PURPOSE:The most commonly used intervention for opioid overdoses is naloxone. With naloxone soon to be sold over-the-counter in the United States, the goal of this paper is to categorize frequently asked questions (FAQs) and answers about naloxone using internet sources in a cross-sectional fashion. METHODS:Terms "narcan" and "naloxone" were searched on a clean Google Chrome browser using the "People also asked" tab to find FAQs and their answer sources. We classified questions and sources and assessed each website's quality and credibility grading with JAMA benchmark criteria. The Kruskal-Wallis H test was used to determine variance of mean JAMA score by source type and Post-Hoc Dunn's test with Bonferroni corrected alpha of 0.005 used to compare source types. RESULTS:Of the 305 unique questions, 202 (66.2%) were classified as facts, 78 (25.6%) were policy, and 25 (8.2%) were value. Of the 144 unique answer sources, the two most common included 55 (38.2%) which were government entities and 47 (32.6%) which were commercial entities. Ninety-two (of 144, 63.9%) sources met three or more JAMA benchmark criteria. Statistical analysis showed a significant difference between the JAMA benchmark scores by source type H(4) = 12.75, p = 0.0126 and between the mean rank of academic and government sources (p = 0.0036). CONCLUSION:We identified FAQs and their citations about naloxone, highlighting potential lack of understanding and knowledge of this important intervention. We recommend updating websites to accurately reflect current and useful information for those that may require naloxone.

Background: A systematic review is an important evidence synthesis technique used to collate results from individual studies, such as treatments for proximal humerus fractures. Therefore it is necessary to minimize bias in systematic reviews, including financial COIs. Financial bias has been shown to result in unreliable assessments of credibility, which is why transparency with COI is essential for accurate assessments of research. Objective: The aim of this study was to characterize the influence of financial bias on the results and conclusions of systematic reviews of proximal humerus fracture treatments and to characterize the nature of disclosed and undisclosed COIs. Methods: Ovid MEDLINE and Ovid Embase databases were searched to locate systematic reviews covering proximal humerus fracture treatments. Following these searches, title and abstract screening was performed in a duplicate, masked fashion. Data from the final reviews were extracted in a triplicate manner. The data included: PubMed ID and/or DOI; journal; publication date; author names; affiliations; interventions; funding source; risk of bias assessment/statement; whether systematic review author(s) on any of the primary studies; the articles primary outcome; whether an overall pooled effect estimate was calculated; pooled effect estimate; type of pooled effect estimate/significance; the primary outcomes favorability of pooled effect estimate; and favorability of narrative results/conclusions. All authors of each systematic review were screened for non-disclosed COIs. Results: We found no relationship between authorial COI and the results and conclusions of the systematic reviews. Among the 17 included systematic reviews, 7 (41.2%) had at least one non-disclosed COI. Of the 7 reviews with a non-disclosed COI, 2 (28.6%) were found to have a high risk of bias. Conclusions: Findings from this study have limited generalizability due to our small sample size. More studies are needed to fully elucidate the effect of financial bias on the results and conclusions of systematic reviews.

Patients taking antipsychotics to treat severe mental illness may develop adverse effects such as dyslipidaemia. We aimed to provide an update to a previous systematic review showing statin therapy lowering lipid levels in individuals taking antipsychotics, while further identifying any safety concerns or changes in BMI or blood pressure. In August 2022, we searched MEDLINE, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials for studies on the effects of statins on lipid profile measures for individuals with severe mental illness taking first- or second-generation antipsychotic medications. Data extraction was performed in a masked duplicate fashion. On the basis of article type, the risk of bias in each study was assessed using ROBINS-I or RoB-2. The GRADE criteria were used for certainty assessment. Our initial search returned 396 articles, of which 6 were included in our analysis. Five of them (83.3%) identified a significant change between baseline and posttreatment lipids. Of the articles recording blood pressure, BMI or weight and significant safety concerns, no significant changes were found. The certainty assessment for this systematic review was rated as moderate. A meta-analysis was not performed. We found that studies continue to demonstrate the use of statin therapy in dyslipidaemia prevention and treatment and, in relation, decrease cardiovascular disease risk through significantly reduced LDL-C levels. Patients at risk of developing dyslipidaemias secondary to antipsychotic treatment should be considered for lipid-lowering therapy with a statin. The limited number of studies included and their heterogeneity demonstrate areas for improvement for future research.

