evidence

证据
  • 文章类型: Journal Article
    背景:检测葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症是治疗疟疾的重要考虑因素。G6PD缺乏可能导致疟疾治疗期间的溶血性贫血,因此,确定G6PD缺乏症在疟疾治疗策略中非常重要。
    方法:本报告提供了范围审查的结果以及证据和差距图,供G6PD近患者试验指南开发小组考虑,以支持间日疟原虫的根治。本范围审查调查了G6PD缺乏症的常见诊断测试以及决策的重要背景和其他因素。这些因素包括世界卫生组织(世卫组织)指南制定手册建议的六个考虑因素,这些因素对确定建议的方向和力度很重要,并包括“可接受性”,\'可行性,\'\'权益,结果的\'\'估值,\'\'性别\'和\'人权\'。本范围审查的目的是为未来的系统审查和证据综合提供指导,这可以更好地为制定世卫组织关于将G6PD缺乏症检测作为疟疾治疗战略一部分的建议提供信息。
    结果:进行了全面搜索,包括出版,任何文章的同行评审文献,研究G6PD诊断测试和“可接受性”因素的任何研究设计和方法,\'可行性,\'\'权益,结果的\'\'估值,\'\'性别\'和\'人权\'。从搜索中确定了1152项研究,其中14人被确定有资格纳入本次审查。这些研究包含来自21个独特国家的数据,这些国家将G6PD诊断测试视为疟疾治疗策略的一部分。上下文和附加因素之间的关系,G6PD缺乏症的诊断测试和研究方法在总体证据和差距中提出,这表明大多数证据是诊断测试的背景因素,和标准G6PD(SD生物传感器)测试。
    结论:本范围审查产生了动态证据和差距图,对G6PD诊断测试领域内的新兴证据具有反应性。证据和差距图提供了所有可用文献的全面描述,这些文献涉及对决策重要的背景和其他因素,关于特定的G6PD诊断测试。调查感兴趣的背景因素的大多数可用数据与定量G6PD诊断测试有关。虽然可以对这些数据进行正式的定性综合,作为系统审查的一部分,数据可能太异,这是不合适的。这些结果现在可用于为世卫组织G6PD指导发展小组的未来方向提供信息,以支持间日疟原虫的根治。
    BACKGROUND: Testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important consideration regarding treatment for malaria. G6PD deficiency may lead to haemolytic anaemia during malaria treatment and, therefore, determining G6PD deficiency in malaria treatment strategies is extremely important.
    METHODS: This report presents the results of a scoping review and evidence and gap map for consideration by the Guideline Development Group for G6PD near patient tests to support radical cure of Plasmodium vivax. This scoping review has investigated common diagnostic tests for G6PD deficiency and important contextual and additional factors for decision-making. These factors include six of the considerations recommended by the World Health Organization (WHO) handbook for guideline development as important to determining the direction and strength of a recommendation, and included \'acceptability\', \'feasibility,\' \'equity,\' \'valuation of outcomes,\' \'gender\' and \'human rights\'. The aim of this scoping review is to inform the direction of future systematic reviews and evidence syntheses, which can then better inform the development of WHO recommendations regarding the use of G6PD deficiency testing as part of malaria treatment strategies.
    RESULTS: A comprehensive search was performed, including published, peer-reviewed literature for any article, of any study design and methodology that investigated G6PD diagnostic tests and the factors of \'acceptability\', \'feasibility,\' \'equity,\' \'valuation of outcomes,\' \'gender\' and \'human rights\'. There were 1152 studies identified from the search, of which 14 were determined to be eligible for inclusion into this review. The studies contained data from over 21 unique countries that had considered G6PD diagnostic testing as part of a malaria treatment strategy. The relationship between contextual and additional factors, diagnostic tests for G6PD deficiency and study methodology is presented in an overall evidence and gap, which showed that majority of the evidence was for the contextual factors for diagnostic tests, and the \'Standard G6PD (SD Biosensor)\' test.
