Systematic synthesis of intersectional best practices: knowledge translation for circumpolar indigenous disability

Numerous theories, models, and frameworks (TMFs) currently exist for knowledge translation (KT), with scholarship that is increasingly inclusive of populations experiencing health inequalities. This study proposes two objectives: 1) exploring a nine-step method for synthesising best practices, acknowledging existing syntheses in the form of tailored-databases and review-style publications; and 2) collating best practices to inform KT that is inclusive to indigenous individuals living with disabilities in circumpolar regions. The resulting synthesis emphasises 10 best practices: explicitly connect the accountability of stakeholders to the wellbeing of the people they serve; recognise entanglement with existing neoliberal systems; assess impacts of KT on indigenous treatment providers; employ personal outreach visits; rectify longstanding delegitimization; avoid assuming the target group to be homogeneous, critically examine inequitable distribution of benefits and risks; consider how emphasis on a KT initiative can distract from historical and systemic inequalities; target inequitable, systemic social and economic forces; consider how KT can also be mobilised to gain power and control; assess what is selected for KT, and how it intersects with power position of external stakeholders and internal champions; and, allow people access-to-knowledge which changes inequitable systems.

Nursing-engineering interdisciplinary research: A synthesis of methodological approach to perform healthcare-technology integrated projects

In the dynamic landscape of contemporary healthcare, the imperative for advancing the frontiers of knowledge and improving patient outcomes necessitates a paradigm shift towards a multidisciplinary approach. This background great enhances a nurse's ability to interface with technology and create technical solutions such as robots, patient care devices, or computer simulation for patient care needs and nursing care delivery. This study aims to describe, through a narrative review of evidence, a methodology to develop and manager Nursing-Engineering interdisciplinary project, clarify the key points and facilitate professionals who are not very familiar with this topic. The methodology employed highlights the importance of this kind of research that allows to achieve highest standards of practice leading to improved patient care, innovative solutions and a global contribution to healthcare excellence.

Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis

A systematic review (SR) is a research method for synthesizing evidence on a specific topic. Among the various types of systematic reviews, there are SRs of guidelines (CPGs) and SRs of SRs. Traditionally, they are limited to just one type of secondary evidence. This paper introduces an innovative SR methodology that combines CPGs and SRs to improve evidence synthesis and overcome the limitations of isolated use. Essential steps that should always precede the actual research process include registering the research protocol, formulating research questions and setting inclusion/exclusion criteria. Using the PRISMA protocol for comprehensive database searches, it's crucial to combine keywords with boolean operators and remove duplicates. The eligibility of studies should be assessed by selecting potentially relevant articles through an initial screening of titles and abstracts, followed by a meticulous analysis of the full-texts. Rigorous evidence evaluation tools, such as AGREE II for CPGs and AMSTAR 2 for SRs, and the double reviewer approach ensure high-quality selections. Additionally, converting summarized results into percentages and applying statistical analyses facilitate interpretation and improve the reliability of rater assessments. A further characteristic of this methodology is its adaptability to the evolution of healthcare research.

The investigation of the efficiency of basic life support education among high school students: Protocol, design and implementation of an interventional, prospective longitudinal, individually randomised, parallel 1:1 grouped trial

Background

Basic life support (BLS) skills are crucial not only for healthcare workers but for all lay people as well. Timely recognition of out-of-hospital cardiac arrest (OHCA) and the initiation of BLS by bystanders before the arrival of healthcare personnel may improve survival. There are several methods of spreading BLS skills and improve BLS skill retention among lay people. One of these methods can be the education of adolescent school children. The introduction of mandatory BLS education in schools was very effective in some European countries to increase the rate of bystander BLS.

Methods/design

The current study aims to investigate the efficacy of a BLS training and BLS curriculum among high school children in Hungary. Moreover, the investigators would like to optimise factors influencing skill retention in this first responder group and aim to compare two types of teaching methods: feedback given by the instructor or software-based feedback on the efficacy of chest compressions during the course. This study will be an interventional, assessor blinded, individually randomised parallel group trial recruiting 360 students. BLS skill retention will be assessed at the end of the course, two months after the training and six months after training.

Discussion

The current study will increase our knowledge on the methods educating BLS among high school children. The results will help us to create an effective BLS curriculum at schools.Trial registration: ClinicalTrials.gov: NCT06016153. Prospectively registered on 08/2023.

Statistical and Machine Learning Analysis in Brain-Imaging Genetics: A Review of Methods

Brain-imaging-genetic analysis is an emerging field of research that aims at aggregating data from neuroimaging modalities, which characterize brain structure or function, and genetic data, which capture the structure and function of the genome, to explain or predict normal (or abnormal) brain performance. Brain-imaging-genetic studies offer great potential for understanding complex brain-related diseases/disorders of genetic etiology. Still, a combined brain-wide genome-wide analysis is difficult to perform as typical datasets fuse multiple modalities, each with high dimensionality, unique correlational landscapes, and often low statistical signal-to-noise ratios. In this review, we outline the progress in brain-imaging-genetic methodologies starting from early massive univariate to current deep learning approaches, highlighting each approach's strengths and weaknesses and elongating it with the field's development. We conclude by discussing selected remaining challenges and prospects for the field.

Diversity, equity, and inclusion (DEI) in medical education: DEI at the bedside

BACKGROUND

The ability to recognize and address bias is an important communication skill not typically addressed during training. We describe the design of an educational curriculum that aims to identify and change behavior related to diversity, equity, and inclusion (DEI). "DEI at the Bedside" uses the existing infrastructure of bedside teaching and provides a tool to normalize DEI discussions and develop skills to address bias during a neurology inpatient rotation.

METHODS

As part of traditional clinical rounds, team members on an inpatient service shared experiences with DEI topics, including bias. The team developed potential responses should they encounter a similar situation in the future. We report the results of our needs assessment and curriculum development to evaluate the feasibility of incorporating a DEI educational curriculum in the neurology inpatient setting.

RESULTS

Forty-two DEI experiences were recorded. Medical students were the most frequent discussants (44%). Direction of bias occurred between healthcare team members (33%), against patients (31%), and patients against healthcare team members (28%). Experiences ranged from microaggressions to explicit comments of racism, sexism, and homophobia.

CONCLUSIONS

Based on needs assessment data, we developed a DEI educational curriculum for the inpatient neurology setting aimed to improve knowledge and skills related to DEI topics as well as to normalize conversation of DEI in the clinical setting. Additional study will demonstrate whether this initiative translates into measurable and sustained improvement in knowledge of how bias and disparity show up in the clinical setting and behavioral intent to discuss and address them.

Neuroma Analysis in Humans: Standardizing Sample Collection and Documentation

INTRODUCTION

The biology of symptomatic neuromas is poorly understood, particularly the factors causing pain in human neuromas. Pain presence varies among and within individuals, with some having painful and nonpainful neuromas. To bridge these knowledge gaps, our group developed a protocol for assessing neuroma pain and collecting tissue for molecular analysis. This manuscript outlines our workflow and challenges and aims to inspire other centers to share their experiences with these tissues.

METHODS

For every included patient and collected nerve or bone tissue specimens, we perform a detailed chart review and a multifaceted analysis of pain and pain perception immediately before surgery. We collect patient-reported outcome measures (PROMs) on pain, function, and mental well-being outcomes at preoperative assessment and at the 6-month follow-up postoperatively. Before surgery, the patient is assessed once again to obtain an immediate preoperative pain status and identify potential differences in pain intensity of different neuromas. Intraoperatively, specimens are obtained and their gross anatomical features are recorded, after which they are stored in paraformaldehyde or frozen for later sample analyses. Postoperatively, patients are contacted to obtain additional postoperative PROMs.

