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      The Landscape of Medical Literature in the Era of COVID-19: Original Research Versus Opinion Pieces

      , MD 1 , , MD, MSc 2 , , MD 3 , , MD 2 , , BM, BCh, DPhil 4 , , MD, FACC, FAHA, FSCAI, FESC, FACP , 5

      Journal of General Internal Medicine

      Springer International Publishing

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          INTRODUCTION There has been rapidly growing scientific literature related to the coronavirus disease 2019 (COVID-19), in attempts to convey any potential hypotheses or confirmed facts about the disease. Notably, there has been a plethora of viewpoints and other opinion pieces to help guide ongoing research efforts. However, this trend carries a risk of redundant publications. 1, 2 Our objective was to evaluate the nature of the published scientific literature (original investigations and opinion pieces) related to COVID-19 and to quantify their relative proportions to determine whether the trend of publication of opinion pieces has changed over time. METHODS For this cross-sectional analysis, we searched the Medline database from February 1, 2020, to April 20, 2020, using the keywords “COVID-19” and “corona.” Articles were categorized to “opinion” articles (i.e., narrative reviews, viewpoints, perspectives, commentaries, news pieces, letters to the Editor, educational material, and consensus statements/guidelines), and original investigations (i.e., randomized control trials [RCTs], observational studies [retrospective, cross-sectional or prospective], meta-analyses, translational or animal studies, and epidemiologic modeling studies). Consensus statements and guidelines were considered as “opinion” articles since the recommendations from these documents are mainly based on expert opinion. Case reports and case series of ≤ 10 patients as well as articles describing a clinical trial design or a prospective study protocol were excluded. Editorials addressing articles published in the same journal issue were excluded since those are integral part of the journal structure. In addition, we excluded systematic reviews given the lack of consensus on whether they should be considered as original investigations. 3 Non-English articles where the exact type could not be determined by reviewing the title and abstract were also excluded. Importantly, to ensure that articles are classified into the correct categories, we manually reviewed the content of each article rather than depending on the provided journal classifications. Analysis of variance (ANOVA) was used to assess the trend in the relative proportion of “opinion” articles over the study period. Descriptive statistical analyses were performed using SPSS statistical package (SPSS version 25.0, IBM Inc., Armonk, NY). RESULTS The search identified 5479 articles, among which 276 were non-COVID-related, 63 were non-English articles that could not be classified, 8 were errata, and 3 articles were retracted. In addition, 403 were case reports or case series of ≤ 10 patients, 89 were systematic reviews, 20 were trial design or study protocol, and 124 were editorials related to an article within the same journal. The final analysis included 4493 articles. Among 1030 (22.9%) original investigations, the majority were retrospective or cross-sectional observational studies (57.9%). Most of the observational studies (93.4%) were related to diagnosis of the disease. Translational or animal studies comprised 16.8% of original investigations, epidemiological modeling analyses 14.8%, prospective observational studies 5.7%, meta-analyses 4.6%, and RCTs 0.3%. The number of “opinion” articles was 3463 (77.1%) (Table 1). The ratio of “opinion” articles to original investigations was 3.4:1. There was no significant change in the trend of the relative proportion of “opinion” articles to original investigations throughout the study period when divided into quintiles from oldest versus latest, R 2 for quadratic trend model was 0.74 and corresponding p value for regression was 0.3 (Figure 1). Table 1 Types of Articles Included in the Analysis Number (%) 4493 Original investigations 1030 (22.8) Randomized controlled trial 3 (0.07) Observational study 655 (14.5) Prospective, number (% of observational studies) 59 (9.0) Retrospective/cross-sectional, number (% of observational studies) 596 (91.0) Related to disease diagnosis, number (% of observational studies) 612 (93.4) Evaluating a therapeutic intervention, number (% of observational studies) 43 (6.6) Translational or animal study 173 (3.9) Epidemiologic modeling analysis 152 (3.4) Meta-analysis 47 (1.0) Opinion articles 3463 (77.1) Narrative review 365 (8.1) Society guideline or consensus statement 140 (3.1) Non-society multicenter guideline or consensus statement 81 (1.8) Viewpoint, perspective, commentary or news piece 2614 (58.2) Letter to the Editor/Response to a letter to the Editor 256 (5.7) Patient education material 7 (0.2) Figure 1 The relative proportion of “opinion” articles (blue) to original investigations (orange) throughout the study period. The total number of articles included in the analysis was divided chronologically into quintiles from oldest (1) to newest (5). DISCUSSION In this cross-sectional analysis of published scientific articles related to COVID-19 in the Medline database over an 80-day period, we found that the number of “opinion” articles was > 3 times the number of original investigations published in this time frame. Interestingly, there was no significant change in the temporal trend of this ratio, which illustrates that the number of “opinion” articles remains high. Since our knowledge and understanding of this disease are premature, there is an understandable need for valuable insights to guide research efforts. However, this analysis suggests that the number of these “opinion” articles continues to be high, and there might be some concerns for redundant publications. For example, there has been > 10 viewpoints related to renin-angiotensin-aldosterone inhibitors and COVID-19 published in several journals even before any original data about the topic became available. 4, 5 This study is limited by search of one online database at a single time point. There are many ongoing research efforts and this trend is expected to change with time. Based on the findings from this analysis, medical journals might want to re-evaluate the usefulness of COVID-19-related opinion pieces being considered for publication.

