POLLing

It's been a while now since Jim Amos, George Dawson, and I started POLL, our free online journal club, where we post an open access article, and ask for discussion.

At first, we were posting our articles on our respective blogs, but then, with some discussion and show of interest, we switched to LinkedIn as a venue, thinking it would be more professional, and could encourage a larger audience. We tried to keep up at the rate of a new article each week, with credit mostly to Jim Amos, but that was a bit much to manage. So then we moved to every other week.

Unfortunately, with the exception of one or two instances, no one was participating in the discussions. I don't know if people weren't interested in the particular articles, or the questions weren't evocative enough, or the venue wasn't working, or we weren't doing enough to promote it, or any of a number of reasons I haven't thought of.

I don't want to give up the idea of on online journal club, because I think it's a perfect venue, and a great way to demonstrate an interest in lifelong learning without shelling out thousands of dollars for meaningless CME.

So I am really, genuinely asking for people's opinions. Are you interested in an online journal club? If so, why, and if not, why not? What venue are you interested in-LinkedIn, individual blogs, twitter, a separate blog, facebook, other suggestions? What would be the function of an online journal club, for you? What topics would you like to see covered? Who would you like to see participate? Who would you like to select the articles? Would you like to be involved in selecting the articles? Should there be separate journal clubs for separate topics? What should the frequency be?

I'm not sending out another survey, because they're so sparsely responded to that it isn't useful. But I really think this is a great opportunity for people with common interests to have open discussions about important professional topics. So please make your voice heard and comment.

Thanks.

POLL Article, Editorial Policies

If you hop on over to POLL, you can check out and contribute to a discussion of the new article, How Psychiatry Journals Support the Unbiased Translation of Clinical Research. A Cross-Sectional Study of Editorial Policies
by Hannes Knüppel, Courtney Metz, Joerg J. Meerpohl, and Daniel Strech.

The authors looked at 123 Psychiatry journals, and a subset of the "Top Ten" journals, which were unspecified, to determine how frequently/strongly these journals encourage or require authors who submit papers to follow reporting guidelines, and to register their respective trials with registries such as ClinicalTrials.gov, and the WHO's International Clinical Trials Registry Platform (ICTRP).
Actually, according to their site, the ICTRP is not a clinical trials registry. To become registered, trials need to be submitted to one of the Primary Registries in the WHO Registry Network.

The ICTRP site had a nice description of why it's important to register clinical trials:

The registration of all interventional trials is considered to be a scientific, ethical and moral responsibility because:

• There is a need to ensure that decisions about health care are informed by all of the available evidence
• It is difficult to make informed decisions if publication bias and selective reporting are present
• The Declaration of Helsinki states that "Every clinical trial must be registered in a publicly accessible database before recruitment of the first subject".
• Improving awareness of similar or identical trials will make it possible for researchers and funding agencies to avoid unnecessary duplication
• Describing clinical trials in progress can make it easier to identify gaps in clinical trials research
• Making researchers and potential participants aware of recruiting trials may facilitate recruitment
• Enabling researchers and health care practitioners to identify trials in which they may have an interest could result in more effective collaboration among researchers. The type of collaboration may include prospective meta-analysis
• Registries checking data as part of the registration process may lead to improvements in the quality of clinical trials by making it possible to identify potential problems (such as problematic randomization methods) early in the research process

Getting back to the original study, they found that 45% (10% of the Top Ten) of the journals made no mention of URM's (Uniform Requirements for Manuscripts, including guidelines and trial registration); 34% (0%) mentioned without specification; 7% (10%) mentioned with the recommendation to adhere; and 14% (80%) mentioned with the requirement to adhere. 

With respect to trial registration, 66% (30%) did not mention; 9% (0%) mentioned with recommendation to adhere; and 25% (70%) mentioned with the requirement to adhere. Furthermore, 70% of the top ten journals did not ask for the specific trial registration number.

The article did not discuss how well the journals that required the use of guidelines and trial registry followed up on compliance. 

