BMJ Evidence-Based Medicine最新文献

{"title":"Efficacy of smartphone apps used alone or with traditional interventions for smoking cessation: a systematic review and meta-analysis.","authors":"Shuilian Chu, Lin Feng, Hang Jing, Di Zhang, Jiachen Li, Xiaoni Meng, Xiaoli Liu, Qiuyue Ma, Chengyang Jing, Chun-Li Lu, Fan Wu, Furong Tian, Jianping Liu, Zhao Hui Tong, Lirong Liang","doi":"10.1136/bmjebm-2025-113971","DOIUrl":"10.1136/bmjebm-2025-113971","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the efficacy of smartphone apps for smoking cessation (SC) used alone or combined with traditional interventions, and to determine whether apps based on psychological-behavioural theories (PBT) increase abstinence more than traditional behavioural apps.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials of smartphone apps, used alone or combined with traditional interventions, for SC among current smokers aged ≥15 years who intended to quit. Comparisons included: no intervention, minimal SC support, traditional interventions and apps based on traditional behavioural interventions.</p><p><strong>Information sources: </strong>Databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang) were searched up to 15 August 2025.</p><p><strong>Risk-of-bias rob assessment: </strong>We assessed RoB using the Cochrane RoB Tool 2.0.</p><p><strong>Synthesis of results: </strong>We used random effects meta-analysis to estimate pooled effects and corresponding 95% CIs for each outcome across all comparisons. The primary outcome was 6-month continuous abstinence. Secondary outcomes included 3-month continuous abstinence and 7-day point prevalence abstinence (PPA) at 1, 3 and 6 months. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>A total of 31 studies (12 802 participants) were included. Low-certainty evidence from four studies (1402 participants) suggests that smartphone apps used alone may improve 6-month continuous abstinence rate compared with no or minimal support (RR 2.85, 95% CI 1.61 to 5.05; I<sup>2</sup>=0%). When combined with traditional interventions, smartphone apps may increase 6-month continuous abstinence compared with traditional interventions alone (RR 1.98, 95% CI 1.24 to 3.16; I<sup>2</sup>=85.7%; 4 studies, 2163 participants; low-certainty evidence). Sub-comparison analyses indicated that, based on low-certainty evidence from three studies (1502 participants), smartphone apps combined with pharmacotherapy may improve 6-month continuous abstinence compared with pharmacotherapy alone (RR 1.77, 95% CI 1.09 to 2.88; I<sup>2</sup>=86.0%). High-certainty evidence showed that PBT-based apps significantly increased 7-day PPA compared with traditional behavioural apps, both at 3 months (RR 1.69, 95% CI 1.42 to 2.00; I<sup>2</sup>=0%; 2 studies, 2565 participants) and at 6 months (RR 1.36, 95% CI 1.19 to 1.54; I<sup>2</sup>=0%; 4 studies, 3258 participants).</p><p><strong>Conclusions: </strong>Smartphone apps may be effective for SC compared with no or minimal support. When combined with traditional interventions-especially pharmacotherapy-they may result in large increases in abstinence rates over traditional methods alone. PBT-based apps demonstrated potential for sup","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"242-253"},"PeriodicalIF":10.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965420","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":"Comparing traditional and AI-enhanced strategies for developing patient decision aids: a multiple case study.","authors":"Anik Giguere, Delphine Auclair-Rochon, Maéva Robin, Lidiya Augustine, Julie Ayre, Kirsten McCaffery","doi":"10.1136/bmjebm-2025-113675","DOIUrl":"10.1136/bmjebm-2025-113675","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to develop and test prompts designed to generate balanced, evidence-based information from artificial intelligence (AI) for the development of patient decision aid (DA) content. We compared the outputs of this AI-enhanced strategy with those produced by an experienced human team using a traditional development approach.</p><p><strong>Methods: </strong>We conducted a comparative, mixed-methods, multiple-case study, with each case being a DA. Eight DAs were randomly selected from the Ottawa Inventory, stratified by author type (commercial, academic, public institution, professional association). We then followed a systematic process involving two researchers working independently. One researcher described the topics of the selected DAs and extracted their content by listing the available options with their benefits and harms. The other researcher-blind to the DA-used the topic description to generate AI-enhanced DA content by iteratively refining the prompt structures based on the International Patient Decision Aids Standards until the generated content stabilised. Quantitative analyses compared the number of options, benefits and harms generated by the traditional and AI-enhanced strategies, while qualitative analyses examined the differences in content.</p><p><strong>Results: </strong>The selected DAs targeted different populations (older adults, women, the general population, children) and were produced in Canada, the UK, the USA or Australia. One type of DA (n=6) focused on a specific option (eg, whether to get vaccinated against COVID-19), the other (n=2) focused on improving an outcome (eg, treating attention-deficit/hyperactivity disorder symptoms). For option-focused DAs, 66% of the benefits/harms were generated by the AI-enhanced strategy only and 6.2% by the traditional strategy only. For outcome-focused DAs, 47% of the options were generated by the AI-enhanced strategy only, and 4% by the traditional strategy only. An evidence search confirmed that the options generated only by the AI-enhanced strategy were indeed beneficial, ruling out hallucinations. However, the AI-enhanced strategy did not suggest optimal combinations. Qualitative analysis showed that AI-enhanced content was generally richer.