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Context: Clinical practice guidelines (CPGs) are vital to establishing a standardized and evidence-based approach in medicine. These guidelines rely on the use of methodologically sound clinical trials, and the subsequent reporting of their methodology. Objective: To evaluate the completeness of randomized controlled trials (RCTs) underpinning CPGs published by the American Academy of Orthopedic Surgeons (AAOS) for management of osteoarthritis of the knee. Data Sources: We searched the most recent AAOS CPGs for surgical and nonsurgical management of osteoarthritis of the knee for RCTs. To estimate the necessary sample size, we performed a power analysis using OpenEpi 3.0 ( openepi.com ). Study Selection: Two authors independently screened the reference sections of the included CPGs. Included studies met the definition of an RCT, were retrievable in the English language, and were cited in at least one of the included CPGs. Study Design: Meta-Analysis Level of Evidence: Level 1a Data Extraction: We performed double-blind screening and extraction of RCTs included in the AAOS CPGs. We evaluated each RCT for adherence to the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. A multiple regression analysis was conducted to assess CONSORT adherence against characteristics of included studies (ie, type of intervention, funding source, etc). Results: Our study included 179 RCTs. The overall adherence was 68.5% with significant differences between those published before and since the development of the 2010 CONSORT guidelines ( P = 0.02). We found that RCTs receiving funding from industry/private sources as well as studies that included a conflict of interest statement showed more completeness than RCTs that reported receiving no funding ( P < 0.01). Conclusion: We found suboptimal CONSORT adherence for RCTs cited in AAOS CGPs for management of osteoarthritis of the knee. Therefore, the CPGs are likely supported by outdated evidence and lack of high-quality reporting. It is important that evidence used to guide clinical decision making be of the highest quality in order to optimize patient outcomes. In order for clinicians to confer the greatest benefits to their patients, CPGs should provide the totality of evidence and emphasize emerging high-quality RCTs to ensure up-to-date, evidence-based clinical decision-making.

BACKGROUND Randomized control trials (RCTs) serve as evidentiary support for recommendations underpinning clinical practice guidelines (CPGs) with the goal of optimizing patient care. A knowledge gap exists within scientific literature when evaluating the quality of RCTs used as evidence in the American Academy of Orthopaedic Surgery (AAOS) pediatric CPGs. We aim to evaluate the reporting quality and risk of bias in RCTs underlying AAOS Pediatric CPG recommendations. METHODS We located all AAOS Pediatric CPGs. We then extracted all RCTs from the CPG reference sections. All included RCTs were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) checklist and Cochrane Collaboration risk of bias assessment tool (RoB 2.0). Descriptive statistics were recorded, and bivariate analysis was used to account for variance in CONSORT scores. A Mann-Whitney U test was completed to compare CONSORT studies published before and after 2010. RESULTS Three CPGs and 23 RCTs met inclusion criteria. Mean CONSORT adherence was 69.8% (21.6/31). The lowest adhered to CONSORT items were 10, 23, and 24, while items 2a, 13a, and 18 displayed the highest adherence. Ten RCTs (43.5%, 10/23) had "low" risk of bias, 5 RCTs (21.7%, 5/23) were of "some concerns," and 8 RCTs (34.8%, 8/23) received a "high" designation for risk of bias. There were no statistically significant associations in the bivariate regression analysis or Mann-Whitney U test. CONCLUSIONS Our results suggest that CONSORT adherence within RCTs used as evidence in AAOS Pediatric CPGs is substandard-relying on evidence that, in some cases, is >20 years old. Many of the RCTs cited as supporting evidence have a "high" risk of bias. Altogether, these CPGs may need to be updated or expanded to include more recent evidence relevant to pediatric orthopaedic surgery.

BACKGROUND Clinical practice guidelines inform evidence-based decision making in the clinical setting; however, systematic reviews which inform these clinical practice guidelines may vary in terms of reporting and methodological quality, which affects confidence in summary effect estimates. OBJECTIVE Our objective was to appraise the methodological and reporting quality of the systematic reviews used in clinical practice guidelines for cutaneous melanoma and evaluate differences in these outcomes between Cochrane and non-Cochrane reviews. METHODS We conducted a cross-sectional analysis by searching PubMed for cutaneous melanoma guidelines published between the dates of January 1, 2015 and May, 21 2021. Next, we extracted systematic reviews composing these guidelines and appraised their reporting and methodological rigor using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) checklists. Lastly, we compared these outcomes between Cochrane and non-Cochrane systematic reviews. All screening and data extraction occurred in a masked, duplicate fashion. RESULTS Of the systematic reviews appraised, the mean completion rate for the PRISMA checklist was 66.5% (SD=12.29) and 44.55% (SD=21.05) for AMSTAR-2. The majority of systematic reviews were of critically low methodological quality, with no systematic reviews being appraised as high quality. There was a statistically significant association between AMSTAR-2 and PRISMA checklists. Cochrane systematic reviews had higher PRISMA mean completion rates and higher methodological quality than non-Cochrane systematic reviews. CONCLUSIONS Systematic reviews supporting clinical practice guidelines focused on the management of cutaneous melanoma vary in reporting and methodological quality, with the majority of systematic reviews being of low quality. Increasing adherence to PRISMA and AMSTAR-2 checks will likely increase the quality of systematic reviews, thereby increasing the level of evidence supporting cutaneous melanoma clinical practice guidelines.

