Authors Of Systematic Reviews Research Articles

Protocol for a systematic review and meta-analysis on Janus kinase inhibitors in the management of vitiligo

BackgroundVitiligo is a disease that affects people of all skin shades and can impact their quality of life. Reliable evidence on the effectiveness and adverse events associated with the recent use of Janus kinase (JAK) inhibitors to treat vitiligo is needed. This protocol for a systematic review and meta-analysis seeks to collect evidence from both randomized controlled trials (RCTs) and observational studies to determine the effectiveness and patient-centered outcomes concerning treatment with JAK inhibitors.MethodsWe will conduct a systematic review of the literature for RCTs and observational studies that used upadacitinib, ritlecitinib, brepocitinib, ifidancitinib, cerdulatinib, deglocitinib, baricitinib, tofacitinib, and ruxolitinib JAK inhibitors as treatments for vitiligo compared to placebo, no treatment, or combination therapies. We will systematically search from inception in Epistemonikos, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, EMBASE, ClinicalTrials.gov, PsycINFO, Allied and Complementary Medicine Database, Latin American and Caribbean Health Sciences Literature, Web of Science Core Collection, relevant preprint servers, and the gray literature. Ethics approval was not sought as the protocol and systematic review will not involve human participants, but rather summarized and anonymous data from studies. Primary outcomes include quality of life, percentage repigmentation, decreased vitiligo within 1 year or more, lasting repigmentation after a 2-year follow-up, cosmetic acceptability of repigmentation and tolerability or burden of treatment, and adverse events. Secondary outcomes are patient and study characteristics. We will include full-text articles, preprints, and clinical trial data in any language and all geographic regions. For data sources unavailable in English, we will obtain translations from global collaborators via the Cochrane Engage network. We will exclude articles for which sufficient information cannot be obtained from the authors of articles and systematic reviews. At least two investigators will independently assess articles for inclusion and extract data; reliability will be assessed before subsequent selection and data extraction of remaining studies. The risk of bias and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation guidelines will be assessed independently by at least two investigators. We will estimate treatment effects by random-effects meta-analyses and assess heterogeneity using I2. Data that cannot be included in the meta-analysis will be reported narratively using themes.DiscussionThe proposed systematic review and meta-analysis describe the methods for summarizing and synthesizing the evidence on the effectiveness and patient-centered outcomes concerning the treatment of vitiligo with JAK inhibitors that were recently approved for this indication. To disseminate further the results of our systematic review, we plan to present them at international conferences and meetings. Our findings will provide robust evidence to facilitate decision-making at the policy or practitioner level.Systematic review registrationPROSPERO CRD42023383920.

Consideration of health inequity in systematic reviews and primary studies on risk factors for hearing loss

AbstractBackgroundHealth inequities are systematic, avoidable, and unfair differences in health between populations or population subgroups. There is increased recognition of the need for systematic reviews (SRs) to address health inequities, including drawing out findings relevant to low‐ and middle‐income countries (LMICs). The aim of this study was to determine the extent to which SRs on risk factors for hearing loss reported findings associated with health inequities, and the extent to which this data was captured in the primary studies included within these SRs.MethodsWe identified SRs on risk factors for hearing loss from a report on this topic which included a systematic search for relevant SRs. SRs thus identified were inspected for data related to health inequity with reference to PROGRESS‐Plus. We compared how data were reported in SRs versus within primary studies included in the SRs, and the extent to which primary studies from LMICs were represented.ResultsWe included 17 SRs which reported findings on a variety of physiological, behavioral, demographic, and environmental risk factors for hearing loss. There were 296 unique primary studies included in the SRs, of which 251 (81.49%) were successfully retrieved. Data relating to health inequities was reported relatively infrequently in the SRs and mainly focused on gender and age. Data related to health inequities was more frequently reported in primary studies. However, several PROGRESS‐Plus criteria were only reported in a minority of primary studies. Approximately one‐third of primary studies were from LMICs.ConclusionsThere is scope to improve the reporting of data relating to health inequities in primary studies on risk factors for hearing loss. However, SR authors could do more to report health inequities than is currently undertaken, including drawing out findings relevant to LMICs where data are available.

