When Are Statins Cost-Effective in Cardiovascular Prevention? A Systematic Review of Sponsorship Bias and Conclusions in Economic Evaluations of Statins

Background

We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions.

Methods and Findings

We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000.

Conclusions

Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention.     

Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials

Background

The efficacy of antidepressant medication has been shown empirically to be overestimated due to publication bias, but this has only been inferred statistically with regard to psychological treatment for depression. We assessed directly the extent of study publication bias in trials examining the efficacy of psychological treatment for depression.

Methods and Findings

We identified US National Institutes of Health grants awarded to fund randomized clinical trials comparing psychological treatment to control conditions or other treatments in patients diagnosed with major depressive disorder for the period 1972–2008, and we determined whether those grants led to publications. For studies that were not published, data were requested from investigators and included in the meta-analyses. Thirteen (23.6%) of the 55 funded grants that began trials did not result in publications, and two others never started. Among comparisons to control conditions, adding unpublished studies (Hedges’ g = 0.20; CI_95% -0.11~0.51; k = 6) to published studies (g = 0.52; 0.37~0.68; k = 20) reduced the psychotherapy effect size point estimate (g = 0.39; 0.08~0.70) by 25%. Moreover, these findings may overestimate the "true" effect of psychological treatment for depression as outcome reporting bias could not be examined quantitatively.

Conclusion

The efficacy of psychological interventions for depression has been overestimated in the published literature, just as it has been for pharmacotherapy. Both are efficacious but not to the extent that the published literature would suggest. Funding agencies and journals should archive both original protocols and raw data from treatment trials to allow the detection and correction of outcome reporting bias. Clinicians, guidelines developers, and decision makers should be aware that the published literature overestimates the effects of the predominant treatments for depression.     

Dynamics of Attentional Bias to Threat in Anxious Adults: Bias towards and/or Away?

The aim of the present study was to question untested assumptions about the nature of the expression of Attentional Bias (AB) towards and away from threat stimuli. We tested the idea that high trait anxious individuals (N = 106; M(SD)_age = 23.9(3.2) years; 68% women) show a stable AB towards multiple categories of threatening information using the emotional visual dot probe task. AB with respect to five categories of threat stimuli (i.e., angry faces, attacking dogs, attacking snakes, pointed weapons, violent scenes) was evaluated. In contrast with current theories, we found that 34% of participants expressed AB towards threat stimuli, 20.8% AB away from threat stimuli, and 34% AB towards some categories of threat stimuli and away from others. The multiple observed expressions of AB were not an artifact of a specific criterion AB score cut-off; not specific to certain categories of threat stimuli; not an artifact of differences in within-subject variability in reaction time; nor accounted for by individual differences in anxiety-related variables. Findings are conceptualized as reflecting the understudied dynamics of AB expression, with implications for AB measurement and quantification, etiology, relations, and intervention research.     

Can Research Assessments Themselves Cause Bias in Behaviour Change Trials? A Systematic Review of Evidence from Solomon 4-Group Studies

Background

The possible effects of research assessments on participant behaviour have attracted research interest, especially in studies with behavioural interventions and/or outcomes. Assessments may introduce bias in randomised controlled trials by altering receptivity to intervention in experimental groups and differentially impacting on the behaviour of control groups. In a Solomon 4-group design, participants are randomly allocated to one of four arms: (1) assessed experimental group; (2) unassessed experimental group (3) assessed control group; or (4) unassessed control group. This design provides a test of the internal validity of effect sizes obtained in conventional two-group trials by controlling for the effects of baseline assessment, and assessing interactions between the intervention and baseline assessment. The aim of this systematic review is to evaluate evidence from Solomon 4-group studies with behavioural outcomes that baseline research assessments themselves can introduce bias into trials.

Methodology/Principal Findings

Electronic databases were searched, supplemented by citation searching. Studies were eligible if they reported appropriately analysed results in peer-reviewed journals and used Solomon 4-group designs in non-laboratory settings with behavioural outcome measures and sample sizes of 20 per group or greater. Ten studies from a range of applied areas were included. There was inconsistent evidence of main effects of assessment, sparse evidence of interactions with behavioural interventions, and a lack of convincing data in relation to the research question for this review.

Conclusions/Significance

There were too few high quality completed studies to infer conclusively that biases stemming from baseline research assessments do or do not exist. There is, therefore a need for new rigorous Solomon 4-group studies that are purposively designed to evaluate the potential for research assessments to cause bias in behaviour change trials.     

A Review of: “Handbook of Material Culture”

The examination of a well‐documented petroglyph site, located near the northeastern shoreline of now‐dry Owens Lake, California, is used as a springboard for a review of explanatory models for the interpretation of rock art sites in California and the Great Basin. Interpretive models and methods of analysis used by Julian Steward, Robert Heizer, and others who have visited or reported on this site are reviewed. The persistence of Heizer's “hunting‐magic” explanation for the creation of the rock art is used as one of several examples of how preconceived notions can affect interpretations of ancient art.     

《Review of Diving Beetles of the world》书评

<正>拥有一本某一类群系统的世界性分类鉴定手册,对昆虫分类工作者来说十分重要。在水生甲虫中,龙虱科Dytiscidae是最大的类群,然而一直缺乏一本世界性的鉴定手册。MillerBergsten编著的《世界龙虱》的出版为了解和鉴定龙虱提供了方便。该书为320页的精美硬装本,也有可购买的电子版。该书可分为以下几部分:1.导言:介绍了龙虱的生活史和行为学、     

Space Medicine—A Review of Current Concepts

Space medicine deals with the branch of research involved with the adaptation of humans to the unique environment of space. More than 100 people have traveled in space. The day will come when some human beings will spend all their time in space. Medical problems encountered in space, such as motion sickness, negative nitrogen and calcium balance, anemia and radiation exposure, are issues that already affect medical practice outside aerospace medicine.     

