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Objective: Language that implies a conclusion not supported by the evidence is common in the medical literature. The hypothesis of the present study was that medical journal publications are more likely to use misleading language for the interpretation of a demonstrated null (i.e. chance or not statistically significant) effect than a demonstrated real (i.e. statistically significant) effect., Methods: This was an observational study of the medical literature with a systematic sampling method. Articles published in The Journal of the American Medical Association, The Lancet and The New England Journal of Medicine over the last two decades were eligible. The language used around the P-value was assessed for misleadingness (i.e. either suggesting an effect existed when a real effect did not exist or vice versa)., Results: There were 228 unique manuscripts examined, containing 400 statements interpreting a P-value proximate to 0.05. The P-value was between 0.036 and 0.050 for 303 (75.8%) statements and between 0.050 and 0.064 for 97 (24.3%) statements. Forty-four (11%) of the statements were misleading. There were 40 (41.2%) false-positive sentences, implying statistical significance when the P-value was >0.05, and four (1.3%) false-negative sentences, implying no statistical significance when the P-value <0.05 (relative risk 31.2; 95% confidence interval 11.5-85.1; P < 0.0001). The proportion of included manuscripts containing at least one misleading sentence was 16.2% (95% confidence interval 12.0-21.6)., Conclusions: Among a random selection of sentences in prestigious journals describing P-values close to 0.05, 1 in 10 are misleading (n = 44, 11%) and this is more prevalent when the P-values are above 0.05 compared to below 0.05. Caution is advised for researchers, clinicians and editors to align with the context and purpose of P-values., (© 2021 Australasian College for Emergency Medicine.)

Background: Male circumcision is one of the most common surgical procedures performed in the Australian private sector. This study examines the trends in childhood circumcision throughout the early 21st century., Methods: Circumcisions performed between 2000 and 2019 amongst preschool-aged Australian boys (0-4 years) were obtained from the Medicare Benefits Schedule. Quarterly data for Victoria and South Australia were divided into three phases separated by (i) state-wide bans of non-therapeutic circumcision in the public sector (2007) and (ii) a disfavouring of non-therapeutic circumcisions by the Royal Australasian College of Physicians (2010). Interrupted time series analyses determined differences between pre-ban (2000-2007), post-ban (2007-2010) and reversal (2010-2019) phases., Results: Altogether, 478 717 circumcisions were performed on preschool-aged boys. Incidence progressed from 2675 per 100 000 preschoolers in 2000 to 3140 in 2008 to 1875 in 2019. In Victoria, the baseline (Q1-2000) rate of circumcision was 294.9 per 100 000. This rose by +1.3 (1.1 to 4.1, p < 0.001) per quarter pre-ban and +6.6 (3.0 to 10.3, p = 0.001) post-ban before decreasing by -13.1 (-16.4 to -9.8, p < 0.001) in the reversal phase. In South Australia, the initial rate was 745.2 per 100 000 and increased by +1.4 (0.0 to 2.8, p = 0.045) per quarter pre-ban, +7.6 (0.5 to 14.7, p = 0.035) post-ban and retracted by -20.8 (-27.9 to -13.7, p < 0.001) during the reversal phase., Conclusion: The incidence of childhood circumcisions in Australia observed a significant rise and fall throughout the early 21st century. Medical and surgical authorities may have played an important role in the gradual reduction of procedures over the last decade., (© 2021 Royal Australasian College of Surgeons.)