Qualitative study of physicians' varied uses of biomedical research in the USA

Legal and Ethical Considerations for the Design and Use of Web Portals for Researchers, Clinicians, and Patients: Scoping Literature Review

Background

This study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings.

Objective

This study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases.

Methods

This study broadly adopts the methods for scoping literature reviews outlined by Arskey and O’Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review.

Results

We found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data.

Conclusions

We identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care.

What cancer research makes the news? A quantitative analysis of online news stories that mention cancer studies

Journalists’ health and science reporting aid the public’s direct access to research through the inclusion of hyperlinks leading to original studies in peer-reviewed journals. While this effort supports the US-government mandate that research be made widely available, little is known about what research journalists share with the public. This cross-sectional exploratory study characterises US-government-funded research on cancer that appeared most frequently in news coverage and how that coverage varied by cancer type, disease incidence and mortality rates. The subject of analysis was 11436 research articles (published in 2016) on cancer funded by the US government and 642 news stories mentioning at least one of these articles. Based on Altmetric data, researchers identified articles via PubMed and characterised each based on the news media attention received online. Only 1.88% (n = 213) of research articles mentioning US government-funded cancer research included at least one mention in an online news publication. This is in contrast to previous research that found 16.8% (n = 1925) of articles received mention by online mass media publications. Of the 13 most common cancers in the US, 12 were the subject of at least one news mention; only urinary and bladder cancer received no mention. Traditional news sources included significantly more mentions of research on common cancers than digital native news sources. However, a general discrepancy exists between cancers prominent in news sources and those with the highest mortality rate. For instance, lung cancer accounted for the most deaths annually, while melanoma led to 56% less annual deaths; however, journalists cited research regarding these cancers nearly equally. Additionally, breast cancer received the greatest coverage per estimated annual death, while pancreatic cancer received the least coverage per death. Findings demonstrated a continued misalignment between prevalent cancers and cancers mentioned in online news media. Additionally, cancer control and prevention received less coverage from journalists than other cancer continuum stages, highlighting a continued underrepresentation of prevention-focused research. Results revealed a need for further scholarship regarding the role of journalists in research dissemination.

Barriers and facilitators to clinical information seeking: a systematic review

OBJECTIVE

The study sought to identify barriers to and facilitators of point-of-care information seeking and use of knowledge resources.

MATERIALS AND METHODS

We searched MEDLINE, Embase, PsycINFO, and Cochrane Library from 1991 to February 2017. We included qualitative studies in any language exploring barriers to and facilitators of point-of-care information seeking or use of electronic knowledge resources. Two authors independently extracted data on users, study design, and study quality. We inductively identified specific barriers or facilitators and from these synthesized a model of key determinants of information-seeking behaviors.

RESULTS

Forty-five qualitative studies were included, reporting data derived from interviews (n = 26), focus groups (n = 21), ethnographies (n = 6), logs (n = 4), and usability studies (n = 2). Most studies were performed within the context of general medicine (n = 28) or medical specialties (n = 13). We inductively identified 58 specific barriers and facilitators and then created a model reflecting 5 key determinants of information-seeking behaviors: time includes subthemes of time availability, efficiency of information seeking, and urgency of information need; accessibility includes subthemes of hardware access, hardware speed, hardware portability, information restriction, and cost of resources; personal skills and attitudes includes subthemes of computer literacy, information-seeking skills, and contextual attitudes about information seeking; institutional attitudes, cultures, and policies includes subthemes describing external individual and institutional information-seeking influences; and knowledge resource features includes subthemes describing information-seeking efficiency, information content, information organization, resource familiarity, information credibility, information currency, workflow integration, compatibility of recommendations with local processes, and patient educational support.

CONCLUSIONS

Addressing these determinants of information-seeking behaviors may facilitate clinicians' question answering to improve patient care.

Why are they not accessing it? User barriers to clinical information access

The Medical Library Association's InSight Initiative provides an open and collaborative environment for library and industry partners to discuss vexing problems and find solutions to better serve their users. The initiative's fifth summit, continuing work from the previous summit, focused on understanding how users discover and access information in the clinical environment. During the summit, participants were divided into working groups and encouraged to create a tangible product as a result of their discussions. At the end of the summit, participants established a framework for understanding users' pain points, discussed possible solutions to those points, and received feedback on their work from an End User Advisory Board comprising physicians, clinical researchers, and clinical faculty in biomedicine. In addition to the pain point framework, participants are developing MLA InSight Initiative Learning content with modules to educate librarians and publishers about critical aspects of user behavior. The 2020 Insight Initiative Fall Forum will serve as a virtual home for constructive dialogue between health sciences librarians and publishers on improving discovery and access to information.

