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Recent reports that PubMed, one of the world's leading biomedical databases, includes predatory journals and their publications is cause for concern. PubMed handles millions of queries daily and represents a key source of knowledge for health researchers worldwide. Much medical research that underpins clinical practice relies on the findings generated by peer-reviewed studies that are retrieved via biomedical databases, in particular, those that are free to search such as MEDLINE and PubMed. Thus, it is imperative that these databases are free of contamination by the outputs of predatory journals with their critically flawed peer review procedures. Most predatory journals are active in the biomedical sphere. Predatory publishing practices allow bad research that is poorly peer-reviewed, or published without peer review, to be published alongside real science that is rigorously reviewed, thus obscuring scientific truth. Furthermore, predatory publications may be included in the resumes of scholars seeking employment or promotion and tenure.

Illnesses and interventions can affect the health status of family carers in addition to patients. However economic evaluation studies rarely incorporate data on health status of carers. We investigated whether changes in carer health status could be 'predicted' from the health data of those they provide care to (patients), as a means of incorporating carer outcomes in economic evaluation. We used a case study of the family impact of meningitis, with 497 carer-patient dyads surveyed at two points. We used regression models to analyse changes in carers' health status, to derive predictive algorithms based on variables relating to the patient. We evaluated the predictive accuracy of different models using standard model fit criteria. It was feasible to estimate models to predict changes in carers' health status. However, the predictions generated in an external testing sample were poorly correlated with the observed changes in individual carers' health status. When aggregated, predictions provided some indication of the observed health changes for groups of carers. At present, a 'one-size-fits-all' predictive model of carer outcomes does not appear possible and further research aimed to identify predictors of carer's health status from (readily available) patient data is recommended. In the meanwhile, it may be better to encourage the targeted collection of carer data in primary research to enable carer outcomes to be better reflected in economic evaluation.

Background Estimates of future survival can be a key evidence source when deciding if a medical treatment should be funded. Current practice is to use standard parametric models for generating extrapolations. Several emerging, more flexible, survival models are available which can provide improved within-sample fit. This study aimed to assess if these emerging practice models also provided improved extrapolations. Methods Both a simulation study and a case-study were used to assess the goodness of fit of five classes of survival model. These were: current practice models, Royston Parmar models (RPMs), Fractional polynomials (FPs), Generalised additive models (GAMs), and Dynamic survival models (DSMs). The simulation study used a mixture-Weibull model as the data-generating mechanism with varying lengths of follow-up and sample sizes. The case-study was long-term follow-up of a prostate cancer trial. For both studies, models were fit to an early data-cut of the data, and extrapolations compared to the known long-term follow-up. Results The emerging practice models provided better within-sample fit than current practice models. For data-rich simulation scenarios (large sample sizes or long follow-up), the GAMs and DSMs provided improved extrapolations compared with current practice. Extrapolations from FPs were always very poor whilst those from RPMs were similar to current practice. With short follow-up all the models struggled to provide useful extrapolations. In the case-study all the models provided very similar estimates, but extrapolations were all poor as no model was able to capture a turning-point during the extrapolated period. Conclusions Good within-sample fit does not guarantee good extrapolation performance. Both GAMs and DSMs may be considered as candidate extrapolation models in addition to current practice. Further research into when these flexible models are most useful, and the role of external evidence to improve extrapolations is required.

There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value. Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16). When all trials are considered, TENS is cost-effective at thresholds of £20-30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D. Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY.

Predatory journals (PJ) exploit the open-access model promising high acceptance rate and fast track publishing without proper peer review. At minimum, PJ are eroding the credibility of the scientific literature in the health sciences as they actually boost the propagation of errors. In this article, we identify issues with PJ and provide several responses, from international and interdisciplinary perspectives in health sciences. Authors, particularly researchers with limited previous experience with international publications, need to be careful when considering potential journals for submission, due to the current existence of large numbers of PJ. Universities around the world, particularly in developing countries, might develop strategies to discourage their researchers from submitting manuscripts to PJ or serving as members of their editorial committees.

