Social justice is defined by the philosopher Nancy Fraser as the achievement of ‘parity of participation’, meaning that justice requires social arrangements that allow all people to interact with one another as peers.
In this paper, we share some of the lessons learnt from the ENGAGEEs project, which had among its objectives the assessment of the decisional needs of women from an underserved territory in Brazil.
Healthcare delivery is being transformed by the rapid growth of data, advancements in artificial intelligence (AI) and other technologies. In healthcare, obtaining real-world data can be time-consuming and limited to those with approved access to protected health information (PHI) due to ethical, legal and regulatory considerations. As patient care becomes increasingly data driven, the need for faster access to data, better ability to protect the identities of patients, and overcoming technical and regulatory barriers to assembling sufficiently large datasets for modern AI methods is paramount. Conventional data access strategies are no longer sufficient to enable evidence generation at scale.
For these reasons, synthetic data—generated data that mimic real-world datasets—are gaining traction in healthcare. Computationally derived synthetic healthcare data—the focus of this paper—go beyond traditional deidentification by generating new, artificial patient records that statistically mirror real data but contain no actual patient information. Unlike deidentification, which removes or...]]>
Endometrial cancer (EC) incidence has been rising globally, while mortality has remained stable, particularly in Nordic countries. This study aimed to explore the role of transvaginal ultrasound (TVUS) use and overdiagnosis in these trends.
We analysed crude and age-adjusted EC incidence and mortality rates by stage and age group using data from the Norwegian Cancer and Causes of Death Registries (1970–2019). Annual percentage changes (APC) in early-stage and late-stage cancers were estimated using linear regression. Trends were assessed with the Mann-Kendall test and Theil-Sen estimator. Spearman’s correlation evaluated the relationship between regional TVUS billing rates and EC incidence.
From 1970 to 2019, age-standardised EC incidence in Norway increased by 79% (16.7–30.0 per 100 000), with a five-yearly growth rate of 7.47% (p=0.020). Mortality remained stable until 2000–2004, with a non-significant drop from 5.0 to 2.75 per 100 000 by 2019 (Sen’s slope: –0.20, p=0.15). In postmenopausal women, early-stage incidence rose by 73% (32.1–55.5 per 100 000) and late-stage diagnoses increased by 108% (7.0–14.6 per 100 000). In premenopausal women, early-stage incidence declined by 24% (3.3–2.5 per 100 000), while late-stage diagnoses rose by 189% (0.23–0.66 per 100 000). TVUS use rose from 7.6% to 8.3% annually (2006–2019). The APC in postmenopausal women was similar across stages, with the largest increase in those aged 70+ years. Evidence for TVUS driving early-stage diagnoses was not strong, although a weak correlation between the two was observed in postmenopausal women (r=0.35, p<0.05).
Overdiagnosis and stage migration may explain the rising EC incidence in postmenopausal women. In premenopausal women, overdiagnosis is less likely. TVUS is unlikely to be the main driver of the trends. Further research is needed to clarify the interplay of factors affecting EC trends globally.
The objective of our study was to assess the benefits and harms of tramadol vs placebo in adults with chronic pain.
The research method was a systematic review of randomised clinical trials with meta-analysis. The review followed the Trial Sequential Analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
The Cochrane Library, MEDLINE, Embase, Science Citation Index and BIOSIS were searched for trials published from inception to 6 February 2025.
Studies were eligible for inclusion if they were published and unpublished randomised clinical trials comparing tramadol vs placebo in adults with any type of chronic pain. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.
The main outcome measures were pain level, adverse events, quality of life, dependence, abuse and depressive symptoms.
We included 19 randomised placebo-controlled clinical trials enrolling 6506 participants. All outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale (NRS) –0.93 points; 97.5% CI –1.26 to –0.60; p<0.0001; low certainty of evidence). However, the effect size was below our predefined minimal important difference of 1.0 point on NRS. Beta binomial regression showed evidence of a harmful effect of tramadol on serious adverse events (OR 2.13; 97.5% CI 1.29 to 3.51; p=0.001; moderate certainty of evidence), mainly driven by a higher proportion of cardiac events and neoplasms. It was not possible to conduct a meta-analysis of the quality of life due to a lack of data. Meta-analysis and Trial Sequential Analysis showed that tramadol increased the risk of several non-serious adverse events including nausea (number needed to harm (NNH) 7), dizziness (NNH 8), constipation (NNH 9), and somnolence (NNH 13) (all very low certainty of evidence).
Tramadol may have a slight effect on reducing chronic pain levels (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.
First, investigate whether a long compared with a short abstract decreases readers’ attention. Second, investigate differences regarding perceptions of informativeness, accuracy, attractiveness and conciseness.
Two-arm, single-blinded, parallel-group, superiority randomised controlled trial with 1:1 allocation.
Researchers worldwide who indexed any type of systematic review in PubMed with an English abstract between 1 January 2024 and 26 March 2024.
