BMJ Evidence-Based Medicine最新文献

{"title":"Mind the gaps between patient experiences and their expectations about outcomes.","authors":"Victoria A Shaffer, Brian J Zikmund-Fisher, Laura D Scherer","doi":"10.1136/bmjebm-2025-113728","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-113728","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readers' attention to shorter versus longer abstracts of systematic reviews: a randomised controlled trial.","authors":"Jasmin Helbach, Kathrin Wandscher, Dawid Pieper, Falk Hoffmann","doi":"10.1136/bmjebm-2024-113613","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113613","url":null,"abstract":"<p><strong>Objectives: </strong>First, investigate whether a long compared with a short abstract decreases readers' attention. Second, investigate differences regarding perceptions of informativeness, accuracy, attractiveness and conciseness.</p><p><strong>Design: </strong>Two-arm, single-blinded, parallel-group, superiority randomised controlled trial with 1:1 allocation.</p><p><strong>Setting/participants: </strong>Researchers worldwide who indexed any type of systematic review in PubMed with an English abstract between 1 January 2024 and 26 March 2024.</p><p><strong>Interventions: </strong>Researchers were randomly assigned to two groups. Both groups received the same cover letter by email with a link to our survey, which was assigned to either the short (277 words) or long abstract (771 words) of the same systematic review published in two different journals.</p><p><strong>Main outcome measures: </strong>Primary outcome was the proportion of trial participation after reading the abstract, indicating readers' attention. Secondary outcomes were researchers' perceptions of four indicators of a well-written abstract (informativeness, accuracy, attractiveness, conciseness), and general abstract characteristics.</p><p><strong>Results: </strong>A total of 5397 authors were randomly assigned to the short (n=2691) or long abstract (n=2706). Trial participation did not differ between groups (37.8% vs 35.0%; p=0.1935). While the short abstract was considered more attractive (60.5% vs 46.6%; p=0.0034) and concise (82.3% vs 37.9%; p<0.0001), the length had no impact on its informativeness (85.5% vs 91.2%; p=0.0594) and accuracy (80.2% vs 86.3%; p=0.0868). Regarding general abstract characteristics, 76.0% preferred a maximum length of 250-300 words, nearly all a structured format and about half supported reporting funding and registration information.</p><p><strong>Conclusions: </strong>Abstract length had no impact on readers' attention, but short abstracts were considered more attractive and concise. Guidelines like PRISMA-A should recommend a range of 250-300 words for abstracts, allowing authors to include key information while prioritising clarity and precision. With authors considering information on funding and registration as important, journals should update their author guidelines to include these by default.</p><p><strong>Trial registration number: </strong>NCT06525805.<b>Funding</b>None.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Over 1000 terms have been used to describe evidence synthesis: a scoping review.","authors":"Danielle Pollock, Sabira Hasanoff, Timothy Hugh Barker, Barbara Clyne, Andrea C Tricco, Andrew Booth, Christina Godfrey, Hanan Khalil, Romy Menghao Jia, Petek-Eylul Taneri, K M Saif-Ur-Rahman, Tom Conway, Menelaos Konstantinidis, Catherine Stratton, Deborah Edwards, Lyndsay Alexander, Judith Carrier, Nahal Habibi, Marco Zaccagnini, Cindy Stern, Chelsea Valenzuela, Carrie Price, Jennifer C Stone, Edoardo Aromataris, Zoe Jordan, Mafalda Dias, Grace McBride, Raju Kanukula, Holger J Schuenemann, Reem A Mustafa, Alan Pearson, Miloslav Klugar, Maria Ximena Rojas, Pablo Alonso-Coello, Paul Whaley, Miranda Langendam, Tracy Merlin, Sharon Straus, Sandeep Moola, Brian S Alper, Zachary Munn","doi":"10.1136/bmjebm-2024-113391","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113391","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To inform the development of an evidence synthesis taxonomy, we aimed to identify and examine all classification systems, typologies or taxonomies that have been proposed for evidence synthesis methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Scoping review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This review followed JBI (previously Joanna Briggs Institute) scoping review methodology and was reported according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Resources that investigated typologies, taxonomies, classification systems and compendia for evidence synthesis within any field were eligible for inclusion. A comprehensive search across MEDLINE (Ovid), Embase (OVID), CINAHL with Full-Text (EBSCO), ERIC (EBSCO), Scopus, Compendex (Elsevier) and JSTOR was performed on 28 April 2022. This was supplemented by citation searching of key articles, contact with experts, targeted searching of organisational websites and additional grey literature searching. Documents were extracted by one reviewer and extractions verified by another reviewer. Data were analysed using frequency counts and a basic qualitative content analysis approach. Results are presented using bar charts, word clouds and narrative summary.