Context Person first language (PFL) – a way of referring to individuals with medical conditions or disability that emphasizes the person over their condition or disability – is important in reducing the stigma surrounding individuals who exhibit drug-seeking behavior. Drug-seeking behavior is generally associated with a negative connotation by healthcare professionals, which may create poor provider perceptions of these individuals and potentially impact patient care. Therefore, to reduce stigmatization surrounding drug-seeking behavior and to improve patient care in these individuals, the use of PFL should be promoted. Objectives The primary objective of this study is to investigate how frequently research articles focused on drug-seeking behavior adhere to PFL. Methods We performed a cross-sectional analysis systematically searching PubMed for articles published between May 1, 2011, and April 30, 2020, focused on drug-seeking behavior. To be included, the article must have met the following criteria: (1) published in a peer-reviewed journal; (2) relevant to drug-seeking behavior; and (3) must include human subjects and be retrievable in English. All articles were screened and data were extracted independently in a masked, duplicate fashion. Each article was reviewed for 19 predefined non-PFL terms with certain terms adopted from the American Medical Association Manual of Style. Results Our search returned 699 articles related to drug-seeking behavior, of which 390 articles met inclusion criteria and were analyzed for non-PFL. Our analysis found only 13.6% (53/390) of articles adhered to PFL while 86.4% (337/390) of articles contained at least some form of non-PFL. There was no association between PFL adherence and extracted study characteristics. Conclusions PFL adherence is uncommon among research literature focused on drug-seeking behavior. The power of language can be profound, and should be understood by researchers, health care providers, and educators alike, specifically when dealing with known and exhibited characteristics of substance use disorders. This is relevant because of the high prevalence of substance use disorders, limited amount of prior research, and the impact stigma has on patients and healthcare providers.

Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education—one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM’s report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.

Context Robust methodology and ethical reporting are paramount for quality scientific research, but recently, that quality in addiction research has been questioned. Avenues to improve such research quality include adherence to reporting guidelines and proper usage of clinical trial registries. Reporting guidelines and clinical trial registries have been shown to lead researchers to more ethical and transparent methodology. Objectives To investigate the reporting guideline and clinical trial registration policies of addiction research journals and identify areas of improvement. Methods We used Google Scholar Metrics’ h-5 index to identify the top 20 addiction research journals. We then examined the instructions for authors from each journal to identify whether they required, recommended, or made no mention of trial registration and reporting guidelines, including the Consolidated Standards of Reporting Trials (CONSORT), Meta-Analysis of Observational Studies in Epidemiology (MOOSE), Quality of Reporting of Meta-analyses (QUOROM), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Standards for Reporting Diagnostic Accuracy Studies (STARD), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Animal Research: Reporting of In Vivo Experiments (ARRIVE), Case Reports (CARE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Standards for Reporting Qualitative Research (SRQR), Standards for Quality Improvement Reporting Excellence (SQUIRE), Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), Consolidated Criteria for Reporting Qualitative Research (COREQ), Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and the International Committee of Medical Journal Editors (ICMJE) guidelines. We performed the same analysis regarding requirements for clinical trial registration. Results Of the 20 journals included in this study, 10 journals (50%) did not require adherence to any reporting guidelines. Trial registration followed a similar trend; 15 journals (75%) did not mention any form of trial or systematic review registration, and ClinicalTrials.gov was only recommended by only 1 journal (5%). Conclusions Among top addiction medicine journals, required adherence to reporting guidelines and clinical trial registry policies remains substandard. A step toward fulfilling the National Institute on Drug Abuses’ call for improvement in transparency and reproducibility within addiction research should include all journals adopting a strict reporting guideline and clinical trial registry adherence policy.

Thunberg's increased media attention coupled with her diagnosis-Asperger Syndrome (AS)-may foster help-seeking behaviors among those with similar psychiatric disorders. Using Google Trends data, we compared values of AS from the week of the UN Climate Summit through the end of the year compared to an ARIMA model predicting search interest had Thunberg not been in the media. The search trend for AS at peak was 254.07% higher than predicted and was on average 10.61 points above the projected model during this time. As the primary goal of AS intervention focuses on improving quality of life and preventing common comorbidities such as depression and anxiety, capitalizing on increased public interest in AS and help-seeking behaviors is imperative.

Background The objective of this study was to evaluate the nature and extent of reproducible and transparent research practices in neurology publications. Methods The NLM catalog was used to identify MEDLINE-indexed neurology journals. A PubMed search of these journals was conducted to retrieve publications over a 5-year period from 2014 to 2018. A random sample of publications was extracted. Two authors conducted data extraction in a blinded, duplicate fashion using a pilot-tested Google form. This form prompted data extractors to determine whether publications provided access to items such as study materials, raw data, analysis scripts, and protocols. In addition, we determined if the publication was included in a replication study or systematic review, was preregistered, had a conflict of interest declaration, specified funding sources, and was open access. Results Our search identified 223,932 publications meeting the inclusion criteria, from which 400 were randomly sampled. Only 389 articles were accessible, yielding 271 publications with empirical data for analysis. Our results indicate that 9.4% provided access to materials, 9.2% provided access to raw data, 0.7% provided access to the analysis scripts, 0.7% linked the protocol, and 3.7% were preregistered. A third of sampled publications lacked funding or conflict of interest statements. No publications from our sample were included in replication studies, but a fifth were cited in a systematic review or meta-analysis. Conclusions Currently, published neurology research does not consistently provide information needed for reproducibility. The implications of poor research reporting can both affect patient care and increase research waste. Collaborative intervention by authors, peer reviewers, journals, and funding sources is needed to mitigate this problem.

