BMJ Evidence-Based Medicine最新文献

{"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":"19 1","pages":""},"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":"31 1","pages":""},"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":"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":"33 1","pages":""},"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}

{"title":"Major UK non-commercial sponsors’ efforts to reduce research waste: a mixed-methods study","authors":"Till Bruckner, Aminul Schuster, Belén Chavarría, Carolina Cruz, Fabiola Karely Lizárraga Illán, Ronak Borana, Tungamirai Ishe Bvute, Daniel Sánchez","doi":"10.1136/bmjebm-2023-112540","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112540","url":null,"abstract":"Worldwide, a significant proportion of clinical trials end up as costly research waste because their results are never made public.1–3 The resulting gaps in the medical evidence base harm patients and undermine public health.4 The Declaration of Helsinki and the WHO both call for all clinical trial results to be made public.5 6 In the wake of a 2018 UK parliamentary enquiry, non-commercial clinical trial sponsors in the UK substantially improved outcome reporting for drug trials (Clinical Trials of Investigative Medicinal Products, CTIMPs) by uploading the summary results of many CTIMPs onto the European Union Clinical Trials Register (EUCTR) which exclusively lists drug trials. However, these efforts typically did not extend to other types of trials, which are listed on other trial registries. This study assesses the current publication status of 145 clinical trials that are not CTIMPs that were sponsored by ten major UK non-commercial sponsors and were completed or terminated in 2017, allowing a 5-year follow-up period for publication. The lead researcher (TB) identified the 10 most prolific non-commercial sponsors of clinical trials in the UK by accessing the EU Trials Tracker on 27 October 2022, employing the …","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":"166 1-2 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612327","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":"Trivalent and quadrivalent seasonal influenza vaccine in adults aged 60 and older: a systematic review and network meta-analysis","authors":"Areti Angeliki Veroniki, Sai Surabi Thirugnanasampanthar, Menelaos Konstantinidis, Jasmeen Dourka, Marco Ghassemi, Dipika Neupane, Paul Khan, Vera Nincic, Margarita Corry, Reid Robson, Amanda Parker, Charlene Soobiah, Angela Sinilaite, Pamela Doyon-Plourde, Anabel Gil, Winnie Siu, Nasheed Moqueet, Adrienne Stevens, Kelly English, Ivan D Florez, Juan J Yepes-Nuñez, Brian Hutton, Matthew Muller, Lorenzo Moja, Sharon Straus, Andrea C Tricco","doi":"10.1136/bmjebm-2023-112767","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112767","url":null,"abstract":"Objectives To compare the efficacy of influenza vaccines of any valency for adults 60 years and older. Design and setting Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from inception to 20 June 20, 2022. Two reviewers screened, abstracted, and appraised articles (Cochrane Risk of Bias (ROB) 2.0 tool) independently. We assessed certainty of findings using Confidence in Network Meta-Analysis and Grading of Recommendations, Assessment, Development and Evaluations approaches. We performed random-effects meta-analysis and network meta-analysis (NMA), and estimated odds ratios (ORs) for dichotomous outcomes and incidence rate ratios (IRRs) for count outcomes along with their corresponding 95% confidence intervals (CIs) and prediction intervals. Participants Older adults (≥60 years old) receiving an influenza vaccine licensed in Canada or the USA (vs placebo, no vaccine, or any other licensed vaccine), at any dose. Main outcome measures Laboratory-confirmed influenza (LCI) and influenza-like illness (ILI). Secondary outcomes were the number of vascular adverse events, hospitalisation for acute respiratory infection (ARI) and ILI, inpatient hospitalisation, emergency room (ER) visit for ILI, outpatient visit, and mortality, among others. Results We included 41 RCTs and 15 companion reports comprising 8 vaccine types and 206 032 participants. Vaccines may prevent LCI compared with placebo, with high-dose trivalent inactivated influenza vaccine (IIV3-HD) (NMA: 9 RCTs, 52 202 participants, OR 0.23, 95% confidence interval (CI) (0.11 to 0.51), low certainty of evidence) and recombinant influenza vaccine (RIV) (OR 0.25, 95%CI (0.08 to 0.73), low certainty of evidence) among the most efficacious vaccines. Standard dose trivalent IIV3 (IIV3-SD) may prevent ILI compared with placebo, but the result was imprecise (meta-analysis: 2 RCTs, 854 participants, OR 0.39, 95%CI (0.15 to 1.02), low certainty of evidence). Any HD was associated with prevention