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Trenti T, Petrini AM, Plebani M. New reimbursement models to promote better patient outcomes and overall value in laboratory medicine and healthcare. Clin Chem Lab Med 2024; 0:cclm-2024-0168. [PMID: 38512121 DOI: 10.1515/cclm-2024-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
The most widespread healthcare reimbursement models, including diagnostic laboratory services, are Fee-for-Service, Reference Pricing and Diagnosis-Related Groups. Within these models healthcare providers are remunerated for each specific service or procedure they operate. Healthcare payers are increasingly exploring alternative models, such as bundled payments or value-based reimbursement to encourage value of patient care rather than the simple amount of delivered services. These alternative models are advised, as they are more efficient in promoting cost-effective, high-quality laboratory testing, thereby improving patient health outcomes. If outcomes-based evaluation is a pillar in a new vision of "Value-Based Healthcare", an active policy of Value-Based Reimbursement in laboratory medicine will assure both an efficiency-based sustainability and a high-quality effectiveness-based diagnostic activity. This review aims to evaluate current and alternative reimbursement models, to support a wider agenda in encouraging more Value-Based Healthcare and Value-Based Reimbursement in laboratory medicine.
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Affiliation(s)
- Tommaso Trenti
- Laboratory Medicine and Pathology Department, Azienda Ospedaliera Universitaria and Azienda USL of Modena, Modena, Italy
| | | | - Mario Plebani
- Department of Medicine, University of Padova, Padova, Italy
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2
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Trinh M, Kalloniatis M, Khuu SK, Nivison-Smith L. Retinal sensitivity changes in early/intermediate AMD: a systematic review and meta-analysis of visual field testing under mesopic and scotopic lighting. Eye (Lond) 2024:10.1038/s41433-024-03033-0. [PMID: 38499857 DOI: 10.1038/s41433-024-03033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
Visual fields under mesopic and scotopic lighting are increasingly being used for macular functional assessment. This review evaluates its statistical significance and clinical relevance, and the optimal testing protocol for early/intermediate age-related macular degeneration (AMD). PubMed and Embase were searched from inception to 14/05/2022. All quality assessments were performed according to GRADE guidelines. The primary outcome was global mean sensitivity (MS), further meta-analysed by: AMD classification scheme, device, test pattern, mesopic/scotopic lighting, stimuli size/chromaticity, pupil dilation, testing radius (area), background luminance, adaptation time, AMD severity, reticular pseudodrusen presence, and follow-up visit. From 1489 studies screened, 42 observational study results contributed to the primary meta-analysis. Supported by moderate GRADE certainty of the evidence, global MS was significantly reduced across all devices under mesopic and scotopic lighting with large effect size (-0.9 [-1.04, -0.75] Hedge's g, P < 0.0001). The device (P < 0.01) and lighting (P < 0.05) used were the only modifiable factors affecting global MS, whereby the mesopic MP-1 and MAIA produced the largest effect sizes and exceeded test-retest variabilities. Global MS was significantly affected by AMD severity (intermediate versus early AMD; -0.58 [-0.88, -0.29] Hedge's g or -2.55 [3.62, -1.47] MAIA-dB) and at follow-up visit (versus baseline; -0.62 [-0.84, -0.41] Hedge's g or -1.61[-2.69, -0.54] MAIA-dB). Magnitudes of retinal sensitivity changes in early/intermediate AMD are clinically relevant for the MP-1 and MAIA devices under mesopic lighting within the central 10° radius. Other factors including pupil dilation and dark adaptation did not significantly affect global MS in early/intermediate AMD.
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Affiliation(s)
- Matt Trinh
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
- School of Medicine (Optometry), Deakin University, Geelong, VIC, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
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Stern C, Munn Z, Barker TH, Porritt K, Stone JC, Pap R, Khalil H, Aromataris E. Implementing GRADE in systematic reviews that adhere to JBI methodological conduct. JBI Evid Synth 2024; 22:351-358. [PMID: 38385457 DOI: 10.11124/jbies-23-00543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
GRADE is a methodological approach used to establish certainty in a body of evidence and is now widely adopted among the evidence synthesis and guideline development community. JBI is an international evidence-based health care organization that provides guidance for a range of evidence synthesis approaches. The GRADE approach is currently endorsed for use in a subset of JBI systematic reviews; however, there is some uncertainty regarding when (and how) GRADE may be implemented in reviews that follow JBI methodology.
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Affiliation(s)
- Cindy Stern
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Zachary Munn
- Health Evidence Synthesis, Recommendations and Impact (HERSI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Timothy H Barker
- Health Evidence Synthesis, Recommendations and Impact (HERSI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Kylie Porritt
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jennifer C Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Robin Pap
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Hanan Khalil
- La Trobe University, School of Psychology and Public Health, Department of Public Health, Melbourne, VIC, Australia
| | - Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Sharif S, Kang J, Sadeghirad B, Rizvi F, Forestell B, Greer A, Hewitt M, Fernando SM, Mehta S, Eltorki M, Siemieniuk R, Duffett M, Bhatt M, Burry L, Perry JJ, Petrosoniak A, Pandharipande P, Welsford M, Rochwerg B. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. Br J Anaesth 2024; 132:491-506. [PMID: 38185564 DOI: 10.1016/j.bja.2023.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/29/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta-analysis to enable direct and indirect comparisons between available medications. METHODS We searched Medline, EMBASE, Cochrane, and PubMed from inception to 2 March 2023 for RCTs comparing two or more procedural sedation and analgesia medications in all patients (adults and children >30 days of age) requiring emergent procedures in the ED or ICU. We focused on the outcomes of sedation recovery time, patient satisfaction, and adverse events (AEs). We performed frequentist random-effects model network meta-analysis and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty in estimates. RESULTS We included 82 RCTs (8105 patients, 78 conducted in the ED and four in the ICU) of which 52 studies included adults, 23 included children, and seven included both. Compared with midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 min, 95% confidence interval [CI] 8.4-24.3 fewer minutes; high certainty), and patient satisfaction was better with ketamine-propofol (mean difference 1.5 points, 95% CI 0.3-2.6 points, high certainty). Regarding AEs, compared with midazolam-opioids, respiratory AEs were less frequent with ketamine (relative risk [RR] 0.55, 95% CI 0.32-0.96; high certainty), gastrointestinal AEs were more common with ketamine-midazolam (RR 3.08, 95% CI 1.15-8.27; high certainty), and neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 1.08-12.53; high certainty). CONCLUSION When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine.
