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Do infographics ‘spin’ the findings of health and medical research? BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-09-12 Ryan Muller, Giovanni Ferreira, Geronimo Bejarano, Andrew R Gamble, James Kirk, James Sindone, Joshua R Zadro
Objective To compare the prevalence of ‘spin’, and specific reporting strategies for spin, between infographics, abstracts and full texts of randomised controlled trials (RCTs) reporting non-significant findings in the field of health and medicine and to assess factors associated with the presence of spin. Design Cross-sectional observational study. Data source Publications in top quintile health and
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How to best convey continuous outcomes in patient decision aids BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-09-10 Glyn Elwyn, Marie Anne Durand, Thomas Agoritsas, Martin Mayer
The work of transforming scientific publications into tools that can support people in comparing treatments, tests and other interventions has been driven by efforts to support shared decision-making. The International Patient Decision Aids Standards (IPDAS) Collaboration has published many articles that guide this process. IPDAS, and others in this field, have considered the challenges of representing
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Development of a competency framework for health technology assessment in India BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-09-05 Simon Dixon, Kirti Tyagi, Malkeet Singh, Sitanshu Sekhar Kar, Bhavani Shankara Bagepally, Shankar Prinja, Andrew Booth, Chris Carroll, Aamir Sohail, Abha Mehndiratta
Health technology assessment (HTA) has become a key part of assessing evidence to determine which treatments are funded. Early applications were within the centrally funded health systems of high-income countries. Recent years have seen increased use within low-income and middle-income countries, including India.1–6 Increased application of HTAs has required corresponding increases in the systems’
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Assessing proposals to update established screening strategies BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-09-03 Alison Huffstetler, Kenneth W Lin, Russell P Harris
The increasing use of statistical modelling and lower certainty evidence to expand screening and the aggressive marketing of multicancer early detection tests raises questions about evidence thresholds for updating existing screening recommendations. Since 2018, five of the updated cancer screening recommendations of the US Preventive Services Task Force (USPSTF) have included statistical models (breast
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Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-09-03 Ingrid Toews, Salman Hussain, John L Z Nyirenda, Maria A Willis, Lucia Kantorová, Simona Slezáková, Minyahil Tadesse Boltena, John Victor Peter, Luis Eduardo Santos Fontes, Miloslav Klugar, Behnam Sadeghirad, Joerg J Meerpohl
Objectives To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs). Design and setting Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations
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Meta-analysis of continuous outcomes: a user’s guide for analysis and interpretation BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-29 Madelin R Siedler, Reem A Mustafa, Lifeng Lin, Rebecca L Morgan, Yngve Falck-Ytter, Philipp Dahm, Shahnaz Sultan, Mohammad Hassan Murad
Binary outcomes, such as mortality and myocardial infarction, are often viewed as most important to patients. However, outcomes that are expressed on a non-dichotomous scale such as quality of life, severity of depression or length of hospitalization, can also be critical to patients. For the purposes of this paper, all of the above examples will be referred to as continuous outcomes. While many binary
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Stop searching and you will find it: Search-Resistant Concepts in systematic review searches BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-06 Farhad Shokraneh
#### WHAT IS ALREADY KNOWN ON THIS TOPIC #### WHAT THIS STUDY ADDS #### HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY Most evidence synthesis projects involving systematic reviewing need a written protocol containing a detailed or brief description of the main review question and its concepts.1 To formulate an answerable question, it is recommended that reviewers follow one of the established
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Risk ratios, odds ratios and the risk difference BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-31 Rachel Richardson, Afroditi Kanellopoulou, Kerry Dwan
### Scenario As a heart surgeon, you regularly perform aortic valve replacement, using a median sternotomy technique. However, you are aware that less-invasive options are available, and you wonder whether these may be as effective and safe as your current practice. After searching the Cochrane Library, you find a systematic review, ‘Limited versus full sternotomy for aortic valve replacement1’. The
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Successes, shortcomings and learning opportunities for evidence-based medicine from the COVID-19 pandemic BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-30 Arnav Agarwal, Gordon Guyatt
The COVID-19 pandemic represents the largest public health crisis of the past century. Faced with a global threat, public health officials, professional societies, clinicians and patients have appropriately sought strategies to prevent SARS-CoV-2 transmission, reduce progression to severe and critical illness, and mitigate short-term and long-term sequelae. Efforts have extended to drug therapies,
