Sepsis is a leading cause of death from infectious disease or traumatic injury. The prevalence and predictor of results underreporting and early stop of sepsis clinical trials remain poorly studied. To fill the gap, we designed this study to characterize sepsis clinical trials registered on ClinicalTrials.gov, particularly to recognize features related to premature discontinuation and lack of results reporting.
Methods
We searched ClinicalTrials.gov to include interventional sepsis trials up to July 8, 2022. All structured data of the identified trials were extracted and reviewed. A descriptive analysis was conducted. Cox and logistic regression analyses were conducted to determine the significance of the association of trial characteristics with early termination and lack of results reporting.
Results
A total of 1654 records were identified, among which 1061 eligible trials were reserved. Results underreporting happened in 91.6% of these sepsis interventional trials. 12.0% were discontinued. Moreover, factors that led to the higher risk of discontinuation were the US-registered clinical research and the small sample size. The factor that contributed to results underreporting was non-US-registered clinical trials.
Conclusion
The frequent discontinuation and underreporting of sepsis trials have highly impaired the progress of sepsis management and studies. Therefore, solutions to early discontinuation and improving the quality of results dissemination remain an urgent problem.
{"title":"Result reporting and early discontinuation of sepsis trials registered on ClinicalTrials.gov","authors":"Handan Hu, Xinyi Wang, Peng Huang","doi":"10.1111/jebm.12543","DOIUrl":"10.1111/jebm.12543","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Sepsis is a leading cause of death from infectious disease or traumatic injury. The prevalence and predictor of results underreporting and early stop of sepsis clinical trials remain poorly studied. To fill the gap, we designed this study to characterize sepsis clinical trials registered on ClinicalTrials.gov, particularly to recognize features related to premature discontinuation and lack of results reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched ClinicalTrials.gov to include interventional sepsis trials up to July 8, 2022. All structured data of the identified trials were extracted and reviewed. A descriptive analysis was conducted. Cox and logistic regression analyses were conducted to determine the significance of the association of trial characteristics with early termination and lack of results reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1654 records were identified, among which 1061 eligible trials were reserved. Results underreporting happened in 91.6% of these sepsis interventional trials. 12.0% were discontinued. Moreover, factors that led to the higher risk of discontinuation were the US-registered clinical research and the small sample size. The factor that contributed to results underreporting was non-US-registered clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The frequent discontinuation and underreporting of sepsis trials have highly impaired the progress of sepsis management and studies. Therefore, solutions to early discontinuation and improving the quality of results dissemination remain an urgent problem.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9856783","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}
Hanna K. Al-Makhamreh, Ahmad A. Toubasi, Layla M. Al-Harasis, Farah H. Albustanji, Thuraya N. Al-Sayegh, Sarah M. Al-Harasis
Objective
Previous studies investigated the effect of pericardial fat on cardiovascular diseases. However, until now there was no systematic review and meta-analysis investigated this association, thus we conducted this article to assess the relationship between pericardial fat and cardiovascular diseases.
Methods
We searched PubMed, The Cochrane Library, Scopus, Google Scholar and Clinicaltrials.gov to select observational studies reported the relationship between pericardial fat and cardiovascular diseases including coronary artery disease (CAD), ventricular dysfunction, heart failure (HF), atrial fibrillation (AF), major adverse cardiac events (MACE), coronary artery calcifications (CAC), arrhythmias other than atrial fibrillation, and cardiovascular events prediction scores. Meta XL 5.3 was used for data analysis.
Results
A total of 83 articles that included 73,934 patients were included in our analysis. The results showed that pericardial fat was significantly associated with CAD (OR = 1.38; 95% CI: 1.28–1.50), ventricular dysfunction (OR = 1.53 per 1 mm3; 95% CI: 1.17–2.01), HF (OR = 1.32 per 1 mm3; 95% CI: 1.23–1.41), AF (OR = 1.16 per 1 mm3; 95% CI: 1.09–1.24), MACE (OR = 1.39 per 1 mm3; 95% CI: 1.22–1.57), and CAC (OR = 1.15 per 1 mm3; 95% CI: 1.05–1.27). On the other hand, there was no enough data about the relationship between pericardial fat with arrhythmias other than atrial fibrillation or cardiovascular risk scores.
Conclusion
The analysis demonstrated that the relationship between pericardial fat volume and cardiovascular diseases was significant. Since pericardial fat is a good predictor of obesity, it suggests investigating its relationship and adds on effect to previously established risk factor to evaluate the possibility of incorporating it with cardiovascular risk scores.