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          Consensus and contention regarding redundant publications in clinical research: cross-sectional survey of editors and authors.

          To examine the perspectives of journal editors and authors on overlapping and redundant publications in clinical research. Pretested cross-sectional survey, containing both forced choice and open ended questions, administered by mail to the senior editors (N=99) and one randomly selected author (N=99) from all journals in the Abridged Index Medicus (1996) that published clinical research. The views of editors and authors about the extent of redundant publications, why they occur, how to prevent and respond to cases, and when the publication of overlapping manuscripts is justified. Seventy two per cent (N=71) of editors and 65% (N=64) of authors completed the survey. There was consensus between both groups that redundant publications occur because authors feel the pressure to publish and journals do not do enough to publicise, criticise, and punish cases, and that the publication of most types of overlapping articles is unacceptable. Sixty seven per cent of authors but only 31% of editors felt, however, that it was justified to publish an overlapping article in a non-peer reviewed symposium supplement, and 68% of editors but 39% of authors supported imposing restrictions on guilty authors' future submissions. In written comments, 15% to 30% of both groups emphasised that it was justified to publish overlapping articles when there were different or non-English-speaking audiences, new data, strengthened methods, or disputed findings. Editors, authors, and other academic leaders should together develop explicit guidelines that clarify points of contention and ambiguity regarding overlapping manuscripts.
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            Repetitive, duplicate, and redundant publications: a review for authors and readers.

            Repetitive, duplicate, and redundant publications are an important concern in the scientific literature. Their occurrence affects science and carries with it sanctions of consequence. This editorial provides a brief review of the definitions, classifications, impact, sanctions, and prevention strategies regarding repetitive, duplicate, and redundant publications.
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              Is Open Access

              Attitudes of editors of core clinical journals about whether systematic reviews are original research: a mixed-methods study

              Objectives In 2009, not all journal editors considered systematic reviews (SRs) to be original research studies, and not all PubMed Core Clinical Journals published SRs. The aim of this study was to conduct a new analysis about editors’ opinion regarding SRs as original research. Design We conducted a survey and qualitative interview study of journal editors. Participants All editors listed as editor-in chief of 118 PubMed Core Clinical Journals. Methods We contacted editors via email and asked them whether they considered SRs original research, whether they published SRs in the journal and, if yes, in which section. We searched PubMed for any SRs (or meta-analyses) published in the included journals in 2017; if we did not find any, we hand-searched these journals. Editors were invited to participate in a follow-up qualitative interview study. Results We received responses from 73 editors representing 72 (62%) journals. Fifty-two (80%) editors considered SRs original research, either for any type of SR (65%) or only for SRs with a meta-analysis (15%) and almost all (91%) of editors published SRs. Compared with the results of the 2009 study of Core Clinical Journals, a similar proportion of editors considered SRs to be original studies (71%), accepted SRs as original on certain condition such as presence of meta-analysis (14%) or published SRs (94%). Interviews with editors showed that they used various criteria to decide whether a SR is original research, including methodology, reproducibility, originality of idea and level of novelty. Conclusion The majority of editors of core clinical journals consider that SRs are original research. Among editors, there was no uniform approach to defining what makes a SR, or any study, original. This indicates that the concepts of originality of SRs and research are evolving and that this would be a relevant topic for further discussion.

                Author and article information

                J Gen Intern Med
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer International Publishing (Cham )
                8 July 2020
                : 1-3
                [1 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Division of Cardiovascular Medicine, , University of California San Fransisco, ; San Fransisco, CA USA
                [2 ]GRID grid.412689.0, ISNI 0000 0001 0650 7433, Heart and Vascular Institute, , University of Pittsburgh Medical Center, ; Pittsburgh, PA USA
                [3 ]GRID grid.412689.0, ISNI 0000 0001 0650 7433, Department of Internal Medicine, , University of Pittsburgh Medical Center, ; Pittsburgh, PA USA
                [4 ]GRID grid.9757.c, ISNI 0000 0004 0415 6205, Keele Cardiovascular Research Group, , Keele University, ; Stoke-on-Trent, UK
                [5 ]Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
                © Society of General Internal Medicine 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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