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Keserlioglu K, Kilicoglu H, Ter Riet G. Impact of peer review on discussion of study limitations and strength of claims in randomized trial reports: a before and after study. Res Integr Peer Rev 2019; 4:19. [PMID: 31534784 PMCID: PMC6745784 DOI: 10.1186/s41073-019-0078-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background In their research reports, scientists are expected to discuss limitations that their studies have. Previous research showed that often, such discussion is absent. Also, many journals emphasize the importance of avoiding overstatement of claims. We wanted to see to what extent editorial handling and peer review affects self-acknowledgment of limitations and hedging of claims. Methods Using software that automatically detects limitation-acknowledging sentences and calculates the level of hedging in sentences, we compared the submitted manuscripts and their ultimate publications of all randomized trials published in 2015 in 27 BioMed Central (BMC) journals and BMJ Open. We used mixed linear and logistic regression models, accounting for clustering of manuscript-publication pairs within journals, to quantify before-after changes in the mean numbers of limitation-acknowledging sentences, in the probability that a manuscript with zero self-acknowledged limitations ended up as a publication with at least one and in hedging scores. Results Four hundred forty-six manuscript-publication pairs were analyzed. The median number of manuscripts per journal was 10.5 (interquartile range 6–18). The average number of distinct limitation sentences increased by 1.39 (95% CI 1.09–1.76), from 2.48 in manuscripts to 3.87 in publications. Two hundred two manuscripts (45.3%) did not mention any limitations. Sixty-three (31%, 95% CI 25–38) of these mentioned at least one after peer review. Changes in mean hedging scores were negligible. Conclusions Our findings support the idea that editorial handling and peer review lead to more self-acknowledgment of study limitations, but not to changes in linguistic nuance.
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Affiliation(s)
- Kerem Keserlioglu
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Halil Kilicoglu
- 2Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine, Bethesda, MD USA
| | - Gerben Ter Riet
- 3Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.,4ACHIEVE Centre for Applied Research, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
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Morgan RL, Thayer KA, Santesso N, Holloway AC, Blain R, Eftim SE, Goldstone AE, Ross P, Ansari M, Akl EA, Filippini T, Hansell A, Meerpohl JJ, Mustafa RA, Verbeek J, Vinceti M, Whaley P, Schünemann HJ. A risk of bias instrument for non-randomized studies of exposures: A users' guide to its application in the context of GRADE. Environ Int 2019; 122:168-184. [PMID: 30473382 PMCID: PMC8221004 DOI: 10.1016/j.envint.2018.11.004] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 05/18/2023]
Abstract
The objective of this paper is to explain how to apply, interpret, and present the results of a new instrument to assess the risk of bias (RoB) in non-randomized studies (NRS) dealing with effects of environmental exposures on health outcomes. This instrument is modeled on the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) instrument. The RoB instrument for NRS of exposures assesses RoB along a standardized comparison to a randomized target experiment, instead of the study-design directed RoB approach. We provide specific guidance for the integral steps of developing a research question and target experiment, distinguishing issues of indirectness from RoB, making individual-study judgments, and performing and interpreting sensitivity analyses for RoB judgments across a body of evidence. Also, we present an approach for integrating the RoB assessments within the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess the certainty of the evidence in the systematic review. Finally, we guide the reader through an overall assessment to support the rating of all domains that determine the certainty of a body of evidence using the GRADE approach.
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Affiliation(s)
- Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Kristina A Thayer
- Integrated Risk Information System (IRIS) Division, National Center for Environmental Assessment (NCEA), Office of Research and Development, US Environmental Protection Agency, Building B (Room 211i), Research Triangle Park, NC 27711, USA.
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Health Sciences Centre, Room 3N52A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Robyn Blain
- ICF International Inc., 9300 Lee Highway, Fairfax, VA, USA.
| | - Sorina E Eftim
- ICF International Inc., 9300 Lee Highway, Fairfax, VA, USA.
| | | | - Pam Ross
- ICF International Inc., 9300 Lee Highway, Fairfax, VA, USA.
| | - Mohammed Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, ON K1H 8M5, Canada.
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Department of Internal Medicine, Faculty of Health Sciences, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut 1107 2020, Lebanon.
