This issue is known as publication bias.

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Stella Caldwell
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1 Scoping gastroenterology journals: 100% of meta-analyses tested positive for publication bias Trace E. Heavener MS-IV, & Matt Vassar Ph.D. Oklahoma State University College of Osteopathic Medicine Inherent to systematic reviews and metaanalyses is a methodological problem that only published clinical trials yielding statistically significant outcomes are included in estimating the overall summary effect. This issue is known as publication bias. Publication bias has been described as the tendency on the parts of investigators, reviewers and editors to submit or accept manuscripts for publication based on the direction or strength of the study findings. Dickersin, K. The existence of publication bias and risk factors for its occurrence. JAMA 1990;263:

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No studies, to date, have looked at the practices

these assessments are routinely conducted as well

3 No studies, to date, have looked at the practices of publication bias assessment among systematic reviews and meta-analyses from the gastroenterology literature, so the extent which these assessments are routinely conducted as well as the degree of publication bias presence is largely unknown. 3

4 4/27/2016 Figure 1 Selection process of articles for review Research questions What are the prevalence, methods and guidelines used to report publication bias in these articles? In those studies not reporting publication bias, to what extent is publication bias present? 4

5 Research questions What are the prevalence, methods and guidelines used to report publication bias in these articles? In those studies not reporting publication bias, to what extent is publication bias present? 5

6 Criteria Did not assess for publication bias Contained 10 or more primary studies Presented data allowing for publication bias assessment Meta-analyses are becoming more common Publication bias is often overlooked by systematic reviewers Publication bias assessment methods need to be standardized Reporting guidelines call for publication bias assessment Publication bias was found in all 15 qualified systematic reviews 6

7 Scoping gastroenterology journals: 100% of meta-analyses tested positive for publication bias Accepted pending minor revision at: Current Medical Research and Opinion (CMRO) Journal Trace E. Heavener MS-IV, & Matt Vassar Ph.D. Oklahoma State University College of Osteopathic Medicine 7

8 Samantha Vang-Cheng, D.O. Family Medicine Resident, PGY 3 April 29 th, 2016 Doctor, my husband did not have any health problems until his stroke. He is only 47 and was doing well at home, and was able to function without any problems. He was on no medications and never complained about pain or even a headache. He only smoked socially with friends, and he is not even a fat person. Since the stroke, he has not been able to communicate very much, let alone use the bathroom by himself. He is weak on his right leg and arm and is wheelchair bound all day. They said he had high blood pressure at the hospital, but I just do not understand why he had a stroke. Uncontrolled hypertension is one of the major risk factors that can lead to CVAs Majority of patients with hypertension do not have symptoms A lot of patients either do not know they have hypertension or do not think of the detrimental consequences of uncontrolled hypertension until it has already occurred 1

9 Group of mountain tribe individuals originating from Southeast Asia American allies during the Vietnam War and were thus forced to leave their homes as refugees to neighboring countries and the United States after the war Majority in Minnesota, California, and Wisconsin, with an estimated 272,825 Hmong in the United States (U.S. Census Bureau 2013 American Community Survey) Many smaller communities throughout the United States ~3,369 Hmong individuals in Oklahoma Have many cultural and spiritual beliefs regarding illness + a poor understanding of chronic medical conditions + strong mistrust of western medicine group vulnerable to western medical treatment regimens No actual concept of chronic illness Participants Recruited during the Tulsa Hmong New Year celebration on October 25 26, 2014 in Tulsa, Oklahoma Health fair booth was set up to check for blood pressure and finger stick blood sugars Individuals were asked to be involved in the study, but did not have to participate in the study in order to obtain blood pressure readings or finger stick blood sugar readings in the health fair. Data Collection 12 question survey regarding their lifestyle and perceptions about hypertension Other info collected: age, gender, current state they were residing in, the length of time since they last ate, and their recorded blood pressures and finger stick blood sugars Written in both English and Hmong 2

10 Analysis Data from the surveys were entered into Microsoft Excel Mark Payton, Ph.D., Oklahoma State University Regents Service Professor and Head of the Department of Statistics 110 participants 62 female, 40 male, 8 did not Average age 49 years AHA Blood Pressure Category Systolic mmhg Diastolic mmhg Normal <120 And <80 PreHTN Or HTN Stage Or HTN Stage Or 100 HTN Crisis >180 Or >110 3

