The impact of intravenous iron therapy in heart failure (HF) patients with iron deficiency (ID) is still controversial.
Method
We performed an extensive search of electronic databases for pertinent studies, encompassing all records up to March 4, 2024. Using random-effects models in a meta-analysis, the collected outcomes data were then synthesized and analyzed.
Result
Fourteen trials with 7786 participants (iron therapy: n = 3994; control: n = 3792) were included. Intravenous iron therapy can decrease the risk of composite events of total hospitalization for HF and cardiovascular (CV) death (RR = 0.82 [0.72, 0.92]), total hospitalization for HF (RR = 0.78 [0.66, 0.91]), first hospitalization for HF and CV death (OR = 0.78 [0.65, 0.93]), CV death (OR = 0.86 [0.76, 0.98]), first hospitalization for HF(OR = 0.77 [0.61, 0.99]), but not significantly reduce the risk of all-cause mortality (OR = 0.93 [0.83, 1.04]). Furthermore, intravenous iron treatment can improve the distance of 6-min walking test (6MWT) (WMD = 18.99 [7.41, 30.57]). Subgroup analyses found that intravenous iron may be more beneficial in HF patients with transferrin saturation (TSAT) <20%, and those with ischemic heart disease. Meta-regression analysis revealed that baseline hemoglobin levels served as a significant moderator of the therapeutic efficacy of intravenous iron supplementation.
Conclusion
For HF patients with ID, intravenous iron therapy can decrease the risk of hospitalization for HF, CV death and improve their exercise capacity. Patients with ischemic cardiomyopathy or with TSAT <20% may derive greater benefit from intravenous iron therapy.
{"title":"Intravenous Iron in Heart Failure Patients With Iron Deficiency: A Meta-Analysis of Randomized Controlled Trials","authors":"Yangguang Liu, Jiahuan Li, Yingwen Chen, Lingxiao Li, Ling Zhao, Xiaomei Zhang, Yuli Huang","doi":"10.1111/jebm.70057","DOIUrl":"10.1111/jebm.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of intravenous iron therapy in heart failure (HF) patients with iron deficiency (ID) is still controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We performed an extensive search of electronic databases for pertinent studies, encompassing all records up to March 4, 2024. Using random-effects models in a meta-analysis, the collected outcomes data were then synthesized and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Fourteen trials with 7786 participants (iron therapy: <i>n</i> = 3994; control: <i>n</i> = 3792) were included. Intravenous iron therapy can decrease the risk of composite events of total hospitalization for HF and cardiovascular (CV) death (RR = 0.82 [0.72, 0.92]), total hospitalization for HF (RR = 0.78 [0.66, 0.91]), first hospitalization for HF and CV death (OR = 0.78 [0.65, 0.93]), CV death (OR = 0.86 [0.76, 0.98]), first hospitalization for HF(OR = 0.77 [0.61, 0.99]), but not significantly reduce the risk of all-cause mortality (OR = 0.93 [0.83, 1.04]). Furthermore, intravenous iron treatment can improve the distance of 6-min walking test (6MWT) (WMD = 18.99 [7.41, 30.57]). Subgroup analyses found that intravenous iron may be more beneficial in HF patients with transferrin saturation (TSAT) <20%, and those with ischemic heart disease. Meta-regression analysis revealed that baseline hemoglobin levels served as a significant moderator of the therapeutic efficacy of intravenous iron supplementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For HF patients with ID, intravenous iron therapy can decrease the risk of hospitalization for HF, CV death and improve their exercise capacity. Patients with ischemic cardiomyopathy or with TSAT <20% may derive greater benefit from intravenous iron therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855514","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}
Li Shen, Chao Gao, Tianrui He, Liting Chu, Jie Wang, Zhenlin Zhang, Guangjun Yu
Objective
The early identification of osteoporosis and vertebral fractures (VFs) is vital for improving the quality of life in elderly men. This study aimed to validate the effectiveness of a self-assessment tool for osteoporosis and VFs primary screening in the elderly men.
Methods
This real-world study analyzed data from two sources: an electronic health record (EHR) database comprising 7187 subjects and a community database including 6313 subjects. Restricted cubic spline curves were utilized to analyze the relationship between the osteoporosis self-assessment tool for Asians (OSTA) index and the prevalence of osteoporosis, overall VFs, and moderate to severe VFs. Diagnostic performance was assessed by calculating sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), and optimal cutoff values were determined for different age groups.