Simulation-Based Analysis of Trial Design in Regional Anesthesia.

In regional anesthesia, the efficacy of novel blocks is typically evaluated using randomized controlled trials (RCTs), the findings of which are aggregated in systematic reviews and meta-analyses. Systematic review authors frequently point out the small sample size of RCTs as limiting conclusions from this literature. We sought to determine via statistical simulation if small sample size could be an expected property of RCTs focusing on novel blocks with typical effect sizes. We simulated the conduct of a series of RCTs comparing a novel block versus placebo on a single continuous outcome measure. Simulation analysis inputs were obtained from a systematic bibliographic search of meta-analyses. Primary outcomes were the predicted number of large trials (empirically defined as N ≥ 256) and total patient enrollment. Simulation analysis predicted that a novel block would be tested in 16 RCTs enrolling a median of 970 patients (interquartile range (IQR) across 1000 simulations: 806, 1269), with no large trials. Among possible modifications to trial design, decreasing the statistical significance threshold from p < 0.05 to p < 0.005 was most effective at increasing the total number of patients represented in the final meta-analysis, but was associated with early termination of the trial sequence due to futility in block vs. block comparisons. Small sample size of regional anesthesia RCTs comparing novel block to placebo is a rational outcome of trial design. Feasibly large trials are unlikely to change conclusions regarding block vs. placebo comparisons.

Knowledge, Skills, and Ability on SME Performance: A Systematic Literature Review Authors Dorris Yadewani

The quantity of micro, small, and medium-sized enterprises determine job creation and earnings equality in alongside the economy's expansion. However, SMEs confront several challenges, one of which is a lack of human resource (HR) skill sets, in particular, capacities, qualifications, as well as expertise. Studies on the factors influencing the performance of small and medium-sized businesses that focus on knowledge, skills, and talents are relatively uncommon in the literature. Therefore, the primary objective of the present investigation seeks to figure out the elements, where its focus on understanding, expertise, along with abilities that promote smaller and medium-sized the company's sustainability. This study is based on the incorporation of multiple research methodologies and reviews based on publication standards, specifically ROSES (Reporting Standards for Systematic Evidence Synthesis). To choose articles, two superior databases, Dimensions and Core, as well as one supporting database, Google Scholar, are used. This review has identified 14 major topics based on the thematic analysis used. With a concentration on expertise, abilities, and knowledge, this research project offers tremendously to our existing awareness of what factors are underlying the profitability of small and medium-sized enterprises. The discoveries highlight that relatively little study is currently conducted regarding employee expertise in businesses of all sizes, focuses on knowledge, skills, and abilities in performance. It additionally aids to clarify the integral part human capital competences serve towards enhancing the operational efficiency of medium- and small-sized companies.

The effect of bakuchiol in the skin aging process: A systematic review Authors

The effect of bakuchiol in the skin aging process: A systematic review Authors

RESERVE - REporting of SystEmatic ReViews in Ethics: development, explanations and examples

Background Systematic reviews (SR) are well elaborated and established for synthesizing statistical information, for example of clinical studies, for determining whether a clinical intervention is effective. SRs are also becoming more and more popular in bioethics. However, the established approach of conducting and reporting cannot be transferred to SRs on ethically sensible questions directly. This is because the object of investigation is not statistical information, but conceptual or normative information, e.g. ethical norms, principles, arguments or conclusions. There is evidence that the quality of reporting of SRs on ethics literature could be improved in many regards. Although insufficient reporting is not a problem specific to bioethics, as poorly reported manuscripts are also very common in SRs in e.g. medicine, authors of such SRs have the possibility to follow existing reporting guidelines (e.g. PRISMA). Method An international group of authors with years of experience in conducting and reviewing SRs on ethics literature developed a reporting guideline for this specific area of application (RESERVE). The relevant background was provided by two reporting guidelines: PRISMA for systematic reviews and ENTREQ due to the importance of qualitative research approaches. Results RESERVE has 22 items and is intended to provide authors of SRs on ethics literature with all information necessary for an adequate reporting. It also allows readers, reviewers and journal editors critically evaluating the presented results and conclusions made. In this paper, we explain the rationale and give examples for each item. Conclusions While we acknowledge heterogeneity on how to conduct a SR on ethics literature, we still maintain that there is a need for general reporting standards for improving transparency, understandability and verifiability. We invite authors of SRs on ethics literature to test and evaluate the usefulness of RESERVE. We hope for a critical discussion of the guideline and welcome its broad implementation.

