ABSTRACT
We propose a new reading of the results of a solid systematic review published in 2022 in Neurology by Truong et al. comparing cholinesterase inhibitors (ChEIs) treatment to placebo or no treatment on all-cause mortality in patients with any type of dementia. Leaving ethical considerations aside, we tested if another method of interpretation of the results of the systematic review would yield different results. We applied the "Rebuild the Evidence Base" method to the data extracted from the meta-analysis and found that the positive result of the meta-analysis (P = .01) and the lack of heterogeneity did not weigh enough in the balance against the strictly exploratory nature of all the results of the individual randomized controlled trials included and the suspected publication bias. There was a lack of evidence of effect of ChEI treatment on overall mortality in patients with dementia.
ABSTRACT
Mammographic screening contributes to a reduction in specific mortality, but it has disadvantages. Decision aids are tools designed to support people's decisions. Because these aids influence patient choice, their quality is crucial. The objective of the current study was to conduct a systematic review of decision aids developed for women eligible for mammographic screening who have an average breast cancer risk and to assess the quality of these aids. The systematic review included articles published between January 1, 1997, and August 1, 2019, in the PubMed, Embase, Cochrane, and PsycInfo databases. The studies were reviewed independently by 2 reviewers. Any study containing a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. Two double-blind reviewers assessed the quality of the selected decision aids using the International Patient Decision Aid Standards instrument, version 3 (IPDASi). Twenty-three decision aids were extracted. Classification of decision aid quality using the IPDASi demonstrated large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172). Three decision aids had high overall scores. The 3 best-rated dimensions were disclosure (maximum score, 8; mean score, 6.8), focusing on transparency; information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details; and probabilities (maximum score, 32; mean score 25), focusing on the presentation of probabilities. The 3 lowest-rated dimensions were decision support technology evaluation (maximum score, 8; mean score, 4.3), focusing on the effectiveness of the decision aid; development (maximum score, 24; mean score, 12.6), evaluating the development process; and plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy. The results of this review identified 3 high-quality decision aids for breast cancer screening.
Subject(s)
Breast Neoplasms/diagnostic imaging , Decision Support Techniques , Mammography , Double-Blind Method , Female , Humans , ProbabilityABSTRACT
BACKGROUND: A growing demand for cancer genetic services has led to suggestions for the involvement of GPs. How, and in which conditions, they can be involved, and whether there are important barriers to implementation should be ascertained. AIM: To review the tools available, clinician attitudes and experiences, and the effects on patients of genetic cancer risk assessment in general practice. DESIGN AND SETTING: Systematic review of papers published worldwide between 1996 and 2017. METHOD: The MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and PsycINFO databases and grey literature were searched for entries dating from January 1996 to December 2017. Study quality was assessed with relevant Critical Appraisal Skills Programme tool checklists and a narrative synthesis of findings was conducted. RESULTS: In total, 40 studies were included in the review. A variety of testing and screening tools were available for genetic cancer risk assessment in general practice, principally for breast, breast-ovarian, and colorectal cancer risk. GPs often reported low knowledge and confidence to engage with genetic cancer risk assessment; however, despite time pressures and concerns about confidentiality and the impact of results on family members, some recognised the potential importance relating to such a development of the GP's role. Studies found few reported benefits for patients. Concerns about negative impacts on patient anxiety and cancer worries were largely not borne out. CONCLUSION: GPs may have a potential role in identifying patients at risk of hereditary cancer that can be facilitated by family-history tools. There is currently insufficient evidence to support the implementation of population-wide screening for genetic cancer risk, especially given the competing demands of general practice.
