Journal of Clinical Epidemiology

BackgroundSystematic reviews (SRs) are essential for evidence-based medicine but require extensive time and resources for abstract screening. Large language models (LLMs) offer potential for automating this process, yet concerns about data privacy, intellectual property protection, and reproducibility limit the use of cloud-based solutions in research settings. ObjectiveTo evaluate the performance of a locally deployed 20-billion parameter LLM for automated abstract screening in systematic revi...

BackgroundIn immune checkpoint inhibitor (ICI) trials, overall survival (OS) benefits are well established, yet improvements in quality of life (QoL) are often inconsistent or absent in conventional analyses. This apparent discordance raises important questions: are QoL outcomes truly unrelated to survival, and how can QoL results be better utilized and interpreted? MethodsA model-based meta-analysis (MBMA) of longitudinal EORTC QLQ-C30 global health status/quality of life data from randomized ...

BackgroundDelivering timely, high-quality feedback on resident scholarly projects is labour-intensive, especially in large programmes. We developed an AI-assisted evaluation system, powered by the open-weight LLaMA-3.1 large-language model (LLM), to generate formative feedback on Family Medicine residents scholarly projects and compared its performance with expert human evaluators. MethodsWe evaluated whether the AI-generated feedback achieves comparable quality to expert feedback. The tool ing...

BackgroundNo randomized clinical trial comparing the most established new modalities of treatment for patients with localized prostate cancer has been published, and there is scarce comparative effectiveness research assessing Patient-Reported Outcome Measures (PROMs). Objectiveto compare the impact of active surveillance, robot-assisted radical prostatectomy (RARP), Intensity-modulated radiotherapy (IMRT), and real-time brachytherapy on patients, through PROMs, from pre-treatment to five years...

ObjectivesGrowth Mindset and Grit have been proposed as key psychological resources for resilience and adaptation, yet their manifestation and social distribution in later life remain underexplored. This study examines the structure, distribution, and correlates of Growth Mindset and Grit in older adulthood using proxy indicators in the English Longitudinal Study of Ageing (ELSA). MethodsProxy indicators reflecting learning behaviour, personality traits, affect, and beliefs were used to derive ...

Hybrid controlled trials (HCTs) incorporate real-world data into randomized controlled trials (RCTs) by augmenting the internal control arm with patients receiving the same treatment in routine care. Beyond increasing power, HCTs may improve recruitment by supporting unequal randomization ratios that increase patient access to experimental treatments. However, HCT validity is threatened by bias from unmeasured confounding due to lack of randomization of external controls, leading to outcome non-...

PurposeLarge language models (LLMs) are used for biomedical text processing, but individual decisions are often hard to audit. We evaluated whether enforcing a mechanically checkable "show your work" quote affects accuracy, stability, and verifiability for trial eligibility-scope classification from abstracts. MethodsWe used 200 oncology randomized controlled trials (2005 - 2023) and provided models with only the title and abstract. Trials were labeled with whether they allowed for the inclusio...

BackgroundArtificial intelligence chatbots (AICs) are increasingly being integrated into scholarly publishing, with the potential to automate routine editorial tasks and streamline workflows. In traditional, complementary, and integrative medicine (TCIM) publishing, editorial and peer review processes can be particularly complex due to diverse methodologies and culturally embedded knowledge systems, presenting unique opportunities and challenges for AIC adoption. MethodsAn anonymous, online cro...

Objective: Evaluating and monitoring patients with cervical spondylotic myelopathy (CSM) remains a challenge due to limited tools for assessing objective neurological disability longitudinally and in the home environment. Given their prevalence and low cost, mobile health (mHealth), and specifically smartphone technologies offer a promising approach to fill this gap. This study explored stakeholder perspectives on the role of mHealth in CSM monitoring to inform development of a smartphone-based ...

ObjectiveTo systematically identify and characterize methodological heterogeneity in sepsis case detection methods using the MIMIC-III database or the eICU-CRD, and to quantify the resulting variability in sepsis detection rates. Materials and MethodsWe conducted a PRISMA-guided systematic review of PubMed and Web of Science (2016-2024), and stratified studies by cohort definition to obtain comparable subsets. We extracted information on sepsis case detection methodology across six domains: par...