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Simple tool implementing Bucher’s method for indirect treatment comparisons in meta-analyses BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-30 Samuel James Tingle, Georgios Kourounis, Felix Liu, Colin H Wilson, Rachel Richardson, Josie Sandercock
Healthcare practitioners and patients are often required to make choices between two treatment options which may have never been compared directly. When performing standard ‘pairwise’ meta-analysis, it is common to find trials comparing one of two experimental treatments against a common control (standard of care or placebo) but no head-to-head trials. Statistical methods are available to perform indirect
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Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-25 Kristen Pickles, Romi Haas, Michelle Guppy, Denise A O'Connor, Thanya Pathirana, Alexandra Barratt, Rachelle Buchbinder
Objective To synthesise the available evidence on the effects of interventions designed to improve the delivery of healthcare that reduces the greenhouse gas (GHG) emissions of healthcare. Design Systematic review and structured synthesis. Search sources Cochrane Central Register of Controlled Trials, PubMed, Web of Science and Embase from inception to 3 May 2023. Selection criteria Randomised, quasi-randomised
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Rapid review method series: interim guidance for the reporting of rapid reviews BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-22 Adrienne Stevens, Mona Hersi, Chantelle Garritty, Lisa Hartling, Beverley J Shea, Lesley A Stewart, Vivian Andrea Welch, Andrea C Tricco
Rapid reviews (RRs) are produced using abbreviated methods compared with standard systematic reviews (SR) to expedite the process for decision-making. This paper provides interim guidance to support the complete reporting of RRs. Recommendations emerged from a survey informed by empirical studies of RR reporting, in addition to collective experience. RR producers should use existing, robustly developed
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Shared decision-making and evidence-based medicine series: exploring contemporary challenges and future directions BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-22 Paula Riganti, Tammy C Hoffmann
While there is consensus that shared decision-making should be an integral part of healthcare, there is ongoing debate about its philosophical and pragmatic aspects. Shared decision-making was initially conceived as a process that involved communicating evidence-based options to address a health problem, the pros and cons of each option, eliciting the patient’s preferences and reaching a shared decision
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Call to improve transparent communication in direct-to-consumer test marketing BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Emma Grundtvig Gram, Helen Macdonald, Barnett Kramer, Steven Woloshin
All tests ‘(…) do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.’ Muir Gray and Angela Raffle.1 Medical tests are widely and increasingly marketed directly to consumers via traditional and social media.2 Such tests may diagnose disease, detect biochemical or hormonal imbalances, or characterise physiological states. Tests come in different forms including
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Reducing low value care: opportunities and challenges for Choosing Wisely campaigns BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Jeremy M Grimshaw, Wendy Levinson
Low value care harms patients (due to adverse events of treatments or secondary unwarranted tests), overburdens healthcare professionals (potentially contributing to burnout), threatens healthcare systems (threatening sustainability due to inefficient use of scarce healthcare resources) and damages the climate (due to negative environmental impact on provision of low value care).1 Low value care is
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Making sustainable healthcare decisions: three turns towards sustainable guidelines BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Sietse Wieringa, Hugh McGuire, Qi Wang, Philip van der Wees, Beth Shaw
Over time, an international consensus on ‘best practice’ for developing a range of guidelines has been reached in many areas. However, there are always new challenges for guideline developers. Sustainability is one of those increasingly important challenges as it is for healthcare professionals, government policy-makers, organisational leaders, patients and citizens.1 Sustainability may nowadays seem
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Open access journal publication in health and medical research and open science: benefits, challenges and limitations BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Patricia Logullo, Jennifer A de Beyer, Shona Kirtley, Michael Maia Schlüssel, Gary S Collins
Scientific progress, including in evidence-based medicine, requires all available evidence to be accessed, scrutinised, interpreted and used. Missing or incomplete evidence creates biases and errors in later research. Open science practices are movements and procedures that aim to increase transparency in science production. They aim to make scientific knowledge available, accessible and reusable,
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Adherence to the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) of studies on evidence-based healthcare e-learning: a cross-sectional study BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Małgorzata M Bała, Tina Poklepović Peričić, Marija Franka Žuljević, Nensi Bralić, Joanna Zając, Nkengafac Villyen Motaze, Anke Rohwer, Michalina Gajdzica, Taryn Young