Comparative evaluation of the clinical performance of conventional and extended depth of focus monofocal intraocular lenses (systematic review)

A systematic review was performed in PubMed using the following keywords monofocal IOLs, monofocal IOLs with extended depth of focus (sharpness), EDOF, cataract phacoemulsification, visual acuity, and quality of life. Studies were selected in accordance with the criteria for prospective or retrospective studies. In a comparative analysis of clinical efficacy, the results of binocular IOL implantation and lens material from the same manufacturer were analyzed as the main sources. In total, 234 studies were analyzed using systematic review filters and authors knowledge of the topic. The duration of the retrospective analysis was 8 years (20172023). A total of 234 papers were analyzed over the last 8 years (20172023), further using systematic review filters and the authors knowledge of the topic.&#x0D; Data obtained indicated that traditional monofocal IOLs acted like bifocal lenses because they formed two main focal points for far and near vision, which did not provide the required level of visual acuity at an intermediate distance. The basic optical principle of EDOF (extended depth of focus) was to create a focal point for distance vision and an elongated focal point to increase the depth of field near and at intermediate distances. The results of the literature analysis indicated that the use of EDOF (compared with monofocal IOL) was associated with a higher level of visual acuity at intermediate and near distances and comparable distance visual acuity and increased depth of field, which generally provides a more natural range of vision and less use of glasses. Light phenomena, spectacle independence, and patient satisfaction were comparable among EDOF types.&#x0D; Given the above advantages, EDOF implantation can be considered a variant of an individual approach to the selection of IOLs, taking into account the possibility of using it in patients whose professional activity is associated with long-term visual work at intermediate distances (e.g., users of personal computers). In the context of the role and place of EDOF in the general system of aphakia correction following cataract phacoemulsification, further accumulation of clinical material is necessary, taking into account the IOL model and patients professional visual activity level.

Machine Learning Methods for Systematic Reviews:: A Rapid Scoping Review.

At the forefront of machine learning research since its inception has been natural language processing, also known as text mining, referring to a wide range of statistical processes for analyzing textual data and retrieving information. In medical fields, text mining has made valuable contributions in unexpected ways, not least by synthesizing data from disparate biomedical studies. This rapid scoping review examines how machine learning methods for text mining can be implemented at the intersection of these disparate fields to improve the workflow and process of conducting systematic reviews in medical research and related academic disciplines. The primary research question that this investigation asked, "what impact does the use of machine learning have on the methods used by systematic review teams to carry out the systematic review process, such as the precision of search strategies, unbiased article selection or data abstraction and/or analysis for systematic reviews and other comprehensive review types of similar methodology?" A literature search was conducted by a medical librarian utilizing multiple databases, a grey literature search and handsearching of the literature. The search was completed on December 4, 2020. Handsearching was done on an ongoing basis with an end date of April 14, 2023. The search yielded 23,190 studies after duplicates were removed. As a result, 117 studies (1.70%) met eligibility criteria for inclusion in this rapid scoping review. There are several techniques and/or types of machine learning methods in development or that have already been fully developed to assist with the systematic review stages. Combined with human intelligence, these machine learning methods and tools provide promise for making the systematic review process more efficient, saving valuable time for systematic review authors, and increasing the speed in which evidence can be created and placed in the hands of decision makers and the public.

Global Mapping of Potentially Inappropriate Prescribing for Older Adults in Community Settings: An Umbrella Review.

