Journal of Evidence‐Based Medicine最新文献

{"title":"Encouraging Versus Neutral Prompts in Large Language Model-Based Appraisal of Clinical Guidelines Using AGREE II.","authors":"Bingyi Wang, Xufei Luo, Yaolong Chen, Janne Estill","doi":"10.1111/jebm.70190","DOIUrl":"https://doi.org/10.1111/jebm.70190","url":null,"abstract":"","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70190"},"PeriodicalIF":4.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Rapid Benefit-Risk Assessment Index for Pediatric Off-Label Drug Use.","authors":"Xuejuan Li, Yingna Xu, Guanglei Jin, Wei Jiang, Zebin Chen, Zhihua Zheng, Xiaoling Wang, Xiaolan Mo, Xinyu Liu, Benjie Zhou, Hong Chang, Shaojie Deng, Xiaomei Fan, Jinping Wang, Yuntao Jia, Zhong Li, Jing Miao, Yunzhu Lin, Rui Fang, Zhiling Li, Jianhong Zhu, Zhichao He, Yinghui Jin, Qiru Su, Wudong Guo, Jie Jiang, Sha Li, Jinqiu Yuan, Jun Yang, Sixi Liu, Zhe Su, Yanmin Bao, Dezhi Cao, Zhaoxia Wang, Weiping Tan, Bihong Zhang, Chunxiu Gong, Xiaodong Wang, Zhiyong Zhang, Chunhong Xie, Yushan Ma, Haidong Fu, Xinle Luo, Junyan Wu","doi":"10.1111/jebm.70177","DOIUrl":"https://doi.org/10.1111/jebm.70177","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a rapid, evidence-based benefit-risk assessment index for off-label drug use in pediatrics, thereby promoting standardized clinical decision-making.</p><p><strong>Methods: </strong>Under the auspices of the Guangdong Pharmaceutical Association, a multidisciplinary expert panel from pediatrics, pharmacy, methodology, and ethics was convened. Systematic literature searches informed a preliminary index framework. Three Delphi rounds refined indicators. Weights were assigned using the analytic hierarchy process. Expert-based validation involved 20 hematology-oncology experts assessing 10 cases; intraclass correlation coefficient (ICC) and Spearman's correlations evaluated reliability and validity.</p><p><strong>Results: </strong>The index consists of 2 primary dimensions (benefits: 56 points; risks: 44 points), 10 third-level, and 40 fourth-level indicators, with five prerequisites (e.g., no alternatives, informed consent). The ICC was 0.77 (good reliability); Spearman's correlations were r_s = 0.97 (benefits) and r_s = 0.68 (risks) (both p < 0.05), indicating strong alignment with expert consensus. Junior experts showed lower correlations (benefits r_s = 0.89; risks r_s = 0.56) than seniors (benefits r_s = 0.97; risks r_s = 0.78), highlighting the system's role in standardizing assessments.</p><p><strong>Conclusion: </strong>This quantitative index provides an evidence-based tool for pediatric off-label drug decisions, supporting clinicians, policymakers, and standardization efforts.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70177"},"PeriodicalIF":4.7,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-Based Decision-Making in Multimorbidity Care: A Semi-Structured Interview Study.","authors":"Zijun Wang, Liliya E Ziganshina, Xiaohui Wang, Yaolong Chen, Janne Estill","doi":"10.1111/jebm.70181","DOIUrl":"https://doi.org/10.1111/jebm.70181","url":null,"abstract":"<p><strong>Background: </strong>The management of multimorbidity often requires applying multiple disease-specific guidelines, which may lead to harmful disease and drug interactions. The objective of the study was to collect the opinions of leading experts on factors influencing the use of guidelines in decision-making in multimorbidity management from a multidisciplinary perspective, and provide empirical insights to inform guideline-based decision support.</p><p><strong>Methods: </strong>We conducted a series of semi-structured interviews with experts in multimorbidity research and practice and guideline development to participate. Interviewees were selected using purposive sampling. Our interviews covered the current use of clinical guidelines in multimorbidity management, key barriers and facilitators, and priority action areas. Thematic analysis was performed using NVivo 12.0.</p><p><strong>Results: </strong>Fifteen experts from nine countries were interviewed. The lack of multimorbidity-specific guidelines and recommendations may lead healthcare providers to either rely solely on personal experience, or follow guidelines without considering the needs and comorbidities of individual patients. Major barriers to guideline application include insufficient evidence and limited awareness and training among clinicians in both multimorbidity management and guideline implementation. The interviewees emphasized flexible use of guidelines, prioritizing patient values and preferences, and individualized management goals informed by (rather than strictly adhering to) guidelines.