AIM:Health system resilience (HSR) has gained prominence in response to acute shocks and chronic stressors, particularly following the COVID-19 pandemic. This study aimed to analyze the conceptualization, frameworks, and operationalization of HSR in empirical research. METHODS:We searched PubMed, Web of Science, and Global Health databases from inception to January 26, 2024 to identify empirical HSR studies. We screened studies independently, and systematically extracted data. Analyzed were conducted across study characteristics, shocks/stressors types, conceptualizations/definitions, framework traditions, and methodological approaches. RESULTS:A total of 125 empirical studies were included, with a marked increase from 2020 onward. Most studies examined acute shocks (84%), with the largest share in the Europe (23.3%) and Africa (16.8%). HSR was predominantly conceptualized as a system capacity to absorb and adapt to shocks, while learning and transformation were less frequently operationalized. Health system-specific frameworks (e.g., Kruk; Blanchet) were most commonly used, primarily as analytical lenses rather than measurement tools. Qualitative methods predominated, although mixed-methods approaches are emerging. Evidence on continuity of essential functions and everyday resilience remained limited. CONCLUSIONS:Despite growing conceptual sophistication, empirical HSR research remains constrained by fragmented frameworks use and limited operationalization. Advancing the field requires clearer conceptual boundaries, improved methodological integration, and greater attention to how resilience is enacted in routine system functioning.

This is a protocol for a Campbell Evidence and Gap Map (EGM) of the studies of the effect of health interventions to reduce out-of-pocket expenses (OOPE). The objective is to identify existing gaps in the available evidence where further primary studies and systematic reviews are needed.

Objective A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of different interventions in preventing gestational hypertension (GHT).Methods A comprehensive search of English databases was performed from database inception to March 1st, 2025 to identify randomized controlled trials (RCTs) evaluating different interventions for the prevention GHT. The methodological quality and risk of bias for the included trials were appraised according to the Cochrane Handbook tool. A network meta-analysis was conducted using Stata version 15.1 software, and pooled effect estimates were expressed as the odds ratio (OR) with 95% confidence interval (CI).Results A total of 50 randomized controlled trials involving 57,836 pregnant women were included in the network meta-analysis. For all included trials, 12 interventions were evaluated, resulting in 66 direct pairwise comparisons. The network meta-analysis demonstrated that compared with Placebo, Aspirin (OR = 0.68, 95% CI [0.48, 0.95]), Calcium (OR = 0.55, 95% CI [0.38, 0.80]), and the combination of Aspirin plus Calcium (OR = 0.12, 95% CI [0.03, 0.47]) were associated with a significantly reduced risk of gestational hypertension. Moreover, exercise (OR = 0.39, 95% CI [0.19, 0.82]) and aspirin plus calcium (OR = 0.12, 95% CI [0.03, 0.42]) were superior to usual-care in the prevention of GHT. Exercise includes yoga and walking. Ranking analysis based on the surface under the cumulative ranking curve (SUCRA) indicated that aspirin plus calcium had the highest probability of becoming the most effective intervention.Conclusions Maternal exercise (such as yoga and walking) or combined aspirin plus calcium supplementation might be promising interventions for the prevention of GHT. However, due to the limited number of available trials and the presence of potential heterogeneity, further large-scale, high-quality randomized controlled trials are warranted to validate these findings.

