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Background: Because industry influence – in the form of study sponsorship and authorial conflicts of interest (COI) – can bias the results and conclusions of systematic reviews, there is a need to understand their role in systematic reviews, particularly for common conditions like psoriasis. Objectives: This study identifies conflicts of interest and industry-author relationships in systematic reviews on psoriasis treatment. Methods: Consistent with our cross-sectional design, we searched MEDLINE and Embase for systematic reviews and meta-analyses focused on psoriasis treatment. We then performed a subgroup analysis to determine further industry ties within the systemic reviews funded by industry. Results: Our study consisted of 27 systematic reviews and meta-analyses by 146 researchers. We found that 22 (81.5%) of the included systematic reviews contained at least 1 conflicted author. Six authors (of 47; 4.1%) disclosed all COI within the systematic review, 23 (of 47; 15.7%) partially disclosed COI but were also found to have undisclosed COI, and 18 (of 47; 12.3%) did not disclose any COI. Thirteen (of 22; 59.1%) contained narratives that favored the treatment group and 19 (of 22; 86.4%) reported conclusions favoring the treatment group. Importantly, 3 systematic reviews were industry-sponsored. In terms of our subgroup analysis, we found several additional industry ties within the primary studies. Conclusion: Our study calls attention to conflicts of interest, industry sponsorship, and their influence on research outcomes in systematic reviews and meta-analyses. Further, we provide examples of how specific industry ties can influence systematic reviews and recommendations for reporting.

Purpose To determine how changing the P value threshold of statistical significance from .05 to .005 could affect the statistical significance of findings in previously published orthopaedic sports medicine randomized controlled trials (RCTs). Methods The authors searched PubMed from January 1, 2016, to December 31, 2017, for RCTs published in the American Journal of Sports Medicine, Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy. Data were extracted blinded and in duplicate fashion by 2 of us. The authors then extracted P value data for primary end points, since RCTs are most often powered for these end points. Discrepancies were resolved by consensus. Google Forms were used for data extraction and STATA 15.1 for the data analysis. Results In total, 275 primary end points were identified from 132 trials. Analysis of primary end points found 45.8% (126/275) had a P value less than .05 and were classified as statistically significant under the current threshold, whereas 54.2% (149/275) had a P value greater than .05 and were not classified as suggestive. Of those end points that were previously considered statistically significant, 38.9% (49/126) were less than .005, whereas 61.1% (77/126) were between .005 and .05 and thereby would be reclassified as suggestive rather than statistically significant under the proposed threshold. Overall, when analyzing the 275 primary end points, we found only 49 (17.8%) of the end points were less than .005 and would hold statistical significance with the proposed threshold. Conclusions The results suggest that if the threshold of statistical significance were to change to .005, the significance of orthopaedic sports medicine RCTs would be heavily altered. The authors also acknowledge the many issues research faces in regard to P value reliability and therefore interpretation of study results. Because P values from RCTs can often influence the ways physicians choose interventions, it is important to implement methodology that decreases incidence of bias and misrepresentation of these results. However, the authors also understand that lowering the P value could increase the needed sample size and by consequence increase study costs as well, while not directly correlating to clinical significance. Thus, the authors recommend that this proposed threshold should be further evaluated and cautiously interpreted. Clinical Relevance If the statistical significance threshold is changed, clinical practice guideline recommendations also may be affected.