{"title":"Pericardial fat and cardiovascular diseases: A systematic review and meta-analysis","authors":"Hanna K. Al-Makhamreh, Ahmad A. Toubasi, Layla M. Al-Harasis, Farah H. Albustanji, Thuraya N. Al-Sayegh, Sarah M. Al-Harasis","doi":"10.1111/jebm.12542","DOIUrl":"10.1111/jebm.12542","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Previous studies investigated the effect of pericardial fat on cardiovascular diseases. However, until now there was no systematic review and meta-analysis investigated this association, thus we conducted this article to assess the relationship between pericardial fat and cardiovascular diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed, The Cochrane Library, Scopus, Google Scholar and Clinicaltrials.gov to select observational studies reported the relationship between pericardial fat and cardiovascular diseases including coronary artery disease (CAD), ventricular dysfunction, heart failure (HF), atrial fibrillation (AF), major adverse cardiac events (MACE), coronary artery calcifications (CAC), arrhythmias other than atrial fibrillation, and cardiovascular events prediction scores. Meta XL 5.3 was used for data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 83 articles that included 73,934 patients were included in our analysis. The results showed that pericardial fat was significantly associated with CAD (OR = 1.38; 95% CI: 1.28–1.50), ventricular dysfunction (OR = 1.53 per 1 mm<sup>3</sup>; 95% CI: 1.17–2.01), HF (OR = 1.32 per 1 mm<sup>3</sup>; 95% CI: 1.23–1.41), AF (OR = 1.16 per 1 mm<sup>3</sup>; 95% CI: 1.09–1.24), MACE (OR = 1.39 per 1 mm<sup>3</sup>; 95% CI: 1.22–1.57), and CAC (OR = 1.15 per 1 mm<sup>3</sup>; 95% CI: 1.05–1.27). On the other hand, there was no enough data about the relationship between pericardial fat with arrhythmias other than atrial fibrillation or cardiovascular risk scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The analysis demonstrated that the relationship between pericardial fat volume and cardiovascular diseases was significant. Since pericardial fat is a good predictor of obesity, it suggests investigating its relationship and adds on effect to previously established risk factor to evaluate the possibility of incorporating it with cardiovascular risk scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10174925","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}
Several issues related to the coronavirus pandemic have not yet been fully and unequivocally identified despite the attempts made in the literature to explain why COVID-19 case-fatality rates vary among countries and why in some developed countries, fatality rates were high. For instance, a study1 investigated the clinical risk factors of COVID-19 fatality, which might include obesity and diabetes.2 Other researchers studied the impact of demographic factors such as age, socioeconomic factors, environmental factors, and all these indicators combined.3 Countries worldwide reported different case-fatality rates (CFR), a measure defined as the proportion of cases of COVID-19 that were fatal within a specified time. However, these differences in mortality rates might not be attributed to just the above-mentioned factors. There were other explanations, including the difference in the number of people tested and the characteristics of the healthcare system. Countries with fewer resources might have a higher mortality risk because their hospitals became overwhelmed with the increased number of infections.
The current study applied statistical methods to investigate the association between COVID-19 deaths and potential clinical, demographic, and socioeconomic risk factors. In addition, the variation of case-fatality rates across the countries and over time was also studied. There was ample research published in the literature about this issue,4 with evidence from different countries and regions. Our contribution was to examine how the results for the MENA (Middle East and North Africa) region compared with results from other populations and whether the association of pandemic mortality and risk factors was confounded with population genotypes and racial differences, as these factors had not been sufficiently emphasized in the literature.
The MENA region includes 22 countries and makes up 6% of the world's population and more than 50% of the world's total oil reserves. Like most countries, the Middle East and North Africa have had their share of human and economic losses because of the COVID-19 outbreak, and as of April 2022, it was estimated that nearly 20 million people had been infected and 300 thousand had died from the coronavirus in the region.5 Although governments in the MENA countries at first reacted swiftly to contain the coronavirus by implementing strict health protocols and developing policy and institutional plans to support households and firms, which helped to limit the first wave of the pandemic, however, after relaxing health restrictions in summer 2020, the situation quickly diverged and cases and death tolls rapidly increased. To compare this situation with the European management of the pandemic, a study6 found that in the first phase of the pandemic, the inefficiency of the he
{"title":"Estimation of death risk factors associated with the coronavirus pandemic in the Middle East and North Africa","authors":"Sami Khedhiri","doi":"10.1111/jebm.12538","DOIUrl":"10.1111/jebm.12538","url":null,"abstract":"<p>Several issues related to the coronavirus pandemic have not yet been fully and unequivocally identified despite the attempts made in the literature to explain why COVID-19 case-fatality rates vary among countries and why in some developed countries, fatality rates were high. For instance, a study<span><sup>1</sup></span> investigated the clinical risk factors of COVID-19 fatality, which might include obesity and diabetes.<span><sup>2</sup></span> Other researchers studied the impact of demographic factors such as age, socioeconomic factors, environmental factors, and all these indicators combined.<span><sup>3</sup></span> Countries worldwide reported different case-fatality rates (CFR), a measure defined as the proportion of cases of COVID-19 that were fatal within a specified time. However, these differences in mortality rates might not be attributed to just the above-mentioned factors. There were other explanations, including the difference in the number of people tested and the characteristics of the healthcare system. Countries with fewer resources might have a higher mortality risk because their hospitals became overwhelmed with the increased number of infections.</p><p>The current study applied statistical methods to investigate the association between COVID-19 deaths and potential clinical, demographic, and socioeconomic risk factors. In addition, the variation of case-fatality rates across the countries and over time was also studied. There was ample research published in the literature about this issue,<span><sup>4</sup></span> with evidence from different countries and regions. Our contribution was to examine how the results for the MENA (Middle East and North Africa) region compared with results from other populations and whether the association of pandemic mortality and risk factors was confounded with population genotypes and racial differences, as these factors had not been sufficiently emphasized in the literature.</p><p>The MENA region includes 22 countries and makes up 6% of the world's population and more than 50% of the world's total oil reserves. Like most countries, the Middle East and North Africa have had their share of human and economic losses because of the COVID-19 outbreak, and as of April 2022, it was estimated that nearly 20 million people had been infected and 300 thousand had died from the coronavirus in the region.<span><sup>5</sup></span> Although governments in the MENA countries at first reacted swiftly to contain the coronavirus by implementing strict health protocols and developing policy and institutional plans to support households and firms, which helped to limit the first wave of the pandemic, however, after relaxing health restrictions in summer 2020, the situation quickly diverged and cases and death tolls rapidly increased. To compare this situation with the European management of the pandemic, a study<span><sup>6</sup></span> found that in the first phase of the pandemic, the inefficiency of the he","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12538","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9798338","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}
Dawid Pieper, Nina-Kristin Mann, Mahmoud Moussa, Tim Mathes, Andreas Sönnichsen, Petra Thürmann
Polypharmacy in the elderly is a recognized public health problem. For many diseases several drugs are available. Thus, it is important to rule out drugs with an unfavorable risk-benefit profile in older patients, and to suggest safer alternatives. This is often done by developing and publishing lists of potentially inappropriate medications (PIM).
