Publisher: BMC (Biomed Central)   (Total: 308 journals)

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Showing 1 - 200 of 308 Journals sorted alphabetically
Acta Neuropathologica Communications     Open Access   (Followers: 1, SJR: 2.683, CiteScore: 5)
Acta Veterinaria Scandinavica     Open Access   (Followers: 4, SJR: 0.655, CiteScore: 1)
Addiction Science & Clinical Practice     Open Access   (Followers: 11, SJR: 1.224, CiteScore: 3)
Advances in Simulation     Open Access   (Followers: 7)
Agriculture & Food Security     Open Access   (Followers: 30, SJR: 0.575, CiteScore: 2)
AIDS Research and Therapy     Open Access   (Followers: 16, SJR: 1.08, CiteScore: 2)
Algorithms for Molecular Biology     Open Access   (Followers: 4, SJR: 1.333, CiteScore: 2)
Allergy, Asthma and Clinical Immunology     Open Access   (Followers: 29, SJR: 0.732, CiteScore: 2)
Alzheimer's Research & Therapy     Open Access   (Followers: 5, SJR: 2.449, CiteScore: 6)
Animal Biotelemetry     Open Access   (Followers: 2, SJR: 1.067, CiteScore: 2)
Animal Diseases     Open Access  
Animal Microbiome     Open Access   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 13, SJR: 1.104, CiteScore: 3)
Annals of General Psychiatry     Open Access   (Followers: 28, SJR: 0.784, CiteScore: 2)
Annals of Occupational and Environmental Medicine     Open Access   (Followers: 15, SJR: 0.452, CiteScore: 1)
Annals of Surgical Innovation and Research     Open Access   (Followers: 3, SJR: 0.328, CiteScore: 1)
Antimicrobial Resistance and Infection Control     Open Access   (Followers: 13, SJR: 1.573, CiteScore: 3)
Archives of Physiotherapy     Open Access   (Followers: 20)
Archives of Public Health     Open Access   (Followers: 13, SJR: 1.244, CiteScore: 3)
Arthritis Research & Therapy     Open Access   (Followers: 18, SJR: 2.154, CiteScore: 4)
Asthma Research and Practice     Open Access   (Followers: 2)
Basic and Clinical Andrology     Open Access   (SJR: 0.564, CiteScore: 2)
Behavioral and Brain Functions     Open Access   (Followers: 5, SJR: 0.986, CiteScore: 3)
Big Data Analytics     Open Access   (Followers: 34)
BioData Mining     Open Access   (Followers: 5, SJR: 0.982, CiteScore: 2)
Bioelectronic Medicine     Open Access   (Followers: 1)
Biological Procedures Online     Open Access   (SJR: 1.352, CiteScore: 4)
Biological Research     Open Access   (Followers: 1, SJR: 0.654, CiteScore: 2)
Biology Direct     Open Access   (Followers: 10, SJR: 1.694, CiteScore: 3)
Biology of Sex Differences     Open Access   (Followers: 2, SJR: 1.902, CiteScore: 4)
Biomarker Research     Open Access   (Followers: 3)
Biomaterials Research     Open Access   (Followers: 6, SJR: 0.735, CiteScore: 3)
Biomedical Dermatology     Open Access  
BioMedical Engineering OnLine     Open Access   (Followers: 7, SJR: 0.542, CiteScore: 2)
BioPsychoSocial Medicine     Open Access   (Followers: 9, SJR: 0.416, CiteScore: 1)
Biotechnology for Biofuels     Open Access   (Followers: 9, SJR: 1.899, CiteScore: 6)
BMC Anesthesiology     Open Access   (Followers: 18, SJR: 0.807, CiteScore: 2)
BMC Biochemistry     Open Access   (Followers: 15, SJR: 0.708, CiteScore: 2)
BMC Bioinformatics     Open Access   (Followers: 217, SJR: 1.479, CiteScore: 2)
BMC Biology     Open Access   (Followers: 63, SJR: 3.842, CiteScore: 5)
BMC Biomedical Engineering     Open Access  
BMC Biophysics     Open Access   (Followers: 4, SJR: 0.682, CiteScore: 2)
BMC Biotechnology     Open Access   (Followers: 17, SJR: 1.012, CiteScore: 3)
BMC Cancer     Open Access   (Followers: 34, SJR: 1.464, CiteScore: 3)
BMC Cardiovascular Disorders     Open Access   (Followers: 25, SJR: 0.909, CiteScore: 2)
BMC Chemical Engineering     Open Access  
BMC Clinical Pathology     Open Access   (Followers: 8, SJR: 1.141, CiteScore: 3)
BMC Complementary Medicine and Therapies     Open Access   (Followers: 24, SJR: 0.858, CiteScore: 3)
BMC Dermatology     Open Access   (Followers: 14, SJR: 0.796, CiteScore: 2)
BMC Developmental Biology     Open Access   (Followers: 14, SJR: 1.43, CiteScore: 2)
BMC Ear, Nose and Throat Disorders     Open Access   (Followers: 1, SJR: 0.653, CiteScore: 2)
BMC Ecology     Open Access   (Followers: 24, SJR: 1.076, CiteScore: 2)
BMC Emergency Medicine     Open Access   (Followers: 25, SJR: 0.572, CiteScore: 1)
BMC Endocrine Disorders     Open Access   (Followers: 7, SJR: 0.965, CiteScore: 2)
BMC Energy     Open Access  
BMC Evolutionary Biology     Open Access   (Followers: 74, SJR: 1.656, CiteScore: 3)
BMC Family Practice     Open Access   (Followers: 16, SJR: 1.137, CiteScore: 2)
BMC Gastroenterology     Open Access   (Followers: 13, SJR: 1.231, CiteScore: 3)
BMC Genetics     Open Access   (Followers: 32, SJR: 1.16, CiteScore: 3)
BMC Genomics     Open Access   (Followers: 92, SJR: 2.11, CiteScore: 4)
BMC Geriatrics     Open Access   (Followers: 19, SJR: 1.257, CiteScore: 3)
BMC Health Services Research     Open Access   (Followers: 20, SJR: 1.151, CiteScore: 2)
BMC Hematology     Open Access   (Followers: 7, SJR: 0.545, CiteScore: 1)
BMC Immunology     Open Access   (Followers: 11, SJR: 0.993, CiteScore: 3)
BMC Infectious Diseases     Open Access   (Followers: 22, SJR: 1.576, CiteScore: 3)
BMC Intl. Health and Human Rights     Open Access   (Followers: 8, SJR: 1.006, CiteScore: 2)
BMC Materials     Open Access   (Followers: 1)
BMC Medical Education     Open Access   (Followers: 50, SJR: 0.765, CiteScore: 2)
BMC Medical Ethics     Open Access   (Followers: 25, SJR: 1.016, CiteScore: 2)
BMC Medical Genetics     Open Access   (Followers: 9, SJR: 1.109, CiteScore: 2)
BMC Medical Genomics     Open Access   (Followers: 5, SJR: 1.688, CiteScore: 3)
BMC Medical Imaging     Open Access   (Followers: 11, SJR: 0.536, CiteScore: 2)
BMC Medical Informatics and Decision Making     Open Access   (Followers: 25, SJR: 0.812, CiteScore: 2)
BMC Medical Physics     Open Access   (Followers: 8)
BMC Medical Research Methodology     Open Access   (Followers: 8, SJR: 2.221, CiteScore: 3)
BMC Medicine     Open Access   (Followers: 15, SJR: 4.219, CiteScore: 7)
BMC Microbiology     Open Access   (Followers: 17, SJR: 1.242, CiteScore: 3)
BMC Molecular and Cell Biology     Open Access   (Followers: 50, SJR: 1.277, CiteScore: 3)
BMC Molecular Biology     Open Access   (Followers: 206, SJR: 1.216, CiteScore: 2)
BMC Musculoskeletal Disorders     Open Access   (Followers: 30, SJR: 0.951, CiteScore: 2)
BMC Nephrology     Open Access   (Followers: 10, SJR: 1.098, CiteScore: 3)
BMC Neurology     Open Access   (Followers: 23, SJR: 1.006, CiteScore: 2)
BMC Neuroscience     Open Access   (Followers: 18, SJR: 1.12, CiteScore: 2)
BMC Nursing     Open Access   (Followers: 31, SJR: 0.766, CiteScore: 2)
BMC Nutrition     Open Access   (Followers: 12)
BMC Obesity     Open Access   (Followers: 9)
BMC Ophthalmology     Open Access   (Followers: 22, SJR: 0.921, CiteScore: 2)
BMC Oral Health     Open Access   (Followers: 7, SJR: 0.867, CiteScore: 2)
BMC Palliative Care     Open Access   (Followers: 39, SJR: 1.105, CiteScore: 2)
BMC Pediatrics     Open Access   (Followers: 21, SJR: 1.278, CiteScore: 2)
BMC Pharmacology     Open Access   (Followers: 3)
BMC Pharmacology & Toxicology     Open Access   (Followers: 8, SJR: 0.785, CiteScore: 2)
BMC Physiology     Open Access   (Followers: 4, SJR: 0.936, CiteScore: 2)
BMC Plant Biology     Open Access   (Followers: 20, SJR: 1.887, CiteScore: 4)
BMC Pregnancy and Childbirth     Open Access   (Followers: 24, SJR: 1.427, CiteScore: 3)
BMC Proceedings     Full-text available via subscription   (Followers: 2, SJR: 0.302, CiteScore: 1)
BMC Psychiatry     Open Access   (Followers: 41, SJR: 1.346, CiteScore: 3)
BMC Psychology     Open Access   (Followers: 22, SJR: 0.817, CiteScore: 2)