AIMS:Pharmacologic treatment is widely used for managing gestational diabetes mellitus (GDM). However, evidence remains limited on the comparative effectiveness and safety across different drug classes for GDM. This study aims to compare the efficacy and safety of pharmacologic treatments for GDM using network meta-analysis of randomised controlled trials (RCTs). MATERIALS AND METHODS:We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science up to May 16, 2025 to identify trials evaluating glucose levels and maternal or neonatal complications in GDM patients using any pharmacologic agents, e.g., insulin, biguanides, sulfonylureas, α-glycosidase inhibitors, sodium-glucose cotransporter-2(SGLT-2) inhibitors, dipeptidyl peptidase IV(DPP-IV) inhibitors or Glucagon-like peptide-1receptor (GLP-1 RAs) versus standard care. We used random-effects model for both pairwise meta-analyses and frequentist network meta-analyses and applied the Confidence in Network Meta-Analysis (CINeMA) framework to assess the certainty of evidence. RESULTS:Seventy-three articles were eligible, comprising 71 trials in which 14 877 participants were enrolled and seven drug classes assessed. All subsequent effects refer to comparisons with standard care. Because of their moderate to high evidence of certainty, sulfonylureas were established as the most effective drugs used for lowering fasting glucose (mean difference [MD]: -0.33 mmol/L; 95% confidence interval [CI]: -0.55 to -0.1), followed by insulin (MD: -0.3 mmol/L; 95% CI: -0.4 to -0.21) and biguanides (MD: -0.2 mmol/L; 95% CI: -0.28 to -0.12). Biguanides were the most effective drugs used to control haemoglobin A1c (MD: -0.1%; 95% CI: -0.16 to -0.03), but their use was associated with increased adverse events leading to low birth weight among infants (OR: 2.04; 95% CI: 1.04-4.01). Insulin (OR: 0.51; 95% CI: 0.34-0.75), biguanides (OR: 0.39; 95% CI: 0.26-0.59), and sulfonylureas (OR: 0.5; 95% CI: 0.31-0.79) use could decrease the risk of macrosomia. Sulfonylureas were found to be more easily get premature delivery and neonatal hypoglycaemia than biguanides; evidence regarding their impact on low birth weight and long-term safety remains lacking. CONCLUSION:Insulin use provides significant benefits in achieving glycaemic control and minimising maternal and foetal complications, and it has a favourable overall safety profile. Biguanide use may be associated with an increased risk of low birth weight, warranting careful consideration and thorough counselling for shared decision-making. Currently, insufficient evidence supporting the efficacy and safety of sulfonylureas, α-glycosidase, DPP-IV, and SGLT-2 inhibitors; and GLP-1 RAs in GDM management is available.

BackgroundEvidence briefs for policy (EBPs) are effective tools for delivering research evidence to policymakers and other stakeholders by highlighting high-priority issues, outlining options and considering implementation strategies. However, policymakers' demands for evidence and policy-relevant information across different fields have led to variability in the terminology used to describe EBPs, and the methodological quality of these EBPs remains unclear. This study aims to (1) identify organizations whose definitions of EBPs contain the three key components of problem, options and implementation considerations, (2) assess the methodological quality of EBPs that incorporate these three key components and (3) identify existing evaluation/assessment tools of EBPs.MethodsA two-stage documentary analysis approach was used. First, we identified documents that were produced by organizations/institutions to inform policymakers and that contained the three key components (Problem, Options and Implementation considerations). Second, the methodological quality of the documents was assessed from the perspectives of the evidence supply side (that is, evidence synthesis) and the evidence demand side (that is, mapping of and engagement between both policymakers and stakeholders).ResultsIn 22 organizations, the term policy brief was the most commonly used, accounting for 50% of organizations, while other terms varied. Issue briefs were used by three organizations (13.6%) and evidence briefs were used by two organizations (9.1%). In total, 50 individual documents from nine different organizations were included to evaluate components and methodology. (1) From the supply-side perspective: 17 (34%) documents described the search resources, 10 (20%) documents described evidence certainty and 15 (30%) assessed the methodological quality of the research evidence. (2) From the demand-side perspective: 30 (60%) documents were developed in response to demand-side needs, while 27 (54%) included both stakeholder mapping and engagement.ConclusionsMethodological shortcomings were identified in the EBPs from both the supply-side and demand-side perspectives, highlighting the need to validate and better implement existing tools and to complement existing guidelines.

