bims-arines Biomed News
on AI in evidence synthesis
Issue of 2026–11–08
thirteen papers selected by
Farhad Shokraneh, Systematic Review Consultants LTD



  1. J Med Imaging (Bellingham). 2026 Sep;13(5): 050101
      This editorial examines the complementary roles of humans and AI in synthesizing a large scientific literature, drawing on a case study involving 53 papers from a multi-institutional consortium. The experience highlights the value of iterative human-AI collaboration, in which machines support large-scale analysis while human experts provide verification, interpretation, and accountability.
    DOI:  https://doi.org/10.1117/1.JMI.13.5.050101
  2. Syst Rev. 2026 Aug 05. pii: 284. [Epub ahead of print]15(1):
       BACKGROUND: The process of consolidating research through meta-analyses is time-consuming and costly. Using text-mining approaches to (semi-)automate the step of screening and selecting articles eligible for inclusion might potentially save hours of workload and costs. A lack of evaluative research on the use of text-mining for literature screening prevents the widespread adoption of text-mining approaches among the psychology research community. This study explores the possibilities of applying text-mining approaches to facilitate or (semi-)automate screening articles for inclusion in psychology meta-analyses.
    METHODS: The performances of two publicly accessible text-mining approaches were evaluated and compared against three recent meta-analyses from different subfields of psychology.
    RESULTS: Averaged over 10 text-mining runs per meta-analysis, across the three meta-analyses the approaches achieved recall performances between 62.5% and 99.3%, specificities between 60.1% and 92.7%, and saved between 54.0% and 92.0% of screening workload. Higher recall was observed when more articles were screened manually in the text-mining process.
    CONCLUSIONS: These findings suggest that text-mining approaches can substantially reduce screening workload while maintaining high recall. These efficiency gains come with a trade-off: the more workload is saved, the lower the recall performance. Text-mining can therefore serve as a valuable tool for the initial identification of potentially eligible studies or as a secondary screening aid, but the risk of missing relevant studies should be mitigated by retaining an appropriate amount of manual screening.
    Keywords:  Article selection; Automation; Literature screening; Meta-analysis; Text-mining
    DOI:  https://doi.org/10.1186/s13643-026-03275-x
  3. Digit Health. 2026 Jan-Dec;12:12 20552076261487043
       Objective: Large language models (LLMs) are emerging as promising tools in medical research, yet their feasibility for automating risk-of-bias assessment in systematic reviews and meta-analyses (SR/MAs) remains underexplored. To this end, we systematically evaluated the accuracy, consistency, and efficiency of two representative LLMs in conducting Cochrane Risk of Bias 2 (RoB-2) assessments, through a head-to-head comparison integrated with a two-phase analytical design that introduced post-hoc chain-of-thought prompt optimization to mirror the human adjudication process. A subsequent meta-reanalysis further traced the downstream impact of LLM-flagged high-risk-of-bias judgments on the robustness of pooled evidence.
    Methods: In a two-phase diagnostic study design, two representative LLMs (LLM-1, open-source; LLM-2, commercial) assessed 56 randomized controlled trials (RCTs) from five systematic reviews and meta-analyses. Standard RoB-2based prompts were refined post hoc through chain-of-thought prompting to mitigate overly risk-averse ratings. LLM assessments were compared against human reference standards from the original reviews. Performance was quantified via confusion matrices, accuracy, F1-score, Matthews Correlation Coefficient (MCC), and Cohen's kappa.
    Results: In post-hoc analysis, binary classification accuracy reached 86.8% (LLM-1) and 89.3% (LLM-2); ternary accuracy reached 85.7% and 87.5%, respectively. MCC exceeded 0.6 for both models, and inter-model kappa improved to 0.601, indicating moderate to high consistency. LLMs reduced assessment time by approximately 16 minutes per RCT compared with manual evaluators. Excluding LLM identified high risk RCTs in meta reanalysis strengthened evidence robustness without altering effect directions.
    Conclusion: LLMs demonstrated high diagnostic accuracy (binary accuracy: 89.3%; ternary accuracy: 87.5%) and reduced assessment time by approximately 16 minutes per RCT compared with manual evaluation. However, both models showed limited ability to reliably distinguish "Some concerns" from "High risk" judgments, and performance depended on post-hoc chain-of-thought prompt optimization. These findings indicate that LLMs are not yet suitable for fully autonomous bias assessment and should be deployed as adjunctive tools, with human oversight retained for final judgments.