BMC Public Health     Open Access   (Followers: 229, SJR: 1.337, CiteScore: 3)
BMC Pulmonary Medicine     Open Access   (Followers: 7, SJR: 1.373, CiteScore: 3)
BMC Research Notes     Open Access   (Followers: 4, SJR: 0.691, CiteScore: 2)
BMC Rheumatology     Open Access   (Followers: 5)
BMC Sports Science, Medicine and Rehabilitation     Open Access   (Followers: 36, SJR: 0.926, CiteScore: 2)
BMC Structural Biology     Open Access   (Followers: 8, SJR: 1.024, CiteScore: 2)
BMC Surgery     Open Access   (Followers: 10, SJR: 0.693, CiteScore: 2)
BMC Systems Biology     Open Access   (Followers: 16, SJR: 1.109, CiteScore: 2)
BMC Urology     Open Access   (Followers: 14, SJR: 0.853, CiteScore: 2)
BMC Veterinary Research     Open Access   (Followers: 20, SJR: 0.934, CiteScore: 2)
BMC Women's Health     Open Access   (Followers: 16, SJR: 0.931, CiteScore: 2)
BMC Zoology     Open Access   (Followers: 1)
BMJ Evidence-Based Medicine     Hybrid Journal   (Followers: 9)
Borderline Personality Disorder and Emotion Dysregulation     Open Access   (Followers: 10)
Breast Cancer Research     Open Access   (Followers: 22, SJR: 3.026, CiteScore: 6)
Burns & Trauma     Open Access   (Followers: 14)
CABI Agriculture and Bioscience     Open Access   (Followers: 2)
Cancer & Metabolism     Open Access   (Followers: 7)
Cancer Cell Intl.     Open Access   (Followers: 7, SJR: 1.13, CiteScore: 3)
Cancer Communications     Open Access  
Cancer Convergence     Open Access   (Followers: 1)
Cancer Imaging     Open Access   (Followers: 3, SJR: 1.012, CiteScore: 3)
Cancer Nanotechnology     Open Access   (Followers: 2, SJR: 1.168, CiteScore: 4)
Cancers of the Head & Neck     Open Access   (Followers: 3)
Carbon Balance and Management     Open Access   (Followers: 5, SJR: 0.977, CiteScore: 2)
Cardio-Oncology     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10, SJR: 2.157, CiteScore: 5)
Cardiovascular Ultrasound     Open Access   (Followers: 6, SJR: 0.812, CiteScore: 2)
Cell Communication and Signaling     Open Access   (Followers: 3, SJR: 2.211, CiteScore: 4)
Cell Division     Open Access   (Followers: 1, SJR: 2.445, CiteScore: 4)
Cellular & Molecular Biology Letters     Hybrid Journal   (Followers: 3)
Cerebellum & Ataxias     Open Access   (Followers: 1)
Chemistry Central J.     Open Access   (Followers: 5, SJR: 0.607, CiteScore: 3)
Child and Adolescent Psychiatry and Mental Health     Open Access   (Followers: 30, SJR: 0.901, CiteScore: 2)
Chinese Medicine     Open Access   (Followers: 2, SJR: 0.57, CiteScore: 2)
Chinese Neurosurgical J.     Open Access  
Chiropractic & Manual Therapies     Open Access   (Followers: 5, SJR: 0.599, CiteScore: 2)
Clinical and Molecular Allergy     Open Access   (Followers: 5, SJR: 0.933, CiteScore: 3)
Clinical Diabetes and Endocrinology     Open Access   (Followers: 23)
Clinical Epigenetics     Open Access   (Followers: 11, SJR: 2.435, CiteScore: 5)
Clinical Hypertension     Open Access   (Followers: 5)
Conflict and Health     Open Access   (Followers: 8, SJR: 1.851, CiteScore: 3)
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1, SJR: 0.755, CiteScore: 2)
Cost Effectiveness and Resource Allocation     Open Access   (Followers: 5, SJR: 0.888, CiteScore: 2)
Critical Care     Open Access   (Followers: 82, SJR: 2.48, CiteScore: 5)
Current Opinion in Molecular Therapeutics     Full-text available via subscription   (Followers: 13)
Diabetology & Metabolic Syndrome     Open Access   (Followers: 7, SJR: 0.943, CiteScore: 2)
Diagnostic and Prognostic Research     Open Access  
Diagnostic Pathology     Open Access   (Followers: 14, SJR: 0.818, CiteScore: 2)
Disaster and Military Medicine     Open Access   (Followers: 5)
Emerging Themes in Epidemiology     Open Access   (Followers: 14, SJR: 1.003, CiteScore: 2)
Energy, Sustainability and Society     Open Access   (Followers: 18, SJR: 0.607, CiteScore: 2)
Environmental Health     Open Access   (Followers: 15, SJR: 1.662, CiteScore: 4)
Environmental Health and Preventive Medicine     Open Access   (Followers: 4, SJR: 0.5, CiteScore: 1)
Environmental Microbiome     Open Access   (SJR: 0.768, CiteScore: 2)
Epigenetics & Chromatin     Open Access   (Followers: 8, SJR: 3.767, CiteScore: 5)
European J. of Medical Research     Open Access   (Followers: 2, SJR: 0.55, CiteScore: 1)
European Review of Aging and Physical Activity     Open Access   (Followers: 12, SJR: 1.308, CiteScore: 4)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 10, SJR: 0.98, CiteScore: 3)
Experimental Hematology & Oncology     Open Access   (Followers: 6, SJR: 0.842, CiteScore: 2)
ExRNA     Open Access  
Eye and Vision     Open Access   (Followers: 1)
Fertility Research and Practice     Open Access   (Followers: 2)
Fibrogenesis & Tissue Repair     Open Access   (SJR: 1.531, CiteScore: 4)
Fisheries and Aquatic Sciences     Open Access   (Followers: 3, SJR: 0.199, CiteScore: 0)
Fluids and Barriers of the CNS     Open Access   (Followers: 3, SJR: 2.054, CiteScore: 5)
Frontiers in Zoology     Open Access   (Followers: 12, SJR: 1.597, CiteScore: 3)
Genes and Environment     Open Access   (Followers: 1, SJR: 0.516, CiteScore: 1)
Genetics Selection Evolution     Open Access   (Followers: 7, SJR: 1.745, CiteScore: 4)
Genome Biology     Open Access   (Followers: 41)
Genome Medicine     Open Access   (Followers: 7, SJR: 4.537, CiteScore: 7)
Global Health Research and Policy     Open Access   (Followers: 4)
Globalization and Health     Open Access   (Followers: 9, SJR: 1.262, CiteScore: 2)
Gut Pathogens     Full-text available via subscription   (Followers: 6, SJR: 1.066, CiteScore: 3)
Gynecologic Oncology Research and Practice     Open Access   (Followers: 1)
Harm Reduction J.     Open Access   (SJR: 1.445, CiteScore: 3)
Head & Face Medicine     Open Access   (Followers: 1, SJR: 0.62, CiteScore: 2)
Health and Quality of Life Outcomes     Open Access   (Followers: 15, SJR: 1.069, CiteScore: 3)
Health Research Policy and Systems     Open Access   (Followers: 16, SJR: 1.11, CiteScore: 2)
Hereditary Cancer in Clinical Practice     Open Access   (Followers: 2, SJR: 0.848, CiteScore: 2)
Hereditas     Open Access   (Followers: 1, SJR: 0.278, CiteScore: 1)
Human Genomics     Open Access   (Followers: 3, SJR: 1.501, CiteScore: 3)
Human Resources for Health     Open Access   (Followers: 12, SJR: 1.301, CiteScore: 2)
Immunity & Ageing     Open Access   (Followers: 10, SJR: 1.218, CiteScore: 3)
Implementation Science     Open Access   (Followers: 23, SJR: 2.443, CiteScore: 4)
Implementation Science Communications     Open Access   (Followers: 6)
Infectious Agents and Cancer     Open Access   (SJR: 0.855, CiteScore: 2)
Infectious Diseases of Poverty     Open Access   (Followers: 3, SJR: 1.212, CiteScore: 3)
Inflammation and Regeneration     Open Access   (Followers: 2)
Intl. Breastfeeding J.     Open Access   (Followers: 26, SJR: 0.913, CiteScore: 3)
Intl. J. for Equity in Health     Open Access   (Followers: 9, SJR: 1.04, CiteScore: 2)
Intl. J. of Behavioral Nutrition and Physical Activity     Open Access   (Followers: 32, SJR: 2.626, CiteScore: 6)
Intl. J. of Health Geographics     Open Access   (Followers: 9, SJR: 1.385, CiteScore: 3)
Intl. J. of Mental Health Systems     Open Access   (Followers: 7, SJR: 0.721, CiteScore: 2)
Intl. J. of Pediatric Endocrinology     Open Access   (Followers: 12)
Intl. J. of Retina and Vitreous     Open Access   (Followers: 4)
Investigative Genetics     Open Access   (Followers: 1, SJR: 1.809, CiteScore: 3)
Irish Veterinary J.     Open Access   (Followers: 4, SJR: 0.657, CiteScore: 1)
Israel J. of Health Policy Research     Open Access   (SJR: 0.488, CiteScore: 1)
Italian J. of Pediatrics     Open Access   (Followers: 2, SJR: 0.685, CiteScore: 2)
J. of Angiogenesis Research     Open Access   (Followers: 2)

