BMJ medicine最新文献

{"title":"Developing a new albuminuria-free risk prediction equation for kidney failure in patients with chronic kidney disease: retrospective cohort study.","authors":"Faye Cleary, David Prieto Merino, Rupert Major, Juan Jesus Carrero, Dorothea Nitsch","doi":"10.1136/bmjmed-2025-001950","DOIUrl":"10.1136/bmjmed-2025-001950","url":null,"abstract":"<p><strong>Objective: </strong>To develop new risk prediction equations for kidney failure in patients with chronic kidney disease who do not require data for the urine albumin to creatinine ratio.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Stockholm Creatinine Measurements (SCREAM) database of routinely collected electronic healthcare records in primary and outpatient care from the region of Stockholm, Sweden.</p><p><strong>Participants: </strong>116 158 adults with chronic kidney disease stages 3-4, defined by two estimated glomerular filtration rate (eGFR) results of <60 to ≥15 mL/min/1.73 m², at least 90 days apart, with no intermediate eGFR value ≥60 mL/min/1.73 m², between 1 January 2010 to 31 December 2018.</p><p><strong>Main outcome measure: </strong>Kidney failure, defined as starting kidney replacement therapy, recorded within five years of the index date.</p><p><strong>Results: </strong>Based on temporal split sample validation, development and validation cohorts included 85 012 patients (736 kidney replacement therapy events) and 28 338 patients (114 kidney replacement therapy events), respectively. After Cox regression with automated backwards selection, the final model included 10 predictors (in order of significance): eGFR, age, diabetes, sex, atrial fibrillation, antihypertensive drugs, peripheral artery disease, reduction in eGFR slope, acute kidney injury, and hypertension. Model discrimination was excellent in both the development cohort (C statistic 0.941, 95% confidence interval (CI) 0.932 to 0.951) and validation cohort (C statistic 0.944, 0.923 to 0.965). In 26 229 patients with data for the urine albumin to creatinine ratio, the four variable kidney failure risk equation (KFRE) showed marginal improvement in discrimination over our new equation (C statistic 0.950, 95% CI 0.942 to 0.958 for KFRE <i>v</i> 0.926, 0.915 to 0.936, for the new equation). KFRE under-estimated the risk in the study cohort, however, with an observed-expected event probability ratio of 2.11, suggesting that recalibration is required.</p><p><strong>Conclusions: </strong>The findings of the study indicate that predicting the risk of kidney failure with high accuracy in a general population of patients with chronic kidney disease is possible based on data that are routinely available, without requiring data for the urine albumin to creatinine ratio.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001950"},"PeriodicalIF":9.3,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144365","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":"Outcome specific optimal systolic blood pressure targets in high risk patients, balancing cardiovascular benefits, renal risks, and cancer prevention: meta-analysis of randomised controlled trials.","authors":"Yuanyuan Zhang, Yanjun Zhang, Sisi Yang, Xiaoqin Gan, Yu Huang, Yiwei Zhang, Yiting Wu, Fan Fan Hou, Xianhui Qin","doi":"10.1136/bmjmed-2025-001791","DOIUrl":"10.1136/bmjmed-2025-001791","url":null,"abstract":"<p><strong>Objective: </strong>To directly compare the efficacy and safety of different intensive systolic blood pressure targets (<120 or <130 mm Hg) versus usual care on cardiovascular and renal outcomes.</p><p><strong>Design: </strong>Meta-analysis of randomised controlled trials.</p><p><strong>Data sources: </strong>Web of Science and Medline, from inception to 20 May 2025.</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials comparing intensive versus usual systolic blood pressure targets. Studies reported cardiovascular disease or kidney outcomes, or both.</p><p><strong>Results: </strong>The study included 18 randomised controlled trials of 60 629 participants. Intensive control of systolic blood pressure significantly reduced the risk of major adverse cardiovascular events (relative risk 0.82, 95% confidence interval (CI) 0.78 to 0.87, P<0.001), including myocardial infarction, stroke, heart failure, and death from cardiovascular disease. Systolic blood pressure targets of <120 mm Hg and <130 mm Hg provided comparable cardiovascular protection. Intensive control of systolic blood pressure increased the risk of the composite chronic kidney disease outcome (relative risk 1.40, 95% CI 1.01 to 1.94, P=0.046), but with a likely higher risk for the target of <120 mm Hg. A systolic blood pressure target of <120 mm Hg also reduced the risk of albuminuria, but increased the risk of bradycardia and hypotension.