Retrospective cohort study highlighted outcome reporting bias in UK publicly funded trials

Objective

To assess outcome reporting bias and dissemination bias in trials funded by the National Health System (NHS) Health Technology Assessment (HTA) program.

Study Design and Setting

A retrospective cohort study of HTA monographs and corresponding journal publications including all clinical effectiveness randomized controlled trials published as HTA monographs between 1999 and 2005 by the NHS HTA program.

Results

There was a higher median P-value (P = 0.33, interquartile range [IQR]: 0.02-0.54) among trials without a journal publication compared with those with a journal publication (P = 0.14, IQR: 0.007-0.43), although the difference was not statistically significant (Mann-Whitney U test, z = −0.70; P = 0.48). A higher proportion of statistically significant findings were reported in journal articles when compared with the outcomes reported in the HTA monographs. Trials published in general medical journals tended to have smaller P-values (median: 0.05, IQR: 0.001-0.22) than those published in more specialist journals (median: 0.33 IQR: 0.008-0.58), although this result was not significant (Mann-Whitney U test, z = −1.63; P = 0.10).

Conclusions

Among journal-published trials, there were a greater proportion of statistically significant findings included in the journal reports compared with those in the HTA monographs.     

The uptake of the international pressure ulcer/injury prevention and treatment guidelines in the scientific literature: A systematic analysis of two major citation databases

BackgroundThe European Pressure Ulcer Advisory Panel, the National Pressure Injury Advisory Panel and the Pan Pacific Pressure Injury Alliance developed international Clinical Practice Guidelines of the prevention and treatment of pressure ulcers/injuries in 2009, 2014, and 2019. Despite substantial dissemination efforts, evidence about guideline dissemination and uptake in the international literature is lacking.AimThe aim of this review was to capture to the greatest detail possible the number of the citations of the three published Clinical Practice Guidelines.MethodsThe citation databases Web of Science and Scopus were searched for citations of the 2009, 2014 and 2019 Clinical Practice Guidelines including all derivative products including short versions and translations. Two separate search strategies were iteratively developed to ensure highest sensitivity.ResultsThe Cited Reference Search in Web of Science identified hundreds of different referencing formats with more than 2000 citing articles. The Scopus search revealed 250 different reference formats and more than 2000 citation counts. After publication there was a gradual increase of citations that peaks approximately after four years.ConclusionThe three Clinical Practice Guidelines including all derivate versions had a substantial uptake in the scientific literature. This supports the assumption that the guideline dissemination strategies were and are successful.     

Intraoperative Pleural Lavage in Esophageal Carcinoma

Background: Cytological examination of intraoperative pleural or peritoneal lavage specimens is useful for predicting outcomes for patients with various carcinomas. There have been few reports regarding cytological examination of pleural lavage fluid in esophageal carcinoma.Methods: Intraoperative pleural lavage fluid was collected before and after esophagectomy and was examined by Papanicolaou and Giemsa staining for 78 patients with esophageal carcinoma.Results: Although epithelial cells were found for 29 patients, only blood cells were detected for 48. The remaining one patient exhibited no cells in the specimen. For 4 of 78 (5.2%) patients, tumor cells were detected in the pleural lavage fluid after esophagectomy. Three of these four patients had T4 tumors.Conclusions: Positive cytological findings for pleural lavage fluid, using Papanicolaou and Giemsa staining, is correlated with regrowth of residual tumor and poor prognosis in esophageal carcinoma.     

How To Be a Champion

The American Dental Association (ADA) in conjunction with the Journal of Evidence-Based Dental Practice and a grant from Procter and Gamble sponsored a conference May 2008 at ADA headquarters. This was the first of 3 similar annual conferences at which approximately 100 dentists will be trained to become Evidence-Based Dentistry Champions. I was one of the attendees at the first Champions conference. In this article, I will share my experiences in disseminating evidence-based dentistry to my colleagues.     

Strain-dependent CNS dissemination in guinea pigs after Mycobacterium tuberculosis aerosol challenge

Clinical reports suggest an association of distinct Mycobacterium tuberculosis strains with CNS disease. We therefore examined CNS dissemination by different laboratory strains (two M. tuberculosis H37Rv, one CDC1551) in a guinea pig aerosol infection model. Although all strains grew exponentially in lungs, with similar bacterial burdens at the time of extrapulmonary dissemination, M. tuberculosis CDC1551 disseminated to the CNS significantly more than the H37Rv strains. No CNS lesions were observed throughout the study, with only a modest cytokine response. These data suggest that M. tuberculosis may have virulence factors that promote CNS dissemination, distinct from those required for pulmonary TB.     

Is omentectomy mandatory in the operation for ovarian cancer? Preliminary results in a rat study

Objective

To investigate whether omentectomy is required in the operation for ovarian cancer, in particular at the early stage.

Study design

F344 nude rats were divided into two groups: one in which laparotomy and omentectomy were performed (primary omentectomy group, n = 6) and one without omentectomy (n = 12). Concurrently, DISS cells derived from ovarian cancer were transplanted intraperitoneally. After three weeks, the 12 rats without omentectomy were divided into two more groups: one in which the omentum was resected together with the tumor (sham operation/omentectomy group, n = 6) and one without omentectomy (sham operation alone group, n = 6).

Results

The survival of the sham operation alone group was shortest with a median of 35 days, while the median of the primary omentectomy group was 42 days. In the sham operation/omentectomy group, four rats survived beyond Day 90, which was significant compared with other two groups. The intraperitoneal findings in the primary omentectomy group revealed extensive disseminated foci on the mesentery and under the abdominal wall. The sham operation alone group was characterized by jaundice resulting from the compression of the biliary system at the liver hilum by the omental mass. Disseminated foci were not observed in the peritoneal cavity from the sham operation/omentectomy group.

Conclusions

This study suggests the possibility that the omentum has a role in capturing cancer cells and suppressing further peritoneal dissemination. Therefore, although omentectomy is rewarding if disseminated foci are present in the omentum, it is suggested that the timing of omentectomy requires reconsideration in the absence of omental metastasis.     

Primary anaplastic pleomorphic xanthoastrocytoma with widespread neuroaxis dissemination at diagnosis––a pediatric case report and review of the literature

We report a 5 year-old boy with primary anaplastic pleomorphic xanthoastrocytoma (PXA) with whole neuroaxis dissemination at diagnosis who experienced the sudden onset of generalized convulsion. Head- and spinal magnetic resonance imaging (MRI) showed widespread gadolinium (Gd)-enhanced lesions extending to the bilateral frontal- and medial temporal lobes and the spinal cord. Subsequent MRI study demonstrated that the lesion size increased without any neurological deterioration. Under a histopathologic diagnosis of anaplastic PXA he underwent adjuvant chemotherapy consisting of 12 cycles of carboplatin and vincristine. The patient is alive without any neurological deficits; follow-up MRI showed that the lesions remained stable during 18 months of chemotherapy. We report a very rare pediatric case of primary anaplastic PXA with dissemination involving the entire neuroaxis at the time of diagnosis.