Objectives The objectives of this study are to assess reporting of evidence-based healthcare (EBHC) e-learning interventions using the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) checklist and explore factors associated with compliant reporting. Design Methodological cross-sectional study. Methods Based on the criteria used in an earlier systematic
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Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Areti Angeliki Veroniki, Sai Surabi Thirugnanasampanthar, Menelaos Konstantinidis, Jasmeen Dourka, Marco Ghassemi, Dipika Neupane, Paul Khan, Vera Nincic, Margarita Corry, Reid Robson, Amanda Parker, Charlene Soobiah, Angela Sinilaite, Pamela Doyon-Plourde, Anabel Gil, Winnie Siu, Nasheed Moqueet, Adrienne Stevens, Kelly English, Ivan D Florez, Juan J Yepes-Nuñez, Brian Hutton, Matthew Muller, Lorenzo
Objectives To compare the efficacy of influenza vaccines of any valency for adults 60 years and older. Design and setting Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from inception to 20 June 20, 2022. Two reviewers screened
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Genetic predisposition, modifiable lifestyles, and their joint effects on human lifespan: evidence from multiple cohort studies BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Zilong Bian, Lijuan Wang, Rong Fan, Jing Sun, Lili Yu, Meihong Xu, Paul R H J Timmers, Xia Shen, James F Wilson, Evropi Theodoratou, Xifeng Wu, Xue Li
Objective To investigate the associations across genetic and lifestyle factors with lifespan. Design A longitudinal cohort study. Setting UK Biobank. Participants 353 742 adults of European ancestry, who were recruited from 2006 to 2010 and were followed up until 2021. Exposures A polygenic risk score for lifespan with long (highest quintile) risk categories and a weighted healthy lifestyle score,
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Rapid review methods series: Guidance on the use of supportive software BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Lisa Affengruber, Barbara Nussbaumer-Streit, Candyce Hamel, Miriam Van der Maten, James Thomas, Chris Mavergames, Rene Spijker, Gerald Gartlehner
This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RRs) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. This paper guides how to use supportive software for RRs. We strongly encourage the use of supportive software throughout RR production
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Preventing overdiagnosis and overuse: proposed guidance for guideline panels BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Guylene Theriault, Roland Grad
Moving from evidence to recommendations, guideline panels can influence decisions in everyday clinical practice. Consequently, guideline panellists should carefully craft their recommendations to minimise the potential for harm, including the possibility of increasing overdiagnosis and promoting overuse of unnecessary tests and treatments. This is particularly important in the context of screening
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Teaching to address overdiagnosis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Natalie Edmiston, Iman Hegazi
> The whole art of medicine is in observation… but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do. William Osler. ‘The Hospital as a College’ Aequanimitas. 1914:332 Learning to diagnose is a crucial skill for medical students and we propose that on this path, we need medical students to
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Survey of US physicians’ attitudes and knowledge of AI BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Sarah Gebauer, Carly Eckert
Artificial intelligence (AI) applications in healthcare have proliferated over the past several years.1 Potential uses include decreased administrative burden, improved diagnostic accuracy and personalised treatment recommendations.2 Image-related fields such as ophthalmology and radiology have seen rapid uptake of AI tools, and the technology will likely continue to develop in other specialties.3
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Ethical implications of AI-driven bias assessment in medicine BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-08-01 Yanyi Wu, Chenghua Lin
Barsby et al present a thought-provoking pilot study which discusses the application of large language models (LLMs) for automating risk-of-bias (RoB) assessments in system evaluation.1 Although LLMs show potential in streamlining evidence synthesis, the major ethical concerns caused by their integration into the medical decision-making process require careful consideration. Patient safety is paramount
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What is the vibration of effects? BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-12 Constant Vinatier, Sabine Hoffmann, Chirag Patel, Nicholas J DeVito, Ioana Alina Cristea, Braden Tierney, John P A Ioannidis, Florian Naudet
Navigating between contradictory results is not rare in the practice of evidence-based medicine. Recently, two papers published in the same year and in the same journal investigated the same research question with the same dataset and reached divergent results regarding the benefits of retrieval bag use during laparoscopic appendectomy.1 The two studies reached contrasting conclusions, one found that