BackgroundStroke is a leading cause of mortality and disability globally. However, information about stroke burden in the Philippines is limited. We sought to analyze stroke burden in the Philippines from 1990 to 2023. MethodsIncidence, prevalence, mortality, and disability-adjusted life-years (DALYs) estimates from the Global Burden of Disease Study 2023 data were used as indicators to analyze the burden of stroke by sex and age. Temporal trends in both crude and age-standardized rates were an...

Introduction: Neurodegenerative diseases (NDDs) including Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and non-AD dementias share chronic neuroinflammatory mechanisms that contribute to neuronal injury and disease progression. While anti-inflammatory therapies (AITs) are associated with reduced neurodegenerative disease risk, knowledge regarding the impact of biological sex and treatment duration across multiple NDDs remains li...

Background Older adults' walking has so far been evaluated using standardised assessments of walking capacity within a clinical setting. By taking the evaluation out of the laboratory into the real world, this study provides first evidence of the ability of Digital Mobility Outcomes (DMOs) to detect changes over time and the Minimal Important Difference (MID) in patients after proximal femoral fracture (PFF). This will guide the implementation of DMOs in research and clinical care. Methods For t...

Students who frequently miss school are at greater risk for academic difficulty. High levels of absenteeism as early as kindergarten have been associated with long-term consequences, such as low reading proficiency in Grade 3 and low academic achievement in Grade 5, both of which have been associated with lower rates of high school graduation and enrollment in post-secondary education. The prevalence of school absenteeism has increased significantly since the COVID-19 pandemic and there have bee...

BackgroundCanine impaction represents one of the most challenging clinical scenarios in orthodontic practice, with maxillary canines being the second most commonly impacted teeth after third molars. The management of impacted canines through orthodontic traction requires an advanced understanding of biomechanical principles, surgical techniques, and patient-specific factors. The decision to attempt traction must be informed by accurate differentiation between mechanical impaction and primary fai...

BackgroundPersonalized medicine promises to tailor treatments to the individual, but it carries a hidden risk: mistaking statistical noise for actionable clinical insight. Current machine learning approaches often provide predictions, but fail to inform clinicians when those predictions are unreliable. ObjectiveDevelop a deployment-readiness framework that integrates causal inference, interpretable effect-trees, and calibration assessment to distinguish actionable signal from unreliable variati...

Objective: Minimum unit pricing (MUP) aims to reduce use of cheap, high strength alcoholic beverages that drive harm, yet concerns remain about inequitable effects for structurally vulnerable groups. As part of the Costs, Harms, Expenditures and Alcohol Prices (CHEAP) study, we linked individual-level, product-specific alcohol consumption data from a customized survey with provincial retail price data to estimate prices per standard drink (PPSD) and examine their association with alcohol-related...

BackgroundTwo RSV immunisations products: a maternal vaccine, Abrysvo, and a long-acting monoclonal antibody, nirsevimab, both designed to prevent RSV illness in infants, have recently become available. Modelling evidence is required to inform how to optimally use these products in immunisation programs to reduce the burden of RSV in young children. MethodsWe extend a dynamic transmission model calibrated to RSV-hospitalisation data of children aged < 5 years in temperate Western Australia (WA)...

IntroductionAtmospheric conditions under climate change increase pressure on healthcare systems. Especially, the intensive care units (ICU) are vulnerable due to low buffer capacity and high utilization rates. MethodsDaily ICU cases from 2009 to 2023 were derived from the German statutory health insurance data of eleven regional AOK insurances. Cases were stratified by age and sex. Generalized additive models were used to investigate the associations between daily ICU cases and lagged atmospher...

Suicide is one of the worlds leading public health problems, with more than 720,000 deaths annually. Suicide has traditionally been studied from an individual perspective. However, research has increasingly highlighted the influence of community-level factors on suicide risk. This study aimed to (1) analyse the spatial distribution of suicide mortality at the provincial level in Spain (2018-2022); (2) perform stratified analyses by sex and age group; and (3) compare suicide risk across differen...