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Kanukula R, McKenzie JE, Cashin AG, Korevaar E, McDonald S, Mello AT, Nguyen PY, Saldanha IJ, Wewege MA, Page MJ. Variation observed in consensus judgments between pairs of reviewers when assessing the risk of bias due to missing evidence in a sample of published meta-analyses of nutrition research. J Clin Epidemiol 2024; 166:111244. [PMID: 38142761 DOI: 10.1016/j.jclinepi.2023.111244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES To evaluate the risk of bias due to missing evidence in a sample of published meta-analyses of nutrition research using the Risk Of Bias due to Missing Evidence (ROB-ME) tool and determine inter-rater agreement in assessments. STUDY DESIGN AND SETTING We assembled a random sample of 42 meta-analyses of nutrition research. Eight assessors were randomly assigned to one of four pairs. Each pair assessed 21 randomly assigned meta-analyses, and each meta-analysis was assessed by two pairs. We calculated raw percentage agreement and chance corrected agreement using Gwet's Agreement Coefficient (AC) in consensus judgments between pairs. RESULTS Across the eight signaling questions in the ROB-ME tool, raw percentage agreement ranged from 52% to 100%, and Gwet's AC ranged from 0.39 to 0.76. For the risk-of-bias judgment, the raw percentage agreement was 76% (95% confidence interval 60% to 92%) and Gwet's AC was 0.47 (95% confidence interval 0.14 to 0.80). In seven (17%) meta-analyses, either one or both pairs judged the risk of bias due to missing evidence as "low risk". CONCLUSION Our findings indicated substantial variation in assessments in consensus judgments between pairs for the signaling questions and overall risk-of-bias judgments. More tutorials and training are needed to help researchers apply the ROB-ME tool more consistently.
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Affiliation(s)
- Raju Kanukula
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne E McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Korevaar
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sally McDonald
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Arthur T Mello
- Post-Graduate Program in Nutrition, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Phi-Yen Nguyen
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian J Saldanha
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Matthew J Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Haslam A, Powell K, Prasad V. How Often do Medical Specialties Question the Practices that They Perform? An Empirical, Cross-Sectional Analysis of the Published Literature. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211061034. [PMID: 35322719 PMCID: PMC8961376 DOI: 10.1177/00469580211061034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An aspect of overuse is who decides which practices are evaluated for overuse and
which of the studies on overuse are published in the medical literature. We
sought to examine the frequency with which studies in medical journals
questioned an established practice. As a secondary objective, we sought to
determine if there was variance among medical specialties. We conducted a
retrospective, cross-sectional review of the published literature in 14 medical
specialty journals. We included studies from one issue in three high-impact
journals (November/December 2020) for each specialty. We assessed whether the
study reported on a medical practice, whether it reported on an existing
practice, whether the author expressed uncertainty regarding the practice,
whether the study was a randomized design, and if the authors encouraged further
testing in randomized studies. For all medical specialties combined, we found
that 37% (n = 98) questioned existing practices, and 15% (n = 40) either tested
the practice in a randomized trial or encouraged future randomized testing of
the practice. The medical specialties that questioned their practices the most
were gastroenterology (61%; n = 10/18), obstetrics/gynecology (52%; n = 11/21),
and cardiovascular (50%; n = 5/10). These findings indicate that, although
research is being conducted to examine current medical practices, few studies
advocate for randomized testing of these practices, and even fewer actually test
them in a randomized fashion. Additionally, the variation across medical
specialties suggests areas in which to look for potential practices that are
low-value, duplicative, and/or wasteful.
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Affiliation(s)
- Alyson Haslam
- University of California San Francisco, San Francisco, CA, USA
| | - Kerrington Powell
- College of Medicine, Texas A&M Health Science Center, College Station, TX, USA
| | - Vinay Prasad
- University of California San Francisco, San Francisco, CA, USA
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Russell MA, Gajos JM. Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry. J Child Psychol Psychiatry 2020; 61:376-394. [PMID: 31997358 PMCID: PMC8428969 DOI: 10.1111/jcpp.13204] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives. FINDINGS A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives. CONCLUSIONS Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.
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Affiliation(s)
| | - Jamie M. Gajos
- Department of Human Development and Family Studies, University of Alabama
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Page MJ, Bero L, Kroeger CM, Dai Z, McDonald S, Forbes A, McKenzie JE. Investigation of Risk Of Bias due to Unreported and SelecTively included results in meta-analyses of nutrition research: the ROBUST study protocol. F1000Res 2019. [PMID: 32117567 DOI: 10.12688/f1000research.20726.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Dietary guidelines should be informed by systematic reviews (SRs) of the available scientific evidence. However, if the SRs that underpin dietary guidelines are flawed in their design, conduct or reporting, the recommendations contained therein may be misleading or harmful. To date there has been little empirical investigation of bias due to selective inclusion of results, and bias due to missing results, in SRs of food/diet-outcome relationships. Objectives: To explore in SRs with meta-analyses of the association between food/diet and health-related outcomes: (i) whether systematic reviewers selectively included study effect estimates in meta-analyses when multiple effect estimates were available; (ii) what impact selective inclusion of study effect estimates may have on meta-analytic effects, and; (iii) the risk of bias due to missing results (publication bias and selective non-reporting bias) in meta-analyses. Methods: We will systematically search for SRs with meta-analysis of the association between food/diet and health-related outcomes in a generally healthy population, published between January 2018 and June 2019. We will randomly sort titles and abstracts and screen them until we identify 50 eligible SRs. The first reported meta-analysis of a binary or continuous outcome in each SR (the 'index meta-analysis') will be evaluated. We will extract from study reports all study effect estimates that were eligible for inclusion in the index meta-analyses (e.g. from multiple instruments and time points) and will quantify and test for evidence of selective inclusion of results. We will also assess the risk of bias due to missing results in the index meta-analyses using a new tool (ROB-ME). Ethics and dissemination: Ethics approval is not required because information will only be extracted from published studies. Dissemination of the results will be through peer-reviewed publications and presentations at conferences. We will make all data collected from this study publicly available via the Open Science Framework.
