Abstract:
OBJECTIVE: To directly compare the performance and externally validate the three most studied prediction tools for osteoporotic fractures-QFracture, FRAX, and Garvan-using data from electronic health records. DESIGN: Retrospective cohort study. SETTING: Payer provider healthcare organisation in Israel. PARTICIPANTS: 1 054 815 members aged 50 to 90 years for comparison between tools and cohorts of different age ranges, corresponding to those in each tools' development study, for tool specific external validation. MAIN OUTCOME MEASURE: First diagnosis of a major osteoporotic fracture (for QFracture and FRAX tools) and hip fractures (for all three tools) recorded in electronic health records from 2010 to 2014. Observed fracture rates were compared to probabilities predicted retrospectively as of 2010. RESULTS: The observed five year hip fracture rate was 2.7% and the rate for major osteoporotic fractures was 7.7%. The areas under the receiver operating curve (AUC) for hip fracture prediction were 82.7% for QFracture, 81.5% for FRAX, and 77.8% for Garvan. For major osteoporotic fractures, AUCs were 71.2% for QFracture and 71.4% for FRAX. All the tools underestimated the fracture risk, but the average observed to predicted ratios and the calibration slopes of FRAX were closest to 1. Tool specific validation analyses yielded hip fracture prediction AUCs of 88.0% for QFracture (among those aged 30-100 years), 81.5% for FRAX (50-90 years), and 71.2% for Garvan (60-95 years). CONCLUSIONS: Both QFracture and FRAX had high discriminatory power for hip fracture prediction, with QFracture performing slightly better. This performance gap was more pronounced in previous studies, likely because of broader age inclusion criteria for QFracture validations. The simpler FRAX performed almost as well as QFracture for hip fracture prediction, and may have advantages if some of the input data required for QFracture are not available. However, both tools require calibration before implementation.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Dagan N,Cohen-Stavi C,Leventer-Roberts M,Balicer RDdoi
10.1136/bmj.i6755subject
Has Abstractpub_date
2017-01-19 00:00:00pages
i6755eissn
0959-8138issn
1756-1833journal_volume
356pub_type
杂志文章abstract:OBJECTIVE:To investigate the risk factors for HIV infection in patients attending clinics for sexually transmitted diseases in India. DESIGN:Descriptive study of HIV serology, risk behaviour, and findings on physical examination. SUBJECTS:2800 patients presenting to outpatient clinics between 13 May 1993 and 15 July ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7000.283
更新日期:1995-07-29 00:00:00
abstract::A study was carried out analysing the operation of a drug rationalisation programme in a central London teaching district that had evolved from experience over 17 years. Creation of a limited list of about 700 drugs had been achieved by local consensus. Drug selection was based on appraisal of efficacy, safety, and co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6646.465
更新日期:1988-08-13 00:00:00
abstract:OBJECTIVES:To describe the change in first day infant mortality during 1935-87. To examine the hypothesis that excess first day mortality in the 1950s and 1960s was attributable to restricting oxygen for sick newborn infants. DESIGN:Time series analysis of first day infant mortality and stillbirth rates. SETTING:Engl...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6823.343
更新日期:1992-02-08 00:00:00
abstract:OBJECTIVES:To develop prediction models that better estimate the pretest probability of coronary artery disease in low prevalence populations. DESIGN:Retrospective pooled analysis of individual patient data. SETTING:18 hospitals in Europe and the United States. PARTICIPANTS:Patients with stable chest pain without ev...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.e3485
更新日期:2012-06-12 00:00:00
abstract:OBJECTIVE:To determine whether a booklet given to patients being discharged from hospital giving details of their admission and treatment increased their knowledge and recall when reviewed in outpatient clinics. DESIGN:Patients alternately allocated to receive a booklet or to serve as controls. Assessment by a questio...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.298.6677.870
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVES:To elucidate current trends and geographical patterns in the sex ratio at birth and in the population aged under 20 in China and to determine the roles played by sex selective abortion and the one child policy. DESIGN:Analysis of household based cross sectional population survey done in November 2005. SETT...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1211
更新日期:2009-04-09 00:00:00
abstract:OBJECTIVES:To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain. DESIGN:Prospective cohort study. SETTING:Two general practices in the south Manchester area. PARTICIPANTS:180 patients, who previously participat...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.318.7199.1662
更新日期:1999-06-19 00:00:00
abstract:OBJECTIVE:To investigate whether an important football match increases stress to such an extent that it triggers acute myocardial infarction and stroke. DESIGN:Longitudinal study of mortality around 22 June 1996 (the day the Dutch football team was eliminated from the European football championship). Mortality on 22 J...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7276.1552
更新日期:2000-12-23 00:00:00
abstract:OBJECTIVE:To evaluate the effects on suicidal behaviour of legislation limiting the size of packs of paracetamol and salicylates sold over the counter. DESIGN:Before and after study. SETTING:UK population, with detailed monitoring of data from five liver units and seven general hospitals, between September 1996 and S...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.322.7296.1203
更新日期:2001-05-19 00:00:00
abstract:OBJECTIVE:To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy. DESIGN:Population based cohort study using data from national health registers. SETTING:Sweden. PARTICIPANTS:332,137 women with a last menstrual period anytime after 1 July 2005 and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7085
更新日期:2012-11-08 00:00:00
abstract:OBJECTIVE:To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Randomised controlled trials involving a threshold for red blood cell transfusion in hospita...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.i1351
更新日期:2016-03-29 00:00:00
