Systematic reviews in the prevention of research waste in emergency medicine randomized controlled trials

Before a randomized controlled trial (RCT) is performed, systematic reviews (SR) of the topic need to be cited to ensure new, meaningful information is being added. Studies that do not do this can cause wasted resources such as funding and time. We analyzed RCTs in the top emergency medicine journals for indication of SR citations. We searched PubMed for studies that were published between 01/01/2014 and 12/31/2017.This search resulted in 615 studies. Of those 615 studies, we found that 275 of them fulfilled the requirements of a RCT. The bibliographies of the 275 studies were analyzed for evidence of SR citation. If a SR citation was present, we determined if information from the citation was used to justify the RCT. Of the 275 studies, we found that 66%, 95%, and 74% studies did not use SR citations as justification or did not have SR citations at all in the introduction, methods, and discussion sections respectively. The average sample size of each RCT was 294 participants. 40% of the studies did not report the type of funding, and 20% of studies received funding from government resources. The most common trial type was a parallel group trial contributing to 69% of our studies.The results from this study reveal that there is a lack of justification for RCTs in emergency medicine research due to the underutilization of meaningful SR citations. Trialists in emergency medicine should be more proactive in citing SRs in their studies to prevent wasted resources

Systematic review and meta-analysis of frequency of acute kidney injury following intravenous contrast administration

Purpose: To update a systematic review and meta-analysis of controlled studies examining the incidence of acute kidney injury (AKI) after exposure to intravenous contrast media compared to AKI after imaging without contrast media (control). The original meta-analysis was published in the Journal of the American College of Radiology in 2013 and is the basis for guidelines for the American College of Radiology and the American College of Family Physicians. Although this meta-analysis concluded there was no association between contrast exposure and AKI, most guidelines still provide recommendations to avoid contrast media under certain conditions for fear that it could theoretically cause AKI. The original meta-analysis called for additional studies to use a non-contrast control group, and the ACR guidelines call for more matched studies. This study attempts to collate the studies conducted on this issue in attempt to strengthen the evidence base behind clinical recommendations related to CIN.Materials and Methods: EMBASE, Scopus, and Medline via PubMed's interface were searched using the same search criteria as the 2013 meta-analysis with the time period of interest changed from before 2011 to 2011 to present. Abstract screening was performed using the same inclusion criteria. The full text review was completed using the same exclusion criteria. The included studies were further screened by a clinician to ensure representation of clinical expertise. Data extraction was completed independently using a Google form and conflicts between researchers was resolved by a clinician. The same data points — baseline SCr or eGFR, contrast type, AKI definition, incidence of AKI, dialysis, and mortality — as the previous meta-analysis were recorded. Data extracted from the previous meta-analysis was combined with our updated data, and all data were analyzed and relative risks were calculated. Relative risk was calculated for incidence of AKI in both groups. A relative risk of less than 1.00 was indicative of a higher incidence of AKI in the non-contrast medium group.Results: There were 8,358 studies identified. Of those, 34 (0.004%) were deemed to have met inclusion criteria; this represented 30,053,234 patients (1,731,241 receiving IV contrast and 28,321,993 not receiving contrast). There was 30 retrospective studies, 13 on which were propensity matched. There were only 4 prospective studies and 2 of those were propensity matched. The risk of AKI in the contrast medium group of the retrospective studies (RR= 0.9805; 95% confidence interval [CI]: 0.97, 0.99; p=0.0000000015) and prospective studies (RR= 1.009; 95% confidence interval [CI]: 0.81, 1.26; p= 0.934) was similar to the non-contrast medium group. The combination of retrospective and prospective studies with the previous meta-analysis findings also showed a similar risk (RR= 0.9806; 95% confidence interval [CI]: 0.97, 0.99; p= 0.0000000016) between contrast medium and non-contrast medium groups.Conclusion: The meta-analysis from 2013 stated there was no difference in incidence of AKI between contrast exposure groups and control groups. Our data support this finding. Guidelines should be updated to reflect current research

An overview of ethnography in healthcare and medical education research

Research in healthcare settings and medical education has relied heavily on quantitative methods. However, there are research questions within these academic domains that may be more adequately addressed by qualitative inquiry. While there are many qualitative approaches, ethnography is one method that allows the researcher to take advantage of relative immersion in order to obtain thick description. The purpose of this article is to introduce ethnography, to describe how ethnographic methods may be utilized, to provide an overview of ethnography's use in healthcare and medical education, and to summarize some key limitations with the method

