Journal of Evidence‐Based Medicine最新文献

{"title":"An Umbrella Review of Diabetes Mellitus and Hearing Impairment","authors":"Longkun Liu,&nbsp;Qian Xu,&nbsp;Mengmeng Zhu,&nbsp;Jing Cui,&nbsp;Yanfei Liu,&nbsp;Yue Liu","doi":"10.1111/jebm.70030","DOIUrl":"https://doi.org/10.1111/jebm.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aims to synthesize current meta-analyses to propose a potentially existing association between diabetes and hearing impairment (HI), elevating their relationship to “high” level of evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was performed in 9 databases up to March 31, 2025. The pooled results were synthesized to elucidate the direction and magnitude of the effects. We used the AMSTAR-2 scale to assess study quality and the GRADE tool to assess the certainty of the evidence. Subgroup analysis was conducted according to age (PROSPERO-ID: CRD42024606416).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This umbrella review comprehensively encompassed over 22 million participants from more than 226 studies. After screening, 21 studies were finally included. Primary outcomes showed that individuals with HI were at a higher risk of developing diabetes, referring to [odds ratio (OR) = 1.88, 95% confidence interval (CI): (1.01, 3.50)] with moderate evidence certainty. Simultaneously, participants with diabetes exhibited a more prevalent occurrence of HI. Higher pure tone audiometric thresholds, lower distortion product otoacoustic emission amplitudes, and increased auditory brainstem-evoked response latency time collectively indicated an increased risk of HI associated with diabetes. Subgroup analysis results revealed that in the younger population, the association between HI and diabetes risk is also high.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall, the current body of evidence underscores a latent bidirectional association between diabetes and HI, coupled with mutually aggravating effects. Our findings suggest that HI may serve as an indicator of the risk of developing diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871467","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":"Chinese Expert Consensus on Integrated Chinese and Western Medicine for the Treatment of Tic Disorders","authors":"Rong Ma,&nbsp;Sumei Wang,&nbsp;Yi Zheng,&nbsp;Jian Chen,&nbsp;Wenxiong Chen,&nbsp;Xia Cui,&nbsp;Yonghua Cui,&nbsp;Yanzhao Guo,&nbsp;Fei Han,&nbsp;Xinmin Han,&nbsp;Daohan Wang,&nbsp;Fan He,&nbsp;Ping Rong,&nbsp;Yan Hu,&nbsp;Yi Huang,&nbsp;Xiaoyan Ke,&nbsp;Bo Li,&nbsp;Min Li,&nbsp;Ruiben Li,&nbsp;Huanzhong Liu,&nbsp;Jing Liu,&nbsp;Zhisheng Liu,&nbsp;Xuerong Luo,&nbsp;Bingxiang Ma,&nbsp;Ping Shi,&nbsp;Jiaxin Sun,&nbsp;Hua Wang,&nbsp;Liping Wu,&nbsp;Min Wu,&nbsp;Haihong Yan,&nbsp;Baoqing Zhang,&nbsp;Jinsong Zhang,&nbsp;Junhua Zhang,&nbsp;Xilian Zhang,&nbsp;Xin Zhang,&nbsp;the Standard Research Project Group on Prevention and Treatment Strategies of Integrated Chinese and Western Medicine","doi":"10.1111/jebm.70012","DOIUrl":"https://doi.org/10.1111/jebm.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Tic disorders are neurodevelopmental conditions that manifest in childhood or adolescence and can significantly impact the quality of life of affected children and their families to varying degrees. Integrated traditional Chinese and Western medicine treatment strategies have demonstrated more pronounced efficacy and better safety profiles. However, there is currently no standardized clinical expert consensus on this approach. To address this, the National Administration of Traditional Chinese Medicine initiated a project, and the China Association of Chinese Medicine assembled a team of authoritative domestic experts to develop this expert consensus, aiming to provide practical and feasible integrated treatment strategies for clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This consensus identified clinical issues through research, conducted literature reviews, and established evidence based on systematic evaluations. Expert surveys, two rounds of Delphi questionnaires, and expert consensus meetings were conducted to formulate a series of recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We established a multidisciplinary consensus development panel. Based on systematic literature reviews, Delphi questionnaires, and consensus meetings, ten clinical issues were identified. Ultimately, a series of recommendations were developed, considering the balance of benefits and risks, the certainty of evidence, clinical feasibility, accessibility, and clinical acceptability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These recommendations comprehensively address key issues in the field of integrated traditional Chinese and Western medicine treatment, including indications for the use of Chinese or Western medicine alone or in combination, specific treatment protocols, methods for dose reduction and discontinuation, evaluation intervals, and the management of adverse reactions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143840839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Hypoglycemic Agents in Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD): A Systematic Review and Network Meta-Analysis","authors":"Qiao Ren,&nbsp;Yao Tan,&nbsp;Guixiang Zhang,&nbsp;Yuzhao Dai,&nbsp;Lidan Yang,&nbsp;Yunmo Wu,&nbsp;He He,&nbsp;Jie Chen","doi":"10.1111/jebm.70021","DOIUrl":"https://doi.org/10.1111/jebm.