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 15 634 titles and abstracts screened, and 703 full texts assessed for eligibility. Ultimately, 446 documents were included, and 49 formal classification systems identified, with the remaining documents presenting structured lists, simple listings or general discussions. Included documents were mostly not field-specific (n=242) or aligned to clinical sciences (n=83); however, public health, education, information technology, law and engineering were also represented. Documents (n=148) mostly included two to three evidence synthesis types, while 22 documents mentioned over 20 types of evidence synthesis. We identified 1010 unique terms to describe a type of evidence synthesis; of these, 742 terms were only mentioned once. Facets that could usefully distinguish (ie, similarities and differences or characteristics) between evidence synthesis approaches were categorised based on similarity into 15 overarching dimensions. These dimensions include review question and foci of interest, discipline/field, perspective, coverage, eligibility criteria, review purpose, methodological principles, theoretical underpinnings/philosophical perspective, resource considerations, compatibility with heterogeneity, sequence planning, analytical synthesis techniques, intended product/output, intended audience and intended impact or influence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This scoping review identified numerous unique terms to describe evidence synthesis approaches and many diverse ways to distinguish or categorise review types. These results suggest a need for the evidence synthesis community to organise, categorise and harmonise evidence synth","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effects of early physical interventions on preventing intensive care unit-acquired weakness: a systematic review and component network meta-analysis.","authors":"Kai-Mei Chang, Yu-Kang Tu, Chia-Rung Wu, Kath Peters, Lucie Ramjan, Wen-Hsuan Hou, Sen-Kuang Hou, Nguyen Thi Phuc, Hsiao-Yean Chiu","doi":"10.1136/bmjebm-2024-113476","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113476","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effects of early physical interventions on the prevention of intensive care unit-acquired weakness (ICUAW) and the improvement of relevant clinical outcomes in patients with critical illness.</p><p><strong>Methods: </strong>We systematically searched the Web of Science, PubMed, Embase and the Cochrane Central Register of Controlled Trials from their inception until 20 August 2024, to identify randomised controlled trials (RCTs) enrolling patients ≥18 years old and implementing early physical intervention that commenced at any time point during mechanical ventilation (MV) use or within 7 days after intensive care unit (ICU) admission for review. We synthesised data using a random-effects model and analysed through network meta-analysis (NMA) and component network meta-analysis (CNMA).</p><p><strong>Main outcome measures: </strong>Primary outcome is the incidence of ICUAW. Secondary outcomes included Medical Research Council sum score, length of stay in the ICU or hospital, duration of MV and mortality rates in the ICU or hospital.</p><p><strong>Results: </strong>Our analyses included 63 RCTs involving 24 treatments and eight components. The NMA results revealed systematic early mobilisation (SEM) combined with neuromuscular electrical stimulation (NMES), SEM alone and NMES alone may lead to a moderate to large reduction in the incidence of ICUAW (odds ratios [ORs]=0.03, 0.09 and 0.12, 95% confidence intervals [CIs]=0.00 to 0.42, 0.01 to 0.97 and 0.03 to 0.44, respectively) and improved relevant clinical outcomes compared with routine care. The CNMA results further indicated that SEM (OR=0.14, 95% CI=0.02 to 0.83) and NMES (OR=0.22, 95% CI=0.09 to 0.52) effectively mitigated the ICUAW incidence.</p><p><strong>Conclusions: </strong>SEM and NMES are optimal interventions for preventing ICUAW. Healthcare providers in ICUs should implement early mobilisation with structured protocols and patient assessments or apply NMES to specific muscle groups to prevent ICUAW in critically ill patients and improve relevant clinical outcomes.</p><p><strong>Prospero registration number: </strong>CRD42024581173.