BMJ medicine最新文献

{"title":"Conservative treatments for chronic non-specific low back pain: time course network meta-analysis.","authors":"Daniel L Belavý, Tobias Saueressig, Nitin Kumar Arora, Arun Prasad Balasundaram, Xiaolong Chen, Ashish D Diwan, Jon J Ford, Andrew J Hahne, Svenja Kaczorowski, Clint T Miller, Niamh L Mundell, Hugo Pedder, Tim Schleimer, Scott D Tagliaferri, Florian Teichert, Xiaohui Zhao, Patrick J Owen","doi":"10.1136/bmjmed-2025-001908","DOIUrl":"10.1136/bmjmed-2025-001908","url":null,"abstract":"<p><strong>Objective: </strong>To examine the efficacy of conservative (non-surgical) treatments, usual care, and no treatment for chronic radicular and non-specific back pain.</p><p><strong>Design: </strong>Time course network meta-analysis.</p><p><strong>Data sources: </strong>Six electronic databases (Medline, SPORTDiscus, CINAHL, PsycINFO, Embase, and CENTRAL), searched from inception to 24 July 2020, and 302 previous systematic reviews.</p><p><strong>Eligibility criteria for selecting studies: </strong>Full peer reviewed publications in English or German of randomised controlled trials, randomised clinical trials, randomised controlled cluster trials, or randomised crossover trials in adults (aged ≥18 years) receiving common conservative treatments for non-specific and radicular chronic low back pain. Treatments examined were acupuncture, education or advice, electrotherapy (including heat and ice electrotherapeutic modalities applied non-invasively), exercise training, manual treatments or manipulation, massage, the McKenzie method, pharmacotherapy, psychological treatments, traction, physical therapy (otherwise not falling into specific treatment combinations), placebo, multidisciplinary pain management, usual care (eg, management by a doctor), and no treatment (true control).</p><p><strong>Results: </strong>Back pain intensity, leg pain intensity, disability, and mental health outcomes were reported immediately (<1 day), and at short term (≥1 day and ≤3 months), intermediate term (>3 and <12 months), and long term (≥12 months) time points. 581 reports of 551 studies (71 126 patients) were included. 510 trials included people with non-specific chronic low back pain and 41 trials included those with radicular chronic low back pain. For back pain (0-100 scale), acupuncture (mean difference -20.91, 95% credible interval -24.00 to -11.95), electrotherapy (-18.98, -21.84 to-10.95), exercise (-15.59, -17.51 to -10.05), manual treatment (-19.48, -22.17 to -11.74), massage (-25.61, -30.42 to -10.91), and multidisciplinary pain management (-18.96, -22.26 to -9.58) exceeded the minimal clinically important difference (set at 0.5 standard deviation) in the short term. For disability (0-100 scale), acupuncture (mean difference -10.52, 95% credible intervals -11.84 to -6.59), massage (-9.95, -11.45 to -5.50), and multidisciplinary pain management (-12.56, -13.91 to -8.55) were clinically effective in the short term. In the immediate and intermediate term only, the McKenzie method and massage, respectively, exceeded the minimal clinically important difference. In the long term, although two of the 14 treatments for back pain and nine of 14 treatments for disability had statistically significant benefits compared with no treatment, the effects were not clinically significant. The certainty of the evidence based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was low (1.4%) to very low (98.6%) across interventi","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001908"},"PeriodicalIF":9.3,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of polygenic risk score communication on short term health outcomes: systematic review and meta-analysis.","authors":"Luigi Russo, Nicolò Lentini, Sara Farina, Antonio Cristiano, Andrea Adduci, Alessio Perilli, Christian Cao, Roberta Pastorino, Stefania Boccia, John Pa Ioannidis","doi":"10.1136/bmjmed-2025-002347","DOIUrl":"10.1136/bmjmed-2025-002347","url":null,"abstract":"<p><strong>Objective: </strong>To summarise the evidence so far from all randomised controlled trials on the efficacy of communication of polygenic risk scores in changing health outcomes.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>Cochrane Central Register of Controlled Trials (CENTRAL) and Pubmed, from inception to 1 March 2025.</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials in human participants; articles published or accepted for publication in peer reviewed journals, or with available results on ClinicalTrials.gov, without time restriction in any language; and randomised controlled trials comparing the disclosure of inherited genetic risk obtained through the polygenic risk score for any phenotype (intervention group) with scenarios where no genetic information was provided (comparator group).