Towards policy impact - an exploration of <i>Clinical Toxicology</i> research cited in policy documents and patents

IntroductionIndividual researcher impact through scientific citations is carefully monitored, with little attention to the impact of individual journals through policy and patent mentions. We aimed to describe policy and patent mentions for articles published in Clinical Toxicology.MethodsUsing Altmetric Explorer, we extracted mentions from 1 January 2013 to 31 December 2023, noting the citing source, Clinical Toxicology article title, and author-generated keywords. We used descriptive statistics to analyse the data.ResultsWe identified 165 individual policy documents (n = 139) and patents (n = 26), citing 146 articles with median of 6.4 years between publication and mention. The highest number of citing documents were by the World Health Organization (n = 45), European Monitoring Centre for Drugs and Drug Addiction (n = 22), and United States Centers for Disease Control and Prevention (n = 16). Most patents were registered in the United States (n = 17) and by the European Patent Office (n = 10), with the main classification of human necessities (n = 23). The commonest subjects of papers cited in policy and patents, from keywords, related to medical conditions and symptoms (26%) and recreational drugs (22%). The most cited article was “A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment.”DiscussionClinical Toxicology articles are cited in policy documents and patents, with a comparable number of mentions to the top-ranked journals in the field. This likely contributes to policy impact, but further work is needed to understand how cited articles are used and ripple effects through onwards citations of policy documents.ConclusionsClinical Toxicology is a toxicology journal for which published research gets recognised within influential policy sources. The Journal can play a key role in guiding public health policy through its selection and development of submitted publications

Pralidoxime in Acute Organophosphorus Insecticide Poisoning-A Randomised Controlled Trial

Background: Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit. Methods and Findings: We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receive pralidoxime (121) or saline placebo (114). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio HR] 1.69, 95% confidence interval CI] 0.88-3.26, p = 0.12). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 21.5%], placebo 24/114 21.1%], adjusted HR 1.27 95% CI 0.71-2.29]). To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit. Conclusions: Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required

Acute Human Lethal Toxicity of Agricultural Pesticides: A Prospective Cohort Study

In a prospective cohort study of patients presenting with pesticide self-poisoning, Andrew Dawson and colleagues investigate the relative human toxicity of agricultural pesticides and contrast it with WHO toxicity classifications, which are based on toxicity in rats