Results
With a cutoff value of −1, the OSTA index demonstrated good diagnostic performance for identifying osteoporosis, achieving an AUC of 0.712 (p < 0.001), with sensitivity and specificity of 81.6% and 78.1%, respectively. The screening performance was notably higher among individuals aged 70–79 and those over 80 years, with AUCs of 0.79 and 0.81, respectively, and sensitivities exceeding 90%. For moderate to severe VFs, the OSTA index demonstrated a sensitivity of 86.6%, a specificity of 53.1%, and an AUC of 0.628.
Conclusions
This large-scale real-world study supports the utility of the OSTA index as a valid tool for the primary screening of osteoporosis and VFs in the elderly men.
{"title":"Validation of a Self-Assessment Tool for Osteoporosis and Vertebral Fracture Primary Screening in Elderly Men","authors":"Li Shen, Chao Gao, Tianrui He, Liting Chu, Jie Wang, Zhenlin Zhang, Guangjun Yu","doi":"10.1111/jebm.70045","DOIUrl":"10.1111/jebm.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The early identification of osteoporosis and vertebral fractures (VFs) is vital for improving the quality of life in elderly men. This study aimed to validate the effectiveness of a self-assessment tool for osteoporosis and VFs primary screening in the elderly men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This real-world study analyzed data from two sources: an electronic health record (EHR) database comprising 7187 subjects and a community database including 6313 subjects. Restricted cubic spline curves were utilized to analyze the relationship between the osteoporosis self-assessment tool for Asians (OSTA) index and the prevalence of osteoporosis, overall VFs, and moderate to severe VFs. Diagnostic performance was assessed by calculating sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), and optimal cutoff values were determined for different age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>With a cutoff value of −1, the OSTA index demonstrated good diagnostic performance for identifying osteoporosis, achieving an AUC of 0.712 (<i>p</i> < 0.001), with sensitivity and specificity of 81.6% and 78.1%, respectively. The screening performance was notably higher among individuals aged 70–79 and those over 80 years, with AUCs of 0.79 and 0.81, respectively, and sensitivities exceeding 90%. For moderate to severe VFs, the OSTA index demonstrated a sensitivity of 86.6%, a specificity of 53.1%, and an AUC of 0.628.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This large-scale real-world study supports the utility of the OSTA index as a valid tool for the primary screening of osteoporosis and VFs in the elderly men.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649668","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}
Biomedical entity linking is essential in natural language processing for identifying and linking biomedical concepts to entities in a knowledge base. Current methods, which involve a multistage recognition-retrieve-read process, achieve high performance but are hindered by slow inference times and error propagation.
Methods
The authors propose ER2, an End-to-End entity linking paradigm following a Retrieval-Rerank framework. It reversely selects mentions in context and their corresponding entities based on the prior knowledge of candidate entities, enabling jointly performing candidates retrieval, mention detection, and candidates rerank in one pass via a lighten-weight reranker that models deep relevance between the context and its candidates at the embedding level. We further introduce a more powerful cross-encoder as the teacher model, thereby enhancing the rerank performance via knowledge distillation from the teacher to the student reranker.
Results
Experiments on several end-to-end entity linking benchmarks demonstrate the efficiency and effectiveness. Notably, our method achieves competitive performance compared with the previous state-of-the-art methods while being nearly 10 times faster.
Conclusions
The research has a significant reference for connecting mentions within unstructured contexts to their corresponding entities in KBs, thereby facilitating the application effect of downstream tasks such as automatic diagnosis, drug–drug interaction prediction and personalized medicine and other fields.
