Journal of Evidence‐Based Medicine最新文献

Background: Traditional Chinese medicine (TCM) with knowledge-intensive framework poses unique challenges to performance for large language models (LLMs). Although TCM-specific benchmarks and models have been developed, the performance of lightweight LLMs remains insufficiently investigated. This study presents a systematic evaluation and comparison of large-scale and lightweight LLMs to assess their capabilities and deployment trade-offs.

Methods: We developed TCM-related question-answering, a dataset comprising 801 questions derived from TCM textbooks. Eleven LLMs were evaluated under zero-shot and few-shot prompting conditions in both English and Chinese. Performance was primarily measured by accuracy.

Results: Large-scale LLMs achieved high accuracy on single-choice (69.01%-90.92%) and true/false questions (52.34%-59.38%) but performed poorly on multiple-choice questions, with a maximum accuracy of only 8.40%. Lightweight LLMs (2.10%-49.48%) generally lagged behind larger LLMs (6.30%-95.07%). However, Qwen3-1.7B (5.92%-54.20%) stood out and even surpassed the domain-specialized TCMChat-7B (2.10%-36.98%). Few-shot prompting enhanced performance in 8/11 (72.7%) of the models, Chinese prompts yielded better results than English in 9/11 (81.8%) of the models. Symptomatic diagnosis emerged as the most challenging reasoning category across all models (16.75%-48.07%).

Conclusion: This study demonstrates that although large-scale LLMs exhibit strong knowledge recall in TCM, their suboptimal performance on multiple-choice questions and substantial computational costs may limit their practical applicability in clinical settings. The robust performance of Qwen3-1.7B indicates that effective model optimization and domain-specific training may offer greater advantages than simply increasing model size. While the current evaluation is based on examination-style tasks and does not involve real-world clinical decision-making, our findings provide insights to support the deployment of optimized models in resource-constrained healthcare environments.

Objective: This study aimed to comprehensively evaluate the efficacy of music intervention as a non-pharmacological approach for improving physiological and psychological outcomes in patients with hypertension through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: We systematically searched PubMed, Embase, The Cochrane Library, Web of Science Core Collection, Wanfang Data, and CNKI for RCTs investigating the effects of music therapy on blood pressure, heart rate (HR), anxiety, and depression in hypertensive adults. Data were pooled using random-effects models, and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. The robustness of findings was assessed via sensitivity analysis, and publication bias was evaluated using Egger's and Begg's tests.

Results: Twenty-one RCTs involving 1436 participants were included. Meta-analysis revealed that music intervention significantly reduced systolic blood pressure (SBP) (WMD = -8.26 mmHg, 95% CI: -10.56 to -5.96), diastolic blood pressure (DBP) (WMD = -5.91 mmHg, 95% CI: -8.03 to -3.79), HR (WMD = -4.17, 95% CI: -7.22 to -1.12), anxiety levels (measured by Self-Rating Anxiety Scale, SAS) (WMD = -5.22, 95% CI: -7.03 to -3.40), and depression levels (measured by Self-Rating Depression Scale, SDS) (WMD = -7.12, 95% CI: -10.27 to -3.98). Sensitivity analyses confirmed the stability of these findings, and statistical tests showed no significant publication bias for primary outcomes.

Conclusion: Music therapy is an effective complementary intervention for reducing blood pressure, HR, anxiety, and depression in hypertensive patients. Personalized music selections and longer intervention sessions may enhance efficacy. Future research should focus on standardizing intervention protocols, clarifying underlying mechanisms, and exploring long-term efficacy.

Aim: In traditional Chinese medicine, different dosage forms of orally administered Chinese herbal medicine (CHM) may introduce bias in estimating treatment and adverse effects. This meta-epidemiological study aimed to evaluate whether the use of different orally administered CHM dosage forms is associated with overestimation or underestimation of treatment and adverse effects in randomized controlled trials (RCTs).