To systematically evaluate the effects of umbilical cord mesenchymal stem cells (UCMSCs) on the ovarian microenvironment in mouse models of premature ovarian failure (POF). A comprehensive search was conducted in Wanfang, VIP, CNKI, PubMed, Web of Science, Embase, and Cochrane Library databases for randomized controlled animal trials on the transplantation of mesenchymal stem cells for treating the ovarian microenvironment. The search period was from the establishment of the databases to September 19, 2025. Two researchers independently screened the literature, extracted data, and evaluated the methodological quality using the SYRCLE risk of bias tool for animal experiments. Quantitative data were analyzed using RevMan 5.4.1 software. A total of 10 randomized controlled animal studies were included. The meta-analysis results showed that the transplantation of UCMSCs could significantly increase the number of primordial follicles [SMD = 3.71, 95

Evidence-based medicine (EBM), formalized in the 1990s, has redefined clinical practice by advocating the integration of research evidence, clinical expertise, and patient values. This paradigm has introduced methodological rigor through randomized controlled trials (RCTs) to establish causality, systematic reviews to synthesize findings, and the GRADE approach to evaluate evidence based on risk of bias, inconsistency, indirectness, imprecision, and publication bias. These advancements have shaped clinical guidelines, reduced practice variability, and influenced medical education toward evidence-based inquiry. Despite its contributions, EBM faces challenges in the evolving landscape of modern medicine. The lengthy process of evidence generation, often requiring years for trials and guideline updates, limits responsiveness to emerging health needs, as observed during the COVID-19 pandemic. The external validity of RCT results is constrained by strict inclusion criteria, posing difficulties in applying findings to diverse patient populations with comorbidities. Additionally, the siloed nature of evidence complicates comprehensive care for multifactorial conditions, while the annual influx of over one million medical publications overwhelms traditional synthesis methods. Artificial intelligence (AI) presents a promising avenue to address these issues, leveraging capabilities in processing heterogeneous data. Natural language processing may enhance literature analysis, machine learning could identify patterns in complex datasets, and causal inference might improve the reliability of observational data insights. These technologies hold potential to accelerate evidence development and tailor it to individual needs. This paper proposes digital intelligent evidence-based medicine (i-EBM) as a conceptual evolution of EBM, designed for the AI era. i-EBM envisions a three-layered framework. The data foundation layer aims to integrate structured evidence from RCTs, domain knowledge such as biomedical ontologies and traditional Chinese medicine principles, and multi- modal patient data, including electronic health records, genomics, and wearable device outputs. Knowledge graphs are proposed to link these elements into a unified, computable knowledge network. The intelligent processing layer seeks to apply AI for evidence retrieval, data extraction, quality assessment, and synthesis, potentially using large language models to assist these processes. The knowledge service layer intends to provide dynamic guidelines and individualized predictions, supported by ongoing human-machine collaboration to ensure clinical relevance and ethical considerations. i-EBM has the potential to mitigate EBM's limitations by facilitating real-time evidence updates, reducing knowledge fragmentation through integrated data, and offering personalized decision support. For instance, it may support precision medicine by connecting diverse data sources, with applications possibly extending to fields like oncology or traditional Chinese medicine. Future research could explore autonomous AI systems, optimized clinical workflows, and governance frameworks to address data privacy, bias, and global standardization. In conclusion, i-EBM offers a theoretical framework to extend EBM principles, harnessing AI's potential alongside human expertise to advance medical research and practice. Meanwhile, for issues such as the quantitative study of the complex intervention characteristics and syndrome differentiation patterns of traditional Chinese medicine, i-EBM can provide methodological support in data integration, pattern recognition, and causal inference, offering potential tools and insights for uncovering the intrinsic regularities of TCM evidence and optimizing its evaluative framework.

This study systematically evaluated the impact of delayed surgery after neoadjuvant chemoradiotherapy (nCRT) on the outcomes of locally advanced rectal cancer (LARC). The PubMed, Embase, Cochrane Library, Web of Science, Chinese Biology Medicine, China National Knowledge Infrastructure, WanFang, and Chinese Scientific Journal (VIP) electronic databases were searched from their inception to September 2024 for relevant publications on LARC for which surgery was performed >8 weeks (long interval, LI) and ≤8 weeks (short interval, SI) of nCRT. The included studies were screened and evaluated according to the inclusion and exclusion criteria, and a meta-analysis was performed using RevMan 5.4 software. The search finally yielded 28 studies involving 20,988 patients were included, with 12,176 in the SI group and 8812 in the LI group. While the pathologic complete response (pCR) rate was higher in the LI group than in the SI group, the LI group showed worse overall and disease-free survival. Morbidity, anastomotic leakage rate, operation time, distant metastasis rate, anal preservation rate, and perioperative mortality did not differ significantly between the two groups. The results of this analysis demonstrated that although a longer interval between nCRT and surgery can improve the pCR rate, it may reduce survival outcomes. Owing to limitations in the study number and quality, these findings require further verification by multicenter, large-sample, high-quality randomized controlled trials.