RESULTS

A total of 220 specimens of nerve tissue have been successfully obtained from 83 limbs, comprising 95 specimens of neuromas and 125 specimens of nerves located proximal to the neuromas or from controls.

CONCLUSIONS

Our approach outlines the methods combining specimen collection and examination, including both macroscopic and molecular biological features, with PROMs, encompassing physical and psychological aspects, along with clinical metadata obtained through clinical teams and chart review.

A measure centrality index for systematic empirical comparison of consciousness theories

Consciousness science is marred by disparate constructs and methodologies, making it challenging to systematically compare theories. This foundational crisis casts doubts on the scientific character of the field itself. Addressing it, we propose a framework for systematically comparing consciousness theories by introducing a novel inter-theory classification interface, the Measure Centrality Index (MCI). Recognizing its gradient distribution, the MCI assesses the degree of importance a specific empirical measure has for a given consciousness theory. We apply the MCI to probe how the empirical measures of the Global Neuronal Workspace Theory (GNW), Integrated Information Theory (IIT), and Temporospatial Theory of Consciousness (TTC) would fare within the context of the other two. We demonstrate that direct comparison of IIT, GNW, and TTC is meaningful and valid for some measures like Lempel-Ziv Complexity (LZC), Autocorrelation Window (ACW), and possibly Mutual Information (MI). In contrast, it is problematic for others like the anatomical and physiological neural correlates of consciousness (NCC) due to their MCI-based differential weightings within the structure of the theories. In sum, we introduce and provide proof-of-principle of a novel systematic method for direct inter-theory empirical comparisons, thereby addressing isolated evolution of theories and confirmatory bias issues in the state-of-the-art neuroscience of consciousness.

Comparison of extraction methods in vitro Plasmodium falciparum: A 1H NMR and LC-MS joined approach

Malaria is a parasitic disease that remains a global concern and the subject of many studies. Metabolomics has emerged as an approach to better comprehend complex pathogens and discover possible drug targets, thus giving new insights that can aid in the development of antimalarial therapies. However, there is no standardized method to extract metabolites from in vitro Plasmodium falciparum intraerythrocytic parasites, the stage that causes malaria. Additionally, most methods are developed with either LC-MS or NMR analysis in mind, and have rarely been evaluated with both tools. In this work, three extraction methods frequently found in the literature were reproduced and samples were analyzed through both LC-MS and 1H NMR, and evaluated in order to reveal which is the most repeatable and consistent through an array of different tools, including chemometrics, peak detection and annotation. The most reliable method in this study proved to be a double extraction with methanol and methanol/water (80:20, v/v). Metabolomic studies in the field should move towards standardization of methodologies and the use of both LC-MS and 1H NMR in order to make data more comparable between studies and facilitate the achievement of biologically interpretable information.

Letter to editor : comparison of the surgical outcomes of the posterior approach, video‑assisted thoracic surgery, and combined approach for thoracic dumbbell tumors based on a new classification: a retrospective study of published cases

This critique evaluates a retrospective study comparing surgical outcomes for thoracic dumbbell tumors utilizing different approaches. The study provides comprehensive insights into the management of this complex condition, highlighting the strengths and weaknesses of its methodology and findings. While the study offers valuable information for guiding clinical practice, its retrospective design and inherent limitations warrant careful interpretation of the results. Addressing these limitations through prospective studies with randomized designs and larger patient populations could further enhance our understanding of the optimal surgical approach for thoracic dumbbell tumors.

OpenWMB: An open-source and automated working memory task battery for OpenSesame

Working memory capacity (WMC) has been measured with a plethora of cognitive tasks. Several preeminent automated batteries of working memory (WM) tasks have been developed recently. However, despite all their advantages, most batteries were programmed in paid platforms and/or only included a single WM paradigm. To address these issues, we developed the OpenWMB, an automated battery comprising seven tasks from three distinct paradigms (complex spans, updating tasks, and binding tasks) that tap into several functional aspects of WM (simultaneous storage and processing, updating, and binding). The battery runs on open-source software (OpenSesame) and is freely available online in a ready-to-download format. The OpenWMB possesses flexible features and includes a data processing script (that converts data into a format ready for statistical analysis). The instrument is available in Portuguese and English. However, we only assessed the psychometric properties of the former version. The Portuguese version presented good internal consistency and considerable internal and predictive validity: all tasks loaded into a single factor. Additionally, the WMC estimate was strongly correlated with a fluid intelligence factor. This study also tried to contribute to the ongoing debate regarding the best method to assess WMC. We computed a permutation analysis to compare the amount of variance shared between a fluid intelligence factor and (1) each WM task, (2) homogenous WMC factors (based on multiple tasks from the same paradigm), and (3) heterogeneous WMC factors (derived from triplets of tasks from different paradigms). Our results suggested that heterogeneous factors provided the best estimates of WMC.

Reporting bias in breast reconstruction clinical trials: Which and when clinical trials get published

BACKGROUND

Reporting bias refers to the phenomenon in which the reporting of research findings is influenced by the nature of the results. Without the totality of evidence, clinical practice may be misguided. The objective of this work was to examine the extent of reporting bias in clinical trials of breast reconstruction surgery.

METHODS

We searched and extracted data from all completed breast reconstruction clinical trials published in ClinicalTrials.gov from database inception to August 2020. Investigators sought to identify published full manuscripts of the registered trials. The primary outcome was classified as positive or nonpositive and trials were classified as industry or nonindustry funded. Time to publication in a peer-reviewed journal was computed and compared using time-to-event analysis. Trial characteristics associated with publication were evaluated using logistic regression.

RESULTS

A total of 156 clinical trials were identified, of which, 53 trials were published. The median time to publication was 22 months (IQR, 13-35 months). Industry-funded studies were associated with a longer time to publication (HR = 2.4, p = 0.023) and publication in lower-impact journals (OR = 3.7, p = 0.048). Randomized clinical trials were associated with faster times to publication than nonrandomized studies (aHR = 3.2, p = 0.030). Statistical significance and the effect size were not associated with time to publication.

CONCLUSIONS

We found no evidence that industry-funded trials were more likely to report a positive primary outcome. However, industry-funded trials were associated with a longer time to publication and publication in lower-impact journals.

What methods are used in research of firsthand experiences with online self-harming and suicidal behavior? A scoping review

BACKGROUND

Online self-harming and suicidal behavior is a novel and rapidly increasing phenomenon warranting comprehensive mapping of used research methods.

AIM

To identify and map how knowledge on online self-harming and suicidal behavior is gathered, including how data are collected e.g. questionnaires and interviews.

METHODS

The review follows the Joanna Briggs Institute Manual for Scoping Reviews in tandem with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A keyword search of three electronic databases was conducted on two occasions, yielding 5422 records. Following duplicate removal, the records were screened based on the following inclusion criterions; (1) in English or Nordic language and published between 2011-2022, (2) presenting results for self-harming and/or suicidal behavior on social media and (3) using tools for either interview or questionnaire aiming at assessment of the experience of online self-harming and suicidal behavior from the perspective of the person who engages in the behavior. A total of 64 articles were included.

RESULTS

45 used questionnaires, 17 used interviews, and two studies mixed the two approaches. 17% of the studies had made some effort to ensure validity within the questionnaires and 15.8% gave full access to the interview guide.

CONCLUSION

Research into online self-harming and suicidal behavior is characterized by a lack of validated measurements and methodological transparency. The results emphasize a need for further development, testing, and validation of questionnaires and greater openness and reflexivity in qualitative methodology to enable cross-study comparison and advance knowledge of this complex phenomenon.