Methods: Seven electronic databases were searched to identify potentially eligible meta-analyses (MAs) of RCTs evaluating CHM interventions. A two-step meta-epidemiological analysis was performed, using ratios of odds ratios for binary outcomes and differences in standardized mean differences for continuous outcomes. These metrics assessed whether different orally administered CHM dosage forms-including CHM decoctions, Chinese patent medicines (CPMs), and CHM granules influenced the magnitude of reported treatment effects or adverse effects.

Results: Eighty-two MAs comprising 1263 RCTs were analyzed. Overall, there was no consistent evidence that any oral dosage form systematically overestimated or underestimated treatment effects or adverse effects. Sensitivity analyses confirmed these findings, with the exception that CHM decoctions showed slightly larger binary treatment effects compared to CPMs after adjusting for incomplete outcome data. However, when adjusted for all confounders, CPMs yielded significantly greater continuous treatment effects than CHM decoctions. Additionally, CHM granules were associated with larger continuous treatment effects than CHM decoctions after adjusting for RCT funding. Subgroup analyses indicated that RCTs on digestive diseases tended to report larger effect estimates when using CHM decoctions, whereas RCTs on endocrine, nutritional, and metabolic diseases tended to report larger effect estimates when using CPMs.

Conclusions: This meta-epidemiological study suggests that while oral dosage forms of CHM are associated with minimal differences in reported treatment and adverse effect estimates, specific dosage forms may offer advantages in certain contexts. Subgroup analyses indicate that digestive disease trials tend to report larger estimates with CHM decoctions, and endocrine/metabolic disease trials with CPMs. When adjusting for confounders, CPMs yield greater continuous treatment effects compared with CHM decoctions, while CHM granules are associated with larger estimates than CHM decoctions after adjusting for RCT funding. Further research is needed to confirm their clinical relevance and guide formulation choices in CHM practice.

Background: Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) is a growing concern due to high mortality and limited therapies, with scarce data on novel antimicrobials in vitro activity against it.

Aims: This research evaluated the in vitro efficacy of six novel antimicrobial drugs including ceftolozane/tazobactam, cefiderocol, eravacycline, omadacycline, temocillin, and plazomicin, against CR-hvKP and characterize its molecular epidemiology.

Methods: 106 non-repetitive clinical CR-hvKP strains were collected from Sichuan Provincial People's Hospital between August 2018 and December 2023. CR-hvKP were identified using VITEK-2 Compact and MALDI-TOF MS, confirmed via string tests and PCR. The E-test strip method assessed the in vitro antibacterial activity of novel antimicrobial drugs against CR-hvKP. The molecular characterization of CR-hvKP was conducted by PCR to amplify resistance genes, virulence genes, housekeeping genes, and wzi genes. The Galleria mellonella infection model explored the virulence characteristics of CR-hvKP strains.

Results: CR-hvKP had a relatively high susceptibility rate of 96.2% to cefiderocol, showing good antibacterial activity, whereas ceftazidime/tazobactam, temocillin, omadacycline, eravacycline, and plazomicin exhibited high resistance rates (81.1%-99.1%). ST11-KL64 was the predominant type in CR-hvKP strains. We identified three new ST subtypes, ST8115, ST8116 and ST8117. The most prevalent carbapenemase genes were bla_KPC and bla_NDM, and approximately 75.5% of CR-hvKP carried bla_KPC, bla_SHV, and bla_CTX-M.

Conclusions: Cefiderocol appears highly promising as a therapy for CR-hvKP infections. Our findings will not only effectively address the challenge of CR-hvKP resistance, but also provide evidence to support the optimization of clinical therapeutic strategies and further promote the development and application of novel antimicrobial drugs.

Background: Traditional Chinese medicine (TCM) is widely used in managing lumbar disc herniation (LDH), but heterogeneous outcome reporting in its trials hinders evidence synthesis. This study intends to develop a core outcome set (COS) for TCM-LDH to standardize reporting and improve research quality.

