Financial conflicts of interest of physicians followed by neurosurgical journals on Twitter.

BACKGROUND: Social media, particularly Twitter, has played an increasing role in networking and the dissemination of neurosurgical research. Despite extensive study on financial conflicts of interest (FCOI) influencing medical research, little is known about the function of conflicts of interest on social media and the influence they may have. In this study, we sought to evaluate the FCOI of physicians followed on Twitter by the top three neurosurgical journals. MATERIALS AND METHODS: We analysed the FCOI of United States (US) physicians followed by the top three neurosurgical journals (Journal of Neurosurgery, World Neurosurgery, Neurosurgery) on Twitter. We determined the FCOIs of each physician using the Open Payments Search Tool located at https://openpaymentsdata.cms.gov and summed the data between 2014 and 2021. RESULTS: We examined 2651 Twitter accounts followed by the top three neurosurgical journals on Twitter and determined 705 (26.6%) belonged to US physicians. Of the 705 US physicians, 577 (81.8%) received general payments between 2014 and 2021. After excluding US physicians currently in residency or fellowship (n = 157), this percentage increased to 93.2% (n = 511/548). In total, nearly $70 million in general payments were made between 2014 and 2021. CONCLUSION: These findings raise questions regarding the interaction between neurosurgical journals and the medical community on Twitter. This study may serve as the basis for future work on best practices for medical journals navigating their affiliations on Twitter.

Associations between depression and diabetic retinopathy in the National Health and Nutrition Examination Survey, 2011 to 2018.

Introduction: Diabetic retinopathy (DR) is a vision-threatening complication of diabetes mellitus (DM). The relationship between depression and DR is unclear, and prior studies are limited by small sample sizes at single centers. This retrospective, cross-sectional study assessed the prevalence of and associations between depression and DR in the US using the National Health and Nutrition Examination Survey for 2011 to 2018. Methods: We collected information on the demographic characteristics, medical conditions, and examination data of NHANES participants with DM. We performed weighted analysis to estimate national prevalence and multivariate analysis to assess the relationship between depression and DR. Results: Of the 22,618 participants included, the prevalence of DM and DR were 3146 (13.9%) and 664 (2.9%). The prevalence of depression was 14.2% in DM only and 19.3% in DR (P = 0.006) with greater severity in the DR group (P < 0.001). After adjusting for comorbidities, DR was no longer significantly associated with depression. Depression was not associated with differences in disease management, although participants with depression had poorer self-perceived health status (P < 0.001). Conclusions: Depression is more prevalent in individuals with DR than those with DM only. The relationship between depression and DR may be mediated by additional medical comorbidities, but further studies are needed.

Financial conflicts of interest of physicians followed by oncology journals on Twitter.

BACKGROUND: Physicians have increasingly adopted Twitter as a discussion and distribution platform for oncology research. While the influence of financial conflicts of interests (FCOI) on medical research is well documented, their role in the dissemination of research on social media platforms is not well known. In this study, we sought to evaluate the FCOIs of physicians followed by the top three oncology journals on Twitter. MATERIALS AND METHODS: We used the Open Payments Search Tool ( https://openpaymentsdata.cms.gov ) to assess FCOIs between 2016 and 2021 of United States (US) physicians followed by three oncology journals (Journal of Clinical Oncology, The Lancet Oncology, and Annals of Oncology) on Twitter. RESULTS: Of 1914 Twitter accounts followed by the top three oncology journals on Twitter, 547 (28.6%) belonged to US physicians. Of these, 463 (84.6%) received general payments between 2016 and 2021. After excluding 30 US physicians currently in residency or fellowship, this percentage increased to 88.2% (n = 456/517). Combined, the median (interquartile range) general payment amount was $8100 ($200-90,000). Additionally, over $42 million in general payments were made between 2016 and 2021. CONCLUSION: Our findings offer insight on FCOIs between oncology journals and US physicians on Twitter. These findings may serve as the foundation for future research regarding optimal medical journal conduct on social media platforms.