</p><p><strong>Results: </strong>Of 7830 articles retrieved, 27 randomised controlled trials were eligible for inclusion in the analysis. Polygenic risk scores mainly predicted risks for cancer (n=9 randomised controlled trials), cardiovascular diseases (n=8), and diabetes (n=6). 21 randomised controlled trials targeted mainly healthy populations, three targeted at-risk populations, and three trials targeted individuals who had already developed a disease and the polygenic risk score predicted complications. Most randomised controlled trials (15/27) concluded in their abstracts with favourable claims about the polygenic risk score, with only 5/15 trials justifying the score with any significant results. Nine of the 27 randomised controlled trials had a high risk of bias. Meta-analysis showed no significant effects on any of the 22 outcomes tested in two or more trials. Standardised mean differences for dietary outcomes were -0.11 (95% confidence interval (CI) -0.22 to 0.01) for daily energy intake, 0.03 (-0.18 to 0.25) for daily fat intake, and -0.11 (-0.28 to 0.06) for alcohol consumption. For physical activity, standardised mean difference was -0.01 (95% CI -0.13 to 0.11). Relative risks were 1.12 (95% CI 0.77 to 1.61) for screening attendance, 1.50 (0.98 to 2.29) for use of statins, and 0.95 (0.32 to 2.79) for incidence of disease. For psychological outcomes, standardised mean differences were -0.02 (95% CI -0.13 to 0.08) for anxiety, -0.06 (-0.23 to 0.10) for worry, -0.04 (-0.21 to 0.13) for perceived risk, and -0.05 (-0.23 to 0.13) for depression. For clinical outcomes, mean differences were -2.01 (95% CI -8.27 to 4.26) for total cholesterol, -3.64 (-7.88 to 0.60) for low density lipoprotein cholesterol, -0.21 (-2.65 to 2.23) for high density lipoprotein cholesterol, -1.88 (-4.17 to 0.42) for diastolic blood pressure, -1.26 (-4.44 to 1.92) for systolic blood pressure, -0.12 (-0.63 to 0.39) for body mass index, and -0.33 (-0.87 to 0.20) for weight. 80 outcomes were reported across multiple studies, with each outcome reported in a single tri","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002347"},"PeriodicalIF":9.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New approaches in the haemostatic management of postpartum haemorrhage.","authors":"Catrin Cox, Lucy Neave, Beverley J Hunt","doi":"10.1136/bmjmed-2025-002256","DOIUrl":"10.1136/bmjmed-2025-002256","url":null,"abstract":"<p><p>Postpartum haemorrhage is the leading cause of maternal mortality worldwide, accounting for a substantial proportion of preventable deaths, particularly in settings with limited resources. Despite its clinical significance, understanding the haemostatic changes underpinning postpartum haemorrhage has historically been limited, with management strategies largely extrapolated from trauma related bleeding. Important physiological differences exist between these conditions, however, which has implications for diagnosis and treatment. Normal pregnancy is characterised by increased coagulation factors and reduced fibrinolysis, resulting in a hypercoagulable state. These adaptations are protective but influence the haemostatic response to bleeding. Recent evidence has refined our understanding of coagulopathy in postpartum haemorrhage. In most cases, haemostasis is preserved despite major blood loss, but fibrinogen depletion is an early and important predictor of severe haemorrhage. A distinct and rare entity, acute obstetric coagulopathy, has been described, characterised by hyperfibrinolysis, hypofibrinogenaemia, dysfibrinogenaemia, and depletion of selective coagulation factors, and is associated with poor maternal and neonatal outcomes. Traditional laboratory coagulation tests are limited by turnaround time and insensitivity to key abnormalities, such as fibrinolysis. Viscoelastic haemostatic assays (eg, thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) offer rapid, point-of-care assessment of clot formation and stability, allowing earlier identification of coagulopathy and more targeted transfusion strategies. Evidence suggests that their use may reduce unnecessary administration of blood products without compromising outcomes. Management strategies are evolving. Tranexamic acid has shown a clear benefit in terms of mortality when given early, and is now widely recommended. In contrast, routine empiric use of fresh frozen plasma is increasingly questioned, given the relative preservation of coagulation factors in most patients with postpartum haemorrhage and the potential risks of over-transfusion. Instead, targeted correction of coagulopathy, especially hypofibrinogenaemia, and judicious use of blood components is gaining interest, guided by clinical and laboratory findings. In summary, advances in the understanding of haemostatic changes in postpartum haemorrhage support a shift towards individualised targeted transfusion strategies. Wider adoption of point-of-care testing and further high quality research are needed to optimise transfusion approaches and improve maternal outcomes globally.