BACKGROUND/OBJECTIVE: Given the drastic increase in publication output in recent years, minimizing research waste should be a top priority. There are established areas of concern regarding research waste within ophthalmology along with a lack of systematic review usage to inform trial design in other areas of medicine. Given these concerns, the aim of this study is to evaluate the use of systematic reviews as justification for conducting randomized controlled trials (RCT) in top ophthalmology and optometry journals. METHODS: We searched PubMed on December 5, 2018 for RCTs published in one of the top five Google Scholar h-5 index journals within Ophthalmology and Optometry. We used a pilot-tested Google Form and searched each RCT for systematic reviews. Each systematic review was then given the designation of “verbatim”, “inferred”, or “not used as justification for conducting the RCT” based on the context the systematic review was used. RESULTS: Our analysis yielded 152 included phase III RCTs. We found 22.4% (34 of 152) of phase III ophthalmology clinical trials cited a systematic review as justification for conducting the trial. A total of 102 systematic reviews were cited in the 152 RCTs. Fifty-seven of the one hundred fifty-two (37.5%) RCTs cited a systematic review somewhere in the manuscript. CONCLUSION: Less than one-quarter of phase III RCTs cited systematic reviews as justification for conducting the RCT. We believe placing a higher priority on justifying RCTs with systematic reviews would go a long way to minimizing research waste within ophthalmology.

ObjectivesThe main objective of this study was to assess the methodological and reporting quality of the systematic reviews (SRs) supporting the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) clinical practice guidelines (CPGs) recommendations for the management of patients with ventricular arrhythmias and sudden cardiac death (SCD). As a secondary objective, we sought to determine: (1) the proportion of Cochrane SRs were cited; and (2) whether Cochrane SRs scored higher on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) appraisals.DesignCross-sectional analysis.Main outcome measuresWe searched for CPGs published by the ESC and the ACC from 2010 to 2020. We selected the CPGs for ventricular arrhythmias and the prevention of SCD. The reference sections were searched for SRs. Two independent investigators evaluated eligible SR using the PRISMA checklist and the AMSTAR-2 assessment tool.ResultsTwo CPGs for ventricular arrhythmia and SCD were included in this study. Fifty-five SRs were included in our analysis. Across all SRs, the mean PRISMA score was 0.70. The lowest scoring PRISMA item related to the presence of a pre-published protocol (item 5, score 0.17). Overall, 40% of included SRs were found to have ‘critically low’ AMSTAR-2 ratings. One of the lowest scoring items for AMSTAR-2 was reporting of sources of funding (item 10). The 4 Cochrane SRs that were included scored higher on both assessment tools than non-Cochrane studies, specifically in PRISMA overall completion (88.7% vs 69.7%).ConclusionOur study suggests the methodological and reporting quality of SRs used within ESC and ACC CPGs is insufficient, as demonstrated by the lack of adherence to both AMSTAR-2 and PRISMA checklists. Given the importance of CPGs on clinical decision making, and ultimately patient care, the methodological rigour and quality reporting within SRs used in CPGs should be held to the highest standard within the field of cardiology.

Clinical practice guidelines (CPGs) are essential to clinical decision-making as their recommendations are supported by published literature. Systematic reviews are considered the highest quality of evidence used to underpin these guidelines. However, research to support these recommendations may lack compliance to quality reporting among systematic reviews (SRs). Here, we aim to evaluate the quality of SRs underpinning CPG recommendations for the management of head and neck cancer (HNC).Retrospective cross-sectional analysis.Using PubMed, we searched for CPGs pertinent to the management of head and neck cancer published between January 2017 and May 2021. Relevant guidelines were analyzed for all SRs. Cited SRs in CPGs were evaluated using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) instruments. Study characteristics were extracted in a masked triplicate fashion.A total of 16 CPGs and 142 unique SRs were included in our study. PRISMA completion ranged from 67.15% to 87.65% across CPGs with a mean of 76.41% (SD = 16.9). AMSTAR-2 completion ranged from 34.38% to 84.38% across CPGs with a mean of 67.55% (SD = 20.9) among all SRs. The lowest rated items included funding sources and publication bias. A higher score was achieved in SR done by Cochrane group and it was only 2.11% (3/142) of all SR's quoted in CPG.Adherence to AMSTAR-2 and PRISMA items exhibits a variation among SRs cited in CPGs for the management of HNC. The mature underpinning CPG recommendation of SRs cited as supportive evidence could be enhanced in reporting quality.NA Laryngoscope, 132:1976-1983, 2022.

Background: Poor diet is a leading cause of premature death and thus diet and lifestyle changes are needed; yet, no consensus exists regarding diets that provide the greatest benefit. One of these diets gaining popularity around the world is a plant-based, vegan diet. Recently, Netflix documentaries What the Health (2017) and The Game Changers (2019) have attempted to improve public awareness of veganism and plant-based diets. Methods: We used Google Trends to obtain data for keywords specific to plant-based diets, veganism, and documentary-specific terms over a time period before and after the release of the Netflix documentaries. We then created a forecasted model for trended search terms using autoregressive integrated moving algorithms and compared the actual trends to the forecast model to determine the effect of the documentaries on each selected term. Results: Search interest for the term “plant-based diet” increased significantly—2.8 times the mean forecasted value for What the Health ( t = 12.892, df = 30.012, P < .001) and 2 times the forecasted mean for The Game Changers ( t = 19.826, df = 30.118, P < .001). Additionally, following the release of The Game Changers, mean search interest for “plant-based athlete” was 2.8 times higher than the forecasted values. Conclusion: The documentaries What the Health (2017) and The Game Changers (2019) are associated with an increased interest in plant-based diets based on Google search trends, highlighting the need for continued research regarding plant-based diets and their health benefits related to chronic disease.

