Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 12 appraisals
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Facilitators and barriers to the implementation of traditional Chinese exercises in cancer patients: a mixed-methods systematic review
PURPOSE: To identify barriers and facilitators to the implementation of traditional Chinese exercises in cancer patients. METHODS: This was a mixed-methods systematic review. It searched for published studies from nine different sources. Data synthesis followed a convergent integrated approach according to the Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were qualitized using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS: Twenty-one studies were included. Forty-three implementation determinants were identified across five domains of the Consolidated Framework for Implementation Research (CFIR), including 25 facilitators and 18 barriers. Key facilitators included perceived benefits, simplicity, social support, and flexible delivery, whereas major barriers involved symptom burden, resource constraints, competing life demands, and limited organizational support. CONCLUSIONS: The implementation of traditional Chinese exercises in cancer patients is shaped by multilevel determinants across CFIR domains. Implementation outcomes depend on the alignment between intervention characteristics, patient capacity, and contextual conditions. Context-sensitive and tailored strategies are required to improve uptake and long-term sustainability.
25 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Acupuncture for chemotherapy-induced dysgeusia (AcuDysg): a randomized controlled trial
PURPOSE: The study investigated the effectiveness of dysgeusia-specific acupuncture combined with self-acupressure compared to supportive acupuncture and self-acupressure for chemotherapy-induced dysgeusia in cancer patients with cancer-related fatigue (CRF) and dysgeusia. METHODS: This multicenter, randomized, controlled, two-armed parallel-group, single-blind trial included cancer patients with CRF and dysgeusia during chemotherapy. All participants received CRF treatment consisting of eight acupuncture sessions over 8 weeks and had access to an eLearning course for self-acupressure. Patients in the intervention group received additional dysgeusia-specific acupuncture treatment and an eLearning with instructions to acupressure points, whereas the control group received an intervention focused solely on addressing CRF. The main outcome was perceived dysgeusia over 8 weeks, measured weekly after each acupuncture session on a numeric rating scale from 1 to 10. Other outcomes included taste and smell tests, and assessments of perceived dysgeusia, fatigue, distress, and quality of life. Due to a small sample size, results can be only judged exploratory. The study was approved by the Cantonal Ethics Committee (CEC) (Kanton Zürich Kantonale Ethikkommission) (approval no. KEK-ZH-Nr. 2020-01900). RESULTS: Since we included only twenty-one patients (11 intervention, 10 control, 90% female) instead of the target sample size of 130, no confirmatory effectiveness analyses were conducted. All participants showed a substantial decrease in dysgeusia over time, regardless of treatment type (estimated mean reduction per session - 0.30; 95% CI - 0.43 to - 0.18), reflecting a 0.30-point reduction per session. Quality of life and cancer-related fatigue improved over time. The exploratory analyses did not show substantial differences between groups in any outcomes. No serious adverse events occurred. CONCLUSIONS: Exploratory findings showed no substantial differences between the study groups in perceived dysgeusia, but both study groups improved over time. TRIAL REGISTRATION NUMBER: DRKS00023348 at 03.11.2020, SNCTP000004128.