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002256"},"PeriodicalIF":9.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Vaccine cold chain and understanding what underpins vaccine security for vaccine preventable diseases.","authors":"","doi":"10.1136/bmjmed-2025-001835corr1","DOIUrl":"10.1136/bmjmed-2025-001835corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjmed-2025-001835.].</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001835corr1"},"PeriodicalIF":9.3,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary fibrosis: evolving therapeutic pipeline.","authors":"Laura Shannon, Sabria Islam, Benjamin Hilary, Gary Murphy, Simon Bailey, Rebecca Rooney, Nazia Chaudhuri","doi":"10.1136/bmjmed-2025-001886","DOIUrl":"10.1136/bmjmed-2025-001886","url":null,"abstract":"<p><p>Current treatment for pulmonary fibrosis is limited to nintedanib and pirfenidone, which slow but do not halt or reverse the progression of the disease. These treatments are widely used globally. Emerging agents, such as nerandomilast, showed positive results in phase 3 trials and was approved in the US in 2025 for idiopathic pulmonary fibrosis and progressive pulmonary fibrosis, but is not yet licensed for clinical use in the UK. As our understanding of the pathogenesis of pulmonary fibrosis advances, so does the potential to develop treatments that more effectively target underlying mechanisms while being safe and well tolerated. Insights into key pathogenic pathways, including epithelial injury, fibroblast activation, extracellular matrix deposition, B and T cell involvement, and dysregulated cytokine signalling pathways, have enabled various therapeutic targets to be explored. Despite the extensive efforts behind each study, many questions remain unanswered. Negative trials are equally important, in providing insights into how future clinical trials can be better designed and targeted. Meanwhile, positive studies show encouraging results and identify potential treatments, all contributing to the overarching goal of not just slowing, but ultimately reversing, fibrosis.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001886"},"PeriodicalIF":9.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procalcitonin-guided decision and antibiotic treatment duration in late onset sepsis of newborns: multicentre, randomised controlled trial (ProABIS).","authors":"Delphine Mitanchez, Romane Lacoste-Badie, Cyril Flamant, Alain Beuchée, Pierre Tourneux, Mostafa Mokhtari, Pierre-Henri Jarreau, Sophie Tuffet, Laurence Berard, Alexandra Rousseau, Christele Gras-Le Guen","doi":"10.1136/bmjmed-2026-002602","DOIUrl":"10.1136/bmjmed-2026-002602","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether procalcitonin-guided decision making can safely reduce the duration of antibiotic treatment in neonatal late onset sepsis.</p><p><strong>Design: </strong>Prospective multicentre, randomised open label trial.</p><p><strong>Setting: </strong>33 level 3 and level 2B neonatology departments in France.</p><p><strong>Participants: </strong>Newborn babies born after 24 weeks' gestation, of postconceptional age 24-45 weeks and after 4 days of life, weighing more than 700 g, with suspected or proven late onset sepsis, requiring antibiotics for more than 48 hours, and without meningitis, septic shock, and deep-seated infection.</p><p><strong>Interventions: </strong>Participants were randomly assigned to procalcitonin-guided or usual care antibiotic treatment. In the procalcitonin-guided group, procalcitonin concentration was measured at randomisation and then every two days. A non-binding recommendation to discontinue antibiotics was given if the procalcitonin concentration was 0.5 µg/L or lower. In the usual care group, treatment was provided according to local protocols.</p><p><strong>Main outcome measures: </strong>The primary outcome was the duration of antibiotic treatment (under the superiority hypothesis). The key secondary outcome was non-inferiority for mortality (margin 3%) at day 28 after randomisation.</p><p><strong>Results: </strong>Between February 2019 and February 2023, 248 newborns were randomised to the procalcitonin-guided group and 256 to the usual care group. In the intention-to-treat analysis, the median duration of antibiotic treatment was eight days (interquartile range (IQR) 5.0-12.0) in the procalcitonin-guided group versus 10 days (8.0-13.0) in the usual care group (absolute difference between groups -2.0 (IQR -3.8 to -1.0), P<0.001). At day 28, the proportion of death was six of 248 newborns (2.4%) in the procalcitonin-guided group versus 10 of 256 (3.9%) in the usual care group (absolute difference between groups -1.5% (95% confidence interval (CI) -5.0 to 1.8). The proportion of recurrence was seven of 248 (2.8%) newborns in the procalcitonin-guided group versus 10 (3.9%) of 256 in the usual care group (absolute difference between groups -1.1% (95% CI -4.6 to 2.3).