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Metabolic dysfunction associated steatotic liver disease (MASLD) is a universal hepatic disease, and many recent randomized clinical trials (RCTs) have explored whether hypoglycemic agents may be beneficial for its treatment. This study aimed to assess the relative effectiveness of each hypoglycemic agent for MASLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>China National Knowledge Infrastructure（CNKI）, WanFang, Weipu, PubMed, Embase, The Cochrane Library, and Web of Science Core Collection were searched for RCTs on the efficacy of hypoglycemic agents in MASLD published up to December 31, 2024. All statistical analyses were performed using R version 4.3.3. The network meta-analysis was conducted using Bayesian statistical methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 26 hypoglycemic agents for treating MASLD in 37 studies with 2406 participants were included. Empagliflozin was most effective in improving liver stiffness measurement (LSM), whereas liraglutide showed significant benefits in body weight, body mass index (BMI), and waist circumference. Both sodium-glucose co-transporter 2 (SGLT-2) inhibitors (e.g., empagliflozin) and glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide) improved liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyltransferase [GGT]), glucose metabolism (fasting plasma glucose [FPG], and homeostasis model assessment of insulin resistance [HOMA-IR]), and lipid profiles. Pioglitazone had limited benefits in these outcomes. Secondary outcomes such as inflammatory markers and fibrosis showed minimal changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Several hypoglycemic agents can improve laboratory and imaging indicators in adult patients with MASLD. Liraglutide is more effective than other agents, whereas empagliflozin emerged as the most effective for reducing LSM. However, different agents have different effects on the indicators; therefore, the relevant agents must be selected according to the specific patient condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831205","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":"A Randomized, Double-Blinded, Placebo-Controlled Study of the Use of Traditional Chinese Medicine for Treating Patients With Mild/Moderate Chronic Obstructive Pulmonary Disease","authors":"Jiansheng Li,&nbsp;Minghang Wang,&nbsp;Yang Xie,&nbsp;Suyun Li,&nbsp;Xueqing Yu,&nbsp;Fengsen Li,&nbsp;Hanrong Xue,&nbsp;Zegeng Li,&nbsp;Nianzhi Zhang,&nbsp;Guiying Liu,&nbsp;Wei Zhang,&nbsp;Qing Miao,&nbsp;ZiKai Sun,&nbsp;Zhenghang Ge,&nbsp;Zhanping Ma,&nbsp;Hongyan Cai,&nbsp;Zhijia Sun,&nbsp;Hailong Zhang,&nbsp;Yanfang Wang","doi":"10.1111/jebm.70023","DOIUrl":"https://doi.org/10.1111/jebm.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Chronic obstructive pulmonary disease (COPD) is a critical disease, with lung function closely linked to disease severity. This study aimed to evaluate the clinical efficacy of treatments for stable COPD in patients with pulmonary function Grades I and II.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We conducted a multicenter, randomized, double-blind, placebo-controlled trial (registration number: NCT01486186). A total of 502 patients were randomly assigned to an experimental group (<i>n </i>= 251, treated with Bufei, Bufei Jianpi, and Bufei Yishen granules based on traditional Chinese medicine [TCM] syndromes) and a control group (<i>n </i>= 251, treated with a Chinese medicine-based placebo). Acute exacerbations (AEs), lung function, clinical symptoms, 6-min walking distance (6MWD), and dyspnea were assessed over 12 months of treatment and 12 months of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 432 patients, including 214 and 218 patients in the experimental and control groups, respectively, completed the trial. The early treatment group had fewer AEs (<i>p </i>&lt; 0.05), better clinical symptom scores (<i>p </i>&lt; 0.05), longer 6MWD (<i>p</i> &lt; 0.05), and better Modified Medical Research Council (mMRC) scores than the control group (<i>p </i>&lt; 0.05). No significant differences were found in forced vital capacity (FVC) and forced expiratory volume in first second (FEV1%) between the two groups, but there was a significant difference in FEV1 and the annual rate of FEV1 decline between the groups over 2 years (<i>p </i>&lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Treatment with TCM for stable COPD significantly reduced AEs, increased the 6MWD, and alleviated dyspnea in patients with pulmonary function Grades I and II. FEV1 was improved, and the slower FEV1 decline indicates a potential benefit in mitigating disease progression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809781","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":"Using Integrative Therapies to Improve Patient-Reported Outcomes in Breast Cancer Survivors: A Living Evidence-Based Clinical Practice Guideline","authors":"Tingting Lu,&nbsp;Honghao Lai,&nbsp;Hongsheng Lin,&nbsp;Fei Ma,&nbsp;Li Hou,&nbsp;Lili Tang,&nbsp;Yi Zhu,&nbsp;Huijuan Mao,&nbsp;Anthony Lin Zhang,&nbsp;Myeong Soo Lee,&nbsp;Akihiko Ozaki,&nbsp;Mariana Cabral Schveitzer,&nbsp;Hui Zhao,&nbsp;Lidan Zhong,&nbsp;Baohui Jia,&nbsp;Lei Fan,&nbsp;Jiajie Huang,&nbsp;Baojin Han,&nbsp;Weilong Zhao,&nbsp;Long Ge,&nbsp;Jie Liu,&nbsp;Luqi Huang","doi":"10.1111/jebm.70029","DOIUrl":"https://doi.org/10.1111/jebm.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Breast cancer imposes a serious disease and economic burden on patients. This guideline aims to develop a living evidence-based clinical practice recommendations to guide the use of integrative therapies for the improvement of patient-reported outcomes (PROs) in breast cancer survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched systematic reviews and meta-analyses or conducted de nova systematic reviews and meta-analyses to support the recommendations. The grading of recommendations, assessment, development, and evaluation approach was used to rate the certainty of evidence and the strength of recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The guideline panel issued 17 recommendations: for alleviating anxiety, strong recommendations in favor of muscle relaxation training, yoga, acceptance and commitment therapy, cognitive behavioral therapy, psychological education, and Tai Chi in general breast cancer survivors; for alleviating depression, strong recommendations in favor of mindfulness therapy, cognitive behavioral therapy, group psychotherapy, muscle relaxation training, acceptanceand commitment therapy in general breast cancer survivors, and exercise intervention for patients received radiotherapy; for sleep quality, conditional recommendations for all therapies; for pain, strong recommendations in favor of exercise intervention for postoperative breast cancer survivors; for alleviating fatigue, strong recommendations in favor of mindfulness therapy and group psychotherapy in general breast cancer survivors; for improving the quality of life, strong recommendations in favor of mindfulness therapy in general breast cancer survivors, Baduanjin and exercise intervention for patients undergoing anticancer treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This proposed guideline provides recommendations for improving the PROs of breast cancer survivors. We hope these recommendations can help support practicing physicians and other healthcare providers for breast cancer survivors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chinese Expert Consensus on Home Nutrition Administration for Older Patients (2024)","authors":"Jie Gong,&nbsp;Xuemei Li,&nbsp;Lei Shi,&nbsp;Xiaofan Jing,&nbsp;Xinyi Liao,&nbsp;Ya Ma,&nbsp;Wen Hu","doi":"10.1111/jebm.70025","DOIUrl":"https://doi.org/10.1111/jebm.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Families constitute important settings for the nutritional management of older adults, and there is a growing demand for continuous nutritional management services extending from hospital care to home-based care. Since the publication of the <i>Chinese Expert Consensus on Home Nutrition Administration for the Elderly (2017 Edition)</i> 7 years ago, accumulating research evidence and practical experience in home-based nutritional management has highlighted an urgent need for updating this consensus. In this revised edition, a total of 35 recommendations and expert consensus statements have been proposed to guide community-based health professionals in delivering scientifically sound, rational, and standardized home nutritional management services to elderly populations residing at home or within community settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bayesian Proactive Dynamic Borrowing Utilizing Propensity Score Overlap for a Hybrid Control Arm and the Impacts of Various Biases: A Simulation Study","authors":"Kai Wang,&nbsp;Han Cao,&nbsp;Chen Yao","doi":"10.1111/jebm.70022","DOIUrl":"https://doi.org/10.1111/jebm.