{"title":"Retrieve Then Rerank: An End-to-End Learning Paradigm for Biomedical Entity Linking","authors":"Yuling Cao, Lanya Peng, Yipeng Zhang, Cui Yang","doi":"10.1111/jebm.70053","DOIUrl":"10.1111/jebm.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Biomedical entity linking is essential in natural language processing for identifying and linking biomedical concepts to entities in a knowledge base. Current methods, which involve a multistage recognition-retrieve-read process, achieve high performance but are hindered by slow inference times and error propagation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The authors propose ER2, an End-to-End entity linking paradigm following a Retrieval-Rerank framework. It reversely selects mentions in context and their corresponding entities based on the prior knowledge of candidate entities, enabling jointly performing candidates retrieval, mention detection, and candidates rerank in one pass via a lighten-weight reranker that models deep relevance between the context and its candidates at the embedding level. We further introduce a more powerful cross-encoder as the teacher model, thereby enhancing the rerank performance via knowledge distillation from the teacher to the student reranker.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Experiments on several end-to-end entity linking benchmarks demonstrate the efficiency and effectiveness. Notably, our method achieves competitive performance compared with the previous state-of-the-art methods while being nearly 10 times faster.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The research has a significant reference for connecting mentions within unstructured contexts to their corresponding entities in KBs, thereby facilitating the application effect of downstream tasks such as automatic diagnosis, drug–drug interaction prediction and personalized medicine and other fields.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553702","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}
Tadesse Gebrye, Chidozie Mbada, Zalmai Hakimi, Francis Fatoye
<p>Randomized controlled trials (RCTs) are considered the gold standard for assessing the efficacy of medical interventions [<span>1</span>]. However, real-world evidence (RWE) is increasingly recognized as essential for comprehensive healthcare decision-making. RCTs provide high internal validity and establish clear causal relationships due to their controlled environments and strict criteria. Nevertheless, the highly selective patient populations and controlled settings of RCTs can limit the external validity of their findings, making it challenging to generalize results to broader, more diverse populations [<span>2</span>]. RWE is derived from real-world data (RWD), such as electronic health records and insurance claims, and provides clinical insights into the usage, benefits, and risks of medical products. Unlike RCTs, RWE offers perspectives on treatment performance in everyday practice, which can significantly aid healthcare decision-making [<span>3</span>]. RWD serves to bridge the gap between clinical trials and real-world settings, informing guidelines, policy decisions, and new therapy approvals [<span>4</span>]. This type of evidence captures a wider range of patient populations and healthcare environments, making it particularly valuable for understanding the effectiveness, safety, and cost-effectiveness of interventions in real-world conditions.</p><p>Regulatory bodies and healthcare organizations increasingly rely on RWE to fill gaps left by RCTs [<span>5</span>]. For instance, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have incorporated RWE to support regulatory decisions and postmarket surveillance [<span>6</span>]. When making healthcare recommendations, it is crucial that they are grounded in the best available research evidence [<span>7</span>]. Incorporating this evidence into healthcare practices can help reduce variations in healthcare delivery. The volume of research studies on healthcare is now enormous for healthcare professionals. RWE is instrumental in understanding the effectiveness and safety of interventions across diverse populations and in identifying rare adverse events and long-term outcomes, thus enhancing healthcare practices and policies [<span>8</span>].</p><p>To summarize and present the findings of individual research studies a structured approach is required. This structured approach, systematic review, provides a comprehensive and unbiased synthesis of many relevant studies in a single document. One of the most critical components of conducting a systematic review is the assessment of the quality of the included studies, as this significantly impacts the overall quality of evidence produced [<span>9</span>]. Quality appraisal refers to evaluating how well a study was designed and conducted looking at its methodological soundness, such as whether it used an appropriate study design, followed rigorous procedures, and addressed key elements like sample selection and dat
{"title":"Validation of the Quality Assessment Tool for Systematic Reviews and Meta-Analyses of Real-World Studies","authors":"Tadesse Gebrye, Chidozie Mbada, Zalmai Hakimi, Francis Fatoye","doi":"10.1111/jebm.70052","DOIUrl":"https://doi.org/10.1111/jebm.70052","url":null,"abstract":"<p>Randomized controlled trials (RCTs) are considered the gold standard for assessing the efficacy of medical interventions [<span>1</span>]. However, real-world evidence (RWE) is increasingly recognized as essential for comprehensive healthcare decision-making. RCTs provide high internal validity and establish clear causal relationships due to their controlled environments and strict criteria. Nevertheless, the highly selective patient populations and controlled settings of RCTs can limit the external validity of their findings, making it challenging to generalize results to broader, more diverse populations [<span>2</span>]. RWE is derived from real-world data (RWD), such as electronic health records and insurance claims, and provides clinical insights into the usage, benefits, and risks of medical products. Unlike RCTs, RWE offers perspectives on treatment performance in everyday practice, which can significantly aid healthcare decision-making [<span>3</span>]. RWD serves to bridge the gap between clinical trials and real-world settings, informing guidelines, policy decisions, and new therapy approvals [<span>4</span>]. This type of evidence captures a wider range of patient populations and healthcare environments, making it particularly valuable for understanding the effectiveness, safety, and cost-effectiveness of interventions in real-world conditions.</p><p>Regulatory bodies and healthcare organizations increasingly rely on RWE to fill gaps left by RCTs [<span>5</span>]. For instance, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have incorporated RWE to support regulatory decisions and postmarket surveillance [<span>6</span>]. When making healthcare recommendations, it is crucial that they are grounded in the best available research evidence [<span>7</span>]. Incorporating this evidence into healthcare practices can help reduce variations in healthcare delivery. The volume of research studies on healthcare is now enormous for healthcare professionals. RWE is instrumental in understanding the effectiveness and safety of interventions across diverse populations and in identifying rare adverse events and long-term outcomes, thus enhancing healthcare practices and policies [<span>8</span>].</p><p>To summarize and present the findings of individual research studies a structured approach is required. This structured approach, systematic review, provides a comprehensive and unbiased synthesis of many relevant studies in a single document. One of the most critical components of conducting a systematic review is the assessment of the quality of the included studies, as this significantly impacts the overall quality of evidence produced [<span>9</span>]. Quality appraisal refers to evaluating how well a study was designed and conducted looking at its methodological soundness, such as whether it used an appropriate study design, followed rigorous procedures, and addressed key elements like sample selection and dat","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144492704","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}
To establish evidence-based guidelines for the application of the foldable capsular vitreous body (FCVB) in managing severe ocular trauma and silicone oil–dependent eyes.