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Similar Journals
Journal Cover
BMJ Evidence-Based Medicine
Number of Followers: 9  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2515-446X - ISSN (Online) 2515-4478
Published by BMC (Biomed Central) Homepage  [308 journals]
  • How to humanise the COVID-19 intensive care units

    • Free pre-print version: Loading...

      Authors: Rivi, V; Melegari, G, Blom, J. M. C.
      Pages: 141 - 142
      Abstract: The COVID-19 is altering the way patients and families endure illness and death. To mitigate the spread of the virus, patient isolation and visitor restrictions in hospitals have been implemented at a scale never seen before. This means that once hospitalised, patients are isolated from their families until discharge. There remains a sort of undefined mental space of wondering if this is a temporary separation or a step towards final departure.1 2 At the same time, outside the hospitals, there are the relatives of patients waiting anxiously for updates. In some cases, because of the exposure to patients, they are quarantined and may live with the feelings of guilt and anxiety of having unwittingly contributed to the spread of the illness. This traumatic separation could make both patients and relatives vulnerable to different degrees of stress disorders as well as depression and anxiety.3...
      Keywords: COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111513
      Issue No: Vol. 26, No. 4 (2021)
       
  • Information and rational decision-making: explanations to patients and
           citizens about personal risk of COVID-19

    • Free pre-print version: Loading...

