BMJ Evidence-Based Medicine最新文献

{"title":"Vibration of effects resulting from treatment selection in mixed-treatment comparisons: a multiverse analysis on network meta-analyses of antidepressants in major depressive disorder.","authors":"Constant Vinatier, Clement Palpacuer, Alexandre Scanff, Florian Naudet","doi":"10.1136/bmjebm-2024-112848","DOIUrl":"10.1136/bmjebm-2024-112848","url":null,"abstract":"<p><strong>Objective: </strong>It is frequent to find overlapping network meta-analyses (NMAs) on the same topic with differences in terms of both treatments included and effect estimates. We aimed to evaluate the impact on effect estimates of selecting different treatment combinations (ie, network geometries) for inclusion in NMAs.</p><p><strong>Design: </strong>Multiverse analysis, covering all possible NMAs on different combinations of treatments.</p><p><strong>Setting: </strong>Data from a previously published NMA exploring the comparative effectiveness of 22 treatments (21 antidepressants and a placebo) for the treatment of acute major depressive disorder.</p><p><strong>Participants: </strong>Cipriani <i>et al</i> explored a dataset of 116 477 patients included in 522 randomised controlled trials.</p><p><strong>Main outcome measures: </strong>For each possible treatment selection, we performed an NMA to estimate comparative effectiveness on treatment response and treatment discontinuation for the treatments included (231 between-treatment comparisons). The distribution of effect estimates of between-treatment comparisons across NMAs was computed, and the direction, magnitude and statistical significance of the 1st and 99th percentiles were compared.</p><p><strong>Results: </strong>4 116 254 different NMAs concerned treatment response. Among possible network geometries, 172/231 (74%) pairwise comparisons exhibited opposite effects between the 1st and 99th percentiles, 57/231 (25%) comparisons exhibited statistically significant results in opposite directions, 118 of 231 (51%) comparisons derived results that were both significant and non-significant at 5% risk and 56/231 (24%) treatment pairs obtained consistent results with only significant differences (or only non-significant differences) at 5% risk. Comparisons based on indirect evidence only were associated with greater variability in effect estimates. Comparisons with small absolute values observed in the complete NMA more frequently obtained statistically significant results in opposite directions. Similar results were observed for treatment discontinuation.</p><p><strong>Conclusion: </strong>In this multiverse analysis, we observed that the selection of treatments to be included in an NMA could have considerable consequences on treatment effect estimations.</p><p><strong>Trial registration: </strong>https://osf.io/mb5dy.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"324-332"},"PeriodicalIF":9.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four overlooked errors in ROC analysis: how to prevent and avoid.","authors":"Zhuoqiao He, Qingying Zhang, Manshu Song, Xuerui Tan, Wei Wang","doi":"10.1136/bmjebm-2024-113078","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113078","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280197","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":"Facilitating GRADE judgements about the inconsistency of effects using a novel visualisation approach.","authors":"Mohammad Hassan Murad, Zhen Wang, Yngve Falck-Ytter","doi":"10.1136/bmjebm-2024-113038","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113038","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280158","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":"Developing guideline recommendations about tests: educational examples of test-management pathways","authors":"Mariska Tuut, Jochen Cals, Jesse Jansen, Jako S Burgers","doi":"10.1136/bmjebm-2024-112984","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-112984","url":null,"abstract":"Recommendations about healthcare related testing in guidelines are common. Tests can be used for several purposes: screening, surveillance, risk classification, diagnosis, staging, treatment triage, determination of prognosis and monitoring/follow-up.1 The development of testing recommendations in guidelines is challenging, especially because the benefit of a test not only depends on test characteristics, such as sensitivity and specificity, but also on population characteristics and test consequences, such as management.2–4 Furthermore, the role of a new test in comparison to the existing testing scenario should be defined, since this influences the interpretation of the new test’s value. The following roles of new tests have been identified in the literature: triage, replacement, add-on, and parallel/combined.5 As with treatment, testing can have negative consequences, including physical impairment, psychological distress, disease labelling, and costs.6 There is limited evidence on harms of testing, and healthcare professionals often overestimate its benefits while underestimating its harms.7 This is also true for patients' expectations of testing.8 Additionally, testing occasionally yields unexpected and coincidental findings, which may result in additional testing and treatment. There is a lack of transparency in processing the evidence and considerations that support testing recommendations in guidelines.9 To facilitate the development of test recommendations, we determined the minimum required knowledge for guideline panel members involved, supplementing the competency-based framework available for guideline development.10 11 The concept of the test-management pathway (figure 1) appeared key to understand. Figure 1 Test-management pathway concept. During our developmental study, the need for practical examples of test-management pathways became apparent.10 In our subsequent teach-the-teacher workshop at the 2023 Guideline International Network conference,12 participants requested additional elaboration of pathways for different test outcomes (such as false positives and false negatives) being helpful for explaining the test-management pathway concept to guideline …","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":"201 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254700","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":"Do infographics ‘spin’ the findings of health and medical research?","authors":"Ryan Muller, Giovanni Ferreira, Geronimo Bejarano, Andrew R Gamble, James Kirk, James Sindone, Joshua R Zadro","doi":"10.1136/bmjebm-2024-113033","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113033","url":null,"abstract":"Objective To compare the prevalence of ‘spin’, and specific reporting strategies for spin, between infographics, abstracts and full texts of randomised controlled trials (RCTs) reporting non-significant findings in the field of health and medicine and to assess factors associated with the presence of spin. Design Cross-sectional observational study. Data source Publications in top quintile health and medical journals from August 2018 to October 2020 (Journal Citation Reports database). Eligibility criteria Infographics, abstracts and full texts of RCTs with non-significant results for a primary outcome. Main outcome(s) and measure(s) Presence of spin (any spin and spin in the results and conclusions of infographics, abstracts and full texts). Exposure(s) Conflicts of interest, industry sponsorship, trial registration, journal impact factor, spin in the abstract, spin in the full text. Results 119 studies from 40 journals were included. One-third (33%) of infographics contained spin. Infographics were not more likely to contain any spin than abstracts (33% vs 26%, OR 1.4; 95% CI 0.8 to 2.4) or full texts (33% vs 26%, OR 1.4; 95% CI 0.8 to 2.4). Higher journal impact factor was associated with slightly lower odds of spin in infographics and full texts, but not abstracts. Infographics, but not abstracts or full texts, were less likely to contain spin if the trial was prospectively registered. No other significant associations were found. Conclusions Nearly one-third of infographics spin the findings of RCTs with non-significant results for a primary outcome, but the prevalence of spin is not higher than in abstracts and full texts. Given the increasing popularity of infographics to disseminate research findings, there is an urgent need to improve the reporting of research in infographics. Data are available on reasonable request. Original data may be made available by the authors on reasonable request.","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":"11 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175805","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":"How to best convey continuous outcomes in patient decision aids","authors":"Glyn Elwyn, Marie Anne Durand, Thomas Agoritsas, Martin Mayer","doi":"10.1136/bmjebm-2024-112871","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-112871","url":null,"abstract":"The work of transforming scientific publications into tools that can support people in comparing treatments, tests and other interventions has been driven by efforts to support shared decision-making. The International Patient Decision Aids Standards (IPDAS) Collaboration has published many articles that guide this process. IPDAS, and others in this field, have considered the challenges of representing complex concepts such as effect sizes, ORs and relative risk rates in terms and formats that are easier to understand by people with varying levels of health literacy and numeracy. The underlying task is how to simplify research results without misleading people, which is essential when communicating healthcare information. Selecting outcome probabilities and comparing data collected from different populations with various study designs would be misleading. Further, only providing relative instead of absolute risk estimates would lead to misinterpretation in most situations, framing that affects both professionals and patients.1 For example, imagine a person with a 4% 10-year risk of breast cancer recurrence: telling that person their risk of breast cancer coming back could be cut in half, or reduced by 50%, using treatment Y (relative risk) is misleading. The more informative approach would be telling them their risk could be reduced from 4% to 2% (absolute risk), a risk that is perhaps even clearer if portrayed in natural frequency (n in 100). This article tackles the challenge of untangling complicated, heterogeneous evidence to deliver comparative information to non-scientists while at the same time avoiding misrepresenting the underlying data. Our focus here is to describe some of the editorial challenges of presenting complex scientific information, particularly when published as continuous outcomes in ways that are accurate yet accessible to a broad public, irrespective of their health literacy and numeracy levels. Those editorial challenges have materialised when developing tools to promote shared decision-making. The …","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":"85 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175810","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":"Development of a competency framework for health technology assessment in India.","authors":"Simon Dixon, Kirti Tyagi, Malkeet Singh, Sitanshu Sekhar Kar, Bhavani Shankara Bagepally, Shankar Prinja, Andrew Booth, Chris Carroll, Aamir Sohail, Abha Mehndiratta","doi":"10.1136/bmjebm-2023-112488","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112488","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139263","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":"Assessing proposals to update established screening strategies.","authors":"Alison Huffstetler, Kenneth W Lin, Russell P Harris","doi":"10.1136/bmjebm-2024-113025","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113025","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124772","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":"Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis.","authors":"Ingrid Toews, Salman Hussain, John L Z Nyirenda, Maria A Willis, Lucia Kantorová, Simona Slezáková, Minyahil Tadesse Boltena, John Victor Peter, Luis Eduardo Santos Fontes, Miloslav Klugar, Behnam Sadeghirad, Joerg J Meerpohl","doi":"10.1136/bmjebm-2024-112886","DOIUrl":"10.1136/bmjebm-2024-112886","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs).</p><p><strong>Design and setting: </strong>Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.</p><p><strong>Participants: </strong>Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included.</p><p><strong>Search methods: </strong>The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP).</p><p><strong>Main outcome measures: </strong>The primary outcome was the prevention of clinically important upper GI bleeding.</p><p><strong>Results: </strong>We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding.The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear.</p><p><strong>Conclusions: </strong>Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598378","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":"Meta-analysis of continuous outcomes: a user's guide for analysis and interpretation.","authors":"Madelin R Siedler, Reem A Mustafa, Lifeng Lin, Rebecca L Morgan, Yngve Falck-Ytter, Philipp Dahm, Shahnaz Sultan, Mohammad Hassan Murad","doi":"10.1136/bmjebm-2024-113031","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113031","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104128","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}