BMJ Evidence-Based Medicine最新文献

{"title":"Potential impact of large language models on academic writing.","authors":"Fares Alahdab","doi":"10.1136/bmjebm-2023-112429","DOIUrl":"10.1136/bmjebm-2023-112429","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10123561","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":"Overly complex methods may impair pragmatic use of core evidence-based medicine principles.","authors":"Rebecca Kuehn, Ying Wang, Gordon Guyatt","doi":"10.1136/bmjebm-2024-112868","DOIUrl":"10.1136/bmjebm-2024-112868","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058653","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":"Direct-to-consumer advertising: a modifiable driver of overdiagnosis and overtreatment.","authors":"David B Menkes, Barbara Mintzes, Joel Lexchin","doi":"10.1136/bmjebm-2023-112622","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112622","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955614","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":"https://doi.org/10.1136/bmjebm-2023-112813","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-05-08","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":"Feasibility of multiorgan risk prediction with routinely collected diagnostics: a prospective cohort study in the UK Biobank","authors":"Celeste McCracken, Zahra Raisi-Estabragh, Liliana Szabo, Michele Veldsman, Betty Raman, Anya Topiwala, Adriana Roca-Fernández, Masud Husain, Steffen E Petersen, Stefan Neubauer, Thomas E Nichols","doi":"10.1136/bmjebm-2023-112518","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112518","url":null,"abstract":"Objectives Despite rising rates of multimorbidity, existing risk assessment tools are mostly limited to a single outcome of interest. This study tests the feasibility of producing multiple disease risk estimates with at least 70% discrimination (area under the receiver operating curve, AUROC) within the time and information constraints of the existing primary care health check framework. Design Observational prospective cohort study Setting UK Biobank. Participants 228 240 adults from the UK population. Interventions None. Main outcome measures Myocardial infarction, atrial fibrillation, heart failure, stroke, all-cause dementia, chronic kidney disease, fatty liver disease, alcoholic liver disease, liver cirrhosis and liver failure. Results Using a set of predictors easily gathered at the standard primary care health check (such as the National Health Service Health Check), we demonstrate that it is feasible to simultaneously produce risk estimates for multiple disease outcomes with AUROC of 70% or greater. These predictors can be entered once into a single form and produce risk scores for stroke (AUROC 0.727, 95% CI 0.713 to 0.740), all-cause dementia (0.823, 95% CI 0.810 to 0.836), myocardial infarction (0.785, 95% CI 0.775 to 0.795), atrial fibrillation (0.777, 95% CI 0.768 to 0.785), heart failure (0.828, 95% CI 0.818 to 0.838), chronic kidney disease (0.774, 95% CI 0.765 to 0.783), fatty liver disease (0.766, 95% CI 0.753 to 0.779), alcoholic liver disease (0.864, 95% CI 0.835 to 0.894), liver cirrhosis (0.763, 95% CI 0.734 to 0.793) and liver failure (0.746, 95% CI 0.695 to 0.796). Conclusions Easily collected diagnostics can be used to assess 10-year risk across multiple disease outcomes, without the need for specialist computing or invasive biomarkers. Such an approach could increase the utility of existing data and place multiorgan risk information at the fingertips of primary care providers, thus creating opportunities for longer-term multimorbidity prevention. Additional work is needed to validate whether these findings would hold in a larger, more representative cohort outside the UK Biobank. Data may be obtained from a third party and are not publicly available. This analysis was produced under UK Biobank Access Application 59867. The data in this study are owned by the UK Biobank (www. ukbiobank.ac.uk) and legal constraints do not permit public sharing of the data. The UK Biobank, however, is open to all bona fide researchers anywhere in the world. Thus, the data used in this communication can be easily and directly accessed by applying through the UK Biobank Access Management System (www.ukbiobank.ac.uk/ register-apply). Results from this study will be returned to UK Biobank according to their published returns policy.","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883781","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":"Cost-effectiveness of emicizumab prophylaxis for haemophilia A with inhibitors: an adaptive health technology assessment for the Indian setting","authors":"Sitanshu Sekhar Kar, Parthibane Sivanantham, Vanessa Ravel, Abha Mehndiratta, Kirti Tyagi, Daniel A Ollendorf","doi":"10.1136/bmjebm-2023-112492","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112492","url":null,"abstract":"Objective To assess the cost-effectiveness of emicizumab prophylaxis for patients having haemophilia A with inhibitors in the Indian context using an adaptive health technology assessment (aHTA) methodology. Design Economic evaluation using multiple approaches aimed at adjusting