Residency Program Characteristics Associated with Higher Cataract Surgery Volume.

PURPOSE: Prior research has shown that ophthalmology residents improve their cataract surgery competency as they perform additional surgeries beyond the 86 minimum cases mandated by the Accreditation Council for Graduate Medical Education (ACGME). Therefore, cataract surgery volume is an important benchmark for ophthalmology programs. Understanding the possible influence of residency program characteristics on resident cataract surgery volume may help educators in identifying areas for improvement and aid applicants in choosing between programs. The aim of this study was to assess residency program characteristics associated with higher mean cataract surgery volume for ophthalmology residents. METHODS: We conducted a retrospective, cross-sectional analysis of the San Francisco Match Program Profile Database to assess various program characteristics from the 113 listed ophthalmology residency programs. The associations between program characteristics and the mean cataract surgery volume per graduating resident (CSV/GR) over years 2018-2021 were analyzed using multiple linear regression. RESULTS: Out of 113 listed residency programs, 109 (96.5%) were included in our study. Across all programs, the mean (SD) CSV/GR was 195.9 (56.9) cases with a range of 86 to 365 cases. In multiple linear regression analysis, the presence of a Veteran Affairs (VA) training site (ß = 38.8, P = .005) and the number of approved fellows per year (ß = 2.9, P = .026) were positively correlated with higher mean CSV/GR. The 85 (78.0%) programs with VA training sites had a higher mean (SD) CSV/GR of 204.1 (55.7) cases compared to 166.7 (52.7) cases in the 24 (22.0%) programs without VA sites (P = .004). The mean CSV/GR increased by 2.9 cases for each additional fellow slot after adjusting for other factors. The number of approved residents per year, affiliation with a medical school, and the number of faculty were not significantly associated with CSV/GR. CONCLUSION: All ophthalmology residency programs included in this study currently meet or exceed the ACGME requirements for cataract surgery case numbers. The presence of a VA training site and a higher number of fellowship positions were associated with higher mean resident cataract surgery volumes. Residency programs may consider further investing in these areas when seeking to improve resident surgical education. Additionally, residency applicants prioritizing cataract surgery volume may consider these factors when evaluating programs.

Healthcare lobbying and campaign finance activities of vision-related professional societies, 2015 to 2022.

Purpose: To compare the lobbying expenditures and political action committee (PAC) campaign finance activities of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), and American Optometric Association (AOA) from 2015 to 2022. Methods: Financial data were collected from the Federal Election Commission and OpenSecrets database. Analysis was performed to characterize and compare financial activity among the organizations. P < 0.05 was considered significant and all analyses were two-sided. Results: From 2015 to 2022, the AAO, ASCRS, and AOA spent $6,745,000, $5,354,406, and $13,335,000 on lobbying, respectively. The AOA's annual lobbying expenditure (median, $1,725,000) was significantly greater than AAO's ($842,500, P = 0.03) and ASCRS's ($694,289, P < 0.001). In PAC donations, OPHTHPAC, affiliated with AAO, received $3,221,737 from 2079 donors (median, $900); eyePAC, affiliated with ASCRS, received $506,255 from 349 donors ($500); and AOA-PAC received $6,642,588 from 3641 donors ($825). Compared to eyePAC, median donations to OPHTHPAC (P = 0.01) and AOA-PAC (P = 0.04) were significantly higher. In campaign spending, OPHTHPAC contributed $2,728,500 to 326 campaigns (median, $5000), eyePAC contributed $293,500 to 58 campaigns ($3000), and AOA-PAC contributed $5,128,673 to 617 campaigns ($5500). eyePAC's median campaign contribution was significantly lower than the AOA's (P < 0.001) and AAO's (P = 0.007). Every PAC directed most of its contributions toward Republican campaigns; eyePAC donated the highest proportion (64.9%). Conclusions: AOA was more assertive in shaping policy by increasing lobbying expenditures, fundraising, and donating to a greater number of election campaigns.