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of evidence on overall survival benefits of cancer drugs included on the national reimbursement drug list of China, 2005-2022: an observational study.","authors":"Yichen Zhang, Huangqianyu Li, Jinyu Chen, Huseyin Naci, Anita K Wagner, Luwen Shi, Xiaodong Guan","doi":"10.1136/bmjebm-2025-113722","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-113722","url":null,"abstract":"<p><strong>Objective: </strong>To assess evidence of overall survival (OS) benefits of cancer drugs listed in China's National Reimbursement Drug List (NRDL), the guiding standard for public insurance coverage of drugs and characterise the evolution of survival evidence after NRDL inclusion.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>China's NRDL and journal publications.</p><p><strong>Participants: </strong>Adult cancer drug indications approved in China from 1 January 2005 to 30 June 2022.</p><p><strong>Main outcome measures: </strong>The primary outcome was the availability of OS benefit evidence at the time of initial NRDL listing, defined as a statistically significant survival gain over the control arm in pivotal clinical trials. The secondary outcome was the availability of evidence on clinical benefits after NRDL inclusion as of 31 December 2023, measured by OS and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) version 1.1. ESMO-MCBS scores A to B in the curative setting or 4 or 5 in the non-curative setting were considered a substantial clinical benefit.</p><p><strong>Results: </strong>By 30 June 2022, 72.6% (175/241) of cancer indications approved in China were included in the NRDL. The median time interval between marketing authorisation and NRDL inclusion decreased from 9.4 years in 2005-2010 to 4.1 years in 2011-2016, and 1.1 years in 2017-2022. 62 (35.4%) and 4 (2.3%) indications had documented OS benefits at the time of NRDL assessment or after, respectively. The median survival benefit was 3.9 months. Of the 109 indications without documented OS benefits by the end of the observation, 21 (19.3%) had substantial clinical benefits as measured by the ESMO-MCBS.</p><p><strong>Conclusions and relevance: </strong>The time interval from regulatory approval to NRDL listing in China decreased over time. However, more than half of cancer drug indications listed for public insurance reimbursement did not have confirmed survival gain or substantial clinical benefits at the time of NRDL inclusion or after. Payers should give sufficient consideration to clinical benefit evidence when making reimbursement and disinvestment decisions to avoid wasteful spending of public health insurance funds.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-driven speech biomarkers for disease diagnosis and monitoring: a systematic review and meta-analysis.","authors":"Yi Yang, Xiaoyan Zhao, Peng Zhao, Dire Ying, Junyu Wang, Yihe Jiang, Qiaoqin Wan","doi":"10.1136/bmjebm-2025-113759","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-113759","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to comprehensively review the literature on the use of speech biomarkers in disease diagnosis and monitoring, focusing on recording protocols, speech tasks, speech features and processing algorithms.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>We conducted a search of six databases: PubMed, Embase, Scopus, Web of Science, PsycINFO and IEEE Xplore, covering studies published from database inception to May 2024.</p><p><strong>Main outcome measures: </strong>The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and the Quality Assessment of Prognostic Accuracy Studies (QUAPAS). Pooled sensitivity and specificity were calculated using a random-effects model. Subgroup analyses examined potential sources of heterogeneity, such as disease type, language, speech tasks, features and algorithms.</p><p><strong>Results: </strong>A total of 96 studies were included, with 83 adopting a cross-sectional design and 50 having sample sizes of fewer than 100 participants. Assessment with QUADAS-2 and QUAPAS revealed that most included studies exhibited a high risk of bias in patient selection and index test domains, while concerns regarding applicability were generally low across studies. These studies covered 20 different diseases, with cognitive disorders, depression and Parkinson's disease being the most frequently studied. The pooled sensitivity and specificity for diagnostic models were 0.80 (95% CI 0.74 to 0.86) and 0.77 (95% CI 0.69 to 0.84) for psychiatric disorders (11 studies, n=2577); 0.85 (95% CI 0.83 to 0.88) and 0.83 (95% CI 0.79 to 0.86) for cognitive disorders (27 studies, n=2068); and 0.81 (95% CI 0.76 to 0.85) and 0.83 (95% CI 0.78 to 0.88) for movement disorders (20 studies, n=852). Further subgroup analyses identified recording device, language, speech task, speech features and algorithm selection as significant contributors to heterogeneity.