14 May 2026
Read appraisal →Journal of ethnopharmacology
Advances in the pharmacology and mechanism of anti-skin aging in Tonifying Traditional Chinese Medicines
ETHNOPHARMACOLOGICAL RELEVANCE: According to the Traditional Chinese Medicine (TCM) tenet that "internal imbalances manifest externally," skin aging reflects deficiencies in qi, blood, and organ systems-particularly the liver and kidneys. Tonifying Traditional Chinese Medicines (TTCM) address these root causes, nourishing the skin and delaying aging through internal regulation, as documented in classical texts including the Shennong Ben Cao Jing and the Compendium of Materia Medica. AIM OF THE STUDY: This article systematically reviews the anti-skin-aging mechanisms of TTCM by integrating traditional applications with modern pharmacological evidence. It explores their multi-component, multi-target, and multi-pathway actions, evaluates current experimental models, and investigates the emerging role of artificial intelligence (AI) in advancing TTCM research. MATERIALS AND METHODS: We systematically searched PubMed, China National Knowledge Infrastructure (CNKI), Web of Science and Scopus for articles published from January 2015 to August 2025 with keywords such as "skin aging", "anti-aging" and the Latin names of TTCM (e.g. Panax ginseng, Astragalus membranaceus). Cellular, animal and clinical studies were analyzed for active constituents, molecular targets, ageing biomarkers and related signalling pathways. RESULTS: TTCM demonstrates anti-skin-aging effects through systemic regulation of organ function and qi-blood-yin-yang balance. At the molecular level, TTCM attenuates senescence through antioxidative, anti-inflammatory, extracellular matrix (ECM) stabilizing mechanisms, mediated by modulation of multiple pathways, such as Mitogen-Activated Protein Kinase (MAPK), Tumor Protein p53 (p53) and Nuclear factor erythroid 2-related factor 2 (Nrf2), exemplifying a "holistic regulation-targeted intervention" therapeutic paradigm. CONCLUSIONS: TTCM exerts anti-skin-aging effects through multi-component, multi-target and multi-pathway synergism. We strongly recommend the further integration of TTCM with modern medicine and in-depth mechanistic studies to promote translational applications.
12 May 2026
Read appraisal →Pakistan journal of pharmaceutical sciences
Network pharmacology and machine learning reveal multi-target mechanisms of poly herbal formulation against atherosclerosis
BACKGROUND: Herbs, like Allium sativum, Ginkgo biloba and Nerium oleander are traditional medicinal plants that have been used to treat atherosclerosis and cardiovascular disease. This study provides valuable insights into how network pharmacology (NP) and emerging machine learning are utilized to identify potential drug candidates from these plants for treatment of atherosclerosis. METHODS: NP analysis was employed to screen compounds and their potential gene targets from databases and tools e.g. IMPPAT, PubChem, KNAPSACK, Swiss ADME, Swiss Target Prediction, Disgenet and GeneCard. Cytoscape 3.10.2 was employed to visually understand these networks. DAVID database was used for functional and enrichment analysis of the genes validated through molecular docking using PyRx and Discovery Studio. RESULTS: Computational tools and bioinformatics approaches showed a few core compounds, such as Quercetin, Naringenin, Luteolin, Kaempferol, Apigenin, Daidzein, Luteolin-7-olate, Pinocembrin, Pregnenolone and Fisetin found to be effective against atherosclerosis. Pathway analysis revealed that mechanism of atherosclerosis development is directly associated with cholesterol metabolism, cellular senescence, Ras, NF-κB and PI3K-Akt signaling pathways. CONCLUSION: NP and molecular docking analysis suggested that screened compounds may inhibit progression of atherosclerosis by modulating key associated pathways. Hence, this machine learning aided NP study provides basis for understanding and recognizing the activity of these plants in treating atherosclerosis.
4 May 2026
Read appraisal →Artificial intelligence in medicine
CL-MHAD: Contrastive Learning-based Multi-Hypergraph Aggregation and Diffusion model for prescription recommendation
Multiple syndrome-based prescription recommendations are significant for personalized diagnosis and treatment in Traditional Chinese Medicine (TCM). However, it remains a challenge to effectively extract and fuse multi-dimensional knowledge in herbs for accurate syndrome-based prescription recommendations. To address it, we propose CL-MHAD, a contrastive learning-based multi-hypergraph aggregation and diffusion model for prescription recommendation. Focusing on prescriptions, herbs, properties, and dosages, this model presents a multi-view hypergraph reconstruction mechanism, which employs a consistent Top-K neighbor strategy to generate affinity and feature matrices. Subsequently, a diffusion-enhanced method is proposed, utilizing multi-step propagation and weighted mapping to capture high-order relationships. Then, we propose a cross-view contrastive learning strategy to enhance discrimination and present a topology-aware random walk augmentation approach to alleviate data sparsity. An integrated loss function combining classification, contrastive, and augmentation losses is designed to optimize model performance. We evaluate CL-MHAD in a real-world clinical setting using Gastrointestinal Diseases (GID) as a case study. Extensive experiments, including comparative evaluations, ablation studies, and parameter sensitivity analyses, show that CL-MHAD achieves overall superior performance compared with representative baselines across multiple evaluation metrics. Specifically, the model achieves performance gains of 1.27% to 24.67% over representative baselines across all datasets. We further evaluate the model through dosage-syndrome interaction and data-sparsity robustness tests, with results demonstrating the effectiveness of our weighted fusion strategy and the model's superior stability. This study offers an effective solution and a promising paradigm for accurate syndrome-based prescription recommendations in TCM.