Making evidence-based decisions for the elderly is often challenging as randomized controlled trials frequently do not include older adults with multimorbidity and are not sufficiently powered for analyzing harms. Despite many PIM lists having been published, there is no methodological guidance on how they should be developed, what we recognized while preparing our update of the German PRISCUS list.1 Most PIM lists use the Delphi method to find consensus.2, 3
When using a Delphi study to develop a PIM list it is crucial to consider what information will be provided to the participants of the Delphi study to formulate recommendations. There is no research on what type of information experts need or prefer to support rating of PIM criteria or derive recommendations for PIMs. Our aim was to investigate the process of providing information and the importance of different sources of information in the context of developing a PIM list.
Our study was carried out as part of updating the Potentially inappropriate medications list in the elderly in Germany (henceforth termed “the PRISCUS list”).1 This included a three-round Delphi process to derive the list of PIMs. In total, 95 experts from clinical practice and research from general medicine, geriatrics, clinical pharmacy, pharmacology, psychiatry, palliative medicine, and internal medicine evaluated whether selected substances are PIM for the elderly. Due to limited resources, we were only able to conduct 13 de novo SRs. Altogether, 187 substances were classed as PIM.4
We conducted a closed follow-up survey of all experts who took part in the assessment of PIM for the update of the PRISCUS list. The survey was administered in German via SurveyMonkey (https://de.surveymonkey.com/). We sent out an invitation email including a hyperlink to all experts who took part in the assessment for the update of the PRISUCS list. The follow-up survey took place between May and June 2021. One reminder was sent via email to all experts.
Participants were told that taking the survey would not take longer than 5 min. There was no incentive for participating in the survey. Collected data was imported into an Excel spreadsheet where all analyses were conducted. The number of participants taking part in at least one Delphi round was 59. These participants were invited to take part in our follow-up study. Of the 59 invitees, 40 (68%) responded, that is, accessed the survey. Of those (n = 40), 36 (90%) completed the entire survey.
{"title":"Systematic reviews were the perceived most important source of information for updating a potentially inappropriate medication list for the elderly: An online survey","authors":"Dawid Pieper, Nina-Kristin Mann, Mahmoud Moussa, Tim Mathes, Andreas Sönnichsen, Petra Thürmann","doi":"10.1111/jebm.12540","DOIUrl":"10.1111/jebm.12540","url":null,"abstract":"<p>Polypharmacy in the elderly is a recognized public health problem. For many diseases several drugs are available. Thus, it is important to rule out drugs with an unfavorable risk-benefit profile in older patients, and to suggest safer alternatives. This is often done by developing and publishing lists of potentially inappropriate medications (PIM).</p><p>Making evidence-based decisions for the elderly is often challenging as randomized controlled trials frequently do not include older adults with multimorbidity and are not sufficiently powered for analyzing harms. Despite many PIM lists having been published, there is no methodological guidance on how they should be developed, what we recognized while preparing our update of the German PRISCUS list.<span><sup>1</sup></span> Most PIM lists use the Delphi method to find consensus.<span><sup>2, 3</sup></span></p><p>When using a Delphi study to develop a PIM list it is crucial to consider what information will be provided to the participants of the Delphi study to formulate recommendations. There is no research on what type of information experts need or prefer to support rating of PIM criteria or derive recommendations for PIMs. Our aim was to investigate the process of providing information and the importance of different sources of information in the context of developing a PIM list.</p><p>Our study was carried out as part of updating the <i>Potentially inappropriate medications list in the elderly</i> in Germany (henceforth termed “the PRISCUS list”).<span><sup>1</sup></span> This included a three-round Delphi process to derive the list of PIMs. In total, 95 experts from clinical practice and research from general medicine, geriatrics, clinical pharmacy, pharmacology, psychiatry, palliative medicine, and internal medicine evaluated whether selected substances are PIM for the elderly. Due to limited resources, we were only able to conduct 13 de novo SRs. Altogether, 187 substances were classed as PIM.<span><sup>4</sup></span></p><p>We conducted a closed follow-up survey of all experts who took part in the assessment of PIM for the update of the PRISCUS list. The survey was administered in German via SurveyMonkey (https://de.surveymonkey.com/). We sent out an invitation email including a hyperlink to all experts who took part in the assessment for the update of the PRISUCS list. The follow-up survey took place between May and June 2021. One reminder was sent via email to all experts.</p><p>Participants were told that taking the survey would not take longer than 5 min. There was no incentive for participating in the survey. Collected data was imported into an Excel spreadsheet where all analyses were conducted. The number of participants taking part in at least one Delphi round was 59. These participants were invited to take part in our follow-up study. Of the 59 invitees, 40 (68%) responded, that is, accessed the survey. Of those (<i>n</i> = 40), 36 (90%) completed the entire survey.</p><p>Syste","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12540","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9794464","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}
