The exponential growth of scientific literature poses increasing challenges for evidence synthesis. Systematic reviews (SRs) usually rely on keyword-based database searches, which are limited by inconsistent terminology and indexing delays. Citation searching-identifying studies that cite or are cited by known relevant articles-offers a complementary route to uncover additional evidence but remains poorly automated and integrated into screening workflows. We developed BibliZap, an open-source, fully automated citation-searching tool built on Lens.org data, performing multi-level forward and backward citation searches with relevance-based ranking. Its performance was evaluated across 66 published SRs, comparing five approaches: (1) PubMed-only searches; (2) PubMed followed by BibliZap restricted to the top 500 ranked results; (3) PubMed followed by full BibliZap screening; and (4-5) two exploratory early-stop strategies where BibliZap was initiated after identifying the first or the first three PubMed relevant records. The primary outcome was sensitivity, with secondary assessments of screening workload and precision. When used after PubMed screening, BibliZap increased mean sensitivity from 75% to 97%, achieving complete recall in over half of the reviews. Screening only the top 500 outputs still allowed over 90% of reviews to reach or exceed 80% recall. BibliZap recovered a median of three additional included articles per review, not retrieved by PubMed, while adding a median of 6,450 additional records. Citation searching via BibliZap enhances the completeness of evidence retrieval in SRs based on restricted database searches and supports transparent, scalable workflows adaptable to rapid and exploratory review contexts.

Background:Developing diagnostic reasoning in nephrology is particularly challenging due to its pathophysiological complexity and reliance on abstract clinical data. Objective Structured Clinical Examinations (OSCEs) are pivotal for nephrology training but remain resource-intensive and difficult to scale. Generative artificial intelligence (AI) offers a promising alternative, yet its capacity to emulate nephrology-specific OSCEs has not been formally assessed. Methods:We developed ECOSBot, a web-based tool powered by GPT-4o, to simulate both standardized patients and examiners for nephrology-focused OSCEs. In this multicenter prospective study, undergraduate medical students from five French medical schools interacted with ECOSBot across four clinical stations. All interactions were double-rated by nephrology faculty members to establish a gold standard. ECOSBot's performance was evaluated against this standard using four criteria (script coverage, authenticity, correctness and relevance) for patient simulation, and via checklists and competency-based ratings for examiner scoring. Usability was assessed using the Chatbot Usability Questionnaire (CUQ), adapted to include six items on feedback quality. Results:Ninety-one students generated 2939 prompts across 184 OSCE sessions. ECOSBot demonstrated high fidelity in patient simulation: authenticity 98.6% [95% confidence interval (CI) 98.2-99.0], correctness 98.3% (95% CI 97.9-98.7) and relevance 99.2% (95% CI 98.9-99.5), including during exchanges not explicitly covered by the pre-specified scenario. As an examiner, ECOSBot showed strong agreement with human raters on global scores [intraclass correlation coefficient (ICC) = 0.94, 95% CI 0.91-0.96], consistent across case formats, training levels and institutions. However, scoring of attitude and communication skills was less reliable (ICC = 0.44, 95% CI 0.28-0.58). Median CUQ score was 69.7/100, with 91.7% of students finding the tool highly useful for OSCE preparation in nephrology. Conclusions:ECOSBot reliably simulated both roles in nephrology OSCEs with high fidelity and strong alignment with expert rating. While challenges remain for subjective skill assessment, this tool offers a scalable and autonomous solution to enhance nephrology education.