    CONCLUSIONS: This scoping review has produced a dynamic evidence and gap map that is reactive to emerging evidence within the field of G6PD diagnostic testing. The evidence and gap map has provided a comprehensive depiction of all the available literature that address the contextual and additional factors important for decision-making, regarding specific G6PD diagnostic tests. The majority of data available investigating the contextual factors of interest relates to quantitative G6PD diagnostic tests. While a formal qualitative synthesis of this data as part of a systematic review is possible, the data may be too heterogenous for this to be appropriate. These results can now be used to inform future direction of WHO Guideline Development Groups for G6PD near patient tests to support radical cure of P. vivax malaria.
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  • 文章类型: Journal Article
    背景:智障人士(ID)经历了许多健康和社会不平等。增加身体活动是解决这种不平等的有效干预措施,然而,这一人群的体力活动率大大低于普通人群。目的:研究越来越多,以了解这是为什么以及如何干预以增加具有ID的人的身体活动水平。方法:使用行为流行病学框架,回顾了该领域的研究,从身体活动的障碍和促进者到自然环境中的转化研究测试干预措施。纳入了总共14项审查的结果以及8项实证研究和方案。结果:虽然有多项研究表明什么促进或增强了具有ID的人的身体活动,干预研究的结果显示,成功的结果很少。确定了现有研究中的差距,并提供了有关如何改善干预效果的建议,以指导未来的研究和实践。结论:以前关于障碍和促进因素的研究结果可以进一步利用,干预研究应该得到更好的理论联系和更系统的方法的支持。
    Background: People with intellectual disabilities (ID) experience many health and social inequalities. Increasing physical activity is a proven intervention to address such inequalities, yet the physical activity rates of this population are substantially lower than the general population. Aim: Research has been growing to understand why this is and how to intervene to increase the physical activity levels of people with ID. Method: Using a behavioural epidemiological framework, the research in this area from barriers and facilitators of physical activity to translational research testing interventions within natural settings is reviewed. Findings from a total of 14 reviews and eight empirical studies and protocols were included. Results: Whilst there are multiple investigations into what promotes or enhances physical activity for people with ID, findings from intervention studies show few successful outcomes. Gaps within the existing research are identified and recommendations about how intervention efficacy might be improved are provided to inform future research and practice. Conclusion: Findings from previous research on barriers and facilitators can be further capitalised on and intervention studies should be underpinned by better links to theory and more systemic approaches.
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  • 文章类型: Journal Article
    这项快速审查通过解决健康的社会决定因素,将社会处方作为一种新颖的自杀预防方法。通过探索包括MEDLINE在内的各种数据库,PsychInfo,威利,还有Sage,总共3,063篇文章最初被确定为与研究潜在相关.经过细致的筛选,最终审查包括13篇文章,阐明社会处方干预措施对自杀预防的潜在有效性和影响。主要研究结果表明,需要对有自杀风险的个人进行额外的监测和支持,强调温暖的转诊和转诊后的持续联系,以提高社会处方模式的疗效。审查还强调了社会资本和弱势群体之间信任的重要性,强调以社区为基础的转介在自杀预防举措中的重要性。总的来说,本综述确定了社会处方在不同人群中作为降低自杀风险因素和促进心理健康和福祉的有价值工具的潜力.
    This rapid review delves into the realm of social prescribing as a novel approach to suicide prevention by addressing the social determinants of health. Through an exploration of various databases including MEDLINE, PsychInfo, WILEY, and Sage, a total of 3,063 articles were initially identified as potentially relevant to the research. Following a meticulous screening process, 13 articles were included in the final review, shedding light on the potential effectiveness and impact of social prescribing interventions on suicide prevention. Key findings indicate the need for additional monitoring and support for individuals at risk of suicide, emphasising warm referrals and sustained connections after referral to enhance the efficacy of social prescribing models. The review also highlights the importance of social capital and trust among vulnerable populations, underscoring the significance of community-based referrals in suicide prevention initiatives. Overall, this review identifies the potential of social prescribing as a valuable tool in mitigating suicide risk factors and promoting mental health and wellbeing in diverse populations.