Santero Marilina, Meade Adriana, Selva Anna, Acosta-Dighero Roberto, Meza Nicolás, Quintana Maria Jesús, Bracchiglione Javier, Requeijo Carolina, Salazar Josefina, Rodríguez Grijalva Gerardo, Solà Ivan, Urrútia Gerard, Bonfill Cosp Xavier, Appropriateness of Systemic Oncological Treatments for Advanced Cancer (ASTAC) Research Group
Objective
To identify, describe, and organize the available evidence regarding systemic oncological treatments compared to best supportive care (BSC) for advanced gastresophageal cancer.
Methods
We conducted a thorough search across MEDLINE (PubMed), EMbase (Ovid), The Cochrane Library, Epistemonikos, PROSPERO, and Clinicaltrials.gov. Our inclusion criteria encompassed systematic reviews, randomized controlled trials, quasi-experimental and observational studies involving patients with advanced esophageal or gastric cancer receiving chemotherapy, immunotherapy or biological/targeted therapy compared to BSC. The outcomes included survival, quality of life, functional status, toxicity, and quality of end-of-life care.
Results
We included and mapped 72 studies, comprising SRs, experimental and observational designs, 12 on esophageal cancer, 51 on gastric cancer, and 10 both locations. Most compared schemes including chemotherapy (47 studies), but did not report therapeutic lines. Moreover, BSC as a control arm was poorly defined, including integral support and placebo. Data favor the use of systemic oncological treatments in survival outcomes and BSC in toxicity. Data for outcomes including quality of life, functional status, and quality of end-of-life care were limited. We found sundry evidence gaps specifically in assessing new treatments such as immunotherapy and important outcomes such as functional status, symptoms control, hospital admissions, and the quality of end-life care for all the treatments.
Conclusions
There are important evidence gaps regarding new for patients with advanced gastresophageal cancer and the effect of systemic oncological treatments on important patient-centered outcomes beyond survival. Future research should clearly describe the population included, specifying previous treatments and considering therapeutic, and consider all patient-centered outcomes. Otherwise, it will be complex to apply research results into practice.
{"title":"Comparative analysis of systemic oncological treatments and best supportive care for advanced gastresophageal cancer: A comprehensive scoping review and evidence map","authors":"Santero Marilina, Meade Adriana, Selva Anna, Acosta-Dighero Roberto, Meza Nicolás, Quintana Maria Jesús, Bracchiglione Javier, Requeijo Carolina, Salazar Josefina, Rodríguez Grijalva Gerardo, Solà Ivan, Urrútia Gerard, Bonfill Cosp Xavier, Appropriateness of Systemic Oncological Treatments for Advanced Cancer (ASTAC) Research Group","doi":"10.1111/jebm.12539","DOIUrl":"10.1111/jebm.12539","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify, describe, and organize the available evidence regarding systemic oncological treatments compared to best supportive care (BSC) for advanced gastresophageal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a thorough search across MEDLINE (PubMed), EMbase (Ovid), The Cochrane Library, Epistemonikos, PROSPERO, and Clinicaltrials.gov. Our inclusion criteria encompassed systematic reviews, randomized controlled trials, quasi-experimental and observational studies involving patients with advanced esophageal or gastric cancer receiving chemotherapy, immunotherapy or biological/targeted therapy compared to BSC. The outcomes included survival, quality of life, functional status, toxicity, and quality of end-of-life care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included and mapped 72 studies, comprising SRs, experimental and observational designs, 12 on esophageal cancer, 51 on gastric cancer, and 10 both locations. Most compared schemes including chemotherapy (47 studies), but did not report therapeutic lines. Moreover, BSC as a control arm was poorly defined, including integral support and placebo. Data favor the use of systemic oncological treatments in survival outcomes and BSC in toxicity. Data for outcomes including quality of life, functional status, and quality of end-of-life care were limited. We found sundry evidence gaps specifically in assessing new treatments such as immunotherapy and important outcomes such as functional status, symptoms control, hospital admissions, and the quality of end-life care for all the treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are important evidence gaps regarding new for patients with advanced gastresophageal cancer and the effect of systemic oncological treatments on important patient-centered outcomes beyond survival. Future research should clearly describe the population included, specifying previous treatments and considering therapeutic, and consider all patient-centered outcomes. Otherwise, it will be complex to apply research results into practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jebm.12539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9794421","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}
Asokan G. Vaithinathan, Leena Khonji, Gayathripriya Narayanan
