Karsten Juhl Jørgensen

University of Southern Denmark | SDU · Cochrane Denmark and Center fo Evidence Based Medicine Odense

The degree of overdiagnosis in common cancer screening trials is uncertain due to inadequate design of trials, varying definition and methods used to estimate overdiagnosis. Therefore, we aimed to quantify the risk of overdiagnosis for the most widely implemented cancer screening programmes and assess the implications of design limitations and bias...

Objectives The MeSH term for ‘Overdiagnosis’ was officially introduced into the NIH National Library of Medicine on 7th Sep 2021. Our primary aim was to describe trends in what has been published under the MeSH term ‘Overdiagnosis’, i.e. how many articles are tagged per month (including time trend); which medical specialties use the term; in which...

There is a growing emphasis on interventions where clinicians identify and aim to change unhealthy habits in individuals, such as dietary advice for people with obesity.1 2 Although such individually oriented lifestyle interventions (IOLIs) might be effective, it may not be feasible to implement all recommended IOLIs in the care of many eligible in...

A well-conducted systematic review requires a scrupulous assessment of the design of included studies. This may unveil major issues in how studies were planned, conducted and reported. This section presents a few examples. 1) A Cochrane review on pain and sedation management in the newborn identified a study described as a randomized trial, which l...

Objective: To identify maternal factors associated with labor dystocia in low-risk nulliparous women. Methods: MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic...

The degree of overdiagnosis in common cancer screening trials is uncertain due to inadequate design of trials, varying definition and methods used to estimate overdiagnosis. Therefore, we aimed to quantify the risk of overdiagnosis for the most widely implemented cancer screening programmes and assess the implications of design limitations and bias...

Background: Acute respiratory infections (ARIs) are by far the most common reason for prescribing an antibiotic in primary care, even though the majority of ARIs are of viral or non-severe bacterial aetiology. It follows that in many cases antibiotic use will not be beneficial to a patient's recovery but may expose them to potential side effects....

Objectives To assess whether recommendations of individually oriented lifestyle interventions (IOLIs) in guidelines from the National Institute for Health and Care Excellence (NICE) were underpinned by evidence of benefit, and whether harms and opportunity costs were considered. Design Cross sectional survey. Setting UK. Data sources NICE guidel...

Background Antidepressant withdrawal symptoms may mimic symptoms of depression relapse and can be challenging for patients when tapering or discontinuing antidepressants. We aimed to assess how withdrawal symptoms are described in major clinical practice guidelines on depression. Methods Systematic review of major clinical practice guidelines on d...

Objectives The prevailing theory is that mammography on average detects tumors 3.3–7 years earlier, based on models and mean lead time (MLT) estimates not accounting for non-progressive tumors and changes in cancer awareness. We estimate MLT and maximum lead time accounting for these factors. Method Design: Proportions of tumors with lead times ov...

Background: Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become...

Background Tapering and discontinuing antidepressants are important aspects of the management of patients with depression and should therefore be considered in clinical practice guidelines. Objectives We aimed to assess the extent and content, and appraise the quality, of guidance on tapering and discontinuing antidepressants in major clinical pra...

Background: Attention deficit hyperactivity disorder (ADHD) is a psychiatric diagnosis increasingly used in adults. The recommended first-line pharmacological treatment is central nervous system (CNS) stimulants, such as methylphenidate, but uncertainty remains about its benefits and harms. Objectives: To assess the beneficial and harmful effect...

Objective: To assess potential dose-response relationships of extended-release methylphenidate for ADHD in adults on efficacy outcomes. Study design and setting: Post-hoc analysis based on a systematic review of extended-release methylphenidate (https://doi.org/10.1002/14651858.CD012857). Using data from clinical trials comparing multiple fixed-dos...

Objectives To assess whether drug regulatory agencies decided on applications for extended-release methylphenidate for use in adult ADHD based on select samples of trials. Study design and setting Case series of publicly available regulatory documents. We matched an index of extended-release methylphenidate trials for adult ADHD with trials appear...

