Focus on sharing individual patient data distracts from other ways of improving trial transparency

The International Committee of Medical Journal Editors (ICMJE) recently reiterated its commitment to improving trial transparency by sharing individual patient data from randomised trials.1 2 But, although sharing individual patient data contributes to transparency, it is not sufficient by itself. Trial transparency requires a data sharing package, which begins with trial registration and contains other elements such as protocols, summary results, and other trial materials. Valuable as sharing individual patient data can be,3 discussion about it has hijacked the broader conversation about data sharing and trial transparency.4-6 For example, we identified 76 articles published in the six leading general medical journals that had “data” and “sharing” in their title and were about clinical trials. In 64 (84%) articles, the content was focused on individual patient data and did not mention any of the other components of trial transparency (see appendix on bmj.com). Much of the discussion has focused on the complexities and practical problems associated with sharing individual patient data and on the processes and systems needed for responsible data sharing.6-9 However, many of the data sharing activities that are needed for trial transparency are not complex. We believe that trying to solve the complex issues around availability of individual patient data should not eclipse or distract from a more pressing problem: the unavailability of even summary data and protocols from all controlled trials. Current estimates are that around 85% of research is avoidably “wasted” because of design flaws, poor conduct, non-publication, and poor reporting.10 Focusing efforts and attention on making individual patient data accessible might paradoxically exacerbate this waste in research. We argue that simpler and more cost efficient activities should be prioritised.</p

Analysing mobile learning designs: A framework for transforming learning post-COVID

Mobile learning is well established in literature and practice, but under-evolved from a rigorous learning design perspective. Activity theory presents a sophisticated way of mapping and understanding learning design, but for mobile learning this does not always translate into change in practice. The reported research addresses this by coupling a mobile learning specific approach to activity theory with a practice-based framework: the design for transformative mobile learning framework mapped to the pedagogy-andragogy-heutagogy continuum matrix (the DTML-PAH Matrix). Seven case studies are analysed using this approach and presented narratively along with framework informed analysis. Findings include that the DTML-PAH Matrix can be used to provide clearer implications and guidance for mobile learning practice, and that the DTML-PAH Matrix can also be guided by the practice over time. Implications for further research and practice are discussed. Implications for practice or policy: Provide technological and pedagogical scaffolds to students. Learning designs should focus upon enabling elements of learner agency and creativity. To develop learning solutions to real world problems utilise a design-based research approach. Create authentic collaborative learning activities and tasks. Integrate mobile learning affordances in the design of the course and curriculum

A mobile ecology of resources for Covid-19 learning

Mobile devices and a vast array of accompanying applications offer significant affordances to create, consume, share, collaborate and communicate—affordances that could be easily leveraged to facilitate meaningful learning. A positive disruption arising from Covid-19 that aligns with the affordances of mobile learning is the uncoupling of time and space in the learning process. Traditionally formal learning is a process that is predominately viewed as an experience that is ‘timetabled’— scheduled to eventuate at a ‘place’—lecture or a tutorial (or similar) in a room or lecture theatre. In this concise paper, an ecology of resources is discussed along with guiding principles for designing and facilitating uncoupled authentic and student-determined learning post the emergency remote teaching phase

Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study

Background Antidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care. Aim To examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine. Design & amp; Retrospective longitudinal study using national and practice-level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019). Method Class- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and logistic regression analysis was conducted. Results Antidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 2.6%) and dosulepin (MPP = 0.7%, IDR = 1.8%), but less for trimipramine (MPP = 0%, IDR = 0.2%). Conclusion Rapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net

Women's beliefs about breast cancer causation in a breast cancer case-control study

Objective: Our study sought to ascertain women's beliefs about breast cancer risk factors and whether these beliefs differed by demographic factors and personal and family history of breast cancer. Methods: Participants in a case-control study of breast cancer rated the effect of 37 exposures on the risk of being diagnosed with breast cancer. Chi-square tests were undertaken to measure differences in responses between cases and controls for each exposure. Logistic regression was undertaken to ascertain whether demographic factors and personal and family history of breast cancer affected participants' ability to correctly identify known breast cancer risk factors. Results: A total of 2742 participants completed the questionnaire, comprising 1109 cases and 1633 controls. Significant differences (p&lt;0.05) between cases and controls were found for 16 of the 37 exposures. Younger women and university-educated women were more likely to correctly identify known breast cancer risk factors. Women's perceptions about the effect of alcohol consumption on breast cancer risk, particularly regarding red wine, differed from that reported in the literature. Conclusions: Beliefs about risk factors for breast cancer may differ between cases and controls. Public health initiatives aimed at increasing awareness of breast cancer risk factors should consider that women's beliefs may differ by demographic factors and family history of breast cancer

Incommensurable worldviews? Is public use of complementary and alternative medicines incompatible with support for science and conventional medicine?

Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, ?conventional? medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research