Diabetes in axial spondyloarthritis: a systematic review and meta-analysis of observational studies.

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition with an increased risk of cardiovascular disease (CVD). Diabetes is a well-established risk factor for CVD and stroke. The objective of this study was to conduct a systematic review to: (i) identify the prevalence of diabetes in axSpA and (ii) compare the risk of diabetes in patients with axSpA and without. A comprehensive literature search was performed for articles published between 1 January 2000 and 15 November 2023 using Medline, Embase and Scopus (PROSPERO: CRD42023482573). Observational studies reporting prevalence, incidence or risk of diabetes in axSpA were included. Search results were independently screened by at least two reviewers. Quality of included studies were assessed using the JBI critical appraisal tool. Study-specific proportions and odds ratios (OR) were combined in a random-effects meta-analysis. 2257 articles were identified from database searching from which 23 studies were included for analysis amounting to a combined sample size of 65 025 patients. The pooled prevalence of diabetes in people with axSpA was 7.0% (95% CI 5.9-8.0%; predictive interval 2.4-12.9%; p < 0.001). The funnel plot was symmetric suggesting no small-study effects (I2 = 98.1% (95% CI 0.05-0.08), τ2 = 0.02; p < 0.001). Comparing patients with axSpA to those without, the pooled OR was 1.29 (95% CI 1.10-1.52; predictive interval 0.76-2.22; p = 0.001) for diabetes. The study suggests an increased prevalence and probably an increased risk of diabetes in people with axSpA. Routine screening for diabetes and lifestyle modifications should be encouraged in this cohort.

"Publish or Perish" Paradigm and Medical Research: Replication Crisis in the Context of Artificial Intelligence Trend.

The "publish or perish" culture in academia has intensified trends in medical research, particularly around artificial intelligence (AI) and machine learning. This letter highlights how the pressure to publish positive findings during research trends, such as artificial intelligence in medicine, exacerbates the replication crisis. Issues like data leakage and lack of cross-institutional validation in AI models, particularly in clinical radiology, raise concerns about their reliability. The letter urges authors, reviewers, and editors to enforce rigorous standards to ensure reproducibility and safeguard the integrity of medical research.

A cross-sectional study assessing visual abstracts of randomized trials revealed inadequate reporting and high prevalence of spin.

OBJECTIVE: Visual abstracts (VAs) lack study-specific reporting guidelines and are increasingly used as stand-alone sources in medical research dissemination although not designed for this purpose. Therefore, our objectives were to describe 1) completeness of reporting in VAs and corresponding written abstracts (WAs) of randomised controlled trials (RCTs), and 2) the extent and type of spin (i.e., any reporting pattern that could distort result interpretation and mislead readers) in VAs and WAs of RCTs with a statistically nonsignificant primary outcome. STUDY DESIGN AND SETTING: We conducted a cross-sectional study evaluating VAs and WAs of RCTs published between 01/01/2021 and 03/31/2023. We searched MEDLINE via PubMed for reports of RCTs published in the 15 highest impact factor journals from six medical fields (among which 34 journals producing VAs of RCTs were identified). One reviewer identified primary reports of RCTs published with a VA and randomly selected a maximum of 10 reports from each journal to avoid overrepresentation. Completeness of reporting assessment was based on the CONSORT extension for Abstracts. Spin was explored using a standardized spin classification for RCTs with statistically nonsignificant primary outcome results. Both assessments were conducted in duplicate, with discussion until consensus in case of discrepancy. RESULTS: A random sample of 253 reports from 34 journals was identified. The information provided in VAs was frequently incomplete: primary outcome identification, primary outcome results, and harms were respectively described or displayed in only 47% (n=116/247), 30% (n=75/247), and 35% (n=88/253). Reporting was slightly better for some items in WAs, although still unsatisfactory. Among trials with nonsignificant primary outcome results (n=101), 57% (n=58) of VAs and 55% (n=56) of WAs exhibited at least one type of spin. Post-hoc analyses showed VAs produced by journal editors of high impact general medical journals were more complete and more accurate than those produced by specialty journals or authors. CONCLUSIONS: The information conveyed in VAs was frequently incomplete and inaccurate, highlighting the urgent need to refer to appropriate specific reporting guidelines to avoid misinterpretation by readers.