Objectives:The objective of the study was to determine, after medication review, the patient risk score threshold that would distinguish between stays with prescriptions triggering pharmacist intervention (PI) and stays with prescriptions not triggering PI. Materials and Methods:The study was retrospective and observational, conducted in the clinical pharmacy team. The patient risk score was adapted from a Canadian score and was integrated in the clinical decision support system (CDSS). For each hospital stay, the score was calculated at the beginning of hospitalization and we retrospectively showed if a medication review and a PI were conducted. Then, the optimal patient risk score threshold was determined to help pharmacist in optimizing medication review. Results:During the study, 973 (56.7%) medication reviews were performed and 248 (25.5%) led to a PI. After analyzing sensitivity, specificity, and positive predictive value of different thresholds, the threshold of 4 was deemed discriminating to identify hospital stays likely to lead to a PI following a medication review. At this threshold, 600 hospital stays would have been detected (33.3% of the latter led to a PI), and 5.0% of stays with a medication review would not have been detected even though they were hospital stays that had triggered a PI. Discussion and Conclusion:Integration of a patient risk score in a CDSS can help clinical pharmacist to target hospital stays likely to trigger a PI. However, an optimal threshold is difficult to determine. Constructing and using a score in practice should be organized with the local clinical pharmacy team, in order to understand the tool's limitations and maximize its use in detecting at-risk drug prescriptions.

IntroductionExplicit definitions for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. The objective of the present study was to validate a list of definitions of PIPs for antidiabetic drugs in a Delphi survey with general practitioners, diabetologists, community pharmacists, hospital pharmacists and pharmacologists from mainland France, Belgium, and Switzerland.MethodsThe experts gave their opinion on each explicit definition and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were validated. The results were discussed during consensus meetings after each round.Results46 participants were recruited, and 38 (82.6%) completed the survey. The Delphi survey resulted in a consensus list of 41 explicit definitions of PIPs for antidiabetic drugs in four groups: (i) the need to temporarily discontinue a medication in the event of acute illness (n = 9; 22%), (ii) the need to review and adjust the dosing regimen (n = 26; 36.6%), (iii) the initiation of an inappropriate drug (n = 3; 7.3%), and (iv) the need for further monitoring of a people with type 2 diabetes (n = 3; 7.3%).ConclusionsThe list is specific for antidiabetic drugs (other than insulin) for people with type 2 diabetes. This explicit list could be implemented in a clinical decision support system for the automatic detection of PIPs and might help healthcare professionals involved in the management of people living with type 2 diabetes.

INTRODUCTION:The management of chronic diabetes mellitus and its complications demands customized glycaemia control strategies. Polypharmacy is prevalent among people with diabetes and comorbidities, which increases the risk of adverse drug reactions. Clinical decision support systems (CDSSs) may constitute an innovative solution to these problems. The aim of our study was to conduct a systematic review assessing the value of CDSSs for the management of antidiabetic drugs (AD). MATERIALS AND METHODS:We systematically searched the scientific literature published between January 2010 and October 2023. The retrieved studies were categorized as non-specific or AD-specific. The studies' quality was assessed using the Mixed Methods Appraisal Tool. The review's results were reported in accordance with the PRISMA guidelines. RESULTS:Twenty studies met our inclusion criteria. The majority of AD-specific studies were conducted more recently (2020-2023) compared to non-specific studies (2010-2015). This trend hints at growing interest in more specialized CDSSs tailored for prescriptions of ADs. The nine AD-specific studies focused on metformin and insulin and demonstrated positive impacts of the CDSSs on different outcomes, including the reduction in the proportion of inappropriate prescriptions of ADs and in hypoglycaemia events. The 11 nonspecific studies showed similar trends for metformin and insulin prescriptions, although the CDSSs' impacts were not significant. There was a predominance of metformin and insulin in the studied CDSSs and a lack of studies on ADs such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. CONCLUSION:The limited number of studies, especially randomized clinical trials, interested in evaluating the application of CDSS in the management of ADs underscores the need for further investigations. Our findings suggest the potential benefit of applying CDSSs to the prescription of ADs particularly in primary care settings and when targeting clinical pharmacists. Finally, establishing core outcome sets is crucial for ensuring consistent and standardized evaluation of these CDSSs.