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  • 文章类型: Journal Article
    姑息治疗牧师对他们照顾的人进行精神评估。这篇叙述性综述研究了有关开发或指定用于姑息治疗牧师的现有精神评估模型的文献。文献综述使用四个数据库进行,由于精神关怀文献中使用的关键字的可变性,包括手动搜索参考文献。确定了五种精神评估模型。对模型的分析集中在三个方面:(1)基础,(2)精神需要,(3)结构框架。已发布的姑息治疗牧师使用的精神评估模型在每个模型的形成方式上都是可变的,每个工具如何描述和构建精神护理需求,以及如何在各自的上下文中实现模型。PC-7推进了这一领域,特别是通过其混合方法的方法。需要进行未来的验证和可靠性研究,以及有关牧师教育者教授和姑息治疗牧师使用哪些模型的调查。
    Palliative care chaplains conduct spiritual assessments for those within their care. This narrative review examined the literature concerning existing spiritual assessment models developed or designated for palliative care chaplain use. The literature review was performed using four databases, including a hand search of references due to the variability of keywords used within the spiritual care literature. Five spiritual assessment models were identified. The analysis of the models focused on three areas: (1) Foundational basis, (2) Spiritual needs, and (3) Structural frameworks. Published spiritual assessment models for palliative care chaplain use are variable in how each one was formed, how each tool describes and structures spiritual care needs, and how the models are implemented within their respective contexts. The PC-7 advances the field, especially through its mixed methods approach. Future validation and reliability research is needed as well as investigations concerning which models are taught by chaplain educators and used by palliative care chaplains.
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  • 文章类型: Journal Article
    YouTube®是领先的健康信息平台之一。然而,缺乏对内容和质量的监管,引起了人们对准确性和可靠性的担忧。CoMICs(简明医学信息电影院)是由医学生和初级医生创建的基于证据的短视频,并由专家审查,以确保临床准确性。我们进行了系统评价,以了解视频对糖尿病和PCOS知识和意识的影响。然后,我们使用各种经过验证的质量评估工具评估了有关糖尿病和PCOS的YouTube®视频的质量,并将其与CoMICs相同主题的视频进行了比较。质量评估工具,如DISCERN,JAMA基准标准,采用全球质量评分(GQS)。这项研究的一些作者还共同撰写了一些评估的CoMICs的创作。我们的研究表明,虽然视频有效地提高了对糖尿病和PCOS的了解,YouTube®上的视频在质量和可靠性方面存在显著差异。对于糖尿病,CoMICs视频的DISCERN得分更高(CoMICsvsYouTube®:2.4vs1.6),较好的可靠性(p<0.01)和治疗质量(p<0.01),并符合JAMA的作者身份标准(100%与30.6%)和货币(100%与53.1%)。对于PCOS,CoMICs的DISCERN得分较高(2.9与1.9),可靠性(p<0.01),和治疗质量(p<0.01);符合JAMA作者标准(100%vs.34.0%)和货币(100%与54.0%);GQS评分较高(4.0vs3.0)。总之,CoMICs在提供可用于患者教育的可靠的循证医学信息方面优于YouTube®上的其他类似来源。
    YouTube® is one of the leading platforms for health information. However, the lack of regulation of content and quality raises concerns about accuracy and reliability. CoMICs (Concise Medical Information Cines) are evidence-based short videos created by medical students and junior doctors and reviewed by experts to ensure clinical accuracy. We performed a systematic review to understand the impact of videos on knowledge and awareness about diabetes and PCOS. We then evaluated the quality of YouTube® videos about diabetes and PCOS using various validated quality assessment tools and compared these with CoMICs videos on the same topics. Quality assessment tools like DISCERN, JAMA benchmark criteria, and global quality scale (GQS) score were employed. Some of the authors of this study also co-authored the creation of some of the CoMICs evaluated. Our study revealed that while videos effectively improve understanding of diabetes and PCOS, there are notable differences in quality and reliability of the videos on YouTube®. For diabetes, CoMICs videos had higher DISCERN scores (CoMICs vs YouTube®: 2.4 vs 1.6), superior reliability (P < 0.01), and treatment quality (P < 0.01) and met JAMA criteria for authorship (100% vs 30.6%) and currency (100% vs 53.1%). For PCOS, CoMICs had higher DISCERN scores (2.9 vs 1.9), reliability (P < 0.01), and treatment quality (P < 0.01); met JAMA criteria for authorship (100% vs 34.0%) and currency (100% vs 54.0%); and had higher GQS scores (4.0 vs 3.0). In conclusion, CoMICs outperformed other similar sources on YouTube® in providing reliable evidence-based medical information which may be used for patient education.
