Background The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19–related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective Using Google’s RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods We searched COVID-19 vaccine terms on Google and used the “People also ask” box to obtain FAQs generated by Google’s machine learning algorithms. FAQs are assigned an “answer” source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association’s (JAMA’s) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine–related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (χ24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions The most frequently asked COVID-19 vaccine–related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine–related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts.

Context On December 1, 2020, Drs. Wolfgang Wodarg and Micheal Yeadon petitioned to withhold emergency use authorization of the BNT162b2 messenger ribonucleic acid vaccine for coronavirus disease 2019 (COVID-19) manufactured by BioNTech and Pfizer, raising concern for female infertility risks but acknowledging the lack of evidence. The European Medicines Agency and the US Food and Drug Administration ultimately issued emergency use authorizations, but misinformation claiming that COVID-19 vaccines cause female infertility began circulating on social media, potentially influencing public perception and medical decision making among pregnant patients or those seeking to become pregnant. Objectives To determine the potential influence misinformation may have had on public interest in infertility related topics, as analyzed through internet search statistics in the US. Methods The Google Trends tool was used to analyze results for the search terms “infertility,” “infertility AND vaccine,” and “infertility AND COVID vaccine” in the US from February 4, 2020 to February 3, 2021. We applied autoregressive integrated moving average models to forecast expected values, comparing them with actual observed values. Results At peak interest (100), the forecasted relative search volumes interest for the search terms “infertility,” “infertility AND vaccine,” and “infertility AND COVID vaccine” were 45.47 (95% CI, 33.27–57.66; p<0.001), 0.88 (95% CI, 2.87–4.63; p<0.001), and 0.29 (95% CI, −2.25–2.82; p<0.001). The actual relative search volumes at peak searching represented 119.9, 11,251, and 34,900% increases, respectively, when compared with forecasted values. Conclusions COVID-19 vaccine misinformation corresponded with increased internet searches for topics related to infertility in the US. Dispelling misinformation and informing patients about the risks and benefits of COVID-19 vaccination may prevent unnecessary vaccine hesitancy or refusal, contributing to successful vaccination efforts.

Context Considering the substantial increase in research funding in the field of urology, minimizing research waste should be a top priority. Systematic reviews (SRs) compile available evidence regarding a clinical question into a single critical resource. If properly utilized, SRs can help minimize redundant studies, focus attention to unsubstantiated treatments, and reduce research waste. Objectives To appraise the use of SRs as justification for conducting randomized controlled trials (RCTs) published in high impact urology journals, and to report the ways SRs were incorporated into RCT manuscripts published in the top four urology journals by h5 index. Methods On December 13, 2019, a PubMed search was conducted for RCTs published in the top four urology journals according to the Google Scholar h5-index: European Urology, BJU International, The Journal of Urology, and Urology. For an article to be eligible for inclusion in this study, it must have been a full length RCT, published between November 30, 2014, and November 30, 2019 in one of the identified journals, reported only human subjects, and been accessible in English. The following data points were extracted independently by select investigators from each included RCT: manuscript title, year of publication, journal title, type of intervention (drug, medical device, procedure, other), funding source (government, hospital/university, industry, mixed) type of trial (parallel groups, crossover, cluster), and total number of participants reported in each RCT. The included RCTs were searched for reference to an SR, which was then recorded as “yes – verbatim,” “yes – inferred,” or “not used as justification” and the location in the manuscript where the SR was cited was recorded. Results Of the 566 articles retrieved, 276 were included. Overall, 150 (54.3%) RCTs cited an SR as either verbatim (108; 39.1%) or inferred (42; 15.2%) trial justification, while 126 (45.7%) did not use an SR for RCT justification. Of those 126, 107 (84.9%) RCTs did not cite an SR to any extent. A significant association was noted between verbatim justification and type of intervention (x 2=20.23, p=0.017), with 18 of 31 (58.1%) “other” interventions (i.e. psychosocial intervention, exercise programs, and online therapy) having an SR cited as verbatim justification. Only 39 of 118 (33.1%) pharmaceutical trials referenced an SR as verbatim justification. Of 403 systematic review citations, 205 (50.8%) appeared in the Discussion section, while 15 (3.7%) were in the Methods section. Conclusions We found that RCTs published in four high impact urology journals inconsistently referenced an SR as justification and 39.1% of our entire sample did not reference an SR at all. These findings indicate that a divide exists between the instruction and implementation of evidence based medicine in the field of urology concerning RCTs published in the top four journals. Educating clinicians and researchers on the use of SR as justification for RCTs in urology may reduce research waste and increase the quality of RCTs in the field.