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The use of external controls in clinical trials can reduce sample size and increase efficiency. Propensity score (PS)-integrated Bayesian borrowing methods discount external controls based solely on prior-data conflict or covariate similarity. We aim to propose a PS-integrated Bayesian proactive dynamic borrowing method that simultaneously considers the similarity of covariates and outcomes and to evaluate its performance under various biases through simulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a two-stage strategy, covariates were balanced via the PS during the design phase, independent of outcomes. In the analysis phase, Power Prior, Elastic Prior, and Mixture Prior with the random discounting parameter were adopted. We proposed a weakly informative initial prior, using the PS overlap between concurrent and external controls as its mean. It was compared to competitors under selection bias, unmeasured confounders, measurement errors (in covariates and outcomes), and effect drift.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Under selection bias, our approach outperformed using Bayesian dynamic borrowing alone. Compared with the discounting parameter fixed at the PS overlap, it exhibited better control of bias and the Type I error rate. Compared with the noninformative uniform prior, it yielded higher power and a narrower 95% credible interval. However, under other biases, it and other PS-integrated Bayesian borrowing methods exhibited undesirable control of bias and the Type I error rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our approach has an advantage in borrowing external controls with selection bias. However, biases that severely affect PS estimation and outcomes can undermine the performance of PS-integrated Bayesian borrowing methods, particularly those that rely solely on covariate similarity for discounting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143793354","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 of 11 Formulas and Breastfeeding for Atopic Dermatitis and Growth in Pediatric Cow's Milk Protein Allergy: A Systematic Review and Network Meta-Analysis of 23 Randomized Controlled Trials","authors":"Tengfei Li,&nbsp;Qingyong Zheng,&nbsp;Jianguo Xu,&nbsp;Yiyi Li,&nbsp;Mingyue Zhang,&nbsp;Bowa Zhang,&nbsp;Li Zhou,&nbsp;Jinhui Tian","doi":"10.1111/jebm.70026","DOIUrl":"https://doi.org/10.1111/jebm.70026","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aimed to evaluate the effectiveness of various formulas and the ability of breastfeeding with the exclusion of cow milk protein to reduce the Scoring Atopic Dermatitis (SCORAD) index and promote growth in infants with cow milk protein allergy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a systematic search of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure, WanFang Data, Weipu, and the China Biomedical Literature Database. The search period ranged from the inception of each database to December 2023 (with an update until January 15, 2025). We included randomized controlled trials (RCTs) comparing formulas and breastfeeding for cow's milk protein allergy in infants. Two independent reviewers extracted data via standardized methods and assessed the risk of bias via the revised Cochrane risk-of-bias 2.0 tool. We performed a network meta-analysis (NMA) via a Bayesian fixed-effects model in RStudio and assessed the certainty of the evidence via the Confidence in Network Meta-Analysis (CINeMA) online application. The protocol for this NMA was preregistered in PROSPERO (No. CRD42024504707).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This analysis included 23 RCTs involving 1997 children and assessed 12 interventions. Compared with the regular formula, the pectin-thickened amino acid formula (TAAF) might reduce the SCORAD index (−12.49, 95% confidence interval [CI] −20.38 to −4.48, low certainty). At ≤6 months of follow-up, compared with rice-hydrolyzed formula (RHF), breastfeeding might improve the length-for-age &lt;i&gt;Z&lt;/i&gt; score (LAZ) (0.47, 95% CI 0.13–0.81, moderate certainty), and breastfeeding (0.39, 95% CI 0.02–0.77, low certainty) and extensively hydrolyzed formula (EHF) with probiotics (0.38, 95% CI 0.00–0.77, low certainty) might respectively improve the weight-for-age &lt;i&gt;Z&lt;/i&gt; score (WAZ) and weight-for-length &lt;i&gt;Z&lt;/i&gt; score (WLZ). At the 12-month follow-up, EHF might improve the LAZ (0.41, 95% CI 0.11–0.71, low certainty) and WLZ (0.37, 95% CI 0.18–0.56, low certainty) compared with RHF, whereas the amino acid formula (AAF) may improve the WAZ (0.33, 95% CI 0.02–0.63, low certainty).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Low-certainty evidence suggested that TAAF might reduce the SCORAD index. Moderate or low certainty evidence indicated that, at ≤6 months of follow-up, breastfeeding might improve the LAZ and WAZ, whereas EHF with probiotics might improve the WLZ. At the 12-month follow-up, EHF might improve the LAZ and WLZ, whereas AAF might imp","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770315","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 Performance of a Large Language Model for the Quality Evaluation of Multi-Language Medical Imaging Guidelines and Consensus","authors":"Zhixiang Wang,&nbsp;Jing Sun,&nbsp;Hui Liu,&nbsp;Xufei Luo,&nbsp;Jia Li,&nbsp;Wenjun He,&nbsp;Zhenhua Yang,&nbsp;Han Lv,&nbsp;Yaolong Chen,&nbsp;Zhenchang Wang","doi":"10.1111/jebm.70020","DOIUrl":"https://doi.org/10.1111/jebm.