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大语言模型在循证医学领域的应用

中国循证医学杂志 2024年第4期24卷 373-377页

作者：罗旭飞吕晗史乾灵王子君刘辉朱迪王晔陈耀龙兰州大学基础医学院循证医学中心兰州730000 首都医科大学附属北京友谊医院北京100050 兰州大学第一临床医学院兰州730000 兰州大学公共卫生学院兰州730000 兰州大学健康数据科学研究院兰州730000 世界卫生组织指南实施与知识转化合作中心兰州730000 中国医学科学院循证评价与指南研究创新单元兰州730000

大型语言模型(LLM)是基于海量数据进行预训练的超大型深度学习模型,ChatGPT是LLM在生成模型应用方面的代表。随着ChatGPT于2022年底发布,生成式聊天机器人已被普遍应用于医学各领域。作为指导临床实践的重要学科,循证医学中ChatGPT等聊... 详细信息

大型语言模型(LLM)是基于海量数据进行预训练的超大型深度学习模型,ChatGPT是LLM在生成模型应用方面的代表。随着ChatGPT于2022年底发布,生成式聊天机器人已被普遍应用于医学各领域。作为指导临床实践的重要学科,循证医学中ChatGPT等聊天机器人的应用也在逐渐增加,但目前其在循证医学领域应用的潜力、环节等内容尚不清楚。本文主要通过对相关文献的回顾和总结,凝练和探讨ChatGPT在循证医学领域应用的前景、挑战以及注意事项,从证据的生产、综合、评价以及传播和实施四个方面进行阐述,旨在为研究人员提供最新进展和未来研究建议。

关键词：大语言模型循证医学系统评价临床实践指南 ChatGPT 质量评价

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共病指南:现状、挑战与机遇

中国循证医学杂志 2024年第6期24卷 621-625页

作者：王子君史乾灵宫恩莹罗旭飞荀杨芹邵瑞太陈耀龙兰州大学基础医学院循证医学中心兰州730000 中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院兰州730000 甘肃省循证医学重点实验室兰州730000 兰州大学健康数据科学研究院兰州730000 兰州大学第一临床医学院兰州730000 中国医学科学院呼吸和共病全国重点实验室北京100005 北京协和医学院群医学与公共卫生学院北京100005 世界卫生组织指南实施与知识转化合作中心兰州730000

因慢性病患病率增加和人口老龄化加速,共病正在成为全球卫生领域面临的重大问题。临床实践指南作为指导临床诊疗实践的关键工具,在共病领域发挥着重要作用的同时,也面临许多挑战。本文将对制订共病指南的必要性、当前现状、面临的挑战... 详细信息

因慢性病患病率增加和人口老龄化加速,共病正在成为全球卫生领域面临的重大问题。临床实践指南作为指导临床诊疗实践的关键工具,在共病领域发挥着重要作用的同时,也面临许多挑战。本文将对制订共病指南的必要性、当前现状、面临的挑战与机遇进行梳理,并在此基础上提出推动我国共病领域指南发展的思考与建议。

关键词：共病临床实践指南指南制订

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正确理解和应用低质量证据形成指南推荐意见

协和医学杂志 2024年第3期15卷 676-685页

作者：史乾灵刘辉王子君罗旭飞王冰怡杨楠孟文勃陈耀龙兰州大学第一临床医学院兰州730000 中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院兰州730000 甘肃省循证医学重点实验室兰州730000 兰州大学健康数据科学研究院兰州730000 兰州大学基础医学院循证医学中心兰州730000 兰州大学第一医院普外科兰州730000 中华医学会杂志社指南与标准研究中心兰州730000 世界卫生组织指南实施与知识转化合作中心兰州730000

推荐意见是临床实践指南的核心。基于低质量证据作出强推荐意见是当前国内外指南普遍存在的现象。医务人员认为缺乏高质量的证据就无法制订高质量的指南或仅可制订专家共识是典型的误解。本文以GRADE分级系统为切入点,阐述低质量证据的... 详细信息

推荐意见是临床实践指南的核心。基于低质量证据作出强推荐意见是当前国内外指南普遍存在的现象。医务人员认为缺乏高质量的证据就无法制订高质量的指南或仅可制订专家共识是典型的误解。本文以GRADE分级系统为切入点,阐述低质量证据的基本内涵和临床作用,介绍基于低质量证据形成指南推荐意见的方法,以期为我国指南制订者和使用者提供参考。

