BMJ Evidence-Based Medicine最新文献

Background: 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.

Objective: This study piloted an adaptive HTA (aHTA) method to evaluate 10 cancer interventions.

Methods: 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.

Results: 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.

Conclusion: 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.

Objectives: 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.

Design: Case-control study.

Setting: Biomedical journals.

Participants: Original peer-reviewed manuscripts submitted between 1 January 2012 and 31 December 2019.

Main outcome measure: Manuscripts accepted (cases) and rejected for publication (controls).

Results: 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).

Conclusions: 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.

Objectives: This study aimed to describe how health researchers identify and counteract fraudulent responses when recruiting participants online.

Design: Scoping review.

Eligibility criteria: 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.

Sources of evidence: Nine databases, including Medline, Informit, AMED, CINAHL, Embase, Cochrane CENTRAL, IEEE Xplore, Scopus and Web of Science, were searched from inception to April 2024.

Charting methods: 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.

Results: 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.

Conclusion: 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.

Objective: The objective of this study is to analyse the perspectives of screening candidates and healthcare professionals on shared decision-making (SDM) in prostate cancer (PCa) screening using the prostate-specific antigen (PSA) test.

Design: Descriptive qualitative study (May-December 2022): six face-to-face focus groups and four semistructured interviews were conducted, transcribed verbatim and thematically analysed using ATLAS.ti software.

Setting: Data were obtained as part of the project PROSHADE (Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer) to develop a tool for SDM in PCa screening with PSA testing in Spain.

Participants: A total of 27 screening candidates (three groups of men: 40-50 years old; 51-60 years old and 61-80 years old), 25 primary care professionals (one group of eight nurses and two groups of physicians: one with more and one with less than 10 years of experience), and four urologists. Focus groups for patients and healthcare professionals were conducted separately.

Main outcome measures: Participants' perceptions of shared decision-making related to PSA opportunistic screening, including their understanding, preferences, and attitudes.

Results: Three themes were generated: (1) perceptions of SDM, (2) perceptions of PSA testing and (3) perceptions of SDM regarding PCa screening. Theme 1: screening candidates valued SDM when it included clear information and empowered them. There was consensus with primary care health professionals on this point, although their knowledge and implementation of SDM varied. Theme 2: candidates were divided on PSA testing; some trusted it for early detection, while others expressed scepticism due to concerns about false positives and invasive procedures, reflecting gaps in accessible information. Theme 3: professionals across primary and specialised care stressed the need for standardised SDM protocols. Primary care physicians were particularly concerned that PSA decisions align with scientific evidence and urologists recognised SDM as valuable in PSA testing only if it was adequately explained to each patient. Barriers to implementing SDM included insufficient coordination across care levels, lack of consensus-driven protocols and limited clinical time.

Conclusions: While patients expect comprehensive information, primarily based on practice to achieve empowerment, healthcare professionals face obstacles such as limited time and insufficient coordination between primary care and urology. All stakeholders agree on the importance of evidence-based tools to reinforce effective SDM and enhance collaboration across urologists and primary care in the context of PSA testing.