Several studies have demonstrated that beneficial gut microorganisms, such as probiotics, can treat functional constipation in children. We aim to evaluate the effectiveness of probiotics, prebiotics, and synbiotics in treating childhood functional constipation. We conducted a comprehensive search of eight electronic databases, dating from their inception up to July 11, 2024. The eligibility criteria were randomized controlled trials (RCTs) that reported on the use of probiotics, prebiotics, or synbiotics for treating childhood functional constipation. The RCTs were evaluated using the Cochrane Risk of Bias tool, and a random effects network meta-analysis was performed under a frequentist framework. Fifteen RCTs involving 1087 participants were identified. Seventeen types of interventions were investigated. With low or very low confidence in the evidence, no significant differences in bowel movements per week were detected between the intervention and placebo groups. Based on very low-certainty evidence, when Mixed was compared with S. boulardii, Mixed (SMD = 0.86, 95

BACKGROUND:Osteoporosis is a common chronic skeletal disorder characterized by decreased bone mass and microarchitectural deterioration, resulting in increased fragility and fracture risk. With rapid population aging in China, the prevalence of osteoporosis is rising, while public awareness and engagement in prevention remain insufficient. Existing national guidelines mainly target healthcare professionals and lack accessible, evidence-based recommendations for the general public. This guideline aims to provide practical guidance for osteoporosis risk assessment and prevention at the population level. METHODS:The guideline was developed by the Chinese Health Risk Management Collaboration-Osteoporosis Group in accordance with the WHO Handbook for Guideline Development, the Principles for Developing or Revising Clinical Practice Guidelines in China (2022), and AGREE II and RIGHT frameworks. Evidence from both English and Chinese databases was synthesized and graded using the GRADE approach. Fourteen key questions were formulated through a modified Delphi consensus process. RESULTS:A total of 15 recommendations were developed, covering osteoporosis risk screening (OSTA, IOF One-Minute Test, FRAX), dietary and nutritional strategies (protein, dairy, calcium, vitamin D, fruits and vegetables), lifestyle interventions (exercise, bodyweight control, sunlight exposure, smoking cessation, alcohol reduction, tea drinking), and fracture prevention in patients with osteoporosis. CONCLUSION:This guideline provides practical, evidence-based strategies to improve public awareness and promote risk management of osteoporosis among the general population, potentially reducing fracture incidence and public health burden.

High prices of medical consumables pose a major barrier for patients. To address those inflated prices, the National Healthcare Security Administration of China implemented the Centralized Volume-Based Procurement policy (CVBP) in 2021. However, evidence assessing the effect of CVBP in Gansu is insufficient. This study aims to estimate the impact of CVBP for high-value medical consumables in Gansu on the hospitalization expenses. Data from 8076 inpatients in Gansu who underwent surgeries involving coronary stents, artificial joints, or intraocular lenses between April 2019 and October 2024 were collected. An interrupted time series analysis (ITSA) was conducted to examine the effect of CVBP on patient hospitalization expenses. An autoregressive integrated moving average (ARIMA) model was used to assess the difference between the predicted and actual expenses after the implementation of CVBP. (i) After implementation, the material expense per patient who underwent surgeries involving artificial joints was reduced by 387.782 Chinese yuan (CNY) (95

