Analysis of changing statistical significance from .05 to .005 in foot and ankle randomized controlled trials

Background: Misinterpretation of p-values in RCTs is extremely problematic since they are the core basis for high levels of recommendation in clinical practice guidelines, especially Orthopaedics. Benjamin et al. proposed a universal protocol change, moving statistical significance from a p-value of .05 to .005 to combat the misinterpretation that is happening in medical literature. In this study, we are looking to evaluate the effect of the protocol suggested by Benjamin et al. on foot and ankle-related RCTs in the top 3 Foot and Ankle-related journals.Methods: We conducted a Pubmed search looking at studies published from January 1st, 2016 to November 10, 2021, in the following three journals; Foot and Ankle International, Journal of Foot and Ankle Surgery, and Foot & Ankle International. The inclusion criteria for the study were RCTs published in the above journals with specifically stated primary endpoints. If a study has multiple primary endpoints, all were included. Exclusion criteria were any study that was not prospective and randomized by design, also any study that did not state primary endpoints was excluded. Two authors extracted the data using a pilot-tested Google form, any disagreements or questions were resolved by published methodologic orthopaedic authors.Results: Of the 222 endpoints, 101 endpoints (45.5%; 101/222) were at or below the .05 threshold while 121 endpoints (54.5%; 121/222) were above the .05 threshold. We also found that 59 endpoints (26.6%; 59/222) were below .005.Conclusion: Our results suggest that changing the threshold for statistical significance from .05 to .005 in foot and ankle RCTs would heavily alter literature published in the field. By implementing this methodology, it is a promising measure to be able to increase RCT quality until a more substantial solution can be found. With that being said, caution must be taken when interpreting our results, also requiring further evaluation

Do all bunions need surgery? An investigation of Google searches for Hallux Valgus

Introduction: Hallux valgus (HV) or a bunion is one of the most common forefoot deformities. Approximately one in four adults will develop HV with a higher prevalence in adult females. Given the high prevalence of HV along with the wide variety of non-surgical and surgical treatment options for it, we believe patients are likely turning to internet search engines for questions germane to HV. Previous orthopaedic investigations have used Google’s “People Also Ask” box to characterize frequently asked questions (FAQs) regarding total knee and hip arthroplasty. Yet, no such investigation has been conducted for HV. Using Google’s Frequently Asked Questions (FAQs), we sought to classify these questions as well as assess their levels quality and transparency.Methods: On October 9, 2022, we searched Google using these four phrases: “Hallux Valgus Treatment,” “Hallux Valgus Treatment Surgery,” “Bunion Treatment,” and “Bunion Surgery.” We refreshed search results until a minimum of 100 FAQs were produced; we extracted the sources of these 100 questions for content analysis. Information transparency was assessed using the Journal of the American Medical Association’s (JAMA) Benchmark tool, question classification was defined using the Rothwell Classification of Questions, and information quality was assessed using Brief DISCERN. This study was approved by an IRB.Results section: Our Google search returned 299 unique FAQs after removing duplicates and unrelated FAQs. The majority were classified as fact based questions (149/299, 49.8%), followed by value (92/299, 30.8%) and policy questions (58/299, 19.4%). Overall the most common topic searched was related to the evaluation of treatment or surgery (79/299, 26.4%). The frequent answer sources were medical practices (158/299, 52.8%), followed by commercial (69/299, 23.1%) and academic (38/299, 12.7%). The one-way analysis of variance revealed a significant difference in mean quality scores among the 5 source types (F= 54.49, P<.001) with medical practices averaging the worst score (12.1/30) compared to academic sources which were found to have the highest score (21.8/30).Discussion: Patients seeking online information concerning treatment options for HV appear to search Google for questions related to treatment efficacy and restrictions. The most common source type encountered by patients are small medical practices; these were found to have both poor transparency and poor quality. Our study has several limitations, JAMA benchmark and Brief DISCERN do not assess the accuracy of the information. Secondly, our study is cross-sectional in design limiting the generalizability of our findings to the time when the search was performed.Significance/Clinical Relevance: In order to increase the transparency and quality of online information regarding HV treatment, online sources should refer to established rubrics such as JAMA benchmark and Brief DISCERN when publishing online information. Physicians should be aware that patients are commonly searching for information related to the evaluation of treatments or surgeries for HV

Organellomic data sets confirm a cryptic consensus on (unrooted) land‐plant relationships and provide new insights into bryophyte molecular evolution

Premise Phylogenetic trees of bryophytes provide important evolutionary context for land plants. However, published inferences of overall embryophyte relationships vary considerably. We performed phylogenomic analyses of bryophytes and relatives using both mitochondrial and plastid gene sets, and investigated bryophyte plastome evolution. Methods We employed diverse likelihood‐based analyses to infer large‐scale bryophyte phylogeny for mitochondrial and plastid data sets. We tested for changes in purifying selection in plastid genes of a mycoheterotrophic liverwort (Aneura mirabilis) and a putatively mycoheterotrophic moss (Buxbaumia), and compared 15 bryophyte plastomes for major structural rearrangements. Results Overall land‐plant relationships conflict across analyses, generally weakly. However, an underlying (unrooted) four‐taxon tree is consistent across most analyses and published studies. Despite gene coverage patchiness, relationships within mosses, liverworts, and hornworts are largely congruent with previous studies, with plastid results generally better supported. Exclusion of RNA edit sites restores cases of unexpected non‐monophyly to monophyly for Takakia and two hornwort genera. Relaxed purifying selection affects multiple plastid genes in mycoheterotrophic Aneura but not Buxbaumia. Plastid genome structure is nearly invariant across bryophytes, but the tufA locus, presumed lost in embryophytes, is unexpectedly retained in several mosses. Conclusions A common unrooted tree underlies embryophyte phylogeny, [(liverworts, mosses), (hornworts, vascular plants)]; rooting inconsistency across studies likely reflects substantial distance to algal outgroups. Analyses combining genomic and transcriptomic data may be misled locally for heavily RNA‐edited taxa. The Buxbaumia plastome lacks hallmarks of relaxed selection found in mycoheterotrophic Aneura. Autotrophic bryophyte plastomes, including Buxbaumia, hardly vary in overall structure