Methods
We conducted a comprehensive search across multiple databases, screening, extracting, and evaluating research evidence. Experts in ocular trauma and vitreoretinal surgery provided practical insights and formulated key questions. Using the Delphi method, the working group identified seven clinical issues and established outcome indicators. Seven recommendations were developed, reviewed, and approved by a multinational consensus expert group.
Results
This consensus presents seven evidence-based recommendations for FCVB implantation, emphasizing the importance of patient assessment, FCVB model selection, and intraoperative and postoperative management. Each recommendation is supported by detailed explanations and evidence, highlighting the potential benefits of FCVB as an alternative to traditional treatments for severe ocular trauma and silicone oil–dependent eyes, including reduced complications and improved visual outcomes.
Conclusions
On the basis of existing literature and expert consensus, this consensus provides evidence-based guidance for FCVB application in treating severe ocular trauma and silicone oil–dependent eyes. The recommendations serve as a valuable resource for ophthalmologists, facilitating more effective and safer treatment options for patients.
{"title":"Consensus on the Treatment of Severe Ocular Trauma and Silicone Oil–Dependent Eyes Using Foldable Capsular Vitreous Body","authors":"Hua Yan, Xiaofeng Lin, Wenbin Wei, Gezhi Xu, Ferenc Kuhn, Yuntao Hu, Dawei Sun, Weihong Yu, Rui Jiang, Peiquan Zhao, Yanming Huang, Jinhong Cai, Nan Wu, Zhen Chen, Jinchen Jia, Shenwen Liu, Huping Song, Jianqiao Li, Xiangyu Shi, Aijun Deng, Umit Beden, Petros Petrou, Van Overdam, Shalva Skihirtladze, Slawomir Cisiecki, Levent Karabas, Chongde Long, Lifeng Qiao, Zhenquan Zhao, Jian Ma, Sujuan Ji, Yanlai Zhang, Gongqiang Yuan, Qihua Xu, Xiangzhong Xu, Xuemin Tian, Haokun Zhang, Siyue Chen","doi":"10.1111/jebm.70041","DOIUrl":"https://doi.org/10.1111/jebm.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To establish evidence-based guidelines for the application of the foldable capsular vitreous body (FCVB) in managing severe ocular trauma and silicone oil–dependent eyes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive search across multiple databases, screening, extracting, and evaluating research evidence. Experts in ocular trauma and vitreoretinal surgery provided practical insights and formulated key questions. Using the Delphi method, the working group identified seven clinical issues and established outcome indicators. Seven recommendations were developed, reviewed, and approved by a multinational consensus expert group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This consensus presents seven evidence-based recommendations for FCVB implantation, emphasizing the importance of patient assessment, FCVB model selection, and intraoperative and postoperative management. Each recommendation is supported by detailed explanations and evidence, highlighting the potential benefits of FCVB as an alternative to traditional treatments for severe ocular trauma and silicone oil–dependent eyes, including reduced complications and improved visual outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>On the basis of existing literature and expert consensus, this consensus provides evidence-based guidance for FCVB application in treating severe ocular trauma and silicone oil–dependent eyes. The recommendations serve as a valuable resource for ophthalmologists, facilitating more effective and safer treatment options for patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144492735","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}
Xinyu Xue, Ningsu Chen, Kai Zhao, Yana Qi, Mengnan Zhao, Lei Shi, Youping Li, Jiajie Yu
Objective
This scoping review aims to map commonly reported multimorbidity patterns in China and summarize the methodologies used to identify these patterns.
Methods
We conducted a comprehensive search of six databases, including PubMed, EMbase, Web of Science Core Collection, WanFang, VIP, and CNKI from inception to December 31, 2024. Both quantitative and qualitative analyses were performed to map the scope of research on multimorbidity patterns and the methodologies used in the included studies. The results are presented in tabular form, with selected visual representations where appropriate.