</p><p><strong>Conclusions: </strong>Applying guidelines in multimorbidity care faces major evidence and applicability gaps. Particularly the generation of high-quality clinical evidence specific to multimorbidity, enhancing the methodological rigor in guideline development, and improvement of the contextual relevance and usability of guidelines in real-world settings need more attention.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70181"},"PeriodicalIF":4.7,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Acceptance of Participating in Clinical Trials of New Drugs: A National Cross-Sectional Study.","authors":"Shujie Dong, Mengmeng Liu, Yuanyuan Zhang, Jinzi Zhang, Qin Han, Xiaohan Chen, Yibo Wu, Wai-Kit Ming","doi":"10.1111/jebm.70176","DOIUrl":"https://doi.org/10.1111/jebm.70176","url":null,"abstract":"<p><strong>Objective: </strong>Clinical trials are regarded as an essential method for developing new treatments and giving patients access to potentially effective medications that are still being studied. This study aimed to evaluate acceptance of participating in clinical trials of new drugs and to further explore the associated factors.</p><p><strong>Methods: </strong>A population-based cross-sectional study was conducted in China from June 20 to August 31, 2022. We collected demographic data and used visual analog scale scores to assess the public's willingness to accept clinical trials of new drugs (range 0-100). Linear regression analysis was adopted to evaluate the factors related to attitudes toward clinical trials of new drugs.</p><p><strong>Results: </strong>This survey contained 19,710 valid questionnaires to investigate acceptance of participating in clinical trials of new drugs. Participants showed low willingness to accept clinical trials of new drugs, with a mean score of 44.69 out of 100. The results showed that rural residence (β = 3.00), western China (β = 3.15), being married (β = 2.93), older age (31-59 years [β = 3.84], ≥60 years [β = 7.71]), having cancer or rare diseases (β = 5.15), higher monthly household income (>6000 yuan [β = 1.76]), medical-related occupations (β = 8.01), anxiety status (moderate anxiety [β = 1.83]), moderate to severe anxiety [β = 2.66]), perceived stress (β = 0.51), health literacy (β = 0.21), self-efficacy (β = 0.34), and media use (β = 0.42) were associated with higher acceptance of participating in clinical trials of new drugs. However, central China (β = -1.65), female sex (β = -2.29), chronic diseases (β = -2.45), and medical insurance (β = -3.78) were associated with lower acceptance of participating in clinical trials of new drugs. Subgroup analysis demonstrated consistent trends across age and chronic disease subgroups.</p><p><strong>Conclusions: </strong>This reveales low public willingness to accept clinical trials of new drugs. The willingness is affected by marital status, occupation, area of residence, income, health insurance, physical and mental health status, media use, and health literacy.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70176"},"PeriodicalIF":4.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint Association of Triglyceride-Glucose Index and a Body Shape Index With Risk of Cardiovascular Disease Among Adults With Prediabetes.","authors":"Feipeng Qiu, Lingxiao Li, Zerong Chen, Hao Zhang, Yue Cao, Weixing Wen, Jiahuan Li, Xiaohui Huang, Xiaolin Zhu, Xiaoyan Cai, Yuli Huang","doi":"10.1111/jebm.70185","DOIUrl":"10.1111/jebm.70185","url":null,"abstract":"<p><strong>Background: </strong>Individuals with prediabetes have a higher cardiovascular disease (CVD) risk than those with normoglycemia. Identifying high-risk subgroups is crucial for targeted prevention. While the triglyceride-glucose index (TyG) and a body shape index (ABSI) are independently linked to CVD risk, their combined utility in individuals with prediabetes remains unexplored. This study aimed to investigate whether concurrent high TyG and ABSI confer an additive CVD risk in this population.</p><p><strong>Methods: </strong>We analyzed 6833 UK Biobank participants with prediabetes and no baseline CVD. Cox proportional hazards models were used to assess the associations between TyG, ABSI, and CVD incidence, adjusting for sociodemographic and metabolic confounders. Predictive performance was evaluated using the area under the curve (AUC) of receiver operating characteristic curves.