Roberta Wines

Screening for multiple types of cancer with a single blood test is potentially transformative. To assess the benefits, accuracy, and harms of screening with blood-based multicancer detection (MCD) tests in asymptomatic adults. MEDLINE, Cochrane Library, trial registries, and relevant websites through March 2025. Controlled studies of MCD tests (for example, cell-free DNA) in asymptomatic populations reporting cancer detection, mortality, quality of life, and harms (psychosocial, adverse events, decrease in standard-of-care screening); uncontrolled studies for harms of diagnostic evaluation; test accuracy studies. One reviewer extracted data; a second checked for accuracy; 2 reviewers independently assessed risk of bias (ROB) and strength of evidence. No controlled studies evaluated benefits of screening. Twenty studies (n = 109 177) reported accuracy for 19 MCD tests. Seven studies (5 with high ROB, 2 of unclear ROB) reported the accuracy of future cancer detection in asymptomatic persons followed for 1 year (prediagnostic performance); the rest estimated accuracy from high ROB case-control studies in clinically confirmed cancer cases and healthy, cancer-free, control participants (diagnostic performance). Across tests, sensitivity ranged from 0.095 to 0.998, specificity ranged from 0.657 to 1.0, and area under the curve (AUC) ranged from 0.52 to 1.0. Sensitivity and AUC were higher in diagnostic performance compared with prediagnostic performance studies. No other patterns in accuracy were discernible. One cohort study reported harms; however, these data were limited. English-language studies only. Heterogeneity precluded quantitative synthesis of accuracy; estimates from the diagnostic performance studies may not be applicable to screening. No controlled studies are completed that report benefits of screening with MCD tests; evidence was judged insufficient to evaluate harms and accuracy. Accuracy varies by test and study design. Agency for Healthcare Research and Quality. (PROSPERO: CRD42024570793).

Borderline personality disorder (BPD) is the most common personality disorder, affecting 1.8% of the general population, 10% of psychiatric outpatients, and 15%-25% of psychiatric inpatients. Practice guidelines recommend psychotherapies as first-line treatments. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative effectiveness of each individual psychotherapy versus treatment as usual (TAU) or other psychotherapies. To systematically assess the comparative effectiveness of commonly used psychotherapies versus TAU or versus other psychotherapies for BPD treatment. We conducted systematic literature searches in MEDLINE, EMBASE, the Cochrane Library, and APA PsycINFO up to July 14, 2022, and searched reference lists of pertinent articles and reviews. Inclusion criteria were (a) patients 13 years or older with a diagnosis of BPD, (b) treatment with commonly used psychotherapies, (c) comparison with TAU or another psychotherapy, (d) assessment of relevant BPD-related health outcomes, and (e) randomized or nonrandomized trials or controlled observational studies. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We found 25 psychotherapy studies meeting inclusion criteria with data on 2,545 participants. Seventeen studies compared nine psychotherapies with TAU and nine studies compared eight psychotherapies with another psychotherapy for the treatment of BPD. Overall, both TAU and included psychotherapies were effective in treating the severity and symptoms of BPD. Moderate certainty of evidence suggests that systems training for emotional predictability and problem solving is more effective than TAU for the treatment of BPD; low certainty of evidence suggests that dialectical behavior therapy, schema therapy, transference-focused psychotherapy, acceptance and commitment therapy, manual-assisted cognitive therapy, and cognitive behavioral therapy are more effective than TAU for treating BPD. We were unable to draw conclusions from head-to-head comparisons of psychotherapies, which were limited to single studies with very low to low certainty of evidence. All commonly used psychotherapies improve BPD severity, symptoms, and functioning. Our assessment found no strong evidence suggesting that any one psychotherapy is more beneficial than another. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The authors summarize the evidence on the use of video teleconferencing when used as a replacement or as an adjunct for usual care. This article also provides an evidence map of the clinical contex... Background: Video teleconferencing (VTC) as a substitute for in-person health care or as an adjunct to usual care has increased in recent years. Purpose: To assess the benefits and harms of VTC vis...

To assess whether response to medications for alcohol use disorders varies by genotype. Systematic review and meta-analysis. We found no studies that assessed the clinical utility of genotype-guided dosing strategies or genotype-guided medication selection, and none randomized by genotype. All included studies assessed the association between genotype and response to medication. Of 15 included studies, eight (n = 1365 participants) assessed variation in naltrexone response and polymorphisms of OPRM1. Our meta-analyses for return to heavy drinking found no significant difference between A allele homozygotes and those with at least one G allele, both without (risk difference: 0.26; 95% CI: -0.01-0.53; n = 174) and with inclusion of studies rated as high or unclear risk of bias (risk difference: 0.14; 95% CI: -0.03-0.3; n = 382). For all other polymorphism-medication pairs, we found just one eligible study. Estimates of effect for return to heavy drinking suggest it is possible that patients with at least one G allele of A118G polymorphism of OPRM1 might be more likely to respond to naltrexone, but confidence intervals were wide; additional studies are needed to improve confidence in the estimates.

By Daniel E. Jonas, Roberta Wines. ...