</p><p><strong>Conclusion: </strong>In this study population, the use of procalcitonin significantly reduced the duration of antibiotic treatment in neonatal late onset sepsis, without increasing mortality or serious adverse events.</p><p><strong>Trial registration: </strong>NCT03730636.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002602"},"PeriodicalIF":9.3,"publicationDate":"2026-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-operative treatment strategy versus surgery for children with simple appendicitis: non-inferiority randomised controlled trial.","authors":"Paul van Amstel, Said Bachiri, Max Knaapen, Johanna H van der Lee, Rik van Eekelen, Willem A Bemelman, Hester Rippen-Wagner, Taco S Bijlsma, Charlotte F J M Blanken-Peeters, Evert-Jan G Boerma, Anne Loes van den Boom, Frank J C van den Broek, Huib A Cense, Peter van Duijvendijk, Frank P Garssen, Klaas H In 't Hof, Vanessa J Leijdekkers, Maarten A Lijkwan, Gerda W Zijp, Hugo A Heij, Joep P M Derikx, Ernest L W van Heurn, Roel Bakx, Ramon R Gorter","doi":"10.1136/bmjmed-2025-002466","DOIUrl":"10.1136/bmjmed-2025-002466","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare a non-operative treatment strategy with appendectomy for children with simple appendicitis, in terms of complications, avoidance of appendectomy, health related quality of life, and costs, after one year of follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Non-inferiority randomised controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;15 academic or general teaching hospitals, Netherlands, 1 January 2017 to 19 October 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;302 children, aged 7-17 years with imaging confirmed simple appendicitis, excluding those with a faecolith.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Participants were randomised to the non-operative treatment strategy group (n=151) or the appendectomy group (n=151). The non-operative treatment strategy group received 48 hours of intravenous amoxicillin-clavulanic acid and gentamicin, followed by five days of oral amoxicillin-clavulanic acid.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;The primary outcome was the proportion of participants with a complication within one year (non-inferiority margin of 5%). Secondary outcomes were the number of participants not requiring appendectomy, health related quality of life, and costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the intention-to-treat population, 14/151 (9.3%) participants in the non-operative treatment strategy group versus 13/151 (8.6%) in the appendectomy group had a complication during the one year follow-up period (absolute risk difference 0.7%, upper limit of 95% confidence interval (CI) 7.1%). Appendectomy was avoided in 105/151 (69.5%) participants in the non-operative treatment strategy group. No difference was found in health related quality of life between the treatment groups. Costs (both direct and societal) were lower in the non-operative treatment strategy group (mean difference €767 (£668; US$902), 95% CI 320 to 1214 for direct costs and €874, 118 to 1631 for societal costs). In the non-operative treatment strategy group, length of hospital stay was significantly longer (3.3±2.4 &lt;i&gt;v&lt;/i&gt; 1.9±1.2 days, mean difference 1.5, 95% CI 1.1 to 1.9) and more unscheduled healthcare visits occurred. Patient satisfaction measured by the Net Promoter Score was significantly lower in the non-operative treatment strategy group (18.9±4.6% &lt;i&gt;v&lt;/i&gt; 48.0±5.8%, mean difference -29.1, 95% CI-30.8 to -27.4) at the one year follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Non-inferiority of a non-operative treatment strategy for acute simple appendicitis in children could not be proven significantly. Most of the 95% CI was within the 5% non-inferiority margin, however, with a probability of 90.7% that a non-operative treatment strategy resulted in an increase in complications of ≤5%. Absolute risk difference in the proportion of participants with complications was marginal. Surgery was avoided in about 70% of participants in the non-operative treatment strategy group. Health related quality of life was comparable between ","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002466"},"PeriodicalIF":9.