4 May 2026
Read appraisal →Journal of ethnopharmacology
MAGED: Multimodal attentive graph learning with gene expression dynamics on knowledge graphs for TCM target prediction
ETHNOPHARMACOLOGICAL RELEVANCE: Plants used in traditional medicine have long provided valuable clues for drug discovery, yet systematically connecting their documented therapeutic effects with modern understanding of biological mechanisms remains a key scientific question. Bridging the gap between traditional knowledge, clinical symptom profiles, and contemporary molecular-level regulation is essential for advancing the study of herbal medicine. OBJECTIVES: This study aims to develop a multimodal graph attention learning framework, named MAGED, which integrates knowledge graphs with gene expression dynamics to improve the accuracy and interpretability of Herb-Target Interaction (HTI) prediction. METHODS: MAGED incorporates multi-source heterogeneous data, including traditional Chinese medicine (TCM) properties, hierarchical clinical symptom information, and molecular-level biological data, such as gene expression dynamics under drug intervention and causal biological networks. A multimodal fusion encoder is employed to embed herb attributes into efficacy-related feature vectors, which are then combined with functional representations (e.g., normalized enrichment scores) to form a unified contextualized representation. Additionally, a hierarchical graph attention network is designed to integrate macroscopic symptom-gene associations with microscopic regulatory pathways, thereby establishing a coherent inference chain from herbal effects to biological targets and phenotypic symptoms. RESULTS: Systematic experimental evaluations demonstrated that MAGED significantly outperforms existing baseline methods across multiple evaluation metrics, achieving a 59.8 % improvement in HR@10. The model also exhibited superior ranking and recall performance under cold-start scenarios. In a case study on Scutellaria baicalensis, 8 out of the top 10 predicted targets were supported by existing literature, with functional or direct interaction evidence, and some targets were further validated through molecular docking. CONCLUSION: MAGED provides an accurate and interpretable framework for predicting herb-target interactions, effectively integrating traditional knowledge with modern molecular evidence. This approach shows strong potential to facilitate the discovery of herbal mechanisms and the identification of novel therapeutic targets.
27 Apr 2026
Read appraisal →BMC pregnancy and childbirth
Comparative effects of rotational effleurage and connective tissue massage on labor pain, duration, and perineal outcomes in pregnant women: a randomized clinical trial
BACKGROUND: Childbirth is a unique and significant experience in every woman's life. A negative childbirth experience, often due to difficult labor, can adversely affect a mother's feelings toward her baby and their subsequent relationship. Massage, a non-pharmacological pain relief method involving coordinated manipulation of soft tissues by hand, aims to alleviate pain and enhance comfort. This ancient technique is widely used during labor and has demonstrated effectiveness in reducing both the intensity and duration of labor pain. This study aimed to compare the effects of two massage methods-rotational effleurage massage and connective tissue massage (CTM)-on pain intensity and labor outcomes. The study subjects in the two intervention groups received effleurage massage and connective tissue massage, but the control group did not receive any intervention and only routine labor care was provided to them. METHODS: This quasi-experimental, multicenter study was conducted on 90 pregnant women (gestational age 38-40 weeks) admitted in labor at three hospitals. Participants were selected through convenience sampling and randomly allocated into three groups of 30 using permuted block randomization within each center. Although random allocation was performed, due to the multicenter design and non-probability sampling, the study is more accurately classified as quasi-experimental. Written informed consent was obtained from all participants. Data collection tools included a demographic and obstetric questionnaire, the McGill Childbirth Satisfaction Questionnaire, a visual analogue scale for pain, and a labor evaluation checklist. DATA: Statistical analyses were performed using SPSS software version 22 (IBM Corp., Armonk, NY, USA). In this randomized clinical trial, 90 primiparous women were randomly assigned to three groups: effleurage massage, Connective tissue massage, and control. The