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Affiliation(s)
- Sameer Sharif
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Jasmine Kang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Fayyaz Rizvi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ben Forestell
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Alisha Greer
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Mark Hewitt
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Mohamed Eltorki
- Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University, Ottawa, ON, Canada
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mark Duffett
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Maala Bhatt
- Department of Medicine, Sinai Health System, Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada
| | - Lisa Burry
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmacy, Sinai Health System, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Petrosoniak
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Pratik Pandharipande
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michelle Welsford
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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5
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Mustafa RA, El Mikati IK, Murad MH, Hultcrantz M, Steingart KR, Yang B, Leeflang MMG, Akl EA, Dahm P, Schünemann HJ. GRADE guidance 37: rating imprecision in a body of evidence on test accuracy. J Clin Epidemiol 2024; 165:111189. [PMID: 38613246 DOI: 10.1016/j.jclinepi.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/07/2023] [Accepted: 10/13/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVES To provide guidance on rating imprecision in a body of evidence assessing the accuracy of a single test. This guide will clarify when Grading of Recommendations Assessment, Development and Evaluation (GRADE) users should consider rating down the certainty of evidence by one or more levels for imprecision in test accuracy. STUDY DESIGN AND SETTING A project group within the GRADE working group conducted iterative discussions and presentations at GRADE working group meetings to produce this guidance. RESULTS Before rating the certainty of evidence, GRADE users should define the target of their certainty rating. GRADE recommends setting judgment thresholds defining what they consider a very accurate, accurate, inaccurate, and very inaccurate test. These thresholds should be set after considering consequences of testing and effects on people-important outcomes. GRADE's primary criterion for judging imprecision in test accuracy evidence is considering confidence intervals (i.e., CI approach) of absolute test accuracy results (true and false, positive, and negative results in a cohort of people). Based on the CI approach, when a CI appreciably crosses the predefined judgment threshold(s), one should consider rating down certainty of evidence by one or more levels, depending on the number of thresholds crossed. When the CI does not cross judgment threshold(s), GRADE suggests considering the sample size for an adequately powered test accuracy review (optimal or review information size [optimal information size (OIS)/review information size (RIS)]) in rating imprecision. If the combined sample size of the included studies in the review is smaller than the required OIS/RIS, one should consider rating down by one or more levels for imprecision. CONCLUSION This paper extends previous GRADE guidance for rating imprecision in single test accuracy systematic reviews and guidelines, with a focus on the circumstances in which one should consider rating down one or more levels for imprecision.
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Affiliation(s)
- Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Centre, 3901 Rainbow Blvd, MS3002, Kansas City, KS 61160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 1st, ST, SW, Rochester, MN 55902, USA
| | - Monica Hultcrantz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodav. 18 A, SE-171 77 Stockholm, Sweden
| | - Karen R Steingart
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Bada Yang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Clinical Epidemiology and Biostatistics and Bioinformatics Academic Medical Center, University of Amsterdam, Meibergdreef 9, P.O.Box 227001100 DE, Amsterdam, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon
| | - Philipp Dahm
- Minneapolis VA Health Care System, Urology Section 112D, One Veterans Drive, Minneapolis, MN 55417, USA
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8 Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milano, Italy; Institute for Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Breisgau, Germany
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6
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Boos-Lima FBDJ, Guastaldi FPS, Kaban LB, Peacock ZS. Accuracy of skeletal scintigraphy for the evaluation of mandibular growth disorders: a systematic review. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00911-6. [PMID: 38158243 DOI: 10.1016/j.ijom.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Bone scans, reflecting blood flow and metabolic activity in a region of interest, are frequently used to evaluate mandibular growth disorders. Increased uptake is a non-specific finding and can occur as a result of multiple causes. The correlation between radioactive tracer uptake and growth activity has not been consistently demonstrated. The aim of this study was to assess the accuracy of planar skeletal scintigraphy (SS), single-photon emission computed tomography (SPECT), and SPECT with computed tomography (CT) images (SPECT/CT) in detecting abnormal mandibular growth activity compared to clinical and radiographic/tomographic methods (reference standard) and histologic findings. A systematic review was conducted following the PRISMA guidelines. Sensitivity, specificity, and accuracy were calculated for planar SS, SPECT, and SPECT/CT. Compared to the reference standard, SPECT/CT had the best diagnostic accuracy (76.5% sensitivity, 90.4% specificity, 83.2% accuracy), followed by planar SS (81.8% sensitivity, 84.5% specificity, 83.0% accuracy) and SPECT (77.7% sensitivity, 72.4% specificity, 74.5% accuracy). The results of this study indicate that SPECT/CT has the best clinical correlation, but the certainty of the evidence is low. The differences in sensitivity and specificity between the three index tests were not clinically significant. The three tests can be useful, with only a small difference in their diagnostic value. Histopathology was found not to be satisfactory as a reference standard.
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Affiliation(s)
- F B D J Boos-Lima
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - F P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - L B Kaban
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - Z S Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
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Willis K, Chaudhry UAR, Chandrasekaran L, Wahlich C, Olvera-Barrios A, Chambers R, Bolter L, Anderson J, Barman SA, Fajtl J, Welikala R, Egan C, Tufail A, Owen CG, Rudnicka A. What are the perceptions and concerns of people living with diabetes and National Health Service staff around the potential implementation of AI-assisted screening for diabetic eye disease? Development and validation of a survey for use in a secondary care screening setting. BMJ Open 2023; 13:e075558. [PMID: 37968006 PMCID: PMC10660949 DOI: 10.1136/bmjopen-2023-075558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The English National Health Service (NHS) Diabetic Eye Screening Programme (DESP) performs around 2.3 million eye screening appointments annually, generating approximately 13 million retinal images that are graded by humans for the presence or severity of diabetic retinopathy. Previous research has shown that automated retinal image analysis systems, including artificial intelligence (AI), can identify images with no disease from those with diabetic retinopathy as safely and effectively as human graders, and could significantly reduce the workload for human graders. Some algorithms can also determine the level of severity of the retinopathy with similar performance to humans. There is a need to examine perceptions and concerns surrounding AI-assisted eye-screening among people living with diabetes and NHS staff, if AI was to be introduced into the DESP, to identify factors that may influence acceptance of this technology. METHODS AND ANALYSIS People living with diabetes and staff from the North East London (NEL) NHS DESP were invited to participate in two respective focus groups to codesign two online surveys exploring their perceptions and concerns around the potential introduction of AI-assisted screening.Focus group participants were representative of the local population in terms of ages and ethnicity. Participants' feedback was taken into consideration to update surveys which were circulated for further feedback. Surveys will be piloted at the NEL DESP and followed by semistructured interviews to assess accessibility, usability and to validate the surveys.Validated surveys will be distributed by other NHS DESP sites, and also via patient groups on social media, relevant charities and the British Association of Retinal Screeners. Post-survey evaluative interviews will be undertaken among those who consent to participate in further research. ETHICS AND DISSEMINATION Ethical approval has been obtained by the NHS Research Ethics Committee (IRAS ID: 316631). Survey results will be shared and discussed with focus groups to facilitate preparation of findings for publication and to inform codesign of outreach activities to address concerns and perceptions identified.
