evidence appraisal

  • 文章类型: Editorial
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  • 文章类型: Journal Article
    使用PubMed摘要自动进行科学索赔验证。
    我们开发了CliVER,一个端到端的科学索赔验证系统,利用检索增强技术自动检索相关的临床试验摘要,提取相关的句子,并使用PICO框架来支持或反驳科学主张。我们还创建了三个最先进的深度学习模型的集合,以对支持的基本原理进行分类,反驳,中立。然后我们建造了Covert,一个新的COVID验证数据集,包括15项PICO编码的药物声明,以及96份人工选择和标记的临床试验摘要,这些摘要支持或驳斥了每项声明.我们使用CoVERT和SciFact(一个公共科学声明验证数据集)来评估CliVER在预测标签方面的表现。最后,我们将CliVER与临床医生进行了比较,验证了来自6个疾病领域的19项索赔,使用189.648PubMed摘要提取2010年1月至2021年10月。
    在CoVERT上评估标签预测精度时,CliVER的F1得分为0.92,突显了检索增强模型的功效。集成模型在F1评分中从3%到11%的绝对增加优于每个单独的最新模型。此外,与四名临床医生相比,CliVER的摘要检索精度为79.0%,67.4%的句子选择,标签预测为63.2%,分别。
    CliVER展示了其使用检索增强策略自动进行科学声明验证的早期潜力,以利用PubMed中丰富的临床试验摘要。未来的研究有必要进一步测试其临床实用性。
    UNASSIGNED: To automate scientific claim verification using PubMed abstracts.
    UNASSIGNED: We developed CliVER, an end-to-end scientific Claim VERification system that leverages retrieval-augmented techniques to automatically retrieve relevant clinical trial abstracts, extract pertinent sentences, and use the PICO framework to support or refute a scientific claim. We also created an ensemble of three state-of-the-art deep learning models to classify rationale of support, refute, and neutral. We then constructed CoVERt, a new COVID VERification dataset comprising 15 PICO-encoded drug claims accompanied by 96 manually selected and labeled clinical trial abstracts that either support or refute each claim. We used CoVERt and SciFact (a public scientific claim verification dataset) to assess CliVER\'s performance in predicting labels. Finally, we compared CliVER to clinicians in the verification of 19 claims from 6 disease domains, using 189 648 PubMed abstracts extracted from January 2010 to October 2021.
    UNASSIGNED: In the evaluation of label prediction accuracy on CoVERt, CliVER achieved a notable F1 score of 0.92, highlighting the efficacy of the retrieval-augmented models. The ensemble model outperforms each individual state-of-the-art model by an absolute increase from 3% to 11% in the F1 score. Moreover, when compared with four clinicians, CliVER achieved a precision of 79.0% for abstract retrieval, 67.4% for sentence selection, and 63.2% for label prediction, respectively.
    UNASSIGNED: CliVER demonstrates its early potential to automate scientific claim verification using retrieval-augmented strategies to harness the wealth of clinical trial abstracts in PubMed. Future studies are warranted to further test its clinical utility.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    增加体力活动(PA)和改善营养的策略将为人口带来巨大的健康益处,包括降低几种癌症的风险。数字技术的日益普及意味着这些工具可能有助于改善年轻人的健康行为。
    我们进行了系统评价,以评估有关旨在增加年轻人亚人群(学龄儿童,学院/大学生,仅限年轻人(18岁以上)以及青少年和年轻人(<25岁))。
    在包括KSREvidence(www。ksrevidence.com),Cochrane系统评论数据库(CDSR)和效果评论摘要数据库(DARE;CRD)。记录由两名审阅者通过标题和摘要独立筛选,并获得被认为合格的记录进行全文筛选。使用系统评价偏差风险评估工具(ROBIS)工具评估偏差风险(RoB)。我们采用了叙事分析并开发了证据差距图。
    纳入了24条评价,每个亚人群至少有一条评价,并采用了一系列数字干预措施。证据的质量有限,在24篇综述中,只有一篇被认为RoB较低。“数字干预”的定义在不同的系统评价中差异很大,一些报告的干预措施属于一个以上的类别(即,互联网干预也可以是移动电话或计算机干预),然而,使用了相关综述中报告的定义.没有评论报告癌症发病率或相关结果。现有证据受到亚人群和干预类型的限制,但是证据在学龄儿童中最为明显。在学龄儿童电子健康干预中,定义为互联网提供的校本课程,电脑,片剂,移动技术,或者远程保健方法,改善结果。加速度计测量(标准化平均差[SMD]0.33,95%置信区间[CI]:0.05至0.61)和自我报告(SMD:0.14,95%CI:0.05至0.23)PA增加,水果和蔬菜摄入量也是如此(SMD:0.11,95%CI:0.03至0.19)(评价为低RoB,结果之间的异质性最小到相当大)。干预后的脂肪消费量(SMD:-0.06,95%CI:-0.15至0.03)或含糖饮料(SSB)和零食消费量联合干预后(SMD:-0.02,95%CI:-0.10至0.06)没有差异,或在干预后的随访(研究报告2周至36个月的随访)(SMD:-0.06,95%CI:-0.15至0.03)(评价为低ROB,结果之间的最小到实质性异质性)。基于智能手机的干预利用短消息服务(SMS),与对照组相比,应用或组合方法也改善了使用客观和主观方法测量的PA(SMD:0.44,95%CI:0.11至0.77),随着总PA[加权平均差(WMD)每天32.35分钟的增加,95%CI:10.36至54.33]和每日步数(大规模杀伤性武器:1,185,95%CI:303至2,068)(评估为高RoB,结果之间的中度到实质性异质性)。对于所有结果,解释在RoB和存在无法解释的异质性方面存在局限性。