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Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-12 Laura Hauge Kristensen, Rannva Winther, Josefine Tvede Colding-Jørgensen, Anton Pottegård, Henrik Nielsen, Jacob Bodilsen
Objective To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals. Design Prospective population-based cohort study. Setting North Denmark. Participants All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021. Main outcome measures UTI was defined as
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Associations between device-measured and self-reported physical activity and common mental disorders: Findings from a large-scale prospective cohort study BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-12 Zhe Wang, Zhi Cao, Jiahao Min, Tingshan Duan, Chenjie Xu
Objectives To investigate the associations between device-measured and self-reported physical activity (PA) and incident common mental disorders in the general population. Design and setting Large-scale prospective cohort study. Participants Using the UK Biobank data, a validated PA questionnaire was used to estimate self-reported weekly PA in 365 656 participants between 2006 and 2010 while 91 800
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Cancer screening attendance rates in transgender and gender-diverse patients: a systematic review and meta-analysis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-10 Alvina Chan, Charlotte Jamieson, Hannah Draper, Stewart O'Callaghan, Barbara-ann Guinn
Objectives To examine disparities in attendance rates at cancer screening services between transgender and gender-diverse (TGD) people in comparison with their cisgender (CG) counterparts, and to determine whether these differences were based on the anatomical organ screened. Design Systematic review and meta-analysis. Data sources PubMed, EMBASE (via Ovid), CINAHL Complete (via EBSCO) and Cochrane
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iHealthFacts: a health fact-checking website for the public BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-10 Paula Byrne, Anne Daly, Deirdre Mac Loughlin, Caoimhe Madden, Therese Mc Donnell, Claire O'Connell, Johanna Pope, K M Saif-Ur-Rahman, Petek Eylul Taneri, Marie Tierney, Elaine Toomey, Declan Devane
Unreliable health information has been identified as a public health challenge. It may lead individuals to explore unproven and potentially harmful medical treatments1 or cause delays in seeking appropriate healthcare services.2 Determining the accuracy of health information is especially challenging in the digital age.3 These challenges were underscored by the onset of the COVID-19 pandemic. In March
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Informatics hygiene to support reuse of routinely collected health care data for evidence-based practice BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-07-04 Elmer V Bernstam, Alejandro Araya, Matthew Decaro, Todd R Johnson
Healthcare data are increasingly collected in transactional systems such as electronic health records (EHRs) and aggregated into analytical systems such as clinical data warehouses (figure 1). Consequently, there has been significant interest in reusing these data for evidence-based practice, research, biosurveillance, quality improvement and other purposes. Despite enthusiasm and multiple successful
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Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-29 Aileen Zeng, Queenie Tang, Edel O’Hagan, Kirsten McCaffery, Kiran Ijaz, Juan C Quiroz, Ahmet Baki Kocaballi, Dana Rezazadegan, Ritu Trivedi, Joyce Siette, Timothy Shaw, Meredith Makeham, Aravinda Thiagalingam, Clara K Chow, Liliana Laranjo
Objectives To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF. Study design Systematic review and meta-analysis. Eligibility criteria Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF. Information sources We searched MEDLINE, EMBASE
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Implementing AI models in clinical workflows: a roadmap BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-24 Fei Wang, Ashley Beecy
Artificial Intelligence (AI) aims at mimicking human intelligence through computer programmes. Machine learning (ML), especially deep learning technologies, aiming at inferring insights from complex data through mathematical modelling, offers an effective way of achieving AI and has achieved great success in many disciplines, such as computer vision and natural language processing. Over the past decade
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Correction: Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-14 BMJ Publishing Group Ltd
Kongkam P, Khongkha W, Lopimpisuth C , et al Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial BMJ Evidence-Based Medicine 2023; 28: 399-406. The journal received a rapid response that raised issues regarding the registration status of this trial and the …
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Meet generative AI… your new shared decision-making assistant BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-12 Glyn Elwyn, Padhraig Ryan, Daniel Blumkin, William B Weeks
Large language models (LLMs), a new family of tools to generate natural language, are likely to radically change how some aspects of healthcare are delivered.1 It is difficult to comprehend the pace at which change is already occurring. For example, ChatGPT, released by OpenAI in November 2022, represented a leap in the capability of artificial intelligence (AI).2 This was followed by the release of
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Ten recommendations to foster healthcare resource stewardship in knowledge translation BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-11 Rene Wittmer, Guylene Theriault, Frantz-Daniel Lafortune, Samuel Boudreault, Marc-Antoine Turgeon, Pascale Breault, Genevieve Bois, Lisa Hannane, Amanda Try
