Journal of Evidence‐Based Medicine最新文献_第9页

The impact of blinding on estimated treatment effects in randomized clinical trials on acupuncture: A meta-epidemiological study 针灸随机临床试验中盲法对估计治疗效果的影响：一项荟萃流行病学研究。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-03-11 DOI: 10.1111/jebm.12589

Youlin Long, Na Zhang, Xinyao Wang, Ruixian Tang, Qiong Guo, Jin Huang, Liang Du

Objective

To evaluate the sole impact of blinding patients and outcome assessors in acupuncture randomized controlled trials (RCTs) on treatment effects while considering the type of outcome measures.

Methods

We searched databases for the meta-analyses on acupuncture with both blinded and non-blinded RCTs. Mixed-effects meta-regression models estimated the average ratio of odds ratios (ROR) and differences in standardized mean differences (dSMD) for non-blinded RCTs versus blinded mixed-effects meta-regression model.

Results

The study included 96 meta-analyses (1012 trials). The average ROR for lack of patient blinding was 1.08 (95% confidence intervals 0.79–1.49) in 18 meta-analyses with binary patient-reported outcomes. The average ROR for lack of outcome assessor blinding was 0.98 (0.77–1.24) in 43 meta-analyses with binary subjective outcomes. The average dSMD was −0.38 (−0.96 to 0.20) in 10 meta-analyses with continuous patient-reported outcomes. The average dSMD was −0.13 (−0.45 to 0.18) in 25 meta-analyses with continuous subjective outcomes. The results of the subgroup analysis were consistent with the primary analysis findings.

Conclusions

Blinding of participants and outcome assessors does not significantly influence acupuncture treatment efficacy. It underscores the practical difficulties of blinding in acupuncture RCTs and the necessity to distinguish between trials with and without successful blinding to understand treatment expectations’ effects. Enhancing blinding procedures’ quality and assessment in future research is crucial for improving RCTs’ internal validity and reliability.

目的：评估针灸随机对照试验（RCT）中对患者和结果评估者实施盲法对治疗效果的影响：评估在针灸随机对照试验（RCT）中对患者和结果评估者实施盲法对治疗效果的唯一影响，同时考虑结果测量的类型：方法：我们检索了数据库中有关针灸的荟萃分析，包括盲法和非盲法随机对照试验。混合效应元回归模型估算了非盲法 RCT 与盲法混合效应元回归模型的平均几率比（ROR）和标准化平均差（dSMD）：研究包括 96 项元分析（1012 项试验）。在18项具有二元患者报告结果的荟萃分析中，缺乏患者盲法的平均ROR为1.08（95%置信区间为0.79-1.49）。在 43 项具有二元主观结果的荟萃分析中，缺乏结果评估者盲法的平均 ROR 为 0.98（0.77-1.24）。在 10 项具有连续性患者报告结果的荟萃分析中，dSMD 的平均值为-0.38（-0.96 至 0.20）。在 25 项具有连续主观结果的荟萃分析中，平均 dSMD 为-0.13（-0.45 至 0.18）。亚组分析结果与主要分析结果一致：结论：对参与者和结果评估者进行盲法并不会显著影响针灸疗效。这凸显了在针灸临床试验中进行盲法操作的实际困难，以及区分成功盲法和未成功盲法试验以了解治疗预期效果的必要性。在未来的研究中，提高盲法程序的质量和评估对于改善RCT的内部效度和信度至关重要。

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引用次数: 0

Time-varying effects of sodium-glucose cotransporter-2 inhibitors in patients with heart failure: An updated meta-analysis 钠-葡萄糖共转运体-2抑制剂对心力衰竭患者的时变效应：最新荟萃分析。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-03-11 DOI: 10.1111/jebm.12597

Xinyu Zou, Qingyang Shi, Sheyu Li

引用次数: 0

Discrepancies in breast cancer guideline recommendations despite similar Cochrane systematic review conclusions 尽管科克伦系统综述结论相似，但乳腺癌指南建议却存在差异。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-03-09 DOI: 10.1111/jebm.12581

Zhigang Zhang, Jie Cheng, Jialu Hou, Mingming Niu, Ya Gao, Jianguo Xu, Qingyong Zheng, Kexin Ji, Min Zhang, Tian Hao, Ning Li, Xinyi Han, Xiujuan Ma, Jiajia Kong, Rui Wang, Ye Zhao, Jinhui Tian, Xiaofang Hu

Aim

This study aims to describe the citation patterns of Cochrane systematic reviews (CSR) in guidelines for managing breast cancer.

