Prevalence and incidence of venous thromboembolism in geriatric patients admitted to long-term care hospitals.

The risk of venous thromboembolism (VTE) increases with age. However, the risk of VTE in the setting of long-term care hospitals is understudied. Our objective was to provide data on the prevalence and incidence of VTE in older adults admitted to long-term care hospitals. In this retrospective cohort study, we collected data about chronically ill and multimorbid patients aged 65 years and older from two long-term care hospitals. The primary endpoint of this study was the lifetime prevalence of VTE, and the secondary endpoint was VTE incidence during residency in long-term care hospitals. We analysed data from 1148 patients with a mean age of 84.1 ± 7.9 years, of whom 74.2% were women. The lifetime prevalence of VTE at baseline was 9.6% (95% CI 7.9-11.4). Cumulative incidence of VTE at 1, 2, and 3 years from baseline was estimated at 3.5% (95% CI 2.5-4.7), 4.2% (95% CI 3.1-5.5), and 5.4% (95% CI 4.1-7.0), respectively. Overall, the incidence rate of VTE in our study was 2.82 (95% CI 2.18-3.66) per 100 person-years. The study indicated a considerably high lifetime prevalence and incidence of VTE during residence in long-term care hospital settings, requiring further evaluation in larger prospective studies.

[WHO guideline on carbohydrate intake for adults and children]. / WHO-Leitlinie zur Kohlenhydratzufuhr für Erwachsene und Kinder.

BACKGROUND: Noncommunicable diseases are the leading cause of death worldwide. Unhealthy diets are a major risk factor. Among other dietary factors, poorer quality of carbohydrates in the diet is associated with an increased risk of NCDs. The proportion of dietary fibre is a particularly important indicator of the quality of carbohydrate. OBJECTIVE: The aim of this World Health Organization (WHO)guideline is to provide guidance on carbohydrate intake, including dietary fibre and healthy food sources of carbohydrates. METHOD: This guideline was developed following the WHO Manual for Guideline Development. The process includes a review of systematically gathered evidence by an international, multidisciplinary group of experts, an assessment of the confidence in this evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, and the consideration of additional factors when translating the evidence into recommendations. RESULTS: The results of seven systematic reviews inform the formulation of carbohydrate intake recommendations. The WHO recommends that carbohydrate intake should consist primarily of whole grains, vegetables, fruits and legumes. It also recommends an intake of at least 400 g of vegetables and fruit per day for adults and at least 250-400 g per day for children and young people, depending on their age. With regard to naturally occurring fiber, a daily intake of at least 25 g is recommended for adults and 15-25 g per day for children and adolescents, depending on age.

Performance of two large language models for data extraction in evidence synthesis.

Accurate data extraction is a key component of evidence synthesis and critical to valid results. The advent of publicly available large language models (LLMs) has generated interest in these tools for evidence synthesis and created uncertainty about the choice of LLM. We compare the performance of two widely available LLMs (Claude 2 and GPT-4) for extracting pre-specified data elements from 10 published articles included in a previously completed systematic review. We use prompts and full study PDFs to compare the outputs from the browser versions of Claude 2 and GPT-4. GPT-4 required use of a third-party plugin to upload and parse PDFs. Accuracy was high for Claude 2 (96.3%). The accuracy of GPT-4 with the plug-in was lower (68.8%); however, most of the errors were due to the plug-in. Both LLMs correctly recognized when prespecified data elements were missing from the source PDF and generated correct information for data elements that were not reported explicitly in the articles. A secondary analysis demonstrated that, when provided selected text from the PDFs, Claude 2 and GPT-4 accurately extracted 98.7% and 100% of the data elements, respectively. Limitations include the narrow scope of the study PDFs used, that prompt development was completed using only Claude 2, and that we cannot guarantee the open-source articles were not used to train the LLMs. This study highlights the potential for LLMs to revolutionize data extraction but underscores the importance of accurate PDF parsing. For now, it remains essential for a human investigator to validate LLM extractions.

