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Gender and other potential biases in peer review: cross-sectional analysis of 38 250 external peer review reports

Por: Severin · A. · Martins · J. · Heyard · R. · Delavy · F. · Jorstad · A. · Egger · M.
Objectives

To examine whether the gender of applicants and peer reviewers and other factors influence peer review of grant proposals submitted to a national funding agency.

Setting

Swiss National Science Foundation (SNSF).

Design

Cross-sectional analysis of peer review reports submitted from 2009 to 2016 using linear mixed effects regression models adjusted for research topic, applicant’s age, nationality, affiliation and calendar period.

Participants

External peer reviewers.

Primary outcome measure

Overall score on a scale from 1 (worst) to 6 (best).

Results

Analyses included 38 250 reports on 12 294 grant applications from medicine, architecture, biology, chemistry, economics, engineering, geology, history, linguistics, mathematics, physics, psychology and sociology submitted by 26 829 unique peer reviewers. In univariable analysis, male applicants received more favourable evaluation scores than female applicants (+0.18 points; 95% CI 0.14 to 0.23), and male reviewers awarded higher scores than female reviewers (+0.11; 95% CI 0.08 to 0.15). Applicant-nominated reviewers awarded higher scores than reviewers nominated by the SNSF (+0.53; 95% CI 0.50 to 0.56), and reviewers from outside of Switzerland more favourable scores than reviewers affiliated with Swiss institutions (+0.53; 95% CI 0.49 to 0.56). In multivariable analysis, differences between male and female applicants were attenuated (+0.08; 95% CI 0.04 to 0.13) whereas results changed little for source of nomination and affiliation of reviewers. The gender difference increased after September 2011, when new evaluation forms were introduced (p=0.033 from test of interaction).

Conclusions

Peer review of grant applications at SNSF might be prone to biases stemming from different applicant and reviewer characteristics. The SNSF abandoned the nomination of peer reviewers by applicants. The new form introduced in 2011 may inadvertently have given more emphasis to the applicant’s track record. We encourage other funders to conduct similar studies, in order to improve the evidence base for rational and fair research funding.

Agreement between ranking metrics in network meta-analysis: an empirical study

Por: Chiocchia · V. · Nikolakopoulou · A. · Papakonstantinou · T. · Egger · M. · Salanti · G.
Objective

To empirically explore the level of agreement of the treatment hierarchies from different ranking metrics in network meta-analysis (NMA) and to investigate how network characteristics influence the agreement.

Design

Empirical evaluation from re-analysis of NMA.

Data

232 networks of four or more interventions from randomised controlled trials, published between 1999 and 2015.

Methods

We calculated treatment hierarchies from several ranking metrics: relative treatment effects, probability of producing the best value and the surface under the cumulative ranking curve (SUCRA). We estimated the level of agreement between the treatment hierarchies using different measures: Kendall’s and Spearman’s correlation; and the Yilmaz and Average Overlap, to give more weight to the top of the rankings. Finally, we assessed how the amount of the information present in a network affects the agreement between treatment hierarchies, using the average variance, the relative range of variance and the total sample size over the number of interventions of a network.

Results

Overall, the pairwise agreement was high for all treatment hierarchies obtained by the different ranking metrics. The highest agreement was observed between SUCRA and the relative treatment effect for both correlation and top-weighted measures whose medians were all equal to 1. The agreement between rankings decreased for networks with less precise estimates and the hierarchies obtained from appeared to be the most sensitive to large differences in the variance estimates. However, such large differences were rare.

Conclusions

Different ranking metrics address different treatment hierarchy problems, however they produced similar rankings in the published networks. Researchers reporting NMA results can use the ranking metric they prefer, unless there are imprecise estimates or large imbalances in the variance estimates. In this case treatment hierarchies based on both probabilistic and non-probabilistic ranking metrics should be presented.

Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme

Por: Deml · M. J. · Jafflin · K. · Merten · S. · Huber · B. · Buhl · A. · Frau · E. · Mettraux · V. · Sonderegger · J. · Kliem · P. · Cattalani · R. · Krüerke · D. · Pfeiffer · C. · Burton-Jeangros · C. · Tarr · P. E.
Introduction

Vaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017–2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient–provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents.

Methods and analysis

Our transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15–26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations.

Ethics and dissemination

The study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.