Potentially inappropriate prescribing (PIP) is a major public health concern with several undesirable health consequences for older adults. In this overview, we aimed to map and gather information from existing literature to provide a better insight into the prevalence of PIP among community dwellers. Electronic databases were searched from their inception to April 2022. The quality of the included systematic reviews (SRs) was assessed using the assessment of multiple systematic reviews checklist. The degree of overlap within the SRs was also evaluated (2% overlap). All SRs on the prevalence of PIP in older individuals in community settings were included, and a narrative approach was used to synthesize data. Nineteen SRs comprising 548 primary studies met the inclusion criteria, and the average quality of the included SRs was moderate. More than half (50.5%) of the primary studies were conducted in Europe, followed by the United States (22.8%), and Asia (18.9%). Thirty different criteria were used in the primary studies to estimate the prevalence of PIP. The most widely used criteria were those presented in Beers (41.8%) and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) (21.8%) criteria. Benzodiazepines, nonsteroidal anti-inflammatory drugs, and antidepressants were the most frequently reported PIPs. A considerable variation in the prevalence of PIP ranging from 0% to 98% was reported by SRs. However, there is a high degree of uncertainty regarding the extent of PIP in community settings. To identify knowledge-to-action gaps, SR authors should consider the differences in prevalence of PIP according to settings, applied tools, data sources, geographical areas, and specific pathologies. There is also a need for primary and SR studies from low- and middle-income countries regarding the prevalence of PIP.

Modern aspects of diagnosis and treatment of subjective manifestations and accommodation disorders in patients — professional users of personal computers (systematic review)

A systematic review was performed in the RSCI and PubMed databases using the following keywords: Computer vision syndrome, Digital eye strain, Accommodation, Accommodative asthenopia, RTS, and Quality of life. Eligible articles were evaluated in accordance with the criteria for prospective or retrospective studies. A total of 792 sources were analyzed, further using systematic review filters and authors knowledge of the topic. The retrospective analysis spanned 7 years (20162022).&#x0D; Data indicated that accommodative asthenopia (AA), as a functional visual disorder, is a natural state of the accommodative system of the eye caused by long-term exposure to visually intense work on a personal computer. AA is characterized by a wide range of subjective manifestations (complaints) and indicators of the examination of the patients vision, associated primarily with objective accommodation. A differentiated approach to the diagnosis of various forms of AA, such as habitual excessive stress of accommodation and asthenic form of accommodative asthenopia, is important to provide adequate treatment based on methods with direct physical effects on the eye (such as low-energy laser radiation, magnetophoresis, and stimulation of accommodation), opto-reflex treatment, and an outpatient course as part of home training.

Current trends, barriers, and facilitators of use of core outcome sets in Cochrane systematic reviews: Protocol

Background: Core outcome sets (COS) represent agreed-upon minimum outcomes that should be reported in all studies in a given topic area. Cochrane reviews are considered among the most rigorously conducted systematic reviews (SRs). In 2019, seven of the first 100 published Cochrane SRs (7%) cited a COS in relation to choosing outcomes. A relevant COS existed but was not mentioned (or cited) for 27 of the remaining 93 SRs (29%). Among Cochrane Review Group editors surveyed in 2019, 86% felt that COS should definitely/possibly be used in Cochrane SRs. As of September 2019, the Cochrane Handbook recommends that SR teams consult resources that host relevant COS when choosing outcomes for the SR. Objectives: (1) Examine the extent to which authors are currently considering COS to inform outcome choice in Cochrane protocols and completed SRs. (2) Understand author barriers and facilitators of using COS in Cochrane protocols and completed SRs. Methods: We will examine the extent to which all Cochrane SRs published in the last 3 months of 2022 and all Cochrane protocols published in 2022: (a) cited a COS, (b) searched for COS, and (c) reported outcome inconsistency among included studies and/or noted the need for COS. One investigator will extract information from SRs and protocols; a second extractor will verify all information, discussing discrepancies to achieve consensus. Using Jisc Online Surveys®, we will conduct an online anonymous survey of authors of all the included completed SRs and protocols to assess author awareness of COS and identify barriers and facilitators of using COS to inform outcome choice. Discussion: This study will provide key information regarding uptake of COS by Cochrane SR authors and the barriers and facilitators that they experience. Our findings will inform approaches to increasing awareness and uptake of COS in future SRs, both with and beyond Cochrane.