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Affiliation(s)
- Matthew J Page
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Lisa Bero
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Cynthia M Kroeger
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Zhaoli Dai
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Sally McDonald
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Andrew Forbes
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
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5
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Page MJ, Bero L, Kroeger CM, Dai Z, McDonald S, Forbes A, McKenzie JE. Investigation of Risk Of Bias due to Unreported and SelecTively included results in meta-analyses of nutrition research: the ROBUST study protocol. F1000Res 2019; 8:1760. [PMID: 32117567 PMCID: PMC7025772 DOI: 10.12688/f1000research.20726.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Dietary guidelines should be informed by systematic reviews (SRs) of the available scientific evidence. However, if the SRs that underpin dietary guidelines are flawed in their design, conduct or reporting, the recommendations contained therein may be misleading or harmful. To date there has been little empirical investigation of bias due to selective inclusion of results, and bias due to missing results, in SRs of food/diet-outcome relationships. Objectives: To explore in SRs with meta-analyses of the association between food/diet and health-related outcomes: (i) whether systematic reviewers selectively included study effect estimates in meta-analyses when multiple effect estimates were available; (ii) what impact selective inclusion of study effect estimates may have on meta-analytic effects, and; (iii) the risk of bias due to missing results (publication bias and selective non-reporting bias) in meta-analyses. Methods: We will systematically search for SRs with meta-analysis of the association between food/diet and health-related outcomes in a generally healthy population, published between January 2018 and June 2019. We will randomly sort titles and abstracts and screen them until we identify 50 eligible SRs. The first reported meta-analysis of a binary or continuous outcome in each SR (the 'index meta-analysis') will be evaluated. We will extract from study reports all study effect estimates that were eligible for inclusion in the index meta-analyses (e.g. from multiple instruments and time points) and will quantify and test for evidence of selective inclusion of results. We will also assess the risk of bias due to missing results in the index meta-analyses using a new tool (ROB-ME). Ethics and dissemination: Ethics approval is not required because information will only be extracted from published studies. Dissemination of the results will be through peer-reviewed publications and presentations at conferences. We will make all data collected from this study publicly available via the Open Science Framework.
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Affiliation(s)
- Matthew J. Page
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Lisa Bero
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Cynthia M. Kroeger
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Zhaoli Dai
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Sally McDonald
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Andrew Forbes
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Joanne E. McKenzie
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Naci H, Salcher-Konrad M, Dias S, Blum MR, Sahoo SA, Nunan D, Ioannidis JPA. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med 2019; 53:859-869. [PMID: 30563873 DOI: 10.1136/bjsports-2018-099921] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the effect of exercise regimens and medications on systolic blood pressure (SBP). DATA SOURCES Medline (via PubMed) and the Cochrane Library. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs) and diuretics were identified from existing Cochrane reviews. A previously published meta-analysis of exercise interventions was updated to identify recent RCTs that tested the SBP-lowering effects of endurance, dynamic resistance, isometric resistance, and combined endurance and resistance exercise interventions (up to September 2018). DESIGN Random-effects network meta-analysis. OUTCOME Difference in mean change from baseline SBP between comparator treatments (change from baseline in one group minus that in the other group) and its 95% credible interval (95% CrI), measured in mmHg. RESULTS We included a total of 391 RCTs, 197 of which evaluated exercise interventions (10 461 participants) and 194 evaluated antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. While all medication trials included hypertensive populations, only 56 exercise trials included hypertensive participants (≥140 mmHg), corresponding to 3508 individuals. In a 10% random sample, risk of bias was higher in exercise RCTs, primarily due to lack of blinding and incomplete outcome data. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference -3.96 mmHg, 95% CrI -5.02 to -2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials. CONCLUSIONS The effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.
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Affiliation(s)
- Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Sofia Dias
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Samali Anova Sahoo
- Department of Life Sciences and Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John P A Ioannidis
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Stanford Prevention Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Sharma H, Verma S. Is positive publication bias really a bias, or an intentionally created discrimination toward negative results? Saudi J Anaesth 2019; 13:352-355. [PMID: 31572081 PMCID: PMC6753760 DOI: 10.4103/sja.sja_124_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Today in publish or perish era, where manuscripts and research with successfully proven hypothesis or positive results are given more importance by journals, editors, funders, and institutions. The publication of researches with negative or null results is on the verge of extinction, thus creating an intentional bias known as publication bias. This review aims to discuss the consequence of the undermined importance of negative results and problems associated with it and will elaborate the importance of reporting negative results. Under-reporting of negative results not only wastes other researchers time, money, and manpower on which their researchers will be based but also introduces bias in meta-analysis leading to distortion of the scientific literature and misleads researchers, doctors, and policymakers in their decision-making. Many such important studies with negative results remain unpublished and therefore unavailable to the scientific community for understanding their values. A large number of human studies with huge risk to life's are carried out with the assurance that the proposed study will be performed with the aim to benefit, and results will be dissipated to everyone concerned, non-publication of such studies with negative results will not only be morally wrong but will also have ethical obligations to deal with. Therefore, all journals and their editor along with researchers and stakeholders need to be generous in giving importance to disseminating negative and positive findings alike.
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Affiliation(s)
- Hunny Sharma
- Department of Public Health Dentistry, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, Chhattisgarh, India
| | - Swati Verma
- Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Kohka, Bhilai, Chhattisgarh, India
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