Reproducibility of Femoropopliteal Artery Intravascular Ultrasound Imaging in Patients With Peripheral Artery Disease.

Despite increased use of intravascular ultrasound (IVUS) during peripheral artery interventions, evidence for reproducibility of IVUS measurements and its relation to angiography is lacking. Forty cross-sectional IVUS images of the femoropopliteal artery from 20 randomly selected patients enrolled in the XLPAD (Excellence in Peripheral Artery Disease) registry who underwent peripheral artery interventions and met criteria based on IVUS consensus guidelines were independently assessed by 2 blinded readers. IVUS images from 6 patients (40 images) were selected for angiographic correlation and met criteria for identifiable landmarks (e.g., stent edge and bifurcation). Lumen cross-sectional area (CSA), external elastic membrane (EEM) CSA, luminal diameter, and reference vessel diameter were repeatedly measured. The Lumen CSA and EEM CSA intra-observer agreement by Spearman rank-order correlation (ρ) was >0.993, intraclass correlation coefficient was >0.997, and repeatability coefficient was <1.34. For the interobserver measurement of luminal CSA and EEM CSA, the ρ = 0.742 and 0.764; intraclass correlation coefficient = 0.888 and 0.885; and repeatability coefficient = 7.24 and 11.34, respectively. A Bland-Altman plot for lumen and EEM CSA showed good reproducibility. For angiographic comparison, the ρ for luminal diameter, luminal area, and vessel area were 0.419, 0.414, and 0.649, respectively. Femoropopliteal IVUS measurements showed strong intra-observer and interobserver agreement; IVUS and angiographic measurements did not demonstrate a similar strong agreement.

The impact of the COVID-19 pandemic on early termination of ophthalmology clinical trials: A cross-sectional analysis of ClinicalTrials.gov.

Objective: To study the effect of the COVID-19 pandemic on the early termination of ophthalmology clinical trials. Methods: On June 10, 2022, we searched ClinicalTrials.gov and identified clinical trials pertaining to eye diseases. We included trials last updated between January 1, 2020 and June 8, 2022, as ones possibly impacted by the pandemic. We selected all interventional trials in any stage and country that were "recruiting," "active, not recruiting," "enrolling by invitation," "suspended," "terminated," "completed," or "withdrawn" and excluded trials that had been completed or discontinued before 2020, had incomplete data, trials in which the eye was not the primary focus of the trial (e.g., Chediak-Higashi syndrome, myasthenia gravis). The following trial-level characteristics were collected: location, trial status, enrollment count, ocular condition, sponsors, intervention purpose, trial phase (I-IV), randomization, number of arms, and reasons for discontinuation. In addition to calculating descriptive statistics, we assessed whether trial characteristics differed between ophthalmology clinical trials canceled due to COVID-19 and those canceled for other reasons. Results: Following the screening, 2280/12,679 (18%) ophthalmology clinical trials were retained. Of these, 142 (6.2%) were discontinued between January 1, 2020 and June 8, 2022. Moreover, 34 out of 142 (23.9%) ophthalmology clinical trials were discontinued due to COVID-19. These trials were more likely to be sponsored by academic medical centers (26/34, 76.5% vs 57/108, 52.8%, p = 0.03) and were not assigned to a specific study phase, indicating they were not investigational new drugs (22/34, 64.7% vs 46/108 42.6%, p = 0.003). Conclusions: COVID-19-related trial discontinuations were more likely to be reported by academic medical centers and associated with trials investigating fully approved drugs, medical devices, procedures, diagnostic imaging, and behavioral changes. Further investigation of these characteristics may lead to a more robust and resilient understanding of the causes of early termination of these clinical trials.

Financial conflicts of interest of OncoAlert: An informal oncology professional network.

