BMJ Evidence-Based Medicine最新文献

{"title":"Tramadol versus placebo for chronic pain: a systematic review with meta-analysis and trial sequential analysis.","authors":"Jehad Ahmad Barakji, Mathias Maagaard, Johanne Juul Petersen, Yousef Ahmad Barakji, Emil Ørskov Ipsen, Christian Gluud, Ole Mathiesen, Janus Christian Jakobsen","doi":"10.1136/bmjebm-2025-114101","DOIUrl":"10.1136/bmjebm-2025-114101","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of our study was to assess the benefits and harms of tramadol vs placebo in adults with chronic pain.</p><p><strong>Design: </strong>The research method was a systematic review of randomised clinical trials with meta-analysis. The review followed the Trial Sequential Analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Data sources: </strong>The Cochrane Library, MEDLINE, Embase, Science Citation Index and BIOSIS were searched for trials published from inception to 6 February 2025.</p><p><strong>Eligibility criteria for selecting studies: </strong>Studies were eligible for inclusion if they were published and unpublished randomised clinical trials comparing tramadol vs placebo in adults with any type of chronic pain. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.</p><p><strong>Main outcome measures: </strong>The main outcome measures were pain level, adverse events, quality of life, dependence, abuse and depressive symptoms.</p><p><strong>Results: </strong>We included 19 randomised placebo-controlled clinical trials enrolling 6506 participants. All outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale (NRS) -0.93 points; 97.5% CI -1.26 to -0.60; p<0.0001; low certainty of evidence). However, the effect size was below our predefined minimal important difference of 1.0 point on NRS. Beta binomial regression showed evidence of a harmful effect of tramadol on serious adverse events (OR 2.13; 97.5% CI 1.29 to 3.51; p=0.001; moderate certainty of evidence), mainly driven by a higher proportion of cardiac events and neoplasms. It was not possible to conduct a meta-analysis of the quality of life due to a lack of data. Meta-analysis and Trial Sequential Analysis showed that tramadol increased the risk of several non-serious adverse events including nausea (number needed to harm (NNH) 7), dizziness (NNH 8), constipation (NNH 9), and somnolence (NNH 13) (all very low certainty of evidence).</p><p><strong>Conclusion: </strong>Tramadol may have a slight effect on reducing chronic pain levels (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"160-169"},"PeriodicalIF":10.8,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of overdiagnosis in the rising incidence of endometrial cancer: a population-based ecological study.","authors":"Behrad Barmayehvar, Alireza Behzadnia, Brian Nicholson, Per-Henrik Zahl, Jason Oke","doi":"10.1136/bmjebm-2025-113688","DOIUrl":"10.1136/bmjebm-2025-113688","url":null,"abstract":"<p><strong>Objectives: </strong>Endometrial cancer (EC) incidence has been rising globally, while mortality has remained stable, particularly in Nordic countries. This study aimed to explore the role of transvaginal ultrasound (TVUS) use and overdiagnosis in these trends.</p><p><strong>Methods: </strong>We analysed crude and age-adjusted EC incidence and mortality rates by stage and age group using data from the Norwegian Cancer and Causes of Death Registries (1970-2019). Annual percentage changes (APC) in early-stage and late-stage cancers were estimated using linear regression. Trends were assessed with the Mann-Kendall test and Theil-Sen estimator. Spearman's correlation evaluated the relationship between regional TVUS billing rates and EC incidence.</p><p><strong>Results: </strong>From 1970 to 2019, age-standardised EC incidence in Norway increased by 79% (16.7-30.0 per 100 000), with a five-yearly growth rate of 7.47% (p=0.020). Mortality remained stable until 2000-2004, with a non-significant drop from 5.0 to 2.75 per 100 000 by 2019 (Sen's slope: -0.20, p=0.15). In postmenopausal women, early-stage incidence rose by 73% (32.1-55.5 per 100 000) and late-stage diagnoses increased by 108% (7.0-14.6 per 100 000). In premenopausal women, early-stage incidence declined by 24% (3.3-2.5 per 100 000), while late-stage diagnoses rose by 189% (0.23-0.66 per 100 000). TVUS use rose from 7.6% to 8.3% annually (2006-2019). The APC in postmenopausal women was similar across stages, with the largest increase in those aged 70+ years. Evidence for TVUS driving early-stage diagnoses was not strong, although a weak correlation between the two was observed in postmenopausal women (r=0.35, p<0.05).</p><p><strong>Conclusions: </strong>Overdiagnosis and stage migration may explain the rising EC incidence in postmenopausal women. In premenopausal women, overdiagnosis is less likely. TVUS is unlikely to be the main driver of the trends. Further research is needed to clarify the interplay of factors affecting EC trends globally.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"152-159"},"PeriodicalIF":10.8,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of evidence on overall survival benefits of cancer drugs included on the national reimbursement drug list of China, 2005-2022: an observational study.","authors":"Yichen Zhang, Huangqianyu Li, Jinyu Chen, Huseyin Naci, Anita K Wagner, Luwen Shi, Xiaodong Guan","doi":"10.1136/bmjebm-2025-113722","DOIUrl":"10.1136/bmjebm-2025-113722","url":null,"abstract":"<p><strong>Objective: </strong>To assess evidence of overall survival (OS) benefits of cancer drugs listed in China's National Reimbursement Drug List (NRDL), the guiding standard for public insurance coverage of drugs and characterise the evolution of survival evidence after NRDL inclusion.