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Affiliation(s)
- Kathryn Willis
- Population Health Research Institute, St George's University of London, London, UK
| | - Umar A R Chaudhry
- Population Health Research Institute, St George's University of London, London, UK
| | | | - Charlotte Wahlich
- Population Health Research Institute, St George's University of London, London, UK
| | - Abraham Olvera-Barrios
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ryan Chambers
- Diabetes and Endocrinolgy, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Louis Bolter
- Diabetes and Endocrinolgy, Homerton Healthcare NHS Foundation Trust, London, UK
| | - John Anderson
- Diabetes and Endocrinolgy, Homerton Healthcare NHS Foundation Trust, London, UK
| | - S A Barman
- School of Computer Science and Mathematics, Kingston University London, London, UK
| | - Jiri Fajtl
- School of Computer Science and Mathematics, Kingston University London, London, UK
| | - Roshan Welikala
- School of Computer Science and Mathematics, Kingston University London, London, UK
| | - Catherine Egan
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's University of London, London, UK
| | - Alicja Rudnicka
- Population Health Research Institute, St George's University of London, London, UK
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Gounden V, Banerjee M, Amundsen EK, Serdar MA, Suárez Sánchez CI, Strain C, Kinniburgh D, Zhao Z. Linking Laboratory Testing to Clinical Outcomes: Bridging the Gap through Outcome-Based Studies in Laboratory Medicine. Clin Chem 2023; 69:1317-1321. [PMID: 37688514 DOI: 10.1093/clinchem/hvad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Verena Gounden
- Department of Chemical Pathology, Inkosi Albert Luthuli Central Hospital, National Health Laboratory Service and University of KwaZulu Natal, Durban, South Africa
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Erik Koldberg Amundsen
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - Muhittin A Serdar
- Department of Medical Biochemistry, Acibadem University, Istanbul, Turkey
| | | | - Colleen Strain
- Scientific Leadership and Education, Core Diagnostics, Scientific and Medical Affairs, Abbott, Canada
| | - David Kinniburgh
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
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9
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Shen P, Chi-Chung Tsang R, Liang Y, Chen X. Diagnostic accuracy of the upper limb neurodynamic test with median bias (ULNT1) for cervical radiculopathy: a systematic review and meta-analysis. Physiotherapy 2023; 120:17-25. [PMID: 37356367 DOI: 10.1016/j.physio.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/06/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The upper limb neurodynamic test for median nerve (ULNT1) is commonly applied for assessment of cervical radiculopathy (CR). However, the diagnostic accuracy of ULNT1 in diagnosing CR remains unclear. OBJECTIVE This study aimed to examine the diagnostic accuracy of the ULNT1 for the CR. DATA SOURCES Four databases were searched for relevant studies published up to April 30, 2023. STUDY SELECTION Cross-sectional or cohort studies that assessed the diagnostic accuracy of ULNT1 for CR were included. DATA SYNTHESIS The methodological quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. A bivariate random-effects regression model was used for the data synthesis. The overall quality of evidence was evaluated using the GRADE approach. RESULTS A total of 592 references were identified, and five studies with 465 patients met the inclusion criteria. The overall quality of the body of evidence was very low across studies. Heterogeneity of studies was high. The pooled sensitivity and specificity of the ULNT1 were 0.69 (95% CI 0.50-0.83) and 0.54 (95% CI 0.36-0.71), respectively. The summary receiver operating characteristic curve area was 0.65 (95% CI 0.61-0.69). CONCLUSION There is low certainty of evidence that the ULNT1 has only fair accuracy in diagnosing CR. The ULNT1 was recommended as an add-on test after the existing diagnostic pathway to enhance diagnostic accuracy further. High-quality studies which follow the Standards for Reporting of Diagnostic Accuracy and the QUADAS-2; a revised tool for the quality assessment of diagnostic accuracy, are needed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42021255686 CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Peng Shen
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China
| | | | - Ying Liang
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China
| | - Xiwen Chen
- The First Affiliated Hospital of Nanchang University, NO.17, Yong Wai Zheng Jie, 330006 Nanchang, Jiangxi, China.
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10
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Treggiari MM, Rabinstein AA, Busl KM, Caylor MM, Citerio G, Deem S, Diringer M, Fox E, Livesay S, Sheth KN, Suarez JI, Tjoumakaris S. Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023; 39:1-28. [PMID: 37202712 DOI: 10.1007/s12028-023-01713-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The neurointensive care management of patients with aneurysmal subarachnoid hemorrhage (aSAH) is one of the most critical components contributing to short-term and long-term patient outcomes. Previous recommendations for the medical management of aSAH comprehensively summarized the evidence based on consensus conference held in 2011. In this report, we provide updated recommendations based on appraisal of the literature using the Grading of Recommendations Assessment, Development, and Evaluation methodology. METHODS The Population/Intervention/Comparator/Outcome (PICO) questions relevant to the medical management of aSAH were prioritized by consensus from the panel members. The panel used a custom-designed survey instrument to prioritize clinically relevant outcomes specific to each PICO question. To be included, the study design qualifying criteria were as follows: prospective randomized controlled trials (RCTs), prospective or retrospective observational studies, case-control studies, case series with a sample larger than 20 patients, meta-analyses, restricted to human study participants. Panel members first screened titles and abstracts, and subsequently full text review of selected reports. Data were abstracted in duplicate from reports meeting inclusion criteria. Panelists used the Grading of Recommendations Assessment, Development, and Evaluation Risk of Bias tool for assessment of RCTs and the "Risk of Bias In Nonrandomized Studies - of Interventions" tool for assessment of observational studies. The summary of the evidence for each PICO was presented to the full panel, and then the panel voted on the recommendations. RESULTS The initial search retrieved 15,107 unique publications, and 74 were included for data abstraction. Several RCTs were conducted to test pharmacological interventions, and we found that the quality of evidence for nonpharmacological questions was consistently poor. Five PICO questions were supported by strong recommendations, one PICO question was supported by conditional recommendations, and six PICO questions did not have sufficient evidence to provide a recommendation. CONCLUSIONS These guidelines provide recommendations for or against interventions proven to be effective, ineffective, or harmful in the medical management of patients with aSAH based on a rigorous review of the available literature. They also serve to highlight gaps in knowledge that should guide future research priorities. Despite improvements in the outcomes of patients with aSAH over time, many important clinical questions remain unanswered.