</p><p><strong>Conclusions: </strong>Intensive control of systolic blood pressure provided substantial cardiovascular benefits but increased the risk of renal adverse events. A systolic blood pressure target of <130 mm Hg had a similar degree of cardiovascular protection as <120 mm Hg with a more favourable renal safety profile, supporting a personalised risk based approach to treatment intensification.</p><p><strong>Trial registration: </strong>PROSPERO CRD42025629962.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001791"},"PeriodicalIF":9.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115278","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 timing and eating duration of time restricted eating on metabolic outcomes: systematic review and network meta-analysis.","authors":"Yu-En Chen, Hui-Li Tsai, Yu-Kang Tu, Ling-Wei Chen","doi":"10.1136/bmjmed-2024-001071","DOIUrl":"10.1136/bmjmed-2024-001071","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of overall time restricted eating on metabolic health outcomes, and to identify the optimal types of time restricted eating in terms of timing and duration of eating.</p><p><strong>Design: </strong>Systematic review and network meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Embase, and the Cochrane databases, from inception to 3 January 2023.</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials investigating the relation between time restricted eating (intervention period >one month) and metabolic health outcomes in humans.</p><p><strong>Results: </strong>41 randomised controlled trials of 2287 participants were included. Time restricted eating was categorised according to time of eating (early, mid-, late, and self-selected; last meal eaten before 1700, between 1700 and 1900, after 1900, or chosen by participant, respectively) and specific duration or window of eating each day (<8 hours, eight hours, and >8 hours). Compared with usual diets, overall time restricted eating significantly improved body weight, body mass index, fat mass, waist circumference, systolic blood pressure, and levels of fasting blood glucose, fasting insulin, and triglycerides. For different time restricted eating subtypes, early time restricted eating consistently showed higher P score rankings for anthropometric measurements (P score range 0.62-0.86, except for fat free mass-lean mass; a score closer to one indicating more favourable subtype) and glycaemic parameters (P score range 0.66-0.99). Compared with late time restricted eating, early time restricted eating significantly reduced body weight (mean difference -1.15 kg, 95% confidence interval -1.86 to -0.45) and fasting insulin concentrations (-3.32 μIU/ml, -5.36 to -1.28; 1 μIU/mL=6.95 pmol/L) and the certainty of the evidence was high. P value rankings for eating duration were inconsistent. Assessment of risk of bias, based on the risk of bias 2 tool, found that most of the included studies (90%) were rated as low risk of bias. In the confidence in network meta-analysis (CINeMA) assessment, about 60.2% of the network evidence showed moderate to high certainty. Inconsistency was generally low (I²<75% for 87% of associations).</p><p><strong>Conclusions: </strong>Time restricted eating overall improved metabolic health outcomes compared with usual diets, and early time restricted eating was superior to late time restricted eating. The association between duration of eating and metabolic health outcomes was inconsistent.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42022302737.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001071"},"PeriodicalIF":9.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047535","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":"Test accuracy of glomerular filtration rate estimation with creatinine and cystatin C in adults with moderate chronic kidney disease: prospective cohort study.","authors":"Edmund J Lamb, Jonathan Barratt, Elizabeth Ann Brettell, Paul Cockwell, R Neil Dalton, Jonathan James Deeks, Gillian Eaglestone, Philip Kalra, Kamlesh Khunti, Fiona C Loud, Phoebe Amelie Mead, Ryan Ottridge, Tracy Pellatt-Higgins, Aisling Potter, Ceri Rowe, Katie Scandrett, Claire Sharpe, Bethany Shinkins, Alice J Sitch, Alison Smith, Paul E Stevens, Andrew J Sutton, Maarten Taal","doi":"10.1136/bmjmed-2025-001827","DOIUrl":"10.1136/bmjmed-2025-001827","url":null,"abstract":"<p><strong>Objective: </strong>To study the performance of two contemporary sets of estimating equations for glomerular filtration rate, published by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) and EKFC (European Kidney Function Consortium) that include one (creatinine or cystatin C only) and combined (creatinine and cystatin C) biomarkers, to assess their accuracy in a population with moderate chronic kidney disease.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Primary, secondary, and tertiary care in six centres in England. Participants were recruited from April 2014 to January 2017.</p><p><strong>Participants: </strong>1167 adults, aged ≥18 years, with moderate chronic kidney disease (estimated glomerular filtration rate 30-59 mL/min/1.73 m² sustained over at least three months before recruitment).