For the older adult population struggling with mobility, utilizing the right assistive device to enhance individual functionality can be difficult and prompts evaluation of common questions. Older adults or their caregivers most frequently ask technical detail questions about mobility aids and answers were most often from a commercial retailer. Mobility inside and outside the home for older adults in need of a mobility device should include counseling from medical professionals on proper use of the device or where to find quality information. To assess frequently asked questions (FAQs) about mobility devices among older adults. We searched multiple terms on Google to find FAQs. Rothwell’s classification, JAMA benchmark criteria, and Brief DISCERN were used to categorize and assess each entry. Our search yielded 224 unique combinations of questions and linked answer sources. Viewing questions alone resulted in 214 unique FAQs, with the majority seeking factual information (130/214, 60.7

OBJECTIVE:Our study examines the association between the favorability of percutaneous coronary intervention (PCI) and/or coronary artery bypass surgery (CABG) and the presence of conflicts of interest (COIs) among authors.METHODS:We used the "Citing Articles" tool on the New England Journal of Medicine website to identify editorials on the use of PCI/CABG for stable ischemic heart disease. Authors were rated as "supportive," "neutral," or "critical" of these interventions based on the content of their editorials. COIs for each author were identified using past publications found on Scopus, PubMed, or a general internet search.RESULTS:A total of 606 articles were identified, and data were extracted from 56 of them. Among the 149 authors, 64 (43.0%) had a COI. Of these 64 authors, 19 (29.7%) disclosed their COI, while 45 (70.3%) did not. Overall, among authors with a COI, there was no association between disclosed and undisclosed COIs and the authors' view of PCI/CABG [χ2 (2, N = 64) = 1.63, p = .44]. If an author was associated with Medtronic, Abbott, or Boston Scientific, they were more likely to favor PCI/CABG if they had an undisclosed COI relative to authors who disclosed COIs [χ2 (1, N = 31) = 5.04, p = .025]. Authors publishing in a cardiology journal were more likely to view PCI/CABG favorably relative to those publishing in a general medicine journal [χ2 (2, N = 62) = 7.17, p = .028].CONCLUSION:Editors should adopt policies to counteract the unbalancing effects that COIs have on medical opinions and evidence.

Objectives: During the Union of European Football Association EURO 2020 Football Championship, Danish football player Christian Eriksen experienced a cardiac arrest on the field of play. With prompt intervention and cardiopulmonary resuscitation (CPR), Erikson had a positive outcome and survived the arrest. Our goal is to determine the extent to which this event informed the general population about cardiac arrests and CPR.Study design: This was a cross-sectional internet analysis.Methods: First, Google Trends was used to identify the search interest of topics "Cardiopulmonary resuscitation," "Myocardial infarction," and disease "Cardiac arrest" worldwide from May 29, 2021, to June 19, 2021. Second, we downloaded Twitter data via Sprout Social using the keywords "CPR" and "cardiac arrest," which are presented as the absolute number of tweets. An ARIMA model was used to forecast expected search volumes.Results: The following week, there was an increase of 91.72% (95% confidence interval [CI] 89.01-94.93) for "Cardiac arrest" above expected values, an 80.67% (95% CI 75.84-85.5) increase for "Cardiopulmonary resuscitation," and a 65.50% (95% CI 62.98-68.02) increase for "Myocardial infarction." Within Twitter, there was a peak increase in daily tweets using "CPR" by 184,706 (95% CI 181,933-187,479) beyond expected values and a peak increase in the daily tweets using "cardiac arrest" by 73,126 (95% CI 72,499-73,752).Conclusion: Although all cardiac arrests are undesirable, public knowledge of the positive effects of CPR could contribute to a means of promoting and increasing the desire for CPR awareness as well as its application.(c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:Scholastic activity through research involvement is a fundamental aspect of a physician's training and may have a significant influence on future academic success. Here, we explore publication rates before, during, and after otolaryngology residency training and whether publication efforts correlate with future academic achievement. METHODS:This cross-sectional analysis included a random sample of 50 otolaryngology residency programs. From these programs, we assembled a list of residents graduating from the years in 2013, 2014, and 2015. Using SCOPUS, PubMed, and Google Scholar, we compiled the publications for each graduate, and data were extracted in an independent, double-blinded fashion. RESULTS:We included 32 otolaryngology residency programs representing 249 residents in this analysis. Graduates published a mean of 1.3 (SD = 2.7) articles before residency, 3.5 (SD = 4.3) during residency, and 5.3 (SD = 9.3) after residency. Residents who pursued a fellowship had more total publications (t247 = -6.1, P < .001) and more first author publications (t247 = -5.4, P < .001) than residents without fellowship training. Graduates who chose a career in academic medicine had a higher number of mean total publications (t247 = -8.2, P < .001) and first author publications (t247 = -7.9, P < .001) than those who were not in academic medicine. There was a high positive correlation between residency program size and publications during residency (r = 0.76). CONCLUSION:Research productivity correlated with a number of characteristics such as future fellowship training, the pursuit of an academic career, and overall h-index in this study.