interventions were performed during the active phase of labor (4-10 cm cervical dilation). Pain intensity was measured using the Visual Analogue Scale at different dilation stages: 3-4 cm, 5-6 cm, 7-8 cm, and 9-10 cm). RESULTS: Pain intensity significantly decreased in both intervention groups compared to the control group at all stages of the active phase of labor (p < 0.001). At 7-8 cm dilation, the mean pain scores were 6.13 ± 0.94 in the effleurage group, 6.23 ± 0.77 in the connective tissue massage group, and 7.87 ± 0.86 in the control group (p < 0.001). Effleurage massage demonstrated greater efficacy than connective tissue massage in reducing pain during the later stages of active labor (p < 0.05). CONCLUSION: Effleurage massage was more effective than connective tissue massage in reducing pain intensity during active labor. Integrating effleurage into maternity care as a non-pharmacological method may improve maternal comfort and support positive birth experiences.
20 Apr 2026
Read appraisal →Analytica chimica acta
Point-of-need and portable sensing strategies for quality and safety assessment of Traditional Chinese Medicine products: A critical analytical review.
Sensor technology has emerged as a transformative tool for point-of-need and portable quality control and safety assessment of Traditional Chinese Medicine (TCM) products. Although separation and detection technologies have improved, there is still a strong need to critically evaluate the entire analytical workflow from sample preparation to data interpretation to meet regulatory and routine monitoring requirements. This review critically evaluates the complete analytical workflow, from sample pretreatment to intelligent data interpretation, necessary to bridge the gap between laboratory prototypes and real-world deployment. Additionally, it provides a systematic summary of the mechanisms and applications of common types of sensors, utilising nanomaterials and molecular recognition elements to overcome the specific challenge of complex TCM matrices. A particular focus is placed on the emerging roles of Artificial Intelligence (AI) and Machine Learning (ML) in resolving high-dimensional spectral data and enhancing pattern recognition accuracy. Furthermore, we critically analyze current bottlenecks, including matrix interference, the lack of standardized validation protocols, and the reliability of portable devices in uncontrolled environments. Future directions are highlighted towards the development of self-validating, cloud-integrated (IoT), and eco-friendly sensing systems, aiming to support the global standardization and safety assurance of TCM products.
9 Apr 2026
Read appraisal →Rheumatology international
The effect of structured hand massage on hand function and grip strength in rheumatoid arthritis patients: a randomized controlled pilot study
INTRODUCTION: This study aimed to assess the impact of a 10-session hand massage protocol on hand function, grip strength, pinch strength, pain threshold, and tactile sensory threshold in patients with early-stage, seropositive rheumatoid arthritis (RA) without radiographic damage or hand deformity. METHODS: This study was a randomized controlled clinical trial. Thirty female RA patients with a diagnosis time of less than two years, seropositive, with low disease activity/remission, and without active arthritis in their hands were included in the study. Participants were randomized 1:1 to intervention and control groups. The intervention group underwent 10 hand massage sessions over a two-week period, in addition to regular medical care. The control group received only regular medical care. All assessments were performed at baseline (T1) and at week 2 (T2). Outcome measures included hand grip strength, pinch strength, pain threshold (dolorimetry), tactile sensory threshold (Semmes-Weinstein monofilament test), Duruöz Hand Index (DHI), and patient global assessment (PGA). RESULTS: A total of 30 RA patients were included in the study (intervention group, n = 15; control group, n = 15). At baseline, no significant differences were observed between the groups in demographic, laboratory, or clinical characteristics (p > 0.05). In the intervention group, significant improvements in hand grip strength and pinch force were observed at T2 compared with baseline (p = 0.008 and p = 0.023, respectively). Median hand grip strength increased from 55 (40-75) to 65 (45-80) kg, and median pinch strength increased from 15 (6-18) to 16 (11-21) kg. No significant alterations were noted in these parameters within the control group (p > 0.05). In the control group, median hand grip strength