Providing healthcare services with little to no benefit represents an important issue in healthcare worldwide. It is estimated that between 20% and 40% of prescribed tests and treatments are not useful in patient management.1 These unnecessary tests and treatments can lead to psychological and physical harm2 and have downstream consequences such as reduced quality of care, opportunity costs and negative
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Strengthening transparency in randomised trials related to multimorbidity: key points and recommendations to guide reporting BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-05 Zijun Wang, Jako S Burgers, Ruitai Shao, Zhaoxiang Bian, Chen Wang, Yaolong Chen, Janne Estill
Multimorbidity, defined by the WHO as the coexistence of two or more chronic conditions,1 is a growing challenge for public health globally. Lower quality of life, psychological distress, long hospital stays, postoperative complications, high costs of care and elevated mortality are becoming an enormous burden for patients and their families as the prevalence of multimorbidity increases along with
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Pilot study on large language models for risk-of-bias assessments in systematic reviews: A(I) new type of bias? BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-23 Joseph Barsby, Samuel Hume, Hamish AL Lemmey, Joseph Cutteridge, Regent Lee, Katarzyna D Bera
Risk-of-bias (RoB) assessment is used to assess randomised control trials for systematic errors. Developed by Cochrane, it is considered the gold standard of assessing RoB for studies included within systematic reviews, representing a key part of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.1 The RoB tool comprises six domains that may signify bias: random sequence
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Guidelines for the development and validation of patient-reported outcome measures: a scoping review BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-23 Andres Jung, Dimitris Challoumas, Larissa Pagels, Susan Armijo-Olivo, Tobias Braun, Kerstin Luedtke
Objective The objectives of this scoping review were to provide an overview of existing guidelines for the development and validation of patient-reported outcome measures (PROMs), review them for comprehensiveness and clarity and provide recommendations for their use based on the goals of the instrument developers. Design Scoping review. Methods A literature search was performed in PubMed, Scopus,
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Overly complex methods may impair pragmatic use of core evidence-based medicine principles BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Rebecca Kuehn, Ying Wang, Gordon Guyatt
The aphorism suggesting that we should keep things as simple as possible but not simpler applies well to the world of evidence-based medicine (EBM). The initial Users’ Guide to the Medical Literature that launched the era of EBM adhered faithfully to the as-simple-as-possible rule. For instance, the first Users’ Guide to therapy published in JAMA in 1993 presenting appraisal guidance for studies of
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How methodological pitfalls have created widespread misunderstanding about long COVID BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Tracy Beth Høeg, Shamez Ladhani, Vinay Prasad
### Key messages High rates of long COVID or post-acute sequelae of COVID-19 (PASC) continue to be reported in academic journals and subsequently filtered to the public. For instance, the Centers for Disease Control and Prevention (CDC) recently stated ‘nearly one in five American adults who have had COVID-19 still have long Covid’.1 Many scientific publications overestimate PASC prevalence because
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High-value care education can learn from the evidence-based medicine movement: moving beyond competencies and curricula to culture BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Christopher Moriates, William K Silverstein, Renato Bandeira de Mello, Lorette Stammen, Brian M Wong
High-value care (HVC) is ‘the best care for the patient, with the optimal result for the circumstances, delivered at the right price’.1 Simply put, it means ensuring only appropriate tests, treatments and procedures are provided to patients, to mitigate overuse. Adopting HVC is increasingly important given that unnecessary medical interventions are costly, harmful to patients and increase the carbon
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Twenty-one years of the International Shared Decision Making Conference: lessons learnt and future priorities BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Natalie Joseph-Williams, Glyn Elwyn, Adrian Edwards
The first International Shared Decision Making (ISDM) Conference took place in Oxford (UK), 2001. It was attended by 120 motivated people who saw the potential of shared decision making (SDM) to lead to safer and more effective healthcare. Two years later in Swansea (UK), the conference book opened with this foreword: ‘In a few decades, the fact that we did not involve patients in the design of services
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Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Adewole S Adamson, Geetanjali Naik, Mark A Jones, Katy JL Bell