Abstract Background Evidence quality assessment is critical for informed public health decision-making, but manual approaches are time-consuming and subject to variability. Automated support tools have been proposed to improve efficiency and consistency, yet their current status has not been comprehensively or systematically mapped. Objective To identify or map the characteristics, performance, and limitations of existing automated tools for evidence quality assessment. Methods Following the JBI methodology and PRISMA-ScR checklist, we searched 6 English and 4 Chinese databases from their inception to February 9, 2025, to identify studies evaluating automated tools for evidence quality assessment. Eligible studies included original research on tool development, application, or validation. Study characteristics (e.g., year, country, design, tool type, technical features, reliability, and validity) were extracted and summarized descriptively. Results Twenty studies were included, most from the United Kingdom (30%), Canada (25%), and Australia (15%). Observational designs predominated (75%), with only 10% randomized controlled trials (RCTs). Twelve distinct tools were identified, of which 65% were publicly available. 58% of the tools were developed for RCTs, while 50% remained experimental and required human oversight. Reported outcomes focused on sensitivity, specificity, precision, efficiency, and consistency. Despite promising results, external validity and scalability were limited. Conclusion Automated tools for evidence quality assessment show potential to enhance efficiency and consistency but remain restricted in applicability. Current tools are often tailored to clinical trials and require human supervision. Broader adaptation and rigorous validation are needed before such tools can be widely integrated into public health decision-making.

This is the protocol for a Campbell systematic review. The objectives are as follows: To evaluate the effectiveness of online distance education compared to other approaches on K-12 students' academic performance; to evaluate the effectiveness of online distance education compared to other approaches on K-12 students' non-academic performance, including classroom participation, learning interest, learning pressure, social skills and social isolation, and; to evaluate the potential moderators between online distance education and students' performance and other outcomes, such as grade, country, subject, study duration, teaching content and methods, and family circumstances.

OBJECTIVE:This mixed-method systematic review evaluated the efficacy and safety of Traditional Chinese Medicine (TCM) for metabolic dysfunction-associated steatotic liver disease (MASLD) and identified core TCM herbs/compatibility regimens. METHODS:Six databases were searched (inception to December 31, 2025) for randomized controlled trials (RCTs) of TCM combinations for adult MASLD, with placebo/treatment-as-usual (TAU) as controls. Two independent teams performed screening, data extraction and quality assessment. Quantitative synthesis included meta-analysis with subgroup/meta-regression analyses, publication bias assessment and sensitivity analysis; qualitative synthesis used TCM data mining to identify core herbs and compatibility patterns. RESULTS:A total of 56 RCTs were included. TCM significantly improved TCM Symptom Score, clinical effective rate, liver controlled attenuation parameter (CAP), liver function (ALT, AST, GGT), lipid metabolism (TC, TG, LDL-C) and reduced BMI, with no benefit for HDL-C. Male proportion had no moderating effect on outcomes. TCM-related adverse events (mainly diarrhea and gastrointestinal discomfort) were mild and rare; 63.2% of studies reported no adverse events. Included RCTs had suboptimal methodological quality (high unclear bias in allocation concealment and blinding). Qualitative analysis of 39 studies identified 78 TCM herbs, with Crataegus pinnatifida (Shan Zha) the most frequent. Six core herbs were identified, with Salvia miltiorrhiza (Dan Shen) and Crataegus pinnatifida (Shan Zha) as the core of the compatibility regimens. CONCLUSIONS:TCM formulations may provide symptomatic and metabolic benefits for MASLD with acceptable safety and identifiable core herbs; however, evidence certainty is very low due to pervasive poor methodological quality of included RCTs, which severely undermines confidence in findings. High-quality RCTs and mechanistic research are warranted.

Hypertension is a major risk factor for cardiovascular disease. Salt substitutes may reduce sodium intake while maintaining palatability, but comparative effects across formulations remain uncertain. We conducted a systematic review and frequentist random-effects network meta-analysis of randomised controlled trials in adults comparing salt substitutes with regular salt, other substitutes or no intervention. Databases (PubMed, Embase, CENTRAL, CNKI, Wanfang), WHO-ICTRP and ClinicalTrials.gov were searched from inception to Oct 3, 2025 (PROSPERO CRD42023451859). We assessed the risk of bias using a modified Cochrane tool and conducted a random-effects network meta-analysis, with evidence certainty evaluated through the GRADE approach. We included 34 randomised controlled trials involving 37,063 participants across 15 countries (17 from China, 17 from other countries; mean age 62.3 years). Our results indicate that moderate-potassium and low-sodium salt substitutes (25–40