Background Results from systematic reviews and meta-analyses, which have the highest level of evidence (Level I), often drive clinical decision-making and health policy. Often, unpublished trial data are omitted from systematic reviews, raising concerns about the extent of the reliability and validity of results that have been drawn from systematic reviews. We aimed to determine the extent to which systematic review authors include searches of clinical trial registries for unpublished data when conducting systematic reviews in orthopaedic surgery. Methods Systematic reviews and/or meta-analyses were gathered from the top 5 orthopaedic surgery journals based on the h5-index from Google Scholar Metrics. Systematic reviews that had been published in the Cochrane Database of Systematic Reviews, which requires the inclusion of a clinical trial registry search, served as controls. For the primary outcome, each systematic review from the top 5 orthopaedic journals was screened to determine whether the authors of each study searched for unpublished data in clinical trial registries. We then compared the rate of registry searches with those in the control group. For the secondary analysis, a search of ClinicalTrials.gov was performed for unpublished trial data for 100 randomized systematic reviews. Results All 38 of the Cochrane systematic reviews (100%) included clinical trial registry searches, while the top 5 orthopaedic journals had only 31 of 480 studies (6.5%) that looked at clinical trial registries. The secondary analysis yielded 59 of 100 systematic review articles (59.0%) that could have included unpublished clinical trial data from ≥1 studies to their sample. Conclusions Systematic reviews that have been published in the top orthopaedic surgery journals seldom included a search for unpublished clinical trial data. Clinical relevance The exclusion of clinical trial registry searches potentially contributes to publication bias within the orthopaedic literature. Moving forward, systematic review authors should include clinical trial registry searches for unpublished clinical trial data to provide the most accurate representation of the available evidence for systematic reviews and meta-analyses.

We retrospectively analysed the relative search interest of malaria to (1) assess the relationship between Internet searches for malaria and rates of infection in 11 countries considered 'high burden' by WHO in 2019 and to (2) determine the ability of World Malaria Day on April 25 to generate interest in the disease.Using Google Trends, we sought to determine the relative popularity of the topic of Malaria over 4 years (2015-2019). Worldwide and country-specific searches for 'malaria' were used to assess the influence the international awareness day has on global and local interest in malaria. In order to determine whether a relationship exists between Internet searches and the disease burden of malaria, the information gathered from Google Trends was then compared with reports of morbidity and mortality of malaria from the 2019 World Malaria Report.Globally, a negative mean difference in relative search volume was observed between World Malaria Day and the control periods of -2.46 (95% CI: -5.57 to 0.66). The relative search volume for malaria-related search terms increased by 2.91% (±4.60) from January 2015 to 1 July 2019 in the 5 countries with the highest malaria disease burden. A positive correlation (r = 0.804) was found between per capita infections and malaria Internet search interest in addition to deaths per 1000 residents and malaria relative search interest (r = 0.663) between 2015 and 2018.Initiatives such as World Malaria Day may help raise public awareness concerning a specific disease, prompting individuals to seek out additional information. This is especially important in high-burden countries where access to the Internet is steadily growing. In these circumstances, having quality and easily accessible information is vital in the continuing fight against malaria.Nous avons analysé rétrospectivement l'intérêt de recherche relatif du paludisme pour (1) évaluer la relation entre les recherches sur Internet pour le paludisme et les taux d'infection dans 11 pays considérés comme «à forte charge» par l'OMS en 2019 et pour (2) déterminer la capacité de la Journée Mondiale contre le Paludisme, le 25 avril à susciter l'intérêt pour la maladie. MÉTHODES: A l'aide de Google Trends, nous avons cherché à déterminer la popularité relative du thème du paludisme sur 4 ans (2015-2019). Des recherches mondiales et spécifiques aux pays pour le «paludisme» ont été utilisées pour évaluer l'influence de la journée internationale de sensibilisation sur l'intérêt mondial et local pour le paludisme. Afin de déterminer s'il existe une relation entre les recherches sur Internet et la charge de morbidité du paludisme, les informations recueillies à partir de Google Trends ont ensuite été comparées aux rapports sur la morbidité et la mortalité du paludisme du Rapport Mondial sur le Paludisme 2019. RÉSULTATS: Globalement, une différence moyenne négative du volume de recherche relative a été observée entre la Journée Mondiale contre le Paludisme et les périodes témoins de -2,46 (IC95%: -5,57 à 0,66). Le volume de recherche relatif pour les termes de recherche liés au paludisme a augmenté de 2,91% (± 4,60) de janvier 2015 au 1er juillet 2019 dans les 5 pays où la charge de morbidité du paludisme est la plus élevée. Une corrélation positive (r = 0,804) a été trouvée entre les infections par habitant et l'intérêt de la recherche sur le paludisme sur Internet en plus des décès pour 1000 habitants et l'intérêt de la recherche relative du paludisme (r = 0,663) entre 2015 et 2018.Des initiatives telles que la Journée Mondiale contre le Paludisme peuvent contribuer à sensibiliser le public à une maladie spécifique, incitant les individus à rechercher des informations supplémentaires. Ceci est particulièrement important dans les pays à forte charge où l'accès à Internet est en constante augmentation. Dans ces circonstances, il est essentiel de disposer d'informations de qualité et facilement accessibles pour la lutte continue contre le paludisme.

