BMJ Evidence-Based Medicine最新文献

{"title":"Associations between device-measured and self-reported physical activity and common mental disorders: Findings from a large-scale prospective cohort study.","authors":"Zhe Wang, Zhi Cao, Jiahao Min, Tingshan Duan, Chenjie Xu","doi":"10.1136/bmjebm-2024-112933","DOIUrl":"10.1136/bmjebm-2024-112933","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the associations between device-measured and self-reported physical activity (PA) and incident common mental disorders in the general population.</p><p><strong>Design and setting: </strong>Large-scale prospective cohort study.</p><p><strong>Participants: </strong>Using the UK Biobank data, a validated PA questionnaire was used to estimate self-reported weekly PA in 365 656 participants between 2006 and 2010 while 91 800 participants wore wrist-worn accelerometers for 7 days in 2013-2015 to derive objectively measured PA. All the participants were followed up until 2021.</p><p><strong>Main outcome measures: </strong>Incidences of depression and anxiety were ascertained from hospital inpatient records. Cox proportional hazards models and restricted cubic splines were used to assess the associations between subjectively and objectively measured PA and common mental disorders.</p><p><strong>Results: </strong>During a median follow-up of 12.6 years, 16 589 cases of depression, 13 905 cases of anxiety and 5408 cases of comorbid depression and anxiety were documented in the questionnaire-based cohort. We found J-shaped associations of self-reported PA with incident risk of depression and anxiety, irrespective of PA intensities. The lowest risk for depression occurred at 550, 390, 180 and 560 min/week of light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) and moderate-to-vigorous PA (MVPA), respectively. During a median follow-up of 6.9 years, a total of 2258 cases of depression, 2166 cases of anxiety and 729 cases of comorbid depression and anxiety were documented in the accelerometer-based cohort. We found L-shaped associations of device-measured MPA and VPA with incident depression and anxiety. MPA was adversely associated with incident depression and anxiety until 660 min/week, after which the associations plateaued. The point of inflection for VPA occurred at 50 min/week, beyond which there was a diminished but continued reduction in the risks of depression and anxiety.</p><p><strong>Conclusion: </strong>Different patterns of associations between self-reported and device-measured PA and mental health were observed. Future PA guidelines should fully recognise this inconsistency and increasingly employ objectively measured PA standards.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"45-54"},"PeriodicalIF":9.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598376","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":"Teaching evidence-based medicine by using a systematic review framework: implementation in a Swedish university setting.","authors":"Maria Björklund, Martin Ringsten, Matteo Bruschettini, Martin Garwicz","doi":"10.1136/bmjebm-2023-112607","DOIUrl":"10.1136/bmjebm-2023-112607","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"5-9"},"PeriodicalIF":9.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304827","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":"Reducing the environmental impact of healthcare to improve health, sustainability and equity.","authors":"Maria-Inti Metzendorf, Eva Madrid, Erik van Raaij","doi":"10.1136/bmjebm-2024-113124","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113124","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027721","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":"Enhancing the transparency of clinical practice guidelines by prospective registration: the PREPARE platform.","authors":"Hui Liu, Nan Yang, Janne Estill, Yaolong Chen","doi":"10.1136/bmjebm-2023-112813","DOIUrl":"10.1136/bmjebm-2023-112813","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"68-70"},"PeriodicalIF":9.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896973","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":"Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysis.","authors":"Aileen Zeng, Queenie Tang, Edel O'Hagan, Kirsten McCaffery, Kiran Ijaz, Juan C Quiroz, Ahmet Baki Kocaballi, Dana Rezazadegan, Ritu Trivedi, Joyce Siette, Timothy Shaw, Meredith Makeham, Aravinda Thiagalingam, Clara K Chow, Liliana Laranjo","doi":"10.1136/bmjebm-2023-112820","DOIUrl":"10.1136/bmjebm-2023-112820","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Eligibility criteria: </strong>Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF.</p><p><strong>Information sources: </strong>We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies.</p><p><strong>Synthesis of results: </strong>We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge.</p><p><strong>Results: </strong>13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference -0.19; 95% CI -0.30 to -0.08; p=0.001; I²=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI -19.5 to -5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I²=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery.</p><p><strong>Conclusions: </strong>In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted.</p><p><strong>Prospero registration number: </strong>CRD42020218025.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"10-21"},"PeriodicalIF":9.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475889","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":"Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study.","authors":"Laura Hauge Kristensen, Rannva Winther, Josefine Tvede Colding-Jørgensen, Anton Pottegård, Henrik Nielsen, Jacob Bodilsen","doi":"10.1136/bmjebm-2024-112920","DOIUrl":"10.1136/bmjebm-2024-112920","url":null,"abstract":"<p><strong>Objective: </strong>To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals.</p><p><strong>Design: </strong>Prospective population-based cohort study.</p><p><strong>Setting: </strong>North Denmark.</p><p><strong>Participants: </strong>All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021.</p><p><strong>Main outcome measures: </strong>UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.</p><p><strong>Results: </strong>Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick.</p><p><strong>Conclusions: </strong>Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"36-44"},"PeriodicalIF":9.