was 45 (25-80) kg at baseline and 45 (20-80) kg at week 2, while median pinch strength was 14 (6-18) kg at baseline and 14 (5-19) kg at week 2. In the intervention group, significant reductions in DHI and PGA scores were recorded at the end of therapy (p = 0.005 and p = 0.001, respectively). No significant differences were noted in DHI and PGA levels in the control group (p > 0.05). Moreover, median PGA scores were significantly lower in the intervention group than in the control group at T2 (4 [2-5] vs. 5 [3-6]; p < 0.001). No significant changes were found in dolorimeter and touch sensory thresholds in either group (p > 0.05). CONCLUSION: Hand massage interventions for patients with RA enhance grip strength, hand function, and overall patient evaluations. No effect on pain or tactile thresholds was observed. Further studies with larger sample sizes and longer follow-up periods are required to corroborate these findings.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Unveiling the genus Taraxacum: From folk medicine to chemodiversity-driven pharmacological and toxicological outcomes-A systematic review
ETHNOPHARMACOLOGICAL RELEVANCE: The genus Taraxacum (dandelion), belonging to the Asteraceae family, encompasses over 2800 species predominantly found in temperate to subtropical regions of the Northern Hemisphere. Dandelion has a long history as a functional food and traditional medicine in numerous countries, including China, Turkey, Spain, Italy, etc. Traditional application records indicate that dandelion might be used extensively to treat kidney stones, constipation, eczema, ulcers, inflammation, etc. However, the therapeutic application of different Taraxacum species varies significantly across regions, which may be influenced by local cultural and medical traditions. AIM OF THE REVIEW: This review provides a comprehensive summary of recent advancements in traditional applications, phytochemistry (highlighting 184 newly identified compounds), pharmacology, and toxicology, offering novel insights into both genus-wide characteristics of Taraxacum (covering 55 species) and species-specific differences. MATERIALS AND METHODS: A comprehensive search for relevant data was conducted using keywords such as "Taraxacum", "dandelion", "Taraxaci Herba", "pu gong ying", and others across multiple scientific databases, including Google Scholar, Web of Science, PubMed, ScienceDirect, Baidu Scholar, CNKI, online ethnobotanical databases, ethnobotanical monographs, The Plant List, Dictionary of Chinese Ethnic Medicine and considered data from 1972 to 2025. World Flora Online (http://www.worldfloraonline.org/) was utilized for confirming the correct species names of Taraxacum genus. The gathered information on the ethnobotanical usages, phytochemistry, pharmacology, and toxicology is comprehensively summarized in this paper. RESULTS: The literature review indicates that dandelion, a medicinal and edible plant, has been extensively utilized in traditional Chinese medicine since the 7th century. In Europe, its edible and medicinal properties began to be acknowledged and applied during the Middle Ages. In ethnomedical practice, dandelion has been used as diuretic, laxative, anti-inflammatory remedy, digestive aid, etc. Building on the 197 compounds reported from T. officinale, this review highlights over 180 newly identified compounds from 19 Taraxacum species, expanding the genus-wide catalog to more than 380 constituents. Recent toxicological and safety evaluations corroborate that T. officinale F.H.Wigg., T. mongolicum Hand.-Mazz., and T. lacistrum Sahlin possess a favorable safety profile. CONCLUSIONS: The genus Taraxacum is a promising medicinal and edible plant, exhibiting a range of biological activities, including anti-cancer, anti-inflammatory, and antioxidant effects. These properties align with its ethnobotanical usages, confirming its traditional use as diuretic, laxative, anti-inflammation, and digestive aid. However, research on its effects on neurodegenerative and cardiovascular diseases remains limited. Future studies should focus on in vivo experiments to explore the material basis and mechanisms underlying the therapeutic effects of dandelion species. Furthermore, current phytochemical and pharmacological research has overlooked several Taraxacum species with well-documented traditional uses. Investigating these understudied species is essential to fully elucidate the potential therapeutic value of the genus Taraxacum.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Trends and multidisciplinary research of torch ginger [Etlingera elatior (Jack) R.M.Sm.]: A systematic review.