    这次审查发现了有限的证据,表明数字干预措施有可能增加PA和,在较小程度上,改善学龄儿童的营养。然而,影响可能很小,而且基于不太可靠的证据。证据的特点是相当大的异质性,不清楚/重叠的人群和干预定义,系统评价的方法论质量较低。当年龄(年龄较大vs.最近),交互性(反馈/调查与没有/更少的反馈/调查),并考虑了数字干预的可访问性(设备类型)。这突显了在技术快速发展的领域中综合证据的困难,以及在推荐在公共卫生中使用数字技术方面所带来的挑战。迫切需要使用当代技术和适当的方法进行进一步的研究。
    UNASSIGNED: Strategies to increase physical activity (PA) and improve nutrition would contribute to substantial health benefits in the population, including reducing the risk of several types of cancers. The increasing accessibility of digital technologies mean that these tools could potentially facilitate the improvement of health behaviours among young people.
    UNASSIGNED: We conducted a review of systematic reviews to assess the available evidence on digital interventions aimed at increasing physical activity and good nutrition in sub-populations of young people (school-aged children, college/university students, young adults only (over 18 years) and both adolescent and young adults (<25 years)).
    UNASSIGNED: Searches for systematic reviews were conducted across relevant databases including KSR Evidence (www.ksrevidence.com), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE; CRD). Records were independently screened by title and abstract by two reviewers and those deemed eligible were obtained for full text screening. Risk of bias (RoB) was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. We employed a narrative analysis and developed evidence gap maps.
    UNASSIGNED: Twenty-four reviews were included with at least one for each sub-population and employing a range of digital interventions. The quality of evidence was limited with only one of the 24 of reviews overall judged as low RoB. Definitions of \"digital intervention\" greatly varied across systematic reviews with some reported interventions fitting into more than one category (i.e., an internet intervention could also be a mobile phone or computer intervention), however definitions as reported in the relevant reviews were used. No reviews reported cancer incidence or related outcomes. Available evidence was limited both by sub-population and type of intervention, but evidence was most pronounced in school-aged children. In school-aged children eHealth interventions, defined as school-based programmes delivered by the internet, computers, tablets, mobile technology, or tele-health methods, improved outcomes. Accelerometer-measured (Standardised Mean Difference [SMD] 0.33, 95% Confidence Interval [CI]: 0.05 to 0.61) and self-reported (SMD: 0.14, 95% CI: 0.05 to 0.23) PA increased, as did fruit and vegetable intake (SMD: 0.11, 95% CI: 0.03 to 0.19) (review rated as low RoB, minimal to considerable heterogeneity across results). No difference was reported for consumption of fat post-intervention (SMD: -0.06, 95% CI: -0.15 to 0.03) or sugar sweetened beverages(SSB) and snack consumption combined post-intervention (SMD: -0.02, 95% CI:-0.10 to 0.06),or at the follow up (studies reported 2 weeks to 36 months follow-up) after the intervention (SMD:-0.06, 95% CI: -0.15 to 0.03) (review rated low ROB, minimal to substantial heterogeneity across results). Smartphone based interventions utilising Short Messaging Service (SMS), app or combined approaches also improved PA measured using objective and subjective methods (SMD: 0.44, 95% CI: 0.11 to 0.77) when compared to controls, with increases in total PA [weighted mean difference (WMD) 32.35 min per day, 95% CI: 10.36 to 54.33] and in daily steps (WMD: 1,185, 95% CI: 303 to 2,068) (review rated as high RoB, moderate to substantial heterogeneity across results). For all results, interpretation has limitations in terms of RoB and presence of unexplained heterogeneity.