IMPORTANCE: Social media platforms have allowed the formation of informal professional healthcare networks. Transparency in funding, membership requirements, financial conflicts of interest (FCOI), and messaging are necessary to ensure best practices for similar networks in the future. OBJECTIVE: To analyze the FCOIs of US-based physician members of the OncoAlert Network and appraise the content of their public Twitter account. DESIGN, SETTING, PARTICIPANTS: This cross-sectional study assessed the FCOIs among US-based physician members of the OncoAlert Network between 2015 and 2020. FCOI data were obtained through the Open Payments Database. Additionally, tweets were examined for content analysis. MAIN OUTCOMES AND MEASURES: The number of US-based physician members with FCOIs with the pharmaceutical industry; the amount of general, research, and associated research payments; and the perceived attitude of tweet content from the OncoAlert Network Twitter account. RESULTS: Of 34 US physician members of the OncoAlert Network, 31 (91.2%) received general payments from pharmaceutical companies according to the Open Payments Database. Between 2015 and 2020, US physician members of the OncoAlert Network received a median of $83,600 in general payments (interquartile range [IRQ], $7,200-$221,500). Fourteen members (41.1%) received more than $100,000 in general payments. Additionally, 480 (15.7 %) of 3064 tweets retrieved from the OncoAlert Twitter account mentioned a drug or clinical trial. Of these, 31.6 % (n = 152) had a positive disposition and 3.3 % (n = 16) were negative or critical. CONCLUSIONS AND RELEVANCE: Over 90% of US physician members of the OncoAlert Network had FCOIs between 2015 and 2020. Despite the network's non-profit status, FCOIs amongst its members may influence content produced on the network's social media platforms, such as Twitter, where content discussing drugs and clinical trials are often positive and seldom negative or critical. For future informal professional networks, further research is required to establish best practices for issues such as membership requirements, funding, and FCOI disclosure.

Trends and Characteristics of Industry Payments for Ophthalmology Research From 2014 to 2020.

Importance: Characterizing industry-ophthalmology collaborations in research can highlight current areas of focus, improve transparency, and identify potential sources for conflicts of interest. Objective: To assess the trends and characteristics in research payments reported from industry to ophthalmologists from 2014 to 2020. Design, Setting, and Participants: This cross-sectional study used data from the Centers of Medicare & Medicaid Services' Open Payments database (OPD), which contains public records of payments between industry and physicians, to identify all ophthalmologists who received industry payments for research purposes between 2014 and 2020. Industry funding was compared with public research funding by the National Eye Institute. Main Outcomes and Measures: The value and distribution of payments, sponsoring manufacturers, and research products were assessed. Changes in aggregate and per individual-level funding were characterized using formal trend analysis. Results: From 2014 to 2020, 2102 ophthalmologists were reported to have received $825 417 233 in industry research payments. Industry funding increased 203% from $62 924 525 in 2014 to $190 714 508 in 2020 (P = .01). Comparatively, total National Eye Institute research funding during the same period was $5 003 407 764 and increased 6.6% from $701 313 262 in 2014 to $747 929 556 in 2020 (P = .04). The share of all medical research funding from industry directed specifically toward ophthalmology research increased from 1.2% in 2014 to 3.2% in 2020 (P = .04). The distribution of industry payments was skewed, with the top 15 of 108 manufacturers accounting for 93.9% of funding. The top 10% of ophthalmologists (210) were reported to have received 65.7% of all research dollars ($542 299 121). The highest funded research products were anti-vascular endothelial growth factor agents, glaucoma treatments, and intraocular lenses. Conclusions and Relevance: Although unequal in distribution, industry-funded research in ophthalmology is extensive and increasing in scope. Industry funding for research is less than that of public funding; however, industry funding increased faster between 2014 and 2020. Results of this study highlight the increasing importance of industry funding in ophthalmology research, but it may also present ethical challenges for clinicians collaborating with industry.

Forecasting Retirement in Pediatric Ophthalmology.

This cross-sectional study uses a forecasting model to assess the potential loss of pediatric ophthalmology care in the US due to potential ophthalmologist retirement.