Importance Randomized clinical trials (RCTs) play an important role in clinical decision-making, and discontinuation or nonpublication of these trials are causes of great concern. The extent of discontinued or unpublished RCTs about head and neck cancer remains unclear. Objective To assess the rate of discontinuation or nonpublication of RCTs involving patients with head and neck cancer. This objective was measured by observing 3 domains: discontinuation of trial, nonpublication of trial data, and feasibility of contacting trial investigators of aforementioned trials. Evidence Review For this study, the sample was derived using the ClinicalTrials.gov advanced search feature on March 18, 2019, to locate completed and discontinued RCTs pertaining to head and neck cancer registered before this date. Trials were analyzed to identify reasons for trial discontinuation and publication status of each trial. If publication status or reason for trial discontinuation was not allocated through the systematic search of ClinicalTrials.gov, the corresponding author was emailed to determine publication status. Findings After exclusions, 130 RCTs were included. Of these trials, 92 (70.8%) were completed and 38 (29.2%) were discontinued for various reasons. The most common reason for discontinuation of trials was committee recommendations. Of the 130 analyzed trials, 67 (51.5%) were published in a peer-reviewed journal and 63 (48.5%) were unpublished trials. Of the 92 completed trials, 55 (59.8%) were published and 37 (40.2%) remained unpublished 3 or more years after trial completion. Trials funded by other sources (private, nonprofit, or the National Institutes of Health) were more likely to reach publication than industry-funded RCTs (unadjusted odds ratio, 4.3 [95% CI, 1.3-14.0]; adjusted odds ratio, 4.1 [95% CI, 1.2-14.3]). Conclusions and Relevance Of RCTs in head and neck cancer, 29.2% were discontinued and 40.2% completed trials never reached publication. The findings suggest that needs exist for RCT guidance of head and neck cancer. The reporting of reasons for trial discontinuation appears to be lacking, and trial publication rates were low. This study is relevant to many physicians and researchers because it identifies potential sources of decreased research productivity and ethics.

Background Previous studies have highlighted the potential influence that industry relationships may have on the outcomes of medical research. Objective We aimed to determine the prevalence of author conflicts of interest (COIs) in systematic reviews focusing on melanoma interventions, as well as to determine whether the presence of these COIs were associated with an increased likelihood of reporting favorable results and conclusions. Methods This cross-sectional study included systematic reviews with or without meta-analyses focusing on interventions for melanoma. We searched MEDLINE and Embase for eligible systematic reviews published between September 1, 2016, and June 2, 2020. COI disclosures were cross-referenced with information from the CMS (Centers for Medicare & Medicaid Services) Open Payments database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office, and previously published COI disclosure statements. Results were quantified using descriptive statistics, and relationships were evaluated by Fisher exact tests. Results Of the 23 systematic reviews included in our sample, 12 (52%) had at least one author with a COI. Of these 12 reviews, 7 (58%) reported narrative results favoring the treatment group and 9 (75%) reported conclusions favoring the treatment group. Of the 11 systematic reviews without a conflicted author, 4 (36%) reported results favoring the treatment group and 5 (45%) reported conclusions favoring the treatment group. We found no significant association between the presence of author COIs and the favorability of results (P=.53) or conclusions (P=.15). Conclusions Author COIs did not appear to influence the outcomes of systematic reviews regarding melanoma interventions. Clinicians and other readers of dermatology literature should be cognizant of the influence that industry may have on the nature of reported outcomes, including those from systematic reviews and meta-analyses.

