BMJ Evidence-Based Medicine最新文献

Objectives: To investigate the reporting, data sharing and spin (using reporting strategies to emphasise the benefit of non-significant results) in acupuncture randomised controlled trials (RCTs).

Design: Cross-sectional meta-epidemiological study.

Data sources: Eligible studies indexed in MEDLINE, Embase, CENTRAL, CBM, CNKI, Wanfang Data and VIP Database between 1 January 2014 and 1 May 2024.

Eligibility criteria: Peer-reviewed acupuncture RCTs used traditional medicine (TM), published in English or Chinese, two parallel arms for humans.

Main outcome measures: We assessed (1) the reporting of acupuncture RCTs by the Consolidated Standards for Reporting Trials (CONSORT) 2010 statement and STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) checklist; (2) the data sharing level by the International Committee of Medical Journal Editors (ICMJE) data sharing statement; (3) spin frequency and level by the prespecified spin strategies.

Results: This study evaluated 476 eligible studies, of which 166 (34.9%) explored the specific efficacy or safety of acupuncture in the nervous system, 68 (14.3%) in the motor system and 61 (12.8%) in the digestive system. 244 (57.7%) studies used conventional acupuncture, 296 (62.2%) used multicentre study design and 369 (77.5%) were supported by institutional funding. 312 (65.5%) eligible studies were poorly reported. The sufficiently reporting scores of the CONSORT 2010 statement and the STRICTA checklist differed from 0.63% to 97.5%, and 32 (59.3%) items were less than 50%. For the data sharing level of acupuncture RCTs, only 66 (17.2%) studies followed the ICMJE data sharing statement, but 49 (14.5%) need to require authors to obtain data, and only 5 (1.5%) provided data by open access. Spins were identified in 408 (85.7%) studies (average spin frequencies: 2.94). 59 (37.2%) studies with non-significant primary outcomes had spin levels.

Conclusions: This study found that the reporting of acupuncture RCTs was low compliance with the CONSORT 2010 statement, the STRICTA checklist and the ICMJE data sharing statement, and spin appeared frequently. Journal policies on using reporting guidelines, data sharing and equitable consideration of non-significant results might enhance the reporting of acupuncture RCTs.

Trial registration number: This study was registered at the Open Science Framework (OSF): (https://doi.org/10.17605/OSF.IO/2WTE6, and https://doi.org/10.17605/OSF.IO/9XDN4,).

Existing reporting checklists lack the specificity and comprehensiveness required to effectively guide the documentation of acupuncture case reports. Therefore, we developed a reporting guideline tailored specifically for acupuncture case reports, building upon the CAse REport (CARE) statement. A multidisciplinary group of international experts including clinicians, researchers and methodologists was convened to draft the initial checklist in accordance with the methodology recommended by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. Through an extensive literature review and a series of expert interviews, the final CARE for acupuncture checklist comprised of 30 items. 38 experts from diverse disciplines participated in three rounds of modified Delphi surveys to refine and clarify these items. CARE for acupuncture is a comprehensive reporting guideline focused on acupuncture case reports developed with rigorous methodology. We hope that CARE for acupuncture will further guide authors, editors, peer reviewers and readers to enhance the transparency, completeness and accuracy of reporting of case reports in acupuncture.

Objective: This study evaluates whether Taiwan's national oral cancer screening programme, implemented in 1999, has led to a reduction in late-stage oral cancer and mortality.

Design: An observational population-based ecological cohort study (2004-2022) using data from the Taiwan Cancer Registry, a nationwide cancer registry.

Setting: Taiwan, an island nation with a population of 23.5 million.

Participants: The entire male population in the nation diagnosed with oral cancer between 2004 and 2022.

Main outcome measures: Change in stage-specific, age-standardised incidence and mortality of oral cancer and their annual percentage change (APC). We hypothesised that an effective screening programme would lead to an increase in early-stage cancer diagnoses while reducing late-stage cancer incidence and mortality.

Results: A total of 92 342 males were diagnosed with oral cancer in Taiwan between 2004 and 2022. Following the introduction of the national oral cancer screening programme, the incidence of early-stage (stages 0-1) oral cancer increased 2.4-fold from 6.6 to 14.5 per 100 000 males between 2004 and 2013 (APC: 11.3% (95% CI 9.4% to 13.5%), p<0.001). However, early-stage incidence subsequently declined to 11.8 per 100 000 males by 2022 (APC: -3.2% (95% CI -5.2% to -1.6%), p<0.001), corresponding to a period of decreased screening uptake between 2015 and 2022. The late-stage (stages 2-4) oral cancer increased from 24.5 to 28.3 per 100 000 males between 2004 and 2009 (APC: 3.3% (95% CI 1.8% to 6.6%), p<0.001) and then remained relatively stable between 2009 and 2022 (APC: 0.1% (95% CI -0.5% to 0.5%), p=0.65). Oral cancer mortality increased from 14.4 to 16.6 per 100 000 males over the entire examined period between 2004 and 2022 (APC: 0.76% (95% CI 0.5% to 1.1%), p<0.001), showing no observed decline despite two decades of screening efforts and a continued decrease in prevalence of betel quid use.

Conclusions: Although oral cancer screening detected more early-stage cancer, no reduction in population late-stage incidence or mortality was observed. Therefore, reducing betel quid and cigarette consumption should be the primary focus for oral cancer control. The public health response to oral cancer should borrow from lessons learnt in tobacco control.