</p><p><strong>Conclusions: </strong>This review and meta-analysis of 96 studies highlights the influence of devices, environments, languages, tasks, features and algorithms on speech model performance across diseases. While speech biomarkers show promise for screening and monitoring-particularly via smartphones-the high risk of bias in many studies, especially in patient selection and index test interpretation, limits the strength of current evidence. Future large-scale, prospective studies are needed to validate generalisability and support clinical implementation.</p><p><strong>Prospero registration number: </strong>CRD42024551962.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tramadol versus placebo for chronic pain: a systematic review with meta-analysis and trial sequential analysis.","authors":"Jehad Ahmad Barakji, Mathias Maagaard, Johanne Juul Petersen, Yousef Ahmad Barakji, Emil Ørskov Ipsen, Christian Gluud, Ole Mathiesen, Janus Christian Jakobsen","doi":"10.1136/bmjebm-2025-114101","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114101","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of our study was to assess the benefits and harms of tramadol vs placebo in adults with chronic pain.</p><p><strong>Design: </strong>The research method was a systematic review of randomised clinical trials with meta-analysis. The review followed the Trial Sequential Analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Data sources: </strong>The Cochrane Library, MEDLINE, Embase, Science Citation Index and BIOSIS were searched for trials published from inception to 6 February 2025.</p><p><strong>Eligibility criteria for selecting studies: </strong>Studies were eligible for inclusion if they were published and unpublished randomised clinical trials comparing tramadol vs placebo in adults with any type of chronic pain. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.</p><p><strong>Main outcome measures: </strong>The main outcome measures were pain level, adverse events, quality of life, dependence, abuse and depressive symptoms.</p><p><strong>Results: </strong>We included 19 randomised placebo-controlled clinical trials enrolling 6506 participants. All outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale (NRS) -0.93 points; 97.5% CI -1.26 to -0.60; p<0.0001; low certainty of evidence). However, the effect size was below our predefined minimal important difference of 1.0 point on NRS. Beta binomial regression showed evidence of a harmful effect of tramadol on serious adverse events (OR 2.13; 97.5% CI 1.29 to 3.51; p=0.001; moderate certainty of evidence), mainly driven by a higher proportion of cardiac events and neoplasms. It was not possible to conduct a meta-analysis of the quality of life due to a lack of data. Meta-analysis and Trial Sequential Analysis showed that tramadol increased the risk of several non-serious adverse events including nausea (number needed to harm (NNH) 7), dizziness (NNH 8), constipation (NNH 9), and somnolence (NNH 13) (all very low certainty of evidence).</p><p><strong>Conclusion: </strong>Tramadol may have a slight effect on reducing chronic pain levels (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing misleading medical information on social media: a scoping review of current interventions.","authors":"Emma Grundtvig Gram, Ray Moynihan, Tessa Copp, Patti Shih, Loai Albarqouni, Elie Akl, Courtney Smith, Leah Hardiman, Brooke Nickel","doi":"10.1136/bmjebm-2025-113704","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-113704","url":null,"abstract":"<p><strong>Background: </strong>Misleading information about medical products on social media may cause overuse.</p><p><strong>Objectives: </strong>Explore interventions targeting the problem of misleading medical information and marketing on social media, with a focus on preventing medical overuse including overdiagnosis.</p><p><strong>Eligibility criteria: </strong>We included peer-reviewed studies with original data on an intervention targeting misleading medical information on social media and governmental/institutional responses with and without evaluation. We excluded responses relating to COVID-19.</p><p><strong>Sources of evidence: </strong>four electronic databases: MEDLINE/PubMed, PsycINFO, Academic Search Complete and Web of Science, and searches of grey literature on Google and Google Scholar. Search date: 9 June 2025.</p><p><strong>Data charting: </strong>We used prespecified data forms populated in duplicate by two reviewers.</p><p><strong>Results: </strong>We identified 27 peer-reviewed articles and 25 organisational and governmental responses (grey literature). 