An Analysis of the Evidence Informing Clinical Practice Guidelines in the Management and Treatment of Breast Cancer.

OBJECTIVE: The aim of this study was to assess the methodological quality and accuracy of reporting within systematic reviews (SRs) that provide evidence to form clinical practice guidelines (CPGs) in the management and treatment of breast cancer. METHODS: The 5 included CPGs for breast cancer management among National Comprehensive Cancer Network and European Society for Medical Oncology were searched for all SRs and meta-analyses. The characteristics of each study along with their methodological reporting were extracted from each SR using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) tools. Our second objective was to compare SRs produced by Cochrane groups vs non-Cochrane. RESULTS: Our study included 5 CPGs for the management of breast cancer, containing 1341 total references with 69 being unique SRs we analyzed. PRISMA completeness percent had a mean 76.3% (n = 69), while AMSTAR-2 completeness score mean was 66.5% (n = 59). Cochrane SRs were found to adhere far better to PRISMA (0.91 vs. 0.74) and AMSTAR-2 (0.95 vs. 0.62) guidelines compared to the non-Cochrane SRs. CONCLUSION: The reporting quality of SRs that underpin CPGs in breast cancer management widely varies. We recommend that authors of SRs adopt a more uniform approach in assessing the quality of reporting within their studies. In addition, CPGs should use a more standardized method to seek out evidence to establish their recommendations. With improved reporting, clinicians may have increased confidence in CPGs and thus increased utilization of CPGs in clinical decision making.

An analysis of the evidence underpinning the national comprehensive cancer network practice guidelines.

OBJECTIVE: This study assesses the quality and completeness of systematic reviews (SRs) included by the National Comprehensive Cancer Network (NCCN) cancer screening clinical practice guidelines (CPGs). METHODS: We evaluated SRs according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess systematic Reviews). RESULTS: Seven NCCN CPGs were included with 109 SRs. The mean PRISMA percent completeness of included SRs was 71 % (range 0.1-1.0). The mean AMSTAR-2 percent completeness was 56 % (range 0.05-0.99). Of the 70 SRs assessed via AMSTAR-2, 42 (60 %) received a "critically low" rating, 11 (15.7 %) received "low" ratings, and 17 (24.3 %) received "moderate". None of the SRs received a "high" rating. CONCLUSION: Lack of adherence to AMSTAR-2 and PRISMA reporting standards among the SRs included is prevalent. We suggest improved reporting of SR inclusion criteria and evaluation to bolster the reporting quality of SRs underpinning CPG recommendations.

Spin Infrequently Occurs in Abstracts of Systematic Reviews For The Pharmacological Treatment of Type 2 Diabetes Mellitus.

AIMS: Currently, there is a growing body of research demonstrating that spin - the misinterpretation and distortion of a study's findings - is common in different fields of medicine. To our knowledge, no study has investigated its presence in systematic reviews focused on diabetic therapies. METHODS: We performed a cross-sectional study by searching MEDLINE and Embase for systematic reviews focused on pharmacologic treatments for type 2 diabetes mellitus. Our search retrieved 26,490 records, from which 199 studies were extracted in a masked, duplicate fashion. Each study was evaluated for the nine most severe types of spin and other study design parameters. Spin was presented as frequencies and odds ratios to identify associations between study characteristics. RESULTS: Spin was identified in the abstracts of 15 systematic reviews (15/199, 7.5%). Spin type 5 was the most common type identified (7/199, 3.5%). Spin types 1, 2, 4, and 8 were not identified. In the last 5 years (2016-2021), 7 systematic reviews contained spin within their abstract. There was no association between spins presence and any extracted study characteristic . CONCLUSIONS: Our findings show that spin infrequently occurs in abstracts of systematic reviews focused on pharmacologic therapies for type 2 diabetes mellitus. However, any amount of spin can lead to the distortion of a reader's interpretation of the study's findings. Thus, we provide recommendations with rationale to prevent spin in future systematic reviews.

YouTube: Searching for answers about breast cancer.

INTRODUCTION: Breast cancer is the most common cancer in women, affecting approximately 1 in 8 women worldwide. Additionally, it is either the most or second-most lethal cancer depending on ethnicity. Many women and concerned family members turn to the internet for information regarding the signs, symptoms, diagnosis and treatment of this life-altering condition. We sought to objectively evaluate the quality of the information available on YouTube concerning breast cancer. METHODS: We searched YouTube for videos relating to breast cancer. We included videos that were less than 20 minutes in length, were in the top 200 for most views and were available in English, either subtitled or narrated. Videos were independently and blindly scored using a standardized scoring form. Possible scores ranged from negative infinity to 25.5 with one point being deducted for each misleading statement or claim. RESULTS: After exclusions, 133 videos in our sample were evaluated. Out of a possible 25.5 points, the true mean was 3.90 with a standard deviation of 1.38. There were only 30 videos (22.5%) that scored more than 7 points. 12 (9.0%) videos scored 0 points or fewer. 12 (9.0%) of the videos in our sample contained at least one misleading statement with 9 of those contained multiple misleading statements with some videos having up to 10 such statements. CONCLUSION: While YouTube is an important source of information regarding breast cancer, few videos contain a significant amount of quality information and many of the videos contain false or misleading statements. In an area where patients are often scared and searching for answers, there is a significant need for more high-quality videos to educate patients and dispel myths and pseudoscience.

Research Gaps in Wilderness Medicine.

INTRODUCTION: Wilderness medicine involves the treatment of individuals in remote, austere environments. Given the high potential for injuries as well as the unique treatment modalities required in wilderness medicine, evidence-based clinical practice guidelines are necessary to provide optimal care. In this study, we identify evidence gaps from low-quality recommendations in wilderness medicine clinical practice guidelines and identify new/ongoing research addressing them. METHODS: We included relevant clinical practice guidelines from the Wilderness Medical Society and obtained all 1C or 2C level recommendations. Patient/Problem/Population, intervention, comparison, outcome (PICO) questions were created to address each recommendation. Using 24 search strings, we extracted titles, clinical trial registry number, and recruitment status for 8899 articles. We categorized the articles by trial design to infer the effect they may have on future recommendations. RESULTS: Twelve clinical practice guidelines met inclusion criteria. From these we located 275 low-quality recommendations and used them to create 275 PICO questions. Thirty-three articles were relevant to the PICO questions. Heat-related illness had the highest number of relevant articles (n=9), but acute pain and altitude sickness had the most randomized clinical trials (n=6). CONCLUSION: Overall, few studies were being conducted to address research gaps in wilderness medicine. Heat-related illness had the most new or ongoing research, whereas no studies were being conducted to address gaps in eye injuries, basic wound management, or spine immobilization. Animals, cadavers, and mannequin research are useful in cases in which human evidence is difficult to obtain. Establishing research priorities is recommended for addressing research gaps identified by guideline panels.