Understanding psychosis complexity through a syndemic framework: A systematic review

Psychotic conditions pose significant challenges due to their complex aetiology and impact on individuals and communities. Syndemic theory offers a promising framework to understand the interconnectedness of various health and social problems in the context of psychosis. This systematic review aims to examine existing literature on testing whether psychosis is better understood as a component of a syndemic. We conducted a systematic search of 7 databases, resulting in the inclusion of five original articles. Findings from these studies indicate a syndemic characterized by the coexistence of various health and social conditions, are associated with a greater risk of psychosis, adverse health outcomes, and disparities, especially among ethnic minorities and deprived populations. This review underscores the compelling need for a new paradigm and datasets that can investigate how psychosis emerges in the context of a syndemic, ultimately guiding more effective preventive and care interventions as well as policies to improve the health of marginalised communities living in precarity.

Towards standardisation of surface electromyography measurements in the horse: Bipolar electrode location

The use of surface electromyography in the field of animal locomotion has increased considerably over the past decade. However, no consensus exists on the methodology for data collection in horses. This study aimed to start the development of recommendations for bipolar electrode locations to collect surface electromyographic data from horses during dynamic tasks. Data were collected from 21 superficial muscles of three horses during trot on a treadmill using linear electrode arrays. The data were assessed both quantitatively (signal-to-noise ratio (SNR) and coefficient of variation (CoV)) and qualitatively (presence of crosstalk and activation patterns) to compare and select electrode locations for each muscle. For most muscles and horses, the highest SNR values were detected near or cranial/proximal to the central region of the muscle. Concerning the CoV, there were larger differences between muscles and horses than within muscles. Qualitatively, crosstalk was suspected to be present in the signals of twelve muscles but not in all locations in the arrays. With this study, a first attempt is made to develop recommendations for bipolar electrode locations for muscle activity measurements during dynamic contractions in horses. The results may help to improve the reliability and reproducibility of study results in equine biomechanics.

Universal Risk Factors for Mortality in Bloodstream Infections (UNIFORM): a systematic review and Delphi survey

BACKGROUND

Significant variations in the variables collected in clinical studies focusing on bacteraemia lead to inconsistency in the evaluation of risk factors for mortality.

OBJECTIVE

We aimed to define a minimum set of risk factors that should be assessed and reported in all studies assessing survival in bacteraemia.

STUDY ELIGIBILITY

We conducted a systematic review including observational prospective and retrospective cohort studies that assessed all-cause mortality among patients with bacteraemia. We included only studies computing an adjusted analysis for mortality, with >500 participants.

EXPOSURES

Independently significant risk factors for all-cause, preferably 30-day, mortality.

DATA SOURCES

PubMed was used to identify eligible studies published between 2000 and 2020. A Delphi survey among experts was used to evaluate and prioritize the factors identified by the systematic review.

RISK OF BIAS

SIGN checklist complemented by risk of bias assessment of the adjusted analysis.

DATA SYNTHESIS

Definite universal risk factors were defined as those assessed in >50% of all included studies and significant in >50% of those. Potential universal risk factors were defined as those significant in >50% of studies evaluating the factor and a subgroup analysis was performed for studies of Staphylococcus aureus bacteraemia.

RESULTS

We included in the systematic review 62 studies, comprising more than 300,000 patients, from which a list of 17 risk factors was derived, whose association with all-cause mortality was statistically significant in most studies. The factors address baseline patient variables, the setting of infection acquisition, factors associated with the specific infection, the inflammatory response at onset of sepsis and management parameters where relevant. There were 14 risk factors for S. aureus bacteraemia.

CONCLUSION

We identified a minimum set of universal factors to be collected, reported, and assessed, in all future studies evaluating factors associated with mortality in bacteraemia to improve study quality and harmonization.

Mitochondrial techniques for physiologists

Mitochondria serve several important roles in maintaining cellular homeostasis, including adenosine triphosphate (ATP) synthesis, apoptotic signalling, and regulation of both reactive oxygen species (ROS) and calcium. Therefore, mitochondrial studies may reveal insights into metabolism at higher levels of physiological organization. The apparent complexity of mitochondrial function may be daunting to researchers new to mitochondrial physiology. This review is aimed, therefore, at such researchers to provide a brief, yet approachable overview of common techniques used to assess mitochondrial function. Here we discuss the use of high-resolution respirometry in mitochondrial experiments and common analytical platforms used for this technique. Next, we compare the use of common mitochondrial preparation techniques, including adherent cells, tissue homogenate, permeabilized fibers and isolated mitochondria. Finally, we outline additional techniques that can be used in tandem with high-resolution respirometry to assess additional aspects of mitochondrial metabolism, including ATP synthesis, calcium uptake, membrane potential and reactive oxygen species emission. We also include limitations to each of these techniques and outline recommendations for experimental design and interpretation. With a general understanding of methodologies commonly used to study mitochondrial physiology, experimenters may begin contributing to our understanding of this organelle, and how it affects other physiological phenotypes.

Taxonomy development methods regarding patient safety in health sciences - A systematic review

BACKGROUND

Taxonomies are needed for automated analysis of clinical data in healthcare. Few reviews of the taxonomy development methods used in health sciences are found. This systematic review aimed to describe the scope of the available taxonomies relative to patient safety, the methods used for taxonomy development, and the strengths and limitations of the methods. The purpose of this systematic review is to guide future taxonomy development projects.

METHODS

The CINAHL, PubMed, Scopus, and Web of Science databases were searched for studies from January 2012 to April 25, 2023. Two authors selected the studies using inclusion and exclusion criteria and critical appraisal checklists. The data were analysed inductively, and the results were reported narratively.

RESULTS

The studies (n = 13) across healthcare concerned mainly taxonomies of adverse events and medication safety but little for specialised fields and information technology. Critical appraisal indicated inadequate reporting of the used taxonomy development methods. Ten phases of taxonomy development were identified: (1) defining purpose and (2) the theory base for development, (3) relevant data sources' identification, (4) main terms' identification and definitions, (5) items' coding and pooling, (6) reliability and validity evaluation of coding and/or codes, (7) development of a hierarchical structure, (8) testing the structure, (9) piloting the taxonomy and (10) reporting application and validation of the final taxonomy. Seventeen statistical tests and seven software systems were utilised, but automated data extraction methods were used rarely. Multimethod and multi-stakeholder approach, code- and hierarchy testing and piloting were strengths and time consumption and small samples in testing limitations.

CONCLUSION

New taxonomies are needed on diverse specialities and information technology related to patient safety. Structured method is needed for taxonomy development, reporting and appraisal to strengthen taxonomies' quality. A new guide was proposed for taxonomy development, for which testing is required. Prospero registration number CRD42023411022.

Leveraging multivariate approaches to advance the science of early-life adversity

Since the landmark Adverse Childhood Experiences (ACEs) study, adversity research has expanded to more precisely account for the multifaceted nature of adverse experiences. The complex data structures and interrelated nature of adversity data require robust multivariate statistical methods, and recent methodological and statistical innovations have facilitated advancements in research on childhood adversity. Here, we provide an overview of a subset of multivariate methods that we believe hold particular promise for advancing the field's understanding of early-life adversity, and discuss how these approaches can be practically applied to explore different research questions. This review covers data-driven or unsupervised approaches (including dimensionality reduction and person-centered clustering/subtype identification) as well as supervised/prediction-based approaches (including linear and tree-based models and neural networks). For each, we highlight studies that have effectively applied the method to provide novel insight into early-life adversity. Taken together, we hope this review serves as a resource to adversity researchers looking to expand upon the cumulative approach described in the original ACEs study, thereby advancing the field's understanding of the complexity of adversity and related developmental consequences.