Sensitivity and Specificity of Using GPT-3.5 Turbo Models for Title and Abstract Screening in Systematic Reviews and Meta-analyses.

BACKGROUND: Systematic reviews are performed manually despite the exponential growth of scientific literature. OBJECTIVE: To investigate the sensitivity and specificity of GPT-3.5 Turbo, from OpenAI, as a single reviewer, for title and abstract screening in systematic reviews. DESIGN: Diagnostic test accuracy study. SETTING: Unannotated bibliographic databases from 5 systematic reviews representing 22 665 citations. PARTICIPANTS: None. MEASUREMENTS: A generic prompt framework to instruct GPT to perform title and abstract screening was designed. The output of the model was compared with decisions from authors under 2 rules. The first rule balanced sensitivity and specificity, for example, to act as a second reviewer. The second rule optimized sensitivity, for example, to reduce the number of citations to be manually screened. RESULTS: Under the balanced rule, sensitivities ranged from 81.1% to 96.5% and specificities ranged from 25.8% to 80.4%. Across all reviews, GPT identified 7 of 708 citations (1%) missed by humans that should have been included after full-text screening at the cost of 10 279 of 22 665 false-positive recommendations (45.3%) that would require reconciliation during the screening process. Under the sensitive rule, sensitivities ranged from 94.6% to 99.8% and specificities ranged from 2.2% to 46.6%. Limiting manual screening to citations not ruled out by GPT could reduce the number of citations to screen from 127 of 6334 (2%) to 1851 of 4077 (45.4%), at the cost of missing from 0 to 1 of 26 citations (3.8%) at the full-text level. LIMITATIONS: Time needed to fine-tune prompt. Retrospective nature of the study, convenient sample of 5 systematic reviews, and GPT performance sensitive to prompt development and time. CONCLUSION: The GPT-3.5 Turbo model may be used as a second reviewer for title and abstract screening, at the cost of additional work to reconcile added false positives. It also showed potential to reduce the number of citations before screening by humans, at the cost of missing some citations at the full-text level. PRIMARY FUNDING SOURCE: None.

Effectiveness and Safety of Measures to Prevent Infections and Other Complications Associated With Peripheral Intravenous Catheters: A Systematic Review and Meta-analysis.

BACKGROUND: Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. METHODS: We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL, and reference lists for controlled studies from 1 January 1980-16 March 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with 3 or more trials, we conducted Bayesian random-effects meta-analyses. RESULTS: 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for 8 research questions. Based on findings of low to high COE, wearing gloves reduced the risk of overall adverse events related to insertion compared with no gloves (1 non-randomized controlled trial [non-RCT]; adjusted risk ratio [RR], .52; 95% CI, .33-.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR, 0.74, 95% credible interval, .49-1.01) compared with clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared with non-chlorhexidine-containing disinfection (1 RCT; 0.14 vs 0.68; P = .003). No statistically significant differences were found for other measures. CONCLUSIONS: Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications. CLINICAL TRIALS REGISTRATION: The protocol was registered in the Open Science Framework (https://osf.io/exdb4).

[WHO Guidelines on Mental Health at Work]. / WHO-Leitlinie zur psychischen Gesundheit am Arbeitsplatz.

The World Health Organization (WHO) published the "Guidelines on mental health at work" in September 2022. WHO developed the guidelines in accordance with WHO standards. The summary of this guideline was translated into German by the team of the WHO Collaborating Center for Evidence-based Medicine at the University for Continuing Education Krems (Austria) for use in German-speaking countries. An estimated 15+% of working-age adults have had some mental disorder at some point of time in their lives. This can lead to impaired capacity to work, resulting in reduction in productivity and performance, and ability to work safely, or in difficulties in retaining their jobs or obtaining gainful employment. The guidelines contain 12 recommendations. These provide evidence-based global public health guidance on organizational interventions, manager and worker training, and individual interventions for the promotion of positive mental health and prevention of mental health conditions, as well as recommendations on returning to work following absence associated with mental health conditions and gaining employment for people living with mental health conditions. Through the provision of these WHO recommendations, it is anticipated that the guidelines will facilitate national and workplace-level actions in the areas of policy development, service planning and delivery in the domains of mental and occupational health.