Justification of oromaxillofacial trials using systematic reviews

Aims: In 2017 alone, $12.7 billion was spent on clinical trial research, though basis for conducting these trials is often questionable, absent, or based in industry interest. Systematic reviews (SR's) provide summaries of existing research and can be used to formulate effective research questions that have not been answered. In this study, we analyzed the scientific bases of randomized controlled trials (RCT's) in Oromaxillofacial Surgery (OMFS) journals to determine if SR's formed the basis of the research question.Methods: This study analyzed RCT's in the top 10 ranked OMFS journals by h5 index as of October 10, 2018. It includes all manuscripts published January 1, 2015 - December 31, 2017. We screened each study to extract data relating to funding sources, presence of SR citations, and research methodology.Results: Nearly half of the RCTs cited at least one SR in the introduction of the paper, but less than half of those used the SR review as justification of the trial. 34.5% of the manuscripts did not report their funding, and 25.6% explicitly declared no funding. Self-funded manuscripts cited SR's at the lowest rates in this study. Interestingly, the highest incidence of SR justification occurred when funding was received from a combination of non-profits and industry. Nonprofit papers and those without funding had the lowest incidence of SRs justification.Conclusions: Proper justification for OMFS clinical trials most often occurs when both industry and nonprofit organizations are invested in the research. More effective research could be performed if journal editors required researchers to cite evidence that their studies were necessary.Significance: While a minority of manuscripts published in high-impact OMFS journals mention SR's as justification for conducting the trial, awareness of proper justification should be increased among the scientific community. This is most likely to occur when both the public and private sectors are invested in the research

Does public interest in specific injuries increase when they occur during mixed martial arts bouts? A study of Google search patterns

Introduction: Mixed martial arts (MMA) is a combat sport that combines fighting techniques from many disciplines, such as wrestling, boxing, karate, Muay Thai, and Brazilian Jiu Jitsu. In the early 1990s MMA entered the United States as the Ultimate Fighting Championship (UFC). Both the internet and social media have advanced the popularity of MMA and have increased the public's exposure to fighting injuries. Here we examine injuries from popular UFC bouts and observe whether the volume of Google searches for specific injuries increases after the associated fights.Study Design: Our sample of injuries was gathered from "Sherdog's Top 10 Worst UFC Injuries" available from www.sherdog.com. Injury information, the injured fighter's name, date of injury, and the popularity of the fighter (measured by number of Twitter followers) were gathered from Google Trends searches.Results: Searches for the fighter and for the injury (i.e., an alignment) had a co-occurring pattern in 9 of 10 cases. The percent change in search interest for injuries increased in 9 of 10 cases (Mdn = 446%, IQR: 168.75%-1643.75%).Conclusions: Search interest in fighters and injuries appears to increase shortly after injury occurrence, possibly providing an opportunity for the timely dissemination of evidence-based information about particular injuries by sports medicine personnel. This study highlights how investigation of public search interest may ultimately have a positive impact on health care outcomes

Analysis of the use of systematic reviews to justify otolaryngology clinical trials - Is research being wasted?

Objective of Research: Avoiding poor research methodology such as research waste through duplicative research certainly provides a more cost effective approach to achieving high quality methodologic studies. The purpose of our study is to explore the level of adherence to guidelines and where a literature search was incorporated and documented SRs were used as justification for conducting a RCT and the amount of research waste as a consequence.Methods and Results: We performed a meta-epidemiological cross-sectional study of RCTs published in top peer reviewed otorhinolaryngological journals according to Google Scholar Metrics. Data points extracted whether or not a study cited a systematic review. We recorded whether or not that study used the cited systematic review as justification for conducting the trial. Of the 304 articles retrieved, 151 were included. Overall, only 58.3% (88/151) of studies referenced a SR while shockingly, 41.7% (63/151) articles did not reference at all a systematic review. Possibly even more alarming is the fact that only 27% (24/88) that did cite at least one SR mentioned the SR as justification for conducting the trial and only 17% (15/88) of studies cited verbatim that a SR implicated the need for a RCT to further gaps in knowledge.Conclusion: Based off of our findings, we recommend that efforts be taken to reduce research waste by using SRs and meta-analysis as justification for conducting RCTs

Analysis of practices to promote reproducibility and transparency in anesthesiology research: Are important aspects "hidden behind the drapes?"