20 (74%) of the peer-reviewed interventions targeted the consumer to enhance 'media literacy', support decision-making or warn about misinformation trends. Approaches included education, such as videos or information materials, to improve detection of misinformation, as well as correcting misinformation and rebutting claims. Only two (7.4%) of the peer-reviewed approaches were sensitive to the problem of medical overuse: a risk-of-deception tool and an informed decision-making service. The grey literature about government and organisational responses chiefly comprised general advertising regulations and other educational resources for consumers to identify and navigate misinformation. The advertising regulations ranged from self-regulatory codes of practice to mandatory regulations, requiring pre-approval of social media marketing material. Most regulations stated advertising should be truthful, presenting both benefits and harms and not be misleading. Most of the grey literature (64%) was sensitive to medical overuse, though none referred explicitly to the problem.</p><p><strong>Conclusions: </strong>Current efforts to address misleading medical marketing on social media often overlook the critical issue of medical overuse and fail to provide sufficient consumer protections in this rapidly evolving digital landscape of social media, such as the speed of dissemination, reach and the role of third-party advertising. These gaps in research, regulation and practice present significant opportunities to strengthen evidence-based policies and public health responses. TRIAL REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/2NJSH.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less is more for patients, practitioners, public and planet: a taxonomy for the harms of too much medicine.","authors":"Emma Grundtvig Gram, Romi Haas, Amanda Niklasson, Steven Woloshin, Barnett Kramer, John Brodersen, Karsten Juhl Jørgensen, Minna Johansson, Timothy Wilt, Katy Bell","doi":"10.1136/bmjebm-2025-113874","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-113874","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol use and risk of dementia in diverse populations: evidence from cohort, case-control and Mendelian randomisation approaches.","authors":"Anya Topiwala, Daniel F Levey, Hang Zhou, Joseph D Deak, Keyrun Adhikari, Klaus P Ebmeier, Steven Bell, Stephen Burgess, Thomas E Nichols, Michael Gaziano, Murray Stein, Joel Gelernter","doi":"10.1136/bmjebm-2025-113913","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-113913","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the relationship between alcohol consumption and dementia.</p><p><strong>Design: </strong>Prospective cohort and case-control analyses combined with linear and non-linear Mendelian randomisation.</p><p><strong>Setting: </strong>Two large-scale population-based cohorts: the US Million Veteran Programme and the UK Biobank. Genetic analyses used summary statistics from genome-wide association studies (GWAS).</p><p><strong>Participants: </strong>559 559 adults aged 56-72 years at baseline were included in observational analyses (mean follow-up: 4 years in the US cohort; 12 years in the UK cohort). Genetic analyses used summary data from multiple large GWAS consortia (2.4 million participants).</p><p><strong>Main outcome measures: </strong>Incident all-cause dementia, determined through health record linkage, and genetic proxies.</p><p><strong>Results: </strong>During follow-up, 14 540 participants developed dementia and 48 034 died. Observational phenotype-only analyses revealed U-shaped associations between alcohol and dementia risk: higher risk was observed among non-drinkers, heavy drinkers (>40 drinks per week; HR 1.41, 95% CI 1.15 to 1.74), and those with alcohol use disorder (AUD) (HR 1.51, 95% CI 1.42 to 1.60) compared with light drinkers. In contrast, Mendelian randomisation genetic analysis identified a monotonic increase in dementia risk with greater alcohol consumption. A 1 SD increase in log-transformed drinks per week was associated with a 15% dementia increase (inverse-variance weighted (IVW) OR 1.15, 95% CI 1.03 to 1.27). A twofold increase in AUD prevalence was associated with a 16% increase in dementia risk (IVW OR 1.16, 95% CI 1.03 to 1.30). Alcohol intake increased dementia, but individuals who developed dementia also experienced a decline in alcohol intake over time, suggesting reverse causation-where early cognitive decline leads to reduced alcohol consumption-underlies the supposed protective alcohol effects in observational studies.</p><p><strong>Conclusions: </strong>These findings provide evidence for a relationship between all types of alcohol use and increased dementia risk. While correlational observational data suggested a protective effect of light drinking, this could be in part attributable to reduced drinking seen in early dementia; genetic analyses did not support any protective effect, suggesting that any level of alcohol consumption may contribute to dementia risk. Public health strategies that reduce the prevalence of alcohol use disorder could potentially lower the incidence of dementia by up to 16%.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}