      Authors: McCartney, M; Sullivan, F, Heneghan, C.
      Pages: 143 - 146
      Abstract: Introduction On 16th March 2020, the UK government published "Guidance on social distancing for everyone in the UK",1 which asked people in particular groups to be "particularly stringent in following social distancing measures". These groups included all people over the age of 70, and under the age of 70 with particular health conditions. People offered influenza vaccines were part of this cohort (which includes people with heart disease, chronic respiratory disease, obesity and major mental illness) as well as people with chronic kidney disease, multiple sclerosis and learning disabilities.2 Subsequently, on the 21st March 2020, a subgroup were identified as recommended to ‘shield’, which entitled them to food deliveries, priority for supermarket deliveries and social care support, if necessary.3 Testing for the presence of COVID-19 in the UK was initially limited and was undertaken only in hospital settings for patients with suspected...
      Keywords: COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111541
      Issue No: Vol. 26, No. 4 (2021)
       
  • COVID-19 clinical trials: see it big and keep it simple

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      Authors: Saesen, R; Huys, I.
      Pages: 147 - 148
      Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly emerged as a major threat to healthcare systems across the globe, resulting in the launch of unprecedented containment efforts by governments worldwide. In many countries, quarantines and stay-at-home orders have been imposed in an attempt to flatten the epidemiological curve and mitigate the acute burden of COVID-19 on hospitals and clinics. Such measures may remain necessary until a safe and effective therapy or vaccine against the disease has been developed. In response to the present pandemic, the US Food and Drug Administration and the European Medicines Agency (EMA) have set up programmes1 2 to incentivise and expedite the development of COVID-19 treatments and vaccines. The International Coalition of Medicines Regulatory Authorities has stressed the importance of randomised controlled trials (RCTs) for generating the robust level I evidence required to support the uptake of promising therapeutic...
      Keywords: COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111447
      Issue No: Vol. 26, No. 4 (2021)
       
  • Upholding trust in therapeutic trials and evidence-based medicine: need
           for full disclosure of data, crowdsourcing data analysis and independent
           review'

    • Free pre-print version: Loading...

      Authors: Ennezat, P. V; Guerbaai, R. A, Le Jemtel, T. H.
      Pages: 149 - 152
      Abstract: An active 74-year-old woman with hypertension and a family history of hypercholesterolaemia was referred for evaluation of chest pain and underwent coronary angiography. Low-density lipoprotein (LDL) cholesterol was 270 mg/dL. Coronary and carotid arteries were patent, and the echocardiogram was normal. The patient could not tolerate statins due to incapacitating muscle weakness and pain. Age combined with a history of familial hypercholesterolaemia are high cardiovascular risk factors, and the 2019 European Society of Cardiology guidelines recommend LDL cholesterol reduction by at least 50% from baseline and targeting LDL cholesterol
      Keywords: General Medicine
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2019-111242
      Issue No: Vol. 26, No. 4 (2021)
       
  • Best timing of tranexamic acid administration for bleeding after trauma or
           childbirth remains to be established

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      Authors: Henriquez, D. D; van der Bom, J. G.
      Pages: 153 - 154
      Abstract: Haemorrhage is worldwide the leading cause of maternal death1 and an important cause of death after trauma.2 Antifibrinolytic drugs inhibit the lysis of a fibrin clot and are, therefore, used to stop or prevent haemorrhage. Intravenous administration of tranexamic acid has been shown to reduce the risk of death due to haemorrhage after trauma3 and the risk of death due to postpartum haemorrhage.4 Previous analyses have suggested that tranexamic acid needs to be administered early after the start of haemorrhage, because effects of delayed administration might be absent or even harmful for patients suffering life-threatening bleeding.3 4 A recent systematic review and individual patient-level data meta-analysis was set up to quantify the effect of treatment delay on the effectiveness of antifibrinolytics.5 This individual patient-level data meta-analysis was registered within PROSPERO and it adhered to the...
      Keywords: Open access, Maternal and child health
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2019-111290
      Issue No: Vol. 26, No. 4 (2021)
       
  • How to create PICO questions about diagnostic tests

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      Authors: Luijendijk; H. J.
      Pages: 155 - 157
      Abstract: Introduction PICOs are popular in medical teaching.1 The acronym stands for Patient (participant, problem or population), Intervention or exposure, Control (comparator) intervention or exposure, and Outcome. It is a useful tool to teach students how to formulate questions about the effect of a treatment in a testable way, and search for answers in the medical literature. A PICO is also helpful when designing and reporting a systematic review. Less obvious, but another strength of a PICO is its direct link with the 2x2 table of study results. The 2x2 table, or contingency table, is often used to present how often the outcomes (columns) occurred in the comparison groups (rows). The effect of the treatment on the risk of the outcome can then be calculated. Hence, the question and answer can be described very succinctly and intuitively in terms of a PICO and 2x2 table, respectively. However,...
      Keywords: Open access
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2021-111676
      Issue No: Vol. 26, No. 4 (2021)
       
  • Does my patient have SARS-CoV-2 infection' A reminder of clinical
           probability formulas

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      Authors: Stovitz, S. D; Shrier, I.
      Pages: 158 - 161
      Abstract: Introduction Around the world, people are wondering, ‘Do I have SARS-CoV-2'’. Determining a person’s probability of illness is central to the practice and teaching of evidence-based medicine (EBM). Probabilities can be calculated through mathematical formulas, but studies find that many clinicians have difficulty with the calculations.1–4 For many conditions in medicine, clinicians can rely on experience and/or established algorithms. However, with SARS-CoV-2 infection, clinicians lack experience and, given the rapidly changing prevalence of the illness, algorithms are difficult to establish. In this manuscript, we use the example of SARS-CoV-2 as an educational reminder of how clinicians can roughly gauge the probability of illness in different contexts and to highlight some conceptual issues in the estimates needed for the formulas. Clinical diagnostic process and the formulas Broadly speaking, the diagnostic process involves a sequence of estimating the probability of...
      Keywords: COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111633
      Issue No: Vol. 26, No. 4 (2021)
       
  • Statins for primary prevention: what is the regulators role'