关键词：临床实践指南推荐意见证据质量 GRADE

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基于循证理念制定卫生健康标准的思考

协和医学杂志 2024年第2期15卷 435-441页

作者：苏仁凤刘辉史乾灵罗旭飞杨楠赵俊贤田倩男张娟娟伍丽群陈耀龙兰州大学公共卫生学院兰州730000 兰州大学基础医学院循证医学中心兰州730000 兰州大学第一临床医学院兰州730000 深圳市健康发展研究和数据管理中心深圳518028 中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院兰州730000 世界卫生组织指南实施与知识转化合作中心兰州730000

国家卫生健康标准是实施卫生健康法律法规和政策、落实卫生健康政策规划、维护人民群众身体健康和生命安全的技术保障。我国卫生健康标准的制定应符合国家法律、法规、部门规章和卫生健康政策。在研制卫生健康标准时,应在科学技术研究... 详细信息

国家卫生健康标准是实施卫生健康法律法规和政策、落实卫生健康政策规划、维护人民群众身体健康和生命安全的技术保障。我国卫生健康标准的制定应符合国家法律、法规、部门规章和卫生健康政策。在研制卫生健康标准时,应在科学技术研究成果和社会实践经验的基础上,深入调查论证,广泛征求意见,然而在制定过程中可能存在缺乏充分研究证据的问题。循证理念强调证据的重要性,因此将循证理念融入卫生健康标准制定过程,可提升其质量与科学性。本文在系统阐述我国卫生健康标准现状与制定流程的基础上,探讨循证理念用于卫生健康标准制定的必要性与可行性,对其面临的挑战与机遇进行分析,并提出思考与建议。

关键词：卫生健康标准循证理念循证医学

医学期刊发表中国指南和共识类文献科学性、透明性和适用性评级方法学———样本确定及专科分配

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协和医学杂志 2024年第2期15卷 429-434页

作者：刘辉杨楠史乾灵罗旭飞张海荣田金徽靳英辉陈耀龙 STAR工作组方法与技术专业委员会中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院兰州730000 甘肃省循证医学重点实验室兰州730000 兰州大学健康数据科学研究院兰州730000 兰州大学基础医学院循证医学中心兰州730000 STAR工作组兰州730000 兰州大学第一临床医学院兰州730000 武汉大学中南医院循证与转化医学中心武汉430071 中华医学会杂志社指南与标准研究中心兰州730000 世界卫生组织指南实施与知识转化合作中心兰州730000 不详

随着指南科学性、透明性和适用性评级工具(Scientific,Transparent and Applicable Rankings tool for clinical practice guidelines,STAR)的研发,2021年和2022年医学期刊发表中国指南和共识STAR评级结果以及部分专科指南和共识STAR评级结果的发布,STAR评级受到医学界广泛关注。为进一步提升STAR评级的科学性和透明性,STAR工作组方法与技术专业委员会特撰写本文,对评级过程中的样本确定及专科分配进行详细介绍。

关键词：指南共识评价评级 STAR

Investigation and evaluation of randomized controlled trials for interventions involving artificial intelligence

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Intelligent Medicine 2021年第2期1卷 61-69页

作者： Jianjian Wang Shouyuan Wu Qiangqiang Guo Hui Lan Estill Janne Ling Wang Juanjuan Zhang Qi Wang Yang Song Nan Yang Xufei Luo Qi Zhou qianling shi Xuan Yu Yanfang Ma Joseph LMathew Hyeong Sik Ahn Myeong Soo Lee Yaolong Chen School of Public Health Lanzhou UniversityLanzhouGansu 730000China Institute of Global Health University of GenevaGenevaSwitzerland Institute of Mathematical Statistics and Actuarial Science University of BernBernSwitzerland Department of Health Research Methods Evidence and ImpactFaculty of Health SciencesMcMaster UniversityHamiltonCanada McMaster Health Forum McMaster UniversityHamiltonCanada Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau(IIB Sant Pau) BarcelonaSpain Evidence-based Medicine Center School of Basic Medical SciencesLanzhou UniversityLanzhouGansu 730000China The First School of Clinical Medicine Lanzhou UniversityLanzhouGansu 730000China Advanced Pediatrics Centre PGIMER ChandigarhChandigarhIndia Department of Preventive Medicine Korea UniversitySeoulKorea Korea Cochrane Centre SeoulKorea Evidence Based Medicine SeoulKorea Korea University School of Medicine SeoulKorea Korea Institute of Oriental Medicine DaejeonKorea University of Science and Technology DaejeonKorea London Southbank University LondonUK Tianjin University of Traditional Chinese Medicine Tianjin 301617China Lanzhou University Institute of Health Data Science LanzhouGansu 730000China Key Laboratory of Evidence Based Medicine&Knowledge Translation of Gansu Province LanzhouGansu 730000China