CP-North: living life in the Nordic countries? A retrospective register research protocol on individuals with cerebral palsy and their parents living in Sweden, Norway, Denmark, Finland and Iceland

Por: Alriksson-Schmidt · A. I. · Ahonen · M. · Andersen · G. L. · Eggertsdottir · G. · Haula · T. · Jahnsen · R. · Jarl · J. · Jeglinsky-Kankainen · I. · Jonsdottir · G. · Seid · A. K. · Asgeirsdottir · T. L. · Moller-Madsen · B. · Nordbye-Nielsen · K. · Saha · S. · Steskal · D. · Sää
Introduction

Cerebral palsy (CP) is one of the most common neurodevelopmental disabilities. Yet, most individuals with CP are adults. How individuals with CP fare in terms of health, quality of life (QoL), education, employment and income is largely unknown. Further, little is known about the effects of having a child with CP on the parents. The Nordic countries are known for their strong welfare systems, yet it is unknown to what extent the added burden related to disability is actually compensated for. We will explore how living with CP affects health, QoL, healthcare utilisation, education, labour market outcomes, socioeconomic status and mortality throughout the lifespan of individuals with CP and their parents. We will also investigate if these effects differ between subgroups, within and across the Nordic countries.

Methods and analyses

CP-North is a multidisciplinary 4-year (1 August 2017 to 31 July 2021) register research project. The research consortium comprises researchers and users from Sweden, Norway, Denmark, Iceland and Finland. Data from CP registries and follow-up programmes, or cohorts of individuals with CP, will be merged with general national registries. All individual studies are structured under three themes: medical outcomes, social and public health outcomes, and health economics. Both case–control and cohort designs will be included depending on the particular research question. Data will be analysed in the individual countries and later merged across nations.

Ethics and dissemination

The ethics approval processes in each individual country are followed. Findings will be published (open access) in international peer-reviewed journals in related fields. Updates on CP-North will be published online at http://rdi.arcada.fi/cpnorth/en/

Is microdiffusion imaging able to improve the detection of cervical myelopathy? Study protocol of a prospective observational trial (MIDICAM-Trial)

Por: Hohenhaus · M. · Egger · K. · Klingler · J.-H. · Hubbe · U. · Reisert · M. · Wolf · K.
Introduction

The diagnosis of degenerative cervical myelopathy (DCM) is difficult in numerous patients due to the limited correlation of clinical symptoms, electrophysiology and MRI. This applies especially for early disease stages with mild symptoms or in uncertainty due to comorbidities. Conventional MRI myelopathy signs show a restricted sensitivity to clinical symptoms of at most 60%. It is desirable to select patients for surgical treatment as early as possible before irreversible neurological damage occurs. To improve treatment, a more reliable imaging is necessary. Microdiffusion imaging (MIDI) is an innovative MRI modality to depict tissue alterations within one voxel based on diffusion-weighted imaging (DWI) postprocessing. By separating the affected area into several mesoscopic compartments, pathological changes might be detected more sensitive through this subtle tissue resolution. We hypothesise, that MIDI shows myelopathic alterations more sensitive than conventional MRI and improves the correlation to functional impairment.

Methods and analysis

In this prospective, observational trial, 130 patients with a relevant degenerative cervical spinal stenosis receive MRI including MIDI and a standard clinical and electrophysiological assessment. Special subvoxel diffusion parameters are calculated. Clinical follow-ups are conducted after 3, 6 and with additional MRI and electrophysiology after 12 months. The primary endpoint is the sensitivity of MIDI to detect functional myelopathy defined by clinical and electrophysiological features correlated to conventional MRI myelopathy signs. Twenty healthy subjects will be included as negative control. The results will provide new insights into the development of mesoscopic spinal cord alterations in DCM associated to the clinical course. Aim is to improve the diagnostics of incipient myelopathy through this new modality.

Ethics and dissemination

The study protocol is approved by the Ethics Committee of the University of Freiburg (reference 261/17). The results will be published in a peer-reviewed journal.

Trial registration number

DRKS00012962.

Enhancing validity through cognitive interviewing. A methodological example using the Epilepsy Monitoring Unit Comfort Questionnaire 通过认知访谈提高有效性。使用癫痫监测器舒适度问卷的方法学示例

Abstract

Aims

To identify problematic items, assess completeness and user‐friendliness, and undertake modifications to enhance face validity of the newly developed Epilepsy Monitoring Unit Comfort Questionnaire.

Design

Qualitative‐descriptive cross‐sectional study.

Methods

Five iterative rounds of cognitive interviewing were conducted with members of the target population between July ‐ November 2017. Think‐aloud technique, verbal probing, and observation were used, to assess how respondents understood and answered questions. Data analysis was based on the framework method; an eight‐column framework matrix was created for this purpose.