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      Authors: Jefferson, T; Demasi, M, Doshi, P.
      Pages: 162 - 166
      Abstract: Globally, drug regulators have approved statins for the prevention of cardiovascular disease (CVD), although their use in primary prevention has been controversial. A highly publicised debate has ensued over whether the benefits outweigh the harms. Drug regulators, which are legally required to make independent judgements on drug approvals, have remained silent during the debate. Our aim was to navigate the decision-making processes of European drug regulators and ultimately request the data upon which statins were approved. Our findings revealed a system of fragmented regulation in which many countries licensed statins but did not analyse the data themselves. There is no easily accessible archive containing information about the licensing approval of statins or a central location for holding the trial data. This is an unsustainable model and serves neither the general public, nor researchers.
      Keywords: Primary care
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2019-111321
      Issue No: Vol. 26, No. 4 (2021)
       
  • Evaluating the quality of systematic reviews and meta-analyses published
           on direct oral anticoagulants in the past 5 years

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      Authors: Eshaghpour, A; Li, A, Javidan, A. P, Chen, N, Yang, S, Crowther, M. A.
      Pages: 167 - 171
      Abstract: Systematic reviews (SRs) have been reported with increasing frequency as a means of collating studies which may have been performed over different period of times, in different geographical areas and by different groups of investigators. As SRs have become more common, quality metrics such as Assessing the Methodological Quality of Systematic Reviews (AMSTAR) have become available for these reviews. AMSTAR is an 11-point checklist that assesses the methodological and reporting quality of a SR. In clinical practice, direct oral anticoagulants (DOACs) have been increasingly used for the treatment and prevention of both venous and arterial thromboembolism. We sought to evaluate the quality of SRs published on DOACs using the AMSTAR criteria. A comprehensive search of Medline, EMBASE and the Cochrane Database of Systematic Reviews from January 2013 to February 2019 was performed. Two reviewers independently screened titles and abstracts and subsequently full texts for eligibility. Data extraction was also completed in duplicate. Categories of extracted data included AMSTAR rating, journal of publication, year of publication, number of studies included in the SR, reporting adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, number of times the paper was cited and journal impact factor. A total of 3729 articles were identified, of which 250 were eligible for analysis. SR quality was highly variable with mean (SD) AMSTAR score of 5.68/11 (2.21). Reporting adherence to PRISMA guideline correlated with a moderate (5–8) or high quality (9–11) (OR=4.19, p
      Keywords: General Medicine
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2019-111326
      Issue No: Vol. 26, No. 4 (2021)
       
  • Methylphenidate for ADHD rejected from the WHO Essential Medicines List
           due to uncertainties in benefit-harm profile

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      Authors: Storebo, O. J; Gluud, C.
      Pages: 172 - 175
      Abstract: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder with estimated global prevalence rates between 3% and 5% in children and 2.5% in adults, depending on the classification system used. The psychostimulant methylphenidate is one of the most frequently used medications for ADHD. In this analysis article we describe shortly the evidence in the field, an application for inclusion of methylphenidate on the WHO Model List of Essential Medicines, the comments raised to the application and the WHO Expert Committee’s decision. The application of getting methylphenidate on the WHO list was overzealous in reporting potential benefits, without highlighting key uncertainties and harms. Decisions encompassing medicines candidate to the WHO Model List should not be based on speculation about potential benefits and should fully incorporate areas of uncertainties. Even though methylphenidate has been used for over 60 years, the evidence concerning the benefits of this medication in children, adolescents and adults with ADHD is uncertain. The decision of the committee was to not include methylphenidate in the WHO Model List of Essential Medicines ‘due to uncertainties in the estimates of benefit, and concerns regarding the quality and limitations of the available evidence for both benefit and harm’.
      Keywords: Mental Health
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2019-111328
      Issue No: Vol. 26, No. 4 (2021)
       
  • COVID-19 and the US response: accelerating health inequities

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      Authors: Okonkwo, N. E; Aguwa, U. T, Jang, M, Barre, I. A, Page, K. R, Sullivan, P. S, Beyrer, C, Baral, S.
      Pages: 176 - 179
      Abstract: Health inequities have long defined health and the healthcare system in the USA. The clinical and research capacity across the USA is unparalleled, yet compared to other high and even some middle-income countries, the average health indicators of the population remain suboptimal in 2020, a finding at least in part explained by inequity in healthcare access. In this context, COVID-19 has rapidly emerged as a major threat to the public’s health. While it was initially thought that severe acute respiratory syndrome coronavirus 2 would be the great equaliser as it would not discriminate, it is clear that COVID-19 incidence and mortality have rapidly reinforced health disparities drawn by historical and contemporary inequities. Here, we synthesise the data highlighting specific risks among particular marginalised and under-resourced communities including those in jails, prisons and detention centers, immigrants and the undocumented, people with disabilities and people experiencing homelessness across the USA. The drivers of these disparities are pervasive structural risks including limited access to preventive services, inability to comply with physical distancing recommendations, underlying health disparities and intersecting stigmas particularly affecting racial and ethnic minorities across the country, including African Americans, Latinx Americans and Native Americans. Advancing the COVID-19 response, saving lives and restarting the economy necessitate rapidly addressing these inequities rather than ignoring and even reinforcing them.
      Keywords: Open access, Mental Health, COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111426
      Issue No: Vol. 26, No. 4 (2021)
       
  • Problem with patient decision aids

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      Authors: Zadro, J. R; Traeger, A. C, Decary, S, O'Keeffe, M.
      Pages: 180 - 183
      Abstract: Patient decision aids are evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. Research shows that patient decision aids increase knowledge, accuracy of risk perceptions, alignment of care with patient values and preferences, and patient involvement in decision making. Some patient decision aids can reduce the use of invasive and potentially low-value procedures. On this basis, clinical practice guidelines and international organisations have begun to recommend the use of patient decision aids and shared decision making as a strategy to reduce medical overuse. Although patient decision aids hold promise for improving healthcare, there are fundamental issues with patient decision aids that need to be addressed before further progress can be made. The problems with patient decision aids are: (1) Guidelines for developing patient decision aids may not be sufficient to ensure developers select the best available evidence and present it appropriately; (2) Biased presentation of low-certainty evidence is common and (3) Biased presentation of low-certainty evidence is misleading, and could inadvertently support, low-value care. We explore these issues in the article and present a case study of online patient decision aids for musculoskeletal pain. We suggest ways to ensure patient decision aids help patients understand the evidence and, where possible, support high-quality care.
      Keywords: General Medicine
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111371
      Issue No: Vol. 26, No. 4 (2021)
       
  • Effect size reporting among prominent health journals: a case study of
           odds ratios