To evaluate the reporting quality of systematic reviews (SRs) underpinning the American Urologic Association (AUA) clinical practice guidelines (CPGs).We searched the AUA for CPGs from 2015-2021. We extracted all SRs from the reference sections and two independent investigators evaluated eligible SR/meta-analysis using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) instruments. We compared SRs conducted by the Cochrane group to non-Cochrane SRs using a Mann-Whitney test. A multivariate regression was used to compare study characteristics.Eighteen CPG's met inclusion criteria. We extracted 120 unique SRs, which accounted for 5.1% (n = 120/2346) of all citations. Mean percent adherence to PRISMA and AMSTAR-2 was 65.4% -d 55.2% respectively. SRs conducted by the Cochrane Collaboration scored higher on AMSTAR-2 compared to non-Cochrane (z = -4.41, P.01) and a positive correlation between PRISMA and AMSTAR-2 scores (r = 0.56, P.001) was determined.Our study indicated the quality of SRs used to develop AUA CPGs across both PRISMA and AMSTAR-2 was variable. Despite higher evaluations, Cochrane SRs accounted for less than 15% of SRs underpinning CPG recommendations. Given the importance placed on CPGs within clinical practice, we recommended a synergistic relationship between the AUA and the Cochrane Collaboration to increase the number of quality urologic SRs.

The aim of this study was to assess the methodological quality and accuracy of reporting within systematic reviews (SRs) that provide evidence to form clinical practice guidelines (CPGs) in the management and treatment of breast cancer.The 5 included CPGs for breast cancer management among National Comprehensive Cancer Network and European Society for Medical Oncology were searched for all SRs and meta-analyses. The characteristics of each study along with their methodological reporting were extracted from each SR using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) tools. Our second objective was to compare SRs produced by Cochrane groups vs non-Cochrane.Our study included 5 CPGs for the management of breast cancer, containing 1341 total references with 69 being unique SRs we analyzed. PRISMA completeness percent had a mean 76.3% (n = 69), while AMSTAR-2 completeness score mean was 66.5% (n = 59). Cochrane SRs were found to adhere far better to PRISMA (0.91 vs. 0.74) and AMSTAR-2 (0.95 vs. 0.62) guidelines compared to the non-Cochrane SRs.The reporting quality of SRs that underpin CPGs in breast cancer management widely varies. We recommend that authors of SRs adopt a more uniform approach in assessing the quality of reporting within their studies. In addition, CPGs should use a more standardized method to seek out evidence to establish their recommendations. With improved reporting, clinicians may have increased confidence in CPGs and thus increased utilization of CPGs in clinical decision making.

Objective This study assesses the quality and completeness of systematic reviews (SRs) included by the National Comprehensive Cancer Network (NCCN) cancer screening clinical practice guidelines (CPGs). Methods We evaluated SRs according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess systematic Reviews). Results Seven NCCN CPGs were included with 109 SRs. The mean PRISMA percent completeness of included SRs was 71 % (range 0.1–1.0). The mean AMSTAR-2 percent completeness was 56 % (range 0.05−0.99). Of the 70 SRs assessed via AMSTAR-2, 42 (60 %) received a “critically low” rating, 11 (15.7 %) received “low” ratings, and 17 (24.3 %) received “moderate”. None of the SRs received a “high” rating. Conclusion Lack of adherence to AMSTAR-2 and PRISMA reporting standards among the SRs included is prevalent. We suggest improved reporting of SR inclusion criteria and evaluation to bolster the reporting quality of SRs underpinning CPG recommendations.

Introduction Clinical practice guidelines(CPGs) are important tools for medical decision-making. Given the high prevalence and financial burden associated with tobacco use disorder(TUD), it is critical that recommendations within CPGs are based on robust evidence. Systematic reviews(SRs) are considered the highest level of evidence, thus, we evaluated the quality of SRs underpinning CPG recommendations for TUD. Methods We used PubMed to search for CPGs relating to TUD published between January 1, 2010 and May 21, 2021. SRs were extracted from CPG references and evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) and A MeaSurement Tool to Assess Systematic Reviews(AMSTAR-2) tools. We then compared SRs conducted by the Cochrane Collaboration with non-Cochrane SRs using a Mann-Whitney U test and determined associations between PRISMA and AMSTAR-2 extracted characteristics using multiple regression. Results Our search generated 10 CPGs with 98 SRs extracted. Mean PRISMA completion was 74.7%(SD = 16.7) and mean AMSTAR-2 completion was 53.8%(SD = 22.0) across all guidelines. Cochrane SRs were more complete than non-Cochrane studies in the PRISMA and AMSTAR-2 assessments. The regression model showed a statistically significant association between PRISMA completion and AMSTAR-2 rating, with those classified as “low” or “moderate” quality having higher PRISMA completion than those with “critically low” ratings. Conclusion We found substandard adherence to PRISMA and AMSTAR-2 checklists across SRs cited in TUD CPGs. A lack of recent SRs in CPGs could lead to outdated recommendations. Therefore, frequent guideline updates with recently published evidence may ensure more accurate clinical recommendations and improve patient care. Implications Systematic reviews used to underpin clinical practice guideline recommendations influence treatment decisions and, ultimately, patient outcomes. We found that many systematic reviews underpinning tobacco use disorder guideline recommendations were out of date and unsatisfactory in reporting and quality. Thus, including newer systematic reviews containing more recently conducted trials and better reporting could alter recommendations and improve the rate of successful tobacco cessation attempts.