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  • 文章类型: Journal Article
    食物过敏是一个全球性的健康问题,影响患者和护理人员的生活质量,并增加医疗成本。最近加强了从怀孕开始确定预防措施的努力。本综述旨在概述母体因素在食物过敏预防中的作用。一些研究表明,在怀孕期间避免食物过敏原并不能降低发生食物过敏的风险。由于对妇女和儿童的必需营养素摄入和整体健康的潜在不利影响,国际准则一致不鼓励避免饮食。研究孕期益生菌和益生元作为预防措施是有希望的,但证据仍然有限。因此,指南缺乏预防食物过敏的具体建议。同样,鉴于缺乏确凿的证据,不可能就补充维生素得出明确的结论,ω-3脂肪酸(n-3PUFA),和其他抗氧化物质。产妇干预的组合,母乳喂养,早期向婴儿引入食物可以降低儿童食物过敏的风险。需要进一步的研究来澄清遗传学之间的相互作用,免疫学途径,和环境因素。
    Food allergy represents a global health problem impacting patients\' and caregivers\' quality of life and contributing to increased healthcare costs. Efforts to identify preventive measures starting from pregnancy have recently intensified. This review aims to provide an overview of the role of maternal factors in food allergy prevention. Several studies indicate that avoiding food allergens during pregnancy does not reduce the risk of developing food allergies. International guidelines unanimously discourage avoidance diets due to potential adverse effects on essential nutrient intake and overall health for both women and children. Research on probiotics and prebiotics during pregnancy as preventive measures is promising, though evidence remains limited. Consequently, guidelines lack specific recommendations for their use in preventing food allergies. Similarly, given the absence of conclusive evidence, it is not possible to formulate definitive conclusions on the supplementation of vitamins, omega-3 fatty acids (n-3 PUFAs), and other antioxidant substances. A combination of maternal interventions, breastfeeding, and early introduction of foods to infants can reduce the risk of food allergies in the child. Further studies are needed to clarify the interaction between genetics, immunological pathways, and environmental factors.
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  • 文章类型: Systematic Review
    中风负担很大程度上是由于长期损害,需要长期护理和生产力损失。我们的目的是确定和评估不同的注册药物疗法的研究,以改善卒中后损伤和/或残疾。
    我们对成年卒中患者作为增强恢复或促进恢复的治疗方法进行了系统的搜索和综述。无论主要适应症如何,治疗必须在任何国家/地区获得注册或市场授权。评价中包括的结果是神经损伤和功能/残疾评估。基于研究设计的“最佳可用研究”,研究规模,选择和/或发表日期,并按共识对证据水平(LOE)进行分级。
    我们的系统搜索产生了7801次引用,我们审查了665篇全文论文。58种出版物被选为25种药理学类别的“最佳研究”:31种关于缺血性中风,21缺血性或出血性中风,4关于脑出血,2蛛网膜下腔出血(SAH)。26个是系统评价/荟萃分析,29项随机临床试验(RCTs),三项是队列研究.只有尼莫地平治疗SAH的LOEA获益(系统评价和网络荟萃分析)。许多研究,其中一些显示出治疗效果,被评估为LOEC-LD,主要是由于样本量小或质量差。7种干预措施具有治疗效果的LOEB-R(系统评价/荟萃分析或RCT)。
    只有一种商业上可获得的治疗具有用于中风的常规使用的LOEA。对推定的神经保护药物作为血运重建手术的辅助治疗的进一步研究以及对促进恢复疗法的更多确证性试验将增强其获益的确定性。使用它们的决定必须以临床概况为指导,神经损伤,和基于现有证据的目标结果。
    https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=376973,PROSPERO,CRD42022376973。
    UNASSIGNED: Stroke burden is largely due to long-term impairments requiring prolonged care with loss of productivity. We aimed to identify and assess studies of different registered pharmacological therapies as treatments to improve post-stroke impairments and/or disabilities.