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Affiliation(s)
- Miriam M Treggiari
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, 5692 HAFS, Box 3059, Durham, NC, 27710, USA.
| | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Meghan M Caylor
- Department of Pharmacy, Temple University Hospital, Philadelphia, PA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, Università Milano Bicocca, Milan, Italy
- NeuroIntensive Care Unit, Department Neuroscience, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Steven Deem
- Neurocritical Care, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Michael Diringer
- Departments of Neurology and Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Elizabeth Fox
- Neurocritical Care, Stanford Health Care, Palo Alto, CA, USA
| | - Sarah Livesay
- Neurocritical Care, University of Washington, Seattle, WA, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Farber Institute for Neuroscience, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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11
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Vasilev Y, Blokhin I, Khoruzhaya A, Kodenko M, Kolyshenkov V, Nanova O, Shumskaya Y, Omelyanskaya O, Vladzymyrskyy A, Reshetnikov R. Routine Brain MRI Findings on the Long-Term Effects of COVID-19: A Scoping Review. Diagnostics (Basel) 2023; 13:2533. [PMID: 37568896 PMCID: PMC10417725 DOI: 10.3390/diagnostics13152533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
RATIONALE AND OBJECTIVES Post-COVID condition (PCC) is associated with long-term neuropsychiatric symptoms. Magnetic resonance imaging (MRI) in PCC examines the brain metabolism, connectivity, and morphometry. Such techniques are not easily available in routine practice. We conducted a scoping review to determine what is known about the routine MRI findings in PCC patients. MATERIALS AND METHODS The PubMed database was searched up to 11 April 2023. We included cohort, cross-sectional, and before-after studies in English. Articles with only advanced MRI sequences (DTI, fMRI, VBM, PWI, ASL), preprints, and case reports were excluded. The National Heart, Lung, and Blood Institute and PRISMA Extension tools were used for quality assurance. RESULTS A total of 7 citations out of 167 were included. The total sample size was 451 patients (average age 51 ± 8 years; 67% female). Five studies followed a single recovering cohort, while two studies compared findings between two severity groups. The MRI findings were perivascular spaces (47%), microbleeds (27%) and white matter lesions (10%). All the studies agreed that PCC manifestations are not associated with specific MRI findings. CONCLUSION The results of the included studies are heterogeneous due to the low agreement on the types of MRI abnormalities in PCC. Our findings indicate that the routine brain MRI protocol has little value for long COVID diagnostics.
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Affiliation(s)
- Yuriy Vasilev
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
| | - Ivan Blokhin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
| | - Anna Khoruzhaya
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
| | - Maria Kodenko
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
- Department of Biomedical Technologies, Bauman Moscow State Technical University, 2nd Baumanskaya Street, 5, Building 1, 105005 Moscow, Russia
| | - Vasiliy Kolyshenkov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
| | - Olga Nanova
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
| | - Yuliya Shumskaya
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
- Department of Information and Internet Technologies, I.M. Sechenov First Moscow State Medical University, Trubetskaya Street, 8, Building 2, 119991 Moscow, Russia
| | - Olga Omelyanskaya
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
| | - Anton Vladzymyrskyy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
- Department of Information and Internet Technologies, I.M. Sechenov First Moscow State Medical University, Trubetskaya Street, 8, Building 2, 119991 Moscow, Russia
| | - Roman Reshetnikov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow, Russian Federation, Petrovka Street, 24, Building 1, 127051 Moscow, Russia
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12
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Zapf A. [Benefit assessment of diagnostics - Dealing with incomplete evidence]. Z Evid Fortbild Qual Gesundhwes 2023:S1865-9217(23)00068-5. [PMID: 37208273 DOI: 10.1016/j.zefq.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/21/2023]
Abstract
Incomplete evidence in diagnostic studies results from missing or too few randomised test-treatment studies or from studies of too low quality. In order to be able to carry out a benefit assessment, it is helpful in the first step to design a hypothetical randomised test-treatment study. In the second step, the linked evidence approach can be used to link the evidence of the individual components of the test-treatment pathway and to assess the potential benefits and risks. In the third step, based on the linked evidence approach, decision analytic models can be used to quantify the benefit-risk ratio. In the case of incomplete evidence, the assessment can thus be made by linking the individual components of the test-treatment pathway, provided that their evidence is sufficient.