</p><p><strong>Conclusions: </strong>This study provides practical guidance on leveraging AI to improve the efficiency of DA development and improve their quality.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"232-241"},"PeriodicalIF":10.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343147","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":"Current knowledge on the adaptation of clinical practice guidelines: a scoping review.","authors":"Simin Zhu, Rui Wang, Andrea J Darzi, Yuan Zhang, Yasser Sami Amer, Kian Torabiardakani, Holger J Schuenemann, Elie Akl, Pablo Alonso-Coello, Yang Song","doi":"10.1136/bmjebm-2025-113925","DOIUrl":"10.1136/bmjebm-2025-113925","url":null,"abstract":"<p><strong>Background: </strong>The adaptation of clinical practice guidelines (CPGs) is increasingly used to efficiently develop contextualised recommendations for local, regional and national settings. However, adaptation approaches lack standardisation, and their application remains unclear.</p><p><strong>Objective: </strong>To identify existing literature on CPG adaptation approaches, synthesise and analyse the definitions, rationales, key steps and their applications.</p><p><strong>Methods: </strong>We conducted a scoping review and identified studies through (1) database searches in MEDLINE and EMBASE (October 2024); (2) forward citation searches (January 2024); (3) manual searches; and (4) expert recommendations. We included documents describing adaptation approaches that allow reproducibility or adapted guidelines reflecting their application, without language restriction. We analysed data using descriptive and content analysis, with visualisations using Tableau.</p><p><strong>Results: </strong>We identified 49 adaptation approaches (2000-2024) and 151 applications (2007-2024). 28 approaches originated from high-income countries (57.1%), primarily aimed at improving guideline development efficiency. We categorised these approaches into methodological frameworks (n=16, 32.7%), medical association frameworks (n=7, 14.3%), organisational handbooks (n=12, 24.5%), national or regional approaches (n=13, 26.5%) and one topic-specific methodology. From the key adaptation steps of the identified approaches, we found that 'judging quality of evidence' and 'establishing guideline group processes' were the least addressed. Approximately 20% of applications modified the original approaches during the adaptation process. ADAPTE (n=50, 33.1%) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT (n=41, 27.2%) are the most commonly used adaptation approaches. Also, over half of the identified applications were adapted at the evidence level (n=88, 58.3%) and completed the process within 12 months (range: 2-36 months).</p><p><strong>Conclusions: </strong>49 adaptation approaches were identified, with a recent surge in interest and utilisation. Although adaptation can save time and resources, substantial variations among existing approaches and their applications remain. These findings highlight the need for comprehensive guidance to support standardisation and optimise the quality of the adaptation process.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"254-268"},"PeriodicalIF":10.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751729","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":"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":"221-231"},"PeriodicalIF":10.8,"publicationDate":"2026-07-21","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":"Correction: Interventions for Menière's disease: an umbrella systematic review.","authors":"","doi":"10.1136/bmjebm-2020-111410corr1","DOIUrl":"https://doi.org/10.1136/bmjebm-2020-111410corr1","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468913","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":"Loss of an ideal: how politics and misinformed advocacy killed the Canadian Task Force.","authors":"Guylene Theriault","doi":"10.1136/bmjebm-2026-114670","DOIUrl":"https://doi.org/10.1136/bmjebm-2026-114670","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444289","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":"Improving inclusivity in UK clinical trials through good practice in the collection and use of ethnicity data: recommendations from the INCLUDED study.","authors":"Ratna Sohanpal, Sian Newton, Percy Akudo, Grainne Colligan, Annette Crosse, Ceri Durham, Heidi Green, Sally Hopewell, Tracy Jackson, Sandra Jayacodi, Imran Khan, Charles Kwaku-Odoi, Emily Lam, Gillian A Lancaster, Sarah Ann Lawton, Meiko Makita, Kirit Mistry, Aliya Mohammed, Beatriz L Ratton, Jo Smith, Ria Sunga, Ann Thomson, Shaun Treweek, Clancy Williams, Manoj Mistry, Sandra Eldridge","doi":"10.1136/bmjebm-2025-114429","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114429","url":null,"abstract":"<p><p>Ethnicity data are essential in understanding how different groups are impacted by different treatments/healthcare interventions, but more work is needed in how these data should be collected, handled and reported in trials to address distrust among marginalised ethnic groups towards healthcare research. To do this, researchers need effective training and opportunities to engage with