Methods

We searched for systematic reviews on breast cancer in The Cochrane Library from the date of inception to November 15, 2023, and identified guidelines that cited them. We described how systematic reviews were cited by the guidelines in each database and each year. Additionally, we presented the relationships between the conclusions of the systematic reviews and guideline recommendations and compared the consistency of the recommendations on the same topic across different guidelines.

Results

A total of 64 systematic reviews and 228 guidelines were included in this study. The average number of the 64 systematic reviews cited by the guidelines was 5.91. We found that the guideline recommendations were irrelevant or inconsistent with the conclusions of the systematic reviews in 56 (38.36%) cited entries. We grouped recommendations on the same topic across different guidelines into one group, of which only 5 groups (15.15%) had completely consistent recommendations, and the other 28 groups (84.85%) had inconsistent recommendations.

Conclusion

The average number of citations for CSR on breast cancer in the guidelines was 5.91. There were also situations in which the guideline recommendations were inconsistent with the conclusions of the included systematic reviews, and recommendations on the same topic across different guidelines were inconsistent.

目的：本研究旨在描述科克伦系统综述（CSR）在乳腺癌管理指南中的引用模式：我们在 Cochrane 图书馆中搜索了自成立之日起至 2023 年 11 月 15 日的乳腺癌系统综述，并确定了引用这些综述的指南。我们描述了每个数据库和每年的指南是如何引用系统综述的。此外，我们还介绍了系统综述结论与指南建议之间的关系，并比较了不同指南对同一主题建议的一致性：本研究共纳入了 64 篇系统综述和 228 份指南。指南引用的 64 篇系统综述的平均数量为 5.91 篇。我们发现，在 56 个（38.36%）被引用的条目中，指南建议与系统综述的结论不相关或不一致。我们将不同指南中关于同一主题的建议归为一组，其中只有 5 组（15.15%）的建议完全一致，其他 28 组（84.85%）的建议不一致：结论：指南中关于乳腺癌的 CSR 的平均引用次数为 5.91 次。结论：指南中关于乳腺癌 CSR 的平均引用次数为 5.91 次，还存在指南建议与纳入的系统综述结论不一致的情况，以及不同指南对同一主题的建议不一致的情况。

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引用次数: 0

Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management 针对非传染性疾病的数字医疗整合：为全生命周期管理绘制综合流程图。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-02-15 DOI: 10.1111/jebm.12583

Tianrui He, Wenbin Cui, Yuxuan Feng, Xingyi Li, Guangjun Yu

Aim

To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement.

Methods

A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus.

Results

We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints.

Conclusions

This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.

目的：在关键利益相关者参与的基础上，为非传染性疾病的全生命周期管理创建一个系统的数字健康流程图框架：采用三阶段定性方法，在中国上海构建非传染性疾病数字化管理流程图框架。第一阶段包括案头研究，以检查当前的指导和实践。在第二阶段，关键利益相关者参加了焦点小组讨论，以确定非传染性疾病终身管理中普遍存在的数字接触点。在最后阶段，采用德尔菲技术，根据专家的见解完善框架并达成共识：结果：我们在非传染性疾病全生命周期管理的五个重要阶段确定了 60 个数字接触点。大多数专家认可这些接触点的合理性和可行性：这项研究促成了一个全面的数字健康流程映射框架的建立，该框架涵盖了非传染性疾病管理的整个生命周期。所获得的见解强调了以人为本的系统性战略方法的重要性，而不是零散的、纯粹以技术为中心的方法。我们建议医疗保健专业人员将这一框架作为高效疾病管理和将技术无缝融入临床实践的关键。