Pharmacological interventions for the management of children and adolescents living with obesity-An update of a Cochrane systematic review with meta-analyses.

IMPORTANCE: The effectiveness of anti-obesity medications for children and adolescents is unclear. OBJECTIVE: To update the evidence on the benefits and harms of anti-obesity medication. DATA SOURCES: Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16-17/3/23). STUDY SELECTION: Randomized controlled trials ≥6 months in people <19 years living with obesity. DATA EXTRACTION AND SYNTHESIS: Screening, data extraction and quality assessment conducted in duplicate, independently. MAIN OUTCOMES AND MEASURES: Body mass index (BMI): 95th percentile BMI, adverse events and quality of life. RESULTS: Thirty-five trials (N = 4331), follow-up: 6-24 months; age: 8.8-16.3 years; BMI: 26.2-41.7 kg/m2. Moderate certainty evidence demonstrated a -1.71 (95% confidence interval [CI]: -2.27 to -1.14)-unit BMI reduction, ranging from -0.8 to -5.9 units between individual drugs with semaglutide producing the largest reduction of -5.88 kg/m2 (95% CI: -6.99 to -4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: -11.88 percentage points (95% CI: -18.43 to -5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance. CONCLUSIONS AND RELEVANCE: Anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.

Data extraction for evidence synthesis using a large language model: A proof-of-concept study.

Data extraction is a crucial, yet labor-intensive and error-prone part of evidence synthesis. To date, efforts to harness machine learning for enhancing efficiency of the data extraction process have fallen short of achieving sufficient accuracy and usability. With the release of large language models (LLMs), new possibilities have emerged to increase efficiency and accuracy of data extraction for evidence synthesis. The objective of this proof-of-concept study was to assess the performance of an LLM (Claude 2) in extracting data elements from published studies, compared with human data extraction as employed in systematic reviews. Our analysis utilized a convenience sample of 10 English-language, open-access publications of randomized controlled trials included in a single systematic review. We selected 16 distinct types of data, posing varying degrees of difficulty (160 data elements across 10 studies). We used the browser version of Claude 2 to upload the portable document format of each publication and then prompted the model for each data element. Across 160 data elements, Claude 2 demonstrated an overall accuracy of 96.3% with a high test-retest reliability (replication 1: 96.9%; replication 2: 95.0% accuracy). Overall, Claude 2 made 6 errors on 160 data items. The most common errors (n = 4) were missed data items. Importantly, Claude 2's ease of use was high; it required no technical expertise or labeled training data for effective operation (i.e., zero-shot learning). Based on findings of our proof-of-concept study, leveraging LLMs has the potential to substantially enhance the efficiency and accuracy of data extraction for evidence syntheses.

[WHO Recommendations for Care of the Preterm or Low-Birth-Weight Infant]. / WHO-Leitlinie: Versorgung von Frühgeborenen und Neugeborenen mit niedrigem Geburtsgewicht.

BACKGROUND: Premature infants (gestation age<37 weeks) and low-birth-weight infants (< 2.5 kg) require complex care to ensure their survival, growth and neurological development. Increased risk for developmental disorders, infections, and challenges with nutrition and body temperature regulation require comprehensive measures in care. AIM: The aim of this guideline was to improve the care of premature and low-birth-weight infants through updated recommendations. METHODS: The recommendations of the World Health Organization (WHO) have been implemented in this guideline in accordance with the WHO handbook for guideline development. This publication has been translated into German by staff members of the WHO Collaborating Centre at the Danube University Krems (Austria). RESULTS/CONCLUSIONS: This guideline includes 11 strong and 14 conditional recommendations, of which 16 describe preventive and promotive care, 6 recommendations about care for complications and 3 for family involvement and support, as well as one statement of good practice.