abstract:OBJECTIVE:To investigate the association of enteroviruses with motor neurone disease, also known as amyotrophic lateral sclerosis. DESIGN:Analysis by enterovirus polymerase chain reaction of wax embedded material from spinal cords taken at necropsy from subjects with motor neurone disease and from age and sex matched ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6943.1541
更新日期:1994-06-11 00:00:00
abstract:OBJECTIVES:To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip. DESIGN:Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. SETTING:One large teaching hospita...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e2147
更新日期:2012-04-19 00:00:00
abstract:OBJECTIVES:To compare outcome and costs of general practitioners, senior house officers, and registrars treating patients who attended accident and emergency department with problems assessed at triage as being of primary care type. DESIGN:Prospective intervention study which was later costed. SETTING:Inner city acci...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7042.1340
更新日期:1996-05-25 00:00:00
abstract:OBJECTIVE:To use funnel plots and cumulative funnel plots to compare in-hospital outcome data for operators undertaking percutaneous coronary interventions with predicted results derived from a validated risk score to allow for early detection of variation in performance. DESIGN:Analysis of prospectively collected dat...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.39512.529120.BE
更新日期:2008-04-26 00:00:00
abstract::Cancers of unknown primary (CUPs) are histologically confirmed, metastatic malignancies with a primary tumor site that is unidentifiable on the basis of standard evaluation and imaging studies. CUP comprises 2-5% of all diagnosed cancers worldwide and is characterized by early and aggressive metastasis. Current standa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.m4050
更新日期:2020-12-07 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury in adolescent female football players. DESIGN:Stratified cluster randomised controlled trial with clubs as the unit of randomisation. SETTING:230 Swedish football clubs (121 in the intervention group, 109 in th...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e3042
更新日期:2012-05-03 00:00:00
abstract: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 favour...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m4234
更新日期:2020-12-09 00:00:00
abstract:OBJECTIVE:To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. DESIGN:Systematic review and network meta-analysis. DATA SOURCES...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.h3728
更新日期:2015-07-28 00:00:00
abstract::The results of a survey of 769 patients attending the St. James's University Fertility Control Clinic, England, for abortion services showed that patients seeing general practitioners were less knowledgeable than those attending specialist clinics. There was a demonstrated need for counseling on pill and condom use a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6877.556
更新日期:1993-02-27 00:00:00
abstract:STUDY OBJECTIVE:To assess effect of intravenous recombinant tissue type plasminogen activator on size of infarct, left ventricular function, and survival in acute myocardial infarction. DESIGN:Double blind, randomised, placebo controlled prospective trial of patients with acute myocardial infarction within five hours ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.297.6660.1374
更新日期:1988-11-26 00:00:00
abstract:OBJECTIVES:(a) To investigate defensive medical practices among general practitioners; (b) to compare any such practices with general practitioners' understanding of certain aspects of the terms of service and medical negligence and practitioners' concerns about the risk of being sued or having a complaint lodged. DES...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6971.27
更新日期:1995-01-07 00:00:00
abstract:OBJECTIVE:To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians. DESIGN:Pooled analyses of 20 prospective cohorts in Asia, including data from 835,082 east Asians and 289,815 south Asians. Cohorts w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.f5446
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population. DESIGN:Cohort study. SETTING:UK electronic primary care records from practices contributing to the Clinical Practice Resea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.k341
更新日期:2018-02-09 00:00:00
abstract::A doctor who performed an abortion in Poland faces two years in prison and the loss of his medical license for up to 10 years if he is found guilty of violating the new abortion laws introduced in 1993 after a lengthy campaign by the Catholic church and the Christian Democratic Union party. The new laws permit aborti...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.310.6994.1556a
更新日期:1995-06-17 00:00:00
abstract:OBJECTIVE:To find out whether enalapril or ramipril causes the sensitivity of the cough reflex to change or symptomatic cough to develop in patients with hypertension. DESIGN:Prospective, placebo controlled, double blind, randomised crossover study. SETTING:Academic units of clinical pharmacology and medicine. PATIE...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.299.6690.13
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:To assess the risk of bias associated with missing outcome data in systematic reviews. DESIGN:Imputation study. SETTING:Systematic reviews. POPULATION:100 systematic reviews that included a group level meta-analysis with a statistically significant effect on a patient important dichotomous efficacy outcome...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.m2898
更新日期:2020-08-26 00:00:00
abstract::Ruben Meerman and Andrew Brown explain why the answer might not be what you expect. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.g7257
更新日期:2014-12-16 00:00:00
abstract:OBJECTIVE:To determine the effects on independence in older people needing rehabilitation in a locality based community hospital compared with care on a ward for elderly people in a district general hospital. DESIGN:Randomised controlled trial. SETTING:Care in a community hospital and district general hospital in Bra...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38498.387569.8F
更新日期:2005-08-06 00:00:00
abstract:OBJECTIVES: To estimate differences in annual income of physicians in the United States by race and sex adjusted for characteristics of physicians and practices. DESIGN: Cross sectional survey study. SETTING: Nationally representative samples of US physicians. PARTICIPANTS: The 2000-13 American Community Survey (ACS...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.i2923
更新日期:2016-06-07 00:00:00