</p><p><strong>Results: </strong>Over a median 9.5-year follow-up, 840 participants developed CVD. Elevated TyG (hazard ratio [HR] = 1.09, 95% confidence interval [CI]: 1.01-1.25) and the highest ABSI quartile (HR = 1.54, 95% CI: 1.22-1.94) showed independent associations with CVD risk. Combined high TyG/high ABSI conferred an additive risk (HR = 1.65, 95% CI: 1.24-2.20), an effect more pronounced in hypertensive participants than in normotensive individuals (p for interaction = 0.018). The dual-marker method showed better discriminative performance for CVD (AUC = 0.685) than TyG or ABSI alone (TyG: 0.661; ABSI: 0.608; DeLong test p < 0.001).</p><p><strong>Conclusion: </strong>The joint elevation of TyG and ABSI identifies individuals with prediabetes at higher CVD risk independent of conventional indicators, especially within hypertensive subgroups, enabling targeted monitoring and intervention to alleviate the CVD burden.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70185"},"PeriodicalIF":4.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison and Selection of Network Meta-Analysis Models for Fitting and Extrapolating Cancer Survival Data.","authors":"Mingye Zhao, Qian Xing, Taihang Shao, Hanqiao Shao, Wenxi Tang","doi":"10.1111/jebm.70183","DOIUrl":"https://doi.org/10.1111/jebm.70183","url":null,"abstract":"<p><strong>Aim: </strong>To assess network meta-analysis (NMA) model biases under different proportional hazards (PHs) scenarios, compare fitting and extrapolation performance for hazard ratios (HRs) using cancer survival data, identify metrics guiding model selection, and compare extrapolation strategies using parametric versus constant-tail HRs.</p><p><strong>Methods: </strong>We conducted 30 NMAs (five three-arm trials, with each arm anchoring pairwise comparisons for overall survival and progression-free survival), subgroup analyses assessed the PH assumption and curve types. Models included Cox-PH, Fractional Polynomial, Royston-Parmar (RP), Piecewise Exponential (PWE), and Parametric Survival Model (PSM). For extrapolation, we categorized models into those using parametric-extrapolation HRs and those assuming constant-tail HRs. Main indicator was sum of squared errors (SSE), alongside Bias, assessed for observed data (SSE-O, Bias-O), fitting (SSE-F, Bias-F), and fitting-extrapolation (SSE-FE, Bias-FE).</p><p><strong>Results: </strong>Model choice introduced much more uncertainty when the PH assumption was violated than when held. RP-2knot had the best HR fitting, comparable to RP-1knot; errors were 0.5- to 33.7-fold higher for other models. RP-2knot and RP-1knot demonstrated the best fitting-extrapolation performance. Friedman tests showed RP-2knot significantly outperformed other models in fitting, except RP-1knot, and in fitting-extrapolation, except RP-1knot and Cox-PH. SSE-O and Bias-O were highly correlated with model fitting (ρ = 0.682-0.713) and moderately with fitting-extrapolation. Within 2-3 years extrapolation window, constant-tail HR models outperformed parametric-extrapolation HR.</p><p><strong>Conclusions: </strong>Model selection required more caution when the PH assumption failed. RP model showed promising fitting and extrapolation performance. SSE-O and Bias-O may guide model selection in HR-fitting; extrapolation utility needs further validation. Non-PH models using constant-tail HRs showed better short-term extrapolation.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70183"},"PeriodicalIF":4.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Nutritional Assessment Tools as Predictors of Hospitalization in Patients Undergoing Maintenance Hemodialysis\".","authors":"","doi":"10.1111/jebm.70191","DOIUrl":"https://doi.org/10.1111/jebm.70191","url":null,"abstract":"","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70191"},"PeriodicalIF":4.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Atherogenic Index of Plasma and Risk of Cardiovascular Disease: A Dose-Response Meta-Analysis of Cohort Studies.","authors":"Taifeng Chen, Jinliang Liang, Yaqin Su, Li Yang, Minqi Gu, Jinyuan Pang, Kexin Li, Kaixin Chen, Yihao Shu, Yuying Wu, Fulan Hu, Dongsheng Hu, Ming Zhang","doi":"10.1111/jebm.70179","DOIUrl":"https://doi.org/10.1111/jebm.70179","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the correlations between atherogenic index of plasma (AIP) and the morbidity and mortality of cardiovascular disease (CVD) and investigate the potential dose-response relationship.