Results
A total of 15,972 studies were retrieved, with 93 studies meeting the inclusion criteria. These studies, published between 2015 and 2024, were mostly cross-sectional with a median sample size was 10,084. Most studies employed a single method to explore multimorbidity patterns, with latent class analysis, association rules, and factor analysis being the most common. Arthritis/rheumatism and hypertension were the most prevalent diseases. Multimorbidity patterns were mainly classified into disease combination patterns and multimorbidity cluster patterns. The most frequent binary combinations were hypertension with diabetes and hypertension with dyslipidemia. The most common ternary combination was hypertension, dyslipidemia, and diabetes. The cardiovascular metabolic cluster was the most prevalent, followed by the respiratory cluster. Forty-nine studies explored influencing factors, with age being the most studied.
Conclusions
Studies on multimorbidity patterns in China have increased since 2020, with a focus on cardiovascular-metabolic clusters and the use of latent class analysis. However, variations in the interpretation of multimorbidity lead to inconsistent disease identification and diagnostic criteria, affecting the consistency of findings. Future research should establish consensus-driven guidelines for defining multimorbidity clusters and apply robust statistical techniques to improve methodological rigor.
目的本综述旨在绘制中国常见的多病模式，并总结用于识别这些模式的方法。方法综合检索PubMed、EMbase、Web of Science Core Collection、万方、VIP、CNKI等6个数据库，检索时间为建库至2024年12月31日。进行了定量和定性分析，以绘制多病模式研究的范围和纳入研究中使用的方法。结果以表格形式呈现，并在适当的地方选择视觉表示。结果共纳入15972项研究，其中93项研究符合纳入标准。这些研究发表于2015年至2024年之间，大多是横断面研究，中位数样本量为10084。大多数研究采用单一方法来探索多发病模式，潜在分类分析、关联规则和因子分析是最常见的。关节炎/风湿病和高血压是最常见的疾病。多病型主要分为疾病合并型和多病聚集型。最常见的二元组合是高血压合并糖尿病和高血压合并血脂异常。最常见的三元组合是高血压、血脂异常和糖尿病。心血管代谢类最常见，其次是呼吸类。49项研究探讨了影响因素，其中年龄研究最多。自2020年以来，中国的多发病模式研究有所增加，重点是心血管代谢聚集性和潜在类分析的使用。然而，对多病的不同解释导致疾病识别和诊断标准不一致，影响了结果的一致性。未来的研究应该建立共识驱动的指导方针来定义多病集群，并应用可靠的统计技术来提高方法的严谨性。
{"title":"Prevalence, Analytical Methods, and Influencing Factors of Multimorbidity in China: A Scoping Review","authors":"Xinyu Xue, Ningsu Chen, Kai Zhao, Yana Qi, Mengnan Zhao, Lei Shi, Youping Li, Jiajie Yu","doi":"10.1111/jebm.70051","DOIUrl":"https://doi.org/10.1111/jebm.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This scoping review aims to map commonly reported multimorbidity patterns in China and summarize the methodologies used to identify these patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a comprehensive search of six databases, including PubMed, EMbase, Web of Science Core Collection, WanFang, VIP, and CNKI from inception to December 31, 2024. Both quantitative and qualitative analyses were performed to map the scope of research on multimorbidity patterns and the methodologies used in the included studies. The results are presented in tabular form, with selected visual representations where appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15,972 studies were retrieved, with 93 studies meeting the inclusion criteria. These studies, published between 2015 and 2024, were mostly cross-sectional with a median sample size was 10,084. Most studies employed a single method to explore multimorbidity patterns, with latent class analysis, association rules, and factor analysis being the most common. Arthritis/rheumatism and hypertension were the most prevalent diseases. Multimorbidity patterns were mainly classified into disease combination patterns and multimorbidity cluster patterns. The most frequent binary combinations were hypertension with diabetes and hypertension with dyslipidemia. The most common ternary combination was hypertension, dyslipidemia, and diabetes. The cardiovascular metabolic cluster was the most prevalent, followed by the respiratory cluster. Forty-nine studies explored influencing factors, with age being the most studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Studies on multimorbidity patterns in China have increased since 2020, with a focus on cardiovascular-metabolic clusters and the use of latent class analysis. However, variations in the interpretation of multimorbidity lead to inconsistent disease identification and diagnostic criteria, affecting the consistency of findings. Future research should establish consensus-driven guidelines for defining multimorbidity clusters and apply robust statistical techniques to improve methodological rigor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339259","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}
This study explored the independent and synergistic effects of cadmium (Cd) and uric acid (UA) levels on hypertension risk, with a focus on sex differences.
