM MANAG 2023. [DOI: 10.1108/ajim-08-2022-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PurposeNo study has investigated the effects of different parameters on publication bias in meta-analyses using a machine learning approach. Therefore, this study aims to evaluate the impact of various factors on publication bias in meta-analyses.Design/methodology/approachAn electronic questionnaire was created according to some factors extracted from the Cochrane Handbook and AMSTAR-2 tool to identify factors affecting publication bias. Twelve experts were consulted to determine their opinion on the importance of each factor. Each component was evaluated based on its content validity ratio (CVR). In total, 616 meta-analyses comprising 1893 outcomes from PubMed that assessed the presence of publication bias in their reported outcomes were randomly selected to extract their data. The multilayer perceptron (MLP) technique was used in IBM SPSS Modeler 18.0 to construct a prediction model. 70, 15 and 15% of the data were used for the model's training, testing and validation partitions.FindingsThere was a publication bias in 968 (51.14%) outcomes. The established model had an accuracy rate of 86.1%, and all pre-selected nine variables were included in the model. The results showed that the number of databases searched was the most important predictive variable (0.26), followed by the number of searches in the grey literature (0.24), search in Medline (0.17) and advanced search with numerous operators (0.13).Practical implicationsThe results of this study can help clinical researchers minimize publication bias in their studies, leading to improved evidence-based medicine.Originality/valueTo the best of the author’s knowledge, this is the first study to model publication bias using machine learning.
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Grant J, Grant L. Quality and constructed knowledge: Truth, paradigms, and the state of the science. MEDICAL EDUCATION 2023; 57:23-30. [PMID: 35803477 DOI: 10.1111/medu.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT AND TRUTH Education is a social science. Social science knowledge is related to its context of origin. The concept of global 'truth' in education is therefore of limited use when truth is tempered by context. The wider applicability of our knowledge can only be judged if we look at the context in which that knowledge was produced and the assumptions that underpin it. This calls into question the idea that educational research is a quest for global 'truth', although in relation to programme evaluation, truth tied to context is an aim. An analysis is presented of the effects of social construction on research and evaluation processes, on the selection of paradigms, reporting and interpreting findings, and on the ethics of all this. QUALITY AND IMPROVEMENT Quality improvement is based on information selected, constructed and interpreted by those who gather, analyse or use it. The strength, and not the weakness, of our knowledge is that it is socially constructed, contextual and of its time. Increasingly looking for our own truth about educational quality, and not importing the truth of others, is crucial to the state of the science. In terms of quality development, using others' findings must be based on informed local judgement. In social science, those judgements are linked to social context and their associated ideologies. IMPLICATIONS FOR FUTURE WORK The hallmark of social science is not a narrowing of focus and the search for one truth, but is a broadening of concepts, theories, paradigms, reported experience and method, and an intention for each to tell their own truth well. This will lead to a wealth of diverse views and analysed experience. The science of medical education must seek many truths.
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Affiliation(s)
- Janet Grant
- Centre for Medical Education in Context (CenMEDIC), London, UK
| | - Leonard Grant
- Centre for Medical Education in Context (CenMEDIC), London, UK
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Thompson W, Hoang H, Whistance J, Johansson R. Publication bias in simulation model studies: The case of ethanol literature. PLoS One 2023; 18:e0284715. [PMID: 37141299 PMCID: PMC10159346 DOI: 10.1371/journal.pone.0284715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
In this study, we explore the potential for publication bias using market simulation results that estimate the effect of US ethanol expansion on corn prices. We provide a new test of whether the publication process routes market simulation results into one of the following two narratives: food-versus-fuel or greenhouse gas (GHG) emissions. Our research question is whether model results with either high price or large land impact are favored for publication in one body of literature or the other. In other words, a model that generates larger price effects might be more readily published in the food-versus-fuel literature while a model that generates larger land use change and GHG emissions might find a home in the GHG emission literature. We develop a test for publication bias based on matching narrative and normalized price effects from simulated market models. As such, our approach differs from past studies of publication bias that typically focus on statistically estimated parameters. This focus could have broad implications: if in the future more studies assess publication bias of quantitative results that are not statistically estimated parameters, then important inferences about publication bias could be drawn. More specifically, such a body of literature could explore the potential that practices common in either statistical methods or other methods tend to encourage or deter publication bias. Turning back to the present case, our findings in this study do not detect a relationship between food-versus-fuel or GHG narrative orientation and corn price effects. The results are relevant to debates about biofuel impacts and our approach can inform the publication bias literature more generally.