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Affiliation(s)
- Antonia Zapf
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
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13
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Mestre TA, Fabbri M, Luo S, Stebbins GT, Goetz CG, Sampaio C. A Unified Framework for Evidence-Based Diagnostic Criteria Programs in Movement Disorders. Mov Disord 2023. [PMID: 37156735 DOI: 10.1002/mds.29420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- Tiago A Mestre
- Parkinson's Disease and Movement Disorder Clinic, The Ottawa Hospital - Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada
| | - Margherita Fabbri
- Department of Neurosciences, Toulouse Parkinson Expert Center, Centre d'Investigation Clinique de Toulouse CIC1436, NS-Park/FCRIN Network, University Hospital of Toulouse, INSERM, University of Toulouse 3, Toulouse, France
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Duan R, Gong F, Wang Y, Huang C, Wu J, Hu L, Liu M, Qiu S, Lu L, Lin Y. Transarterial chemoembolization (TACE) plus tyrosine kinase inhibitors versus TACE in patients with hepatocellular carcinoma: a systematic review and meta-analysis. World J Surg Oncol 2023; 21:120. [PMID: 37004052 PMCID: PMC10064711 DOI: 10.1186/s12957-023-02961-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/22/2023] [Indexed: 04/03/2023] Open
Abstract
PURPOSE Transarterial chemoembolization (TACE) with tyrosine kinase inhibitors (TKIs) has been increasingly used to treat unresectable hepatocellular carcinoma (uHCC). However, the superiority of combination therapy to TACE monotherapy remains controversial. Therefore, here we performed a meta-analysis to evaluate the efficacy and safety of TACE plus TKIs in patients with uHCC. METHODS We searched four databases for eligible studies. The primary outcome was time to progression (TTP), while the secondary outcomes were overall survival (OS), tumor response rates, and adverse events (AEs). Pooled hazard ratios (HRs) with 95% confidence intervals (95% CIs) were collected for TTP and OS, and the data were analyzed using random-effects meta-analysis models in STATA software. OR and 95% CIs were used to estimate dichotomous variables (complete remission[CR], partial remission[PR], stable disease[SD], progressive disease[PD], objective response rate[ORR], disease control rate[DCR], and AEs) using RStudio's random-effects model. Quality assessments were performed using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane risk of bias tool for randomized controlled trials (RCTs). RESULTS The meta-analysis included 30 studies (9 RCTs, 21 observational studies) with 8246 patients. We judged the risk of bias as low in 44.4% (4/9) of the RCTs and high in 55.6% (5/9) of the RCTs. All observational studies were considered of high quality, with a NOS score of at least 6. Compared with TACE alone or TACE plus placebo, TACE combined with TKIs was superior in prolonging TTP (combined HR 0.72, 95% CI 0.65-0.80), OS (combined HR 0.57, 95% CI 0.49-0.67), and objective response rate (OR 2.13, 95% CI 1.23-3.67) in patients with uHCC. However, TACE plus TKIs caused a higher incidence of AEs, especially hand-foot skin reactions (OR 87.17%, 95%CI 42.88-177.23), diarrhea (OR 18.13%, 95%CI 9.32-35.27), and hypertension (OR 12.24%, 95%CI 5.89-25.42). CONCLUSIONS Our meta-analysis found that TACE plus TKIs may be beneficial for patients with uHCC in terms of TTP, OS, and tumor response rates. However, combination therapy is also associated with a significantly increased risk of adverse reactions. Therefore, we must evaluate the clinical benefits and risks of combination therapy. Further well-designed RCTs are needed to confirm our findings. TRIAL REGISTRATION PROSPERO registration number: CRD42022298003.
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Affiliation(s)
- Ruihua Duan
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fen Gong
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Wang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Caixia Huang
- Medical Examination Center, Huizhou Central People's Hospital, Huizhou, Guangdong, China
| | - Jiaming Wu
- Zhongshan Affiliated Hospital, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Leihao Hu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 16 Jichang Road, Guangzhou, China
| | - Shijun Qiu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Liming Lu
- Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yisheng Lin
- Dongguan Institute of Guangzhou University of Chinese Medicine, Dongguan, 523808, China.
- Department of Interventional Radiology, Huizhou Municipal Central Hospital, Huizhou Guangdong, China.
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15
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Anzola LK, Hernandez N, Rodriguez LF, Sanguino G, Martinez E, Lopez R, Moreno S, Prill R, Mut F, Rasch H, Hirschmann M. The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis-a diagnostic test accuracy review. J Orthop Surg Res 2023; 18:223. [PMID: 36945001 PMCID: PMC10031962 DOI: 10.1186/s13018-023-03687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE The aim of this systematic review was to present the current evidence on the clinical use of single-photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of noninfected painful knees after knee arthroplasty. METHODS Embase, PubMed, Google Scholar, Ovid, Scopus, Science Direct and the Cochrane Database of Systematic Reviews were searched from database inception to May 2022 following the PRISMA guidelines. As a primary outcome, we defined the role of SPECT/CT in the diagnostic approach to noninfected painful knee arthroplasty; as a secondary objective, we described the noninfection-related factors linked to painful knee arthroplasty. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio values and other indicators were calculated; receiver operating characteristic (ROC) curve analysis results and a summary of the areas under the curve (AUCs) from the included studies were reported. A Fagan plot, likelihood ratio plot and Deeks' funnel plot were generated and analysed. Methodological quality was assessed using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. RESULTS A total of 493 publications were identified, of which eight met the inclusion criteria, with a final pooled sample size of 308 patients. The pooled sensitivity and specificity of SPECT/CT in diagnosing the source of pain in painful knee prostheses were 0.86 (95% CI: 0.75-0.93) and 0.90 (95% CI: 0.79-0.96), respectively, with pooled +LR and -LR values of 8.9 (95% CI: 4.11-19.19) and 0.15 (95% CI: 0.09-0.28). The pooled diagnostic odds ratio was 57.35, and the area under the curve was 0.94. SPECT/CT highly accurately identified different sources of pain, such as loosening of the prosthetic components, patellofemoral overloading, instability, malalignment of the components and degeneration of the patellofemoral compartment. The confidence of the estimates was moderate according to the GRADE approach. CONCLUSION With demonstrated high sensitivity and specificity, as a diagnostic tool, SPECT/CT can identify the source of pain in painful knees after knee arthroplasty, particularly in cases of loosening, patellofemoral disorders and component malalignment (level of evidence III). These findings have significant clinical repercussions, such as in changing the initial diagnosis, identifying or excluding different causes of painful knee arthroplasties, guiding subsequent treatment and positively impacting the final clinical outcome. We moderately recommend the use of SPECT/CT for identifying the source of pain after knee arthroplasty according to the GRADE assessment. This review was preregistered in Prospero under code CRD42022320457.
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Affiliation(s)
- Luz Kelly Anzola
- Department of Nuclear Medicine, Clinica Reina Sofia, Bogota, Colombia.
- Department of Nuclear Medicine, Clinica Colombia, Bogota, Colombia.