What I found most interesting, though, were the reporting guidelines, which I found at the Equator Network. For example, CONSORT (CONsolidated Standards Of Reporting Trials), the guideline for randomized trials, has the following Results excerpt from their checklist:

Participant flow (a diagram is strongly recommended)	13a	For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome
	13b	For each group, losses and exclusions after randomisation, together with reasons
Recruitment	14a	Dates defining the periods of recruitment and follow-up
	14b	Why the trial ended or was stopped
Baseline data	15	A table showing baseline demographic and clinical characteristics for each group
Numbers analysed	16	For each group, number of participants (denominator) included in each analysis and whether the analysis was by original assigned groups
Outcomes and estimation	17a	For each primary and secondary outcome, results for each group, and the estimated effect size and its precision (such as 95% confidence interval)
	17b	For binary outcomes, presentation of both absolute and relative effect sizes is recommended
Ancillary analyses	18	Results of any other analyses performed, including subgroup analyses and adjusted analyses, distinguishing pre-specified from exploratory
Harms	19	All important harms or unintended effects in each group (for specific guidance see CONSORT for harms)

STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) is the guideline for observational studies, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for meta-analyses and systematic reviews, etc. 

So different types of studies have different, and apparently clear and explicit guidelines. 

Not much more to say about this right now, except that I like the idea that the authors looked at sources of bias coming from a less common place (as opposed to from greedy pharmaceutical companies, not that they aren't).

New POLL Article: Childhood Emotional Maltreatment

I'm posting a new POLL article on LinkedIn, entitled:

Childhood Emotional Maltreatment Severity Is Associated with Dorsal Medial Prefrontal Cortex Responsivity to Social Exclusion in Young Adults

Abstract

Children who have experienced chronic parental rejection and exclusion during childhood, as is the case in childhood emotional maltreatment, may become especially sensitive to social exclusion. This study investigated the neural and emotional responses to social exclusion (with the Cyberball task) in young adults reporting childhood emotional maltreatment. Using functional magnetic resonance imaging, we investigated brain responses and self-reported distress to social exclusion in 46 young adult patients and healthy controls (mean age = 19.2±2.16) reporting low to extreme childhood emotional maltreatment. Consistent with prior studies, social exclusion was associated with activity in the ventral medial prefrontal cortex and posterior cingulate cortex. In addition, severity of childhood emotional maltreatment was positively associated with increased dorsal medial prefrontal cortex responsivity to social exclusion. The dorsal medial prefrontal cortex plays a crucial role in self-and other-referential processing, suggesting that the more individuals have been rejected and maltreated in childhood, the more self- and other- processing is elicited by social exclusion in adulthood. Negative self-referential thinking, in itself, enhances cognitive vulnerability for the development of psychiatric disorders. Therefore, our findings may underlie the emotional and behavioural difficulties that have been reported in adults reporting childhood emotional maltreatment.

The study looks at reactions to the Cyberball game, in which the participant plays a game of cyber-catch with the computer and two other players, one male and one female. In the first, inclusion, part of the game, the computer throws the ball to each player an equal number of times. In the second, exclusion, part, the computer throws the ball to the subject once or twice a the beginning of the game, and then never again. The game is supposed to be a model for social exclusion.

The study examined severity of childhood emotional maltreatment using the Dutch version of something called the Childhood Trauma Questionnaire.

They looked at Mood and something called, "Need Threat", after the inclusion section, then after the exclusion, and then after the whole thing was done:

The Cyberball game didn't seem to have much differential effect between groups, and what you see is mostly a difference in baseline, unrelated to the game. The main difference seemed to be in fMRI, with greater childhood emotional maltreatment corresponding to greater dorsal medial prefrontal cortex activity:

It's hard to know how much this matters, in the grand scheme of things-whether people who suffered childhood emotional maltreatment are really more vulnerable to social exclusion, and if the difference in brain activity amounts to a difference in perceived experience, and greater vulnerability to other pathology.

But please take a look at the article and let me know what you think, either here, or on POLL.