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引用次数: 0

Does HPV biotype influence the characteristics and evolution of plantar warts? HPV 生物型会影响跖疣的特征和演变吗？

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-02-02 DOI: 10.1111/jebm.12584

Sara García-Oreja, Francisco Javier Álvaro-Afonso, David Sevillano-Fernández, Esther Alicia García-Morales, Mateo López-Moral, José Luis Lázaro-Martínez

Background

Few studies have addressed the relationship of human papillomavirus (HPV) biotypes to patient characteristics and the clinical signs, course, and response to the treatment of plantar warts.

Objective

Analyze the HPV types associated with plantar warts and their relationship with warts characteristics, patient characteristics and response to treatment.

Methods

A total of 372 patients sampled for hyperkeratosis of a plantar wart were included. Multiplex polymerase chain reaction (PCR) was performed to detect the HPV biotype.

Results

The prevalence of HPV was 81.2%, and HPV1 was the most prevalent biotype (36.1%). HPV1 was the most prevalent biotype in patients < 70 years old (90.9% in < 10 years), and biotypes 2, 19 and 27 were the most prevalent in patients > 70 years old (p = 0.012). HPV1 was the most frequent in patients with one (39,9%) or two (47.1%) warts and HPV5 (33.3%) in patients with three warts (p < 0.001). Cure, spontaneous resolution, and recurrence were higher in HPV1 (p < 0.001). HPV14 warts healed the fastest (2 months quartile 1–3 (2.0–2.0)), and HPV5 (10.977 (6.0–20.0)) and HPV27 (7.5 (3.0–10.0)) warts (p = 0.033) took the longest to heal.

Conclusions

HPV biotype is associated with age and the number of warts and appears to influence the natural history of warts and their response to treatment.

背景：很少有研究探讨人类乳头瘤病毒（HPV）生物型与患者特征、临床症状、病程和治疗反应的关系：人类乳头瘤病毒（HPV）生物型与跖疣患者特征、临床症状、病程和治疗反应的关系鲜有研究：分析与跖疣相关的 HPV 类型及其与疣特征、患者特征和治疗反应的关系：方法：共纳入 372 例因跖疣角化过度而采样的患者。方法：共纳入 372 例因跖疣引起角化过度的患者，采用多重聚合酶链反应（PCR）检测 HPV 生物型：结果：HPV 感染率为 81.2%，HPV1 是最常见的生物型（36.1%）。在 70 岁的患者中，HPV1 是最常见的生物型（p = 0.012）。在有一个（39.9%）或两个（47.1%）疣的患者中，HPV1 是最常见的生物型，而在有三个疣的患者中，HPV5（33.3%）是最常见的生物型：HPV 生物型与年龄和疣的数量有关，似乎会影响疣的自然病史及其对治疗的反应。

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引用次数: 0

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing low back pain in Alberta, Canada 就加拿大艾伯塔省评估、诊断和管理腰背痛的初级保健临床决策工具达成共识。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-01-25 DOI: 10.1111/jebm.12582

Breda H. F. Eubank, Jason Martyn, Geoff M. Schneider, Gord McMorland, Sebastian W. Lackey, Xu Rong Zhao, Mel Slomp, Jason R. Werle, Jill Robert, Kenneth C. Thomas

Background

Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province-wide standardized clinical care pathway based on evidence-based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision-making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management.

Methods

A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision-making tool. Forty-seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI).

Results

A province-wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision-making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history-taking, physical examination, patient education, and management.

Conclusions

This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision-making for primary care providers in both public and private sectors.