Beyond statistical significance: nuanced interpretations of statistically nonsignificant results were rare in Cochrane reviews – a metaepidemiological study

ObjectivesTo assess the language used by systematic review authors to emphasize that statistically nonsignificant results show meaningful differences. To determine whether the magnitude of these treatment effects was distinct from nonsignificant results that authors interpreted as not different. Study Design and SettingWe screened Cochrane reviews published between 2017 and 2022 for statistically nonsignificant effect estimates that authors presented as meaningful differences. We classified interpretations qualitatively and assessed them quantitatively by calculating the areas under the curve of the portions of confidence intervals exceeding the null or a minimal important difference, indicating one intervention's greater effect. ResultsIn 2,337 reviews, we detected 139 cases where authors emphasized meaningful differences in nonsignificant results. Authors commonly used qualifying words to express uncertainty (66.9%). Sometimes (26.6%), they made absolute claims about one intervention's greater benefit or harm without acknowledging statistical uncertainty. The areas under the curve analyses indicated that some authors may overstate the importance of nonsignificant differences, whereas others may overlook meaningful differences in nonsignificant effect estimates. ConclusionNuanced interpretations of statistically nonsignificant results were rare in Cochrane reviews. Our study highlights the need for a more nuanced approach by systematic review authors when interpreting statistically nonsignificant effect estimates.

GRADE Reporting in Systematic Reviews Published in the Urological Literature (2009-2021).

To evaluate the reporting of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rating the certainty of evidence in systematic reviews (SRs) published in the urological literature. Based on a predefined protocol we identified all SRs published in 5 major urological journals from 1998 to 2021 that reported the use of GRADE. Two authors performed study selection and data abstraction independently to assess reporting in accordance with established criteria for applying GRADE. We included 68 of 522 (13.0%) SRs that reported the use of GRADE; the first was published in 2009. Approximately half were published between 2009-2018 (n=36) and the other half between 2019-2021 (n=32). Oncology (24; 35.3%) was the most common clinical topic and the authors were mostly based in Europe (34; 50%). In their abstract, less than half of all SRs (32; 47.1%) provided any certainty of evidence rating. Only 41 (60.3%) included a tabular result summary in the format of a summary of findings table (24; 35.3%) or evidence profile (17; 25.0%). Few (35.3%) addressed the GRADE certainty of evidence rating in the discussion section. Reporting did not improve over time when comparing the 2 time-periods. Whereas GRADE is increasingly being applied for rating the certainty of evidence, SRs published in the urological literature frequently have not followed established criteria for applying or using GRADE. There is a need for better training of authors and editors as well as for a GRADE reporting checklist for SR authors.

Effect of important modifiers on harmful effects in evidence synthesis practice of adverse events were insufficiently investigated: an empirical investigation

BackgroundSafety is important in the assessment of health interventions, while the results of adverse events are often susceptive to potential effect modifiers since the event risk tends to be rare. In this study, we investigated whether the potential impact of the important effect modifiers on harmful effects was analyzed in meta-analyses of adverse events.MethodsSystematic reviews of healthcare interventions, had adverse events as the exclusive outcomes, had at least one meta-analysis, and published between 1st January 2015, and 1st January 2020 were collected. An adverse event was defined as any untoward medical occurrence in a patient or subject in healthcare practice. Six effect modifiers that are the most important for harmful effects were identified by a group discussion. The proportions of eligible systematic reviews that investigated the potential impact of the six effect modifiers on harmful effects were summarized.ResultsWe identified 279 systematic reviews eligible for this study. Except for the modifier of interventions/controls (70.61%, 197/279), most of the systematic reviews failed to investigate the potential impact of treatment duration (21.15%, 59/279), dosage (24.73%, 69/279), age (11.47%, 32/279), risk of bias (6.45%, 18/279), and source of funding (1.08%, 3/279) on harmful effects. Systematic reviews with meta-analyses containing more studies were more likely to investigate the potential impacts of these modifiers on the effects, but the proportion was still low (2.3% to 33.3%). Systematic reviews that developed a protocol were significantly more likely to investigate the potential impact of all these effect modifiers (e.g. treatment duration: odds ratio = 5.08, 95% CI: 2.76 to 9.35) on the results.ConclusionsCurrent systematic reviews rarely investigated the potential impact of the important effect modifiers on harmful effects. Methodological guidelines for meta-analysis of adverse events should consider “effect modifier” as one of the domains to help systematic review authors better investigate harmful effects.