</p><p><strong>Main outcome measures: </strong>Accuracy of estimating equations CKD-EPI_creatinine, CKD-EPI_cystatin, CKD-EPI_{creatinine-cystatin}, EKFC_creatinine, EKFC_cystatin, and EKFC_{creatinine-cystatin} compared with measured glomerular filtration rate (iohexol clearance). Remodelled 2021 versions of the CKD-EPI equations were also studied. Accuracy was expressed as P30 (percentage of estimates within 30% of measured glomerular filtration rate).</p><p><strong>Results: </strong>Median age was 67.5 years, 58.3% of patients were men, 86.9% were white participants, and 27.8% had diabetes. Median measured glomerular filtration rate was 47.0 mL/min/1.73 m²; 57.0% of participants had albuminuria. Test calibration critically affected measurement of cystatin C. After recalibration of cystatin C, P30 values were 90.2% (CKD-EPI_creatinine), 89.5% (CKD-EPI_cystatin), 94.9% (CKD-EPI_{creatinine-cystatin}), 88.0% (CKD-EPI(2021)_creatinine), 94.9% (CKD-EPI(2021)_{creatinine-cystatin}), 89.4% (EKFC_creatinine), 91.0% (EKFC_cystatin), and 94.9% (EKFC_{creatinine-cystatin}). Creatinine based equations showed varying bias depending on the glomerular filtration rate level; inclusion of cystatin C in the equations improved this effect. Differences in accuracy in age, sex, and glomerular filtration rate level subgroups varied by equation. Equations combining creatinine and cystatin performed equally across age, sex, diabetes status, albuminuria status, and body mass index categories.</p><p><strong>Conclusions: </strong>The CKD-EPI_creatinine equation had acceptable accuracy in a white population in England with moderate chronic kidney disease. Combined dual biomarker equations showed higher accuracy than the CKD-EPI_creatinine equation and their equivalent creatinine only equations. Further research is needed to determine the most accurate equation to use in people of black and South Asian origin living in England.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001827"},"PeriodicalIF":9.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047487","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":"Physical activity types, variety, and mortality: results from two prospective cohort studies.","authors":"Han Han, Jinbo Hu, Dong Hoon Lee, Yiwen Zhang, Edward Giovannucci, Meir J Stampfer, Frank B Hu, Yang Hu, Qi Sun","doi":"10.1136/bmjmed-2025-001513","DOIUrl":"10.1136/bmjmed-2025-001513","url":null,"abstract":"<p><strong>Objective: </strong>To examine the associations of long term engagement in individual physical activities and physical activity variety with the risk of death.</p><p><strong>Design: </strong>Prospective cohort studies.</p><p><strong>Setting: </strong>Nurses' Health Study (1986-2018) and Health Professionals Follow-Up Study (1986-2020).</p><p><strong>Participants: </strong>70 725 women and 40 742 men who were free of diabetes, cardiovascular disease, cancer, respiratory disease, or neurological disease and had complete physical activity information at baseline (leisure time physical activity was biennially updated using validated questionnaires during follow-up; the variety of physical activity was measured as the total number of individual physical activities in which participants consistently engaged).</p><p><strong>Main outcome measures: </strong>All cause and cause specific mortality.</p><p><strong>Results: </strong>During 2 431 318 person years of follow-up, 38 847 deaths were recorded, with 9901 from cardiovascular disease, 10 719 from cancer, and 3159 from respiratory disease. Total physical activity and most individual physical activities, except for swimming, were associated with lower mortality with non-linear dose-response relations. The pooled multivariable adjusted hazard ratios for all cause mortality in the highest categories of physical activity levels, compared with the lowest, were 0.83 (95% confidence interval 0.80 to 0.85) for walking, 0.89 (0.85 to 0.94) for jogging, 0.87 (0.80 to 0.93) for running, 0.96 (0.93 to 0.99) for bicycling, 1.01 (0.97 to 1.05) for swimming, 0.85 (0.80 to 0.89) for tennis or squash, 0.90 (0.87 to 0.93) for climbing stairs, 0.86 (0.84 to 0.89) for rowing or callisthenics, and 0.87 (0.82 to 0.91) for weight training or resistance exercises. Higher physical activity variety was associated with lower mortality. After adjustment for total physical activity levels, participants in the group with the highest physical activity variety score (group 5), compared with those in the lowest group (group 1), had a 19% lower all cause mortality and 13-41% lower mortality from cardiovascular disease, cancer, respiratory disease, and other causes (all P for trend <0.001).