AIM The fragility index is calculated by changing one outcome event to a nonevent within a trial until the associated P value exceeds 0.05. In this study, we assessed the robustness, risk of bias (RoB), and power of randomized controlled trials that underlie recommendations set forth by the American College of Gastroenterology (ACG) on managing dyspepsia and Helicobacter pylori infections. METHODS All citations referenced in the guidelines were screened for inclusion criteria. The fragility indexes for eligible trials were then calculated. The likelihood and sources of bias in the included trials were evaluated by the Cochrane 'RoB' Tool 2.0. RESULTS The median fragility index for the 52 trials was three events. Five studies (9.6%) resulted in a fragility index of 0 when statistical analysis was applied. For the 52 trials, 12 (23.1%) were at a low RoB, 15 (28.8%) had some concerns, and 25 (48.1%) were at a high RoB. High RoB was most commonly due to bias of selection in the reported result (15.5%). CONCLUSION A median of three events was needed to nullify statistical significance in 52 trials that underpin guideline recommendations on the management of dyspepsia and H. pylori infections. In addition, concerns for RoB were found for these trials.

Background Cardiac assessment in noncardiac surgery clinical practice guidelines should be supported by the highest-quality evidence such as that offered by systematic reviews. Currently, the methodological and reporting quality of these studies remains unknown. Methods We used PubMed to search for all clinical practice guidelines related to perioperative cardiovascular patients undergoing noncardiac surgery from 2010 to 2021. The included clinical practice guidelines were analysed for all systematic reviews and meta-analyses. The primary objective of this study was to determine reporting and methodological quality using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) instruments. Our secondary objective was to compare systematic reviews conducted by the Cochrane Collaboration with non-Cochrane studies. Results Three clinical practice guidelines were included in our study. Within these, 78 systematic reviews were included. PRISMA completion ranged from 34.8% to 100.0% with a mean of 76.9%. AMSTAR-2 completion ranged from 15.6% to 96.9% with a mean of 58.0%. Fifty-four systematic reviews underpinned a clinical practice guidelines recommendation, of which 25 were rated ‘critically low' by AMSTAR-2 appraisal. Cochrane systematic reviews typically performed better than non-Cochrane studies, but were a minority of the included studies (10/78). Conclusion We found deficiencies in several key areas regarding the methodological and reporting qualities of systematic reviews included in cardiac assessment in noncardiac surgery clinical practice guidelines. As these clinical practice guidelines are instrumental to clinical decision-making and patient care in cardiac assessment in noncardiac surgery, we advocate for improved reporting quality among systematic reviews cited as supportive evidence for these recommendations.

Objectives Randomized controlled trial (RCT) discontinuation and nonpublication are potential mechanisms of waste in resources and lead to decreased advancement of medical science and compromised ethical issues in all specialties. However, the prevalence of discontinued or unpublished RCTs regarding common pediatric otolaryngology disorders and interventions remains unclear. Study design Cross-sectional analysis. Methods Retrospective analysis of common pediatric otolaryngology RCTs registered in ClinicalTrials.gov up until November 2, 2018. Data were collected from the registry, and publication status was identified. If a reason for trial discontinuation or nonpublication was not identified through a systematic search, corresponding trialists were contacted through email. Results After exclusion, 260 RCTs were included for analysis. Analysis found 198 (76%) RCTs were completed, and 62 (24%) trials were discontinued. The most commonly reported reasons for RCT discontinuation were program termination by sponsor or management (7/24; 29.2%), lack of participant enrollment, difficulty recruiting, or slow accrual (7/24; 29.2%). A total of 192 (192/260; 73.8%) published RCTs and 68 (68/260; 26.2%) unpublished RCTs were identified. Twenty-six (26/62; 42%) of the discontinued RCTs reached publication, while 36 (58%) remained unpublished. Regarding the completed RCTs, 166 of 198 (83.8%) completed trials reached publication, while 32 (32/198; 16.2%) remained unpublished after trial completion. Conclusions Approximately 1 in 4 of included RCTs were discontinued or did not reach publication. Findings suggest further guidance is needed for RCTs regarding common pediatric otolaryngology disorders and interventions. Level of evidence NA.

Evidence-based decision making is crucial in reducing the health and economic burdens imposed by tonsillar-related pathologies. Clinical practice guidelines are used to guide these decisions; however, uptake of recommendations in these guidelines is low. Systematic reviews are the highest level of evidence used to influence guideline recommendations; therefore, improving the reporting and methodological quality of systematic reviews related to tonsillar-related pathologies may improve guideline uptake and patient care.We used PubMed to search for all clinical practice guidelines related to tonsillar-related pathologies from 2010 to 2020. Included guidelines were then searched for all systematic reviews and meta-analyses. Study characteristics were extracted from each cited systematic review/meta-analysis before being evaluated using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) instruments. We then compared systematic reviews conducted by a Cochrane systematic review group with non-Cochrane systematic reviews.Seven clinical practice guidelines were included in our study and within these guidelines 98 SRs/MAs were cited, 80 of which were unique and included. Systematic reviews composed 9.1% (98/1082) of all guideline citations. Guideline PRISMA scores ranged from 0.47 to 0.83 with a mean score of 0.71 (n = 80) and guideline AMSTAR-2 scores ranged from 0.52 to 0.83 with a mean of 0.56 (7.29/13) and 0.75 (11.94/16) (n = 80). Cochrane systematic reviews displayed greater PRISMA (0.88 vs. 0.64: p 0.001) and AMSTAR-2 (0.90 vs. 0.57; p 0.001) scores compared to the non-Cochrane studies. We found PRISMA and AMSTAR-2 scores were positively correlated across guidelines (r = 0.93).Wide variation exists in adherence to PRISMA and AMSTAR-2 guidelines among systematic reviews cited in clinical practice guidelines for tonsillar-related pathologies. Prior registration and adequate risk of bias assessment are two areas where improvements may be needed. Given the importance of guideline uptake, careful considerations to improve the methodological and reporting quality of evidence supporting tonsillar-related pathology recommendations are necessary.