Globally, on average, 16 billion injections are administered every year; of these, vaccination accounts for 5%.1 The World Health Organization’s (WHO) toolkit on best practices classifies injections based on target tissue of delivery as intradermal (ID), subcutaneous (SC), intramuscular (IM), intravenous (IV), intraosseous, intraarterial, and peritoneal. Adhering to the safety standards, the choice of the IM sites (deltoid, dorsogluteal, rectus femoris, vastus lateralis, and ventrogluteal muscles) depends on the volume to be administered2; a “safe injection” does not harm the recipient, provider, or health of the community.1 The Centers for Disease Control and Prevention (CDC) says: aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion before injection) is not necessary because no large blood vessels are present at the recommended injection sites.3 Most vaccines are given via the IM route to optimize immunogenicity, whereas inadvertent administration may lead toadverseevents, vaccine failure, or poor seroconversion. The status of the coronavirus (COVID-19) vaccinations as of May 23, 2023, indicates that 70% of the world’s population had received at least one dose of a COVID-19 vaccine, 13.38 billion doses have been administered globally, and 3.09million doses each day. Only 29.9% of people in low-income countries have received at least one dose.4 The purpose of this perspective is to appraise the prevailing IM injection techniques while administering the authorized COVID-19 vaccines in the context of adverse events reported; identify the evidence and knowledge gaps chiefly on aspiration technique before administering the COVID-19 vaccine; and address the best evidencebased practice to adopt. An EUA is a mechanism to facilitate the use of therapeutics and vaccines during public health emergencies. The US Food and Drug Administration (FDA) approved five vaccines under EUA; the European Medicines Agency (EMA) approved eight vaccines for marketing or conditional marketing (Table 1). Almost 50 COVID-19 vaccines that have been approved by various agencies around the world, but the WHO has granted emergency use status for the 11 vaccines. Currently, there are 242 vaccine candidates and 821 vaccine trials in 80 countries.5 The COVID-19 vaccines are considered safe and effective. Like any other vaccine, vaccinees have reported mild to moderate side
{"title":"Necessitating evidence-based practice in COVID-19 intramuscular vaccination techniques (to aspirate or not) in the context of scientific/evidence uncertainty amidst the pandemic","authors":"Asokan G. Vaithinathan, Leena Khonji, Gayathripriya Narayanan","doi":"10.1111/jebm.12537","DOIUrl":"10.1111/jebm.12537","url":null,"abstract":"Globally, on average, 16 billion injections are administered every year; of these, vaccination accounts for 5%.1 The World Health Organization’s (WHO) toolkit on best practices classifies injections based on target tissue of delivery as intradermal (ID), subcutaneous (SC), intramuscular (IM), intravenous (IV), intraosseous, intraarterial, and peritoneal. Adhering to the safety standards, the choice of the IM sites (deltoid, dorsogluteal, rectus femoris, vastus lateralis, and ventrogluteal muscles) depends on the volume to be administered2; a “safe injection” does not harm the recipient, provider, or health of the community.1 The Centers for Disease Control and Prevention (CDC) says: aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion before injection) is not necessary because no large blood vessels are present at the recommended injection sites.3 Most vaccines are given via the IM route to optimize immunogenicity, whereas inadvertent administration may lead toadverseevents, vaccine failure, or poor seroconversion. The status of the coronavirus (COVID-19) vaccinations as of May 23, 2023, indicates that 70% of the world’s population had received at least one dose of a COVID-19 vaccine, 13.38 billion doses have been administered globally, and 3.09million doses each day. Only 29.9% of people in low-income countries have received at least one dose.4 The purpose of this perspective is to appraise the prevailing IM injection techniques while administering the authorized COVID-19 vaccines in the context of adverse events reported; identify the evidence and knowledge gaps chiefly on aspiration technique before administering the COVID-19 vaccine; and address the best evidencebased practice to adopt. An EUA is a mechanism to facilitate the use of therapeutics and vaccines during public health emergencies. The US Food and Drug Administration (FDA) approved five vaccines under EUA; the European Medicines Agency (EMA) approved eight vaccines for marketing or conditional marketing (Table 1). Almost 50 COVID-19 vaccines that have been approved by various agencies around the world, but the WHO has granted emergency use status for the 11 vaccines. Currently, there are 242 vaccine candidates and 821 vaccine trials in 80 countries.5 The COVID-19 vaccines are considered safe and effective. Like any other vaccine, vaccinees have reported mild to moderate side","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10154403","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}
Kenton Cooksey, Sajesh K. Veettil, Nathorn Chaiyakunapruk, Teerapon Dhippayom