MP25-02 POOR METHODOLOGICAL QUALITY OF SYSTEMATIC REVIEWS PUBLISHED IN THE UROLOGICAL LITERATURE

You have accessJournal of UrologyCME1 Apr 2023MP25-02 POOR METHODOLOGICAL QUALITY OF SYSTEMATIC REVIEWS PUBLISHED IN THE UROLOGICAL LITERATURE Maylynn Ding, Jared Johnson, Gustavo Ariel Alvez, and Philipp Dahm Maylynn DingMaylynn Ding More articles by this author , Jared JohnsonJared Johnson More articles by this author , Gustavo Ariel AlvezGustavo Ariel Alvez More articles by this author , and Philipp DahmPhilipp Dahm More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Large number of systematic reviews (SRs) are published each year. While often of poor methodological quality, they are placed at the top of the ‘hierarchy of evidence’ and frequently cited. We performed this study to provide a longitudinal analysis of the methodological quality of SRs published in major urology journals over a 6-year time-period (2016-2021). METHODS: We systematically searched and analyzed all SRs related to questions of therapy or prevention published in the five major urology journals (European Urology, Journal of Urology, BJU International, Urology and World Journal of Urology). Three independent reviewers working in pairs selected eligible studies and abstracted the data in duplicate. We used the updated Assessment of Multiple Systematic Reviews (AMSTAR-2) instrument to assess SR quality. We performed pre-planned statistical hypothesis testing by time-period and journal of publication in SPSS Version 27.0. RESULTS: After screening 740 references (latest search date: 3/25/2022) we included 258 SRs of which 144 (55.8%) were published from 2016-2018 and 114 (44.2%) from 2019-2021. The main contributors were European Urology (30.2%), World Journal of Urology (22.1%) and Urology (20.5%). The most frequent topic by far was oncology (45.3%), followed by voiding dysfunction (20.5%) and infection/inflammation (8.9%). Overall, 2.3%, 3.5%, 18.6% and 75.6% of SRs had high, moderate, low, or critically low confidence ratings, respectively. ‘Justification for excluding individual studies’ and ‘protocol registered before commencement of the review’ were the main critical AMSTAR-2 criteria not met by 89.1% and 53.5% of SRs, respectively. Comparing time-periods 2016-2018 to 2019-2021, the proportion of SRs with high/moderate ratings did not increase (4.9% versus 6.1%; p = 0.481). The proportion of high/moderate quality reviews was highest for BJU International (15.4%) followed by Journal of Urology (9.7%), World Journal of Urology (5.3%), Urology (1.9%) and European Urology (1.3%; p = 0.030). CONCLUSIONS: Most SRs published in the urological literature continue to have serious methodological limitations and cannot be relied upon. There is a critical need for raising greater awareness among SR authors, editors, and consumers of the urological literature about established standards for high-quality SRs in order to improve their future quality. Source of Funding: Departmental © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e342 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maylynn Ding More articles by this author Jared Johnson More articles by this author Gustavo Ariel Alvez More articles by this author Philipp Dahm More articles by this author Expand All Advertisement PDF downloadLoading ...

Nonpublication and Selective Outcome Reporting of Oral Health Trials

Less than one-quarter of oral health trials are registered in a public registry. However, no study has assessed the extent of study publication and selective outcome reporting bias in the field of oral health. We identified oral health trials registered between 2006 and 2016 in ClinicalTrials.gov. We assessed whether results of early discontinued trials, trials having an unknown status, and completed trials had been published and, among published trials, whether outcomes differed between the registered record and the corresponding publication. We included 1,399 trials, of which 81 (5.8%) were discontinued, 247 (17.7%) had an unknown status, and 1,071 (76.6%) were completed. The registration was prospective for 719 (51.9%) trials. Over half the registered trials were unpublished (n = 793, 56.7%). To explore the association between trials publication and characteristics of trials, we performed a multivariate logistic regression analysis. Trials conducted in the United States (P = 0.003) or Brazil (P < 0.001) were associated with increased odds of publication, whereas trials registered prospectively (P = 0.001) and industry-sponsored trials (P = 0.02) were associated with decreased odds. Among the 479 published trials with completed status, the primary outcomes of 215 (44.9%) articles differed from that registered. Major discrepancies consisted of the introduction of a new primary outcome in the published article (196 [91.2%]) and the transformation of a registered secondary outcome into a primary outcome (112 [52.1%]). In the remaining 264 (55.1%) trials, primary outcomes did not differ from that registered, but 141 (53.4%) had been registered retrospectively. Our study highlights the high rate of nonpublication and selective outcome reporting in the field of oral health. These results could alert sponsors, funders, authors of systematic reviews, and the oral health research community at large to combat the nondisclosure of trial results.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Evaluation of the use of GRADE in dentistry systematic reviews and its impact on conclusions: a protocol for a methodological study