Aim: The management of type 2 diabetes patients poses challenges for non-diabetologists healthcare professionals and may result in potentially inappropriate prescriptions of antidiabetic drugs which can be limited using screening tools. The aim was to set up nominal groups of healthcare professionals from several disciplines and develop a list of explicit definition of potentially inappropriate prescriptions of antidiabetic drugs. Methods: In a qualitative, nominal-groups approach, expert diabetologists, general practitioners, and pharmacists in France developed explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes. The study was overseen by a steering committee and complied with the Consolidated Criteria for Reporting Qualitative Research. Results: Three nominal groups comprised a total of 30 participants (14 pharmacists, 10 diabetologists, and 6 general practitioners) and generated 89 explicit definitions. These definitions were subsequently merged and validated by the steering committee and nominal group participants, resulting in 38 validated explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs. The definitions encompassed four contexts: (i) the temporary discontinuation of a medication during acute illness (n=9; 24%), (ii) dose level adjustments (n=23; 60%), (iii) inappropriate treatment initiation (n=3; 8%), and (iv) the need for further monitoring in the management of type 2 diabetes (n=3; 8%). Conclusion: This qualitative study is the first to have produced a specific tool of explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs. Although the new list provides valuable insights, it must be validated by expert consensus (e.g. in a Delphi survey) before implementation in practice

Purpose The management of type 2 diabetes mellitus patients has changed over the past decade, and a large number of antidiabetic drug treatment options are now available. This complexity poses challenges for healthcare professionals and may result in potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus which can be limited using screening tools. The effectiveness of explicit tools such as lists of potentially inappropriate prescriptions has been widely demonstrated. The aim was to set up nominal groups of healthcare professionals from several disciplines and develop a list of explicit definition of potentially inappropriate prescriptions of antidiabetic drugs. Methods In a qualitative, nominal-groups approach, 30 diabetologists, general practitioners, and pharmacists in France developed explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus. A nominal group technique is a structured method that encourages all the participants to contribute and makes it easier to reach an agreement quickly. Each meeting lasted for two hours. Results The three nominal groups comprised 14 pharmacists, 10 diabetologists, and 6 general practitioners and generated 89 explicit definitions. These definitions were subsequently merged and validated by the steering committee and nominal group participants, resulting in 38 validated explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs. The definitions encompassed four contexts: (i) the temporary discontinuation of a medication during acute illness (n = 9; 24%), (ii) dose level adjustments (n = 23; 60%), (iii) inappropriate treatment initiation (n = 3; 8%), and (iv) the need for further monitoring in the management of type 2 diabetes mellitus (n = 3; 8%). Conclusion The results of our qualitative study show that it is possible to develop a specific list of explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus by gathering the opinions of healthcare professionals caring for these patients. This list of 38 explicit definitions necessitates additional confirmation by expert consensus before use in clinical practice.

Introduction Potentially inappropriate prescriptions (PIPs) of antidiabetic drugs (ADs) (PIPADs) to patients with type 2 diabetes mellitus (T2DM) have been reported in some studies. The detection of PIPs in electronic databases requires the development of explicit definitions. This approach is widely used in geriatrics but has not been extended to PIPADs in diabetes mellitus. The objective of the present literature review was to identify all explicit definitions of PIPADs in patients with T2DM. Materials and methods We performed a systematic review of the literature listed on Medline (via PubMed), Scopus, Web of Science, and, Embase between 2010 and 2021. The query included a combination of three concepts ("T2DM" AND "PIPs" AND "ADs") and featured a total of 86 keywords. Two independent reviewers selected publications, extracted explicit definitions of PIPADs, and then classified the definitions by therapeutic class and organ class. Results Of the 4,093 screened publications, 39 were included. In all, 171 mentions of PIPADs (corresponding to 56 unique explicit definitions) were identified. More than 50% of the definitions were related to either metformin (34%) or sulfonylureas (29%). More than 75% of the definitions were related to either abnormal renal function (56%) or age (22%). In addition, 20% (n = 35) mentions stated that biguanides were inappropriate in patients with renal dysfunction and 17.5% (n = 30) stated that sulfonylureas were inappropriate above a certain age. The definitions of PIPADs were heterogeneous and had various degrees of precision. Conclusion Our results showed that researchers focused primarily on the at-risk situations related to biguanide prescriptions in patients with renal dysfunction and the prescription of sulfonylureas to older people. Our systematic review of the literature revealed a lack of consensus on explicit definitions of PIPADs, which were heterogeneous and limited (in most cases) to a small number of drugs and clinical situations.