Objective Complete and transparent reporting is of critical importance for randomized controlled trials(RCTs).The present study aimed to determine the reporting quality and methodological quality of RCTs for interventions involving artificial intelligence(AI)and their protocols.Methods We searched MEDLINE(via PubMed),Embase,Web of Science,CBMdisc,Wanfang Data,and CNKI from January 1,2016,to November 11,2020,to collect RCTs involving AI.We also extracted the protocol of each included RCT if it could be obtained.CONSORT-AI(Consolidated Standards of Reporting Trials-Artificial Intelligence)statement and Cochrane Collaboration’s tool for assessing risk of bias(ROB)were used to evaluate the reporting quality and methodological quality,respectively,and SPIRIT-AI(The Standard Protocol Items:Recommendations for Interventional Trials-Artificial Intelligence)statement was used to evaluate the reporting quality of the protocols.The associations of the reporting rate of CONSORT-AI with the publication year,journal’s impact factor(IF),number of authors,sample size,and first author’s country were analyzed univariately using Pearson’s chi-squared test,or Fisher’s exact test if the expected values in any of the cells were below 5.The compliance of the retrieved protocols to SPIRIT-AI was presented descriptively.Results Overall,29 RCTs and three protocols were considered eligible.The CONSORT-AI items“title and abstract”and“interpretation of results”were reported by all RCTs,with the items with the lowest reporting rates being“funding”(0),“implementation”(3.5%),and“harms”(3.5%).The risk of bias was high in 13(44.8%)RCTs and not clear in 15(51.7%)RCTs.Only one RCT(3.5%)had a low risk of bias.The compliance was not significantly different in terms of the publication year,journal’s IF,number of authors,sample size,or first author’s country.Ten of the 35 SPIRIT-AI items(funding,participant timeline,allocation concealment mechanism,implementation,data management,auditing,declaration of interests,access to data,informed consent material

关键词： Artificial intelligence Randomized controlled trials Reporting quality Methodological quality

The SUPER reporting guideline suggested for reporting of surgical technique

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 534-544,I0024-I0026页

作者： Kaiping Zhang Yanfang Ma Jinlin Wu qianling shi Leandro Cardoso Barchi Marco Scarci Rene Horsleben Petersen Calvin S.H.Ng Steven Hochwald Ryuichi Waseda Fabio Davoli Robert Fruscio Giovanni Battista Levi Sandri Michel Gonzalez Benjamin Wei Guillaume Piessen Jianfei Shen Xianzhuo Zhang Panpan Jiao Yulong He Nuria M.Novoa Benedetta Bedetti Sebastien Gilbert Alan D.L.Sihoe Alper Toker Alfonso Fiorelli Marcelo F.Jimenez Toni Lerut Aung Y.Oo Grace S.Li Xueqin Tang Yawen Lu Hussein Elkhayat Tomaz Stupnik Tanel Laisaar Firas Abu Akar Diego Gonzalez-Rivas Zhanhao Su Bin Qiu Stephen D.Wang Yaolong Chen Shugeng Gao Editorial Office AME Publishing CompanyHong KongChina School of Chinese Medicine Hong Kong Baptist UniversityHong KongChina Department of Cardiovascular Surgery Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhouChina Evidence-based Medicine Center School of Basic Medical SciencesLanzhou UniversityLanzhouChina Lanzhou University Institute of Health Data Science LanzhouChina Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineSão PauloBrazil Department of Cardiothoracic Surgery Imperial College Healthcare NHS TrustLondonUK Department of Cardiothoracic Surgery University Hospital of CopenhagenRigshospitaletCopenhagenDenmark The Chinese University of Hong Kong Prince of Wales HospitalShatinNew TerritoriesHong KongChina Department of Surgical Oncology Roswell Park Cancer InstituteBuffaloNYUSA Department of General Thoracic Breast and Pediatric SurgeryFukuoka UniversityFukuokaJapan Department of Thoracic Surgery AUSL RomagnaS.Maria delle Croci Teaching HospitalRavennaItaly Clinic of Obstetrics and Gynecology University of Milan-BicoccaSan Gerardo HospitalMonzaItaly Division of General Surgery and Liver Transplantation S.Camillo HospitalRomeItaly Service of Thoracic Surgery Lausanne University Hospital(CHUV)LausanneSwitzerland Division of Cardiothoracic Surgery Department of SurgeryUniversity of Alabama BirminghamBirminghamALUSA University of Lille CNRSInsermCHU LilleUMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to TherapiesLilleFrance Department of Cardiothoracic Surgery Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityLinhaiChina The First School of Clinical Medicine Lanzhou UniversityLanzhouChina Thoracic Surgery Service University Hospital of SalamancaBiomedical Institute of SalamancaSalamancaSpain Department of Thoracic Surgery Helios Clinic Bonn/Rhein SiegBonnGermany Division of Thoracic Surgery Department of SurgeryThe Ottawa