Potential of artificial intelligence in injury prevention research and practice

There is increasing interest and use of artificial Intelligence algorithms and methods in biomedical research and practice, particularly as the technology has made significant advances in the past decade and become more accessible to more disciplines. This editorial briefly reviews this technology and its potential for injury prevention research and practice, proposing ways that it can be used to advance the discipline, as well as the potential pitfalls, concerns and biases that accompany it.

The burden of headache disorders in North India: methodology, and validation of a Hindi version of the HARDSHIP questionnaire, for a community-based survey in Delhi and national capital territory region

BACKGROUND

Knowledge of the prevalence and attributable burden of headache disorders in India is sparse, with only two recent population-based studies from South and East India. These produced conflicting results. A study in North India is needed. We report the methodology of such a study using, and validating, a Hindi translation of the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire developed by Lifting The Burden (LTB). Almost half of the Indian population speak Hindi or one of its dialects.

METHODS

The study adopted LTB's standardized protocol for population-based studies in a cross-sectional survey using multistage random sampling conducted in urban Delhi and a surrounding rural area. Trained interviewers visited households unannounced, randomly selected one adult member from each and applied the Hindi version of HARDSHIP in face-to-face interviews. The most bothersome headache reported by participants was classified algorithmically into headache on ≥ 15 days/month (H15 +), migraine (including definite and probable) or tension-type headache (including definite and probable). These diagnoses were mutually exclusive. All participants diagnosed with H15 + and a 10% subsample of all others were additionally assessed by headache specialists and classified as above. We estimated the sensitivity and specificity of HARDSHIP diagnoses by comparison with the specialists' diagnoses.

RESULTS

From 3,040 eligible households, 2,066 participants were interviewed. The participating proportions were 98.3% in rural areas but 52.9% in urban Delhi. In the validation subsample of 291 participants (149 rural, 142 urban), 61 did not report any headache (seven of those assessed by HARDSHIP, eight by headache specialists and 46 by both) [kappa = 0.83; 95% CI: 0.74-0.91]. In the remaining 230 participants who reported headache in the preceding year, sensitivity, specificity and kappa with (95% CI) were 0.73 (0.65-0.79), 0.80 (0.67-0.90) and 0.43 (0.34-0.58) for migraine; 0.71 (0.56-0.83), 0.80 (0.730.85) and 0.43 (0.37-0.62) for TTH and 0.75 (0.47-0.94), 0.93 (0.89-0.96) and 0.46 (0.34-0.58) for H15 + respectively.

CONCLUSION

This study validates the Hindi version of HARDSHIP, finding its performance similar to those of other versions. It can be used to conduct population surveys in other Hindi-speaking regions of India.

[Significance and application of quality improvement in clinical medicine]

Quality improvement is a methodology which was initially developed and employed in the field of industrial manufacturing. This approach involves implementing a series of interventions aimed at elevating the existing quality standards to a higher level. In daily medical work, there are often spontaneous quality improvements. Medical quality improvements supported by scientific methodology can evaluate medical quality more scientifically and provide objective feedback on the quality of medical work for healthcare professionals. This article provides a concise introduction to quality improvement and shows its application and significance in the field of clinical medicine through examples.

Distributive randomization: a pragmatic fractional factorial design to screen or evaluate multiple simultaneous interventions in a clinical trial

BACKGROUND

In some medical indications, numerous interventions have a weak presumption of efficacy, but a good track record or presumption of safety. This makes it feasible to evaluate them simultaneously. This study evaluates a pragmatic fractional factorial trial design that randomly allocates a pre-specified number of interventions to each participant, and statistically tests main intervention effects. We compare it to factorial trials, parallel-arm trials and multiple head-to-head trials, and derive some good practices for its design and analysis.

METHODS

We simulated various scenarios involving 4 to 20 candidate interventions among which 2 to 8 could be simultaneously allocated. A binary outcome was assumed. One or two interventions were assumed effective, with various interactions (positive, negative, none). Efficient combinatorics algorithms were created. Sample sizes and power were obtained by simulations in which the statistical test was either difference of proportions or multivariate logistic regression Wald test with or without interaction terms for adjustment, with Bonferroni multiplicity-adjusted alpha risk for both. Native R code is provided without need for compiling or packages.

RESULTS

Distributive trials reduce sample sizes 2- to sevenfold compared to parallel arm trials, and increase them 1- to twofold compared to factorial trials, mostly when fewer allocations than for the factorial design are possible. An unexpectedly effective intervention causes small decreases in power (< 10%) if its effect is additive, but large decreases (possibly down to 0) if not, as for factorial designs. These large decreases are prevented by using interaction terms to adjust the analysis, but these additional estimands have a sample size cost and are better pre-specified. The issue can also be managed by adding a true control arm without any intervention.

CONCLUSION

Distributive randomization is a viable design for mass parallel evaluation of interventions in constrained trial populations. It should be introduced first in clinical settings where many undercharacterized interventions are potentially available, such as disease prevention strategies, digital behavioral interventions, dietary supplements for chronic conditions, or emerging diseases. Pre-trial simulations are recommended, for which tools are provided.

Measuring digital intervention user experience with a novel ecological momentary assessment (EMA) method, CORTO

Digital interventions often suffer from low usage, which may reflect insufficient attention to user experience. Moreover, the existing evaluation methods have limited applicability in the remote study of user experience of complex interventions that have expansive content and that are used over an extensive period of time. To alleviate these challenges, we describe here a novel qualitative Ecological Momentary Assessment (EMA) method: the CORTO method (Contextual, One-item, Repeated, Timely, Open-ended). We used it to gather digital intervention user experience data from Finnish adults (n = 184) who lived with interview-confirmed major depressive disorder (MDD) and took part in a randomized controlled trial (RCT) that studied the efficacy of a novel 12-week game-based digital intervention for depression. A second dataset on user experience was gathered with retrospective interviews (n = 22). We inductively coded the CORTO method and retrospective interview data, which led to four user experience categories: (1) contextual use, (2) interaction-elicited emotional experience, (3) usability, and (4) technical issues. Then, we used the created user experience categories and Template Analysis to analyze both datasets together, and reported the results qualitatively. Finally, we compared the two datasets with each other. We found that the data generated with the CORTO method offered more insights into usability and technical categories than the interview data that particularly illustrated the contextual use. The emotional valence of the interview data was more positive compared with the CORTO data. Both the CORTO and interview data detected 55 % of the micro-level categories; 20 % of micro-level categories were only detected by the CORTO data and 25 % only by the interview data. We found that the during-intervention user experience measurement with the CORTO method can provide intervention-specific insights, and thereby further the iterative user-centered intervention development. Overall, these findings highlight the impact of evaluation methods on the categories and qualities of insights acquired in intervention research.

A conceptual framework for cautious escalation of anticancer treatment: How to optimize overall benefit and obviate the need for de-escalation trials

BACKGROUND

The developmental workflow of the currently performed phase 1, 2 and 3 cancer trial stages lacks essential information required for the determination of the optimal efficacy threshold of new anticancer regimens. Due to this there is a serious risk of overdosing and/or treating for an unnecessary long time, leading to excess toxicity and a higher financial burden for society. But often post-approval de-escalation trials for dose-optimization and treatment de-intensification are not performed due to failing resources and time. Therefore, the developmental workflow needs to be restructured toward cautious systemic cancer treatment escalation, in order to guarantee optimal efficacy and sustainability.

METHODS

In this manuscript we discuss opportunities to produce the information needed for cautious escalation, based on models of cancer growth and cancer kill kinetics as well as exploratory biomarkers, for the purpose of designing the optimal phase 3 superiority trial. Subsequently, we compare the sample size needed for a phase 3 superiority trial, followed by a necessary de-escalation trial with the sample size needed for a multi-arm phase 3 trial with intervention arms of differing intensity. All essential items are structured within a Framework for Cautious Escalation (FCE). The discussion uses illustrations from the breast cancer setting, but aims to be applicable for all cancers.