Methods: Candidate outcomes were identified via a systematic review of TCM-related randomized controlled trials (RCTs) for LDH, with studies retrieved from multiple databases between January 1 2019 and December 31 2023 and supplemented by clinical trial registry searches. Semistructured interviews with LDH patients and clinician questionnaires were conducted to refine candidate outcomes. Two Delphi rounds were carried out among clinicians, pharmaceutical researchers, journal editors, methodologists, and patients, followed by an online-offline consensus meeting to finalize the COS.

Results: A candidate outcome pool was established via a systematic review (413 RCTs, 51 registered studies), 30 LDH patient interviews, and 73 clinician surveys. After integration, deduplication, and steering committee refinement, two rounds of Delphi surveys were conducted. Following a consensus meeting attended by 24 multidisciplinary experts, 7 core outcomes were finalized for LDH: lumbar dysfunction, pain/discomfort, recurrence rate, straight leg raise angle, adverse reactions/adverse events, TCM syndromes, and sciatica frequency.

Conclusion: The developed COS for TCM-related LDH clinical trials provides standardized recommendations for outcome selection and reporting, which can enhance the consistency of research evidence, facilitate meta-analysis, and ultimately advance the quality of TCM-based interventions for LDH.

Background: Conflict of interest (COI) management is critical for ensuring the scientific integrity and fairness of clinical practice guidelines (CPGs). Large language models (LLMs) have great potential in strengthening COI management, particularly in information collection, assessment, and supporting guideline development groups.

Objective: To explore LLMs' role in COI management during CPG development, focusing on applications, challenges, and future directions.

Methods: We examined how LLMs can support COI management by designing and testing a set of simulated COI scenarios based on established management principles.

Results: LLMs can improve efficiency in data collection (e.g., in analyzing disclosures), objectivity in risk assessment, and transparency in reporting. However, privacy risks (e.g., data breaches) and technical issues (e.g., model bias) hinder the adoption of LLM based approaches. Setting up policy frameworks, research collaboration, and enhanced security, such as differential privacy levels, can enhance reliability.

Conclusion: LLMs can support COI management in CPG development if ethical issues are adequately considered, but validation in real-world settings is still needed.

Cytomegalovirus (CMV) is an increasingly recognized complication of chimeric antigen receptor T-cell (CAR-T) and bispecific antibody (BsAb) therapies for hematologic malignancies, driven by therapy-related immunosuppression and cumulative exposure to lymphodepleting or steroid regimens. Given China's high adult CMV IgG seroprevalence (>90%), baseline risk, interpretation of low-level DNAemia, and operational thresholds differ from low-seroprevalence settings, requiring context-specific guidance. This China-adapted, evidence-graded consensus was developed by a multidisciplinary panel from major centers using a modified Delphi process and Oxford Centre for Evidence-Based Medicine levels to translate international guidance into a high-seroprevalence setting. Recommendations prioritize early risk stratification and pragmatic surveillance. We advise routine CMV monitoring by real-time quantitative PCR during the first 30 days after therapy, with risk-adapted extension thereafter. Interpretation and treatment triggers are anchored to WHO-traceable IU/mL and specified by specimen matrix to support comparability across assays. Consideration of prophylaxis is proposed for well-defined high-risk subgroups, acknowledging the need for prospective validation. Syndrome-based diagnostic and treatment algorithms are provided for tissue-invasive disease, including CMV pneumonia and encephalitis, with guidance on antiviral induction, step-down, and monitoring for virologic response and drug toxicity. This consensus explicitly adapts international recommendations to China's epidemiology, assay practice, and drug accessibility. By standardizing prevention, surveillance, and management in CAR T-cell and BsAb recipients, this consensus aims to lower non-relapse mortality and improve long-term outcomes. Priority research needs include harmonized viral-load thresholds, validation of risk-adapted prophylaxis strategies, and studies that clarify the significance of low-level DNAemia in this population.