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      Authors: Chu, B; Liu, M, Leas, E. C, Althouse, B. M, Ayers, J. W.
      Pages: 184 - 184
      Abstract: BackgroundThe accuracy of statistical reporting that informs medical and public health practice has generated extensive debate, but no studies have evaluated the frequency or accuracy of effect size (the magnitude of change in outcome as a function of change in predictor) reporting in prominent health journals.ObjectiveTo evaluate effect size reporting practices in prominent health journals using the case study of ORs.DesignArticles published in the American Journal of Public Health (AJPH), Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM) and PLOS One from 1 January 2010 through 31 December 2019 mentioning the term ‘odds ratio’ in all searchable fields were obtained using PubMed. One hundred randomly selected articles that reported original research using ORs were sampled per journal for in-depth analysis.Main outcomes and measuresWe report prevalence of articles using ORs, reporting effect sizes from ORs (reporting the magnitude of change in outcome as a function of change in predictor) and reporting correct effect sizes.ResultsThe proportion of articles using ORs in the past decade declined in JAMA and AJPH, remained similar in NEJM and increased in PLOS One, with 6124 articles in total. Twenty-four per cent (95% CI 20% to 28%) of articles reported the at least one effect size arising from an OR. Among articles reporting any effect size, 57% (95% CI 47% to 67%) did so incorrectly. Taken together, 10% (95% CI 7% to 13%) of articles included a correct effect size interpretation of an OR. Articles that used ORs in AJPH more frequently reported the effect size (36%, 95% CI 27% to 45%), when compared with NEJM (26%, 95% CI 17.5% to 34.7%), PLOS One (22%, 95% CI 13.9% to 30.2%) and JAMA (10%, 95% CI 3.9% to 16.0%), but the probability of a correct interpretation did not statistically differ between the four journals (2=0.56, p=0.90).ConclusionsArticles that used ORs in prominent journals frequently omitted presenting the effect size of their predictor variables. When reported, the presented effect size was usually incorrect. When used, ORs should be paired with accurate effect size interpretations. New editorial and research reporting standards to improve effect size reporting and its accuracy should be considered.
      Keywords: Open access
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111569
      Issue No: Vol. 26, No. 4 (2021)
       
  • Completeness of reporting for systematic reviews of point-of-care
           ultrasound: a meta-research study

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      Authors: Prager, R; Pratte, M, Guy, A, Bala, S, Bachar, R, Kim, D. J, Millington, S, Salameh, J.-P, McGrath, T. A, McInnes, M. D.
      Pages: 185 - 186
      Abstract: ObjectivesSystematic reviews are often considered among the highest quality of evidence. Completely reported systematic reviews, however, are required so readers can assess for generalisability of the research to practice and risk of bias. The objective of this study was to assess the completeness of reporting for systematic reviews assessing the diagnostic accuracy of point-of-care ultrasound (POCUS) using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Diagnostic Test Accuracy (PRISMA-DTA) checklist that was published in 2018.Design and settingIn this meta-research study, MEDLINE, EMBASE and Cochrane Library databases were searched, with no date restriction, on March 1st, 2020 for systematic reviews assessing the diagnostic accuracy of POCUS. Adherence to PRISMA-DTA for the main text and abstract was scored independently and in duplicate using a modified checklist. Prespecified subgroup analyses were performed.Main outcome measuresThe primary outcome was the mean PRISMA-DTA checklist adherence for the full-text and abstract.ResultsA total of 71 studies published from 2008 to 2020 met the inclusion criteria. The overall adherence for the full-text was moderate: 19.8 out of 26.0 items (76%) and for the abstract was 7.0 out of 11.0 items (64%). Although many items in the PRISMA-DTA checklist were frequently reported, several were r infrequently reported (
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111652
      Issue No: Vol. 26, No. 4 (2021)
       
  • Barriers to reporting guideline adherence in point-of-care ultrasound
           research: a cross-sectional survey of authors and journal editors

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      Authors: Prager, R; Gagnon, L, Bowdridge, J, Unni, R. R, McGrath, T. A, Cobey, K, Bossuyt, P. M, McInnes, M. D. F.
      Pages: 188 - 189
      Abstract: ObjectiveAlthough the literature supporting the use of point-of-care ultrasound (POCUS) continues to grow, incomplete reporting of primary diagnostic accuracy studies has previously been identified as a barrier to translating research into practice and to performing unbiased systematic reviews. This study assesses POCUS investigator and journal editor attitudes towards barriers to adhering to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines.Design, setting, participantsTwo separate surveys using a 5-point Likert scale were sent to POCUS study investigators and journal editors to assess for knowledge, attitude and behavioural barriers to the complete reporting of POCUS research. Respondents were identified based on a previous study assessing STARD 2015 adherence for POCUS studies published in emergency medicine, anaesthesia and critical care journals. Responses were anonymously linked to STARD 2015 adherence data from the previous study. Written responses were thematically grouped into the following categories: knowledge, attitude and behavioural barriers to quality reporting, or other. Likert response items are reported as median with IQRs.Main outcome measuresThe primary outcome was the median Likert score for the investigator and editor surveys assessing knowledge, attitude and behavioural beliefs about barriers to adhering to the STARD 2015 guidelines.ResultsThe investigator survey response rate was 18/69 (26%) and the editor response rate was 5/21 (24%). Most investigator respondents were emergency medicine practitioners (13/21, 62%). Two-thirds of investigators were aware of the STARD 2015 guidelines (12/18, 67%) and overall agreed that incomplete reporting limits generalisability and the ability to detect risk of bias (median 4 (4, 5)). Investigators felt that the STARD 2015 guidelines were useful, easy to find and easy to use (median 4 (4, 4.25); median 4 (4, 4.25) and median 4 (3, 4), respectively). There was a shared opinion held by investigators and editors that the peer review process be primarily responsible for ensuring complete research reporting (median 4 (3, 4) and median 4 (3.75, 4), respectively). Three of 18 authors (17%) felt that the English publication language of STARD 2015 was a barrier to adherence.ConclusionsAlthough investigators and editors recognise the importance of completely reported research, reporting quality is still a core issue for POCUS research. The shared opinion held by investigators and editors that the peer review process be primarily responsible for reporting quality is potentially problematic; we view completely reported research as an integral part of the research process that investigators are responsible for, with the peer review process serving as another additional layer of quality control. Endorsement of reporting guidelines by journals, auditing reporting guideline adherence during the peer review process and translation of STARD 2015 guidelines into additional languages may improve reporting completeness for the acute POCUS literature.Trial registration numberOpen Science Framework Registry (https://osf.io/5pzxs/).
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111604
      Issue No: Vol. 26, No. 4 (2021)
       
  • Public awareness of the National Suicide Prevention Lifeline following the
           release of a hip-hop song