    UNASSIGNED: We performed a systematic-search-and-review of treatments that have been investigated as recovery-enhancing or recovery-promoting therapies in adult patients with stroke. The treatment must have received registration or market authorization in any country regardless of primary indication. Outcomes included in the review were neurological impairments and functional/disability assessments. \"The best available studies\" based on study design, study size, and/or date of publication were selected and graded for level of evidence (LOE) by consensus.
    UNASSIGNED: Our systematic search yielded 7,801 citations, and we reviewed 665 full-text papers. Fifty-eight publications were selected as \"the best studies\" across 25 pharmacological classes: 31 on ischemic stroke, 21 on ischemic or hemorrhagic stroke, 4 on intracerebral hemorrhage, and 2 on subarachnoid hemorrhage (SAH). Twenty-six were systematic reviews/meta-analyses, 29 were randomized clinical trials (RCTs), and three were cohort studies. Only nimodipine for SAH had LOE A of benefit (systematic review and network meta-analysis). Many studies, some of which showed treatment effects, were assessed as LOE C-LD, mainly due to small sample sizes or poor quality. Seven interventions had LOE B-R (systematic review/meta-analysis or RCT) of treatment effects.
    UNASSIGNED: Only one commercially available treatment has LOE A for routine use in stroke. Further studies of putative neuroprotective drugs as adjunctive treatment to revascularization procedures and more confirmatory trials on recovery-promoting therapies will enhance the certainty of their benefit. The decision on their use must be guided by the clinical profile, neurological impairments, and target outcomes based on the available evidence.
    UNASSIGNED: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=376973, PROSPERO, CRD42022376973.
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  • 文章类型: Journal Article
    纤维肌痛(FM)通常伴有慢性疲劳综合征(CFS)。这是一种鲜为人知的疾病,主要影响女性并导致慢性疼痛,疲劳,失眠,在其他症状中,这会降低生活质量。由于目前的药物治疗效率低下,越来越多的兴趣指向非药物多组分疗法。然而,在开发多组分疗法时,营养和时间生物学经常被忽视。这篇叙述和批判性评论探讨了营养和时间生物学策略在FM和经常相关的CFS的治疗管理中的相关性。经过审查的文献为饮食习惯的关联提供了科学证据,营养水平,身体成分,肠道微生物群失衡,时间生物学改变,以及它们与症状的发展和严重程度的相互关系。这篇综述强调了营养和时间生物学作为FM和CFS多学科方法中相关和不可或缺的组成部分的关键作用。
    Fibromyalgia (FM) is often accompanied by chronic fatigue syndrome (CFS). It is a poorly understood disorder that mainly affects women and leads to chronic pain, fatigue, and insomnia, among other symptoms, which decrease quality of life. Due to the inefficiency of current pharmacological treatments, increasing interest is being directed towards non-pharmacological multicomponent therapies. However, nutrition and chronobiology are often overlooked when developing multicomponent therapies. This narrative and critical review explore the relevance of nutritional and chronobiological strategies in the therapeutic management of FM and the often-associated CFS. Reviewed literature offers scientific evidence for the association of dietary habits, nutrient levels, body composition, gut microbiota imbalance, chronobiological alterations, and their interrelation with the development and severity of symptoms. This review highlights the key role of nutrition and chronobiology as relevant and indispensable components in a multidisciplinary approach to FM and CFS.