Background: The primary aim of our study was to evaluate the effects of undisclosed financial conflicts of interest in Achilles tendon rupture repair–focused systematic reviews. Methods: Following a cross-sectional study design, we searched MEDLINE and Embase for Achilles tendon rupture repair systematic reviews. We performed screening and data extraction in a blind, triplicate fashion. Each systematic review was evaluated on the individual characteristics of the study, presence of undisclosed and disclosed conflicts of interest, favorability of results and conclusions, and the relationship between conflicts of interest and the favorability of results and conclusions. Results: Our search produced 172 total systematic reviews pertaining to Achilles tendon rupture repair; of those, only 12 were included in our study. Undisclosed conflicts of interest were found in half (6/12) of the included reviews. However, no significant association was found between conflict of interest and the favorability of results and conclusions. Conclusion: Undisclosed conflicts of interests were discovered in a large percentage of our sample. This lack of disclosure did not appear to increase the likelihood of the systematic review results or conclusions reporting favorability of the intervention being investigated. Level of Evidence: Level II.

Background Spin is the misrepresentation of study findings, which may positively or negatively influence the reader’s interpretation of the results. Little is known regarding the prevalence of spin in abstracts of systematic reviews, specifically systematic reviews pertaining to the management and treatment of acne vulgaris. Objective The primary objective of this study was to characterize and determine the frequency of the most severe forms of spin in systematic review abstracts and to evaluate whether various study characteristics were associated with spin. Methods Using a cross-sectional study design, we searched PubMed and EMBASE for systematic reviews focusing on the management and treatment of acne vulgaris. Our search returned 316 studies, of which 36 were included in our final sample. To be included, each systematic review must have addressed either pharmacologic or nonpharmacologic treatment of acne vulgaris. These studies were screened, and data were extracted in duplicate by two blinded investigators. We analyzed systematic review abstracts for the nine most severe types of spin. Results Spin was present in 31% (11/36) of abstracts. A total of 12 examples of spin were identified in the 11 abstracts containing spin, with one abstract containing two instances of spin. The most common type of spin, selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention, was identified five times (5/12, 42%). A total of 44% (16/36) of studies did not report a risk of bias assessment. Of the 11 abstracts containing spin, six abstracts (55%) had not reported a risk of bias assessment or performed a risk of bias assessment but did not discuss it. Spin in abstracts was not significantly associated with a specific intervention type, funding source, or journal impact factor. Conclusions Spin is present in the abstracts of systematic reviews and meta-analyses covering the treatment of acne vulgaris. This paper raises awareness of spin in abstracts and emphasizes the importance of its recognition, which may lead to fewer incidences of spin in future studies.

Background Reproducible research is a foundational component for scientific advancements, yet little is known regarding the extent of reproducible research within the dermatology literature. Objective This study aimed to determine the quality and transparency of the literature in dermatology journals by evaluating for the presence of 8 indicators of reproducible and transparent research practices. Methods By implementing a cross-sectional study design, we conducted an advanced search of publications in dermatology journals from the National Library of Medicine catalog. Our search included articles published between January 1, 2014, and December 31, 2018. After generating a list of eligible dermatology publications, we then searched for full text PDF versions by using Open Access Button, Google Scholar, and PubMed. Publications were analyzed for 8 indicators of reproducibility and transparency—availability of materials, data, analysis scripts, protocol, preregistration, conflict of interest statement, funding statement, and open access—using a pilot-tested Google Form. Results After exclusion, 127 studies with empirical data were included in our analysis. Certain indicators were more poorly reported than others. We found that most publications (113, 88.9%) did not provide unmodified, raw data used to make computations, 124 (97.6%) failed to make the complete protocol available, and 126 (99.2%) did not include step-by-step analysis scripts. Conclusions Our sample of studies published in dermatology journals do not appear to include sufficient detail to be accurately and successfully reproduced in their entirety. Solutions to increase the quality, reproducibility, and transparency of dermatology research are warranted. More robust reporting of key methodological details, open data sharing, and stricter standards journals impose on authors regarding disclosure of study materials might help to better the climate of reproducible research in dermatology.