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>China's NRDL and journal publications.</p><p><strong>Participants: </strong>Adult cancer drug indications approved in China from 1 January 2005 to 30 June 2022.</p><p><strong>Main outcome measures: </strong>The primary outcome was the availability of OS benefit evidence at the time of initial NRDL listing, defined as a statistically significant survival gain over the control arm in pivotal clinical trials. The secondary outcome was the availability of evidence on clinical benefits after NRDL inclusion as of 31 December 2023, measured by OS and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) version 1.1. ESMO-MCBS scores A to B in the curative setting or 4 or 5 in the non-curative setting were considered a substantial clinical benefit.</p><p><strong>Results: </strong>By 30 June 2022, 72.6% (175/241) of cancer indications approved in China were included in the NRDL. The median time interval between marketing authorisation and NRDL inclusion decreased from 9.4 years in 2005-2010 to 4.1 years in 2011-2016, and 1.1 years in 2017-2022. 62 (35.4%) and 4 (2.3%) indications had documented OS benefits at the time of NRDL assessment or after, respectively. The median survival benefit was 3.9 months. Of the 109 indications without documented OS benefits by the end of the observation, 21 (19.3%) had substantial clinical benefits as measured by the ESMO-MCBS.</p><p><strong>Conclusions and relevance: </strong>The time interval from regulatory approval to NRDL listing in China decreased over time. However, more than half of cancer drug indications listed for public insurance reimbursement did not have confirmed survival gain or substantial clinical benefits at the time of NRDL inclusion or after. Payers should give sufficient consideration to clinical benefit evidence when making reimbursement and disinvestment decisions to avoid wasteful spending of public health insurance funds.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"189-198"},"PeriodicalIF":10.8,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educating health professionals in evidence-based practice in 2026.","authors":"Tiziano Innocenti, Gordon Guyatt, Nino Cartabellotta, Paul Glasziou, Dragan Ilic, David Nunan","doi":"10.1136/bmjebm-2025-114184","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114184","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855846","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":"Equity and representativeness in pragmatic drug trials: methodological and ethical considerations.","authors":"Rafael Dal-Re, Ana Abreu, Tor Biering-Sørensen, Christopher P Gale, Sigrun Halvorsen, Søren Holm, Borja Ibanez, Stefan James, Roberto Latini, David Shaw","doi":"10.1136/bmjebm-2025-114106","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114106","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147761965","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":"Uncovering seeding trials: examining non-scientific purposes in clinical trials.","authors":"Sukhun Kang, Ivan Lin, Sungyong Chang","doi":"10.1136/bmjebm-2025-114242","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114242","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637835","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":"Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: an overview of systematic reviews and evidence mapping.","authors":"Qingcong Mo, Zhenmeng Deng, Jialing Zheng, Tong Wu, Fangfei Hu, Siqi Xu, Jihua Zou, Xiaoyan Zheng","doi":"10.1136/bmjebm-2025-114067","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114067","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effectiveness and clinical relevance of kinesio taping (KT) in musculoskeletal disorders (MSDs) at different follow-ups.</p><p><strong>Design: </strong>Overview of systematic reviews (SRs) and evidence mapping.</p><p><strong>Information sources: </strong>Ten electronic databases were searched for SRs published from inception to 31 December 2024, and updated on 15 October 2025.</p><p><strong>Eligibility criteria: </strong>SRs with and without meta-analysis of randomised controlled trials (RCTs) were eligible for inclusion if they compared KT with interventions other than KT (eg, active interventions, no tape, placebo/sham KT) in participants with MSDs.</p><p><strong>Main outcome measures: </strong>The primary outcomes were pain intensity, function/disability, range of motion, muscle strength, quality of life and disease-specific symptoms. The secondary outcome was adverse events (AEs).</p><p><strong>Results: </strong>A total of 128 SRs (73 published SRs and 55 registered yet unpublished SRs) involving 15 812 participants from 310 unique RCTs were included. Substantial SRs were focused on lower extremity conditions (45%) and reported pain intensity (89%). Most SRs were evaluated as critically low (78%) in methodological quality and low (58%) in risk of bias, with a median total compliance rate of 75.6% in reporting quality. Findings from new meta-analyses indicated that KT may reduce pain intensity in the immediate (Hedges' g -0.69, 95% CI -0.81 to -0.57) and short (Hedges' g -0.57, 95% CI -0.77 to -0.37) term and improve function/disability (Hedges' g -0.54, 95% CI -0.69 to -0.40) in the immediate term. These effect estimates may achieve the predefined minimal clinically important difference of 0.5 SD (medium effect size). KT may show little to no effect on pain intensity in the medium term, function/disability in the short and medium term, muscle strength, range of motion, disease-specific symptoms at all follow-ups. The effects of KT may vary across subgroups or conditions, and its impact on quality of life is unclear. AEs related to KT mainly included skin irritation (number needed to harm (NNH) 173) and pruritus (NNH 356). All evidence was highly inconclusive due to very low certainty (Grading of Recommendations Assessment, Development and Evaluation), non-significant level (evidence level) and unstable clinical relevance across most outcomes.