Objectives To quantify the proportion of melanoma diagnoses (invasive and in situ) in the USA that might be overdiagnosed. Design In this ecological study, incidence and mortality data were collected from the Surveillance, Epidemiology and End Results 9 registries database. DevCan software was used to calculate the cumulative lifetime risk of being diagnosed with melanoma between 1975 and 2018, with
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Efficacy of non-pharmacological interventions for primary dysmenorrhoea: a systematic review and Bayesian network meta-analysis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Xinglin Li, Xinyu Hao, Jian-hua Liu, Jian-peng Huang
Objectives To assess the relative benefits of various non-pharmacological interventions on treating primary dysmenorrhoea within a network meta-analysis. Study design Systematic review and Bayesian network meta-analysis. Inclusion criteria Randomised controlled trial involving patient with primary dysmenorrhoea and received non-pharmacological interventions. Data sources Four databases (Medline, Embase
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De-escalation of dual antiplatelet therapy for patients with acute coronary syndrome after percutaneous coronary intervention: a systematic review and network meta-analysis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Ovidio De Filippo, Francesco Piroli, Francesco Bruno, Pier Paolo Bocchino, Andrea Saglietto, Luca Franchin, Filippo Angelini, Guglielmo Gallone, Giulia Rizzello, Mahmood Ahmad, Mauro Gasparini, Saurav Chatterjee, Gaetano Maria De Ferrari, Fabrizio D'Ascenzo
Objectives To compare dual antiplatelet therapy (DAPT) de-escalation with five alternative DAPT strategies in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Design We conducted a systematic review and network meta-analysis (NMA). Parallel-arm randomised controlled trials (RCTs) comparing DAPT strategies were included and arms of interest were compared
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How to use the regulatory data from Health Canada for secondary analyses on new drugs, biologics and vaccines BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Isaac Bai, Peter Doshi, Matthew Herder
Incorporating clinical data held by national health product regulatory authorities into secondary analyses such as systematic reviews can help combat publication bias and selective outcome reporting, in turn, supporting more evidence-based decisions regarding the prescribing of drugs, biologics and vaccines. Owing to recent changes in Canadian law, Health Canada has begun to make clinical information—whether
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Rapid reviews methods series: guidance on rapid qualitative evidence synthesis BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Andrew Booth, Isolde Sommer, Jane Noyes, Catherine Houghton, Fiona Campbell
This paper forms part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group and addresses rapid qualitative evidence syntheses (QESs), which use modified systematic, transparent and reproducible methodsu to accelerate the synthesis of qualitative evidence when faced with resource constraints. This guidance covers the review process as it relates to synthesis of qualitative
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Potential impact of large language models on academic writing BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Fares Alahdab
Although the development of artificial intelligence (AI) tools started in the 1950s,1 recent breakthroughs have placed powerful models in the hands of millions for vast potential uses. The advent of large language models (LLMs), such as Open AI’s ChatGPT2 and GPT-4,3 Google’s Bert4 and Bard (a fine-tuned LaMDA-2),5 among many others, has brought unprecedented potential, along with new ethical dilemmas
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Integrating a climate lens into the design of education programmes for health professionals BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Tara Tai-Wen Chen, Denise Thomson, Julia Sharobim, Omolola Titilayo Alade, Thanya Pathirana
Climate change is the major public health crisis of this century. Extreme climate events lead to direct impacts on health systems. For example, increased hospital admissions and emergency department visits may result from exacerbated cardiorespiratory morbidity caused by extreme heat.1 2 Indirectly, climate change also leads to health system disruptions through impacts on hospital infrastructure and
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Equity of access to healthcare for a patient with a severe intellectual disability BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Anonymous
My friend Dorothy (a pseudonym) is in her mid-40s. She loves parties and sharing good food with family and friends. She likes watching musicals and films, going to the ballet and the pantomime, to the pub and to church as well as expressing herself creatively. Whatever she is doing, she enjoys looking stylish and receiving compliments about her appearance. It has not been possible for Dorothy to have
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Correspondence on “How methodological pitfalls have created widespread misunderstanding about long COVID” by Høeg et al BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Thomas R Fanshawe
Høeg et al have written an opinion piece about what they consider to be the methodological limitations of some epidemiological studies into long COVID.1 Some of these points, such as the need for a specific case definition and the need for adequate control group selection, are common to all epidemiological research and are certainly limitations of some of the published studies in this area. However