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  • 文章类型: Journal Article
    已对含铝除臭剂/止汗剂与乳腺癌之间的潜在关联进行了研究和辩论。本文全面分析了现有文献,以检验证据并提供对这种关系的见解。这篇综合综述讨论了与铝化合物的吸收和分布有关的方面,它对氧化应激诱导的影响,铝的雌激素活性,以及荷尔蒙通路的潜在破坏,以及在乳腺癌诱导中的潜在作用。目前,可用的研究,包括流行病学研究和临床试验,我们还分析并讨论了荟萃分析和以前发表的关于确定含铝除臭剂/止汗剂与乳腺癌风险之间关系的综述.社会因素,个人卫生考虑,生活方式的改变有助于止汗剂的使用增加,但它们与乳腺癌没有直接的因果关系。采用大规模研究和严格方法的进一步研究必须验证现有发现并探索所涉及的潜在机制。持续的多学科研究工作和研究人员之间的合作,监管机构,和公共卫生当局对于发展对这个复杂主题的更明确理解至关重要。
    The potential association between aluminum-containing deodorants/antiperspirants and breast cancer has been investigated and debated. This paper comprehensively analyzes existing literature to examine the evidence and provide insights into this relationship. This comprehensive review discusses aspects related to the absorption and distribution of aluminum compounds, its effects on the induction of oxidative stress, the estrogenic activity of aluminum, and potential disruption of hormonal pathways, and the potential role in breast cancer induction. Currently, available research, consisting of epidemiological studies as well as clinical trials, together with meta-analyses and previously published reviews conducted on identifying the relationship between aluminum-containing deodorants/antiperspirants and the risk of breast cancer were also analyzed and discussed. Societal factors, personal hygiene considerations, and lifestyle changes contribute to the increased usage of antiperspirants, but they do not establish a direct causal connection with breast cancer. Further research employing larger-scale studies and rigorous methodologies must validate the existing findings and explore the underlying mechanisms involved. Continued multidisciplinary research efforts and collaboration between researchers, regulatory bodies, and public health authorities are vital to developing a more definitive understanding of this complex topic.
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  • 文章类型: Journal Article
    目的:评估外科创新的每个阶段,并产生高质量的研究证据,理想(Idea,发展,探索,评估,制定了长期研究)框架。本研究旨在探索IDEAL框架在肝胰胆管手术中的应用,并确定限制其传播的因素。
    方法:我们在PubMed中对8篇核心IDEAL框架文章进行了引文搜索,Embase,WebofScience,和2009年至2022年的Scopus数据库。两名独立评审者筛选并选择了与肝胰胆管手术有关的文章。
    结果:通过引文检索共识别出1621篇文章。筛选后,最终保留了132篇文章,包括75项原始研究(57%)和57项次要研究(43%)。在原始研究中,只有10篇文章(13%)在方法论上准确应用了理想框架,分布如下:1在理想阶段(0),2在想法阶段(1),7在开发阶段(2a),1在勘探阶段(2b),在评估和长期研究阶段没有文章(3,4)。在次要研究中,36篇文章(63%)提到并讨论了理想框架,和所有支持它的应用程序。
    结论:IDEAL框架在肝胰胆管手术中的应用日益广泛,它在许多文章中的大量引用证明了这一点。然而,IDEAL框架的利用仍然主要局限于早期阶段的创新在肝胰胆管手术,再加上由于对框架理解不足而导致的误用实例。需要进一步努力扩大IDEAL框架的影响,并为外科医生提供明智实施的全面指导。
    OBJECTIVE: To evaluate every stage of surgical innovation and generate high-quality research evidence, the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) framework was developed. This study aimed to explore the application of the IDEAL framework in hepatopancreatobiliary surgery and identify factors limiting its dissemination.
    METHODS: We conducted a citation search of 8 core IDEAL framework articles in PubMed, Embase, Web of Science, and Scopus databases from 2009 to 2022. Two independent reviewers screened and selected articles related to hepatopancreatobiliary surgery.
    RESULTS: A total of 1621 articles were identified through citation search. Following screening, 132 articles were finally retained, including 75 original studies (57%) and 57 secondary studies (43%). Of the original studies, only 10 articles (13%) accurately applied the IDEAL framework in methodology, distributed as follows: 1 in pre-IDEAL stage (0), 2 in Idea stage (1), 7 in Development stage (2a), 1 in Exploration stage (2b), and no articles in Assessment and Long-term study stages (3, 4). In the secondary studies, 36 articles (63%) mentioned and discussed the IDEAL framework, and all supported its application.
    CONCLUSIONS: The application of the IDEAL framework in hepatopancreatobiliary surgery is increasingly widespread, as evidenced by its substantial citation in numerous articles. However, the utilization of the IDEAL framework remains predominantly confined to the early stages of innovation in hepatopancreatobiliary surgery, coupled with instances of misapplication stemming from insufficient comprehension of the framework. Further efforts are necessary to extend the impact of the IDEAL framework and provide surgeons with comprehensive guidance for its judicious implementation.
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