communities from a diverse range of ethnicities. Developing guidance on how to meaningfully involve diverse ethnic groups in all stages of a trial including planning the collection of ethnicity data is one way to improve the impact of clinical trial results and ensure these groups can access equitable healthcare.Our collaborative work between health researchers and diverse ethnic communities produced 13 initial recommendations aimed at academic health researchers to change their practice involving diverse ethnic communities in areas from trial design through to reporting. The first four recommendations are concerned with the planning stage of the trial, the fifth with how researchers interact with funding bodies. Recommendations 6, 7 and 8 are relevant to data collection during trial set up, and recommendations 9, 10 and 11 focus on training and responsibility during the trial set up and the trial conduct stage. Recommendations 12 and 13 cover reporting.The recommendations will benefit from piloting but have the potential to help trial teams make their research more inclusive with regard to ethnicity, which in turn will support more representative, equitable and impactful research.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444236","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":"Perspectives on the definition of 'evidence': a qualitative interview study among interest-holders.","authors":"Xuan Yu, Janne Estill, Karen Spruyt, Yoseph G Abraha, Joseph L Mathew, Xiaoting Shi, Zachary Munn, Dawid Pieper, Akihiko Ozaki, Yanfang Ma, Zhaoxiang Bian, Yaolong Chen","doi":"10.1136/bmjebm-2025-114245","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114245","url":null,"abstract":"<p><strong>Objective: </strong>To clarify the perspectives of different interest-holders on the definition of 'evidence'.</p><p><strong>Design and setting: </strong>This qualitative study employed purposeful sampling to select respondents from various disciplines and fields worldwide for semistructured interviews. The initial draft of the interview guide was developed based on a scoping review of definitions of 'evidence' and relevant documents. A pilot test was conducted to refine the interview guide. Interviews were conducted both online and in person until data saturation was achieved. Interview transcripts were analysed in NVivo V.12 using thematic analysis, which involved generating initial codes, searching for and reviewing themes and agreeing on the final set of themes.</p><p><strong>Results: </strong>Interviews were conducted with 25 interest-holders from 16 countries, including policymakers, researchers, journal editors, clinicians and representatives of patients and the public. Findings show that most respondents believe there is a lack of clear, precise definitions of evidence and that the term is used variably and informally. Although respondents identified multiple barriers to establishing a standardised definition, some questioned whether a new definition is necessary, argued that existing definitions are sufficient or noted the practical difficulties of developing one. Moreover, views differed on which interest-holders should be involved and considered in developing such a definition. Based on these discussions, 13 of the 25 respondents explicitly provided personal definitions of 'evidence' for users' reference.</p><p><strong>Conclusions: </strong>The unclear definitions of evidence and their inconsistent usage not only lead researchers to misunderstand and overuse the term but also contribute to the misuse or mistrust of evidence by users, especially patients and the public, and even to criticism of evidence-based practice. We urge users to consult existing definitions of the term 'evidence' before employing it, to ensure standardised and accurate usage. If no accepted definition is available, we recommend clearly defining the term prior to use, so that users can accurately comprehend its meaning.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435111","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":"Safety of proton pump inhibitors: an overview of systematic reviews and meta-analyses.","authors":"Chao Wang, Huier Gao, Cheng Zhu, Yue Zhao, Yinpeng Qin, Yude Qian, Guodong Feng, Xinran Zhang, Ting Yuan, Fan He, Qianqian Dou, Bei Zhang, Mei Shu, Yi Zhang, Yishan Bu","doi":"10.1136/bmjebm-2025-114134","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114134","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Proton pump inhibitors (PPIs) have been widely used for over 35 years. However, in recent decades, numerous adverse drug reactions (ADRs) have been reported, with evidence often inconsistent and heterogeneous across studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To conduct an overview of systematic reviews/meta-analyses (SR/MAs) to provide a contemporary review of the evidence for the safety of PPIs in patients using them for treating or prophylaxis, to summarise the outcome data, assess the methodological quality and rate the certainty of the evidence and to provide references for clinical decision-making and the subsequent formulation of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted an overview of reviews following the Preferred Reporting Items for Overviews of Reviews guidelines. We identified SR/MAs regarding PPI safety through a search of multiple databases, including the China National Knowledge Infrastructure, Chinese Science and Technology Journal Database and Wanfang Database (WanFang) on 6 December 2025 as well as Embase, PubMed and the Cochrane Library database on 7 December 