RESULTS

The FCE is a promising model of clinical development in oncology to prevent overtreatment and associated issues, especially with regard to the number of repetitive treatment cycles. It will hopefully increase the relevance and success rate of clinical trials, to deliver improved patient-centric outcomes.

Tips and tools to obtain and assess mosquito viromes

Due to their vectorial capacity, mosquitoes (Diptera: Culicidae) receive special attention from health authorities and entomologists. These cosmopolitan insects are responsible for the transmission of many viral diseases, such as dengue and yellow fever, causing huge impacts on human health and justifying the intensification of research focused on mosquito-borne diseases. In this context, the study of the virome of mosquitoes can contribute to anticipate the emergence and/or the reemergence of infectious diseases. The assessment of mosquito viromes also contributes to the surveillance of a wide variety of viruses found in these insects, allowing the early detection of pathogens with public health importance. However, the study of mosquito viromes can be challenging due to the number and complexities of steps involved in this type of research. Therefore, this article aims to describe, in a straightforward and simplified way, the steps necessary for obtention and assessment of mosquito viromes. In brief, this article explores: the capture and preservation of specimens; sampling strategies; treatment of samples before DNA/RNA extraction; extraction methodologies; enrichment and purification processes; sequencing choices; and bioinformatics analysis.

The SAFE procedure: a practical stopping heuristic for active learning-based screening in systematic reviews and meta-analyses

Active learning has become an increasingly popular method for screening large amounts of data in systematic reviews and meta-analyses. The active learning process continually improves its predictions on the remaining unlabeled records, with the goal of identifying all relevant records as early as possible. However, determining the optimal point at which to stop the active learning process is a challenge. The cost of additional labeling of records by the reviewer must be balanced against the cost of erroneous exclusions. This paper introduces the SAFE procedure, a practical and conservative set of stopping heuristics that offers a clear guideline for determining when to end the active learning process in screening software like ASReview. The eclectic mix of stopping heuristics helps to minimize the risk of missing relevant papers in the screening process. The proposed stopping heuristic balances the costs of continued screening with the risk of missing relevant records, providing a practical solution for reviewers to make informed decisions on when to stop screening. Although active learning can significantly enhance the quality and efficiency of screening, this method may be more applicable to certain types of datasets and problems. Ultimately, the decision to stop the active learning process depends on careful consideration of the trade-off between the costs of additional record labeling against the potential errors of the current model for the specific dataset and context.

Qualitative research in cardiac arrest research: A narrative review

Qualitative research is defined as "the study of the nature of phenomena", including "their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived". It is a methodology which is becoming extremely valuable in resuscitation science, especially in terms of improving our understanding of the true impact of sudden cardiac arrest on survivors, family members, lay responders and health care providers. This narrative review provides a high-level overview of qualitative methods as well as the current state of the qualitative evidence and key knowledge gaps in resuscitation science. It finishes with discussion of the bright future of qualitative research in our field.

Robust and Objective Evaluation of Superficial Punctate Keratopathy in a Murine Dry Eye Model

Purpose

To establish a robust and objective method to evaluate (SPK) superficial punctate keratopathy in a murine dry eye model by developing a reliable photographic system.

Design

Experimental study.

Subjects

A murine dry eye model was generated by exorbital lacrimal gland excision. Sham-operated mice were used as healthy controls. For the sham operation, an incision was made without touching the gland.

Methods

A photographic system was constructed, consisting of an LED lamp and a digital camera fitted with a zoom lens and sharp cut filter. SPK was detected by applying fluorescein solution. To validate the system, SPK was compared between dry eye mice and healthy control mice, and diquafosol (DIQUAS ophthalmic solution 3%; Santen Pharmaceutical Co., Ltd.) or cyclosporine (PAPILOCK Mini ophthalmic solution 0.1%; Santen Pharmaceutical Co., Ltd.) was used to dry eye mice.

Main Outcome Measures

SPK was evaluated using the parameters of fluorescence score and fluorescein-stained area.

Results

The photographs clearly indicated SPK in dry eye mice. A fluorescence score of 0 to 9 could be easily assessed, and the fluorescein-stained area was quantifiable. The fluorescein-stained area correlated with fluorescence score (correlation coefficient: 0.98), with good interobserver reliability (intraclass correlation coefficient: 0.999). The fluorescein-stained area increased significantly in dry eye mice compared with that of healthy controls (P < 0.0001). Both types of therapeutic eye drops decreased the fluorescein-stained area relative to saline-treated mice (P < 0.05 in diquafosol vs. saline; P < 0.01 in cyclosporine vs. saline).

Conclusions

This newly developed system is a robust alternative for quantitative evaluation of SPK in a murine dry eye model.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A methodological review of the high-dimensional propensity score in comparative-effectiveness and safety-of-interventions research finds incomplete reporting relative to algorithm development and robustness

OBJECTIVES

The use of secondary databases has become popular for evaluating the effectiveness and safety of interventions in real-life settings. However, the absence of important confounders in these databases is challenging. To address this issue, the high-dimensional propensity score (hdPS) algorithm was developed in 2009. This algorithm uses proxy variables for mitigating confounding by combining information available across several healthcare dimensions. This study assessed the methodology and reporting of the hdPS in comparative effectiveness and safety research.

STUDY DESIGN AND SETTING

In this methodological review, we searched PubMed and Google Scholar from July 2009 to May 2022 for studies that used the hdPS for evaluating the effectiveness or safety of healthcare interventions. Two reviewers independently extracted study characteristics and assessed how the hdPS was applied and reported. Risk of bias was evaluated with the Rrisk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool.

RESULTS

In total, 136 studies met the inclusion criteria; the median publication year was 2018 (Q1-Q3 2016-2020). The studies included 192 datasets, mostly North American databases (n = 132, 69%). The hdPS was used in primary analysis in 120 studies (88%). Dimensions were defined in 101 studies (74%), with a median of 5 (Q1-Q3 4-6) dimensions included. A median of 500 (Q1-Q3 200-500) empirically identified covariates were selected. Regarding hdPS reporting, only 11 studies (8%) reported all recommended items. Most studies (n = 81, 60%) had a moderate overall risk of bias.

CONCLUSION

There is room for improvement in the reporting of hdPS studies, especially regarding the transparency of methodological choices that underpin the construction of the hdPS.

Randomized controlled trials reporting patient-reported outcomes with no significant differences between study groups are potentially susceptible to unjustified conclusions-a systematic review

OBJECTIVES

Ceiling effect may lead to misleading conclusions when using patient-reported outcome measure (PROM) scores as an outcome. The aim of this study was to investigate the potential source of ceiling effect-related errors in randomized controlled trials (RCTs) reporting no differences in PROM scores between study groups.

STUDY DESIGN AND SETTING

A systematic review of RCTs published in the top 10 orthopedic journals according to their impact factors was conducted, focusing on studies that reported no significant differences in outcomes between two study groups. All studies published during 2012-2022 that reported no differences in PROM outcomes and used parametric statistical approach were included. The aim was to investigate the potential source of ceiling effect-related errors-that is, when the ceiling effect suppresses the possible difference between the groups. The proportions of patients exceeding the PROM scales were simulated using the observed dispersion parameters based on the assumed normal distribution, and the differences in the proportions between the study groups were subsequently analyzed.

RESULTS

After an initial screening of 2343 studies, 190 studies were included. The central 95% theoretical distribution of the scores exceeded the PROM scales in 140 (74%) of these studies. In 33 (17%) studies, the simulated patient proportions exceeding the scales indicated potential differences between the compared groups.