In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs.

Au cours des dix dernières années, les recommandations pour la prise en charge du patient vivant avec un diabète de type 2 (DT2) ont évolué vers une approche globale et individualisée, prenant en compte les besoins spécifiques de chaque patient. Toutefois, la diversité des options thérapeutiques, la gestion des comorbidités et l'évolution constante des recommandations posent un défi, notamment, pour les médecins généralistes qui assurent le suivi de 90% des patients vivant avec un DT2 en France. Ce contexte contribue au risque accru de prescriptions potentiellement inappropriées (PPI), définies comme l'utilisation de médicaments avec une balance bénéfices/risques défavorable en présence d'alternatives plus sûres. L’une des méthodes possibles pour réduire les PPI est l’approche explicite, fondée sur des critères standardisés. L’objectif de cette thèse est de développer et valider une liste de définitions explicites des prescriptions potentiellement inappropriées des traitements antidiabétiques pour les patients vivant avec un diabète de type 2 par une approche en 3 étapes : une revue systématique, une étude qualitative et une enquête Delphi.Dans un premier temps, une revue systématique de la littérature a été menée pour identifier 56 définitions explicites. Ces définitions ont mis en évidence des situations de PPI, notamment l’utilisation de metformine chez les patients présentant une insuffisance rénale ou de sulfamide hypoglycémiant chez les personnes âgées. Cette revue a mis en avant une absence de consensus, mais également une grande hétérogénéité des critères utilisés, ainsi qu’un manque de prise en compte des thérapies les plus récentes. Dans une deuxième étape, une étude qualitative a été menée à l'aide de la technique des groupes nominaux, impliquant 30 professionnels de santé (14 pharmaciens, 10 diabétologues et 6 médecins généralistes). Cette méthodologie structurée a permis de recueillir des propositions de définitions explicites des PPI. Les participants ont proposé 89 définitions, qui ont ensuite été fusionnées et validées par un comité de pilotage, aboutissant à une liste de 38 définitions finales. Enfin, une enquête Delphi, impliquant 46 participants de France, de Belgique et de Suisse, a été conduite pour valider une liste consensuelle de définitions explicites. Après deux tours et deux réunions de consensus, une liste finale de 41 définitions explicites a été validée. Ces définitions ont été regroupées en quatre catégories : (i) arrêt temporaire des médicaments dans un contexte clinique aigu ; (ii) ajustement des doses ; (iii) initiation inappropriée de traitement ; et (iv) renforcement nécessaire du suivi médical.Cette thèse propose une méthodologie rigoureuse et reproductible pour identifier et valider des définitions explicites des PPI chez le patient vivant avec un DT2. Cette liste de définitions constitue un nouvel outil de détection des PPI, notamment pour les non-spécialistes du diabète, et peut être intégrée dans des systèmes d’aide à la décision clinique pour une détection rapide et automatisée des PPI. La pertinence des définitions et leur impact devront toutefois être évalués en pratique réelle, en soins premiers ou hospitaliers. À terme, ce travail pourrait réduire les PPI et rationaliser les pratiques de prescription. Il ouvre également la voie à des recherches futures allant de l’implémentation dans les systèmes d’aide à la décision à l’exploitation des critères pour des analyses épidémiologiques et des stratégies de prévention, ainsi qu’à une harmonisation internationale de la prise en charge des patients DT2.