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to develop and evaluate an automated large language model (LLM)-based system for assessing the quality of medical imaging guidelines and consensus (GACS) in different languages, focusing on enhancing evaluation efficiency, consistency, and reducing manual workload.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We developed the QPC-HASE-GuidelineEval algorithm, which integrates a Four-Quadrant Questions Classification Strategy and Hybrid Search Enhancement. The model was validated on 45 medical imaging guidelines (36 in Chinese and 9 in English) published in 2021 and 2022. Key evaluation metrics included consistency with expert assessments, hybrid search paragraph matching accuracy, information completeness, comparisons of different paragraph matching approaches, and cost-time efficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The algorithm demonstrated an average accuracy of 77%, excelling in simpler tasks but showing lower accuracy (29%–40%) in complex evaluations, such as explanations and visual aids. The average accuracy rates of the English and Chinese versions of the GACS were 74% and 76%, respectively (<i>p</i> = 0.37). Hybrid search demonstrated superior performance with paragraph matching accuracy (4.42) and information completeness (4.42), significantly outperforming keyword-based search (1.05/1.05) and sparse-dense retrieval (4.26/3.63). The algorithm significantly reduced evaluation time to 8 min and 30 s per guideline and reduced costs to approximately 0.5 USD per guideline, offering a considerable advantage over traditional manual methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The QPC-HASE-GuidelineEval algorithm, powered by LLMs, showed strong potential for improving the efficiency, scalability, and multi-language capability of guideline evaluations, though further enhancements are needed to handle more complex tasks that require deeper interpretation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770316","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":"Developing the Artificial Intelligence Method and System for “Multiple Diseases Holistic Differentiation” in Traditional Chinese Medicine and Its Interpretability to Clinical Decision","authors":"Zhe Chen,&nbsp;Dong Zhang,&nbsp;Pengfei Nie,&nbsp;Guanhao Fan,&nbsp;Zhiyuan He,&nbsp;Hui Wang,&nbsp;Chenyue Zhang,&nbsp;Fengwen Yang,&nbsp;Chunxiang Liu,&nbsp;Junhua Zhang","doi":"10.1111/jebm.70016","DOIUrl":"https://doi.org/10.1111/jebm.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The development of artificial intelligence (AI) for traditional Chinese medicine (TCM) has played an important role in clinical decision-making, mainly reflected in the intersectionality and variability of symptoms, syndromes, and patterns for TCM multiple diseases holistic differentiation (MDHD). This study aimed to develop a TCM AI method and system for clinical decisions more transparent with explainable structural framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study developed the TCM syndrome elements integration with priori rule and deep learning (TCM-SEI-RD) method and TCM-MDHD system by high-quality expert knowledge datasets, to predict various TCM syndromes and patterns in hierarchical modules. TCM-BERT-CNN model fused the BERT with CNN model capture feature-related sequence, as the benchmark model in the TCM-SEI-RD method, to improve the performance of predicting TCM syndrome elements. The framework of the TCM-MDHD system involved the TCM-SEI-RD method and TCM “diseases—syndromes—patterns” benchmark sequences, to provide distributed results with credibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For predicting results to the overall TCM syndrome elements, the TCM-SEI-RD achieves 95.4%, 94.43%, and 94.89% in precision, recall, and <i>F</i>1 score, respectively, and 3.33%, 2.28%, and 2.81% improvement over the benchmark model. TCM-MDHD system demonstrates credibility grading at each stage in various diseases and uses the practical example to illustrate the process of distributed decision-making results and transparency with credibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our method and system, as the general AI technologies for TCM syndromes and patterns diagnosis in multiple diseases, can provide the clinical diagnostic basis with the best performance for the TCM preparations rational use, and distribute interpretability to the clinical decision-making process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761883","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}