BACKGROUND Colorectal cancer (CRC) has the third highest cancer mortality rate in the United States. Enhanced screening has reduced mortality rates; however, certain populations remain at high risk, notably African Americans. Raising awareness among at-risk populations may lead to improved CRC outcomes. The influence of celebrity death and illness is an important driver of public awareness. As such, the death of actor Chadwick Boseman from CRC may have influenced CRC awareness. OBJECTIVE We sought to assess the influence of Chadwick Boseman’s death on public interest in CRC in the United States, evidenced by internet searches, website traffic, and donations to prominent cancer organizations. METHODS We used an auto-regressive integrated moving average model to forecast Google searching trends for the topic “Colorectal cancer” in the United States. We performed bivariate and multivariable regressions on state-wise CRC incidence rate and percent Black population. We obtained data from the American Cancer Society (ACS) and the Colon Cancer Foundation (CCF) for information regarding changes in website traffic and donations. RESULTS The expected national relative search volume (RSV) for colorectal cancer was 2.71 (95% CI 1.76-3.66), reflecting a 3590% (95% CI 2632%-5582%) increase compared to the expected values. With multivariable regression, the statewise RSV increased for each percent Black population by 1.09 (SE 0.18, PP CONCLUSIONS Our results suggest that Chadwick Boseman’s death was associated with substantial increases in awareness of CRC. Increased awareness of CRC may support earlier detection and better prognoses.

Context The Reporting Items for Practice Guidelines in Health Care (RIGHT) Statement was developed by a multidisciplinary team of experts to improve reporting quality and transparency in clinical practice guideline development. Objective To assess the quality of reporting in clinical practice guidelines put forth by the Society of Interventional Radiology (SIR) and their adherence to the RIGHT statement checklist. Methods In March 2018, using the 22 criteria listed in the RIGHT statement, two researchers independently documented adherence to each item for all eligible guidelines listed by the SIR by reading through each guideline and using the RIGHT statement elaboration and explanation document as a guide to determine if each item was appropriately addressed as listed in the checklist. To qualify for inclusion in this study, each guideline must have met the strict definition for a clinical practice guideline as set forth by the National Institute of Health and the Institute of Medicine, meaning they were informed by a systematic review of evidence and intended to direct patient care and physician decisions. Guidelines were excluded if they were identified as consensus statements, position statements, reporting standards, and training standards or guidelines. After exclusion criteria were applied, the two researchers scored each of the remaining clinical practice guidelines (CPGs) using a prespecified abstraction Google form that reflected the RIGHT statement checklist (22 criteria; 35 items inclusive of subset questions). Each item on the abstraction form consisted of a “yes/no” option; each item on the RIGHT checklist was recorded as “yes” if it was included in the guideline and “no” if it was not. Each checklist item was weighed equally. Partial adherence to checklist items was recorded as “no.” Data were extracted into Microsoft Excel (Microsoft Corporation) for statistical analysis. Results The initial search results yielded 129 CPGs in the following areas: 13 of the guidelines were in the field of interventional oncology; 16 in neurovascular disorders; five in nonvascular interventions; four in pediatrics; 25 in peripheral, arterial, and aortic disease; one in cardiac; one in portal and mesenteric vascular disease; 37 in practice development and safety; three in spine and musculoskeletal disorders; 14 in venous disease; five in renal failure/hemodialysis; and five in women’s health. Of the 46 guidelines deemed eligible for evaluation by the RIGHT checklist, 12 of the checklist items showed less than 25% adherence and 13 showed more than 75% adherence. Of 35 individual RIGHT statement checklist items, adherence was found for a mean (SD) of 22.9 items (16.3). The median number of items with adherence was 21 (interquartile range, 7.5–38). Conclusion The quality of reporting in interventional radiology guidelines is lacking in several key areas, including whether patient preferences were considered, whether costs and resources were considered, the strength of the recommendations, and the certainty of the body of evidence. Poor adherence to the RIGHT statement checklist in these guidelines reveals many areas for improvement in guideline reporting.

ObjectiveIn light of the current national mental health crisis, we use Google Trends, Twitter and data obtained from the National Suicide Prevention Lifeline to evaluate the effect of ‘1-800-273-8255’ on public awareness for the National Suicide Prevention Lifeline.DesignCross-sectional analysis.Main outcome measuresWe extracted data from Google Trends and Twitter for terms related to suicide following the release of Logic’s song, ‘1-800-273-8255’. We then used a forecasting autoregressive integrated moving algorithm model to determine the greater than expected search interest.ResultsGoogle searches for ‘Suicide Hotline’ increased 49% more than expected the day after Logic’s song was released and sustained increase of queries resulted in an average relative search volume of 59.5%–9.1% higher than the mean forecasted value of 50.4% for the 28 days following the release. Tweets that engaged with the account ‘@800 273talk’ on Twitter increased by 10 450% more than expected the day after the song was released and increased by a mean of 1497% greater than expected the week after the songs released.ConclusionFindings from our study suggest that the entertainment industry can play an important role in increasing awareness of hotline numbers. Logic’s song provides an example of a positive influence on public health and provides support for further development and standards for proper awareness of suicide in the public view.