of ILI compared with placebo (NMA: 9 RCTs, 65 658 participants, OR 0.38, 95%CI (0.15 to 0.93)). Adjuvanted quadrivalent IIV (IIV4-Adj) may be associated with the least vascular adverse events, but the results were very uncertain (NMA: eight 8 RCTs, 57 677 participants, IRR 0.18, 95%CI (0.07 to 0.43), very low certainty of evidence). RIV on all-cause mortality may be comparable to placebo (NMA: 20 RCTs, 140 577 participants, OR 1.01, 95%CI (0.23 to 4.49), low certainty of evidence). Conclusions This systematic review demonstrated efficacy associated with IIV3-HD and RIV vaccines in protecting older persons against LCI. RIV vaccine may reduce all-cause mortality when compared with other vaccines, but the evidence is uncertain. Differences in efficacy between influenza vaccines remain uncertain with very low to moderate certainty of evidence. PROS","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":"30 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561447","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":"A call for community-shared decisions","authors":"Jason N Doctor, Daniella Meeker, Craig R Fox, Stephen D Persell, Zachary Wagner, Kathryn E Bouskill, Kyle A Zanocco, Robert J Romanelli, Chad M Brummett, Allison Kirkegaard, Katherine E Watkins","doi":"10.1136/bmjebm-2023-112641","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112641","url":null,"abstract":"Shared decision-making in medicine is widely viewed as a collaboration between the patient and the clinician. For example, Montori et al state, ‘The patient and clinician must collaborate to arrive at a useful formulation of the problem’.1 Patients are encouraged to evaluate care choices in light of the benefits and harms of each, state their preferences and identify the best course of action along with their doctor.2 Despite its broad reach, shared decision-making solely between a patient and doctor has clear limits. Over 30 years ago, Brock and Wartman cautioned that ‘[p]atients do not have an unqualified right to make even rational individual choices that risk serious harm to others’.3 Elywin et al noted that ‘limits on shared decision-making will occur when… wider interests overrule individual wishes’.4 These authors lay out problems with shared decisions for antibiotics, opioids and vaccine hesitancy. A crucial gap is how to address these problems in practice. Antibiotic-resistant bacterial infections, overdoses from diverted opioid pills and the resurgence of measles are all medical problems that affect an individual through actions others in the community have taken. Here cooperation has either failed or has not been attempted at all. Lack of cooperation occurs when individuals believe it is in their best interest to deviate from the action that they would like others to take.5 While various forms of cooperative behaviour exist in the wild (eg, a large number of individuals choose to recycle, vote, tip at restaurants and donate to charity),5 there are barriers to cooperation in medicine that require special attention. Two of the biggest barriers are a lack of awareness that cooperation is needed and the implementation of approaches to encourage cooperation. To address barriers, community members benefit from working towards a resolution on a common strategy that …","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":"12 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561446","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":"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":"https://doi.org/10.1136/bmjebm-2023-112607","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-03-27","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":"Can the HEARTS initiative reduce the burden of cardiovascular disease?","authors":"Martin O'Flaherty, Nikkil Sudharsanan, Chris Kypridemos","doi":"10.1136/bmjebm-2023-112590","DOIUrl":"https://doi.org/10.1136/bmjebm-2023-112590","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140189487","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":"Visualisation of evidence for shared decision making.","authors":"Marie-Anne Durand, Kevin Selby, Yasmina Okan","doi":"10.1136/bmjebm-2023-112565","DOIUrl":"10.1136/bmjebm-2023-112565","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"117-120"},"PeriodicalIF":5.8,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648383","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":"Talk to me, but rather: talk to each other.","authors":"Marloes Keeris","doi":"10.1136/bmjebm-2023-112653","DOIUrl":"10.1136/bmjebm-2023-112653","url":null,"abstract":"","PeriodicalId":9059,"journal":{"name":"BMJ Evidence-Based Medicine","volume":" ","pages":"135-136"},"PeriodicalIF":5.8,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72013432","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}