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      Authors: Torgerson, T; Swayze, C, Sanghera, S, Cooper, C, Beaman, J, Hartwell, M, Vassar, M.
      Pages: 191 - 191
      Abstract: ObjectiveIn light of the current national mental health crisis, we use Google Trends, Twitter and data obtained from the National Suicide Prevention Lifeline to evaluate the effect of ‘1-800-273-8255’ on public awareness for the National Suicide Prevention Lifeline.DesignCross-sectional analysis.Main outcome measuresWe extracted data from Google Trends and Twitter for terms related to suicide following the release of Logic’s song, ‘1-800-273-8255’. We then used a forecasting autoregressive integrated moving algorithm model to determine the greater than expected search interest.ResultsGoogle searches for ‘Suicide Hotline’ increased 49% more than expected the day after Logic’s song was released and sustained increase of queries resulted in an average relative search volume of 59.5%–9.1% higher than the mean forecasted value of 50.4% for the 28 days following the release. Tweets that engaged with the account ‘@800 273talk’ on Twitter increased by 10 450% more than expected the day after the song was released and increased by a mean of 1497% greater than expected the week after the songs released.ConclusionFindings from our study suggest that the entertainment industry can play an important role in increasing awareness of hotline numbers. Logic’s song provides an example of a positive influence on public health and provides support for further development and standards for proper awareness of suicide in the public view.
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111509
      Issue No: Vol. 26, No. 4 (2021)
       
  • Inactivated trivalent influenza vaccination is associated with lower
           mortality among patients with COVID-19 in Brazil

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      Authors: Fink, G; Orlova-Fink, N, Schindler, T, Grisi, S, Ferrer, A. P. S, Daubenberger, C, Brentani, A.
      Pages: 192 - 193
      Abstract: ObjectiveTo estimate associations between trivalent influenza vaccination and COVID-19 mortality as well as severe clinical outcomes among hospitalised patients.DesignRetrospective observational study.SettingThis study was conducted among hospitalised patients with COVID-19 in Brazil.ParticipantsWe analysed all hospitalised patients with COVID-19 with available vaccination information captured in Brazil’s national electronic respiratory infection data system between 1 January 2020 and 23 June 2020.Main outcome measuresThe primary outcomes were age-specific mortality rates of hospitalised patients with COVID-19 with and without recent inactivated trivalent influenza vaccination.ResultsA total of 53 752 clinically confirmed COVID-19 cases were analysed. Controlling for health facility of treatment, comorbidities as well as an extensive range of sociodemographic factors, patients who received a recent influenza vaccine experienced on average 7% lower odds of needing intensive care treatment (95% CI 0.87 to 0.98), 17% lower odds of requiring invasive respiratory support (95% CI 0.77 to 0.88) and 16% lower odds of death (95% CI 0.78 to 0.90). Protective effects were larger when the vaccine was administered after onset of symptoms as well as among younger patients.ConclusionPatients with COVID-19 with recent inactivated influenza vaccination experience significantly better health outcomes than non-vaccinated patients in Brazil. Beneficial off-target effects of influenza vaccination through trained innate immune responses seem plausible and need to be further explored. Large-scale promotion of influenza vaccines seems advisable, especially in populations at high risk for severe COVID-19 disease progression.
      Keywords: Primary care, COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111549
      Issue No: Vol. 26, No. 4 (2021)
       
  • An evidence map of randomised controlled trials evaluating genetic
           therapies

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      Authors: Apaydin, E. A; Richardson, A. S, Baxi, S, Vockley, J, Akinniranye, O, Ross, R, Larkin, J, Motala, A, Azhar, G, Hempel, S.
      Pages: 194 - 194
      Abstract: ObjectivesGenetic therapies replace or inactivate disease-causing genes or introduce new or modified genes. These therapies have the potential to cure in a single application rather than treating symptoms through repeated administrations. This evidence map provides a broad overview of the genetic therapies that have been evaluated in randomised controlled trials (RCTs) for efficacy and safety.Eligibility criteriaTwo independent reviewers screened publications using predetermined eligibility criteria. Study details and data on safety and efficacy were abstracted from included trials. Results were visualised in an evidence map.Information sourcesWe searched PubMed, EMBASE, Web of Science, ClinicalTrials.gov and grey literature to November 2018.Risk of biasOnly RCTs were included in this review to reduce the risk of selection bias in the evaluation of genetic therapy safety and efficacy.Included studiesWe identified 119 RCTs evaluating genetic therapies for a variety of clinical conditions.Synthesis of resultsOn average, samples included 107 participants (range: 1–1022), and were followed for 15 months (range: 0–124). Interventions using adenoviruses (40%) to treat cardiovascular diseases (29%) were the most common.Description of the effectIn RCTs reporting safety and efficacy outcomes, in the majority (60%) genetic therapies were associated with improved symptoms but in nearly half (45%) serious adverse event (SAEs) were also reported. Improvement was reported in trials treating cancer, cardiovascular, ocular and muscular diseases. However, only 19 trials reported symptom improvement for at least 1 year.Strengths and limitations of evidenceThis is the first comprehensive evidence map of RCTs evaluating the safety and efficacy of genetic therapies. Evidence for long-term effectiveness and safety is still sparse. This lack of evidence has implications for the use, ethics, pricing and logistics of genetic therapies.InterpretationThis evidence map provides a broad overview of research studies that allow strong evidence statements regarding the safety and efficacy of genetic therapies. Most interventions improve symptoms, but SAE are also common. More research is needed to evaluate genetic therapies with regard to the potential to cure diseases.
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111448
      Issue No: Vol. 26, No. 4 (2021)
       
  • Asthma and COVID-19: review of evidence on risks and management
           considerations

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      Authors: Hartmann-Boyce, J; Gunnell, J, Drake, J, Otunla, A, Suklan, J, Schofield, E, Kinton, J, Inada-Kim, M, Hobbs, F. D. R, Dennison, P.
      Pages: 195 - 195
      Abstract: BackgroundRespiratory illnesses typically present increased risks to people with asthma (PWA). However, data on the risks of COVID-19 to PWA have presented contradictory findings, with implications for asthma management.ObjectiveTo assess the risks and management considerations of COVID-19 in people with asthma (PWA).MethodWe conducted a rapid literature review. We searched PubMed, medRxiv, LitCovid, TRIP, Google and Google Scholar for terms relating to asthma and COVID-19, and for systematic reviews related to specific management questions within our review, in April 2020. References were screened and data were extracted by one reviewer.ResultsWe extracted data from 139 references. The evidence available is limited, with some sources suggesting an under-representation of PWA in hospitalised cases and others showing an increased risk of worse outcomes in PWA, which may be associated with disease severity. Consensus broadly holds that asthma medications should be continued as usual. Almost all aspects of asthma care will be disrupted during the pandemic due not only to limits in face-to-face care but also to the fact that many of the diagnostic tools used in asthma are considered aerosol-generating procedures. Self-management and remote interventions may be of benefit for asthma care during this time but have not been tested in this context.ConclusionsEvidence on COVID-19 and asthma is limited and continuing to emerge. More research is needed on the possible associations between asthma and COVID-19 infection and severity, as well as on interventions to support asthma care in light of constraints and disruptions to healthcare systems. We found no evidence regarding health inequalities, and this urgently needs to be addressed in the literature as the burdens of asthma and of COVID-19 are not equally distributed across the population.
      Keywords: COVID-19
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111506
      Issue No: Vol. 26, No. 4 (2021)
       