2025. The participants were human populations who had been administered PPIs; the intervention groups used PPI-based regimens and the control group received different PPI regimens, no-PPIs, H2-receptor antagonists (H2RAs), potassium-competitive acid blockers (P-CAB) or placebo; the outcomes mainly included the specific ADRs associated with PPI use. We used the A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) tool to assess the methodological quality of the included SR/MAs and employed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to evaluate the quality of evidence for the reported outcomes. The focus of the data presentation was descriptive, featuring detailed tabular presentations of characteristics and results at both the review level and the primary studies level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;A total of 940 studies were retrieved from various databases according to the search strategies. After eliminating duplicates and the screening process, 36 SR/MAs were finally included. Overall, there was a slight overlap (corrected covered area, CCA of 0.91%) in 483 primary studies included in the 36 SR/MAs. AMSTAR-2 evaluation results showed that 34 SR/MAs were of low quality, and the other two were of critically low quality. The GRADE evaluation results indicated that the certainty of evidence for all outcomes was &lt;i&gt;low&lt;/i&gt; or &lt;i&gt;very low&lt;/i&gt;. The use of PPIs might be associated with an increased risk of acute kidney injury (AKI) (relative risk (RR) 1.75, 95% CI 1.40 to 2.19), chronic kidney disease (CKD) (RR 1.35, 95% CI 1.15 to 1.56), gastric cancers (GC) (RR 1.67, 95% CI 1.39 to 2.00) and community-acquired pneumonia (CAP) (OR 1.37, 95% CI 1.22 to 1.53). PPI therapy was associated with a higher recurrence rate of &lt;i&gt;Clostridioides difficile&lt;/i&gt; infection (CDI) (24% vs ","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263287","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":"Quality of instruments to assess the process of shared decision-making: a comprehensive systematic review and COSMIN quality appraisal.","authors":"Christin Hoffmann, Samuel Lawday, Vignesh Gopalan, Rados Keravica, Arwen Pieterse, Hilary Bekker, Denitza Williams, Natalie Joseph-Williams, Jennifer Hall, Kerry Avery, Val Snelgrove, Della Hopkins, Christie Cabral, Jane Blazeby, Shireen Hickey, Angus G K McNair","doi":"10.1136/bmjebm-2025-114092","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114092","url":null,"abstract":"&lt;p&gt;&lt;p&gt;ObjectiveShared decision-making (SDM) is a key component of patient-centred care and major driver of healthcare policy, clinical practice and research globally. Widespread implementation of SDM is hindered by uncertainty about how to best measure decision-making processes. A seminal methodological review of SDM instruments published in 2018 identified widespread deficiencies in instrument quality and provided recommendations for improvement. This systematic review and COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) quality appraisal aims to provide an update SDM instrument inventory, re-evaluated progress in the field and provided future direction for researchers, funders and policymakers. This systematic review and COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) quality appraisal aims to provide an update SDM instrument inventory, re-evaluated progress in the field and provided future direction for researchers, funders and policymakers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A systematic search of six databases (September 2017-December 2024) identified studies of instruments measuring the process of SDM. Instrument appraisal followed COSMIN guidelines in a three-step process: appraisal of the methodological quality of instruments and of the quality of the measurement properties of newly identified measures (steps i, ii). This informed the comprehensive best-evidence synthesis which included the data from the original review (step iii).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 127 studies were included describing the development and/or evaluation of 105 unique instruments to measure the process of SDM. Some 61 new instruments were identified since the last review, of which 35 (57%) were translations/revisions to existing ones. The best-evidence synthesis revealed positive results for internal consistency (72%), structural validity (75%) and intrarater reliability (50%), but also negative or unknown results for test-retest reliability (58%), content validity (54%) and intrarater reliability (50%), where evaluated. No single instrument consistently showed positive evidence across all relevant measurement properties. Evidence gaps for many properties remain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This updated inventory guides researchers, clinicians and policymakers to the most appropriate instrument for an intended context/population. There was a proliferation of new, primarily patient-reported measurement instruments, but no single instrument had sufficient evidence of measurement quality. Methods were aligned with the original review and applied the 2011 COSMIN checklist which was updated in 2024, although using a previous checklist version is unlikely to affect overall conclusions. We recommend an international consensus with key interest holders on preferred instrument(s) for further validation and future core measurement set for efficient evidence synthesis","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263216","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}