Neurologist

joined 11 months ago
 

Summary:

Selective outcome reporting can result in overestimation of treatment effects, research waste, and reduced openness and transparency. 

This review aimed to examine selective outcome reporting in trials of behavioural health interventions and determine potential outcome reporting bias. 

A review of nine health psychology and behavioural medicine journals was conducted to identify randomised controlled trials of behavioural health interventions published since 2019. 

Discrepancies in outcome reporting were observed in 90% of the 29 trials with corresponding registrations/protocols. 

Discrepancies included 72% of trials omitting prespecified outcomes; 55% of trials introduced new outcomes. 

Thirty-eight percent of trials omitted prespecified and introduced new outcomes. Three trials (10%) downgraded primary outcomes in registrations/protocols to secondary outcomes in final reports; downgraded outcomes were not statistically significant in two trials. 

Five trials (17%) upgraded secondary outcomes to primary outcomes; upgraded outcomes were statistically significant in all trials. 

In final reports, three trials (7%) omitted outcomes from the methods section; three trials (7%) introduced new outcomes in results that were not in the methods. 

These findings indicate that selective outcome reporting is a problem in behavioural health intervention trials. 

Journal- and trialist-level approaches are needed to minimise selective outcome reporting in health psychology and behavioural medicine.

My Comment: We need better ethics and more rigorous methodology.

[–] Neurologist@mander.xyz 5 points 6 months ago* (last edited 6 months ago)

Damn I can’t find the original gif from the movie. Here’s a low quality edit I could find.

[–] Neurologist@mander.xyz 12 points 6 months ago

No it’s not.

We usually have guidelines and protocols to follow which minimise the chance of harm and standardise care. Here we’re left with nothing, unsure what we’re allowed to do or not, unsure what we should do. There have already been multiple reports of mismanagement of pre-natal care resulting in deaths because of this.

 
[–] Neurologist@mander.xyz 7 points 7 months ago

Sounds like my colleagues. But since medicine is a hierarchical culture that values conformity over critical thought, that type of behaviour tends to actually work in favour of the person.

[–] Neurologist@mander.xyz 25 points 7 months ago* (last edited 7 months ago) (9 children)

Although it’s true that nurses can have some fucked up beliefs, don’t underestimate doctors. Some of my colleagues are ableist, misogynistic, bigoted, power hungry, with a superiority complex. I think these are the kind of Gps and specialists making r/medicine so awful.

[–] Neurologist@mander.xyz 53 points 7 months ago (15 children)

That aside, as a medical professional, I have to say r/medicine is such a cesspool of a subreddit, and I don’t say this lightly.

They regularly ridicule patients and specific conditions, harbour prejudiced views towards poor people and people from minority groups, and generally push pseudoscientific nonsense.

It’s a really disheartening subreddit to visit when you’ve got your patient’s best interests at heart.

Apart from that, I do agree with their view on UnitedHealth’s CEO.

 
[–] Neurologist@mander.xyz 1 points 8 months ago (1 children)

if youve got to any, could you tell me what you think? It’s always useful to know what I should recommend to my patients to show their friends and family.

[–] Neurologist@mander.xyz 2 points 8 months ago* (last edited 8 months ago) (3 children)

This channel has a bunch of short (5 mins long videos) about ME to educate people.

There’s also a slightly outdated (but still worth the watch) oscar nominated documentary about it, which has been made free and put on youtube recently It’s Unrest by Jennifer Brea

One of my patients also runs this excellent website with a bunch of resources about the disease.

[–] Neurologist@mander.xyz 5 points 8 months ago* (last edited 8 months ago) (1 children)

I’m sorry I really shouldn’t be giving medical advice. It’s been a long time since I studied neurology. I’ve spent the past decade only on post viral diseases like ME.

But please please find yourself a doctor that listens and cares if that is possible. Because it clearly sounds like you need tests and you need a doc thats available for you. Maybe join some local MS support groups and ask if anyone has docs that do a really good job and try from there.

I’ll tell you this as a doctor. I would stay the hell away from some of my colleagues. Not every doctor is anywhere near good at their jobs. Some don’t care, some barely passed and don’t want to learn anything new, some like to always assume their patients have psychological problems. Find yourself a good doctor who is proactive and cares, and everything will be so much easier. Sending you good luck.

[–] Neurologist@mander.xyz 1 points 8 months ago (5 children)

For you to help your friend. Or for your friend themselves?