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualified prediction system for allograft failure in real world settings: extended validation study.","authors":"Marc Raynaud, Agathe Truchot, Sofia Naser, Olivier Aubert, Gillian Divard, Thibaut Thalamas, Yannis Lombardi, Christophe Legendre, Elodie Bailly, Mathias Buchler, Marta Crespo, Dolores Redondo, Brad C Astor, Didier Mandelbrot, Sandesh Parajuli, Ivana Juric, Nikolina Basic-Jukic, Ilkka Helanterä, Rhys D R Evans, Aruna Sanghera, Maryam Javed, Miklos Z Molnar, Junji Yamauchi, Katalin Fornadi, Kamilla Linhares, Michel Baujard, Kevin J Fowler, Enver Akalin, Gaurav Gupta, Gervacio Soler Pujol, Helio Tedesco-Silva, Babak J Orandi, Maarten Naesens, Klemens Budde, Marcel Naik, Alexandre Hertig, Dany Anglicheau, Nassim Kamar, Dorry L Segev, Carmen Lefaucheur, Alexandre Loupy","doi":"10.1136/bmjmed-2025-002088","DOIUrl":"10.1136/bmjmed-2025-002088","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To perform comprehensive validations of the integrative Box (iBox) system, a prediction model for long term risk of kidney allograft failure, for extension of its context of use in clinical trials as well as for its wider implementation in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Extended validation study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Paris Transplant Group database (comprising kidney recipients with transplantations between 1 January 2005 and 1 January 2014) and European, North American, and South American hospitals (comprising recipients of kidneys transplanted beween 1 January 2000 and 1 January 2022). Patients were followed until 1 November 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;12 683 kidney tranplant recipients from 21 academic centres in Europe, North America, and South America; 4000 patients in the derivation cohort and 8683 in the validation cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Performance of the iBox, including flexible iBox versions in specific clinical contexts (race-free estimated glomerular filtration rate (eGFR) equations (ie, without including race as a factor in the calculation), in specific clinical contexts (initial nephropathy recurrence, BK virus associated nephropathy, and different immunosuppressive strategies), and over-extended follow-up periods. Predictive performance was assessed by discrimination, calibration, overall fit, and clinical utility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;12 683 kidney transplant recipients were included in the study (n=4000 in the derivation cohort and n=8683 in the validation cohorts). Median follow-up time after risk evaluation was 5.78 years (interquartile range (IQR) 3.51-7.00) in the derivation cohort and 4.68 years (2.48-7.00) in the validation cohorts. 549 (13.7%) and 991 (11.4%) patients had graft loss in the derivation and validation cohorts, respectively. All versions of the iBox algorithm maintained good discrimination and overall fit performance in the derivation and validation cohorts (C index range 0.79-0.87, Brier scores 0.08-0.11). Calibration was adequate in some but not all external validation cohorts, with trends toward overestimation or underestimation of predicted risks. Decision curve analysis showed positive and comparable net benefit for all iBox algorithms across decision thresholds up to 40% in the derivation cohort (net benefit 0.07-0.08 at 20% threshold) and validation cohorts (net benefit 0.03-0.11 at 20% threshold). Accounting for the competing risk of death with a functioning graft resulted in similar performance, except for calibration which varied across cohorts, without any model consistently outperforming any other model. The model performed well with different race-free eGFR equations (C index 0.81), in various clinical scenarios, including disease recurrence and BK virus nephropathy, with different immunosuppressive strategies, such as calcineurin inhibitors and mTOR (mechanistic target of rapamyc","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002088"},"PeriodicalIF":9.3,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Characteristics, outcomes, and maternity care experiences of women with children's social care involvement who subsequently died: national cohort study and confidential enquiry.","authors":"","doi":"10.1136/bmjmed-2025-001464corr1","DOIUrl":"10.1136/bmjmed-2025-001464corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjmed-2025-001464.].</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001464corr1"},"PeriodicalIF":9.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: When means and standard deviations are an incomplete summary of a continuous variable: problems, solutions, and utilising the reference ranges to check normality.","authors":"","doi":"10.1136/bmjmed-2025-001796corr1","DOIUrl":"10.1136/bmjmed-2025-001796corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjmed-2025-001796.].</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001796corr1"},"PeriodicalIF":9.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}