Results

In 25 interviews, problems regarding completeness of the item pool, comprehension of items, retrieval of information, judgment while finding answers and reporting the appropriate responses could be detected. According to the results, 27 items remained unchanged, 11 items were reworded, and six items were added. Instructions section of the questionnaire was reworked, too.

Conclusion

Although time‐consuming, cognitive interviewing turned out to be a valuable approach for revealing problems in an instrument, which would, otherwise, remain undetected and threaten validity.

目的

识别问题项目、评价完整性和用户方便性,并进行修改,以提高新编制的癫痫监测器舒适度问卷的表面有效性。

设计

定性描述性横断面研究。

方法

2017年7月˜11月对目标人群进行5轮重复认知访谈。运用有声思维、语言探究、观察等方法,评估受访者对问题的理解和回答。数据分析基于框架法,为此建立了八列框架矩阵。

结果

在25次访谈中,可以发现关于题库的完整性、题目理解、信息检索、寻找答案时的判断以及报告适当答案等问题。根据调查结果,有27个题目保持不变,11个题目被改写,6个题目被添加。问卷的说明部分也经过了修改。

结论

认知访谈虽然耗费时间,但却是揭示问题的一种有价值的方法,否则将无法发现问题并影响有效性。

Adherence, knowledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation 在射频消融术后易患血栓的房颤患者中,对于口服抗凝血剂的依从

Abstract

Aims

This study aimed to: (a) determine adherence rates to oral anticoagulants in atrial fibrillation patients with a high risk for thromboembolic events postradiofrequency ablation; (b) evaluate patients’ knowledge and perceptions towards oral anticoagulants; and (c) explore the impact of patients’ knowledge and perceptions on treatment adherence.

Background

Atrial fibrillation is a common arrhythmia associated with an increased risk of developing thromboembolic events such as stroke. Although adherence to oral anticoagulants is crucial to prevent such complications, the relationship between adherence, knowledge and patient perceptions is poorly understood in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation.

Design

A cross‐sectional observational survey study was performed in a single centre.

Methods

The levels of adherence, knowledge, and perception towards oral anticoagulants were assessed using the 8‐item Morisky Medication Adherence Scale, Knowledge of Oral Anticoagulation Tool, Perception of Anticoagulant Treatment Questionnaire and Benefit‐Risk Perception Tool, respectively. Results from these self‐reported tools were analysed descriptively. A multivariable binary logistic regression model was used to identify factors associated with levels of adequate adherence.

Results

Adequate treatment adherence was found in three‐quarters of patients. The total mean knowledge score was low. Participants expressed high ease of use and low burden of treatment. Higher total knowledge and satisfaction scores were significant factors associated with higher levels of adherence.

Conclusion

There remains a huge unmet need to follow‐up and educate patients with atrial fibrillation, focusing on good knowledge and correct perception of the advantages and disadvantages of oral anticoagulants. Our results suggest that increased knowledge and satisfaction rates might have a positive impact on adherence to oral anticoagulants.

目标

本研究旨在:(a)确定在射频消融术后易患血栓的房颤患者口服抗凝血剂的依从率;(b)评估患者对口服抗凝血剂的了解和认知;以及(c)探讨患者的了解和认知对治疗依从性的影响。

背景

房颤是一种常见的心律失常,与中风等患血栓的风险增加有关。尽管坚持口服抗凝血剂对于预防这种并发症非常重要,但对射频消融术后易患血栓的房颤患者的依从性、了解和患者认知之间的关系却知之甚少。

设计

进行了单中心横断面观察性调查研究。

方法

对口服抗凝血剂的依从性、了解和认识水平进行了评估,分别采用了8条目Morisky服药依从性量表、口服抗凝治疗工具知识、抗凝治疗问卷的看法和利弊认知工具。对这些自我报告工具的结果进行了描述性分析。同时,采用了多变量二元逻辑回归模型来确定与适当依从性水平相关的因素。

结果

在四分之三的患者中发现有适当的治疗依从性。总平均了解评分较低。受试者表现出了对治疗的高度接受和较低的心理负担。此外,较高的了解和满意度总分是与更高的依从性水平相关的重要因素。

结论

仍有大量未被满足的需求,需要对房颤患者进行随访和教育,以便患者良好了解和正确认识口服抗凝血剂的优缺点。研究结果表明,增加的了解和满意度可能对口服抗凝血剂的依从性有积极的影响。

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