Methods proposed for monitoring the implementation of evidence-based research: a cross-sectional study.

OBJECTIVES: Evidence-based research (EBR) is the systematic and transparent use of prior research to inform a new study so that it answers questions that matter in a valid, efficient, and accessible manner. This study surveyed experts about existing (e.g., citation analysis) and new methods for monitoring EBR and collected ideas about implementing these methods. STUDY DESIGN AND SETTING: We conducted a cross-sectional study via an online survey between November 2022 and March 2023. Participants were experts from the fields of evidence synthesis and research methodology in health research. Open-ended questions were coded by recurring themes; descriptive statistics were used for quantitative questions. RESULTS: Twenty-eight expert participants suggested that citation analysis should be supplemented with content evaluation (not just what is cited but also in which context), content expert involvement, and assessment of the quality of cited systematic reviews. They also suggested that citation analysis could be facilitated with automation tools. They emphasized that EBR monitoring should be conducted by ethics committees and funding bodies before the research starts. Challenges identified for EBR implementation monitoring were resource constraints and clarity on responsibility for EBR monitoring. CONCLUSION: Ideas proposed in this study for monitoring the implementation of EBR can be used to refine methods and define responsibility but should be further explored in terms of feasibility and acceptability. Different methods may be needed to determine if the use of EBR is improving over time.

Rapid review methods series: Guidance on the use of supportive software.

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RRs) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. This paper guides how to use supportive software for RRs.We strongly encourage the use of supportive software throughout RR production. Specifically, we recommend (1) using collaborative online platforms that enable working in parallel, allow for real-time project management and centralise review details; (2) using automation software to support, but not entirely replace a human reviewer and human judgement and (3) being transparent in reporting the methodology and potential risk for bias due to the use of supportive software.

Rapid reviews methods series: Guidance on assessing the certainty of evidence.

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RRs) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. This paper addresses considerations for rating the certainty of evidence (COE) in RRs. We recommend the full implementation of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) for Cochrane RRs if time and resources allow.If time or other resources do not permit the full implementation of GRADE, the following recommendations can be considered: (1) limit rating COE to the main intervention and comparator and limit the number of outcomes to critical benefits and harms; (2) if a literature review or a Delphi approach to rate the importance of outcomes is not feasible, rely on informal judgements of knowledge users, topic experts or team members; (3) replace independent rating of the COE by two reviewers with single-reviewer rating and verification by a second reviewer and (4) if effect estimates of a well-conducted systematic review are incorporated into an RR, use existing COE grades from such a review. We advise against changing the definition of COE or the domains considered part of the GRADE approach for RRs.

Full publication of preprint articles in prevention research: an analysis of publication proportions and results consistency.

There is concern that preprint articles will lead to an increase in the amount of scientifically invalid work available. The objectives of this study were to determine the proportion of prevention preprints published within 12 months, the consistency of the effect estimates and conclusions between preprint and published articles, and the reasons for the nonpublication of preprints. Of the 329 prevention preprints that met our eligibility criteria, almost half (48.9%) were published in a peer-reviewed journal within 12 months of being posted. While 16.8% published preprints showed some change in the magnitude of the primary outcome effect estimate, 4.4% were classified as having a major change. The style or wording of the conclusion changed in 42.2%, the content in 3.1%. Preprints on chemoprevention, with a cross-sectional design, and with public and noncommercial funding had the highest probabilities of publication. The main reasons for the nonpublication of preprints were journal rejection or lack of time. The reliability of preprint articles for evidence-based decision-making is questionable. Less than half of the preprint articles on prevention research are published in a peer-reviewed journal within 12 months, and significant changes in effect sizes and/or conclusions are still possible during the peer-review process.

Psychotherapies for the treatment of borderline personality disorder: A systematic review.