previously generated cost-effectiveness results based on (1) price differences only (‘simple’) and (2) differences in cost and expected treatment duration (‘moderate’) and differences in cost, inflation and life expectancy (‘complex’). Setting Typical haemophilia care in India. Participants Patients with haemophilia A and inhibitors. Intervention Emicizumab prophylaxis using two vial strengths (30 or 150 mg/mL) in comparison to no prophylaxis. Main outcome measures Adjusted incremental cost-effectiveness ratio (ICERa), incremental costs and incremental quality-adjusted life years associated with emicizumab prophylaxis from both the health system and societal perspectives. Results Using the simple ICER adjustment method, emicizumab prophylaxis resulted in potential cost savings from the payers’ perspective for both vial strengths in patients aged ≥12 and <12 years. However, from a societal perspective, emicizumab prophylaxis was not cost-effective. Using the moderate adjustment method, emicizumab prophylaxis showed potential cost saving from the health system perspective. The complex adjustment method also revealed cost savings for emicizumab prophylaxis from the health system and societal perspectives across different age groups. Conclusion We found that implementing emicizumab prophylaxis for patients with haemophilia A and inhibitors in India has the potential to result in cost savings. This study highlights the feasibility of using the expanded aHTA methodology for rapid evidence generation in the Indian context. However, it is crucial to address certain research gaps, including data limitations, challenges in translating international evidence to Indian context and associated uncertainties. Additionally, conducting a comprehensive budget impact analysis is necessary. These findings hold significant implications for decision-making regarding the potential provision of emicizumab prophylaxis through federal or/and state government-funded programmes and institutions in India. Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883738","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":"Global considerations for informed consent with shared decision-making in the digital age","authors":"Edward Robert St John, Connor James Stewart Moore, Raghu Ram Pillarisetti, Erica Sarah Spatz","doi":"10.1136/bmjebm-2023-112740","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112740","url":null,"abstract":"Shared decision-making (SDM) is increasingly recognised as fundamental to patient-centred care and enabling patients to make voluntary, informed decisions about their health.1 SDM is the process whereby patients and clinicians come together to share their expertise. The patient acts as an expert of themselves, understanding their own preferences and their attitudes to risk. The clinician is an expert on the medical knowledge and scientific evidence. Together, treatment options should be explored, arriving at a treatment decision that is right for the patient and supported by the clinician. When dealing with invasive or high-risk procedures (eg, operations, chemotherapy, radiotherapy, immunotherapy), once the treatment decision has been made, the conversation turns to informed consent. This is the process of communicating and agreeing to the potential risks and benefits of the procedure, while acknowledging that there are alternative treatment options that have not been chosen. Though informed consent should be the culmination of SDM, alone it does not encapsulate the entire process. There is a distinction between decision-making and consent and this should ideally be accompanied by a period for reflection. Despite advances in SDM, the subsequent informed consent process has remained stagnant, often failing to meet ethical or legal standards of supporting meaningful patient autonomy.2 In reality, rapid surgical decisions may be required (e.g. emergency or cancer pathways), where time is a precious commodity to deliver optimal patient care. In these scenarios, it is common for discussions to move quickly from diagnosis to treatment options, to consent. However, scarcity of clinician time should not be an excuse for inadequate consent. Therefore, reimagining the consent process in the digital age by ensuring the benefits, risks and alternative treatment options are clearly and correctly presented as early as possible, has the ability of transforming this step from a ritualised gesture into a …","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140841217","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":"Genetic predisposition, modifiable lifestyles, and their joint effects on human lifespan: evidence from multiple cohort studies","authors":"Zilong Bian, Lijuan Wang, Rong Fan, Jing Sun, Lili Yu, Meihong Xu, Paul R H J Timmers, Xia Shen, James F Wilson, Evropi Theodoratou, Xifeng Wu, Xue Li","doi":"10.1136/bmjebm-2023-112583","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112583","url":null,"abstract":"Objective To investigate the associations across genetic and lifestyle factors with lifespan. Design A longitudinal cohort study. Setting UK Biobank. Participants 353 742 adults of European ancestry, who were recruited