Background:Existing reporting guidelines pay insufficient attention to the detail and comprehensiveness reporting of surgical technique.The Surgical techniqUe rePorting chEcklist and standaRds(SUPER)aims to address this gap by defining reporting standards for surgical technique.The SUPER guideline intends to apply to articles that encompass surgical technique in any study design,surgical discipline,and stage of surgical innovation.Methods:Following the EQUATOR(Enhancing the QUAlity and Transparency Of health Research)Network approach,16 surgeons,journal editors,and methodologists reviewed existing reporting guidelines relating to surgical technique,reviewed papers from 15 top journals,and brainstormed to draft initial items for the SUPER.The initial items were revised through a three-round Delphi survey from 21 multidisciplinary Delphi panel experts from 13 countries and regions.The final SUPER items were formed after an online consensus meeting to resolve disagreements and a three-round wording refinement by all 16 SUPER working group members and five SUPER consultants.Results:The SUPER reporting guideline includes 22 items that are considered essential for good and informative surgical technique reporting.The items are divided into six sections:background,rationale,and objectives(items 1 to 5);preoperative preparations and requirements(items 6 to 9);surgical technique details(items 10 to 15);postoperative considerations and tasks(items 16 to 19);summary and prospect(items 20 and 21);and other information(item 22).Conclusions:The SUPER reporting guideline has the potential to guide detailed,comprehensive,and transparent surgical technique reporting for surgeons.It may also assist journal editors,peer reviewers,systematic reviewers,and guideline developers in the evaluation of surgical technique papers and help practitioners to better understand and reproduce surgical technique.

关键词： Surgical technique surgical innovation reporting guideline reporting checklist Surgical techniqUe rePorting chEcklist and standaRds(SUPER)

Analysis of COVID-19 Guideline Quality and Change of Recommendations:A Systematic Review

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Health Data Science 2021年第1期2021卷 88-109页

作者： Siya Zhao Shuya Lu Shouyuan Wu Zijun Wang Qiangqiang Guo qianling shi Hairong Zhang Juanjuan Zhang Hui Liu Yunlan Liu Xianzhuo Zhang Ling Wang Mengjuan Ren Ping Wang Hui Lan Qi Zhou Yajia Sun Jin Cao Qinyuan Li Janne Estill Joseph LMathew Hyeong Sik Ahn Myeong Soo Lee Xiaohui Wang Chenyan Zhou Yaolong Chen School of Public Health Lanzhou UniversityLanzhouChina Institute of Health Data Science Lanzhou UniversityLanzhouChina Department of Pediatric Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengduChina Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital ChengduChina Evidence-Based Medicine Center School of Basic Medical SciencesLanzhou UniversityLanzhouChina The First School of Clinical Medicine Lanzhou UniversityLanzhouChina National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and DisordersChina International Science and Technology Cooperation Base of Child Development and Critical DisordersChildren’s Hospital of Chongqing Medical UniversityChongqingChina Institute of Global Health University of GenevaGenevaSwitzerland Institute of Mathematical Statistics and Actuarial Science University of BernBernSwitzerland Advanced Pediatrics Centre PGIMER ChandigarhChandigarhIndia Department of Preventive Medicine Korea UniversitySeoulRepublic of Korea Korea Cochrane Centre SeoulRepublic of Korea Evidence Based Medicine SeoulRepublic of Korea Korea University School of Medicine SeoulRepublic of Korea Korea Institute of Oriental Medicine DaejeonRepublic of Korea University of Science and Technology DaejeonRepublic of Korea London Southbank University LondonUK Tianjin University of Traditional Chinese Medicine TianjinChina WHO Collaborating Centre for Guideline Implementation and Knowledge Translation LanzhouChina Guideline International Network Asia China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province Lanzhou UniversityLanzhouChina Lanzhou University GRADE Center China