  • Diclofenac in adolescents: diagnosing and treating gastrointestinal
           adverse drug reactions can prevent future deaths

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      Authors: Thomas, E. T; Richards, G. C.
      Pages: 196 - 199
      Abstract: High doses or prolonged use of diclofenac, a commonly prescribed non-steroidal anti-inflammatory drug (NSAID), may result in gastrointestinal complications, which, if ignored, can be fatal. A preventable death attributed to diclofenac in a 16-year-old girl with complex needs has been identified, and is described in this article. Adverse drug reactions from NSAIDs should be considered and treated in children and adolescents, especially those with complex needs. This article is part of the Coroners’ Concerns to Prevent Harms series.1 It discusses a Prevention of Future Death (PFD) report related to harm from diclofenac in an adolescent.2 Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that is commonly prescribed for its analgesic, antipyretic and anti-inflammatory effects. About 658 000 prescriptions were dispensed for diclofenac in English primary care in the 12 months from September 2019 to August 2020, costing £8.3 million.3 Diclofenac is thought to exert...
      Keywords: Coroner's concerns to prevent harm
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111640
      Issue No: Vol. 26, No. 4 (2021)
       
  • Ibuprofen for acute pain relief in the emergency department

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      Authors: Collins; D.
      Pages: 200 - 201
      Abstract: In the emergency department there has been uncertainty over the analgesic ceiling for ibuprofen in the treatment of mild to moderate acute pain. A recent randomised trial addressed the minimally effective dose used to optimise pain management. Clinicians may reduce the rate of adverse events by using the minimally effective dose both in the emergency department and for discharge prescriptions. The management of acute pain is fundamental to the practice of emergency medicine. In 2016, in the USA, there were more than 145 million emergency department visits with acute pain syndromes being the most common presentation.1 Ibuprofen is a common, available, inexpensive non-steroidal anti-inflammatory drug (NSAID) and as such, it is non-addictive with analgesic, antipyretic and anti-inflammatory effects. It is available in both parenteral and enteral routes, making it a versatile option for pain management. While higher doses are required for its anti-inflammatory effect, dental and oral surgery...
      Keywords: Emergency care, EBM Verdict
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2019-111312
      Issue No: Vol. 26, No. 4 (2021)
       
  • Multidisciplinary teams effect on major amputations in patients with
           diabetes

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      Authors: Heneghan, C; Mahtani, K. R.
      Pages: 202 - 203
      Abstract: Patients with diabetic foot ulcers are at high risk of lower leg amputations, which have a considerable impact on their quality of life. Identifying strategies to reduce this risk are a priority. Growing evidence suggests that supporting these patients through multidisciplinary teams (MDTs) may reduce the risk of amputations. A new systematic review gives insights into how these teams should be composed. The global prevalence of diabetes and its associated complications has risen substantially, with 153 million people affected in 1980, rising to 347 million in 2008.1 The macrovascular complications associated with diabetes, including cardiovascular disease (CVD), stroke and peripheral arterial disease (PAD), cause substantial morbidity and mortality. PAD may lead to non-healing injuries including ulcers, persistent infection, gangrene and act as a significant risk factor for lower-leg amputation. The incidence of non-traumatic amputations is at least 15 times greater in those with diabetes.2 Annually, approximately 1%–4%...
      Keywords: Primary care, EBM Verdict
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111342
      Issue No: Vol. 26, No. 4 (2021)
       
  • Does taking omega-3 supplements reduce the risk of having depression or
           anxiety' Probably not

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      Authors: Onakpoya; I.
      Pages: 204 - 204
      Abstract: Findings from observational studies have led to suggestions that dietary omega-3 supplementation can lower the risk of depression and anxiety; however, results of a recent meta-analysis of randomised trials prove otherwise. Depression is the leading course of disability, and many patients with depression also suffer from anxiety symptoms.1 Research has shown that people with depression have a lower level of omega-3 polyunsaturated fatty acids (PUFA) compared with the general population,2 and data from observational studies suggest that dietary supplementation with long chain fatty acids (PUFA) can lower the risk of developing depression or anxiety.3 In a recent systematic review,4 the authors assessed the effect of omega-3 PUFA supplementation on the risk of anxiety and depression using evidence from randomised clinical trials (RCTs). They included trials lasting at least 6 months with adults who were not seriously ill or pregnant. The included studies...
      Keywords: Primary care, EBM Verdict
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111341
      Issue No: Vol. 26, No. 4 (2021)
       
  • Sacubitril, valsartan and SARS-CoV-2

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      Authors: Vitiello, A; La Porta, R, Ferrara, F.
      Pages: 205 - 205
      Abstract: Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) is responsible for the current global pandemic. To date, no antivirals directed against the virus or effective vaccines are available.1 It is essential to recognise the risk factors and components that may play a protective role. There is no clear evidence on the correlation between changes in the renin–angiotensin system (RAS) by treatment with ACEIs, ARBs or DRis and COVID-19 infection.2–4 Randomised controlled trials are needed to verify the involvement of COVID-19 viral infection and chronic treatment with these drugs. A possible scientific hypothesis to investigate is the role of the neprilisin inhibitor sacubitril in association with valsartan in the more severe stages of COVID-19 infection. The challenge to defeat the current pandemic poses several objectives, among them trying to give added values to therapeutic solutions; in this direction, the association...
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111497
      Issue No: Vol. 26, No. 4 (2021)
       
  • EBM in Brazil and the creation of the Oxford-Brazil EBM Alliance

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      Authors: Riera, R; Miranda, E, Fontes, L. E. S, Pacheco, R. L, Nunan, D.
      Pages: 206 - 208
      Abstract: The key concepts of Evidence-Based Medicine (EBM) arrived in Brazil in the mid-90s. Since then, a considerable number of initiatives have been implemented to disseminate its use and importance in the decision process of healthcare. Table 1 outlines various EBM-related initiatives in Brazil that we have identified over the years. It is important to note that this summary list is not intended to be comprehensive of every EBM activity that has happened in Brazil. Our objective is not to quantify or rate what exists, but to identify and classify examples of the types of actions that have taken place in Brazil from 1997 to 2019. A need for the consolidation of existing local EBM practices and implementation of sustainability strategies for the expansion and improvement of EBM in Brazil was clear. Taking into account these concerns, the first formal collaboration between a Latin American country and the...
      PubDate: 2021-07-23T09:27:17-07:00
      DOI: 10.1136/bmjebm-2020-111377
      Issue No: Vol. 26, No. 4 (2021)
       
 
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