- Fundacion Universitaria Sanitas Nuclear Medicine Postgraduate Program, Bogota, Colombia.
| | - Nathaly Hernandez
- Fundacion Universitaria Sanitas Nuclear Medicine Postgraduate Program, Bogota, Colombia
| | | | - Gilberto Sanguino
- Department of Orthopedics and Traumatology, Clinica Reina Sofia, Bogota, Colombia
| | - Ernesto Martinez
- Department of Orthopedics and Traumatology, Clinica Reina Sofia, Bogota, Colombia
| | - Rodrigo Lopez
- Department of Orthopedics and Traumatology, Clinica Reina Sofia, Bogota, Colombia
| | - Sergio Moreno
- Clinical Epidemiologist, Universidad Nacional de Colombia, Bogota, Colombia
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodore Fontane, Neuruppin, Germany
| | - Fernando Mut
- Department of Nuclear Medicine, Hospital Italiano, Montevideo, Uruguay
| | - Helmut Rasch
- Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
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16
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Pires GN, Arnardóttir ES, Islind AS, Leppänen T, McNicholas WT. Consumer sleep technology for the screening of obstructive sleep apnea and snoring: current status and a protocol for a systematic review and meta-analysis of diagnostic test accuracy. J Sleep Res 2023:e13819. [PMID: 36807680 DOI: 10.1111/jsr.13819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 02/20/2023]
Abstract
There are concerns about the validation and accuracy of currently available consumer sleep technology for sleep-disordered breathing. The present report provides a background review of existing consumer sleep technologies and discloses the methods and procedures for a systematic review and meta-analysis of diagnostic test accuracy of these devices and apps for the detection of obstructive sleep apnea and snoring in comparison with polysomnography. The search will be performed in four databases (PubMed, Scopus, Web of Science, and the Cochrane Library). Studies will be selected in two steps, first by an analysis of abstracts followed by full-text analysis, and two independent reviewers will perform both phases. Primary outcomes include apnea-hypopnea index, respiratory disturbance index, respiratory event index, oxygen desaturation index, and snoring duration for both index and reference tests, as well as the number of true positives, false positives, true negatives, and false negatives for each threshold, as well as for epoch-by-epoch and event-by-event results, which will be considered for the calculation of surrogate measures (including sensitivity, specificity, and accuracy). Diagnostic test accuracy meta-analyses will be performed using the Chu and Cole bivariate binomial model. Mean difference meta-analysis will be performed for continuous outcomes using the DerSimonian and Laird random-effects model. Analyses will be performed independently for each outcome. Subgroup and sensitivity analyses will evaluate the effects of the types (wearables, nearables, bed sensors, smartphone applications), technologies (e.g., oximeter, microphone, arterial tonometry, accelerometer), the role of manufacturers, and the representativeness of the samples.
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Affiliation(s)
- Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.,European Sleep Research Society (ESRS), Regensburg, Germany
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna Sigridur Islind
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Department of Computer Science, Reykjavik University, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
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El Mikati IK, Morgan RL, Murad MH, Sultan S, Falck-Ytter Y, Mustafa RA. Testing guidelines during times of crisis: challenges and limitations of developing rapid and living guidelines. Clin Microbiol Infect 2023; 29:424-428. [PMID: 36736663 PMCID: PMC9892317 DOI: 10.1016/j.cmi.2023.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/30/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The start of the COVID-19 pandemic presented a situation in which there was an urgent need for decision-making that relates to diagnosis, but the evidence was lacking, of low certainty or constantly changing. Rapid and living guideline development methods were needed and had to be applied to rigorous guideline approaches, such as the Grading of Recommendations Assessment, Development, and Evaluation approach. OBJECTIVES To describe the process of developing rapid diagnosis guidelines when there is limited and imperfect available data at the time of crisis. SOURCES Case example from four Infectious Disease Society of America COVID-19 diagnostic guidelines. CONTENT As the world was experiencing panic with COVID-19, there were serious doubts about the feasibility of following a rigorous process for guideline development when timeliness was of extreme value. The Infectious Disease Society of America guideline panels supported by several methodologists strongly believed that at times of crisis, it is more important than ever to follow a rigorous process. The panel adopted a rapid and living systematic review methodology and applied the Grading of Recommendations Assessment, Development and Evaluation approach to four diagnosis guidelines despite the challenges of scarce and dynamic evidence. We describe the methodological details of the rapid and living approach (data extraction, meta-analysis, Evidence to Decision framework, and recommendation development), the challenge of resources, the challenge of scarce evidence, the challenge of rapidly changing evidence, as well as 'wins' from the Infectious Disease Society of America experience. IMPLICATIONS Mitigation of pandemics relies on rapid and accurate diagnosis, which is challenged by many knowledge gaps. This necessitates emerging evidence is rapidly incorporated in a living fashion with several decisional and contextual factors to ensure the best public health strategies and care for patients. This process must be systematic and transparent for developing trustworthy guidelines and should be supported by all stakeholders, including researchers, editors, publishers, professional societies, and policymakers.
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Affiliation(s)
- Ibrahim K. El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - M. Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, University of Minnesota, Minneapolis, MN, USA
| | - Yngve Falck-Ytter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA,VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | - Reem A. Mustafa
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Departments of Internal Medicine and Population Health, University of Kansas Medical Centre, Kansas City, KS, USA,Corresponding author. Reem A. Mustafa, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Garay S, Haeger M, Kühnlein L, Sulmann D, Suhr R. Interventions to enhance safety culture for nursing professionals in long-term care: a systematic review. International Journal of Nursing Studies Advances 2023. [DOI: 10.1016/j.ijnsa.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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19
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Ho S, Ly A, Ohno-Matsui K, Kalloniatis M, Doig GS. Diagnostic accuracy of OCTA and OCT for myopic choroidal neovascularisation: a systematic review and meta-analysis. Eye (Lond) 2023; 37:21-29. [PMID: 36456704 PMCID: PMC9829918 DOI: 10.1038/s41433-022-02227-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/26/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/OBJECTIVES The purpose of this project was to systematically review and meta-analyse studies assessing the diagnostic accuracy of optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) for myopic choroidal neovascularisation (mCNV). Fluorescein angiography (FA) was accepted as the reference standard. METHODS PUBMED and EMBASE were searched from inception to March 2021 for studies evaluating the test accuracy of OCTA and/or OCT for diagnosing mCNV. The Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Test Accuracy Studies guideline was followed, and the Grading of Recommendations, Assessment, Development and Evaluation approach was used to frame clinical recommendations. Pooled estimates of test accuracy were obtained using a bivariate model. RESULTS Of 410 studies assessed for eligibility, 3 studies were identified that compared OCTA to FA and 3 studies were identified that compared spectral domain (SD) OCT to FA. All studies had at least one major methodological flaw leading to an overall high risk of bias. On meta-analysis, the pooled sensitivity of OCTA was 0.89 (95% CI 0.78-0.94) and pooled specificity was 0.93 (95% CI 0.79-0.98). The pooled sensitivity of SD-OCT was 0.99 (95% CI 0.91-1.00). Due to uncertainty in individual studies, the pooled specificity of SD-OCT could not be estimated. CONCLUSIONS OCTA can reliably diagnose mCNV in clinically suspected patients, however, SD-OCT may not reliably establish a positive diagnosis of mCNV. Future large, prospective studies with improvements in conduct and reporting are needed to strengthen these clinical recommendations.