Methods
Data from 8043 National Health and Nutrition Examination Survey participants were analyzed using logistic regression, restricted cubic spline (RCS), and interaction effect models. A meta-analysis of eight studies was also conducted.
Results
Blood, urinary Cd, and UA levels were more strongly associated with hypertension in females than in males (p < 0.05). Among females, blood Cd (odds ratio [OR] = 1.84, 95% confidence interval [CI]: 1.20–2.83), urinary Cd (OR = 3.38, 95% CI: 2.15–5.30), and UA levels (OR = 3.67, 95% CI: 2.47–5.45) were significantly associated with increased hypertension risk. RCS analysis showed linear dose–response relationships for blood (Pnon-linear = 0.085) and urinary Cd (Pnon-linear = 0.070) levels, whereas UA levels (Pnon-linear = 0.031) exhibited a non-linear association with hypertension risk. Multiplicative interaction showed 176% (OR = 2.76, 95% CI: 2.00–3.80) and 370% (OR = 4.70, 95% CI: 3.49–6.33) increased hypertension risks for high blood Cd–UA and urinary Cd–UA levels, respectively. Additive interaction confirmed synergy (relative excess risk due to interaction [RERI] = 1.74, 95% CI: 0.37–3.10). The meta-analysis using a random-effects model confirmed that blood Cd (OR = 1.93, 95% CI: 1.28–2.93) and urinary Cd levels (OR = 1.81, 95% CI: 0.93–3.50) were significantly increased hypertension risk.
Conclusions
Elevated Cd and UA levels independently and synergistically increased hypertension risk, especially in females, highlighting the need for targeted prevention strategies.
{"title":"Sex Differences in the Effects of Cadmium and Uric Acid Levels on Hypertension Risk: A Dose–Response Relationship and Synergistic Effect Study","authors":"Ruiqi Yang, Yiling Chen, Xu Hui, Xin Fan, Xiaonan Li, Weize Kong, Qian Liu, Yizhuo Chen, Kaiwen Wang, Xinyi Li, Peijing Yan, Jinhui Tian, Yongbin Lu","doi":"10.1111/jebm.70049","DOIUrl":"https://doi.org/10.1111/jebm.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explored the independent and synergistic effects of cadmium (Cd) and uric acid (UA) levels on hypertension risk, with a focus on sex differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 8043 National Health and Nutrition Examination Survey participants were analyzed using logistic regression, restricted cubic spline (RCS), and interaction effect models. A meta-analysis of eight studies was also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Blood, urinary Cd, and UA levels were more strongly associated with hypertension in females than in males (<i>p </i>< 0.05). Among females, blood Cd (odds ratio [OR]<i> = </i>1.84, 95% confidence interval [CI]: 1.20–2.83), urinary Cd (OR = 3.38, 95% CI: 2.15–5.30), and UA levels (OR = 3.67, 95% CI: 2.47–5.45) were significantly associated with increased hypertension risk. RCS analysis showed linear dose–response relationships for blood (<i>P</i><sub>non-linear</sub> = 0.085) and urinary Cd (<i>P</i><sub>non-linear</sub> = 0.070) levels, whereas UA levels (<i>P</i><sub>non-linear</sub> = 0.031) exhibited a non-linear association with hypertension risk. Multiplicative interaction showed 176% (OR = 2.76, 95% CI: 2.00–3.80) and 370% (OR = 4.70, 95% CI: 3.49–6.33) increased hypertension risks for high blood Cd–UA and urinary Cd–UA levels, respectively. Additive interaction confirmed synergy (relative excess risk due to interaction [RERI] = 1.74, 95% CI: 0.37–3.10). The meta-analysis using a random-effects model confirmed that blood Cd (OR = 1.93, 95% CI: 1.28–2.93) and urinary Cd levels (OR = 1.81, 95% CI: 0.93–3.50) were significantly increased hypertension risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elevated Cd and UA levels independently and synergistically increased hypertension risk, especially in females, highlighting the need for targeted prevention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331921","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}
<p>Dear Editor,</p><p>We read with great interest the letter by Kuitunen et al., in which they evaluate the performance of ChatGPT-4o in conducting risk of bias (RoB) assessments using the Cochrane RoB2 tool. Their study sampled 100 randomized controlled trials (RCTs) from recent meta-analyses published in top-tier medical journals, prompting ChatGPT-4o to provide an overall rating (“low,” “some concerns,” or “high”) and domain-specific ratings for each study. The authors found that the interrater agreement was generally slight to poor, aligning with previous smaller scale observations and highlighting that ChatGPT-4o's default outputs may be overly optimistic when determining bias levels.</p><p>We commend the authors for their systematic approach. Their standardized prompt and focus on RoB2 across a larger sample of RCTs strengthen the validity of their findings. Furthermore, their interrater reliability analyses revealed low correlation coefficients, which underscores the challenges inherent in automating such nuanced evaluations. These results add valuable quantitative data to an area where robust evidence is still emerging.