11 % of participants' BP based on AHA guidelines 3% 4%3% 6% 39% 45% Nml BP PreHTN Stage 1 HTN Stage 2 HTN HTN Crisis BP not recorded Finger Stick Blood Sugar Readings Mean 136 for females, and 132 for males FSBS was positively correlated with blood pressure 4

12 Question 1-3 Do you drink alcohol/smoke/exercise? Question 4: What do you usually eat? Question 5: Do you have a history of HTN, stroke, heart disease, diabetes, high cholesterol, and/or other? 5

13 Question 6: Do you take medications for HTN, stroke, heart disease, diabetes, high cholesterol, and/or other? Question 7: Do you take herbal medications for HTN, stroke, heart disease, diabetes, high cholesterol, and/or other? Question 8: Do you think it is important to control blood pressure? 6

14 Question 9: Do you think having high blood pressure is bad for your health? Question 10: How often do you see a doctor? Question 11: Do you prefer herbal medicines or western medicine for treatment of your health conditions? 39.09% preferred herbal medications 73.64% preferred western medications 7

15 Question 12: What do you think contributes to a stroke? HTN 80% Heart disease 24.55% DM 41.82% Hyperlipidemia 35.45% ETOH/tobacco use 23.64% Other causes (stress) 50% Other causes (stress and food) 25% Small participant size Poorly written survey A lot of the data collected was not statistically significant with regards to blood pressures Significant data: HTN self-identified participant had HTN; CVA hx had HTN (164/105mmHg) FSBS were significantly positively correlated with blood pressure Interesting aspect of data collection Understanding and Managing High Blood Pressure. American Heart Association, Inc. Published Accessed January 5, Johnson, SK. Hmong Health Beliefs and Experiences in the Western Health Care System. Journal of Transcultural Nursing. April 2002; 13(2): Thalacker, KM. Hypertension and the Hmong Community: Using the Health Belief Model for Health Promotion. Health Promotion Practice. July 2011; 12: Wong, CC, Mouanoutoua, V, Chen, M, Gray, K, Tseng, W. Adherence with Hypertension Care among Hmong Americans. Journal of Community Health Nursing 2005; 22(3): Helsel, D, Mochel, M, Bauer, R. Chronic Illness and Hmong Shamans. Journal of Transcultural Nursing. April 2005; 16(2): American Community Survey. United States Census Bureau. Accessed January 5, Pfeifer, ME, Yang, K. (2013). Hmong Population and Demographic Trends in the 2010 Census and 2010 American Community Survey. In M.E. Pfeifer and B.K. Thao (Eds.), States of the Hmong American Community Washington, DC: Hmong National Development. 8

16 Thank you to the ladies who came out to help with the health fair and data collection: Malinda Yang, Lily Vang, Mai See Lor, Nunu Vang, and Yeng Hang. Thank you to the OMECO Research Fund for providing me with the necessary funds to make the health fair and data collection possible. Thank you to my faculty advisors, Amanda Gorden-Green, D.O. and Sarah Hall, D.O. for guiding me through the research process from the first step to the last. A special thank you to Mark Payton, Ph.D., Oklahoma State University Regents Service Professor and Head of the Department of Statistics, for directing me in the data entry of my collected data, and for running the needed statistical analysis. At last, thank you to my husband, Ger Cheng, for entering all of the data into excel. Without every one of these individuals, this research would not have been possible. 9

17 Differential Effects of Digoxin Use on Atrial Fibrillation Patients by Race and Gender Jessica Branstetter, OMS III, Matthew Rogers, OMS III, Christen Greuel, OMS III, Charles Bingham, OMS III, and William Paiva, Ph.D. INTRODUCTION Rate control in atrial fibrillation Verapamil - Calcium Channel Blocker Digoxin - Cardiac Glycoside Of the two medications, verapamil is the only FDA approved medication for rate control in atrial fibrillation OBJECTIVE Compare mortality across gender and ethnic groups in patients taking verapmil, digoxin, and verapamil + digoxin. 1