BackgroundThere is a growing body of evidence of systematic reviews (SRs) with varying degrees of methodological quality. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach allows SR authors to assess the certainty of the evidence they found and transparently relay their conclusions. As there appears to be infrequent utilization of GRADE in the field of dentistry, to identify the impact of GRADE, the aim of this study is to evaluate the use of GRADE in the dental literature and determine whether SRs that use GRADE differ from those that do not with respect to their conclusions.Methods/designWe will search Ovid MEDLINE for SRs published from 2016 to the present. We will conduct both screening and data extraction independently and in duplicate and use pre-piloted, standardized forms for data extraction. We will determine the frequency of the use of GRADE and the varying levels of certainty in the current literature and evaluate whether GRADE is being used appropriately. We will also evaluate whether SRs not using GRADE differ from those that use GRADE with regard to methodological quality. We will also determine whether the conclusions of SRs that do not use GRADE would change had GRADE been utilized. Additionally, we will evaluate whether SRs using GRADE are more likely to formulate appropriate conclusions compared to SRs that do not use it.DiscussionThis study will investigate the frequency of GRADE assessments in dentistry SRs and the impact of GRADE assessments on the conclusions of a SR. It has important implications for both SR authors and users of this type of literature.

GRADE guidance 36: updates to GRADE's approach to addressing inconsistency

ObjectivesTo update previous Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance by addressing inconsistencies and interpreting subgroup analyses. Study Design and SettingUsing an iterative process, we consulted with members of the GRADE working group through multiple rounds of written feedback and discussions at GRADE working group meetings. ResultsThe guidance complements previous guidance with clarification in two areas: (1) assessing inconsistency and (2) assessing the credibility of possible effect modifiers that might explain inconsistency. Specifically, the guidance clarifies that inconsistency refers to variability in results, not in study characteristics; that inconsistency assessment for binary outcomes requires consideration of both relative and absolute effects; how to decide between narrower and broader questions in systematic reviews and guidelines; that, with the same evidence, ratings of inconsistency may differ depending on the target of certainty rating; and how GRADE inconsistency ratings relate to a statistical measure of inconsistency I2 depending on the context in which one views results. The second part of the guidance illustrates, based on a worked example, the use of the instrument to assess the credibility of effect modification analyses. The guidance explains the stepwise process of moving from a subgroup analysis to assessing the credibility of effect modification and, if found credible, to subgroup-specific effect estimates and GRADE certainty ratings. ConclusionThis updated guidance addresses specific conceptual and practical issues that systematic review authors frequently face when considering the degree of inconsistency in estimates of treatment effects across studies.

Sickening: who is protecting pharma consumers?

In 2022, John Abramson published Sickening: How Big Pharma Broke American Healthcare and How We Can Repair It. The book illustrates how large pharmaceutical companies have become misinformation machines that have corrupted peer-reviewed journals, systematic review authors, and guideline committees. Industry influence includes selective reporting of clinical trial results and selection of control groups likely to enhance benefits and disguise side effects. Other documented forms of influence include clear conflicts of interest for members of guideline committees and even direct intimidation. The book concludes with a series of implementable reforms, such as ensuring the accuracy and completeness of evidence, developing an independent National Health Board, designing clinical research to optimize health outcomes, requiring the posting of research data so that independent scholars can replicate analyses, and ensuring the accuracy of direct consumer advertising. Abramson's book is a must read for students of medicine, public health, and public policy.