This study aims to develop a theoretical framework to support the implementation of health-system guidance, contributing to broader efforts to promote evidence-informed policymaking in health systems. A critical interpretive synthesis was conducted to identify relevant literature from 11 databases and gray literature sources. The documents were assessed for relevance and quality, and data were extracted and synthesized using an interpretive analytic method. Based on the synthesized data, the framework was developed and subsequently refined by the authors. A total of 21 documents published from 2004 to 2024 were included, with 15 (71%) empirical studies and six (29%) non-empirical. The resulting theoretical framework for supporting health-system guidance implementation identified 10 facilitators, 10 barriers, nine combined facilitators and barriers, and 11 strategies across six levels: political system, health system, community, organizational, providers and patients/public. This framework offers a structured approach to comprehensively understanding the various factors and levels involved in health-system guidance implementation. With further development into a practical tool, it may help inform implementation efforts across diverse topics and contexts.

Background Living evidence (LE) synthesis refers to the method of continuously updating systematic evidence reviews to incorporate new evidence. It has emerged to address the limitations of the traditional systematic review process, particularly the absence of or delays in publication updates. The emergence of COVID-19 accelerated the progress in the field of LE synthesis, and currently, the applications of artificial intelligence (AI) in LE synthesis are expanding rapidly. However, in which phases of LE synthesis should AI be used remains an unanswered question. Objective This study aims to (1) document the phases of LE synthesis where AI is used and (2) investigate whether AI improves the efficiency, accuracy, or utility of LE synthesis. Methods We searched Web of Science, PubMed, the Cochrane Library, Epistemonikos, the Campbell Library, IEEE Xplore, medRxiv, COVID-19 Evidence Network to support Decision-making, and McMaster Health Forum. We used Covidence to facilitate the monthly screening and extraction processes to maintain the LE synthesis process. Studies that used or developed AI or semiautomated tools in the phases of LE synthesis were included. Results A total of 24 studies were included, including 17 on LE syntheses, with 4 involving tool development, and 7 on living meta-analyses, with 3 involving tool development. First, a total of 34 AI or semiautomated tools were involved, comprising 12 AI tools and 22 semiautomated tools. The most frequently used AI or semiautomated tools were machine learning classifiers (n=5) and the Living Interactive Evidence synthesis platform (n=3). Second, 20 AI or semiautomated tools were used for the data extraction or collection and risk of bias assessment phase, and only 1 AI tool was used for the publication update phase. Third, 3 studies demonstrated the improvement in efficiency achieved based on time, workload, and conflict rate metrics. Nine studies applied AI or semiautomated tools in LE synthesis, obtaining a mean recall rate of 96.24%, and 6 studies achieved a mean F1-score of 92.17%. Additionally, 8 studies reported precision values ranging from 0.2% to 100%. Conclusions AI and semiautomated tools primarily facilitate data extraction or collection and risk of bias assessment. The use of AI or semiautomated tools in LE synthesis improves efficiency, leading to high accuracy, recall, and F1-scores, while precision varies across tools. Trial Registration OSF Registries 87tp4; https://osf.io/4fvdq/overview