    Keywords:  Cochrane RoB-2; chain-of-thought prompting; diagnostic accuracy; large language models; meta-analysis; risk of bias assessment; systematic reviews
    DOI:  https://doi.org/10.1177/20552076261487043
  4. Nurs Open. 2026 Nov;pii: e71007. [Epub ahead of print]13(11):
       AIM: To explore how community nurses describe clinical decision-making across simulated cases and to examine how themes and quotations from human thematic analysis compare with those from generative artificial intelligence-assisted analysis.
    DESIGN: Qualitative descriptive study using simulated clinical cases and semi-structured debriefing interviews.
    METHODS: Between May and July 2024, 68 academic nurses with at least 1 year of community nursing experience were recruited in Israel. Each nurse responded to four simulated cases and a debriefing interview. Three researchers analysed transcripts thematically. Separately, Claude Projects (Claude 3.5 Sonnet) analysed the same de-identified Hebrew corpus without access to the human themes. The researchers then compared corresponding themes and illustrative quotations.
    RESULTS: Six themes described nurses' decision-making: perceived control over treatment management; challenges in responding to scenarios; consultation with professional colleagues; use of non-human support resources; training and experience and promotion of patient health and well-being. Both analyses identified corresponding themes and sometimes selected identical or related quotations. The comparison was not a test of agreement, reliability or validity.
    CONCLUSION: Community nurses described decision-making as a context-dependent process shaped by experience, perceived control, consultation, protocols and a holistic orientation to health promotion. Generative artificial intelligence may assist in organizing qualitative material but requires transparent procedures and human oversight. The study does not establish that AI can reproduce or substitute for human qualitative interpretation.
    IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Generative AI tools must remain subordinate to professional nursing judgement in community practice; AI-assisted qualitative analysis requires transparent, human-verified procedures.
    IMPACT: The findings characterize nurses' accounts of decision-making in simulated community cases. The study did not evaluate clinical effectiveness, implementation or outcomes.
    REPORTING METHOD: The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research.
    PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. Community nurses participated as research participants.
    Keywords:  artificial intelligence; clinical decision‐making; community nursing; generative artificial intelligence; qualitative research; thematic analysis
    DOI:  https://doi.org/10.1002/nop2.71007
  5. WMJ. 2026 ;125(4): 492-497
       INTRODUCTION: The use of generative artificial intelligence (AI) for medical education research remains controversial. Although AI has the potential to revolutionize qualitative research analysis, concerns regarding its validity and accuracy remain barriers to its use in research. We sought to compare AI-generated qualitative coding with human coding.
    METHODS: As part of a mandatory course, third-year medical students watched 2 health care-related videos and responded to prompts on a virtual discussion board. Students' posts were anonymized. Human coders met multiple times over a 4-month period to create a code list, generate themes, and produce an explanatory model. Generative AI also was asked to identify the main themes. Three external reviewers with expertise in qualitative research compared each pair of human-coded and AI-generated themes.
    RESULTS: Human coders required nine 60-minute meetings to code students' posts, whereas AI completed the analysis in approximately 30 seconds. Consensus among the external reviewers was that the pairs of themes were not the same or similar.
    CONCLUSIONS: AI required substantially less time and effort than human coders. Although most reviewers concluded that AI-generated themes were not comparable to human-generated themes, this finding was not unanimous. Generative AI may facilitate and accelerate qualitative research in medical education; however, concerns regarding the validity and contextual interpretation of AI-generated analyses must be addressed before its widespread use in qualitative medical education research.