背景：腰背痛（LBP）是一种导致残疾和高医疗费用的常见疾病。艾伯塔省面临着不必要的专家转诊和漫长的等待时间的挑战。基于循证最佳实践的全省标准化临床护理路径可以提高效率、减少等待时间并改善患者的治疗效果。在艾伯塔省的其他医疗保健领域，实施此类路径已经取得了成功。本研究开发了一种临床决策路径，以实现护理标准化，最大限度地减少评估、诊断和管理中的不确定性：方法：通过系统性快速审查，确定了可支持综合腰背痛临床决策工具的现有工具和证据。47 名医疗保健专业人员参与了四轮改良德尔菲法，以就加拿大阿尔伯塔省初级医疗机构对腰背痛患者的评估、诊断和管理达成共识。该项目由艾伯塔省卫生服务部门的骨与关节健康战略临床网络（BJHSCN）和艾伯塔省骨与关节健康研究所（ABJHI）合作开展：由来自不同卫生学科和地区的专业人士组成的全省专家小组合作开发了一种腰椎间盘突出症临床决策工具。该工具介绍了急性、亚急性和慢性腰椎间盘突出症的临床护理路径。它还为病史采集、体格检查、患者教育和管理提供了指导：该临床决策工具将有助于实现护理标准化，为腰背痛的诊断和管理提供指导，并协助公共和私营部门的初级保健提供者做出临床决策。

{"title":"Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing low back pain in Alberta, Canada","authors":"Breda H. F. Eubank, Jason Martyn, Geoff M. Schneider, Gord McMorland, Sebastian W. Lackey, Xu Rong Zhao, Mel Slomp, Jason R. Werle, Jill Robert, Kenneth C. Thomas","doi":"10.1111/jebm.12582","DOIUrl":"10.1111/jebm.12582","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province-wide standardized clinical care pathway based on evidence-based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision-making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision-making tool. Forty-seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A province-wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision-making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history-taking, physical examination, patient education, and management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision-making for primary care providers in both public and private sectors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":"17 1","pages":"224-234"},"PeriodicalIF":7.3,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546458","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}

引用次数: 0

Topical antimitotic treatments for plantar warts are more beneficial: A Bayesian network meta-analysis of randomized controlled trials 跖疣的局部抗炎治疗更有益：随机对照试验的贝叶斯网络荟萃分析。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-01-19 DOI: 10.1111/jebm.12586

Yantao Xu, Ying Wang, Kai Huang, Weihong Huang, Shuang Zhao, Zixi Jiang

Background

Plantar warts are common infectious cutaneous growths causing severe physiological and psychological discomforts in patients and heaving global financial burdens. However, paucity of clear-cut guidelines for plantar warts, selecting appropriate treatments for plantar warts remains challenging. The objective of the study is to evaluate the efficacy and safety of common treatments for plantar warts.

Methods

PubMed, EMbase, and The Cochrane Library were searched from inception to March 1, 2023 for randomized controlled trials (RCTs) of plantar warts. The primary outcome (complete response) and secondary outcome (recurrence and pain) were extracted and combined using Bayesian network meta-analysis (NMA) with random-effect and fixed-effect models.

Results

Totally, 33 RCTs were included in the systematic review and quantitative NMA. In NMA of complete response, topical application of 1% cantharidin, 20% podophylotoxin, 30% salicylic acid (CPS), microneedles plus bleomycin (MNB), and intralesional bleomycin injection (INB) were the only three treatments significantly superior to no treatment (NT) and CPS was of the highest possibility to be the top-ranked treatment (SUCRA = 0.9363). However, traditional warts treatments, salicylic acid (SA) and cryotherapy were not superior to NT.

Conclusions

The NMA has produced evidence for using CPS, MNB, and INB, which are all topical antimitotic treatments, to improve the management of plantar warts. The classic treatment modalities for plantar warts, including SA and cryotherapy, may play a less important role in the clinical practice of plantar warts.