Background: Superlatives are exaggerative terms that may not accurately portray a treatment's effectiveness, safety, or availability. Objectives: The objective of this study was to evaluate the use of superlatives in news articles describing multiple sclerosis treatments. Methods: We searched Google News for 11 prespecified superlative terms describing multiple sclerosis therapies in online news articles. Results: We found that news articles commonly describe non-FDA approved multiple sclerosis therapies with superlative terms without providing clinical evidence or attribution. Additionally, no articles were published on a HONcode certified webpage. Conclusion: It is important that healthcare professionals are aware of medical misinformation presented to the public.

IntroductionThe objective of this study was to assess for spin - a form of reporting that overemphasizes benefits or downplay harms - within abstracts of systematic reviews and meta-analyses related to the clinical practice of emergency medicine (EM). MethodsPubMed was searched for systematic reviews and meta-analyses published since 2015 in either EM or general medical journals that examined an aspect of emergency medical care. In a duplicate, masked fashion, article titles and abstracts were screened to determine eligibility based on predetermined inclusion criteria. The included full-text studies were read and evaluated for spin using a previously determined search strategy. Two authors further evaluated study quality using the AMSTAR-2 tool. ResultsOur PubMed search identified 478 systematic reviews and meta-analyses, of which a random sample of 200 was selected for data extraction. Spin within the abstract of the manuscript was identified in 34.5% (69/200) of the included reviews. We identified seven of the nine spin types, with two types being most common: (1) conclusion claiming a benefit despite high risk of bias among studies reviewed (19.5% of abstracts), and (2) conclusion claiming a benefit despite reporting bias (14.5%). No significant associations were found between the presence of spin and any of the evaluated study characteristics, the AMSTAR-2 appraisal, or the journal of publication. ConclusionSpin is commonly present in abstracts of EM systematic reviews. The reporting quality for EM systematic reviews requires improvement. Measures should be taken to improve the overall review process and way information is conveyed through abstracts.

In young, healthy adults, early phase (i.e., 0-50 ms) rate of torque development (RTD) is primarily determined by neural characteristics. However, it is unclear if this remains the case in older adults. PURPOSE: To examine the physiological characteristics of early phase RTD in older men. METHODS: Seventeen older males (age = 73 ± 6 y) completed 2 maximal (MVIC) and 2 rapid (rMVIC) isometric knee extensions. Early phase RTD values were calculated from the first 50 ms (aRTD50) of the rapid contractions and normalized (nRTD50) to maximal torque (%MVIC/s). Muscle activation amplitude (EMG) was calculated during the first 50 ms (nEMG50) of EMG onset and was normalized to the peak-to-peak M-wave amplitude (%MPP) of the vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF). Evoked peak twitch torque (PTT) was determined as the maximal torque (Nm) produced from a single electrical stimulus. Motor unit number estimation (MUNE) was calculated as a ratio of the ensemble average of the single MU potential amplitude to the compound muscle action potential amplitude and was corrected for alteration. Muscle quality (MQ) was determined by examining the average muscle cross-sectional area relative to the average muscle echo intensity for each muscle using an ultrasound. Relationships between the predictor variables (nEMG50, MUNE, PTT, MQ) and RTD (aRTD50 and nRTD50) were analyzed via Pearson’s correlation coefficients. Stepwise multiple regression was used to examine the amount of variance in aRTD50 and nRTD50 accounted for by each of the predictor variables. RESULTS: aRTD50 (577.8 ± 241.0 Nm/s-1) was related to MUNE (144.1 ± 47.1, r = .549, p = .023), nEMG (137.5 ± 97.7 %MPP, r = .673, p = .003), and PTT (20.34 ± 12.5 Nm, r = .504, p = .039). nRTD50 (433.2 ± 175.4 %MVIC/s) was related to MUNE (r = .531, p = .028) and nEMG50 (r = .604, p = .010). nEMG50 and PTT were significant determinants (p = .001) that accounted for 45.3% and 15.5% of the variance in aRTD50, respectively. nEMG50 was the only significant predictor (p = .01), explaining 36.4% of the variance in nRTD50. CONCLUSIONS: These pilot data support the notion that early phase RTD is primarily determined by neural factors, even in older adults. These data also suggest that possessing a higher number of viable MUs may influence early phase absolute RTD in older men.