  6. J Comp Eff Res. 2026 Nov 04. e260079
      Aim: To assess expert panel agreement with responses from three large language models, Claude, Gemini and ChatGPT, to questions based on guidelines for non-muscle-invasive bladder cancer (NMIBC), muscle-invasive bladder cancer (MIBC) and upper tract urothelial carcinoma (UTUC). Materials & methods: The 2025 European Association of Urology (EAU) guidelines were provided to Claude 3.5 Haiku, Gemini 2.5 Flash and GPT-4.1-mini. Figures and tables were converted into plain language text. Each model answered 25 questions per entity. Panels of 7-10 experts rated responses on a 9-point scale using a modified Delphi process with two rounds. Outcomes were consensus in agreement and median expert panel score ≥7. Results: For Claude, Gemini and ChatGPT, respectively, consensus in agreement was achieved for 88%, 100% and 96% of NMIBC responses (p = 0.097); 92%, 100% and 96% of MIBC responses (p = 0.223); and 56%, 100% and 96% of UTUC responses (p < 0.001). For UTUC, significantly fewer Claude responses achieved consensus in agreement than Gemini or ChatGPT responses. Across all questions, consensus in agreement was achieved for 59/75 Claude responses (78.7%), 75/75 Gemini responses (100%), and 72/75 ChatGPT responses (96%) (p < 0.001). Median scores ≥7 were achieved for 88%, 100% and 100% of NMIBC responses; 96%, 100% and 100% of MIBC responses; and 68%, 100% and 96% of UTUC responses. In UTUC, Claude had significantly fewer such responses than Gemini, but the difference from ChatGPT was not statistically significant. Overall, median scores ≥7 were achieved for 63/75 Claude responses (84%), 75/75 Gemini responses (100%) and 74/75 ChatGPT responses (98.7%) (p < 0.001). Conclusion: Under the study conditions, large language model responses frequently achieved expert panel agreement, particularly for Gemini and ChatGPT, supporting the potential of these models for guideline interpretation. Further validation is required to establish clinical utility and safety.
    Keywords:  artificial intelligence; consensus; large language models; upper urinary tract tumor; urinary bladder neoplasms; urothelial cancer
    DOI:  https://doi.org/10.57264/cer-2026-0079
  7. J Comp Eff Res. 2026 Nov 04. e260082
      Aim: Large language models (LLMs) may facilitate the interpretation of clinical guideline information, but their performance in renal cell carcinoma (RCC) remains insufficiently characterized. We evaluated agreement between a multidisciplinary expert panel and the responses generated by Claude, Gemini and ChatGPT to RCC guideline-based questions. Materials & methods: A multidisciplinary tumor board developed 25 clinical questions based on the 2025 European Association of Urology RCC guidelines. Guideline figures and tables were converted into structured, plain-language textual summaries and supplied to the models. Each LLM generated one response per question using direct prompting. An 11-member multidisciplinary expert panel evaluated the responses in a two-round modified Delphi process using a 9-point scale and predefined consensus criteria. Results: Consensus in agreement was reached for 24/25 Gemini responses (96%) and 23/25 responses (92%) for both Claude and ChatGPT. No response reached consensus in disagreement. The proportion of responses with a median score ≥7 was 25/25 (100%) for Gemini, 24/25 (96%) for Claude and 23/25 (92%) for ChatGPT. No statistically significant differences were detected among the models overall or in pairwise comparisons. Responses requiring further discussion or failing to reach consensus mainly involved clinically uncertain or individualized scenarios. Panelists identified occasional factual inaccuracies, omitted options and limited clinical nuance. Conclusion: When provided with structured, guideline-derived material, selected LLMs generated responses that frequently aligned with multidisciplinary expert consensus. These findings support their potential for guideline interpretation but do not demonstrate independent clinical reasoning or real-world decision-making performance. Expert oversight remains essential, particularly in complex scenarios.
    Keywords:  Delphi technique; artificial intelligence; clinical decision support systems; consensus; guideline adherence; large language models; renal cell carcinoma
    DOI:  https://doi.org/10.57264/cer-2026-0082
  8. J Comp Eff Res. 2026 Nov 04. e260080
      Aim: Large language models (LLMs) may help interpret clinical guideline information, but their performance in penile and testicular cancer remains poorly defined. We evaluated agreement between multidisciplinary expert panels and responses generated by Claude 3.5 Haiku, Gemini 2.5 Flash and GPT-4.1-mini to guideline-based questions on these cancers. Materials & methods: Specialized tumor boards developed 25 questions for each cancer based on the 2025 European Association of Urology guidelines. The original guideline text, with figures and tables converted into structured, plain-language textual descriptions, was provided to each LLM. Separate panels of nine experts evaluated the responses using a two-round modified Delphi process with predefined consensus criteria. Results: For penile cancer, consensus in agreement was reached on 21/25 responses (84%) for Claude, 24/25 (96%) for Gemini and 23/25 (92%) for ChatGPT, with no statistically significant differences in overall or pairwise comparisons. For testicular cancer, consensus in agreement was reached on 24/25 items (96%) for each model. One Claude response and one ChatGPT response reached consensus in disagreement. No significant inter-model differences were observed. In both cancers, most responses not reaching consensus or requiring a second round related to prognosis or staging. Across both cancers combined, consensus in agreement was 90% for Claude, 96% for Gemini and 94% for ChatGPT, with no significant inter-model differences. Median scores ≥7 occurred in 94-98% of responses for all LLMs. Conclusion: Selected lightweight variants from widely used LLM families showed substantial agreement with expert consensus when provided with guideline content, although findings reflect performance in a controlled, guideline-fed setting and require specialist validation before clinical application.