Background.Hundreds of coronavirus disease 2019(COVID-19)clinical practice guidelines(CPGs)and expert consensus statements have been developed and published since the outbreak of the epidemic.However,these CPGs are of widely variable quality.So,this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs,exploring factors that may influence their quality,and analyzing the change of recommendations in CPGs with evidence published.Methods.We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs.The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE II instrument and RIGHT checklist.Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19(remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir)were also systematically assessed.And the statistical inference was performed to identify factors associated with the quality of CPGs.Results.We included a total of 92 COVID-19 CPGs developed by 19 countries.Overall,the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0%,and the AGREE II domain score was 30.4%.The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020.Factors associated with high methodological and reporting qualities included the evidence-based development process,management of conflicts of interest,and use of established rating systems to assess the quality of evidence and strength of recommendations.The recommendations of only seven(7.6%)CPGs were informed by a systematic review of evidence,and these seven CPGs have relatively high methodological and reporting qualities,in which six of them fully meet the Institute of Medicine(IOM)criteria of guidelines.Besides,a rapid advice CPG developed by the World Health Organization(WHO)of the seven CPGs got the highest overall scores in methodological(72.8%)and reporting

关键词： register formal transparency

2019年期刊公开发表的中国临床实践指南文献调查与评价——摘要报告现状分析

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协和医学杂志 2022年第5期13卷 880-887页

作者：任梦娟杨楠刘云兰孙雅佳史乾灵周奇王子君陈耀龙兰州大学公共卫生学院兰州730000 兰州大学基础医学院循证医学中心兰州730000 兰州大学第一临床医学院兰州730000 中国医学科学院循证评价与指南研究创新单元兰州大学基础医学院兰州730000 兰州大学健康数据科学研究院兰州730000 世界卫生组织指南实施与知识转化合作中心兰州730000 Cochrane中国协作网兰州大学分中心兰州730000 兰州大学GRADE中心兰州730000

目的调查2019年期刊公开发表的中国临床实践指南摘要报告现状,为相关研究人员撰写指南摘要及开展指南摘要报告规范研究提供参考。方法系统检索并筛选2019年期刊公开发表的中国临床实践指南,提取指南摘要相关信息,对2019年中国指南摘要... 详细信息

目的调查2019年期刊公开发表的中国临床实践指南摘要报告现状,为相关研究人员撰写指南摘要及开展指南摘要报告规范研究提供参考。方法系统检索并筛选2019年期刊公开发表的中国临床实践指南,提取指南摘要相关信息,对2019年中国指南摘要的报告情况进行分析;基于初拟版RIGHT-Abstract报告清单(包含7个领域,19个条目)对摘要报告质量进行评价,并比较摘要与正文内容报告的一致性。结果共纳入符合要求的指南226篇,报告摘要的指南96篇(42.5%);79篇(82.3%)指南发表语种为中文,其中同时提供中、英文摘要的指南52篇(65.8%),17篇(17.7%)发表语种为英文;仅6篇(6.3%)指南为结构式摘要,仅16篇(16.7%)指南在摘要中报告了推荐意见关注的主要内容。RIGHT-Abstract各领域的报告率分别为:背景61.0%,方法13.0%,结果7.3%,审核1.0%,讨论、注册和资助的报告率均为0。分析2019年中国指南摘要与正文内容报告的一致性,发现“疾病和卫生问题”的报告一致性最高(91.7%),其次为“目的”(78.1%)、“目标人群”(70.8%)、“使用者”(38.5%)和“制订人员”(38.5%),其余条目的一致性均低于20.0%。结论2019年中国指南摘要的整体报告率较低,结构式摘要占比较少,摘要报告的信息有限,未来需研发和推广正式的指南摘要报告规范,为相关研究人员提供指导。

关键词：临床实践指南摘要报告质量