</p><p><strong>Conclusions: </strong>Current evidence is very uncertain regarding the clinical effects of KT on MSDs. Considerable heterogeneity, unclear clinical relevance and potential AEs may limit its application in clinical practice. Further high-quality, well-reported RCTs and SRs are warranted to address the uncertainty regarding overall effects along with comprehensive consideration of heterogeneity in KT usage.</p><p><strong>Prospero registration number: </strong>CRD42024517528.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589942","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":"Evidence contamination: what it is and why it matters.","authors":"Chang Xu, Luis Furuya-Kanamori, Zhichun Gu, Yoon Loke, Lifeng Lin, Jennifer Stone, Zhaohu Fan, Su Golder, Zongshi Qin, Xiaodong Guan, Justin Clark, Liang Du, Sheyu Li, Yang Song, Linan Zeng, Haitao Chu, Mohammad Hassan Murad, Ben W Mol, Sunita Vohra, Suhail A Doi","doi":"10.1136/bmjebm-2025-114305","DOIUrl":"https://doi.org/10.1136/bmjebm-2025-114305","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147526549","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":"MetaImpact: a novel tool to enable evidence-based sample sizes for future trials.","authors":"Clareece Nevill, Terence J Quinn, Nicola Cooper, Alex Sutton","doi":"10.1136/bmjebm-2025-113694","DOIUrl":"10.1136/bmjebm-2025-113694","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"135-138"},"PeriodicalIF":7.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336310","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":"Effects of various exercise interventions in insomnia patients: a systematic review and network meta-analysis.","authors":"Zhi-Jun Bu, Feng-Shuang Liu, Md Shahjalal, Yi-Ke Song, Meng-Chi Li, Rong-Er Zhuo, Qing-Hong Zhong, Ya-Wen Du, Chen-Ge Lu, Zi-Han Yang, Han-Yu Yang, Pu Zhong, Jian-Ping Liu, Zhao-Lan Liu","doi":"10.1136/bmjebm-2024-113512","DOIUrl":"10.1136/bmjebm-2024-113512","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the effectiveness of different exercise interventions in improving sleep quality and alleviating insomnia severity among patients with insomnia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Our study design was a systematic review and network meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Our study eligibility criteria was restricted to include randomised controlled trials (RCTs) involving adults with insomnia that evaluated exercise-based interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;PubMed, Cochrane Library, Embase, Web of Science, SPORTDiscus, and PsycINFO databases were systematically searched from inception to 1 April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias and certainty assessment: &lt;/strong&gt;Risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. The certainty of the evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) platform.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;A frequentist network meta-analysis was performed to assess the effectiveness of interventions, with outcomes presented as mean differences (MDs) and 95% confidence intervals (95% CIs). Sleep outcomes were measured using validated tools, including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), sleep diaries, and combined objective sleep measures such as polysomnography or actigraphy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The review included 1348 participants from 22 RCTs, examining 13 distinct interventions, of which seven were exercise-based: yoga, Tai Chi, walking or jogging, aerobic plus strength exercise, strength training alone, aerobic exercise combined with therapy, and mixed aerobic exercises. Among the included trials, four (18%) were rated as low risk of bias, 15 (68%) had some concerns, and three (14%) were considered to have a high risk. Compared with active controls (eg, usual care, lifestyle modifications), yoga likely results in a large increase in total sleep time (MD 110.88 minutes (min), 95% CI 58.66 to 163.09; moderate-certainty evidence) and may improve sleep efficiency (MD 15.59%, 95% CI 5.76 to 25.42; low-certainty evidence), reduce wake after sleep onset (MD -55.91 min, 95% CI -98.14 to -13.68; low-certainty evidence), and shorten sleep onset latency (MD -29.27 min, 95% CI -50.09 to -8.45; low-certainty evidence), all based on sleep diary data. Walking or jogging may result in a large reduction in ISI scores (MD -9.57 points, 95% CI -12.12 to -7.02; low-certainty evidence). Tai Chi may reduce PSQI scores (MD -4.57 points, 95% CI -7.50 to -1.63; low-certainty evidence), increase total sleep time (MD 52.07 min, 95% CI 25.53 to 78.61; low-certainty evidence), reduce wake after sleep onset (MD -36.11 min, 95% CI -62.81 to -9.42; low-certainty evidence), and shorten sleep onset latency (MD -24.76 min, 95% CI -41.07 to -8.46; low-certainty evidence), also based on sleep diary data. Additionally, Tai Chi may increase total sleep time as measured by combined obje","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"102-113"},"PeriodicalIF":10.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641756","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}