    Keywords:  Delphi technique; artificial intelligence; consensus; guideline adherence; large language models; penile neoplasms; testicular neoplasms
    DOI:  https://doi.org/10.57264/cer-2026-0080
  9. J Comp Eff Res. 2026 Nov 04. e260081
      Aim: Large language models (LLMs) may help interpret clinical guideline content. However, their performance in guideline-based prostate cancer (PC) scenarios remains insufficiently validated. This study evaluated the agreement between a multidisciplinary expert panel and responses generated by three leading LLMs (Claude, Gemini and ChatGPT) when addressing structured, guideline-derived clinical questions on PC. Materials & methods: A multidisciplinary tumor board created 25 structured questions based on the 2025 European Association of Urology guidelines. The guideline figures and tables were transformed into plain-language summaries for use by the LLMs. Each model was prompted with a simple, unmodified query and a panel of experts in PC management independently rated their level of agreement with the responses. The evaluation used a two-round modified Delphi method with predefined consensus criteria. Results: Eleven experts evaluated 25 guideline-based questions. After two Delphi rounds, consensus in agreement was reached for 23/25 responses (92%) with Gemini, 20/25 (80%) with ChatGPT and 14/25 (56%) with Claude (p = 0.0033). Explicit disagreement was noted in three questions (12%) with Claude after the second round. Median scores of at least 7 out of 9, indicating strong agreement, were achieved in 24/25 responses (96%) for Gemini, 22/25 (88%) for ChatGPT, and 14/25 (56%) for Claude (p = 0.0002). Most consensus difficulties involved complex cases, advanced imaging, genetic testing or questions with limited data or controversial topics. Conclusion: Advanced LLMs, when provided with PC guidelines with plain-language adaptations of figures and tables, can achieve strong alignment with expert consensus in routine situations. However, performance varies among models, with Claude showing lower agreement rates, especially in complex cases. These results emphasize the importance of expert oversight, continuous validation and standardized guideline formats interpretable by both clinicians and AI systems.
    Keywords:  Delphi technique; artificial intelligence; clinical decision support systems; consensus; guideline adherence; large language models; prostate cancer
    DOI:  https://doi.org/10.57264/cer-2026-0081
  10. Public Health. 2026 Oct 31. pii: S0033-3506(26)00403-8. [Epub ahead of print]261 106534
       OBJECTIVES: The aim of this study was to describe and assess a framework that generates epidemiological analysis scripts from natural-language queries constrained by surveillance data dictionaries.
    STUDY DESIGN: Methodological framework development with internal consistency assessment.
    METHODS: PEFES (Prompt Engineering for Epidemiological Surveillance) restricts large language model output to dictionary-declared variables and coding schemes, validates scope before generating a script, and does not execute code. Two authors with prior programming experience ('raters') submitted identical sets of 22 in-scope and 22 scope-control queries across three case studies (respiratory syncytial virus, influenza A and dengue) using Claude Opus 4.8 and Gemini 3.7 Flash against OpenDataSUS datasets.
    RESULTS: The two raters agreed on the behavior for all 22 scope-control queries: the 17 queries that were expected to be declined did not produce a script, and all 5 in-scope counterparts produced a script. Every source field read was dictionary-declared. Reported values were identical for 14 of the 22 in-scope queries and divergent for 8 (all where a prompt left a choice unstated). One session compared a declared field against wrong-type values, returning empty tables under formatted headings.
    CONCLUSIONS: Dictionary constraints restricted which data a generated script could analyze, but not how it was analyzed: reproducibility was dependent on both the prompt and dictionary, not the constraint mechanism alone. Errors within the declared set were identified by rater review, not by the framework, motivating pre-execution type checks or returning unstated choices as clarification requests. PEFES accelerates epidemiological work rather than replacing it, and it is a step toward wider access to surveillance data analysis.