TRANSURETHRAL PROSTATECTOMIES—A Review of 560 Cases

Of 560 prostatectomies in an 11-year period on patients with benign or malignant disease of the prostate gland, almost 98 per cent were done transurethrally.Although many of the patients were considered to be in poor condition preoperatively, results achieved by the transurethral operation were excellent or good in 91 per cent of those who had benign disease of the prostate and in 84 per cent of those with malignant invasion. The rate of deaths attributable to the operation was 3.1 per cent in the group of patients with benign disease, 5.3 per cent in patients who had cancer.Complications, such as urinary incontinence, persistent pyuria, epididymitis, strictures of the urethra and of the meatus, and contracture of the neck of the bladder, arose in a surprising number of cases.     

Hemolytic Disease of the Newborn—Review of Deaths in California

In order to find ways to decrease mortality from hemolytic disease of the newborn, a study was undertaken by physicians of the California Medical Association in cooperation with the California State Department of Public Health. Neonatal deaths during a two and a half year period were investigated and analyzed by review committees with the view of evaluating presumed deficiencies in management.The findings indicate that proper prenatal prediction and preparation by the physician for the management of HDN calls for earlier and more comprehensive use of warning signals, as well as a constant reappraisal of current technology. New advances in the management of HDN require increasingly close cooperation between patients, their physicians and consultants.     

Measurement of Physician-Patient Communication—A Systematic Review

Background

Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients'' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures.

Methods

A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues.

Results

Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.''s criteria was rated mainly intermediate or positive.

Discussion

This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of psychometric property studies as well as the comparability of the studies'' results.     

Modelling the Efficiency of Codon–tRNA Interactions Based on Codon Usage Bias

The tRNA adaptation index (tAI) is a widely used measure of the efficiency by which a coding sequence is recognized by the intra-cellular tRNA pool. This index includes among others weights that represent wobble interactions between codons and tRNA molecules. Currently, these weights are based only on the gene expression in Saccharomyces cerevisiae. However, the efficiencies of the different codon–tRNA interactions are expected to vary among different organisms. In this study, we suggest a new approach for adjusting the tAI weights to any target model organism without the need for gene expression measurements. Our method is based on optimizing the correlation between the tAI and a measure of codon usage bias. Here, we show that in non-fungal the new tAI weights predict protein abundance significantly better than the traditional tAI weights. The unique tRNA–codon adaptation weights computed for 100 different organisms exhibit a significant correlation with evolutionary distance. The reported results demonstrate the usefulness of the new measure in future genomic studies.     

Review: Application of biotechnology to forestry – molecular biology of conifers

Genetic improvement in plantation forestry relies significantly on conventional breeding techniques which have been used extensively to improve various characteristics in forest trees such as growth and form, volume yield, resistance to pathogens and quality of the end product. This review concentrates on molecular techniques which have been used successfully in agriculture and which have more recently become available to improve further characteristics of forest trees and introduce new traits which are currently not available in the breeding population.     

THE IMPAIRED DRIVER—A Review of the Facts

Traffic accidents have been subject to relatively little scientific study in California. A substantial barrier to adequate basic research in this field has been the assumption that more is known about the underlying causes of accidents than actually is. For example, within the medical profession, there is a tendency to assume that physical impairments of drivers are important in the causation of accidents, although little evidence has been collected to confirm or deny this assumption.Research into the underlying causes of accidents is a worthy but infinitely complex task. It must be accomplished before the driver''s contribution to accidents can be seen in proper perspective, its components identified and dealt with on a rational basis.     

A Review of: “New Interpretations of Complex Trace Fossils”

Dinosaur Tracks and Traces, edited by David D. Gillette and Martin G. Lockley, 1989. Cambridge University Press, 110 Midland Avenue, Port Chester, New York 10573, USA. lvii + 454 pages. US$54.50.     

Finger Tip Amputations—Review of Procedures and Applications

Repair of finger tip amputations depends upon the slope of transsection and how much of the tip has been amputated. Type 1 and 2 injuries are easily handled in the emergency room by local flaps with results acceptable by functional and economic criteria. Type 3 amputations with losses of less than 25 percent can be repaired by primary closure. Losses of 50 percent or over are best treated by local or “distant” flaps from the involved or adjacent fingers or palm. Each style of flap and technique has advantages and disadvantages.     

Interfacial Effects of Superhydrophobic Plant Surfaces： A Review

Nature is a huge gallery of art involving nearly perfect structures and properties over the millions of years of development. Many plants and animals show water-repellent properties with fine micro-structures, such as lotus leaf, water skipper and wings of butterfly. Inspired by these special surfaces, the artificial superhydrophobic surfaces have attracted wide attention in both basic research and industrial applications. The wetting properties of superhydrophobic surfaces in nature are affected by the chemical compositions and the surface topographies. So it is possible to realize the biomimetic superhydrophobic surfaces by tuning their surface roughness and surface free energy correspondingly. This review briefly introduces the physical-chemical basis of superhydrophobic plant surfaces in nature to explain how the superhydrophobicity of plant surfaces can be applied to different biomimetic functional materials with relevance to technological applications. Then, three classical effects of natural surfaces are classified： lotus effect, salvinia effect, and petal effect, and the promising strategies to fabricate biomimetic su- perhydrophobic materials are highlighted. Finally, the prospects and challenges of this area in the future are proposed.