Context Injuries are common among high profile players in the National Basketball Association (NBA), and could provide an opportunity for physicians to provide accurate sports injury information and reliable rehabilitation data to the general public in the immediate aftermath. Objectives To evaluate social media trends to investigate public interest in athletic injuries in the NBA and to evaluate the length of maintained interest in these injuries. Methods The Google Trends tool was used to analyze search data around two high profile players—Kevin Durant and Klay Thompson—who suffered injuries during the 2019 NBA Finals. The results were compared to the expected search forecast derived from an autoregressive integrated moving algorithm model. Results Both players were associated with a mean increase of 1,052.4% (standard deviation [SD], 703.96%) in relative search volumes for terms related to their injuries. This data showed a significant increase in search engine activity related to injuries associated with NBA players in the first 6.13 days (SD, 3.14 days) following the injuries, marking a substantial timeframe for public engagement. Conclusions Search traffic information may be beneficial to the sports medicine community, as social media can provide a platform for patient education in a limited timeframe. By increasing patient awareness and knowledge regarding athletic injuries, social media can expand the pool of potential patients for physicians and surgeons.

Introduction Given that 72% of internet users seek out health information using an internet search engine (Google being the most popular); we sought to investigate the public internet search interest in cannabis as a health topic when cannabis legislation appeared on state ballots and during presidential elections. Materials and methods We searched Google Trends for “cannabis” as a health topic. Google Trends data were extracted during the time period of May 1, 2008 to May 1, 2019 for the United States (US) and select states (18) within the US including: Alaska, Arizona, Arkansas, California, Colorado, Florida, Maine, Massachusetts, Michigan, Missouri, Nevada, North Dakota, Ohio, Oregon, Oklahoma, South Dakota, Utah, and Washington when cannabis was on the ballot. These state elections were referenda, not legislative votes. We then compared the internet search interest for cannabis before and after each election. To evaluate whether any associations with changes in the volume of cannabis internet searches were specific to the cannabis topic, or also occurred with other topics of general interest during an election year, the authors ran additional analyses of previously popular debated policies during Presidential Elections that may act as control topics. These policies included Education, Gun Control, Climate Change, Global Warming, and Abortion. We used the autoregressive integrated moving average (ARIMA) algorithm to forecast expected relative internet search interests for the 2012 and 2016 Presidential Elections. Individual variables were compared using a linear regression analysis for the beta coefficients performed in Stata Version 15.1 (StataCorp). Results Public internet search interest for “cannabis” increased during the voting month above the previous mean internet search interest for all 18 bills. For the US, observed internet search interest during each Presidential Election was 26.9% [95% CI, 18.4–35.4%] greater than expected in 2012 and 29.8% [95% CI, 20.8–38.8%] greater than expected in 2016. In 2016, significant state-level findings included an increase in relative internet search rates for cannabis in states with higher usage rates of cannabis in the past month (Coeff (95% CI), 3.4 (2.8–4.0)) and past month illicit drug use except cannabis rates (Coeff (95% CI), 17.4 (9.8–25.0)). Relative internet search rates for cannabis from 2008 to 2019 were also associated with increased cannabis usage in the past month (Coeff (95% CI), 3.1 (2.5–3.7)). States with higher access to legal cannabis were associated with higher relative internet search volumes for cannabis (Coeff (95% CI), 0.31 (0.15–0.46)). Of the five additional policies that were searched as topics, only two showed an increase in internet search interest during each Presidential Election. Climate Change increased by 3.5% [95% CI, − 13-20%] in 2012 and 20.1% [95% CI, 0–40%] in 2016 while Global Warming increased by 1.1% [95% CI, − 19-21%] in 2012 and 4.6% [95% CI, − 6-15%] in 2016. Conclusion Based on these results, we expect public interest in cannabis will spike prior to the Presidential election in 2020. Of the five selected control policies, only two showed an increase in internet search interest during both Presidential Elections and neither exceeded the internet search increase of cannabis. These results may indicate the growing awareness of cannabis in the US and mark a possible target for the timely dissemination of evidence-based information regarding cannabis and its usage/side-effects during future elections. Consequently, the results of this study may be important to physicians since they will likely receive an increased volume of questions relating to cannabis and its therapeutic uses during election season from interested patients. We recommend establishing a cannabis repository of evidence-based information, providing physician education, and a dosing guide be created to enable physicians to provide high quality care around the issue of cannabis.

Purpose To use Google search data to determine the public’s interest in learning about athletic injuries sustained by NFL quarterbacks and to investigate how long this interest persists after the injuries. Methods We identified starting NFL quarterbacks during the 2019–2020 season online and used the official NFL injury report to determine whether an injury had occurred to a quarterback. We used the Google Trends tool to analyze search trends around a quarterback’s injuries from July 22, 2019, to October 22, 2019. Google trends data was extracted as relative search volume over time. We then compared the results to the expected search forecast derived from an autoregressive integrated moving algorithm (ARIMA) model. Results All 6 injured quarterbacks were associated with increases (64% to 100%) in relative search volumes for terms related to their injury. Furthermore, the data showed a consistent increase in search engine activity around the injuries associated with NFL quarterbacks in the first 3 days, marking a particularly influential time frame for public engagement. Conclusion Our data show an increase in Google traffic surrounding the injuries of prominent NFL quarterbacks within the first 3 days following their injuries. Clinical Relevance Social media can provide a platform for patient education through increasing patient awareness and knowledge regarding athletic injuries.

This study examines a rise in telephone calls to the Rape, Abuse, and Incest National Network rape crisis hotline in the wake of an episode of the television show Grey’s Anatomy focused on rape and ending with the hotline number.