OBJECTIVE: Borderline personality disorder (BPD) is the most common personality disorder, affecting 1.8% of the general population, 10% of psychiatric outpatients, and 15%-25% of psychiatric inpatients. Practice guidelines recommend psychotherapies as first-line treatments. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative effectiveness of each individual psychotherapy versus treatment as usual (TAU) or other psychotherapies. To systematically assess the comparative effectiveness of commonly used psychotherapies versus TAU or versus other psychotherapies for BPD treatment. METHOD: We conducted systematic literature searches in MEDLINE, EMBASE, the Cochrane Library, and APA PsycINFO up to July 14, 2022, and searched reference lists of pertinent articles and reviews. Inclusion criteria were (a) patients 13 years or older with a diagnosis of BPD, (b) treatment with commonly used psychotherapies, (c) comparison with TAU or another psychotherapy, (d) assessment of relevant BPD-related health outcomes, and (e) randomized or nonrandomized trials or controlled observational studies. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: We found 25 psychotherapy studies meeting inclusion criteria with data on 2,545 participants. Seventeen studies compared nine psychotherapies with TAU and nine studies compared eight psychotherapies with another psychotherapy for the treatment of BPD. Overall, both TAU and included psychotherapies were effective in treating the severity and symptoms of BPD. Moderate certainty of evidence suggests that systems training for emotional predictability and problem solving is more effective than TAU for the treatment of BPD; low certainty of evidence suggests that dialectical behavior therapy, schema therapy, transference-focused psychotherapy, acceptance and commitment therapy, manual-assisted cognitive therapy, and cognitive behavioral therapy are more effective than TAU for treating BPD. We were unable to draw conclusions from head-to-head comparisons of psychotherapies, which were limited to single studies with very low to low certainty of evidence. CONCLUSIONS: All commonly used psychotherapies improve BPD severity, symptoms, and functioning. Our assessment found no strong evidence suggesting that any one psychotherapy is more beneficial than another. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Outpatient Treatment of Confirmed COVID-19: A Living, Rapid Evidence Review for the American College of Physicians (Version 2).

BACKGROUND: Clinicians and patients want to know the benefits and harms of outpatient treatment options for the Omicron variant of SARS-CoV-2. PURPOSE: To assess the benefits and harms of 22 different COVID-19 treatments. DATA SOURCES: The Epistemonikos COVID-19 L·OVE platform, the iSearch COVID-19 portfolio, and the World Health Organization (WHO) COVID-19 Research Database from 26 November 2021 to 2 March 2023. STUDY SELECTION: Two reviewers independently screened abstracts and full texts against a priori-defined criteria. DATA EXTRACTION: One reviewer extracted the data and assessed the risk of bias and certainty of evidence (COE). A second reviewer verified the data abstraction and assessments. DATA SYNTHESIS: Two randomized controlled trials and 6 retrospective cohort studies were included. Nirmatrelvir-ritonavir was associated with a reduction in hospitalization due to COVID-19 (for example, 0.7% vs. 1.2%; moderate COE) and all-cause mortality (for example, <0.1% vs. 0.2%; moderate COE). Molnupiravir led to a higher recovery rate (31.8% vs. 22.6%; moderate COE) and reduced time to recovery (9 vs. 15 median days; moderate COE) but had no effect on all-cause mortality (0.02% vs. 0.04%; moderate COE) and the incidence of serious adverse events (0.4% vs. 0.3%; moderate COE). Ivermectin had no effect on time to recovery (moderate COE) and resulted in no difference in adverse events compared with placebo (low COE). Sotrovimab resulted in no difference in all-cause mortality compared with no treatment (low COE). No eligible studies for all other treatments of interest were identified. LIMITATION: Evidence for nirmatrelvir-ritonavir and sotrovimab is based on nonrandomized studies only. CONCLUSION: Nirmatrelvir-ritonavir and molnupiravir probably improve outcomes for outpatients with mild to moderate COVID-19. PRIMARY FUNDING SOURCE: American College of Physicians. (PROSPERO: CRD42023406456).