ObjectiveTo characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.DesignRetrospective, population-based cohort study.SettingClinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.ParticipantsPopulation-based cohort of 10 216 adults who underwent lumbar surgery in England from 1997/1998 through 2011/2012 and had at least 1 year of presurgery data and 2 years of postoperative follow-up data in the linked CPRD–HES.Primary and secondary outcomes measuresIncidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery.ResultsThe rate of individuals undergoing lumbar surgery in the CPRD–HES linked data doubled over the 15-year study period, fiscal years 1997/1998 to 2011/2012, from 2.5 to 4.9 per 10 000 adults. Over the most recent 5-year period (2007/2008 to 2011/2012), on average 20.8% (95% CI 19.7% to 21.9%) of lumbar surgery patients met criteria for PPP. Rates of healthcare usage were significantly higher for patients with PPP across all types of care. Over 2 years following initial spine surgery, the mean cost difference between patients with and without PPP was £5383 (95% CI £4872 to £5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to £10 195 (95% CI £8726 to £11 669) and £14 318 (95% CI £8386 to £19 771), respectively. Extrapolated to the UK population, we estimate that nearly 5000 adults experience PPP after spine surgery annually, with each new cohort costing the UK National Health Service in excess of £70 million over the first 10 years alone.ConclusionsPersistent pain affects more than one-in-five lumbar surgery patients and accounts for substantial long-term healthcare costs. There is a need for formal, evidence-based guidelines for a coherent, coordinated management strategy for patients with continuing pain after lumbar surgery.

IntroductionRaCeR 2 is a pragmatic multicentre, open-label, randomised controlled trial, with full economic evaluation. The primary aim is to assess whether individualised (early) patient-directed rehabilitation (EPDR) results in less shoulder pain and disability at 12 weeks postrandomisation following surgical repair of full-thickness tears of the rotator cuff of the shoulder compared with the current standard (delayed) rehabilitation. This paper provides the protocol for the RaCeR 2 health economic evaluation.Methods and analysisThe health economic analysis of RaCeR 2 is made up of three phases: (1) development of an initial state-transition model structure, (2) within-trial cost consequence analysis and (3) long-term model-based cost-effectiveness analysis (CEA) from the National Health Service and Personal Social Service perspective in England. Descriptive statistics (eg, mean, standard deviation, 95% confidence intervals and minimum and maximum values) will be reported for within-trial resource use, costs and health-related quality of life (HRQoL). Health state-specific costs and HRQoL will be estimated using regression model approaches and used to inform a state-transition simulation model designed to quantify the long-term costs and quality-adjusted life years (QALYs) experienced by patients over the model’s time horizon. Where appropriate, final CEA model results will be reported as cost per QALY gained for individualised EPDR versus standard (delayed) rehabilitation. Model assumptions and overall parameter uncertainty will be tested using probabilistic sensitivity analysis and scenario analyses. All regression analyses will be adjusted for baseline participant demographic and symptomatic characteristics.Ethics and disseminationA favourable ethical review was granted by London-Stanmore Research Ethics Committee (23/LO/0195) on 13 April 2023. Findings will be disseminated in peer-reviewed journals, at scientific conferences, and via the study website.Trial registration numberISRCTN11499185

Using the multi‐states (MuSt) theory framework, this study examined the interplay between self‐confidence, emotional arousal control, worry, concentration disruption, challenge and threat appraisals, psychobiosocial experiences, and self‐evaluated performance of medalist kickboxers involved in the WAKO World Kickboxing Championship 2021. Participants were 103 gold, silver, or bronze medalists (58 women and 45 men), aged 18–39 (M = 25.16 ± 4.54 years), who were contacted via email and social media and asked to fill an online survey 3 months after the event. According to the MuSt theory predictions, self‐confidence and emotional arousal control were positively related to challenge appraisal, functional psychobiosocial experiences, and self‐evaluated performance. Worry and concentration disruption were positively associated with threat appraisal, and negatively related to functional psychobiosocial experiences; concentration disruption was also negatively related to self‐evaluated performance. Results from path analysis revealed a positive indirect link from self‐confidence to self‐evaluated performance via challenge appraisal and psychobiosocial experiences. Negative indirect links from worry and concentration disruption to self‐evaluated performance through threat appraisal and psychobiosocial experiences were significant. A positive indirect effect from emotional arousal control to self‐evaluated performance via psychobiosocial experiences was also shown. The findings are discussed in light of the MuSt theory. Highlights According to the multi‐states (MuSt) theory predictions, we observed that self‐confidence and emotional arousal control were positively related to challenge appraisal, functional psychobiosocial experiences, and self‐evaluated performance. We also showed that worry and concentration disruption were positively associated with threat appraisal, and negatively related to functional psychobiosocial experiences, with concentration disruption being also negatively related to self‐evaluated performance. We provide preliminary support to the multidimensional interplay between functional (i.e., self‐confidence and emotional arousal control) and dysfunctional (i.e., worry and concentration disruption) individual dispositions, challenge and threat appraisals, psychobiosocial experiences, and performance. We recommend that athletes adopt self‐regulation strategies, such as self‐talk, imagery, cognitive restructuring, mindfulness, and action monitoring to improve their self‐confidence, challenge appraisal, functional emotions, and ability to manage competitive pressure.