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598377","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":"Peer reviewers' conflicts of interest in biomedical research: scoping review.","authors":"Christoffer Bruun Korfitsen, Camilla Hansen Nejstgaard, Asbjørn Hróbjartsson, Isabelle Boutron, Lisa Bero, Andreas Lundh","doi":"10.1136/bmjebm-2024-112967","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-112967","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peer review may improve the quality of research manuscripts and aid in editorial decisions, but reviewers can have conflicts of interest that impact on their recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The objective was to systematically map and describe the extent and nature of empirical research on peer reviewers' conflicts of interest in biomedical research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Scoping review METHODS: In this scoping review, we included studies investigating peer reviewers' conflicts of interest in journal manuscripts, theses and dissertations, conference abstracts, funding applications and clinical guidelines. We searched MEDLINE, Embase, The Cochrane Methodology Register, Google Scholar (up to January 2024) and other sources. Two authors independently included studies and extracted data on key study characteristics and results, and we organised data by study domain (eg, journal manuscripts) and study aims. We included studies directly investigating peer reviewers' conflicts of interest in our primary analysis, and studies investigating other questions (eg, reasons for retraction), but reporting relevant data on peer reviewers' conflicts of interest, were solely included in a supplementary analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After screening 44 353 references, we included 71 studies, of which 41 were included in our primary analysis. The 41 studies were published between 2005 and 2023, and 34 (83%) were journal publications. 30 (73%) studies investigated journal manuscripts, 1 (2%) conference abstracts, 4 (10%) funding applications and 6 (15%) clinical guidelines. No studies investigated theses or dissertations. 37 (90%) studies used quantitative research methods, 2 (5%) qualitative and 2 (5%) mixed methods. 21 (51%) studies investigated both financial and non-financial interests, 6 (15%) solely financial interests, 5 (12%) solely non-financial interests and 9 (22%) did not report the type of interest. We organised included studies based on study aims, with some studies having multiple aims: impact on recommendations (one study), occurrence of peer reviewers' conflicts of interest (11 studies), stakeholders' experiences (13 studies) and policy and management (22 studies). One (2%) study investigated the impact of peer reviewers' personal connections with authors on reviewers' recommendations. Nine (22%) studies estimated prevalences of conflicts of interest among peer reviewers, ranging from 3%-91%. Two (5%) studies both reported that conflicts of interest were a reason for declining to review in 1% of cases. 13 (32%) studies investigated stakeholders' experiences with peer reviewers' conflicts of interest, primarily using questionnaires of reviewers, editors and researchers. 16 (39%) studies estimated prevalences of having conflict of interest policies for peer reviewers, ranging from 5%-96%, among journals, conferences and clinical guideline organisations. Finally, six (15%) studies es","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944311","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":"Opportunities, challenges and risks of using artificial intelligence for evidence synthesis.","authors":"Waldemar Siemens, Erik von Elm, Harald Binder, Daniel Böhringer, Angelika Eisele-Metzger, Gerald Gartlehner, Piet Hanegraaf, Maria-Inti Metzendorf, Jacob-Jan Mosselman, Artur Nowak, Riaz Qureshi, James Thomas, Siw Waffenschmidt, Valérie Labonté, Joerg J Meerpohl","doi":"10.1136/bmjebm-2024-113320","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113320","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944306","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":"Unknowns of drug company payment disclosure: why the UK needs payment transparency legislation.","authors":"Piotr Ozieranski, Emily Rickard, Shai Mulinari","doi":"10.1136/bmjebm-2024-113101","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113101","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944316","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":"Exploring adaptive health technology assessment for evaluating 10 cancer interventions: insights and lessons from a pilot study in India.","authors":"Srobana Ghosh, C S Pramesh, Manju Sengar, Priya Ranganathan, Francis Ruiz, Tabassum Wadasadawala, Prakash Nayak, Jayashree Thorat, Apurva Ashok, Malkeet Singh, Abha Mehndiratta, Cassandra Nemzoff, Hiral Anil Shah","doi":"10.1136/bmjebm-2023-112490","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112490","url":null,"abstract":"<p><strong>Background: </strong>Health technology assessment (HTA) is a valuable tool for informing the efficient allocation of resources in healthcare. However, the resource-intensive nature of HTA can limit its application, especially in low-resource settings. Adapting HTA processes by assessing the available international evidence offers a pragmatic approach to provide evidence for decision-making where resources are constrained.</p><p><strong>Objective: </strong>This study piloted an adaptive HTA (aHTA) method to evaluate 10 cancer interventions.</p><p><strong>Methods: </strong>We arranged a joint collaboration with the International Decision Support Initiative and the National Cancer Grid in India to form a working group of clinicians and health economists. We conducted a rapid review of HTA reports and economic evaluations for ten prioritised common cancer interventions for breast, lung, and head and neck cancers. We extracted data on cost-effectiveness, conducted a price benchmarking analysis, estimated treatment costs and calculated the treatment's share of the national insurance family allowance. Finally, we determined through qualitative appraisal whether the intervention would likely to be considered cost-effective in the Indian context.</p><p><strong>Results: </strong>Of the 10 interventions assessed, 9 had sufficient evidence to make determinations on the likely cost-effectiveness. Three were potentially cost-effective (one after a price discount and another by using the generic price), while five were not, and one was only cost-effective in a subgroup. One intervention required a full HTA due to remaining uncertainty. Information on the likely cost-effectiveness, clinical and safety benefits, and treatment costs was consistently found through publicly available evidence. Assessment methods were modified slightly across the 10 interventions, including expanding the data extraction criteria, updating the calculations and broadening the evidence retrieval.</p><p><strong>Conclusion: </strong>The aHTA method is a feasible resource-sensitive alternative to traditional HTA for informing decision-making in resource-constrained settings when ample international data on cost-effectiveness for a given topic is available.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920467","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}