Objective Orthopaedic trauma is one of the largest surgical fields in medicine, and as such, requires the latest evidence to ensure the best standard of care. Systematic reviews are an invaluable resource that compiles an exhaustive summary of the most current evidence on a given clinical question. The primary aim of this study is to evaluate the use of systematic reviews as justification in conducting randomized controlled trials published in high impact orthopaedic trauma journals. Methods We analyzed randomized controlled trials published in the top three high impact orthopaedic trauma journals between 2015 and 2018. We performed data extraction blind, independent, and in duplicative manner to ensure the validity of the findings. For each trial, data was extracted by the number of systematic reviews cited in each clinical trial and whether or not the study used a systematic review as justification for conducting the trial. A subgroup of general orthopaedic clinical trials were included for comparison. Results Of 144 articles retrieved, 128 were included. Overall, 71.1% (91/128; [95% CI, 63.2–78.9]) of included orthopaedic trauma randomized controlled trials referenced a systematic review and 28.9% (37/128) of studies did not cite a systematic review. Of the 91 trials that referenced a systematic review, 33.0% (30/91; [95% CI, 23.3–42.6]) of RCTs cited a systematic review as trial justification, whether that be “verbatim” or “inferred”. “Verbatim” justifications occurred in 20.0% (6/30; [95% CI, 5.7–34.3]) of included trauma RCTs that cited a systematic review as justification for conducting the trial and “inferred” justifications occurred in 80.0% (24/30; [95% CI, 65.7–94.3]). Conclusion Systematic reviews are frequently cited in orthopaedic trauma RCTs but are not commonly cited as justification for conducting a clinical trial. Ideally, evidentiary uncertainty regarding a research question should be established by existing literature through a systematic review to reduce research waste.

OBJECTIVES/HYPOTHESIS Randomized controlled trials (RCTs) play a crucial role in advancing patient care within otolaryngology-head and neck surgery (OTL-HNS), yet studies have shown the reporting of these trials needs improvement. Here, we evaluate the completeness of intervention reporting of RCTs in OTL-HNS and evaluate whether the publication of the Template for Intervention Description and Replication (TIDieR) checklist has influenced intervention reporting. STUDY DESIGN Retrospective Cross-Sectional Analysis. METHODS We searched PubMed for RCTs published in top OTL-HNS journals in two cohorts, one before the release of the TIDieR and one afterward. A sample of 300 RCTs was randomly selected and screened for inclusion. Once the dataset was finalized, we extracted trial characteristics and assessed each trial's adherence to the TIDieR checklist. We then used descriptive characteristics, a generalized estimated equation, time-series analysis, and a two-sample t test to analyze our data. RESULTS After screening was completed, 173 RCTs were included in our analysis. Of these RCTs, 103 (59.5%) showed

IntroductionClinical research serves as the foundation for evidence-based patient care, and reproducibility of results is consequently critical. We sought to assess the transparency and reproducibility of research studies in otolaryngology by evaluating a random sample of publications in otolaryngology journals between 2014 and 2018.MethodsWe used the National Library of Medicine catalog to identify otolaryngology journals that met the inclusion criteria (available in the English language and indexed in MEDLINE). From these journals, we extracted a random sample of 300 publications using a PubMed search for records published between January 1, 2014, and December 31, 2018. Specific indicators of reproducible and transparent research practices were evaluated in a blinded, independent, and duplicate manner using a pilot-tested Google form.ResultsOur initial search returned 26,498 records, from which 300 were randomly selected for analysis. Of these 300 records, 286 met inclusion criteria and 14 did not. Among the empirical studies, 2% (95% CI, 0.4%-3.5%) of publications indicated that raw data were available, 0.6% (95% CI, 0.3%-1.6%) reported an analysis script, 5.3% (95% CI, 2.7%-7.8%) were linked to an accessible research protocol, and 3.9% (95% CI, 1.7%-6.1%) were preregistered. None of the publications had a clear statement claiming to replicate, or to be a replication of, another study.ConclusionsInadequate reproducibility practices exist in otolaryngology. Nearly all studies in our analysis lacked a data or material availability statement, did not link to an accessible protocol, and were not preregistered. Most studies were not available as open access. Taking steps to improve reproducibility would likely also improve patient care.

OBJECTIVE It has been estimated that much of health research may be wasted, resulting in billions of dollars in wasteful research spending worldwide each year. Given the increased use of randomized trials and their influence on medicine, one method to combat research waste is to conduct randomized clinical trials (RCTs) only when a systematic review (SR) suggests more data are needed or when no previous SRs are identified. Here, we analyzed RCTs to determine whether SRs were cited as justification for conducting a trial. METHODS We analyzed phase III RCTs published between 2016 and 2018 in New England Journal of Medicine, Lancet, and JAMA. We performed duplicate and independent data extraction to ensure the accuracy and validity of our data. For each trial, we extracted whether SRs were cited as justification for conducting the clinical trial. RESULTS We examined 637 RCTs that cited 728 SRs. Overall, 38.1% (243/637) of RCTs cited an SR as either verbatim (6.9%, 44/637) or inferred (31.2%, 199/637) for trial justification. The 79 remaining RCTs cited SRs in other ways. Approximately, 49.5% (315/637) of RCTs did not cite a SR. CONCLUSIONS Less than half of the analyzed clinical trials cited a SRs as the basis for undertaking the trial. We believe trialists should be required to present relevant SRs to an ethics or peer review committee demonstrating an unmet need prior to initiating a trial. Eliminating research waste is both a scientific and ethical responsibility.

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.

This cross-sectional study uses Google Trends and cleidocranial dysplasia–related foundation website data to investigate the association of television portrayals of cleidocranial dysplasia with public interest and awareness of the disorder.