Tear down the walls: Disseminating open access research for a global impact

OBJECTIVE

Publications are the cornerstone of the dissemination of scientific innovation and scholarly work, but published works are mostly behind paywalls. Therefore, many researchers and institutions are searching for alternative models for disseminating scholarly work that bypasses the current structure of paywalls. This study aimed to determine whether a self-published open access (OA) journal, the International Journal of Health Sciences (IJHS), has been able to reach a global audience in terms of authorship, readership, and impact using the OA model.

METHODS

All IJHS articles were retrieved and analyzed using scientometric methods. Using the keywords from abstracts and titles, unsupervised clustering was performed to map research trends. Network analysis was used to chart the network of collaboration. The analysis of articles' metadata and the visualizations was performed using R programming language.

RESULTS

Using Google Scholar as a source, the general statistics of IJHS from inception to 2019 showed that the average citation per article was 11.29, and the impact factor of the journal was 2.28. The results demonstrate the obvious local and global impact of a locally published journal that allows unrestricted OA and uses an open source publishing platform. The journal's success at attracting diverse topics, authors, and readers is a testament to the power of the OA model.

CONCLUSIONS

Open source is feasible and rewarding and enables a global reach for research from under-represented regions. Local journals can help the Global South disseminate their scholarly work, which is frequently ignored by commercial and established publications.

Reader engagement with medical content on Wikipedia

Articles on Wikipedia about health and medicine are maintained by WikiProject Medicine (WPM), and are widely used by health professionals, students and others. We have compared these articles, and reader engagement with them, to other articles on Wikipedia. We found that WPM articles are longer, possess a greater density of external links, and are visited more often than other articles on Wikipedia. Readers of WPM articles are more likely to hover over and view footnotes than other readers, but are less likely to visit the hyperlinked sources in these footnotes. Our findings suggest that WPM readers appear to use links to external sources to verify and authorize Wikipedia content, rather than to examine the sources themselves.

Open access policies of leading medical journals: a cross-sectional study

OBJECTIVES

Academical and not-for-profit research funders are increasingly requiring that the research they fund must be published open access, with some insisting on publishing with a Creative Commons Attribution (CC BY) licence to allow the broadest possible use. We aimed to clarify the open access variants provided by leading medical journals and record the availability of the CC BY licence for commercially funded research.

METHODS

We identified medical journals with a 2015 impact factor of ≥15.0 on 24 May 2017, then excluded from the analysis journals that only publish review articles. Between 29 June 2017 and 26 July 2017, we collected information about each journal's open access policies from their websites and/or by email contact. We contacted the journals by email again between 6 December 2017 and 2 January 2018 to confirm our findings.

RESULTS

Thirty-five medical journals publishing original research from 13 publishers were included in the analysis. All 35 journals offered some form of open access allowing articles to be free-to-read, either immediately on publication or after a delay of up to 12 months. Of these journals, 21 (60%) provided immediate open access with a CC BY licence under certain circumstances (eg, to specific research funders). Of these 21, 20 only offered a CC BY licence to authors funded by non-commercial organisations and one offered this option to any funder who required it.

CONCLUSIONS

Most leading medical journals do not offer to authors reporting commercially funded research an open access licence that allows unrestricted sharing and adaptation of the published material. The journals' policies are therefore not aligned with open access declarations and guidelines. Commercial research funders lag behind academical funders in the development of mandatory open access policies, and it is time for them to work with publishers to advance the dissemination of the research they fund.

Exploring PubMed as a reliable resource for scholarly communications services

Objective

PubMed’s provision of MEDLINE and other National Library of Medicine (NLM) resources has made it one of the most widely accessible biomedical resources globally. The growth of PubMed Central (PMC) and public access mandates have affected PubMed’s composition. The authors tested recent claims that content in PMC is of low quality and affects PubMed’s reliability, while exploring PubMed’s role in the current scholarly communications landscape.

Methods

The percentage of MEDLINE-indexed records was assessed in PubMed and various subsets of records from PMC. Data were retrieved via the National Center for Biotechnology Information (NCBI) interface, and follow-up interviews with a PMC external reviewer and staff at NLM were conducted.

