BMJ Evidence-Based Medicine最新文献

{"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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874267/pdf/","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":"OA","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874357/pdf/","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":"OA","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}

{"title":"Gender and geographical bias in the editorial decision-making process of biomedical journals: a case-control study.","authors":"Angèle Gayet-Ageron, Khaoula Ben Messaoud, Mark Richards, Cyril Jaksic, Julien Gobeill, Jeevanthi Liyanapathirana, Luc Mottin, Nona Naderi, Patrick Ruch, Zoé Mariot, Alexandra Calmy, Julia Friedman, Leonard Leibovici, Sara Schroter","doi":"10.1136/bmjebm-2024-113083","DOIUrl":"10.1136/bmjebm-2024-113083","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether the gender (primary) and geographical affiliation (post-hoc) of the first and/or last authors are associated with publication decisions after peer review.</p><p><strong>Design: </strong>Case-control study.</p><p><strong>Setting: </strong>Biomedical journals.</p><p><strong>Participants: </strong>Original peer-reviewed manuscripts submitted between 1 January 2012 and 31 December 2019.</p><p><strong>Main outcome measure: </strong>Manuscripts accepted (cases) and rejected for publication (controls).</p><p><strong>Results: </strong>Of 6213 included manuscripts, 5294 (85.2%) first and 5479 (88.1%) last authors' gender were identified; 2511 (47.4%) and 1793 (32.7%) were women, respectively. The proportion of women first and last authors was 48.4% (n=1314) and 32.2% (n=885) among cases and 46.4% (n=1197) and 33.2% (n=908) among controls. After adjustment, the association between the first author's gender and acceptance for publication remained non-significant 1.04 (0.92 to 1.17). Acceptance for publication was lower for first authors affiliated to Asia 0.58 (0.46 to 0.73), Africa 0.75 (0.41 to 1.36) and South America 0.68 (0.40 to 1.16) compared with Europe, and for first author affiliated to upper-middle country-income 0.66 (0.47 to 0.95) and lower-middle/low 0.69 (0.46 to 1.03) compared with high country-income group. It was significantly higher when both first and last authors were affiliated to different countries from same geographical and income groups 1.35 (1.03 to 1.77), different countries and geographical but same income groups 1.50 (1.14 to 1.96) or different countries, geographical and income groups 1.78 (1.27 to 2.50) compared with authors from similar countries. The study funding was independently associated with the acceptance for publication (when compared with no funding, 1.40; 1.04 to 1.89 for funding by association & foundations, 2.76; 1.87 to 4.10 for international organisations, 1.30; 1.04 to 1.62 for non-profit & associations & foundations). The reviewers' recommendations of the original submitted version were significantly associated with the outcome (unadjusted 5.36; 4.98 to 5.78 for acceptance compared with rejection). Gender of the first author was not associated with reviewers' recommendations (adjusted 0.96, 0.87 to 1.06).</p><p><strong>Conclusions: </strong>We did not identify evidence of gender bias during the editorial decision-making process for papers sent out to peer review. However, the under-representation in manuscripts accepted for publication of first authors affiliated to Asia, Africa or South America and those affiliated to upper/lower-middle and low country-income group, indicates poor representation of global scientists' opinion and supports growing demands for improving equity, diversity and inclusion in biomedical research. The more diverse the countries and incomes of the first and last authors, the greater the chances of the publication being accepted.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891984","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":"Identifying and counteracting fraudulent responses in online recruitment for health research: a scoping review.","authors":"Josielli Comachio, Adam Poulsen, Adeola Bamgboje-Ayodele, Aidan Tan, Julie Ayre, Rebecca Raeside, Rajshri Roy, Edel O'Hagan","doi":"10.1136/bmjebm-2024-113170","DOIUrl":"10.1136/bmjebm-2024-113170","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to describe how health researchers identify and counteract fraudulent responses when recruiting participants online.</p><p><strong>Design: </strong>Scoping review.</p><p><strong>Eligibility criteria: </strong>Peer-reviewed studies published in English; studies that report on the online recruitment of participants for health research; and studies that specifically describe methodologies or strategies to detect and address fraudulent responses during the online recruitment of research participants.</p><p><strong>Sources of evidence: </strong>Nine databases, including Medline, Informit, AMED, CINAHL, Embase, Cochrane CENTRAL, IEEE Xplore, Scopus and Web of Science, were searched from inception to April 2024.</p><p><strong>Charting methods: </strong>Two authors independently screened and selected each study and performed data extraction, following the Joanna Briggs Institute's methodological guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A predefined framework guided the evaluation of fraud identification and mitigation strategies within the studies included. This framework, adapted from a participatory mapping study that identified indicators of fraudulent survey responses, allowed for systematic assessment and comparison of the effectiveness of various antifraud strategies across studies.</p><p><strong>Results: </strong>23 studies were included. 18 studies (78%) reported encountering fraudulent responses. Among the studies reviewed, the proportion of participants excluded for fraudulent or suspicious responses ranged from as low as 3% to as high as 94%. Survey completion time was used in six studies (26%) to identify fraud, with completion times under 5 min flagged as suspicious. 12 studies (52%) focused on non-confirming responses, identifying implausible text patterns through specific questions, consistency checks and open-ended questions. Four studies examined temporal events, such as unusual survey completion times. Seven studies (30%) reported on geographical incongruity, using IP address verification and location screening. Incentives were reported in 17 studies (73%), with higher incentives often increasing fraudulent responses. Mitigation strategies included using in-built survey features like Completely Automated Public Turing test to tell Computers and Humans Apart (34%), manual verification (21%) and video checks (8%). Most studies recommended multiple detection methods to maintain data integrity.</p><p><strong>Conclusion: </strong>There is insufficient evaluation of strategies to mitigate fraud in online health research, which hinders the ability to offer evidence-based guidance to researchers on their effectiveness. Researchers should employ a combination of strategies to counteract fraudulent responses when recruiting online to optimise data integrity.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881266","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":"From promise to practice: challenges and pitfalls in the evaluation of large language models for data extraction in evidence synthesis.","authors":"Gerald Gartlehner, Leila Kahwati, Barbara Nussbaumer-Streit, Karen Crotty, Rainer Hilscher, Shannon Kugley, Meera Viswanathan, Ian Thomas, Amanda Konet, Graham Booth, Robert Chew","doi":"10.1136/bmjebm-2024-113199","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113199","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963742","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}