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of interventions in non‐healthcare‐related workplaces to reduce the risk of SARS‐CoV‐2 infection relative to other interventions or no intervention.

Objectives To determine to which degree industry partners in randomised clinical trials own the data and can constrain publication rights of academic investigators. Methods Cohort study of trial protocols, publication agreements and other documents obtained through Freedom of Information requests, for a sample of 42 trials with industry involvemen...

Background Very preterm infants are at high risk of developing chronic lung disease, which requires respiratory support and might have long-term sequelae. As lung inflammation plays an important role in pathogenesis, antileukotrienes have been explored in both clinical and animal studies. We aimed to assess the benefits and harms of antileukotriene...

Background Healthcare professionals are exposed to advertisements for prescription drugs in medical journals. Such advertisements may increase prescriptions of new drugs at the expense of older treatments even when they have no added benefits, are more harmful, and are more expensive. The publication of medical advertisements therefore raises ethic...

Concern has been raised about whether HPV vaccines might cause serious neurological disorders including postural orthostatic tachycardia syndrome (POTS) and chronic regional pain syndrome (CRPS). The European Medicines Agency (EMA) investigated the issue and declared in 2015 that there is no link between HPV vaccines and serious neurological advers...

Objective: To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Design: Systematic review. Eligibility criteria: Studies that compared the association between conflicts of interest and favourable recommendations of...

Background Treatment and diagnostic recommendations are often made in clinical guidelines, reports from advisory committee meetings, opinion pieces such as editorials, and narrative reviews. Quite often, the authors or members of advisory committees have industry ties or particular specialty interests which may impact on which interventions are rec...

Objective: To investigate if Cochrane reviews that assess screening interventions address their major harms. Study design and setting: A systematic search for Cochrane reviews that assess screening interventions was performed. Two authors independently screened abstracts, assessed full-texts, and extracted data from included reviews. For each revi...

Better intervention strategies for patients with treatment-resistant depression are greatly needed. McIntyre and colleagues1 set out to investigate the effectiveness of intravenous (IV) ketamine through a chart review of 201 such outpatients that all received four IV ketamine infusions over one-to-two weeks. They concluded that IV ketamine was effe...

Background: Handwashing is important to reduce the spread and transmission of infectious disease. Ash, the residue from stoves and fires, is a material used for cleaning hands in settings where soap is not widely available. Objectives: To assess the benefits and harms of hand cleaning with ash compared with hand cleaning using soap or other mate...

To the Editor Based on their randomized clinical trial, Dr Flint and colleagues concluded that continuing sertraline and olanzapine compared with sertraline and placebo reduced the risk of relapse of depression in patients with psychotic depression in remission.¹ We are concerned about limitations in their study design.

Objective To investigate to what extent evidence from previous similar trials or systematic reviews was considered before conducting new trials. Design Cohort study of contemporary protocols for trials with ethical approval. Methods All protocols for randomised trials approved by the five ethical committees in Denmark between January 2012 and Mar...

Background: Screening for malignant melanoma has the potential to reduce morbidity and mortality from the disease through early detection, as prognosis is closely associated with the thickness of the lesion at the time of diagnosis. However, there are also potential harms from screening people without skin lesion concerns, such as overdiagnosis of...

Background: General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also, screening leads to increase...

Objectives In October 2016 the French Minister of Health released the report of an independent inquiry into mammography screening, presenting two options for the future: end the national breast screening program, or end the current program and put in place a radically reformed program. Our objective was to critically analyse the report and the proc...

Background: Large reductions in the incidence of abdominal aortic aneurysm (AAA) and AAA-related mortality mean that results from randomised trials of screening for the disorder might be out-dated. The aim of this study was to estimate the effect of AAA screening in Sweden on disease-specific mortality, incidence, and surgery. Methods: Individua...