Results

Almost all PubMed content (91%) is indexed in MEDLINE; however, since the launch of PMC, the percentage of PubMed records indexed in MEDLINE has slowly decreased. This trend is the result of an increase in PMC content from journals that are not indexed in MEDLINE and not a result of author manuscripts submitted to PMC in compliance with public access policies. Author manuscripts in PMC continue to be published in MEDLINE-indexed journals at a high rate (85%). The interviewees clarified the difference between the sources, with MEDLINE serving as a highly selective index of journals in biomedical literature and PMC serving as an open archive of quality biomedical and life sciences literature and a repository of funded research.

Conclusion

The differing scopes of PMC and MEDLINE will likely continue to affect their overlap; however, quality control exists in the maintenance and facilitation of both resources, and funding from major grantors is a major component of quality assurance in PMC.

#MedEd: exploring the relationship between altmetrics and traditional measures of dissemination in health professions education

INTRODUCTION

Researchers, funders, and institutions are interested in understanding and quantifying research dissemination and impact, particularly related to communicating with the public. Traditionally, citations have been a primary impact measure; however, citations can be slow to accrue and focus on academic use. Recently altmetrics, which track alternate dissemination forms (e. g., social media), have been suggested as a complement to citation-based metrics. This study examines the relationship between altmetrics and traditional measures: journal article citations and access counts.

METHODS

The researchers queried Web of Science and Altmetric Explorer for articles published in HPE journals between 2013-2015. They identified 2,486 articles with altmetrics. Data were analyzed using negative binomial and linear regression models.

RESULTS

Blogging was associated with the greatest increase in citations (13% increase), whereas Tweets (1.2%) and Mendeley (1%) were associated with smaller increases. Journal impact factor (JIF) was associated with a 21% increase in citations. Publicly accessible articles were associated with a 19% decrease, but the interactive effect between accessible articles and JIF was associated with a 12% increase. When examining access counts, publicly accessible articles had an increase of 170 access counts whereas blogging was associated with a decrease of 87 accesses.

DISCUSSION

This study suggests that several altmetrics outlets are positively associated with citations, and that public accessibility, holding all other independent variables constant, is positively related to article access. Given the scientific community's evolving focus on dissemination these findings have implications for stakeholders, providing insight into the factors that may improve citations and access of articles.

Wikipedia as a gateway to biomedical research: The relative distribution and use of citations in the English Wikipedia

Wikipedia is a gateway to knowledge. However, the extent to which this gateway ends at Wikipedia or continues via supporting citations is unknown. Wikipedia's gateway functionality has implications for information design and education, notably in medicine. This study aims to establish benchmarks for the relative distribution and referral (click) rate of citations-as indicated by presence of a Digital Object Identifier (DOI)-from Wikipedia, with a focus on medical citations. DOIs referred from the English Wikipedia in August 2016 were obtained from Crossref.org. Next, based on a DOI's presence on a WikiProject Medicine page, all DOIs in Wikipedia were categorized as medical (WP:MED) or non-medical (non-WP:MED). Using this categorization, referred DOIs were classified as WP:MED, non-WP:MED, or BOTH, meaning the DOI may have been referred from either category. Data were analyzed using descriptive and inferential statistics. Out of 5.2 million Wikipedia pages, 4.42% (n = 229,857) included at least one DOI. 68,870 were identified as WP:MED, with 22.14% (n = 15,250) featuring one or more DOIs. WP:MED pages featured on average 8.88 DOI citations per page, whereas non-WP:MED pages had on average 4.28 DOI citations. For DOIs only on WP:MED pages, a DOI was referred every 2,283 pageviews and for non-WP:MED pages every 2,467 pageviews. DOIs from BOTH pages accounted for 12% (n = 58,475). The referral of DOI citations found in BOTH could not be assigned to WP:MED or non-WP:MED, as the page from which the referral was made was not provided with the data. While these results cannot provide evidence of greater citation referral from WP:MED than non-WP:MED, they do provide benchmarks to assess strategies for changing referral patterns. These changes might include editors adopting new methods for designing and presenting citations or the introduction of teaching strategies that address the value of consulting citations as a tool for extending learning.

The Future of CRISPR Applications in the Lab, the Clinic and Society

CRISPR (clustered regularly interspaced short palindromic repeats) has emerged as one of the premiere biological tools of the century. Even more so than older genome editing techniques such as TALENs and ZFNs, CRISPR provides speed and ease-of-use heretofore unheard of in agriculture, the environment and human health. The ability to map the function of virtually every component of the genome in a scalable, multiplexed manner is unprecedented. Once those regions have been explored, CRISPR also presents an opportunity to take advantage of endogenous cellular repair pathways to change and precisely edit the genome [1-3]. In the case of human health, CRISPR operates as both a tool of discovery and a solution to fundamental problems behind disease and undesirable mutations.