18 BACKGROUND When compared based on drug usage alone, there is not a significant difference in mortality with verapamil versus digoxin use. In full population results, verapamil + digoxin showed a higher mortality rate than monotherapy. METHODS 1.Data extracted from Cerner HealthFacts Data Warehouse. Data is stored in a SQL database at Oklahoma State University. 2.SQL query was written to extract patients who had a diagnosis code for atrial fibrillation using ICD-9 code METHODS 3. Data was cleaned and prepared for analytics 4. A comparative analysis on the patient data was performed for patients who were given either verapamil or digoxin. This study uses a part of the CRISP-DM methodology 2

POPULATION DISTRIBUTION Total Females Males African Americans Caucasians African American Females African American

2,276 1,153 2,166 185 223 968 1,943 Verapamil + Digoxin 1,117 682 435 78 983 50 28 596 387 Total 7,084 3,303 3,781

0528% Males: Verapamil: 1.3084% Digoxin: 1.7169% Verapamil + Digoxin: 2.

19 POPULATION DISTRIBUTION Total Females Males African Americans Caucasians African American Females African American Males Caucasian Females Caucasian Males Verapamil 2,476 1,406 1, , , Digoxin 3,491 1,215 2,276 1,153 2, ,943 Verapamil + Digoxin 1, Total 7,084 3,303 3,781 1,415 5, ,799 3,274 RESULTS Females: Verapamil: % Digoxin: % Verapamil + Digoxin: % Males: Verapamil: % Digoxin: % Verapamil + Digoxin: % RESULTS African Americans: Verapamil: % Digoxin: % Verapamil + Digoxin: % Caucasians: Verapamil: % Digoxin: % Verapamil + Digoxin: % 3

RESULTS African American Females: Verapamil: 5.6075% Digoxin: 3.3849% Verapamil + Digoxin: 6.0000% African American Males: Verapamil: 2.5974% Digoxin: 2.7618% Verapamil + Digoxin: 3.

20 RESULTS African American Females: Verapamil: % Digoxin: % Verapamil + Digoxin: % African American Males: Verapamil: % Digoxin: % Verapamil + Digoxin: % Caucasian Females: Verapamil: % Digoxin: % Verapamil + Digoxin: % Caucasian Males:: Verapamil: % Digoxin: % Verapamil + Digoxin: % CONCLUSION 1. In women, digoxin monotherapy is associated with a lower mortality rate when compared with verapamil monotherapy and verpamil + digoxin 2. In men, verapamil monotherapy is associated with a lower mortality rate when compared with verapamil + digoxin. CONCLUSION 3. In African Americans, digoxin is associated with a lower mortality rate when compared with verapamil and verapamil + digoxin. 4. In Caucasians, the mortality rate seen with verapamil monotherapy is slightly lower than digoxin monotherapy. 4

21 CONCLUSION 5. Both verapamil and digoxin use are associated with a lower mortality rate than verapamil + digoxin use in Caucasians. 6. The mortality rate with verapamil monotherapy in Caucasians is lower than the mortality rate in African Americans. The same can be said for digoxin monotherapy. CONCLUSION 7. In African American women, digoxin is associated with a moderately lower mortality rate than verapamil and verapamil + digoxin use. 8. In Caucasian men, verapamil is associated with a moderately lower mortality rate than digoxin and verapamil + digoxin use. NEXT STEPS Statistical Analysis is pending. In the future, these findings may become important considerations for physicians when choosing which medication to prescribe. This research is being extended to include other medications. 5

22 REFERENCES Seshadri Sundararajan, Adithya & Ganesan, Ajay Analyzing the Risks associated with Digoxin and Verapamil Using SAS Enterprise Guide and SAS Enterprise Miner Tze-Fan, C., Chia-Jen, L., Ta-Chuan, T., Su-Jung, C., Kang-Ling, W., Yenn-Jiang, L., Shih-Lin, C., Li-Wei, L., Yu-Feng, Hu., Tzeng-Ji, C., Chern-En C., & Shih-Ann, C. (2015). Rate-Control Treatment and Mortality in Atrial Fibrillation. Circulation, 132(17), /CIRCULATIONAHA QUESTIONS 6

Hypertension, Hyperlipidemia and Obesity. Mi-CCSI

Hypertension, Hyperlipidemia and Obesity Mi-CCSI Objectives Review the prevalence of hypertension, hyperlipidemia and obesity Correlation of the 3 conditions Discuss why it is important to treat these