PURPOSE: To establish the intra- and inter-day reliability of the mean firing rate (MFR) versus recruitment threshold (RT) of the vastus lateralis (VL) during a maximal voluntary isometric contraction (MVIC) of the knee extensor musculature. METHODS: Thirty-two young, healthy males (Mean ± SD; Age: 23 ± 3 years; Height: 176.4 ± 5.9 cm; Weight: 87.3 ± 13.4 kg) reported to the laboratory on three separate occasions, each separated by 6 ± 1 days. Each visit occurred at the same time of day (±1 hour) and consisted of MVIC testing and ramp contractions, during which MU behavior was recorded. Specifically, subjects completed 2 MVIC attempts each separated by approximately 2 min., in the subject’s maximal force (FMAX) was obtained. Following an additional 2 minutes of rest, subjects completed 2 maximal ramp contraction, each separated by 2 minutes of rest, during which MU behavior was recorded through surface electromyography (sEMG). The ramp contraction trajectory consisted of a 3 second quiescent period, followed by a 10 second linear increase to FMAX, a 6 second hold at FMAX, a 5 second linear decrease back to baseline and another 3 second quiescent period. Both relative intra- and inter-day reliability of the MFR versus RT relationship were examined using the intra-class correlation coefficients (ICC2,1). The standard error of measurement (SEM) was calculated as the square root of the mean square error term from the ANOVA table and expressed in the units of measurement. The coefficient of variation (CV) was also calculated by expressing the SEM relative to the grand mean (%). RESULTS: For intra- and inter-day analyses, 16 and 20 subjects met the inclusion criteria and were included in final analyses, respectively. Both intra- and inter-day reliability statistics are presented in Table 1. CONCLUSIONS: The MFR versus RT relationship of the VL demonstrates strong intra- and inter-day reliability during a maximal voluntary contraction in young, healthy men.

New Findings What is the central question of this study? Does a common genetic variant in the β2‐adrenergic receptor (β2‐AR) have effects on skeletal muscle function in young, healthy men? What is the main finding and its importance? This study provides preliminary evidence that β2‐AR Arg16Gly genotype has a significant effect on fat‐free mass, muscle strength and motor unit behaviour in recreationally trained men. These data might have important clinical and exercise‐related implications. For example, β2‐AR (rs1042713) genotype might influence the responsiveness of skeletal muscle to clinical or exercise‐based interventions or β‐AR agonist treatment. AbstractThis study explored whether the β2‐adrenergic receptor (β2‐AR) single nucleotide polymorphism at amino acid 16 (Arg16Gly) has functional effects on skeletal muscle mass, torque production and motor unit behaviour in young, healthy men. Twenty‐eight recreationally active men (mean ± SD 23.1 ± 1.3 years of age) were genotyped for Arg16Gly polymorphisms of β2‐AR as arginine homozygous (ArgArg; n = 5), glycine homozygous (GlyGly; n = 11) or arginine–glycine heterozygous (ArgGly; n = 12). The participants then completed body composition testing, assessments of leg extensor size and echo intensity, and evoked and voluntary isometric leg‐extension muscle actions. During the evoked muscle actions, peak twitch torque, peak rate of torque development and peak relaxation rate were assessed. During the voluntary muscle actions, maximal voluntary isometric (MVIC) strength was assessed, and surface EMG signals were obtained during submaximal isometric muscle actions and later decomposed to examine motor unit firing behaviour. Fat‐free mass and MVIC strength were greater (P = 0.004, d = 1.74 and P = 0.026, d = 1.10, respectively) in those expressing the GlyGly versus ArgArg allele. The slope of the mean firing rate versus recruitment threshold relationship was more negative in the GlyGly than the ArgArg allele carriers (P = 0.012, d = 1.68) at 50% MVIC, but was less negative in GlyGly and ArgGly versus ArgArg allele carriers (P = 0.013 and 0.016, respectively; d = 1.34 and 1.20, respectively) at 70% MVIC. These data provide preliminary evidence that β2‐AR Arg16Gly genotype has a significant effect on fat‐free mass, muscle strength and motor unit behaviour in humans.