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Affiliation(s)
- Sharon Ho
- grid.1005.40000 0004 4902 0432Centre for Eye Health, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia
| | - Angelica Ly
- grid.1005.40000 0004 4902 0432Centre for Eye Health, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia ,Brien Holden Vision Institute, University of New South Wales, Sydney, NSW Australia
| | - Kyoko Ohno-Matsui
- grid.265073.50000 0001 1014 9130Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Michael Kalloniatis
- grid.1005.40000 0004 4902 0432Centre for Eye Health, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia
| | - Gordon S. Doig
- grid.1005.40000 0004 4902 0432Centre for Eye Health, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432School of Optometry and Vision Science, UNSW Medicine and Health, University of New South Wales, Sydney, NSW Australia
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20
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Yao L, Hui X, Li M, Li J, Ahmed MM, Lin C, Kandi M, Sreekanta A, Makhdami N, Tamilselvan D, Ali DS, Dandurand K, Yang K, Bilezikian JP, Brandi ML, Clarke BL, Mannstadt M, Rejnmark L, Khan AA, Guyatt G. Complications, Symptoms, Presurgical Predictors in Patients With Chronic Hypoparathyroidism: A Systematic Review. J Bone Miner Res 2022; 37:2642-2653. [PMID: 36375810 DOI: 10.1002/jbmr.4673] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022]
Abstract
The complications and symptoms of hypoparathyroidism remain incompletely defined. Measuring serum parathyroid hormone (PTH) and calcium levels early after total thyroidectomy may predict the development of chronic hypoparathyroidism. The study aimed (i) to identify symptoms and complications associated with chronic hypoparathyroidism and determine the prevalence of those symptoms and complications (Part I), and (ii) to examine the utility of early postoperative measurements of PTH and calcium in predicting chronic hypoparathyroidism (Part II). We searched Medline, Medline In-Process, EMBASE, and Cochrane CENTRAL to identify complications and symptoms associated with chronic hypoparathyroidism. We used two predefined criteria (at least three studies reported the complication and symptom and had statistically significantly greater pooled relative estimates). To estimate prevalence, we used the median and interquartile range (IQR) of the studies reporting complications and symptoms. For testing the predictive values of early postoperative measurements of PTH and calcium, we used a bivariate model to perform diagnostic test meta-analysis. In Part I, the 93 eligible studies enrolled a total of 18,973 patients and reported on 170 complications and symptoms. We identified nine most common complications or symptoms probably associated with chronic hypoparathyroidism. The complications or symptoms and the prevalence are as follows: nephrocalcinosis/nephrolithiasis (median prevalence among all studies 15%), renal insufficiency (12%), cataract (17%), seizures (11%), arrhythmia (7%), ischemic heart disease (7%), depression (9%), infection (11%), and all-cause mortality (6%). In Part II, 18 studies with 4325 patients proved eligible. For PTH measurement, regarding the posttest probability, PTH values above 10 pg/mL 12-24 hours postsurgery virtually exclude chronic hypoparathyroidism irrespective of pretest probability (100%). When PTH values are below 10 pg/mL, posttest probabilities range from 3% to 64%. Nine complications and symptoms are probably associated with chronic hypoparathyroidism. A PTH value above a threshold of 10 pg/mL 12-24 hours after total thyroidectomy is a strong predictor that the patients will not develop chronic hypoparathyroidism. Patients with PTH values below the threshold need careful monitoring as some will develop chronic hypoparathyroidism. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xu Hui
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jing Li
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Muhammad Muneeb Ahmed
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Clement Lin
- Faculty of Health Sciences, McMaster University, Canada
| | - Maryam Kandi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ashwini Sreekanta
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nima Makhdami
- Internal Medicine Resident, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Divya Tamilselvan
- Faculty of Health Sciences and Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Karel Dandurand
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Kehu Yang
- Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - John P Bilezikian
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maria Luisa Brandi
- Fondazione Italiana sulla Ricerca sulle Malattie dell'Osso (F.I.R.M.O. Foundation), Florence, Italy
| | - Bart L Clarke
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lars Rejnmark
- Dept of Endocrinology and Internal Medicine, Aarhus University hospital, Aarhus, Denmark
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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del Pino-Sedeño T, Infante-Ventura D, de Armas Castellano A, de Pablos-Rodríguez P, Rueda-Domínguez A, Serrano-Aguilar P, Trujillo-Martín MM. Molecular Biomarkers for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 46:105-127. [DOI: 10.1016/j.euros.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
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22
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Zheng X, Tang Y, Yang Q, Wang S, Chen R, Tao C, Zhang P, Fan B, Zhan J, Tang C, Lu L. Effectiveness and safety of anti-tau drugs for Alzheimer's disease: Systematic review and meta-analysis. J Am Geriatr Soc 2022; 70:3281-3292. [PMID: 36208415 DOI: 10.1111/jgs.18025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the cognitive effectiveness and safety of tau-targeting drugs for Alzheimer's disease (AD) METHODS: The MEDLINE, Embase, Cochrane Library, PsycINFO, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform databases were searched from inception to 22 November 2021. A systematic review and meta-analysis of randomized controlled trials were performed RESULTS: Thirty-four randomized controlled trials comprising 5549 participants, of which fifteen (51.7%) had a low risk of bias, were included. The meta-analysis showed no differences in the cognitive subscale of the AD: Assessment Scale (ADAS-Cog) between anti-tau drugs and placebo (mean difference [MD]: -0.77, 95% CI: -1.64 to 0.10; minimal important difference 3.1-3.8 points, moderate certainty evidence). For ADAS-Cog, the results subgroup analysis suggested a statistical effect of tau posttranslational modifications on drug inhibition (MD: -0.80, 95% CI: -1.43 to -0.17), which was not seen with tau aggregation inhibitors or immunotherapy (interaction p = 0.24). A total of 11.0%, 5.2%, and 4.8% of drugs inhibiting tau aggregation, immunotherapy, and drugs targeting posttranslational modifications, respectively, had a reduced risk of dropouts due to adverse events (AEs). DISCUSSION Current evidence suggests that anti-tau drugs are unlikely to have an important impact on slowing cognitive impairment. Although the subgroup analysis suggested that inhibition of tau posttranslational modifications is statistically effective and generally safer because of reduced dropouts due to AEs, the analysis has limited credibility. Additional large-scale and well-designed randomized and placebo-controlled trials will be necessary to explore the benefit of a certain type of anti-tau drug for AD.