背景：跖疣是一种常见的传染性皮肤赘生物，会给患者造成严重的生理和心理不适，并给全球带来沉重的经济负担。然而，由于缺乏明确的跖疣治疗指南，选择适当的跖疣治疗方法仍具有挑战性。本研究旨在评估跖疣常见治疗方法的有效性和安全性：方法：在 PubMed、EMbase 和 Cochrane 图书馆检索了从开始到 2023 年 3 月 1 日的跖疣随机对照试验 (RCT)。采用贝叶斯网络荟萃分析（NMA）和随机效应与固定效应模型提取并合并了主要结果（完全应答）和次要结果（复发和疼痛）：共有 33 项研究纳入了系统综述和定量 NMA。在完全反应的NMA中，局部应用1%卡他列汀、20%荚膜霉素、30%水杨酸（CPS）、微针加博莱霉素（MNB）和局部注射博莱霉素（INB）是仅有的三种显著优于无治疗（NT）的治疗方法，而CPS最有可能成为排名第一的治疗方法（SUCRA = 0.9363）。然而，传统的尖锐湿疣治疗方法、水杨酸（SA）和冷冻疗法并不优于NT：NMA为使用CPS、MNB和INB（均为局部抗炎治疗）改善跖疣治疗提供了证据。跖疣的传统治疗方法，包括SA和冷冻疗法，在跖疣的临床实践中发挥的作用可能较小。

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引用次数: 0

Core outcome sets for myocardial infarction in clinical trials of traditional Chinese medicine and Western medicine 中西医临床试验中心肌梗死的核心结果集。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-01-12 DOI: 10.1111/jebm.12579

Ruijin Qiu, Siqi Wan, Changming Zhong, Songjie Han, Tianmai He, Ya Huang, Xuxu Wei, Meng Li, Zhiyue Guan, Xinyi Zhang, Huanlin Wu, Hongcai Shang

Background

Clinical trials of traditional Chinese medicine (TCM) and Western medicine showed there was heterogeneity of outcome reporting in myocardial infarction (MI). Developing a core outcome set (COS) might improve the consistency of outcome reporting in future clinical trials.

Methods

A list of outcomes was developed based on a systematic review of randomized controlled trials (RCTs) of MI and semistructured interviews with MI patients. Two rounds of Delphi survey for clinicians, researchers, journal editors, and methodologists were conducted. An online questionnaire sent to nurses. After an online consensus meeting, a COS for MI RCTs was developed.

Results

After extracted data from clinical trials and discussed, 216 outcomes were included in round 1 of the Delphi survey. Seventy-four participants completed round 1 of the Delphi survey. Sixty-five participants completed round 2 of the Delphi survey. Twenty-two nurses completed the online questionnaire. Fifteen participants attended the online consensus meeting, and 14 of them voted and determined the final COS. For all types of MI, it was recommended that left ventricular ejection fraction and quality of life be measured and reported. For acute MI, the participants in the consensus meeting recommended the following core outcomes: death from cardio-cerebrovascular disease, cardiogenic shock, heart failure, troponin I, troponin T, creatine kinase isoenzyme, Killip class, target vessel revascularization, and emergency CABG. For previous MI, recurrent MI, recurrent angina pectoris, and heart failure readmission were recommended.

Conclusions

The COS for MI in RCTs provides recommendations for clinical trials that seek to improve outcomes for patients with MI.

背景：中西医临床试验显示，心肌梗死（MI）的结果报告存在异质性。制定核心结果集（COS）可提高未来临床试验结果报告的一致性：方法：根据对心肌梗死随机对照试验（RCT）的系统回顾和对心肌梗死患者的半结构式访谈，制定了一份结果列表。对临床医生、研究人员、期刊编辑和方法论专家进行了两轮德尔菲调查。向护士发送在线问卷。在线共识会议后，制定了 MI RCT 的 COS：从临床试验中提取数据并进行讨论后，216 项结果被纳入德尔菲调查的第一轮。74 位参与者完成了德尔菲调查的第一轮。65名参与者完成了德尔菲调查第二轮。22 名护士完成了在线问卷调查。15 名参与者参加了在线共识会议，其中 14 人进行了投票并确定了最终的 COS。对于所有类型的心肌梗死，建议测量并报告左心室射血分数和生活质量。对于急性心肌梗死，共识会议与会者推荐了以下核心结果：心脑血管疾病导致的死亡、心源性休克、心力衰竭、肌钙蛋白 I、肌钙蛋白 T、肌酸激酶同工酶、Killip 分级、靶血管再通术和急诊 CABG。对于既往的心肌梗死、复发性心肌梗死、复发性心绞痛和心力衰竭再入院，建议采用COS：RCT中的心肌梗死COS为旨在改善心肌梗死患者预后的临床试验提供了建议。

