Characterization and Reach of Orthopaedic Research Posted to Preprint Servers: Are We "Undercooking" Our Science?

BACKGROUND: Although biomedical preprint servers have grown rapidly over the past several years, the harm to patient health and safety remains a major concern among several scientific communities. Despite previous studies examining the role of preprints during the Coronavirus-19 pandemic, there is limited information characterizing their impact on scientific communication in orthopaedic surgery. QUESTIONS/PURPOSES: (1) What are the characteristics (subspecialty, study design, geographic origin, and proportion of publications) of orthopaedic articles on three preprint servers? (2) What are the citation counts, abstract views, tweets, and Altmetric score per preprinted article and per corresponding publication? METHODS: Three of the largest preprint servers (medRxiv, bioRxiv, and Research Square) with a focus on biomedical topics were queried for all preprinted articles published between July 26, 2014, and September 1, 2021, using the following search terms: "orthopaedic," "orthopedic," "bone," "cartilage," "ligament," "tendon," "fracture," "dislocation," "hand," "wrist," "elbow," "shoulder," "spine," "spinal," "hip," "knee," "ankle," and "foot." Full-text articles in English related to orthopaedic surgery were included, while nonclinical studies, animal studies, duplicate studies, editorials, abstracts from conferences, and commentaries were excluded. A total of 1471 unique preprints were included and further characterized in terms of the orthopaedic subspecialty, study design, date posted, and geographic factors. Citation counts, abstract views, tweets, and Altmetric scores were collected for each preprinted article and the corresponding publication of that preprint in an accepting journal. We ascertained whether a preprinted article was published by searching title keywords and the corresponding author in three peer-reviewed article databases (PubMed, Google Scholar, and Dimensions) and confirming that the study design and research question matched. RESULTS: The number of orthopaedic preprints increased from four in 2017 to 838 in 2020. The most common orthopaedic subspecialties represented were spine, knee, and hip. From 2017 to 2020, the cumulative counts of preprinted article citations, abstract views, and Altmetric scores increased. A corresponding publication was identified in 52% (762 of 1471) of preprints. As would be expected, because preprinting is a form of redundant publication, published articles that are also preprinted saw greater abstract views, citations, and Altmetric scores on a per-article basis. CONCLUSION: Although preprints remain an extremely small proportion of all orthopaedic research, our findings suggest that nonpeer-reviewed, preprinted orthopaedic articles are being increasingly disseminated. These preprinted articles have a smaller academic and public footprint than their published counterparts, but they still reach a substantial audience through infrequent and superficial online interactions, which are far from equivalent to the engagement facilitated by peer review. Furthermore, the sequence of preprint posting and journal submission, acceptance, and publication is unclear based on the information available on these preprint servers. Thus, it is difficult to determine whether the metrics of preprinted articles are attributable to preprinting, and studies such as the present analysis will tend to overestimate the apparent impact of preprinting. Despite the potential for preprint servers to function as a venue for thoughtful feedback on research ideas, the available metrics data for these preprinted articles do not demonstrate the meaningful engagement that is achieved by peer review in terms of the frequency or depth of audience feedback. CLINICAL RELEVANCE: Our findings highlight the need for safeguards to regulate research dissemination through preprint media, which has never been shown to benefit patients and should not be considered as evidence by clinicians. Clinician-scientists and researchers have the most important responsibility of protecting patients from the harm of potentially inaccurate biomedical science and therefore must prioritize patient needs first by uncovering scientific truths through the evidence-based processes of peer review, not preprinting. We recommend all journals publishing clinical research adopt the same policy as Clinical Orthopaedics and Related Research®, The Bone & Joint Journal, The Journal of Bone and Joint Surgery, and the Journal of Orthopaedic Research, removing any papers posted to preprint servers from consideration.

Epidemiology of Food Insecurity in a Nationally Representative Sample of Lymphoma Patients.

BACKGROUND: In 2020, the United States had approximately 85,000 new diagnoses of Hodgkin and Non-Hodgkin lymphoma. Food insecurity is both a direct and indirect detriment to health outcomes. The rate and risk factors for food insecurity among lymphoma patients are unknown, as the unemployment rate soars far above pre-COVID19 pandemic levels further heightening the economic stresses of a lymphoma diagnosis. METHODS: Data regarding the food security status were obtained from the cross-sectional National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention. A raw score compiled from a series of 10 food security questions was used to determine the Food Secure and Food Insecure groups. Respondents who reported a history of lymphoma from 2011 to 2019 were included in the analysis. RESULTS: Of the 921 patients reporting a history of lymphoma 9.06% were considered Food Insecure. The sociodemographic subgroups with the highest risk of being Food Insecure included respondents living below 100% of the Federal Poverty Level, non-US citizens, the uninsured, and those on Medicare. CONCLUSION: Food insecurity is common among lymphoma patients. Therefore, oncologists across the country should be aware of the sociodemographic risk factors for food insecurity in order to assist in mediation, maximizing the efficacy of treatments. Research regarding the impact of food insecurity on therapy compliance and patient outcomes is warranted in future studies.

Good Morning, Orthopods: The Growth and Future Implications of Podcasts in Orthopaedic Surgery.

BACKGROUND: As the landscape of medical education evolves with emerging technologies and the COVID-19 pandemic, e-learning platforms continue to gain popularity. Orthopaedic podcasts, a burgeoning e-learning platform, continue to gain traction; however, there is a paucity of information regarding their coverage of topics and their distribution over time. Therefore, our analysis sought to (1) characterize podcast content related to orthopaedic surgery, and (2) evaluate the changes in the prevalence of orthopaedic podcasts over the past 15 years. METHODS: Three common podcasting platforms (Apple Podcasts, Google Podcasts, and Spotify) were queried using the key terms "orthopaedic," "orthopedic," and "ortho" in order to identify a list of podcasts that are related to orthopaedic surgery. For each unique orthopaedic podcast, the title, the show description, the number of episodes, the date of the first episode, the date of the most recent episode, and episode frequency were collected. Podcasts were then classified based on a predetermined list of podcast domains. The number of existing active (released within the last 3 months) orthopaedic podcasts was then trended on a monthly basis from 2011 to 2020. RESULTS: Ninety-four unique podcasts met inclusion criteria, 62 of which remained active as of October 25, 2020. The most common podcast domains were "general" (38 [40.4%]) and "clinical knowledge" (20 [21.3%]). Among the assessed podcasts, 90 (95.7%) utilized an exclusively audio format. The majority of podcasts were based in the United States (89.4%), included introductory music (72.3%), and included interviews (63.8%). Most podcast hosts were practicing orthopaedic surgeons (52.1%). Between January 2016 and October 2020, the number of active orthopaedic surgery podcasts grew more than twelvefold (1,240%) at an average rate of roughly 1 new podcast each month (average, 1.0 podcast; standard deviation, 1.8). DISCUSSION: The past decade has seen sizable growth in the number of readily available podcasts related to orthopaedic surgery. Additional research is required to independently assess the quality of these resources and their implications for remote trainee education.