Background Person-centered language places a person’s identity before any disability or medical condition they may have. Using person-centered language reduces stigma and improves the patient-physician relationship, potentially optimizing health outcomes. Patients with psoriasis often feel stigmatized due to their chronic skin condition. Objective We seek to evaluate the use of person-centered language in psoriasis literature and to explore whether certain article characteristics were associated with non–person-centered language. Methods We performed a systematic search on PubMed for recently published articles in journals that regularly publish psoriasis studies. After article reduction procedures, randomization, and screening, we reached our target sample of 400 articles. The following non–person-centered language terms were extracted from each article: “Psoriasis Patient,” “Psoriasis subject,” “Affected with,” “Sufferer,” “Suffering from,” “Burdened with,” “Afflicted with,” and “Problems with.” Screening and data extraction occurred in a masked duplicate fashion. Results Of the 400 included articles, 272 (68%) were not adherent to person-centered language guidelines according to the American Medical Association Manual of Style. The most frequent non–person-centered language term was “Psoriasis Patient,” found in 174 (43.5%) articles. The stigmatizing language was associated with the type of article and funding status, with original investigations and funded studies having higher rates of stigmatizing language. Conclusions Articles about psoriasis commonly use non–person-centered language terms. It is important to shift away from using stigmatizing language about patients with psoriasis to avoid potential untoward influences. We recommend using “patients with psoriasis” or “patient living with psoriasis” to emphasize the importance of person-centered care.

Objective: With approximately 15 million individuals in the United States meeting criteria for Alcohol Use Disorder (AUD), advancing effective medication-assisted treatment options is crucial. This advancement stems from the publication of clinical trial (CT) results. The primary objective of this study was to assess the rates of discontinuation and non-publication of results in CTs focused on the pharmacologic treatment of AUD and to assess associated factors. Design: A cross-sectional study was completed after acquiring trials focused on AUD within the ClinicalTrials.gov database. Inclusion criteria for CTs were the use of a pharmaceutical intervention with an outcome measure of alcohol intake or craving, conducted between October 2008 through September 2018. The primary outcome measures were the frequency of trial discontinuation and non-publication. Discontinuation was assessed as the listed status on ClinicalTrials.gov. Publications were identified through verification of listings on ClinicalTrials.gov, or via searches of PubMed, Embase, and Google Scholar. If publications were not found, correspondence to trial contacts were sent. Data analysis occurred on December 5th, 2020. Results: Of 235 trials returned from the search, 87 met inclusion criteria. Our study found that 12.6% (11) of CTs involving pharmaceutical treatments for AUD were prematurely terminated, and 39.1% (34) had no published results. Recruitment and lower cutoff of targeted age groups were significantly associated with discontinuation and nonpublication, respectively. Conclusions: Scientific evidence advances faster when all results are known-furthering the progress of positive studies, while avoiding duplicative efforts to test the same hypotheses with the same methods, thereby reducing scientific waste. Given the number of unpublished AUD trials, potentially useful information regarding treatment for individuals with AUD may be inaccessible to clinicians while also adding to the abundance of research waste. KEY POINTSQuestion: What are the rates of discontinuation or non-publication of clinical trials for pharmacological treatments for AUD and associated factors? Findings: Among 87 trials, 11 (12.6%) were prematurely terminated and 34 (39.1%) did not reach publication, with trials that included participants 21 years and older more likely to reach publication than those with younger participants. Meaning: Low publication rates of CTs for pharmacological treatments of AUD may (1) stunt the advancement of AUD research, (2) decrease the value in funding AUD research from government entities, and (3) needlessly expose participants to potentially harmful interventions.