Barriers and facilitators to faecal immunochemical testing in symptomatic populations: A rapid systematic scoping review and gap analysis.

AIM: Faecal immunochemical testing (FIT) is used to triage people with signs or symptoms of a colorectal cancer (CRC). Recent guidelines have recommended further research to improve access, uptake and return of FIT. This systematic scoping review aims to understand the barriers and facilitators to FIT testing in symptomatic patients. METHOD: Qualitative, quantitative and mixed-methods studies published after September 2013 were included. MEDLINE, EMBASE and PsycINFO databases were searched to identify publications examining barriers and facilitators to FIT. Initially, the data underwent thematic analysis, and subsequently, factors were aligned to components of the Capability, Opportunity, Motivation, Behaviour model. All outcomes are presented in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: One thousand two hundred thirty-two papers were identified; 11 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., general practitioner awareness) and service level (e.g., method of providing FIT kits). Factors were categorised into the subcomponents of the model: psychological capability (e.g., lack of FIT knowledge), reflective motivation (e.g., beliefs regarding FIT sampling and faeces being unhygienic) and automatic motivation (e.g., embarrassment, scary, anxiety provoking). Gaps in knowledge emerged in three domains: (1) patient experience, (2) FIT pathway and (3) healthcare professionals experience of FIT. CONCLUSION: This systematic scoping review provides a summary of the literature on FIT uptake, and identified factors across multiple levels and components. To increase adherence to FIT completion within primary care, a multifaceted theory and evidence-based approach is needed to underpin future behavioural science interventions.

Unlocking Real-World Health Data from Non-University Locations Through Effective Provision of Tools and Knowledge.

INTRODUCTION: The Medical Informatics Initiative (MII) in Germany has pioneered platforms such as the National Portal for Medical Research Data (FDPG) to enhance the accessibility of data from clinical routine care for research across both university and non-university healthcare settings. This study explores the efficacy of the Medical Informatics Hub in Saxony (MiHUBx) services by integrating Klinikum Chemnitz gGmbH (KC) with the FDPG, leveraging the Fast Healthcare Interoperability Resources Core Data Set of the MII to standardize and harmonize data from disparate source systems. METHODS: The employed procedures include deploying installation packages to convert data into FHIR format and utilizing the Research Data Repository for structured data storage and exchange within the clinical infrastructure of KC. RESULT: Our results demonstrate successful integration, the development of a comprehensive deployment diagram, additionally, it was demonstrated that the non-university site can report clinical data to the FDPG. DISCUSSION: The discussion reflects on the practical application of this integration, highlighting its potential scalability to even smaller healthcare facilities and to pave the way to access to more medical data for research. This exemplary demonstration of the interplay of different tools provides valuable insights into technical and operational challenges, setting a precedent for future expansions and contributing to the democratization of medical data access.

Simplifying Multiparty Computation: A Client-Driven Metaprotocol for Federated Secure Computing.

INTRODUCTION: Secure Multi-Party Computation (SMPC) offers a powerful tool for collaborative healthcare research while preserving patient data privacy. STATE OF THE ART: However, existing SMPC frameworks often require separate executions for each desired computation and measurement period, limiting user flexibility. CONCEPT: This research explores the potential of a client-driven metaprotocol for the Federated Secure Computing (FSC) framework and its SImple Multiparty ComputatiON (SIMON) protocol as a step towards more flexible SMPC solutions. IMPLEMENTATION: This client-driven metaprotocol empowers users to specify and execute multiple calculations across diverse measurement periods within a single client-side code execution. This eliminates the need for repeated code executions and streamlines the analysis process. The metaprotocol offers a user-friendly interface, enabling researchers with limited cryptography expertise to leverage the power of SMPC for complex healthcare analyses. LESSONS LEARNED: We evaluate the performance of the client-driven metaprotocol against a baseline iterative approach. Our evaluation demonstrates performance improvements compared to traditional iterative approaches, making this metaprotocol a valuable tool for advancing secure and efficient collaborative healthcare research.