The recent growth of networkmeta-analysis (NMA) has revolutionized outcomes research and our abilities to compare treatments to improve patient outcomes.1 Despite this innovation, most evidence synthesis of health service interventions (HSI) have focused on exploring the effect of interventions rather than how to deliver such interventions.2 To fill this gap, a framework classifying delivery by Theme (T), Intensity (I), and Provider/Platform (P) (TIP framework) was developed.3 In brief, the TIP framework was designed to be analogous to three elements of a medication intervention that contribute to its pharmaceutical effects: (1) active ingredient, (2) dose, and (3) dosage form or route of administration.3 These elements also the constitute of HSI. The theme corresponds to the active ingredient and specifies the main element of the intervention. Intensity corresponds to the dose regimen, while the provider or platform corresponds to the dosage form or route of administration and indicates how the main element is delivered. Three NMAs have been published utilizing this framework to provide granular data on effective delivery techniques. Compared to T-only NMA, which only reports data on type of intervention, this new framework provides further practical data on real-world clinical delivery. In this paper, we compared the findings of three NMAs of HSI with and without the use of the TIP framework. The first NMA to incorporate TIP evaluated patient selfmanagement of asthma, where “T” was the strategy to support asthma self-management (i.e., behavior, educational and psychosocial interventions), “I” was frequency of providing these interventions, and “P” was the provider/platform (i.e., health care personal and e-Health) that delivered information to the patient.4 The secondNMAwith a TIP framework evaluated warfarin self-care strategies (T = Patient selftesting, patient self-management; I = frequency which is more (high) or less (low) often or flexible; and P =Healthcare practitioner, patient, and e-Health) and the third one evaluated music interventions to reduce depression in older adults (T = Active music therapy, receptive music therapy, music medicine; I = >60 min per week (high), ≤60 min per week (low); and P=with or without music therapist). As the use of the framework grows, a gap remains in if the knowledge presented by TIP NMA is pertinent to clinical practice compared to T-only NMA. To investigate the potential benefits of the TIP framework, T-only NMAs were performed using the same data as previously published TIP NMAs and the surface under the cumulative ranking curve
{"title":"The potential benefits of the TIP framework to characterize health services interventions for network meta-analysis","authors":"Kenton Cooksey, Sajesh K. Veettil, Nathorn Chaiyakunapruk, Teerapon Dhippayom","doi":"10.1111/jebm.12536","DOIUrl":"10.1111/jebm.12536","url":null,"abstract":"The recent growth of networkmeta-analysis (NMA) has revolutionized outcomes research and our abilities to compare treatments to improve patient outcomes.1 Despite this innovation, most evidence synthesis of health service interventions (HSI) have focused on exploring the effect of interventions rather than how to deliver such interventions.2 To fill this gap, a framework classifying delivery by Theme (T), Intensity (I), and Provider/Platform (P) (TIP framework) was developed.3 In brief, the TIP framework was designed to be analogous to three elements of a medication intervention that contribute to its pharmaceutical effects: (1) active ingredient, (2) dose, and (3) dosage form or route of administration.3 These elements also the constitute of HSI. The theme corresponds to the active ingredient and specifies the main element of the intervention. Intensity corresponds to the dose regimen, while the provider or platform corresponds to the dosage form or route of administration and indicates how the main element is delivered. Three NMAs have been published utilizing this framework to provide granular data on effective delivery techniques. Compared to T-only NMA, which only reports data on type of intervention, this new framework provides further practical data on real-world clinical delivery. In this paper, we compared the findings of three NMAs of HSI with and without the use of the TIP framework. The first NMA to incorporate TIP evaluated patient selfmanagement of asthma, where “T” was the strategy to support asthma self-management (i.e., behavior, educational and psychosocial interventions), “I” was frequency of providing these interventions, and “P” was the provider/platform (i.e., health care personal and e-Health) that delivered information to the patient.4 The secondNMAwith a TIP framework evaluated warfarin self-care strategies (T = Patient selftesting, patient self-management; I = frequency which is more (high) or less (low) often or flexible; and P =Healthcare practitioner, patient, and e-Health) and the third one evaluated music interventions to reduce depression in older adults (T = Active music therapy, receptive music therapy, music medicine; I = >60 min per week (high), ≤60 min per week (low); and P=with or without music therapist). As the use of the framework grows, a gap remains in if the knowledge presented by TIP NMA is pertinent to clinical practice compared to T-only NMA. To investigate the potential benefits of the TIP framework, T-only NMAs were performed using the same data as previously published TIP NMAs and the surface under the cumulative ranking curve","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9795334","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}
Wuyongga Bao, Youlin Long, Jiayan Huang, Min Liao, Jie Yang, Liang Du, Qiang Lu
Objective
Contrast-enhanced ultrasound offers numerous potential applications in diagnostic and interventional radiology. However, systematic studies on the status of clinical studies are limited. Hence, the aim of this study was to analyze the characteristics of registered contrast-enhanced ultrasound studies on ClinicalTrials.gov and identify features associated with early discontinuation and results reporting.
Methods
A data set containing all contrast-enhanced ultrasound clinical studies from ClinicalTrials.gov registered was downloaded. Then, a cross-sectional descriptive study of clinical contrast-enhanced ultrasound studies was conducted. Cox and logistic regression of early discontinuation and reported results, respectively, were also performed.