</p><p>Nevertheless, we wish to highlight certain methodological limitations that warrant further consideration. First, the inclusion of five duplicate articles [<span>1-5</span>]—each cited in two different meta-analyses—introduced a situation in which identical articles had identical “ground truth” RoB2 assessments yet received different evaluations by ChatGPT-4o, illustrating variability in large language model (LLM) responses. For instance, for this article [<span>4</span>], D5 was either low and some concerns. Second, the rule-based determination of the overall RoB (low/some concerns/high) from domain-specific ratings itself is algorithmic and does not necessarily require a generative LLM for completion, suggesting that a simpler automated “classification” method might suffice for this aspect. Third, as Kuitunen et al. acknowledge, relying on a single LLM extraction to generate these assessments may be inherently limited, particularly if the model's output can shift based on small prompt changes or session variability.</p><p>To address these issues, we replicated the methodology in the same data set of 100 RCTs using both the original ChatGPT-4o and its updated iteration, 4o-new. Additionally, we employed a sophisticated framework (4o-fram) that integrates 4o as an input for processing .jsonl files associated with full-text articles. The 4o-fram framework (DAM Assess Version 1.25.01; DeepDocs LLC) utilizes a systematic multi-step approach; it applies a predefined evaluation grid to OCR-converted full-text PDFs using a language model, then structures the results into a clean, analyzable Excel table (Figure S1). We also tested OpenAI's newer “o1” model using exactly the same prompts. We replicated the analysis using our own dataset and models, comparing the original ChatGPT-4o results reported by Kuitunen et al. to new o
{"title":"Variability and Advancements in ChatGPT Risk of Bias Assessments: A Replication and Comparative Analysis","authors":"Jules Descamps, Matthieu Resche-Rigon, Guillaume Draznieks, Cesar Quirino, Rémy Nizard, Pierre-Alban Bouché","doi":"10.1111/jebm.70046","DOIUrl":"https://doi.org/10.1111/jebm.70046","url":null,"abstract":"<p>Dear Editor,</p><p>We read with great interest the letter by Kuitunen et al., in which they evaluate the performance of ChatGPT-4o in conducting risk of bias (RoB) assessments using the Cochrane RoB2 tool. Their study sampled 100 randomized controlled trials (RCTs) from recent meta-analyses published in top-tier medical journals, prompting ChatGPT-4o to provide an overall rating (“low,” “some concerns,” or “high”) and domain-specific ratings for each study. The authors found that the interrater agreement was generally slight to poor, aligning with previous smaller scale observations and highlighting that ChatGPT-4o's default outputs may be overly optimistic when determining bias levels.</p><p>We commend the authors for their systematic approach. Their standardized prompt and focus on RoB2 across a larger sample of RCTs strengthen the validity of their findings. Furthermore, their interrater reliability analyses revealed low correlation coefficients, which underscores the challenges inherent in automating such nuanced evaluations. These results add valuable quantitative data to an area where robust evidence is still emerging.</p><p>Nevertheless, we wish to highlight certain methodological limitations that warrant further consideration. First, the inclusion of five duplicate articles [<span>1-5</span>]—each cited in two different meta-analyses—introduced a situation in which identical articles had identical “ground truth” RoB2 assessments yet received different evaluations by ChatGPT-4o, illustrating variability in large language model (LLM) responses. For instance, for this article [<span>4</span>], D5 was either low and some concerns. Second, the rule-based determination of the overall RoB (low/some concerns/high) from domain-specific ratings itself is algorithmic and does not necessarily require a generative LLM for completion, suggesting that a simpler automated “classification” method might suffice for this aspect. Third, as Kuitunen et al. acknowledge, relying on a single LLM extraction to generate these assessments may be inherently limited, particularly if the model's output can shift based on small prompt changes or session variability.</p><p>To address these issues, we replicated the methodology in the same data set of 100 RCTs using both the original ChatGPT-4o and its updated iteration, 4o-new. Additionally, we employed a sophisticated framework (4o-fram) that integrates 4o as an input for processing .jsonl files associated with full-text articles. The 4o-fram framework (DAM Assess Version 1.25.01; DeepDocs LLC) utilizes a systematic multi-step approach; it applies a predefined evaluation grid to OCR-converted full-text PDFs using a language model, then structures the results into a clean, analyzable Excel table (Figure S1). We also tested OpenAI's newer “o1” model using exactly the same prompts. We replicated the analysis using our own dataset and models, comparing the original ChatGPT-4o results reported by Kuitunen et al. to new o","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309140","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}
Fatima Ezzahra Mokhlis, Adam Hrimech, Maryam Fourtassi, Khalid El Bairi
{"title":"The Measles Outbreak in Morocco: A Failure of Scientific Communication and Training on Evidence-Based Medicine","authors":"Fatima Ezzahra Mokhlis, Adam Hrimech, Maryam Fourtassi, Khalid El Bairi","doi":"10.1111/jebm.70048","DOIUrl":"https://doi.org/10.1111/jebm.70048","url":null,"abstract":"","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309139","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}
Due to the limited evidence, the effects and neuroimaging mechanisms of acupuncture for amnestic mild cognitive impairment (aMCI) are still needed to investigate. Our objectives were to assess the effects and investigate its therapy-driven modification in functional neural response.