    Keywords:  Data dictionary; Epidemiological surveillance; Large language models; Natural language processing; Prompt engineering; Public health informatics
    DOI:  https://doi.org/10.1016/j.puhe.2026.106534
  11. Front Endocrinol (Lausanne). 2026 ;17 1976190
       Background: Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-age adults, yet scalable early detection is limited by the unreliability of AI-assisted screening. Multimodal large language models can interpret fundus photographs and support DR grading, but they frequently hallucinate - fabricating lesions or misclassifying referable DR - which directly threatens timely treatment and prevention of vision loss. We developed HalluciGuard-Eye to make AI-assisted DR assessment trustworthy.
    Methods: HalluciGuard-Eye combines knowledge graph-enhanced retrieval-augmented generation with hierarchical hallucination detection. An Ophthalmic Clinical Knowledge Graph containing 47,832 medical entities and 156,294 semantic relationships was constructed from clinical guidelines and published literature. A dual-stream architecture uses a Visual-Semantic Alignment Module to verify cross-modal consistency and a Clinical Factuality Grounding Network to anchor generated content to reranked evidence. The Hierarchical Factuality Score assesses anatomical, pathological, and clinical-recommendation accuracy. The framework was evaluated on four public ophthalmic imaging benchmarks.
    Results: HalluciGuard-Eye reduced hallucination rates by 42.2% compared with state-of-the-art medical multimodal large language models and achieved 91.6% factual accuracy for clinical entity recognition on EyePACS. For diabetic retinopathy grading, sensitivity was 89.6% and specificity was 92.1%, representing improvements of 2.4% and 2.7%, respectively, over MedRAG. In the component ablation, removing knowledge-graph retrieval lowered EyePACS HFS by 9.4 percentage points. Additional analyses yielded 87.6% critical-evidence recall@20, 89.2% lesion-location accuracy, and 88.9% sensitivity in a patient-clustered cohort.
    Conclusions: These results indicate that knowledge-grounded retrieval and hierarchical factuality assessment can reduce hallucinations while preserving diagnostic performance in ophthalmic multimodal language models.
    Keywords:  AI screening; diabetic retinopathy; early detection; hallucination detection; knowledge graph; multimodal large language models; retrieval-augmented generation
    DOI:  https://doi.org/10.3389/fendo.2026.1976190
  12. Res Integr Peer Rev. 2026 Aug 05. pii: 62. [Epub ahead of print]11(1):
      The growing use of large language models (LLMs) across research workflows, including literature review, evidence synthesis, peer-review support, citation validation, and research evaluation, has intensified debates about research integrity, accountability, transparency, and the boundary between legitimate assistance and inappropriate delegation. While LLMs may enhance the efficiency and semantic depth of scientometric and scholarly review practices, their use also raises concerns about hallucinated evidence, fabricated references, biased evaluation, unclear authorship, inadequate disclosure, and the erosion of human responsibility. This study conducts a workflow-oriented systematic scoping review with qualitative thematic synthesis to map and critically synthesize the emerging literature on LLMs in scientometrics and scholarly review processes, rather than a comprehensive review of AI and research integrity as a whole. Following PRISMA-informed procedures, searches were conducted in Scopus, the Web of Science Core Collection, and IEEE Xplore for English-language publications published from 2023 to 2025. After eligibility-based screening and backward citation searching, 74 studies were included as an analytical sample. The review maps five conceptual and methodological approaches: human-in-the-loop and hybrid architectures, retrieval-augmented generation, autonomous and multi-agent research systems, semantic and ontological integration, and prompt engineering with structured evaluation frameworks. It also identifies five major application clusters, review automation and intelligent screening, automated review generation and agentic research workflows, quality assessment and peer-review support, data extraction and semantic classification, and citation analysis and source validation, alongside a governance-oriented category addressing disclosure, confidentiality, accountability, and responsible-use frameworks. The scoping synthesis suggests that retrieval-grounded, domain-adapted, and human-supervised systems offer more reliable pathways than unsupported general-purpose generation, especially for citation-sensitive, evaluative, and high-stakes scholarly tasks. Quantitative performance indicators reported in individual studies were treated descriptively as part of mapping evaluation practices, rather than as directly comparable outcomes for pooled estimation. As a normative implication of the scoping synthesis, the review argues that responsible LLM use should be framed as accountable human-machine collaboration grounded in traceable evidence, transparent disclosure, domain-specific validation, fairness auditing, reproducibility, and non-delegable human responsibility.
    Keywords:  Accountability; Disclosure; Evidence synthesis; Human-in-the-loop; Large language models; Peer review; Research integrity; Retrieval-augmented generation; Scholarly communication; Scientometrics
    DOI:  https://doi.org/10.1186/s41073-026-00239-6