</p><p><strong>Conclusions: </strong>Habitual engagement in most types of physical activity was associated with lower mortality. The variety of physical activity was inversely associated with mortality, independent of total physical activity levels. Overall, these data support the notion that long term engagement in multiple types of physical activity may help extend the lifespan.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e001513"},"PeriodicalIF":9.3,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031850","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":"Costs and benefits of early access to new cancer drugs through the US Food and Drug Administration's accelerated approval pathway: retrospective observational study and economic evaluation.","authors":"Huseyin Naci, Mahnum Shahzad, Peter Murphy, Yichen Zhang, Rebecca Costa, Joseph S Ross, Anita K Wagner","doi":"10.1136/bmjmed-2025-001934","DOIUrl":"10.1136/bmjmed-2025-001934","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the survival gains and additional Medicare spending associated with early access to new cancer drugs granted accelerated approval by the US Food and Drug Administration (FDA), compared with access to cancer drugs following completion of confirmatory trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective observational study and economic evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;US Medicare programme, which provides health insurance for adults aged 65 years and older.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Medicare beneficiaries who received new cancer drug indications from the time of FDA accelerated approval to conversion to regular approval, withdrawal from the market, or 31 December 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Use of cancer drugs for indications that initially received FDA accelerated approval between 1 January 2012 and 31 December 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcomes were life year gains and additional Medicare spending associated with cancer drug indications that initially received FDA accelerated approval. Each indications's overall survival benefit to patients, if present, was determined, and a partitioned survival model was developed to estimate the life year gains and incremental Medicare spending attributable to early drug access. Beneficiaries who received accelerated approval indications were followed for survival and spending outcomes until 31 December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;An estimated 178 708 Medicare beneficiaries received access to 90 new cancer drug indications from the time of accelerated approval to conversion to regular approval, withdrawal from the market, or 31 December 2020. Seventeen per cent of beneficiaries (n=30 374) received drugs for indications that were ultimately withdrawn, 5574 (3.1%) received drugs for indications that remained under accelerated approval, and 142 760 (79.9%) received drugs for indications that were subsequently converted to regular approval. Overall, 80 885 (45.3%) beneficiaries received drugs for indications that provided an overall survival benefit to patients. Between 2012 and 2022, use of these drug indications was associated with an estimated 76 164 life years gained. Only three accelerated approvals (nivolumab to treat melanoma, pembrolizumab to treat non-small cell lung cancer, and pemetrexed to treat non-small cell lung cancer) accounted for 68.4% (n=52 107 years) of the total life year gains. The estimated additional cost of early access to these drugs to Medicare was $20.1bn (£15.4bn; €17.4bn) corresponding to a mean spending of $263 371 (95% confidence interval $180 139 to $373 884) per life year gained. Additional mean Medicare spending per life year gained ranged from $25 947 ($18 174 to $39 829) for melanoma indications to $4.5m ($3.1m to $12.2m) for breast cancer indications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study examined the trade-off between the benefits of earli","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001934"},"PeriodicalIF":10.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12718571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812453","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":"Opioid prescribing to people on orthopaedic waiting lists during the covid-19 pandemic in England: retrospective cohort study using linked electronic health record data in OpenSAFELY-TPP.","authors":"Rose Higgins, Rebecca M Smith, Iain Dillingham, Jane Quinlan, Victoria Speed, Helen J Curtis, Christopher Wood, Milan Wiedemann, Meghna Jani, Sebastian C J Bacon, Amir Mehrkar, Ben Goldacre, OpenSAFELY Collaborative, Brian MacKenna, Andrea L Schaffer","doi":"10.1136/bmjmed-2025-001743","DOIUrl":"10.1136/bmjmed-2025-001743","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the changes in opioid prescribing over time to a population with high rates of opioid use to understand the impact of longer elective wait times during the covid-19 pandemic.</p><p><strong>Design: </strong>With the approval of NHS England, a retrospective cohort study using linked electronic health record data in OpenSAFELY-TPP.