ETHNOPHARMACOLOGICAL RELEVANCE: Etlingera elatior (Jack) R.M.Sm. (torch ginger) is a tropical plant traditionally used as a cut flower, culinary ingredient, and medicinal resource across Southeast Asia and other regions. However, integrated research on its multidisciplinary utilization remains limited. AIM OF THE STUDY: This study aims to provide a comprehensive systematic review of scientific publications on torch ginger, including analyses of contributing countries, institutions, plant parts, chemical constituents, and research fields. MATERIALS AND METHODS: Publications up to 2024 were retrieved from Scopus and screened using predefined exclusion criteria based on PRISMA principles. The data were analyzed to determine publication trends and bibliometric distributions. Phytochemical and pharmacological data were also extracted. RESULTS: Research on torch ginger began in 1997 and now involves fifteen contributing countries, with Indonesia, Malaysia, and Brazil as major contributors. Studies span fourteen research fields, with pharmacology and phytochemistry as dominant areas. The literature reports eighty-five major bioactive compounds. Extractives from most plant parts contain n-hexadecanoic acid, and essential oils from all parts contain dodecanal and 1-dodecanol. Most research focuses on flowers because their bioactive compounds show wide pharmacological potential, including antioxidant, anti-inflammatory, anti-aging, anti-allergic, anti-hyperuricemic, antidiabetic, anti-obesity, anticancer, antimicrobial, and anthelmintic activities. However, extracts from stems, rhizomes, and fruits demonstrate pharmacological potentials that exceed those of flowers and leaves. CONCLUSIONS: Torch ginger demonstrates remarkable pharmacological potential. Its ease of cultivation and versatile applications support its suitability for large-scale development. As a multifunctional industrial crop, it holds strong promise for zero-waste bioeconomic utilization. Further research must investigate plant parts other than the flower.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Evaluation of the association of pseudoaldosteronism with licorice-containing herbal medicine using the Japanese adverse drug event report (JADER) database
ETHNOPHARMACOLOGICAL RELEVANCE: Herbal medicine in Japan is known as Kampo preparation, a traditional medicine that combines multiple medicinal herbs and is widely used in medical practice. Pseudoaldosteronism is an issue associated with herbal medicines that contain licorice. However, the relationship between licorice intake and pseudoaldosteronism is not fully understood and is debatable. AIM OF THE STUDY: This study evaluates the association between herbal medicine preparations containing licorice and pseudoaldosteronism using data from the Japanese Adverse Drug Reaction Reporting System (JADER) database. MATERIALS AND METHODS: The JADER database contained 961,171 reports published between April 2004 and December 2024. The association between herbal medicines and pseudoaldosteronism was evaluated using the pharmacovigilance index as the reporting odds ratio (ROR) and logistic regression models. RESULTS: There were 537 cases of pseudoaldosteronism (PT code: 10037113). The reporting ratio of pseudoaldosteronism was higher in the licorice-containing herbal medicines group than in the overall herbal medicines group. The RORs of the top 20 herbal medicines with the highest number of pseudoaldosteronism reports, all of which contained licorice, exceeded one, and a signal was detected. The risk of pseudoaldosteronism increased with increasing licorice intake. According to the receiver operating characteristic (ROC) curve for pseudoaldosteronism (area under the curve (AUC) = 0.71, sensitivity = 0.8493, 1-specificity = 0.5530), the cutoff value was 1.125 g/day. CONCLUSIONS: This study is the first to clarify the association between licorice intake from herbal medicines and pseudoaldosteronism using Japan's spontaneous adverse event-reporting database. These findings will be useful and informative for medical professionals considering treatments with herbal medicines.
6 Apr 2026
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