    UNASSIGNED: This review of reviews has identified limited evidence that suggests some potential for digital interventions to increase PA and, to lesser extent, improve nutrition in school-aged children. However, effects can be small and based on less robust evidence. The body of evidence is characterised by a considerable level of heterogeneity, unclear/overlapping populations and intervention definitions, and a low methodological quality of systematic reviews. The heterogeneity across studies is further complicated when the age (older vs. more recent), interactivity (feedback/survey vs. no/less feedback/surveys), and accessibility (type of device) of the digital intervention is considered. This underscores the difficulty in synthesising evidence in a field with rapidly evolving technology and the resulting challenges in recommending the use of digital technology in public health. There is an urgent need for further research using contemporary technology and appropriate methods.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    BACKGROUND: Comments in PubMed are usually short papers for supporting or refuting claims, or discussing methods and findings in original articles. This study aims to explore whether they can be used as a quick and reliable evidence appraisal instrument for promoting research findings into practice, especially in emergency situations such as COVID-19 in which only missing, incomplete or uncertain evidence is available.
    METHODS: Evidence-comment networks (ECNs) were constructed by linking COVID-19-related articles to the commentaries (letters, editorials or brief correspondence) they received. PubTator Central was used to extract entities with a high volume of comments from the titles and abstracts of the articles. Among them, six drugs were selected, and their evidence assertions were analysed by exploring the structural information in the ECNs as well as the sentiment of the comments (positive, negative, neutral). Recommendations in WHO guidelines were used as the gold standard control to validate the consistency, coverage and efficiency of comments in reshaping clinical knowledge claims.
    RESULTS: The overall positive/negative sentiments of comments were aligned with recommendations for/against the corresponding treatments in the WHO guidelines. Comment topics covered all significant points of evidence appraisal and beyond. Furthermore, comments may indicate the uncertainty regarding drug use for clinical practice. Half of the critical comments emerged 4.25 months earlier on average than the guideline release.
    CONCLUSIONS: Comments have the potential as a support tool for rapid evidence appraisal as they have a selection effect by appraising the benefits, limitations and other clinical practice issues of concern in existing evidence. We suggest as a future direction an appraisal framework based on the comment topics and sentiment orientations to leverage the potential of scientific commentaries supporting evidence appraisal and decision-making.
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  • 文章类型: Journal Article
    背景:\'评估系统评论的测量工具,版本2(AMSTAR2)是经过验证的16项量表,旨在评估医疗保健干预措施的系统评价(SRs)并对其结果进行总体信心评分。本评论旨在从用户的角度描述各个项目的评级和AMSTAR2的应用方面的挑战。
    结论:一组六位有经验的使用者(在不同临床领域工作至少10年的方法学专家)确定并讨论了每个项目的评级和AMSTAR2评估SRs的一般使用方面的挑战。小组讨论用于就用户如何应对已确定的挑战提出建议。我们确定了项目2-16的内容以及AMSTAR2的总体置信度等级的推导的各种挑战。这些挑战包括需要(1)提供额外的定义(例如,什么构成了与SR协议第2项)的主要偏差,(2)在单个项目上选择多个条件的评级策略(例如,如果研究是一式两份选择的,如何对项目5进行评分,但没有报道两位作者之间的共识),和(3)确定用于推导置信度等级的规则(例如,哪些项目对此类评级至关重要)。基于这些挑战,我们为项目2-16制定了具体建议,AMSTAR2用户可以在应用该工具之前考虑这些建议。我们的评论通过从用户的角度对AMSTAR2工具进行了首次深入检查,从而增加了现有文献。可以通过其他决策规则来解决所确定的挑战,包括对模糊项目的定义以及对复杂项目的评级和信心评级的推导的指导。我们建议在评估程序开始之前,需要就此类决策规则达成团队共识。
    背景:不适用。
    \'A Measurement Tool to Assess Systematic Reviews, version 2\' (AMSTAR 2) is a validated 16-item scale designed to appraise systematic reviews (SRs) of healthcare interventions and to rate the overall confidence in their results. This commentary aims to describe the challenges with rating of the individual items and the application of AMSTAR 2 from the user perspective.