[–] Neurologist@mander.xyz 4 points 8 months ago* (last edited 8 months ago)

Hopefully it’s something immunomodulators can fix. Fingers crossed.

[–] Neurologist@mander.xyz 4 points 8 months ago (2 children)

Probably triggered. But we don’t really know.

[–] Neurologist@mander.xyz 29 points 8 months ago* (last edited 8 months ago) (12 children)

Hey I’m a researcher who works on ME (in the past called CFS).

ME/CFS is currently classified as a disease/biological illness according to the CDC.

ME is a disease state in itself. We don’t know much about it, but it can’t be explained by other diagnoses, as the defining factor, neuro-immune abnormalities including immune activation showing up post exertion is unique to it. You’re completely right that we don’t yet have a reliable biomarker. We have a test that differentiates from healthy controls, but it was discontinued for ethical reasons because conducting the test leads to a sometimes permanent worsening of the illness.

In the past it’s been mixed up and jumbled a lot, but the picture is getting clearer.

There have been a few case reports of degenerative forms of the illness. But in general it takes a more classical relapsing remitting pattern. Although even in less bad stages some patients are severely functionally disabled, even bedridden and tubefed. It has a really wide range of severities with the least severely affected able to work part time and walk and travel, while the most severe might not even be able to communicate.

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submitted 9 months ago* (last edited 9 months ago) by Neurologist@mander.xyz to c/science@lemmy.world
 

ELI12 TLDR: Decent accuracy was found ~80% when using these to differentiate between people with Long COVID versus people who had recovered. People with Long COVID tend to have high Artemin which is linked to nerve cell communication problems and the elevated levels found may provide a clue into the cognitive problems many of these patients have. High Galectin-9 levels (which were also found here) are often associated with immune issues such as overactivation, which seems to fit well with all the immune abnormalities we see in these patients.

Abstract: This study aimed to assess plasma galectin-9 (Gal-9) and artemin (ARTN) concentrations as potential biomarkers to differentiate individuals with Long COVID (LC) patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) from SARS-CoV-2 recovered (R) and healthy controls (HCs). Receiver operating characteristic (ROC) curve analysis determined a cut-off value of plasma Gal-9 and ARTN to differentiate LC patients from the R group and HCs in two independent cohorts. Positive correlations were observed between elevated plasma Gal-9 levels and inflammatory markers (e.g. SAA and IP-10), as well as sCD14 and I-FABP in LC patients. Gal-9 also exhibited a positive correlation with cognitive failure scores, suggesting its potential role in cognitive impairment in LC patients with ME/CFS. This study highlights plasma Gal-9 and/or ARTN as sensitive screening biomarkers for discriminating LC patients from controls. Notably, the elevation of LPS-binding protein in LC patients, as has been observed in HIV infected individuals, suggests microbial translocation. However, despite elevated Gal-9, we found a significant decline in ARTN levels in the plasma of people living with HIV (PLWH). Our study provides a novel and important role for Gal-9/ARTN in LC pathogenesis.

 

Background

A considerable number of patients who contracted SARS-CoV-2 are affected by persistent multi-systemic symptoms, referred to as Post-COVID Condition (PCC). Post-exertional malaise (PEM) has been recognized as one of the most frequent manifestations of PCC and is a diagnostic criterion of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Yet, its underlying pathomechanisms remain poorly elucidated.

Results

Upon physical activity, affected patients exhibit a reduced systemic oxygen extraction and oxidative phosphorylation capacity. Accumulating evidence suggests that these are mediated by dysfunctions in mitochondrial capacities and microcirculation that are maintained by latent immune activation, conjointly impairing peripheral bioenergetics. Aggravating deficits in tissue perfusion and oxygen utilization during activities cause exertional intolerance that are frequently accompanied by tachycardia, dyspnea, early cessation of activity and elicit downstream metabolic effects. The accumulation of molecules such as lactate, reactive oxygen species or prostaglandins might trigger local and systemic immune activation. Subsequent intensification of bioenergetic inflexibilities, muscular ionic disturbances and modulation of central nervous system functions can lead to an exacerbation of existing pathologies and symptoms

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🐊🐓🦖 (mander.xyz)
submitted 11 months ago* (last edited 11 months ago) by Neurologist@mander.xyz to c/science_memes@mander.xyz
 

If you’re confused: Birds are dinosaurs, crocodiles aren’t; note the “closest living relatives

 
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