Results
A total of 225 studies were identified; 174 were interventional and 51 were observational. Regarding the outcomes measure, 175 (77.78%) were diagnosis-oriented, and the remaining 50 (22.22%) were interventional radiology studies. The most common regions of interest were abdominal (56%), superficial (14.22%), or vascular (7.11%) organs. As of the contrast agents, SonoVue/Lumason (39.11%) was most frequently used, followed by Definity (20.89%) and Sonazoid (8.89%). Of all contrast-enhanced ultrasound studies, 32 (14.22%) were discontinued early, and 29 (12.89%) completed studies reported their results. Cox regression analysis revealed that a large sample size and US registration were factors reducing early discontinuation risk. Among completed studies, factors associated with reported results were industry funding and US registration.
Conclusion
The findings suggest that the number of contrast-enhanced ultrasound studies has grown over time, but is still small. Developing new advancements in contrast-enhanced ultrasound will require a concerted effort to increase the quality and quantity of clinical studies in this field.
{"title":"Contrast-enhanced ultrasound studies registered on ClinicalTrials.gov: A cross-sectional analysis of characteristics, early discontinuation, and reporting results","authors":"Wuyongga Bao, Youlin Long, Jiayan Huang, Min Liao, Jie Yang, Liang Du, Qiang Lu","doi":"10.1111/jebm.12531","DOIUrl":"10.1111/jebm.12531","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Objective</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p>Contrast-enhanced ultrasound offers numerous potential applications in diagnostic and interventional radiology. However, systematic studies on the status of clinical studies are limited. Hence, the aim of this study was to analyze the characteristics of registered contrast-enhanced ultrasound studies on ClinicalTrials.gov and identify features associated with early discontinuation and results reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A data set containing all contrast-enhanced ultrasound clinical studies from ClinicalTrials.gov registered was downloaded. Then, a cross-sectional descriptive study of clinical contrast-enhanced ultrasound studies was conducted. Cox and logistic regression of early discontinuation and reported results, respectively, were also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 225 studies were identified; 174 were interventional and 51 were observational. Regarding the outcomes measure, 175 (77.78%) were diagnosis-oriented, and the remaining 50 (22.22%) were interventional radiology studies. The most common regions of interest were abdominal (56%), superficial (14.22%), or vascular (7.11%) organs. As of the contrast agents, SonoVue/Lumason (39.11%) was most frequently used, followed by Definity (20.89%) and Sonazoid (8.89%). Of all contrast-enhanced ultrasound studies, 32 (14.22%) were discontinued early, and 29 (12.89%) completed studies reported their results. Cox regression analysis revealed that a large sample size and US registration were factors reducing early discontinuation risk. Among completed studies, factors associated with reported results were industry funding and US registration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings suggest that the number of contrast-enhanced ultrasound studies has grown over time, but is still small. Developing new advancements in contrast-enhanced ultrasound will require a concerted effort to increase the quality and quantity of clinical studies in this field.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9851751","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}
Nowadays, oral health has become a global academic consensus. A major threat to the oral health of the elderly population is the loss of teeth. In many countries, the rate of total teeth loss in people over 65 years old is between 7% and 45%.1 Recessionary masticatory ability in edentulous populations leads to lacked food diversity, changes the dietary structure and insufficient nutritional intake, whichmay further lead to decreased blood lipids and body resistance.2 Meanwhile, lipid metabolism also plays an important role in immune cell function.3 It is closely related to liver physiology and pathology and is also involved in regulating macrophage biology.4 Abnormal blood lipids may affect the basic life activities of cells and lead to an imbalance of immune function. A recent study has found that blood lipids were correlated with immune function.5 The change inmasticatory function could affect the metabolism of blood lipids and the risk of immune abnormality. The evaluation of immune function is of great significance in the elderly population. Complement components, produced partly in the liver and secreted partly by the macrophages, are essential to immune system.6 Complement components play an important role in body resistance through immunoconditioning and interfere with the release of cytokines involved in immune responses.7 Whether masticatory function affects the alteration in blood lipids and complement levels has not yet been determined, especially in Chinese elderly population. This study investigated the relationships between masticatory function, blood lipids, and complement components in Chinese oldest-old and centenarians (Figure S1A). Based on the China Hainan Centenarian Cohort Study (CHCCS), this survey was carried out in 18 cities and counties of Hainan, China. All 1712 oldest-old and centenarian participants with complete data and had no diagnosed rheumatoid arthritis and other autoimmune diseases. Home interviews and physical checkups were conducted following standard procedures by our strictly trained investigator.8 A portable ultrasound machine (Philips CX50, Philips Medical Systems, Andover, MA, USA) was used to measure the periumbilical fat thickness (PFT) by experienced radiologists. In the oral examination of each participant, professional dentists were arranged to record the number of remaining teeth, missing teeth, tooth position, and denture restoration using mouth mirror and probe. Edentulous participants without dentures were assigned to the group without masticatory function,