New POLL Article! and Obit

I just posted a new article and discussion on POLL. Please check it out, and comment freely.

The article, Evidence b(i)ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications , compares the studies submitted to the Swedish regulatory agency for approval of 5 SSRI's, with the articles that were eventually published based on those studies.

They note 3 problematic areas.

1. Multiple Publication-individual studies yielded multiple publications, without acknowledging that they came from the same study. Also, subsets of data from multiple studies were pooled to create new publications.
2. Selective Publication-studies that made the drug look good were published more often than studies that showed no difference from placebo.
3. Selective Reporting-studies ignored the results of intention to treat analyses in favor of per protocol analyses, which make the drug look better.

In case you've forgotten, in an intention to treat analysis, subjects who dropped out of a study, for whatever reason, are analyzed as thought they had completed the study, with the last available result carried forward.
In a per protocol analysis, subjects who drop out are ignored in the final analysis. Since many subjects drop out due to adverse effects, or lack of effect, if you don't include those subjects, your results will look better (the subjects who tolerate the drug well and do better on it are more likely to remain in the trial).

Please check out the study and comment (I already wrote that, but it bears repeating).

On another, related note, Ann Wolpert, MIT's director of libraries since 1996, died last month. The reason this is relevant is because she was a big believer in open access, and beginning in 2000, developed DSpace,

"an open-source digital archive for research that has been adopted by more than 1,000 institutions worldwide. DSpace ensure(s) that there (is) a common, permanent platform for library material. Then, in 2009, she conceived the MIT Faculty Open Access Policy, where professors give the Institute permission to disseminate journal articles for open access through DSpace@MIT. In turn, those articles can be republished on open Web sites like the Public Library of Science or PLOS. It was the first policy of its kind in the United States, and has been imitated by other universities around the globe." (Jason Pontin, MIT Technology Review Editor)


“(Wolpert) believed in open access, but it went deeper than that...Her central insight was that in the age of the Internet, a great research library could serve not only as a window into scholarly output for given members of university and research communities, but also as a window for the world at large into the scholarly enterprise. That was a great and thrilling idea...” (Hal Abelson, Class of 1922 Professor of Computer Science and Engineering at MIT and founding director of both Creative Commons and the Free Software Foundation (source))

 POLL, our free online journal club that uses open access articles, was created in the spirit of Wolpert's work. Please make use of it.

Ann Wolpert

POLL!

We did it! Drs. James Amos and George Dawson (of the Real Psychiatry blog) and I created a LinkedIn group entitled, Psychiatry Online Lifelong Learning (POLL).  Here's the description:

This is a free Psychiatry journal club. Links to free articles, along with managers' initial comments, will be posted at regular intervals. Enthusiastic discussion is highly encouraged.
The purpose of this group is to foster professional interaction and collaboration, and to promote the principle of lifelong learning so important to continued growth as a clinician. 
The group is primarily intended for psychiatrists, but anyone with an interest in psychiatry, and a scientific bent, is welcome to apply for membership.
We ask simply that comments be respectful and relevant to the discussion at hand.

And guess what? The first discussion has already begun, kicked off by none other than Dr. James Amos of The Practical Psychosomaticist blog. There's a timely article entitled,

Collaborative Care for Patients with Depression and Chronic Illnesses, byWayne Katon, et al.

So don't delay! Head on over to LinkedIn, and apply for membership. If you don't already have a LinkedIn account, it's free and easy to set one up, and not a bad thing to have, in any case.

We're really excited about this, and we'd like it to be something good for everyone. So please help us, and yourself, out by joining and participating.

Thanks.

Follow Up Poll

Back in April, I posted a survey about the DSM-5: whether people planned to purchase it, what people thought the problems with it would be.

Now I'm following up. I want to know if people have purchased it, and whether they feel it's been helpful.

Click HERE to participate. It's completely anonymous, and you don't need to have participated in the first poll to join in on this one.

This survey will close 07.27.13, 12am. Thank you in advance for participating.