CONCLUSION

It is common to have a mismatch between the chosen PROM instrument and the population being studied increasing the risk of an unjustified "no difference" conclusion due to a ceiling effect. Thus, a considerable ceiling effect should be considered a potential source of error.

A scoping review on the methodological and reporting quality of scoping reviews in China

BACKGROUND

Scoping reviews have emerged as a valuable method for synthesizing emerging evidence, providing a comprehensive contextual overview, and influencing policy and practice developments. The objective of this study is to provide an overview of scoping reviews conducted in Chinese academic institutions over the last decades.

METHOD

We conducted a comprehensive search of nine databases and six grey literature databases for scoping reviews conducted in Chinese academic institutions. The reporting quality of the included reviews was assessed using the Preferred Reporting Items for PRISMA-ScR checklist. We performed both quantitative and qualitative analyses, examining the conduct of the scoping reviews and exploring the breadth of research topics covered. We used Chi-squared and Wilcoxon rank-sum tests to compare methodological issues and reporting quality in English and Chinese-language reviews.

RESULTS

A total of 392 reviews published between 2013 and 2022 were included, 238 English-reported reviews and 154 Chinese-reported reviews, respectively. The primary purposes of these reviews were to map and summarize the evidence, with a particular focus on health and nursing topics. 98.7% of reviews explicitly used the term "scoping review", and the Arksey and O'Malley framework was the most frequently cited framework. Thirty-five English-reported scoping reviews provided a protocol for scoping review. PubMed was the most common source in English-reported reviews and CNKI in Chinese-reported reviews. Reviews published in English were more likely to search the grey literature (P = 0.005), consult information specialists (P < 0.001) and conduct an updated search (P = 0.012) than those in Chinese. Reviews published in English had a significantly high score compared to those published in Chinese (16 vs. 14; P < 0.001). The reporting rates in English-reported reviews were higher than those in Chinese reviews for seven items, but lower for structured summary (P < 0.001), eligibility criteria (P < 0.001), data charting process (P = 0.009) and data items (P = 0.015).

CONCLUSION

There has been a significant increase in the number of scoping reviews conducted in Chinese academic institutions each year since 2020. While the research topics covered are diverse, the overall reporting quality of these reviews is need to be improved. And there is a need for greater standardization in the conduct of scoping reviews in Chinese academic institutions.

Application of the PANELVIEW instrument to evaluate the guideline development process of the German polytrauma guideline

BACKGROUND

PANELVIEW is an instrument for evaluating the appropriateness of the process, methods, and outcome of guideline development and the satisfaction of the guideline group with these steps.

OBJECTIVE

To evaluate the guideline development process of the German guideline on the treatment of patients with severe/multiple injuries ('German polytrauma guideline') from the perspective of the guideline group, and to identify areas where this process may be improved in the future.

METHODS

We administered PANELVIEW to the participants of the 2022 update of the German polytrauma guideline. All guideline group members, including delegates of participating medical societies, steering group members, authors of guideline chapters, the chair, and methodological lead, were invited to participate. Responses were analysed using descriptive statistics. Comments received were categorised by domains/items of the tool.

RESULTS

After the first, second, and last consensus conference, the guideline group was invited via email to participate in a web-based survey. Response rates were 36% (n/N = 13/36), 40% (12/30), and 37% (20/54), respectively. The mean scores for items ranged between 5.1 and 6.9 on a scale from 1 (fully disagree) to 7 (fully agree). Items with mean scores below 6.0 were related to (1) administration, (2) consideration of patients' views, perspectives, values, and preferences, and (3) the discussion of research gaps and needs for future research.

CONCLUSION

The PANELVIEW tool showed that the guideline group was satisfied with most aspects of the guideline development process. Areas for improvement of the process were identified. Strategies to improve response rates should be explored.

Prediction model protocols indicate better adherence to recommended guidelines for study conduct and reporting

BACKGROUND AND OBJECTIVE

Protocols are invaluable documents for any research study, especially for prediction model studies. However, the mere existence of a protocol is insufficient if key details are omitted. We reviewed the reporting content and details of the proposed design and methods reported in published protocols for prediction model research.

METHODS

We searched MEDLINE, Embase, and the Web of Science Core Collection for protocols for studies developing or validating a diagnostic or prognostic model using any modeling approach in any clinical area. We screened protocols published between Jan 1, 2022 and June 30, 2022. We used the abstract, introduction, methods, and discussion sections of The Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis (TRIPOD) statement to inform data extraction.

RESULTS

We identified 30 protocols, of which 28 were describing plans for model development and six for model validation. All protocols were open access, including a preprint. 15 protocols reported prospectively collecting data. 21 protocols planned to use clustered data, of which one-third planned methods to account for it. A planned sample size was reported for 93% development and 67% validation analyses. 16 protocols reported details of study registration, but all protocols reported a statement on ethics approval. Plans for data sharing were reported in 13 protocols.

CONCLUSION

Protocols for prediction model studies are uncommon, and few are made publicly available. Those that are available were reasonably well-reported and often described their methods following current prediction model research recommendations, likely leading to better reporting and methods in the actual study.

Test negative design for vaccine effectiveness estimation in the context of the COVID-19 pandemic: A systematic methodology review

BACKGROUND

During the height of the global COVID-19 pandemic, the test-negative design (TND) was extensively used in many countries to evaluate COVID-19 vaccine effectiveness (VE). Typically, the TND involves the recruitment of care-seeking individuals who meet a common clinical case definition. All participants are then tested for an infection of interest.

OBJECTIVES

To review and describe the variation in TND methodology, and disclosure of potential biases, as applied to the evaluation of COVID-19 VE during the early vaccination phase of the pandemic.

METHODS

We conducted a systematic review by searching four biomedical databases using defined keywords to identify peer-reviewed articles published between January 1, 2020, and January 25, 2022. We included only original articles that employed a TND to estimate VE of COVID-19 vaccines in which cases and controls were evaluated based on SARS-CoV-2 laboratory test results.

RESULTS

We identified 96 studies, 35 of which met the defined criteria. Most studies were from North America (16 studies) and targeted the general population (28 studies). Outcome case definitions were based primarily on COVID-19-like symptoms; however, several papers did not consider or specify symptoms. Cases and controls had the same inclusion criteria in only half of the studies. Most studies relied upon administrative or hospital databases assembled for a different (non-evaluation) clinical purpose. Potential unmeasured confounding (20 studies), misclassification of current SARS-CoV-2 infection (16 studies) and selection bias (10 studies) were disclosed as limitations by some studies.

CONCLUSION

We observed potentially meaningful deviations from the validated design in the application of the TND during the COVID-19 pandemic.

Contextual effects: how to, and how not to, quantify them

The importance of contextual effects and their roles in clinical care controversial. A Cochrane review published in 2010 concluded that placebo interventions lack important clinical effects overall, but that placebo interventions can influence patient-reported outcomes such as pain and nausea. However, systematic reviews published after 2010 estimated greater contextual effects than the Cochrane review, which stems from the inappropriate methods employed to quantify contextual effects. The effects of medical interventions (i.e., the total treatment effect) can be divided into three components: specific, contextual, and non-specific. We propose that the most effective method for quantifying the magnitude of contextual effects is to calculate the difference in outcome measures between a group treated with placebo and a non-treated control group. Here, we show that other methods, such as solely using the placebo control arm or calculation of a 'proportional contextual effect,' are limited and should not be applied. The aim of this study is to provide clear guidance on best practices for estimating contextual effects in clinical research.

