BMJ Evidence-Based Medicine最新文献

{"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":"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":"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":"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}

{"title":"Encounter versus patient decision aids to enhance shared decision-making.","authors":"Joshua Christensen, Angie Fagerlin, Kirstin Beck, Elissa M Ozanne","doi":"10.1136/bmjebm-2024-113208","DOIUrl":"https://doi.org/10.1136/bmjebm-2024-113208","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963736","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":"Cancer screening attendance rates in transgender and gender-diverse patients: a systematic review and meta-analysis.","authors":"Alvina Chan, Charlotte Jamieson, Hannah Draper, Stewart O'Callaghan, Barbara-Ann Guinn","doi":"10.1136/bmjebm-2023-112719","DOIUrl":"10.1136/bmjebm-2023-112719","url":null,"abstract":"<p><strong>Objectives: </strong>To examine disparities in attendance rates at cancer screening services between transgender and gender-diverse (TGD) people in comparison with their cisgender (CG) counterparts, and to determine whether these differences were based on the anatomical organ screened.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>PubMed, EMBASE (via Ovid), CINAHL Complete (via EBSCO) and Cochrane Library from inception to 30 September 2023.</p><p><strong>Methods: </strong>Studies for inclusion were case-control or cross-sectional studies with quantitative data that investigated TGD adults attending any cancer screening service. Exclusion criteria were studies with participants who were ineligible for cancer screening or without samples from TGD individuals, qualitative data and a cancer diagnosis from symptomatic presentation or incidental findings. A modified Newcastle-Ottawa Scale was used to assess risk of bias, during which seven reports were found incompatible with the inclusion criteria and excluded. Results were synthesised through random-effects meta-analysis and narrative synthesis.</p><p><strong>Results: </strong>We identified 25 eligible records, of which 18 were included in the analysis. These were cross-sectional studies, including retrospective chart reviews and survey analyses, and encompassed over 14.8 million participants. The main outcomes measured were up-to-date (UTD) and lifetime (LT) attendance. Meta-analysis found differences for UTD cervical (OR 0.37, 95% CI 0.23 to 0.60, p<0.0001) and mammography (OR 0.41, 95% CI 0.20 to 0.87, p=0.02) but not for prostate or colorectal screening. There were no meaningful differences seen in LT attendance based on quantitative synthesis. Narrative synthesis of the seven remaining articles mostly supported the meta-analysis. Reduced rates of screening engagement in TGD participants were found for UTD cervical and mammography screening, alongside LT mammography screening.</p><p><strong>Conclusions: </strong>Compared with their CG counterparts, TGD individuals had lower rates of using cervical and mammography screening at the recommended frequencies but displayed similar prevalences of LT attendance. The greatest disparity was seen in UTD cervical screening. Limitations of this review included high risk of bias within studies, high heterogeneity and a lack of resources for further statistical testing. Bridging gaps in healthcare to improve cancer screening experiences and outcomes will require consolidated efforts including working with the TGD community.</p><p><strong>Prospero registration number: </strong>CRD42022368911.</p>","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"385-393"},"PeriodicalIF":9.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141578895","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":"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":" ","pages":"353-357"},"PeriodicalIF":9.0,"publicationDate":"2024-11-22","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":"Reporting health and medical research.","authors":"Harrison J Hansford, Georgia C Richards, Matthew J Page, Melissa K Sharp, Hopin Lee, Aidan G Cashin","doi":"10.1136/bmjebm-2023-112563","DOIUrl":"10.1136/bmjebm-2023-112563","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"358-362"},"PeriodicalIF":9.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058654","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}