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.
| | - Anna Hansell
- MRC-PHE Centre for Environment and Health, Imperial College London, St Mary's Campus, Praed St, Paddington, London W2 1PG, UK; Public Health Directorate, Imperial College Healthcare NHS Trust, St Mary's Hospital, Paddington, London, W2 1PG, UK; Centre for Environmental Health and Sustainability, University of Leicester, George Davies Building, University Road, Leicester LE1 7RH, UK.
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany.
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Jos Verbeek
- Finnish Institute of Occupational Health, Cochrane Work, Neulaniementie 4, 70701 Kuopio, Finland.
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Paul Whaley
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK.
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Department of Medicine, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
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Amoroso T. The spurious relationship between ecstasy use and neurocognitive deficits: A Bradford Hill review. Int J Drug Policy 2018; 64:47-53. [PMID: 30579220 DOI: 10.1016/j.drugpo.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/13/2018] [Accepted: 11/07/2018] [Indexed: 12/13/2022]
Abstract
Numerous studies have suggested that MDMA can cause neurocognitive deficits. However, the available data can only suggest an association - rather than a causal relationship - between MDMA use and neurocognitive deficits. The reliability and robustness of this association was evaluated using Bradford Hill's criteria for determining causation in epidemiology research. Several limitations in the literature were found. Studies have recruited people who abuse ecstasy - an illicit drug that does not always contain MDMA. There is inherent risk in consuming impure or falsely identified substances; and using this as a source as for scientific opinion may introduce biases in our understanding the actuals risks associated with MDMA. Importantly, given that ecstasy research is predominately retrospective, baseline functioning cannot be established; which may be influenced by a variety of preexisting factors. Many studies introduce statistical errors by inconsistently dichotomizing and comparing light and heavy ecstasy users, making dose-response relationships inconclusive. When interpreting the ecstasy literature effect sizes are a more meaningful indicator of neurocognitive functioning rather than relying on p-values alone. Most meta-analyses have failed to find clinically relevant differences between ecstasy users and controls. There is also consistent evidence of publication bias in this field of research, which indicates that the literature is both biased and incomplete. Finally, suggestions for improving the ecstasy literature are provided.
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Affiliation(s)
- Timothy Amoroso
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Furukawa TA, Miura T, Chaimani A, Leucht S, Cipriani A, Noma H, Mitsuyasu H, Kanba S, Salanti G. Using the contribution matrix to evaluate complex study limitations in a network meta-analysis: a case study of bipolar maintenance pharmacotherapy review. BMC Res Notes 2016; 9:218. [PMID: 27074861 PMCID: PMC4831112 DOI: 10.1186/s13104-016-2019-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/31/2016] [Indexed: 01/07/2023] Open
Abstract
Background Limitations in the primary studies constitute one important factor to be considered in the grading of recommendations assessment, development, and evaluation (GRADE) system of rating quality of evidence. However, in the network meta-analysis (NMA), such evaluation poses a special challenge because each network estimate receives different amounts of contributions from various studies via direct as well as indirect routes and because some biases have directions whose repercussion in the network can be complicated. Findings In this report we use the NMA of maintenance pharmacotherapy of bipolar disorder (17 interventions, 33 studies) and demonstrate how to quantitatively evaluate the impact of study limitations using netweight, a STATA command for NMA. For each network estimate, the percentage of contributions from direct comparisons at high, moderate or low risk of bias were quantified, respectively. This method has proven flexible enough to accommodate complex biases with direction, such as the one due to the enrichment design seen in some trials of bipolar maintenance pharmacotherapy. Conclusions Using netweight, therefore, we can evaluate in a transparent and quantitative manner how study limitations of individual studies in the NMA impact on the quality of evidence of each network estimate, even when such limitations have clear directions.
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Affiliation(s)
- Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Tomofumi Miura
- Department of Neuropsychiatry Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Anna Chaimani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Lane, Headington, Oxford, OX3 7JX, UK
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo, 190-8562, Japan
| | - Hiroshi Mitsuyasu
- Department of Neuropsychiatry Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shegenobu Kanba
- Department of Neuropsychiatry Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM) & Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
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