Defining usual care comparators when designing pragmatic trials of complex health interventions: a methodology review

BACKGROUND

Pragmatic trials evaluating complex health interventions often compare them to usual care. This comparator should resemble care as provided in everyday practice. However, usual care can differ for the same condition, between patients and practitioners, across clinical sites and over time. Heterogeneity within a usual care arm can raise methodological and ethical issues. To address these it may be necessary to standardise what usual care entails, although doing so may compromise a trial's external validity. Currently, there is no guidance detailing how researchers should decide the content of their usual care comparators. We conducted a methodology review to summarise current thinking about what should inform this decision.

METHODS

MEDLINE, Embase, CINAHL and PsycINFO were searched from inception to January 2022. Articles and book chapters that discussed how to identify or develop usual care comparators were included. Experts in the field were also contacted. Reference lists and forward citation searches of included articles were screened. Data were analysed using a narrative synthesis approach.

RESULTS

One thousand nine hundred thirty records were identified, 1611 titles and abstracts screened, 112 full texts screened, and 16 articles included in the review. Results indicated that the content of a usual care comparator should be informed by the aims of the trial, existing care practices, clinical guidelines, and characteristics of the target population. Its content should also be driven by the trial's requirements to protect participants, inform practice, and be methodologically robust, efficient, feasible and acceptable to stakeholders. When deciding the content of usual care, researchers will need to gather information about these drivers, balance tensions that might occur when responding to different trial objectives, and decide how usual care will be described and monitored in the trial.

DISCUSSION

When deciding the content of a usual care arm, researchers need to understand the context in which a trial will be implemented and what the trial needs to achieve to address its aim and remain ethical. This is a complex decision-making process and trade-offs might need to be made. It also requires research and engagement with stakeholders, and therefore time and funding during the trial's design phase.

TRIAL REGISTRATION

PROSPERO CRD42022307324.

Guiding Principles for Writing About Immigrants and Immigrant Health

This perspective identifies harmful phrasing and frames in current clinician and researcher work relating to immigrant health and provides equity-centered alternatives. Recommendations are organized within two broad categories, one focused on shifting terminology toward more humanizing language and the second focused on changing frames around immigration discourse. With regards to shifting terminology, this includes: 1) avoiding language that conflates immigrants with criminality (i.e., "illegal"); 2) using person-first language (i.e., "person applying for asylum" or "detained person" rather than "asylum-seeker" or "detainee"); 3) avoiding comparisons to "native" populations to mean non-foreign-born populations, as this contributes to the erasure of Native Americans and indigenous people; 4) avoiding hyperbolic and stigmatizing "crisis" language about immigrants; and 5) understanding inherent limitations of terms like "refugee," "asylum seeker," "undocumented" that are legal not clinical terms. With regards to challenging dominant frames, recommendations include: 6) avoiding problematization of certain borders compared to others (i.e., U.S.-Mexico versus U.S.- Canada border) that contributes to selectively subjecting people to heightened surveillance; 7) recognizing the heterogeneity among immigrants, such as varying reasons for migration along a continuum of agency, ranging from voluntary to involuntary; 8) avoiding setting up a refugee vs. migrant dichotomy, such that only the former is worthy of sympathy; and 9) representing mistrust among immigrants as justified, instead shifting focus to clinicians, researchers, and healthcare systems who must build or rebuild trustworthiness. Ensuring inclusive and humanizing language use and frames is one critical dimension of striving for immigrant health equity.

Advances in methodologies of negative controls: a scoping review

OBJECTIVES

Negative controls are considered an important tool to mitigate biases in observational studies. The aim of this scoping review was to summarize current methodologies of negative controls (both negative control exposure [NCE] and negative control outcome [NCO]).

STUDY DESIGN AND SETTING

We searched PubMed, Web of Science, Embase, and Cochrane Library (up to March 9, 2023) for articles on methodologies of negative controls. Two reviewers selected eligible studies and collected relevant data independently and in duplicate. We reported total numbers and percentages, and summarized methodologies narratively.

RESULTS

A total of 37 relevant methodological articles were included in our review. These publications covered NCE (n = 11, 29.8%), NCO (n = 13, 35.1%), or both (n = 13, 35.1%), with most focused on bias detection (n = 14, 37.8%), bias correction (n = 16, 43.3%), and P value or confidence interval (CI) calibration (n = 5, 13.5%). For the two remaining articles (5.4%), one discussed bias detection and P value or CI calibration and the other covered all the three functions. For bias detection, the existence of an association between the NCE (NCO) and outcome (exposure) variables of interest simply indicates that results may suffer from confounding bias, selection bias and/or information bias. For bias correction, however, the algorithms of negative control methods need more stringent assumptions such as rank preservation, monotonicity, and linearity.

CONCLUSION

Negative controls can be leveraged for bias detection, P value or CI calibration, and bias correction, among which bias correction has been the most studied methodologically. The current available methods need some stringent assumptions to detect or remove bias. More methodological research is needed to optimize the use of negative controls.

Exploring Elinor Ostrom's principles for collaborative group working within a user-led project: lessons from a collaboration between researchers and a user-led organisation

BACKGROUND

Some research has been undertaken into the mechanisms that shape successful participatory approaches in the context of efforts to improve health and social care. However, greater attention needs to be directed to how partnerships between researchers and user-led organisations (ULOs) might best be formed, practiced, managed, and assessed. We explored whether political economist Elinor Ostrom's Nobel prize winning analysis of common pool resource management-specifically eight principles to enhance collaborative group working as derived from her empirical research-could be usefully applied within a user-led project aiming to co-design new services to support more inclusive involvement of Disabled people in decision-making processes in policy and practice.

METHODS

Participant observation and participatory methods over a 16-month period comprising observational notes of online user-led meetings (26 h), online study team meetings (20 h), online Joint Interpretive Forum meetings (8 h), and semi-structured one-to-one interviews with project participants (44 h) at two time points (months 6 and 10).

RESULTS

Initially it proved difficult to establish working practices informed by Ostrom's principles for collaborative group working within the user-led project. Several attempts were made to put a structure in place that met the needs of both the research study and the aims of the user-led project, but this was not straightforward. An important shift saw a move away from directly applying the principles to the working practices of the group and instead applying them to specific tasks the group were undertaking. This was a helpful realisation which enabled the principles to become-for most but not all participants-a useful facilitation device in the latter stages of the project. Eventually we applied the principles in a way that was useful and enabled collaboration between researchers and a ULO (albeit in unexpected ways).

CONCLUSIONS

Our joint reflections emphasise the importance of being reflexive and responsive when seeking to apply theories of collaboration (the principles) within user-led work. At an early stage, it is important to agree shared definitions and understanding of what 'user-led' means in practice. It is crucial to actively adapt and translate the principles in ways that make them more accessible and applicable within groups where prior knowledge of their origins is both unlikely and unnecessary.

Navigating PROSPERO4animals: 10 top tips for efficient pre-registration of your animal systematic review protocol

Systematic reviews are an essential tool in identifying knowledge gaps and synthesizing evidence from in vivo animal research to improve human health. The review process follows an explicit and systematic methodology to minimize bias, but is not immune to biases or methodological flaws. Pre-registering a systematic review protocol has several benefits, including avoiding unplanned duplication of reviews, reducing reporting biases, and providing structure throughout the review process. It also helps to align the opinions of review team members and can shield researchers from post-hoc critique. PROSPERO4animals is the international prospective register of systematic reviews (PROSPERO) for the preregistration of systematic review of animal studies. As administrators, here we provide 10 tips to facilitate pre-registration in PROSPERO4animals. These tips address common difficulties that both beginners and experienced researchers may face when pre-registering their systematic review protocols. This article aims to help authors write and register a detailed systematic review protocol on PROSPERO4animals.