Methods
Right-handed aMCI patients were enrolled and randomly assigned to an acupuncture group (AG) or a waitlist control group (WG) in the randomized clinical trial using computer-generated randomization sequence method. Twenty normal cognition individuals were included in the normal control (NC) group. The primary outcomes were the changes in the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score from baseline to the 12th and 24th week. Acupuncture's neural responses were investigated by detecting changes in regional homogeneity (ReHo), seed-based functional connectivity (FC), and effective connectivity (EC) from baseline to the 12th week. Generalized estimating equations and correlational analyses were employed.
Results
Overall, 343 participants were screened, and 72 aMCI patients were included. The ADAS-Cog score changes at Weeks 12 and 24 of AG were significantly higher than that of WG. In neural response, aMCI patients had higher ReHo in the left dorsolateral prefrontal cortex (DLPFC.L) compared to NCs. Acupuncture significantly reduced ReHo in the DLPFC.L and its FC with the left anterior cingulate cortex (ACC.L) compared to the WG. The causal evidence for decreased EC from the DLPFC.L to the ACC.L after acupuncture, which correlated with change in ADAS-Cog score.
Conclusion
Acupuncture was effective in overall cognitive function in aMCI patients, and the effect was associated with the DLPFC.L-ACC.L circuit.
{"title":"Effects and Neuroimaging Findings of Acupuncture for Amnestic Mild Cognitive Impairment: A Randomized Controlled Trial","authors":"Zihan Yin, Yaqin Li, Xinyue Zhang, Yiwei Liu, Ziqi Wang, Fang Ye, Xia He, Qiongnan Bao, Manze Xia, Zhenghong Chen, Wanqi Zhong, Kexin Wu, Jin Yao, Ziwen Chen, Ziwen Wang, Mingsheng Sun, Jiao Chen, Xiaojuan Hong, Ling Zhao, Fanrong Liang","doi":"10.1111/jebm.70047","DOIUrl":"https://doi.org/10.1111/jebm.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Due to the limited evidence, the effects and neuroimaging mechanisms of acupuncture for amnestic mild cognitive impairment (aMCI) are still needed to investigate. Our objectives were to assess the effects and investigate its therapy-driven modification in functional neural response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Right-handed aMCI patients were enrolled and randomly assigned to an acupuncture group (AG) or a waitlist control group (WG) in the randomized clinical trial using computer-generated randomization sequence method. Twenty normal cognition individuals were included in the normal control (NC) group. The primary outcomes were the changes in the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score from baseline to the 12th and 24th week. Acupuncture's neural responses were investigated by detecting changes in regional homogeneity (ReHo), seed-based functional connectivity (FC), and effective connectivity (EC) from baseline to the 12th week. Generalized estimating equations and correlational analyses were employed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 343 participants were screened, and 72 aMCI patients were included. The ADAS-Cog score changes at Weeks 12 and 24 of AG were significantly higher than that of WG. In neural response, aMCI patients had higher ReHo in the left dorsolateral prefrontal cortex (DLPFC.L) compared to NCs. Acupuncture significantly reduced ReHo in the DLPFC.L and its FC with the left anterior cingulate cortex (ACC.L) compared to the WG. The causal evidence for decreased EC from the DLPFC.L to the ACC.L after acupuncture, which correlated with change in ADAS-Cog score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Acupuncture was effective in overall cognitive function in aMCI patients, and the effect was associated with the DLPFC.L-ACC.L circuit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"18 2","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309141","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}
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