</p><p><strong>Setting: </strong>Primary and secondary care electronic health records of people registered at general practices in England that use TPP SystmOne software, covering about 43% of the total registered population in England, linked to data from the Waiting List Minimum Dataset (WLMDS) within the OpenSAFELY-TPP platform, which is part of the NHS England OpenSAFELY covid-19 service.</p><p><strong>Participants: </strong>63 850 eligible patients on the waiting list for elective trauma procedures or orthopaedic procedures whose wait ended in admission between May 2021 and April 2022.</p><p><strong>Main outcome measures: </strong>Opioid prescribing to eligible patients before referral to the waiting list, while waiting for treatment, and after discharge from treatment. Opioids were classified based on their strength (weak, moderate, or strong opioids) and duration of action (immediate release <i>v</i> modified release opioids).</p><p><strong>Results: </strong>Of 63 850 people on elective trauma or orthopaedic waiting lists whose wait ended during the study period (median age 61 years, 54.6% female), 20.5% waited for more than 52 weeks to be admitted. In the three months before their waiting list referral date, 9890 (15.5%) participants had three or more opioid prescriptions, and 3790 (5.9%) were prescribed a strong opioid. Weekly opioid prescribing rates per 100 people on the waiting list were stable over time, with prescription rates peaking immediately after treatment and plateauing about three months after treatment. Comparing the three month period before the waiting list referral date to the period four to six months after the waiting list end date, changes in the proportion of people with three or more prescriptions for an opioid during that period were -1.6% (95% confidence interval -2.2% to -1.0%) for people on the waiting list for 18 weeks or less, -1.1% (-1.7% to -0.5%) for people waiting for 19-52 weeks, and -0.5% (-1.4% to 0.4%) for people waiting for more than 52 weeks.</p><p><strong>Conclusions: </strong>In this study, one in five people who received treatment for an elective orthopaedic procedure between May 2021 and April 2022 waited for more than one year. Nearly one in seven people were prescribed opioids long term before their referral date to the waiting list, and only small reductions in long term opioid prescribing were observed after a patient's procedure, regardless of length of time spent on the waiting list.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001743"},"PeriodicalIF":10.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758504","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":"Ethnicity and sub-Saharan African representation in the emergency development of covid-19 vaccines.","authors":"Alice E Taylor, Gabriella Millard, Alice Packham, Jean Claude Semuto Ngabonziza, Claude Mambo Muvunyi, Christopher A Green","doi":"10.1136/bmjmed-2023-000780","DOIUrl":"10.1136/bmjmed-2023-000780","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e000780"},"PeriodicalIF":10.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716604","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":"Reproducibility of meta-analytic results in systematic reviews of interventions: meta-research study.","authors":"Phi-Yen Nguyen, Joanne E McKenzie, Zainab Alqaidoom, Daniel G Hamilton, David Moher, Matthew J Page","doi":"10.1136/bmjmed-2025-002024","DOIUrl":"10.1136/bmjmed-2025-002024","url":null,"abstract":"<p><strong>Objective: </strong>To determine how often meta-analyses of effects of interventions are reproducible.</p><p><strong>Design: </strong>Meta-research study.</p><p><strong>Setting: </strong>Systematic reviews with meta-analyses of the effects of health, social, behavioural, or educational interventions indexed in five databases (PubMed, Science Citation Index, Social Sciences Citation Index, Scopus, and Education Collection), 2 November to 2 December 2020.</p><p><strong>Population: </strong>296 reviews meeting the inclusion criteria formed the overall sample of the study. 175/296 (59%) reviews included a forest plot from Review Manager and were considered inherently reproducible. The remaining 121/296 (41%) reviews constituted the reproduction sample.</p><p><strong>Main outcome measures: </strong>Original review authors were contacted to obtain meta-analysis data files, and analytic code used to generate the first reported (index) meta-analysis; if not provided, the necessary data and statistical details of the meta-analysis methods were extracted from the review. Two investigators independently reproduced each review's first reported meta-analysis using the original computational steps and analytic code. Meta-analyses were classified as fully reproducible if the difference between the original and reproduced summary estimates and 95% confidence interval (CI) widths was less than 10%. Differences in meta-analysis results were classified as meaningful if there was a change in direction of the summary effect estimate or if the 95% CI included the null, which may alter the interpretation of the results.