Statistical controversies in clinical research: publication bias evaluations are not routinely conducted in clinical oncology systematic reviews.

Background: Publication bias is an over-representation of statistically significant results in the published literature and may exaggerate summary effect estimates in oncology systematic reviews. Omitting non-significant results in systematic reviews may therefore affect clinical decision-making. We investigate ways that systematic reviewers attempted to limit publication bias during the search process as well as the statistical methods used to evaluate it. For a subset of reviews not reporting publication bias evaluations, we carried out our own assessments for publication bias to determine its likelihood among these reviews. Design: We examined systematic reviews from the top five highest impact factor oncology journals published between 2007 and 2015. Systematic reviews were screened for eligibility and qualifying reviews (n = 182) were coded for relevant publication bias study characteristics by two authors. A re-analysis of reviews not initially evaluating for publication bias was carried out using Egger's regression, trim-and-fill, and selection models. Results: Of the 182 systematic reviews, roughly half carried out a hand search to locate additional studies. Conference abstracts were the most commonly reported form of gray literature, followed by clinical trials registries. Fifty-one reviews reported publication bias evaluations. The most common method was the funnel plot (80%, 41/51) followed by Egger's regression (59%, 30/51) and Begg's test (43%, 22/51). Our publication bias evaluations on non-reporting reviews suggest that the degree of publication bias depends on the method employed. Conclusion: Our study shows publication bias assessments are not frequently used in oncology systematic reviews. Furthermore, evidence of publication bias was found in a subset of non-reporting reviews. Systematic reviewers in oncology are encouraged to conduct such analyses when appropriate and to employ more robust methods for both mitigating and evaluating publication bias.

Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity.

Paediatric obesity rates remain high despite extensive efforts to prevent and treat obesity in children. We investigated the quality of the methodology and reporting within systematic reviews (SRs) underpinning paediatric content in US clinical practice guidelines (CPGs). In June 2016 we searched guideline clearinghouses and professional organization websites for guidelines published by national or professional organizations in the United States from January 2007 onwards. In our primary, a priori analysis, we used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) instruments to score SRs and meta-analyses that included paediatric populations and were cited by included CPGs. In a secondary, post hoc analysis, we determined the extent to which US CPGs use available, relevant SRs and meta-analyses compared with non-US CPGs. Eight US-based CPGs with 27 references to 22 unique SRs were found. AMSTAR and PRISMA scores were low overall, with only three SRs having 'high' methodological quality. Items dealing with bias assessments and search strategies had especially low scores. US CPGs were also older on average and cited fewer SRs than their international counterparts. Low quality scores and dated guidelines should be a cause for concern among practicing clinicians and a call to action for future guideline developers, publishers and research institutions.

Femoral neck fractures: admissions, bed use, outcome and projections.

A number of epidemiological studies have shown that the incidence of femoral neck fractures in industrialized countries increases at an exponential rate with age and that age-adjusted incidence rates are approximately twice as high in women than in men. Femoral neck fractures often have serious consequences for the aged, including permanently limiting their mobility, which results in increased dependence on others and hence an increased probability of being admitted to an institution. In this study, hospital inpatient statistics for New South Wales were examined to elucidate age-related trends in admissions to hospital for acute care, length of stay, bed use and outcome of this condition. Projections of the number of persons expected to suffer from femoral neck fractures, the associated number of bed-days that are required and the expected cost of hospital care to the year 2011 have been made. It seems probable that hospital services will not be provided at the necessary rate to cater for the expected increase in bed use from femoral neck fractures and other age-related conditions. Therefore, rational planning of scarce hospital resources will be required. Reductions in acute care hospital bed use for patients with femoral neck fractures could be made by reducing the number of technical failures in surgical treatment, providing more intensive nursing care to reduce postoperative and bed-rest complications, and by providing integrated slow-stream beds for the physical and social rehabilitation of patients.

Australia: special needs in health care--the aged.

Australian health and welfare services have developed in an ad hoc fashion. In response to demands by interested groups within the community, governments have relied on fiscal control and political expediency to regulate the growth of services and benefits. The lack of comprehensive policies and adequate planning has resulted in legislative complexity and administrative fragmentation, which has adversely affected the development of effective health and welfare services for the elderly Australian. The nature of these difficulties is discussed and recommendations are made for their resolution.

Variation in blood pressure in a New Guinea population.

The contributions of age and anthropometric, biochemical and socio-economic variables to blood pressure variation in the population of Karkar Island, Papua New Guinea are examined. Blood pressure does not change with age in males; in females there is a decline from ages 21 to 40 and an increase (in systolic pressure) thereafter. Body weight and skinfold thicknesses decline with age in females; arm circumferences decline in both sexes. There were no age effects on serum cholesterol or serum sodium. Variation in ponderal index and subcutaneous fat contribute to variation in blood pressure. The correlations of blood pressure with physique are more important in males and the particular variables concerned suggest a nutritional basis. The socio-economic variables examined showed little variation and this was not associated with variation in blood pressure.

Lifestyle, health and disease: a comparison between Papua New Guinea and Australia.

The proposition that lifestyle is a major determinant of community health is explored by contrasting the features of a rural subsistence community in the highlands of Papua New Guinea and the features of the community in urbanized, industrialized Australia. Reference is made to differences in physical environment, housing, work, social situation, human relationships, patterns of disease, population statistics, diet, growth, obesity, physical fitness, blood lipid concentrations, blood pressure, salt intake and the occurrence of hypertension, diabetes, cardiovascular disease and signs of degenerative changes in various tissues. The Papua New Guinea community is seen as a self-reliant, self-contained, socially cohesive subsistence society whose members are well adapted to their physical and social environment, free from major degenerative cardiovascular diseases, with little overt psychiatric illness, but with a heavy burden of infectious disease, with marginal nutritional levels of degenerative disease and disease from psychological stress. It is clear that health, in its fullest sense, is not the prerogative of any one type of society.

Lactate dehydrogenase electrophoretic variant in a New Guinea Highland population.

Six examples of a variation in the LDH-A subunit have been detected in 408 samples from three exogamous clans in the New Guinea Highlands. The New Guinea variant is similar to the Memphis-4 variant. Origin of the New Guinea variant could not be traced by genealogy but it seems likely to have persisted for several generations.