    A group of six experienced users (methodologists working in different clinical fields for at least 10 years) identified and discussed the challenges in rating of each item and the general use of AMSTAR 2 to appraise SRs. A group discussion was used to develop recommendations on how users could deal with the identified challenges. We identified various challenges with the content of items 2-16 and with the derivation of the overall confidence ratings on AMSTAR 2. These challenges include the need (1) to provide additional definitions (e.g., what constitutes major deviations from SR protocol on item 2), (2) to choose a rating strategy for multiple conditions on single items (e.g., how to rate item 5 if studies were selected in duplicate, but consensus between two authors was not reported), and (3) to determine rules for deriving the confidence ratings (e.g., what items are critical for such ratings). Based on these challenges we formulated specific recommendations for items 2-16 that AMSTAR 2 users could consider before applying the tool. Our commentary adds to the existing literature by providing the first in-depth examination of the AMSTAR 2 tool from the user perspective. The identified challenges could be addressed by additional decision rules including definitions for ambiguous items and guidance for rating of complex items and derivation of confidence ratings. We recommend that a team consensus regarding such decision rules is required before appraisal procedure begins.
    Not applicable.
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  • 文章类型: Journal Article
    现实主义审查/综合已成为证据综合的一种越来越突出的方法论方法,可以为政策和实践提供信息。虽然有进行现实主义审查的出版标准和准则,发表的评论通常提供关于他们如何进行一些方法步骤的最少细节。这包括选择和评估证据来源,这些通常被认为是它们的相关性,丰富,严谨.与其他审查方法相比,例如,叙事评论和荟萃分析,纳入标准和评估的证据在现实主义者的审查较少依赖于研究的方法论的质量,更多的是它的贡献,我们的理解生成因果关系,通过逆向理论化的过程发现。本研究简介旨在讨论评估文件相关性的当前挑战和实践,丰富,严谨,并为现实主义者的审稿人如何将其付诸实践提供务实的建议。本文受版权保护。保留所有权利。
    The realist review/synthesis has become an increasingly prominent methodological approach to evidence synthesis that can inform policy and practice. While there are publication standards and guidelines for the conduct of realist reviews, published reviews often provide minimal detail regarding how they have conducted some methodological steps. This includes selecting and appraising evidence sources, which are often considered for their \'relevance, richness and rigour.\' In contrast to other review approaches, for example, narrative reviews and meta-analyses, the inclusion criteria and appraisal of evidence within realist reviews depend less on the study\'s methodological quality and more on its contribution to our understanding of generative causation, uncovered through the process of retroductive theorising. This research brief aims to discuss the current challenges and practices for appraising documents\' relevance, richness and rigour and to provide pragmatic suggestions for how realist reviewers can put this into practice.
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  • 文章类型: Journal Article
    目的:钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i)已被证明对心力衰竭(HF)患者有益处。已对SGLT2i与安慰剂进行了比较的随机对照试验(RCT)的多个系统评价和荟萃分析(SRs和MAs)。然而,证据质量和相关疗效存在不确定性.我们对RCT的SRs和MA进行了概述,以总结与SGLT2i治疗HF疗效相关的证据。
    结果:对三个数据库的全面搜索(CochraneLibrary,EMBASE,和PubMed)进行到2021年2月21日。评价SGLT2i在HF患者中的疗效的RCT的所有SR均符合纳入条件。主要结果是全因死亡率。使用AMSTAR-2评估工具评估方法学质量。使用建议分级评估来总结证据的总体质量,发展,和评价方法。最初的搜索产生了3431个参考文献,其中,八名SR和MA符合纳入标准。方法学质量从极低到极高不等。证据的总体质量从非常低到中等。大多数SR和MA在全因死亡率方面显示出益处,HF相关的住院治疗,和KCCQ分数变化。
    结论:SGLT2i可能对HF患者有益,然而,没有一个SR和MA比较不同类型SGLT2i的疗效。此外,本文强调需要一致的可重复行为和SRs报告,以产生高质量的证据并促进临床决策.
    Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to have benefit in patients with heart failure (HF). Multiple systematic reviews and meta-analyses (SRs and MAs) of randomized control trials (RCTs) comparing SGLT2i to placebo have been performed. However, there is uncertainty in the quality of the evidence and associated efficacy. We performed an overview of SRs and MAs of RCTs to summarize the evidence related to the efficacy of SGLT2i for the management of HF.
    A comprehensive search of three databases (the Cochrane Library, EMBASE, and PubMed) was conducted until February 21, 2021. All SRs of RCTs evaluating the efficacy of SGLT2i in patients with HF were eligible for inclusion. The primary outcome was all-cause mortality. Methodological quality was evaluated using the AMSTAR-2 assessment tool. The overall quality of evidence was summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. The initial search yielded 3431 references, of which, eight SRs and MAs met the inclusion criteria. The methodological quality ranged from critically low to high. The overall quality of evidence ranged from very low to moderate. Most of the SRs and MAs showed benefits in all-cause mortality, HF-related hospitalizations, and KCCQ score change.
    SGLT2i are possibly beneficial in patients with HF, however, none of the SRs and MAs compared the efficacy between different types of SGLT2i. Furthermore, this paper emphasizes the need for consistent reproducible conduct and reporting of SRs to generate high-quality evidence and facilitate clinical decision-making.
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  • 文章类型: Journal Article
    Teosinte,来自墨西哥和中美洲的野生玉米近缘种,在法国和西班牙成为一种有害的农业杂草。2016年,欧洲食品安全局(EFSA)发布了一份技术报告,评估了有关teosinte的可用科学信息,以评估其与转基因(GM)玉米MON810,Bt11,1507和GA21种植的环境风险评估(ERA)和风险管理(RM)的相关性。结论是,转基因玉米杂种后代(可能通过转基因玉米和玉米之间的杂交获得)的抗虫性和/或除草剂耐受性对目标和非目标生物的影响,在欧盟条件下,非生物环境和生物地球化学循环将非常低。根据欧盟委员会的要求,EFSA评估了EFSA(2016)的ERA结论和RM建议是否仍然适用,或需要根据自EFSA(2016)发布以来已获得的有关teosinte的新科学证据进行修订。制定了一项议定书,以澄清对任务授权职权范围的解释并使其运作。评估依赖于通过广泛的文献检索和法国和西班牙主管当局的报告检索的证据,以及听取专家证词.检索并评估了有限的18种相关性和质量各不相同的出版物。根据这些证据,得出的结论是,EFSA(2016)的ERA结论和RM建议仍然适用,除了与在玉米GA21上使用草甘膦除草剂有关的那些,这些除草剂应根据法规(EC)No1107/2009考虑。在受感染的农业地区(尤其是玉米MON810广泛种植的地区),杂草管理措施实施监测,控制和/或根除teosinte必须留在原地,因为它们将有助于进一步降低转基因玉米和欧盟teosinte之间的低垂直基因流动潜力。
    Teosinte, wild maize relatives originating from Mexico and Central America, emerged as a noxious agricultural weed in France and Spain. In 2016, the European Food Safety Authority (EFSA) issued a technical report that assessed the available scientific information on teosinte for its relevance for the environmental risk assessment (ERA) and risk management (RM) of genetically modified (GM) maize MON810, Bt11, 1507 and GA21 for cultivation. It was concluded that the impact of insect resistance and/or herbicide tolerance in GM teosinte hybrid progeny (potentially acquired through hybridisation between GM maize and teosinte) on target and non-target organisms, the abiotic environment and biogeochemical cycles would be very low under EU conditions. Following a request of the European Commission, EFSA evaluated whether the ERA conclusions and RM recommendations of EFSA (2016) remain applicable, or require revision in light of new scientific evidence on teosinte that has become available since the publication of EFSA (2016). A protocol was developed to clarify the interpretation of the terms of reference of the mandate and make them operational. The assessment relied on evidence retrieved via an extensive literature search and from reports of the Competent Authorities of France and Spain, and on hearing expert testimonies. A limited collection of 18 publications of varying relevance and quality was retrieved and assessed. Based on this evidence, it is concluded that the ERA conclusions and RM recommendations of EFSA (2016) remain applicable, except those pertaining to the use of glyphosate-based herbicides on maize GA21 which should be considered under Regulation (EC) No 1107/2009. In infested agricultural areas (especially in regions where maize MON810 is widely grown), weed management measures implemented to monitor, control and/or eradicate teosinte must remain in place, as they will contribute to further reduce the low vertical gene flow potential between GM maize and EU teosinte.
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