A novel methodological approach to participant engagement and policy relevance for community-based primary medical care research during the COVID-19 pandemic in Australia and New Zealand

Community-based primary care, such as general practice (GP) or urgent care, serves as the primary point of access to healthcare for most Australians and New Zealanders. Coronavirus disease 2019 (COVID-19) has created significant and ongoing disruptions to primary care. Traditional research methods have contributed to gaps in understanding the experiences of primary care workers during the pandemic. This paper describes a novel research design and method that intended to capture the evolving impact of the COVID-19 pandemic on primary care workers in Australia and New Zealand. Recurrent, rapid cycle surveys were fielded from May 2020 through December 2021 in Australia, and May 2020 through February 2021 in New Zealand. Rapid survey development, fielding, triangulated analysis and dissemination of results allowed close to real-time communication of relevant issues among general practice workers, researchers and policy-makers. A conceptual model is presented to support longitudinal analysis of primary care worker experiences during the COVID-19 pandemic in Australia and New Zealand, and key learnings from applying this novel method are discussed. This paper will assist future research teams in development and execution of policy-relevant research in times of change and may inform further areas of interest for COVID-19 research in primary care.

Manual for the study of tapeworms (Cestoda) parasitic in ray-finned fish, amphibians and reptiles

Based on long-term and often frustrating experiences with the poor quality of tapeworms (Cestoda) collected throughout the world for taxonomic and phylogenetic studies, and considering the increasing obstacles to obtaining new material, a simple, easy-to-use and illustrated methodological guide (manual) is provided. It focusses mainly on key steps in examining hosts, collecting cestodes from poikilothermous vertebrates except elasmobranchs, i.e., from ray-finned fish (Actinopterygii), amphibians and 'reptiles' (a paraphyletic group comprising all sauropsids except birds), and fixing them for subsequent morphological and molecular study. It is proposed that the following methodological points should be followed: (i) ideally only freshly euthanised hosts (not previously frozen) should be used for parasitological examination; (ii) hosts examined should be documented by photographs; host tissue should also be preserved for future genotyping if necessary; (iii) tapeworms should be detached carefully to keep the scolex intact and properly cleaned before fixation; (iv) a small piece of cestode tissue should be always preserved in molecular grade ethanol for DNA sequencing; (v) tapeworms should be fixed as quickly as possible after collecting them and while they are still alive, always using hot (heated) fixatives; this prevents unnatural contraction or deformation and ensures uniform fixation; (vi) each sample (vial) should be properly labelled (a unique code should be given to every cestode sample); (vii) vouchers of sequenced specimens (hologenophores or paragenophores) should always be preserved for identification, and deposited in internationally recognised collections. It is hoped that this guide helps researchers and students to properly process valuable material of cestodes to make it suitable for reliable identification including genotyping and comparative anatomy, which is a prerequisite for any subsequent ecological, biogeographical, phylogenetic life cycle or molecular study.

Use of chitin:DNA ratio to assess growth form in fungal cells

BACKGROUND

Dimorphism, the ability to switch between a 'yeast-like' and a hyphal growth form, is an important feature of certain fungi, including important plant and human pathogens. The switch to hyphal growth is often associated with virulence, pathogenicity, biofilm formation and stress resistance. Thus, the ability to accurately and efficiently measure fungal growth form is key to research into these fungi, especially for discovery of potential drug targets. To date, fungal growth form has been assessed microscopically, a process that is both labour intensive and costly.

RESULTS

Here, we unite quantification of the chitin in fungal cell walls and the DNA in nuclei to produce a methodology that allows fungal cell shape to be estimated by calculation of the ratio between cell wall quantity and number of nuclei present in a sample of fungus or infected host tissue. Using the wheat pathogen Zymoseptoria tritici as a test case, with confirmation in the distantly related Fusarium oxysporum, we demonstrate a close, linear relationship between the chitin:DNA ratio and the average polarity index (length/width) of fungal cells. We show the utility of the method for estimating growth form in infected wheat leaves, differentiating between the timing of germination in two different Z. tritici isolates using this ratio. We also show that the method is robust to the occurrence of thick-walled chlamydospores, which show a chitin:DNA ratio that is distinct from either 'yeast-like' blastospores or hyphae.

CONCLUSIONS

The chitin:DNA ratio provides a simple methodology for determining fungal growth form in bulk tissue samples, reducing the need for labour-intensive microscopic studies requiring specific staining or GFP-tags to visualise the fungus within host tissues. It is applicable to a range of dimorphic fungi under various experimental conditions.

A critical moment in machine learning in medicine: on reproducible and interpretable learning

Over the past two decades, advances in computational power and data availability combined with increased accessibility to pre-trained models have led to an exponential rise in machine learning (ML) publications. While ML may have the potential to transform healthcare, this sharp increase in ML research output without focus on methodological rigor and standard reporting guidelines has fueled a reproducibility crisis. In addition, the rapidly growing complexity of these models compromises their interpretability, which currently impedes their successful and widespread clinical adoption. In medicine, where failure of such models may have severe implications for patients' health, the high requirements for accuracy, robustness, and interpretability confront ML researchers with a unique set of challenges. In this review, we discuss the semantics of reproducibility and interpretability, as well as related issues and challenges, and outline possible solutions to counteracting the "black box". To foster reproducibility, standard reporting guidelines need to be further developed and data or code sharing encouraged. Editors and reviewers may equally play a critical role by establishing high methodological standards and thus preventing the dissemination of low-quality ML publications. To foster interpretable learning, the use of simpler models more suitable for medical data can inform the clinician how results are generated based on input data. Model-agnostic explanation tools, sensitivity analysis, and hidden layer representations constitute further promising approaches to increase interpretability. Balancing model performance and interpretability are important to ensure clinical applicability. We have now reached a critical moment for ML in medicine, where addressing these issues and implementing appropriate solutions will be vital for the future evolution of the field.

Barriers and facilitators in developing patient versions of clinical practice guidelines - qualitative interviews on experiences of international guideline producers

BACKGROUND

Several guideline organizations produce patient versions of clinical practice guidelines (PVGs) which translate recommendations into simple language. A former study of our working group revealed that few guideline organizations publish their methods used to develop PVGs. Clear definitions of PVGs do not prevail and their purposes often remain unclear. We aimed to explore experts' perspectives on developing, disseminating and implementing PVGs to discuss and incorporate these experiences when consenting on methodological guidance and further improving PVGs.

METHODS

We conducted 17 semi-structured telephone interviews with international experts working with PVGs from September 2021 through January 2022. We conducted the interviews in English or German, they were recorded and transcribed verbatim. We utilized Mayring's qualitative content analysis with MAXQDA software to analyze the data.

RESULTS

In two interviews two participants were interviewed at the same time. This resulted in a total of 19 participants from 16 different organizations and eight different countries participated. Most were female (16/19) and their experience in working with PVGs ranged from 1 to 20 years. All follow methodological standards when developing PVGs, but the extent of these standards and their public accessibility differs. Aims and target groups of PVGs vary between organizations. Facilitators for developing PVGs are working with a multidisciplinary team, financial resources, consultation processes and a high-quality underlying CPG. Facilitators for disseminating and implementing PVGs are using various strategies. Barriers, on the other hand, are the lack of these factors. All participants mentioned patient involvement as a key aspect in PVG development.

CONCLUSION

The steps in the PVG development process are largely similar across the countries. Focus is placed on the involvement of patients in the development process, although the extent of participation varies. The experts collectively attribute great importance to PVGs overall, but in order to constantly adapt to medical progress and changing conditions, the focus in the future may be more on formats like living guidelines. Although there are different views on the mandatory development of PVGs, there is a consistent call for more transparency regarding the methodology used for PVGs.