from 2006 to 2010 and were followed up until 2021. Exposures A polygenic risk score for lifespan with long (<lowest quintile), intermediate (quintiles 2 to 4), and short (>highest quintile) risk categories and a weighted healthy lifestyle score, including no current smoking, moderate alcohol consumption, regular physical activity, healthy body shape, adequate sleep duration, and a healthy diet, categorised into favourable, intermediate, and unfavourable lifestyles. Main outcome measures Lifespan defined as the date of death or the censor date minus the date of birth. Results Of the included 353 742 participants of European ancestry with a median follow-up of 12.86 years, 24 239 death cases were identified. Participants were grouped into three genetically determined lifespan categories including long (20.1%), intermediate (60.1%), and short (19.8%), and into three lifestyle score categories including favourable (23.1%), intermediate (55.6%), and unfavourable (21.3%). The hazard ratio (HR) of death for individuals with a genetic predisposition to a short lifespan was 1.21 (95% CI 1.16 to 1.26) compared to those with a genetic predisposition to a long lifespan. The HR of death for individuals in the unfavourable lifestyle category was 1.78 (95% CI 1.71 to 1.85), compared with those in the favourable lifestyle category. Participants with a genetic predisposition to a short lifespan and an unfavourable lifestyle had 2.04 times (95% CI 1.87 to 2.22) higher rates of death compared with those with a genetic predisposition to a long lifespan and a favourable lifestyle. No multiplicative interaction was detected between the polygenic risk score of lifespan and the weighted healthy lifestyle score (p=0.10). The optimal combination of healthy lifestyles, including never smoking, regular physical activity, adequate sleep duration, and a healthy diet, was derived to decrease risk of premature death (death before 75 years). Conclusion Genetic and lifestyle factors were independently associated with lifespan. Adherence to healthy lifestyles could largely attenuate the genetic risk of a shorter lifespan or premature death. The optimal combination of healthy lifestyles could convey better benefits for a longer lifespan, regardless of genetic background. Data are available in a public, open access repository. NHANES data are available at <http://www.cdc.gov/nchs/nhis/index.htm>. UK Biobank study was under Application Number 66354. The UK Biobank is an open access resource and bona fide researchers can apply to use the UK Biobank dataset by registering and applying at <http://ukbiobank.ac.uk/register-apply/>. Further information is available from the corresponding author upon request.","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140841182","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":"Insights on the German College of General Practitioners and Family Physicians (DEGAM) guideline addressing medical overuse.","authors":"Lisette Warkentin, Susann Hueber, Thomas Kühlein, Martin Scherer","doi":"10.1136/bmjebm-2023-112697","DOIUrl":"10.1136/bmjebm-2023-112697","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139939659","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":"Bad news: how the media reported on an observational study about cardiovascular outcomes of COVID-19","authors":"Camilla Alderighi, Raffaele Rasoini, Rebecca De Fiore, Fabio Ambrosino, Steven Woloshin","doi":"10.1136/bmjebm-2023-112814","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112814","url":null,"abstract":"Medical research gets plenty of media attention. Unfortunately, the attention is often problematic, frequently failing to provide readers with information needed to understand findings or decide whether to believe them.1 Unless journalists highlight study cautions and limitations, avoid spin2 and overinterpretation of findings, the public may draw erroneous conclusions about the reliability and actionability of the research. Coverage of observational research may be especially challenging given inherent difficulty in inferring causation, a limitation that is rarely mentioned in medical journals articles or corresponding news.3 We used news coverage of a retrospective cohort study, published in Nature Medicine in 2022,4 as a case study to assess news reporting quality. The index study used national data from US Department of Veteran Affairs to characterise the post-acute cardiovascular manifestations of COVID-19. We chose this study because of its potential public health impact (ie, reporting increased cardiovascular diseases after even mild COVID-19 infection) and its enormous media attention: one of the highest Altmetric scores ever (>20 k, coverage in over 600 news outlets and 40 000 tweets). Our study supplements a previous analysis limited to Italian news.5 To assess news quality, we derived a coding scheme (online supplemental appendix 1) from published quality measures developed to capture proper reporting of observational research6 7: the need to refrain from inappropriate causal inferences and unsupported …","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140611957","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}