OBJECTIVES:To systematically review the utilisation of the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework within the context of WHO public health guidelines (PHGs), identifying key features, areas of concentration and potential deficiencies. DESIGN AND SETTING:From 2007 to February 2024, a comprehensive search of the WHO website was conducted to identify PHGs that have incorporated the GRADE methodology. PARTICIPANTS:The study focused on the PHGs identified through the above search. INTERVENTIONS:Data extraction and analysis were independently conducted by researchers using Microsoft Excel 2019. MAIN OUTCOME MEASURES:For each PHG, key recorded characteristics included publication details, thematic areas, the strength of recommendations, the certainty of evidence, and characteristics of the GRADE downgrading/upgrading domains. RESULTS:Out of 228 PHGs examined, 9234 (90.55%) outcome indicators used the GRADE rating system, predominantly in the area of sexual and reproductive health (50%). Only 31.62% of the outcomes reported moderate and high certainty in evidence. The main clustering results were dominated by adverse events. Among the 4013 recommendations, 2067 (51.51%) were strong, while 1477 (36.81%) were weak/conditional. It is noteworthy that 46.83% of the strong recommendations were based on low or very low confidence in evidence. Among these strong recommendations, 119 met the criteria of five paradigmatic situations where it was necessary to issue a strong recommendation despite low or very low confidence in the effect estimates. Among the 13 230 instances of downgrading, 41.09% were due to the risk of bias and 35.90% were due to imprecision. Only 0.25% outcomes were upgraded by the magnitude of effect size and 0.03% by dose-response gradient. CONCLUSION:The GRADE approach is widely used in the development of PHGs. More than half of the recommendations in PHGs are based on low or very low-quality evidence, primarily due to risks of bias and imprecision. Additionally, strong recommendations based on low-confidence or very low-confidence estimates are frequently made. Therefore, it is necessary to enhance guideline developers' understanding of the GRADE methodology and to further investigate and clarify discordant recommendations in PHGs.

OBJECTIVES:To identify the reporting characteristics and recommended design features of mapping reviews for public health decision-makers. STUDY DESIGN AND SETTING:We conducted a scoping review of mapping reviews and related methodological studies for public health decision-makers, following JBI scoping review methodology and PRISMA extension for Scoping Reviews (PRISMA-ScR). We searched nine English- and Chinese-language databases, six relevant websites, and supplementary Google searches for studies published from January 2003 to December 2025. Screening and data extraction were conducted independently by paired reviewers, and any disagreements were resolved through discussion with a third reviewer. Results were synthesized using descriptive statistics and basic qualitative content analysis. RESULTS:A total of 77 studies were included: 71 mapping reviews and 6 methodological studies. Most studies were from the UK (44.16%), used interactive maps (50, 64.94%), focused on communicable and infectious diseases (21, 27.27%), and were funded primarily by government or public funders (24, 31.17%); "evidence and gap map" was the most commonly used term. Among journal-identified mapping reviews, reporting was limited for registration information (20.51%), deviations from protocol (25.64%), excluded studies (30.77%), stakeholder engagement (33.33%), and plans for map updates (41.03%). Among website-identified evidence maps, 12 (37.5%) reported evidence quality or recommendation strength, and descriptive reporting was fragmented. Methodological studies suggested that mapping reviews for public health decision-makers should be standardized, transparent, traceable, and updateable to support decision-making. CONCLUSION:Reporting quality of mapping reviews for public health decision-makers varies across dissemination routes, and tailored reporting guidance is needed to improve transparency, updatability, and decision utility.

RESUMO A trombose venosa profunda (TVP) é uma condição na qual um coágulo se forma nas veias profundas, mais comumente nas pernas. A incidência dessa condição é de aproximadamente uma em cada 1.000 pessoas. Se não tratada, o coágulo pode se deslocar para os pulmões e causar uma embolia pulmonar (EP), que pode ser fatal. Tradicionalmente, o tratamento para TVP envolvia o uso de heparina e antagonistas da vitamina K. No entanto, foram desenvolvidas duas formas de anticoagulantes orais diretos (ACODs), os inibidores diretos da trombina (IDTs) e os inibidores do fator Xa. Esses medicamentos apresentam características que podem ser favoráveis em comparação ao tratamento convencional, como a administração oral, efeitos previsíveis, ausência da necessidade de monitoramento frequente ou ajuste de dose e poucas interações medicamentosas conhecidas. Atualmente, os ACODs são comumente usados no tratamento de TVP e EP, sendo recomendados por diretrizes recentes, em vez dos anticoagulantes convencionais. Esta Revisão Cochrane, publicada inicialmente em 2015, foi a primeira revisão sistemática a avaliar a eficácia e segurança desses medicamentos no tratamento da TVP. Esta é uma atualização da revisão de 2015.