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引用次数: 0

Correction to: Risk prediction of hepatobiliary and pancreatic cancersin elderly Chinese: The Dongfeng-Tongji cohort 更正：中国老年人肝胆胰癌的风险预测：东风-同济队列。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-01-12 DOI: 10.1111/jebm.12580

Lyu J, Guan X, Zhou Y, Guo H, Cheng S, Wang C. Risk prediction of hepatobiliary and pancreatic cancers in elderly Chinese: The Dongfeng-Tongji cohort. J Evid Based Med. 2023; 16:39-49.

1. In Supplementary Figure l, the unit in “Diagnosis of pancreatic or hepatobiliary cancer in < 3 or > 70 weeks of follow-up” was incorrect. The unit “weeks” should be changed to “months.”

2. In the second last paragraph of the Results section, the text “and even lower for PC (0.21%, 95% CI (0.13%, 0.28%)) and PPV (67.63%, 95% CI (67.19%, 68.07%) specificity, Table 3)” should be modified to “and even lower for PC (0.21% (0.13-0.28%) PPV and 67.63% (67.19-68.07%) specificity, Table 3).”

3. In the second paragraph of the Discussion section, three numbers of AUC were incorrect. The number 0.828 on line 6 should be 0.818. The number 0.862 on line 12 should be 0.843. The number 0.890 on line 13 should be 0.873.

We apologize for these errors, which were introduced unintentionally during the revision (1 and 3) and the production process (2). The correction does not change any results and conclusions of the article.

Lyu J, Guan X, Zhou Y, Guo H, Cheng S, Wang C. 中国老年人肝胆胰癌的风险预测：东风-同济队列。J Evid Based Med.2023; 16:39-49.1.在补充图l中，"随访3周或70周诊断为胰腺癌或肝胆癌 "中的单位不正确。单位 "周 "应改为 "月"。结果部分倒数第二段中，"PC（0.21%，95% CI (0.13%, 0.28%)）和 PPV（67.63%，95% CI (67.19%, 68.07%) 特异性，表 3）"应改为 "PC（0.21%，95% CI (0.13%, 0.28%)）和 PPV（67.63%，95% CI (67.19%, 68.07%) 特异性，表 3）"。21% (0.13-0.28%) PPV 和 67.63% (67.19-68.07%) 特异性，表 3）"。 3.讨论部分第二段中，AUC 的三个数字不正确。第 6 行的数字 0.828 应为 0.818。第 12 行的数字 0.862 应为 0.843。第 13 行的数字 0.890 应为 0.873。我们对这些错误表示歉意，这些错误是在修订（1 和 3）和生产过程（2）中无意引入的。更正并不改变文章的任何结果和结论。

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引用次数: 0

Diagnostic performance of angiography-derived fractional flow reserve and CT-derived fractional flow reserve: A systematic review and Bayesian network meta-analysis 血管造影得出的分数血流储备和 CT 得出的分数血流储备的诊断性能：系统综述和贝叶斯网络荟萃分析。

IF 7.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine

Pub Date : 2024-01-11 DOI: 10.1111/jebm.12573

Zhongxiu Chen, Junyan Zhang, Yujia Cai, Hongsen Zhao, Duolao Wang, Chen Li, Yong He

Objective

Accumulating evidence has demonstrated that fractional flow reserves (FFRs) derived from invasive coronary angiograms (CA-FFRs) and coronary computed tomography angiography-derived FFRs (CT-FFRs) are promising alternatives to wire-based FFRs. However, it remains unclear which method has better diagnostic performance. This systematic review and meta-analysis aimed to compare the diagnostic performances of the two approaches.