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Affiliation(s)
- Wyatt Thompson
- Division of Applied Social Sciences, University of Missouri-Columbia, Missouri, Columbia, United States of America
| | - Hoa Hoang
- Division of Applied Social Sciences, University of Missouri-Columbia, Missouri, Columbia, United States of America
| | - Jarrett Whistance
- Division of Applied Social Sciences, University of Missouri-Columbia, Missouri, Columbia, United States of America
| | - Robert Johansson
- American Sugar Alliance, Arlington, Virginia, United States of America
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Residual Disease After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 2: Network Meta-analysis Incorporating Expert Elicitation to Adjust for Publication Bias. Am J Ther 2022; 30:e56-e71. [PMID: 36048531 PMCID: PMC9812412 DOI: 10.1097/mjt.0000000000001548] [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] [Indexed: 01/14/2023]
Abstract
BACKGROUND Previous work has identified a strong association between the achievements of macroscopic cytoreduction and improved overall survival (OS) after primary surgical treatment of advanced epithelial ovarian cancer. Despite the use of contemporary methodology, resulting in the most comprehensive currently available evidence to date in this area, opponents remain skeptical. AREAS OF UNCERTAINTY We aimed to conduct sensitivity analyses to adjust for potential publication bias, to confirm or refute existing conclusions and recommendations, leveraging elicitation to incorporate expert opinion. We recommend our approach as an exemplar that should be adopted in other areas of research. DATA SOURCES We conducted random-effects network meta-analyses in frequentist and Bayesian (using Markov Chain Montel Carlo simulation) frameworks comparing OS across residual disease thresholds in women with advanced epithelial ovarian cancer after primary cytoreductive surgery. Elicitation methods among experts in gynecology were used to derive priors for an extension to a previously reported Copas selection model and a novel approach using effect estimates calculated from the elicitation exercise, to attempt to adjust for publication bias and increase confidence in the certainty of the evidence. THERAPEUTIC ADVANCES Analyses using data from 25 studies (n = 20,927 women) all showed the prognostic importance of complete cytoreduction (0 cm) in both frameworks. Experts accepted publication bias was likely, but after adjustment for their opinions, published results overpowered the informative priors incorporated into the Bayesian sensitivity analyses. Effect estimates were attenuated but conclusions were robust in all analyses. CONCLUSIONS There remains a strong association between the achievement of complete cytoreduction and improved OS even after adjustment for publication bias using strong informative priors formed from an expert elicitation exercise. The concepts of the elicitation survey should be strongly considered for utilization in other meta-analyses.
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Maier M, VanderWeele TJ, Mathur MB. Using selection models to assess sensitivity to publication bias: A tutorial and call for more routine use. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1256. [PMID: 36909879 PMCID: PMC9247867 DOI: 10.1002/cl2.1256] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In meta-analyses, it is critical to assess the extent to which publication bias might have compromised the results. Classical methods based on the funnel plot, including Egger's test and Trim-and-Fill, have become the de facto default methods to do so, with a large majority of recent meta-analyses in top medical journals (85%) assessing for publication bias exclusively using these methods. However, these classical funnel plot methods have important limitations when used as the sole means of assessing publication bias: they essentially assume that the publication process favors large point estimates for small studies and does not affect the largest studies, and they can perform poorly when effects are heterogeneous. In light of these limitations, we recommend that meta-analyses routinely apply other publication bias methods in addition to or instead of classical funnel plot methods. To this end, we describe how to use and interpret selection models. These methods make the often more realistic assumption that publication bias favors "statistically significant" results, and the methods also directly accommodate effect heterogeneity. Selection models have been established for decades in the statistics literature and are supported by user-friendly software, yet remain rarely reported in many disciplines. We use a previously published meta-analysis to demonstrate that selection models can yield insights that extend beyond those provided by funnel plot methods, suggesting the importance of establishing more comprehensive reporting practices for publication bias assessment.
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Affiliation(s)
- Maximilian Maier
- Department of Experimental PsychologyUniversity College LondonLondonUK
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Maya B. Mathur
- Quantitative Sciences Unit, Department of PediatricsStanford UniversityStanfordCaliforniaUSA
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