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Reliance on the highest-quality studies of Long Covid is appropriate and not evidence of bias BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-06-01 Tracy Beth Høeg, Shamez Ladhani, Vinay Prasad
We want to thank Dr. Fanshawe for his letter.1 We believe we share the common goal of enhancing understanding of Long Covid so we can better estimate the burden, appropriately allocate healthcare provisions and improve patient care. To respond to his points in order, historical studies that employed a change in seropositivity status to distinguish infected cases from controls2 3 are expected to be
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Vibration of effects resulting from treatment selection in mixed-treatment comparisons: a multiverse analysis on network meta-analyses of antidepressants in major depressive disorder BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-20 Constant Vinatier, Clement Palpacuer, Alexandre Scanff, Florian Naudet
Objective It is frequent to find overlapping network meta-analyses (NMAs) on the same topic with differences in terms of both treatments included and effect estimates. We aimed to evaluate the impact on effect estimates of selecting different treatment combinations (ie, network geometries) for inclusion in NMAs. Design Multiverse analysis, covering all possible NMAs on different combinations of treatments
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Clinical trial design and treatment effects: a meta-analysis of randomised controlled and single-arm trials supporting 437 FDA approvals of cancer drugs and indications BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-17 Daniel Tobias Michaeli, Thomas Michaeli, Sebastian Albers, Julia Caroline Michaeli
Objectives This study aims to analyse the association between clinical trial design and treatment effects for cancer drugs with US Food and Drug Administration (FDA) approval. Design Cross-sectional study and meta-analysis. Setting Data from Drugs@FDA, FDA labels, ClincialTrials.gov and the Global Burden of Disease study. Participants Pivotal trials for 170 drugs with FDA approval across 437 cancer
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Direct-to-consumer advertising: a modifiable driver of overdiagnosis and overtreatment BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-15 David B Menkes, Barbara Mintzes, Joel Lexchin
The USA and New Zealand (NZ) are the only high-income countries that allow unrestricted direct-to-consumer advertising (DTCA) of prescription medicines, including both the name of the drug and its indications. Many other countries allow companies to conduct unbranded ‘disease-oriented’ advertising, which falls outside the scope of pharmaceutical advertising regulations (see Table 1). View this table:
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Enhancing the transparency of clinical practice guidelines by prospective registration: the PREPARE platform BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-08 Hui Liu, Nan Yang, Janne Estill, Yaolong Chen
Prospective registration of clinical practice guidelines has received increasing attention from researchers in recent years.1–3 Registration means submitting information such as the title, purpose, developer, methodology and conflicts of interest of a planned guideline to a publicly accessible registration platform before commencing the development.4 Registration can reduce unnecessary duplication
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Cost-effectiveness of emicizumab prophylaxis for haemophilia A with inhibitors: an adaptive health technology assessment for the Indian setting BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-06 Sitanshu Sekhar Kar, Parthibane Sivanantham, Vanessa Ravel, Abha Mehndiratta, Kirti Tyagi, Daniel A Ollendorf
Objective To assess the cost-effectiveness of emicizumab prophylaxis for patients having haemophilia A with inhibitors in the Indian context using an adaptive health technology assessment (aHTA) methodology. Design Economic evaluation using multiple approaches aimed at adjusting previously generated cost-effectiveness results based on (1) price differences only (‘simple’) and (2) differences in cost
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Feasibility of multiorgan risk prediction with routinely collected diagnostics: a prospective cohort study in the UK Biobank BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-06 Celeste McCracken, Zahra Raisi-Estabragh, Liliana Szabo, Michele Veldsman, Betty Raman, Anya Topiwala, Adriana Roca-Fernández, Masud Husain, Steffen E Petersen, Stefan Neubauer, Thomas E Nichols
Objectives Despite rising rates of multimorbidity, existing risk assessment tools are mostly limited to a single outcome of interest. This study tests the feasibility of producing multiple disease risk estimates with at least 70% discrimination (area under the receiver operating curve, AUROC) within the time and information constraints of the existing primary care health check framework. Design Observational
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Global considerations for informed consent with shared decision-making in the digital age BMJ Evid. Based Med. (IF 9.0) Pub Date : 2024-05-02 Edward Robert St John, Connor James Stewart Moore, Raghu Ram Pillarisetti, Erica Sarah Spatz
Shared decision-making (SDM) is increasingly recognised as fundamental to patient-centred care and enabling patients to make voluntary, informed decisions about their health.1 SDM is the process whereby patients and clinicians come together to share their expertise. The patient acts as an expert of themselves, understanding their own preferences and their attitudes to risk. The clinician is an expert