Introduction: Reliable, high quality research is essential to the field of anesthesiology. Investigating reproducibility and transparency has been accomplished broadly in the biomedical domain and in the social sciences; however, practices that promote reproducibility and transparency have never been evaluated in the anesthesiology research community. In this study, we applied 14 indicators of reproducibility to evaluate the current climate of the anesthesiology research community.Methods: We used the National Library of Medicine (NLM) catalog to search for all journals using the subject terms tag Anesthesiology[ST]. The inclusion criteria required that journals provided full-text publications in English and were MEDLINE indexed. The list of journals in the NLM catalog fitting the inclusion criteria were then extracted using the electronic International Standard Serial Number (ISSN). This series of ISSN were used in a PubMed search to identify all publications within these journals. We then limited the sample to publications from January 1, 2014 to December 31, 2018. Subsequently, we randomly sampled 300 publications that fit the inclusion criteria for our analysis. Data extraction was then conducted in a blinded, duplicate fashion using a pilot-tested Google form.Results: The PubMed search of these journals identified 171,441 publications, with 28,310 being within the time-frame. From the 300 publications sampled, 296 (296/300, 98% [97% to 99%]) full text publications were obtained, while 4 (4/300, 1% [0% to 3%]) only showed the abstract or could not be accessed. Most (104/107, 97% [95% to 99%]) of the studies did not include material availability statements or protocol availability statements. For the analysis scripts, the majority of publications (121/122, 99% [98% to 100%]) did not provide a data analysis script statement. The majority (94/122, 77% [72% to 81%]) of the publications did not contain a pre-registration statement. Other study characteristics were found to be insufficient.Conclusion: Anesthesiology research needs to drastically improve with regards to reproducibility and transparency. By making research easily accessible online and by improving the accessibility of detailed components (raw data, materials and protocols, analysis scripts) primary research can be reproduced in subsequent studies and help contribute to the development of new practice guidelines, helping change patient care through evidence-based conclusions

Program Evaluation in Medical Education: An Overview of the Utilization-focused Approach

Medical school administrators, educators, and other key personnel must often make difficult choices regarding the creation, retention, modification, or termination of the various programs that take place at their institutions. Program evaluation is a data-driven strategy to aide decision-makers in determining the most appropriate outcome for programs within their purview. The purpose of this brief article is to describe one program evaluation model, the utilization-focused approach. In particular, we address the focus of this model, the personal factor, the role of the evaluator, and the evaluation process. Based on the flexibility of this model as well as its focus on stakeholder involvement, we encourage readers to consider the utilization-focused approach when evaluating programs

Evaluation of industry payments and financial conflict of interest disclosures among task force authors of Endocrine Society clinical practice guidelines

Introduction: Clinical practice guidelines are considered the gold standard for disease management and treatment. Industry payments to guideline authors may influence their clinical recommendations, potentially resulting in medical and/or financial consequences to patients.Research Question: Determine the extent Endocrine Society guideline authors receive industry payments and report financial conflicts of interest in adherence to the Physician Payments Sunshine Provision of the Affordable Care Act.Study Design: Cross-sectional analysis of all clinical practice guidelines published by the Endocrine Society since the Sunshine Provision mandate.Methods: We searched the Endocrine Society's website for clinical guidelines published between January 2014 and December 2017. Identified guideline authors were independently searched by two investigators on the Open Payments Database. Received payments were extracted and statistically analyzed (excluding food/beverage payments). Payments were cross-referenced with corresponding author disclosure statements.Results: Of the 57 evaluable guideline authors, 34 authors (59.6%) received at least one industry payment. Of these authors, thirty-three (57.89%) received ≥ $1,000, twenty-six (45.61$10,000, twenty-two (38.60%) ≥ $50,000, and twenty-one (36.84$100,000. Sixteen authors (28.07%) received ≥ $250,000 in industry payments. Median total payments were$4,060 (interquartile range [IQR] $0-263,264.23). Twenty-seven (47.37$28,523.93 (IQR $5,714-94,418.02), with a payment total of$2,870,485.27.Conclusion: Industry payments among Endocrine Society clinical practice guideline authors were widespread, with several exceeding $250,000. Nearly half of author disclosure statements were inaccurate. The Endocrine Society's disclosure policy should be more strictly enforced for future guideline authors