Researchers were randomly assigned to two groups. Both groups received the same cover letter by email with a link to our survey, which was assigned to either the short (277 words) or long abstract (771 words) of the same systematic review published in two different journals.
Primary outcome was the proportion of trial participation after reading the abstract, indicating readers’ attention. Secondary outcomes were researchers’ perceptions of four indicators of a well-written abstract (informativeness, accuracy, attractiveness, conciseness), and general abstract characteristics.
A total of 5397 authors were randomly assigned to the short (n=2691) or long abstract (n=2706). Trial participation did not differ between groups (37.8% vs 35.0%; p=0.1935). While the short abstract was considered more attractive (60.5% vs 46.6%; p=0.0034) and concise (82.3% vs 37.9%; p<0.0001), the length had no impact on its informativeness (85.5% vs 91.2%; p=0.0594) and accuracy (80.2% vs 86.3%; p=0.0868). Regarding general abstract characteristics, 76.0% preferred a maximum length of 250–300 words, nearly all a structured format and about half supported reporting funding and registration information.
Abstract length had no impact on readers’ attention, but short abstracts were considered more attractive and concise. Guidelines like PRISMA-A should recommend a range of 250–300 words for abstracts, allowing authors to include key information while prioritising clarity and precision. With authors considering information on funding and registration as important, journals should update their author guidelines to include these by default.
Funding
None.
To compare the effects of early physical interventions on the prevention of intensive care unit-acquired weakness (ICUAW) and the improvement of relevant clinical outcomes in patients with critical illness.
We systematically searched the Web of Science, PubMed, Embase and the Cochrane Central Register of Controlled Trials from their inception until 20 August 2024, to identify randomised controlled trials (RCTs) enrolling patients ≥18 years old and implementing early physical intervention that commenced at any time point during mechanical ventilation (MV) use or within 7 days after intensive care unit (ICU) admission for review. We synthesised data using a random-effects model and analysed through network meta-analysis (NMA) and component network meta-analysis (CNMA).
Primary outcome is the incidence of ICUAW. Secondary outcomes included Medical Research Council sum score, length of stay in the ICU or hospital, duration of MV and mortality rates in the ICU or hospital.
Our analyses included 63 RCTs involving 24 treatments and eight components. The NMA results revealed systematic early mobilisation (SEM) combined with neuromuscular electrical stimulation (NMES), SEM alone and NMES alone may lead to a moderate to large reduction in the incidence of ICUAW (odds ratios [ORs]=0.03, 0.09 and 0.12, 95% confidence intervals [CIs]=0.00 to 0.42, 0.01 to 0.97 and 0.03 to 0.44, respectively) and improved relevant clinical outcomes compared with routine care. The CNMA results further indicated that SEM (OR=0.14, 95% CI=0.02 to 0.83) and NMES (OR=0.22, 95% CI=0.09 to 0.52) effectively mitigated the ICUAW incidence.
SEM and NMES are optimal interventions for preventing ICUAW. Healthcare providers in ICUs should implement early mobilisation with structured protocols and patient assessments or apply NMES to specific muscle groups to prevent ICUAW in critically ill patients and improve relevant clinical outcomes.
CRD42024581173.
To assess evidence of overall survival (OS) benefits of cancer drugs listed in China’s National Reimbursement Drug List (NRDL), the guiding standard for public insurance coverage of drugs and characterise the evolution of survival evidence after NRDL inclusion.
Retrospective observational study.
China’s NRDL and journal publications.
Adult cancer drug indications approved in China from 1 January 2005 to 30 June 2022.
The primary outcome was the availability of OS benefit evidence at the time of initial NRDL listing, defined as a statistically significant survival gain over the control arm in pivotal clinical trials. The secondary outcome was the availability of evidence on clinical benefits after NRDL inclusion as of 31 December 2023, measured by OS and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) version 1.1. ESMO-MCBS scores A to B in the curative setting or 4 or 5 in the non-curative setting were considered a substantial clinical benefit.
By 30 June 2022, 72.6% (175/241) of cancer indications approved in China were included in the NRDL. The median time interval between marketing authorisation and NRDL inclusion decreased from 9.4 years in 2005–2010 to 4.1 years in 2011–2016, and 1.1 years in 2017–2022. 62 (35.4%) and 4 (2.3%) indications had documented OS benefits at the time of NRDL assessment or after, respectively. The median survival benefit was 3.9 months. Of the 109 indications without documented OS benefits by the end of the observation, 21 (19.3%) had substantial clinical benefits as measured by the ESMO-MCBS.
The time interval from regulatory approval to NRDL listing in China decreased over time. However, more than half of cancer drug indications listed for public insurance reimbursement did not have confirmed survival gain or substantial clinical benefits at the time of NRDL inclusion or after. Payers should give sufficient consideration to clinical benefit evidence when making reimbursement and disinvestment decisions to avoid wasteful spending of public health insurance funds.
There is a recognised knowledge deficit about the absolute size of benefits and harms of treatments among clinicians
The website gpevidence.org