Zombies circulate among us

Detecting false data presents reviewers, editors, journals, publishers and readers with many problems. Manuscripts alone, which are submitted to journals for peer review and consideration for publication, are seldom enough to make an informed judgment on the truth of included data. In this new study, John Carlisle reports his analysis of 153 randomised controlled trials submitted to Anaesthesia for which he requested authors supply individual patient data spreadsheets (Fig. 1). He detected false data in almost half of these spreadsheets, which likely translates to around a quarter of all randomised controlled trials submitted to the journal. He concludes that journals and editors should ask more questions about data on which submitted trials are based, rather than relying on summary statistics alone, which may not contain vital clues about data trustworthiness. In the accompanying editorial, Ioannidis looks at the nature and scale of the problem, as well as what can be done. The solutions are far from perfect, but include: more widespread use of individual patient data spreadsheets during review processes; a new focus on methods to interrogate other designs, such as observational studies; incorporation of the likelihood of false data into the design of systematic reviews; and promotion of transparency by funders and regulators. 

Figure 1 The cumulative submission of 526 randomised controlled trials (black line), in 73 (14%) of which Carlisle identified false data (solid red line) and in turn 43 (8%) he categorised ‘zombie’ (dashed red line). The rates Carlisle identified false data and categorised trials zombie increased after March 2019, when Anaesthesia adopted a policy of routinely requesting individual patient data spreadsheets from countries that submitted the most trials.

We have a number of important papers this month that each have an associated podcast, which can be accessed for free on PodbeanSpotify and iTunes. First, Odor et al. report the results from DREAMY in relation to general anaesthetic and airway management practice for obstetric surgery in England. They find that propofol and, to a lesser extent, rocuronium are now being used more frequently. The associated editorial from Wilson and Wrench suggests the UK is currently lagging the adoption of change, rather than leading it. Cook and Farrar, in our second most popular paper on social media, ever, discuss everything to do with COVID-19 vaccines, including the many implications for peri-operative practice as well as other wider issues for society (Fig. 2).

Figure 2 The access to COVID‐19 tools (ACT)‐accelerator is a collaboration whose stakeholders aim to speed up development, production and access to novel agents that are central to the response to COVID‐19, including diagnostics, therapeutics and vaccines. Stakeholders include organisations and individuals from the public, industry, commerce, academia and politics. Synergistic cooperation should mean its efficacy is greater than the sum of its parts. From https://www.who.int/initiatives/act‐accelerator with permission from ACT‐accelerator.

We were also delighted to publish this new consensus statement on the prevention of opioid-related harm in adult surgical patients by Levy et al. The document allows for all healthcare professionals to be aware of the risks and benefits of peri-operative opioid use, which will hopefully lead to better informed patients.

In 2008, it was predicted that there would be no publications in relation to peri-operative practice from UK authors by the year 2020. This new analysis from Ratnayake et al. provides and updated perspective, with ~124 papers per year published by UK groups in indexed journals. A worrying feature is the predominance of secondary research (for example, reviews) as compared with primary research (for example, clinical trials). Overall, the trend identified by Feneck et al. in 2008 seems to have been halted but not yet reversed. Paul Myles offers some insights and reminds us that the studies by Feneck et al. and Ratanayake et al. provide a UK-centric view, and that most peri-operative medicine journals across the world have improved in quality over the last ten years. Moreover, there are now more many more studies in high-impact general medical journals led or contributed to by UK anaesthetists, which is great progress. Yeung and Shelton argue that academic anaesthesia does not belong to the elite, as it belongs to us all. Perhaps where the real work is needed is advocacy, to encourage recognition of how and why research is fundamental to high-quality patient care. 

Each month, we are taking a look back through our archives at important papers from each decade, since the first issue of the journal was published 75 years ago. This month, Laycock and Harrop-Griffiths tackle the assessment of pain with reference to a key paper from 1976 by Revill et al. Note that the ‘assessment’ of pain and not its measurement is discussed, the importance of which is thoughtfully discussed. They argue that what perhaps is even more important than the assessment or measurement of pain is how we respond to its occurrence. 

Elsewhere we have: a systematic review of intra-articular infiltration analgesia for arthroscopic surgery; two prospective observational studies of alternative devices for postoperative patient temperature measurement;an ethnographic study of decision-making around admission to intensive care; and a feasibility study of the effect of advanced recovery room care on postoperative outcomes in moderate-risk surgical patients

Finally, we are looking for new Assistant Editors (deadline March 31st) and a new Trainee Fellow (deadline May 31st). Both adverts and all the details are provided here, on the journal webpage, on Twitter, in this month’s Anaesthesia News and via the Association of Anaesthetists. Join us!

Mike Charlesworth and Andrew Klein

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