</p><p><strong>Results: </strong>22 authors provided data files or analytic code, or both. 104 meta-analyses (86%) were fully reproducible, seven (6%) were not fully reproducible, and 10 (8%) had insufficient data available to attempt reproduction. No meaningful differences were found in the reproduced meta-analytic results that might alter their interpretation (eg, changes in the direction of summary effect estimate or if the 95% CI included the null).</p><p><strong>Conclusions: </strong>The findings of the study suggested that the results of meta-analyses could be reliably replicated if the original data or analytic code, or both, could be obtained, or if the necessary data were accessible in the review. Few systematic reviewers responded to requests to share data or code. Making data files and analytic code publicly available will facilitate future investigations of reproducibility.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e002024"},"PeriodicalIF":10.0,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716652","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":"Household size and its role in the association between multimorbidity and health and social care outcomes in older adults in Wales: retrospective cohort study.","authors":"Clare MacRae, Stewart W Mercer, Rhiannon K Owen, Rose Penfold, Stella Arakelyan, Chris Dibben, Jamie Pearce, Andrew Lawson, Nazir I Lone, Karin Modig, Bruce Guthrie","doi":"10.1136/bmjmed-2024-001317","DOIUrl":"10.1136/bmjmed-2024-001317","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine how the risk of unplanned admission to hospital and transitioning to live in a care home by number of long term conditions varies by household size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Wales Census 2011 household data, linked to the Welsh Secure Anonymised Information Linkage (SAIL) Databank, 27 March 2011 to 26 March 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;391 686 residents of Wales recorded in the Wales Census on 27 March 2011, aged ≥65 years, living in Welsh households of one to six residents, registered with a general practitioner contributing data to the SAIL Databank.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Time to the first unplanned hospital admission and time to transition from living at home in the community to living in a care home, for individuals with 0-1, 2-3, or ≥4 long term conditions living alone or in households with two residents or three or more residents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 391 686 individuals included, 36.8% lived alone, 54.0% lived in households of two, and 9.2% lived in households with three or more people. The number of long term conditions was strongly associated with the risk of hospital admission and transition to a care home. In those living in two person households, participants with ≥4 long term conditions versus those with 0-1 long term conditions had a higher risk of unplanned hospital admissions (adjusted hazard ratio 2.51, 95% confidence interval (CI) 2.47 to 2.55; crude event rate 180.1 (95% CI 178.5 to 181.7) &lt;i&gt;v&lt;/i&gt; 54.8 (53.9 to 55.7) per 1000 person years) and of transitioning to live in a care home (adjusted hazard ratio 2.57, 2.49 to 2.66; crude event rate 7.2 (6.9 to 7.5) &lt;i&gt;v&lt;/i&gt; 1.40 (1.3 to 1.5) per 1000 person years). Household size was associated with an increased risk of both outcomes but more strongly with transition to a care home than unplanned hospital admission. The risk of unplanned hospital admissions was higher for people with 0-1 long term conditions who lived alone than for those who lived in a two person household (adjusted hazard ratio 1.19, 95% CI 1.17 to 1.22; crude event rate 74.9 (95% CI 73.4 to 76.4) &lt;i&gt;v&lt;/i&gt; 54.8 (53.9 to 55.7) per 1000 person years) and for transitioning to live in a care home (adjusted hazard ratio 1.48, 1.42 to 1.54; crude event rate 5.4 (5.0 to 5.8) &lt;i&gt;v&lt;/i&gt; 1.4 (1.3 to 1.5) per 1000 person years). The association between the number of long term conditions and both outcomes varied by household size. Individuals with 0-1 long term conditions and living alone showed a higher risk of transitioning to live in a care home than individuals with 2-3 long term conditions living in two person households.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this study, the number of long term conditions was strongly associated with the risk of hospital admission and transition to living in a care home, and this association was less pronounced among those livi","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001317"},"PeriodicalIF":10.0,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716617","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}