</p><p><strong>Methods: </strong>We comprehensively searched the PubMed, Embase, and Web of Science Core Collection, CNKI, WanFang, and VIP for relevant literature until January 31, 2026. The included studies were cohort studies. The pooled relative risk (RR) and 95% confidence interval (CI) for dose-response relationships were calculated. The linear/nonlinear relationships were evaluated by using restricted cubic splines.</p><p><strong>Results: </strong>A total of 24 studies were included for the analysis. The pooled RRs for CVD morbidity and mortality in the highest versus lowest AIP group were 1.35 (95% CI: 1.25 to 1.45) and 1.49 (95% CI: 1.19 to 1.87), respectively. For per 1-unit increase in AIP, the risk of CVD morbidity and mortality increased by 47% (RR = 1.47, 95% CI: 1.32 to 1.64) and 42% (RR = 1.42, 95% CI: 1.18 to 1.71), respectively. Dose-response results showed linear associations between AIP and CVD morbidity (p_{non-linearity} = 0.659), as well as between AIP and CVD mortality (p_{non-linearity} = 0.619).</p><p><strong>Conclusion: </strong>This dose-response meta-analysis revealed a correlation between elevated AIP and the morbidity and mortality of CVD. The association has a dose-response profile between AIP and CVD morbidity, suggesting that AIP may serve as a potential predictor of CVD and provide an important basis for early clinical identification and intervention in populations at high risk of CVD.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70179"},"PeriodicalIF":4.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological Quality and Health Equity of AI Prediction Models in Rectal Cancer.","authors":"Chengqian Ye, Zhaochu Wang, Qingjie Wu, Guosheng Lin, Cai Zhang","doi":"10.1111/jebm.70186","DOIUrl":"https://doi.org/10.1111/jebm.70186","url":null,"abstract":"","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70186"},"PeriodicalIF":4.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Cost-Effectiveness of First-Line Immunotherapy-Based Regimens for Advanced Triple-Negative Breast Cancer.","authors":"Xiaoyue Sun, Xinyi Chen, Fandi Zhang, Xin Wu, Lei Liu, Jing Jing, Yuli Luo, Jiaqi Han, Jie Lan","doi":"10.1111/jebm.70184","DOIUrl":"https://doi.org/10.1111/jebm.70184","url":null,"abstract":"<p><strong>Aim: </strong>Several first-line immunotherapy-based regimens are available for patients with programmed death ligand 1 positive advanced or metastatic triple-negative breast cancer, but their relative economic value in China remains uncertain. This study evaluated selected regimens from the perspective of the Chinese healthcare system.</p><p><strong>Methods: </strong>We developed an exploratory cross-trial partitioned survival model using survival data from the IMpassion130, KEYNOTE-355, TORCHLIGHT, and ASCENT-04 Phase III trials, with utility and cost inputs from published sources and the Chinese healthcare setting. Outcomes included total costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-utility ratios. Pairwise comparisons used a willingness-to-pay threshold of USD 43,333 per QALY.</p><p><strong>Results: </strong>Pembrolizumab plus Sacituzumab Govitecan yielded the most LYs and QALYs, but at the highest cost. Toripalimab plus chemotherapy had the lowest cost, produced health outcomes similar to those of Pembrolizumab plus chemotherapy, and had the most favorable economic profile at the prespecified threshold. Pembrolizumab plus chemotherapy was cost-effective versus Atezolizumab plus chemotherapy. Pembrolizumab plus Sacituzumab Govitecan was not cost-effective, as its limited incremental benefit did not offset its substantially higher cost. Sensitivity analyses generally supported the base-case findings.</p><p><strong>Conclusions: </strong>Among the regimens evaluated, Toripalimab plus chemotherapy provided the most favorable balance between costs and health outcomes in China. Pembrolizumab plus chemotherapy also offered reasonable economic value versus Atezolizumab plus chemotherapy, whereas the value of Pembrolizumab plus Sacituzumab Govitecan was constrained by its high acquisition cost.</p>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":" ","pages":"e70184"},"PeriodicalIF":4.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}