Methods

The Cochrane Library, PubMed, Embase, Medline (Ovid), the Chinese China National Knowledge Infrastructure Database (CNKI), VIP, and WanFang Data databases were searched for relevant studies that included comparisons between CA-FFR and CT-FFR, from their respective database inceptions until January 1, 2023. Studies where both noninvasive FFR (including CA-FFR and CT-FFR) and invasive FFR (as a reference standard) were performed for the diagnosis of ischemic coronary artery disease and were designed as prospective, paired diagnostic studies, were pulled. The diagnostic test accuracy method and Bayesian hierarchical summary receiver operating characteristic (ROC) model for network meta-analysis (NMA) of diagnostic tests (HSROC-NMADT) were both used to perform a meta-analysis on the data.

Results

Twenty-six studies were included in this NMA. The results from both the diagnostic test accuracy and HSROC-NMADT methods revealed that the diagnostic accuracy of CA-FFR was higher than that of CT-FFR, in terms of sensitivity (Se; 0.86 vs. 0.84), specificity (Sp; 0.90 vs. 0.78), positive predictive value (PPV; 0.83 vs. 0.70), and negative predictive value (NPV; 0.91 vs. 0.89) for the detection of myocardial ischemia. A cumulative ranking curve analysis indicated that CA-FFR had a higher diagnostic accuracy than CT-FFR in the context of this study, with a higher area under the ROC curve (AUC; 0.94 vs. 0.87).

Conclusions

Although both of these two commonly used virtual FFR methods showed high levels of diagnostic accuracy, we demonstrated that CA-FFR had a better Se, Sp, PPV, NPV, and AUC than CT-FFR. However, this study provided only indirect comparisions; therefore, larger studies are warranted to directly compare the diagnostic performances of these two approaches.

目的：越来越多的证据表明，由有创冠状动脉造影（CA-FFR）和冠状动脉计算机断层扫描血管造影（CT-FFR）得出的分数血流储备（FFR）很有希望替代基于导线的 FFR。然而，目前仍不清楚哪种方法具有更好的诊断性能。本系统综述和荟萃分析旨在比较这两种方法的诊断性能：方法：在 Cochrane Library、PubMed、Embase、Medline (Ovid)、中国国家知识基础设施数据库 (CNKI)、VIP 和万方数据等数据库中检索了自各自数据库建立至 2023 年 1 月 1 日期间纳入 CA-FFR 和 CT-FFR 比较的相关研究。在这些研究中，无创 FFR（包括 CA-FFR 和 CT-FFR）和有创 FFR（作为参考标准）均用于缺血性冠状动脉疾病的诊断，且均为前瞻性、配对诊断研究。采用诊断测试准确性方法和贝叶斯分层汇总接收器操作特征（ROC）模型对数据进行诊断测试网络荟萃分析（NMA）（HSROC-NMADT）：本次 NMA 共纳入了 26 项研究。诊断测试准确性和 HSROC-NMADT 两种方法的结果显示，在检测心肌缺血方面，CA-FFR 的诊断准确性在灵敏度（Se；0.86 对 0.84）、特异性（Sp；0.90 对 0.78）、阳性预测值（PPV；0.83 对 0.70）和阴性预测值（NPV；0.91 对 0.89）方面均高于 CT-FFR。累积排名曲线分析表明，在本研究中，CA-FFR 的诊断准确率高于 CT-FFR，ROC 曲线下面积（AUC；0.94 对 0.87）更高：尽管这两种常用的虚拟 FFR 方法都显示出较高的诊断准确性，但我们发现 CA-FFR 的 Se、Sp、PPV、NPV 和 AUC 均优于 CT-FFR。不过，本研究仅提供了间接比较；因此，需要进行更大规模的研究，以直接比较这两种方法的诊断性能。

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