{"title":"Positive relationships between masticatory function, blood lipids, and complement components in Chinese oldest-old and centenarian population","authors":"Lijun Zhou, Ping Ping, Ting Yang, Xiang Zhu, Lihua Bian, Yali Zhao, Qing Song, Shihui Fu","doi":"10.1111/jebm.12535","DOIUrl":"10.1111/jebm.12535","url":null,"abstract":"Nowadays, oral health has become a global academic consensus. A major threat to the oral health of the elderly population is the loss of teeth. In many countries, the rate of total teeth loss in people over 65 years old is between 7% and 45%.1 Recessionary masticatory ability in edentulous populations leads to lacked food diversity, changes the dietary structure and insufficient nutritional intake, whichmay further lead to decreased blood lipids and body resistance.2 Meanwhile, lipid metabolism also plays an important role in immune cell function.3 It is closely related to liver physiology and pathology and is also involved in regulating macrophage biology.4 Abnormal blood lipids may affect the basic life activities of cells and lead to an imbalance of immune function. A recent study has found that blood lipids were correlated with immune function.5 The change inmasticatory function could affect the metabolism of blood lipids and the risk of immune abnormality. The evaluation of immune function is of great significance in the elderly population. Complement components, produced partly in the liver and secreted partly by the macrophages, are essential to immune system.6 Complement components play an important role in body resistance through immunoconditioning and interfere with the release of cytokines involved in immune responses.7 Whether masticatory function affects the alteration in blood lipids and complement levels has not yet been determined, especially in Chinese elderly population. This study investigated the relationships between masticatory function, blood lipids, and complement components in Chinese oldest-old and centenarians (Figure S1A). Based on the China Hainan Centenarian Cohort Study (CHCCS), this survey was carried out in 18 cities and counties of Hainan, China. All 1712 oldest-old and centenarian participants with complete data and had no diagnosed rheumatoid arthritis and other autoimmune diseases. Home interviews and physical checkups were conducted following standard procedures by our strictly trained investigator.8 A portable ultrasound machine (Philips CX50, Philips Medical Systems, Andover, MA, USA) was used to measure the periumbilical fat thickness (PFT) by experienced radiologists. In the oral examination of each participant, professional dentists were arranged to record the number of remaining teeth, missing teeth, tooth position, and denture restoration using mouth mirror and probe. Edentulous participants without dentures were assigned to the group without masticatory function,","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9785936","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}
Value-based healthcare (VBHC) puts patient outcomes at the center of the healthcare process while optimizing the use of hospital resources across multiple stakeholders. This scoping review was conducted to summarize how VBHC had been represented in theory and in practice, how it had been applied to assess hospital performance, and how well it had been ultimately implemented.
Methods
For this review, we followed the PRISMA-ScR protocol and searched five major online databases for articles published between January 2006 and July 2022. We included original articles that used the concept of VBHC to conduct performance assessments of healthcare organizations. We extracted and analyzed key concepts and information on the dimensions of VBHC, specific strategies and methods for using VBHC in performance assessment, and the effectiveness of the assessment.
Results
We identified 48 eligible studies from 7866 articles. Nineteen nonempirical studies focused on the development of a VBHC performance assessment indicator system, and 29 empirical studies reported on the ways and points of introducing VBHC into performance assessment and its effectiveness. Ultimately, we summarized the key dimensions, processes, and effects of performance assessment after introducing VBHC.
Conclusion
Current healthcare performance assessment has begun to focus on implementing VBHC as an integrated strategy, and future work should further clarify the reliability of metrics and their association with evaluation outcomes and consider the effective integration of clinical outcomes and patient-reported outcomes.
{"title":"Introducing value-based healthcare perspectives into hospital performance assessment: A scoping review","authors":"Wenbo He, Meixuan Li, Liujiao Cao, Rui Liu, Jiuhong You, Fangyuan Jing, Jiawen Zhang, Wei Zhang, Mengling Feng","doi":"10.1111/jebm.12534","DOIUrl":"10.1111/jebm.12534","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Value-based healthcare (VBHC) puts patient outcomes at the center of the healthcare process while optimizing the use of hospital resources across multiple stakeholders. This scoping review was conducted to summarize how VBHC had been represented in theory and in practice, how it had been applied to assess hospital performance, and how well it had been ultimately implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For this review, we followed the PRISMA-ScR protocol and searched five major online databases for articles published between January 2006 and July 2022. We included original articles that used the concept of VBHC to conduct performance assessments of healthcare organizations. We extracted and analyzed key concepts and information on the dimensions of VBHC, specific strategies and methods for using VBHC in performance assessment, and the effectiveness of the assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 48 eligible studies from 7866 articles. Nineteen nonempirical studies focused on the development of a VBHC performance assessment indicator system, and 29 empirical studies reported on the ways and points of introducing VBHC into performance assessment and its effectiveness. Ultimately, we summarized the key dimensions, processes, and effects of performance assessment after introducing VBHC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current healthcare performance assessment has begun to focus on implementing VBHC as an integrated strategy, and future work should further clarify the reliability of metrics and their association with evaluation outcomes and consider the effective integration of clinical outcomes and patient-reported outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16090,"journal":{"name":"Journal of Evidence‐Based Medicine","volume":null,"pages":null},"PeriodicalIF":7.3,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829860","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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