In October 2016, the French Minister of Health released the report of an independent inquiry into mammography screening. The report presented 2 options: (1) end the national breast screening program, or (2) end the current program and put in place a radically reformed program.

Purpose: To summarise recommendations about 21 selected non-surgical interventions for recent onset (<12 weeks) non-specific neck pain (NP) and cervical radiculopathy (CR) based on two guidelines from the Danish Health Authority. Methods: Two multidisciplinary working groups formulated recommendations based on the GRADE approach. Results: Twel...

A Cochrane systematic review on immediate-release methylphenidate for adults with attention deficit hyperactivity disorder (ADHD) was withdrawn from the Cochrane Library on 26 May 2016 after substantial criticism of its methods and flawed conclusions. Retraction of scientific papers on this basis is unusual but can be necessary. We provide a summar...

Kazan hosted Russia's second International Conference QiQUM 2015 on Cochrane evidence for health policy, which was entirely independent of the pharmaceutical or other health industry, bringing together 259 participants from 11 countries and 13 regions of the Russian Federation. The Conference was greeted and endorsed by world leaders in Evidence-ba...

Background: Effective breast cancer screening should detect early-stage cancer and prevent advanced disease. Objective: To assess the association between screening and the size of detected tumors and to estimate overdiagnosis (detection of tumors that would not become clinically relevant). Design: Cohort study. Setting: Denmark from 1980 to...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects on morbidity and mortality of screening for malignant melanoma in the general population. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Faglig anbefaling, Sundhedsstyrelsen 2015

Providing information to enable informed choices about healthcare sounds immediately appealing to most of us. But Minna Johansson and colleagues argue that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation The idea of infor...

Objective: To investigate whether invitations for publicly funded cervical screening provide sufficient information to enable an informed choice about participation. Design: Cross-sectional study using a checklist of 23 information items on benefits and harms from cervical screening and the risks related to cervical cancer. Material: Invitatio...

To the Editor In the systematic review of breast cancer screening, Dr Myers and colleagues1 claimed that our Cochrane review2 showed that breast screening reduces cause-specific mortality by 19%, there was no significant heterogeneity, and our results were similar to those of other reviews. This misrepresents our findings and creates an impression...

Systematically review and analyse the efficacy of CBT versus treatment as usual in adults with ADHD. The literature was systematically searched ending the 28 March 2014. Standardised mean differences (SMD) and 95 % confidence intervals were calculated. CBT was efficacious in reducing symptoms of ADHD (SDM −1.0, 95 % CI −1.5 to −0.5) when evaluated...

The recently updated breast cancer screening guidelines from the American Cancer Society are less aggressive than previous versions and clearer about overdiagnosis. However, a lack of attention was placed on the differences in effect estimates between trials at high and low risk of bias, and the authors failed to quantify the most serious harm.

This article reviews four important screening principles applicable to screening mammography in order to facilitate informed choice. The first principle is that screening may help, hurt, or have no effect. In order to reduce mortality and mastectomy rates, screening must reduce the rate of advanced disease, which likely has not happened. Through ov...

To the Editor: The report from the International Agency for Research on Cancer (IARC) (June 11 issue)(1) does not represent expert consensus. The authors of reports that question breast-cancer screening and were published in major medical journals were not included in the panel. Reductions in breast-cancer-related mortality among young women never...

Purpose: Most guidelines recommend pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary disease (COPD) and modified Medical Research Council dyspnea scale (mMRC) levels ≥2, but the effectiveness of PR in patients with less advanced disease is not well established. Our aim was to investigate the effects of PR in patients wi...

Resistance training (RT) is thought to be effective in preventing muscle depletion, whereas endurance training (ET) is known to improve exercise capacity and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD). Our objectives were to assess the efficiency of combining RT with ET compared with ET alone. We identifi...

Endurance training (ET) as part of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to improve exercise capacity and health-related quality of life, but dyspnea limits the exercise intensity. Therefore, resistance training (RT), which may cause less dyspnea, could be an alternative. The purpose o...