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Affiliation(s)
- Xiaoyan Zheng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
| | - Yuyuan Tang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qinghui Yang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuting Wang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rouhao Chen
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chenyang Tao
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peiming Zhang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Baochao Fan
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Zhan
- Postdoctoral Research Station, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunzhi Tang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liming Lu
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Muthusamy S, Wagh D, Tan J, Bulsara M, Rao S. Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:980-989. [PMID: 36036913 PMCID: PMC9425289 DOI: 10.1001/jamapediatrics.2022.3079] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/30/2022] [Indexed: 01/23/2023]
Abstract
Importance The Ages and Stages Questionnaire (ASQ) is a commonly used developmental screening tool, but its utility is debated. Objectives To conduct a a systematic review and meta-analysis to evaluate ASQ's utility as a screening or diagnostic tool to identify developmental delay in children aged 12-60 months. Data Sources Medline, EMBASE, CINAHL, PsycINFO, and Mednar were searched from inception until December 2021. Study Selection Studies meeting both criteria were included. ASQ was performed at age 12 to 60 months or where the median age at ASQ was at least 12 months and formal developmental assessments were done within 2 months of ASQ. Data Extraction and Synthesis True positive, false positive, false negative, and true negatives from individual studies were extracted. Meta-analysis was conducted with Stata version 16.1. Risk of bias was assessed using the QUADAS-2 tool. Certainty of evidence (COE) was assessed using GRADE guidelines. Main Outcomes and Measures Ability of ASQ scores more than 2 SDs below the mean in more than 1 domain (ASQ-2SD) to identify any developmental delay or severe delay. Based on generally accepted interpretation of likelihood ratio (LR) values, a positive LR (PLR) more than 5 and a negative LR (NLR) of 0.2 or less were considered necessary to rule in or rule out developmental delay, respectively, with at least moderate probability. Results Initial search yielded 5777 citations of which 43 were included in the review. Of them, 36 were included in the meta-analysis. The pooled sensitivity, specificity, PLR, and NLR are as follows: ASQ-2SD to predict any delay in 1 or more domain (n = 16), 0.77 (95% CI, 0.64-0.86), 0.81 (95% CI, 0.75-0.86), 4.10 (95% CI, 3.17-5.30), and 0.28 (95% CI, 0.18-0.44); ASQ-2SD to predict severe delay in 1 or more domain (n = 15), 0.84 (95% CI, 0.75-0.90), 0.77 (95% CI, 0.71-0.82), 3.72 (95% CI, 2.98-4.64), and 0.20 (95% CI, 0.13-0.32); ASQ-2SD motor domain to predict motor delay (n = 7), 0.41 (95% CI, 0.26-0.57), 0.94 (95% CI, 0.87-0.97), 6.5 (95% CI, 3.8-11.1), and 0.63 (95% CI, 0.50-0.81); and ASQ-2SD cognitive domain to predict cognitive delay (n = 2), 0.44 (95% CI, 0.24-0.65), 0.93 (95% CI, 0.81-0.95), 6.4 (95% CI, 2.4-16.8), and 0.61 (95% CI, 0.43-0.86). The COE was low/very low. Conclusions and Relevance If a child aged 12 to 60 months passes all ASQ domains, there is a moderate probability that they do not have severe developmental delay (low COE). If a child aged 12-60 months fails the motor or cognitive domain of ASQ, there is a moderate probability that they have some motor or cognitive delay, respectively (very low COE). Trial Registration PROSPERO (CRD42021268543).
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Affiliation(s)
- Saravanan Muthusamy
- Neonatal Intensive Care Unit, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Deepika Wagh
- Neonatal Intensive Care Unit, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Jason Tan
- Neonatal Intensive Care Unit, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Shripada Rao
- Neonatal Intensive Care Unit, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Caruso S, Szoke D, Panteghini M. 'Penelope test': a practical instrument for checking appropriateness of laboratory tests. Clin Chem Lab Med 2022; 60:1342-1349. [PMID: 35785546 DOI: 10.1515/cclm-2022-0368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022]
Abstract
In medical laboratories, the appropriateness challenge directly revolves around the laboratory test and its proper selection, data analysis, and result reporting. However, laboratories have also a role in the appropriate management of those phases of total testing process (TTP) that traditionally are not under their direct control. So that, the laboratory obligation to act along the entire TTP is now widely accepted in order to achieve better care management. Because of the large number of variables involved in the overall TTP structure, it is difficult to monitor appropriateness in real time. However, it is possible to retrospectively reconstruct the body of the clinical process involved in the management of a specific laboratory test to track key passages that may be defective or incomplete in terms of appropriateness. Here we proposed an appropriateness check-list scheme along the TTP chain to be potentially applied to any laboratory test. This scheme consists of a series of questions that healthcare professionals should answer to achieve laboratory test appropriateness. In the system, even a single lacking answer may compromise the integrity of all appropriateness evaluation process as the inability to answer may involve a significant deviation from the optimal trajectory, which compromise the test appropriateness and the quality of subsequent steps. Using two examples of the check-list application, we showed that the proposed instrument may offer an objective help to avoid inappropriate use of laboratory tests in an integrated way involving both laboratory professionals and user clinicians.
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Affiliation(s)
- Simone Caruso
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dominika Szoke
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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Taylor-Phillips S, Seedat F, Kijauskaite G, Marshall J, Halligan S, Hyde C, Given-Wilson R, Wilkinson L, Denniston AK, Glocker B, Garrett P, Mackie A, Steele RJ. UK National Screening Committee's approach to reviewing evidence on artificial intelligence in breast cancer screening. Lancet Digit Health 2022; 4:e558-e565. [PMID: 35750402 DOI: 10.1016/s2589-7500(22)00088-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/04/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
Artificial intelligence (AI) could have the potential to accurately classify mammograms according to the presence or absence of radiological signs of breast cancer, replacing or supplementing human readers (radiologists). The UK National Screening Committee's assessments of the use of AI systems to examine screening mammograms continues to focus on maximising benefits and minimising harms to women screened, when deciding whether to recommend the implementation of AI into the Breast Screening Programme in the UK. Maintaining or improving programme specificity is important to minimise anxiety from false positive results. When considering cancer detection, AI test sensitivity alone is not sufficiently informative, and additional information on the spectrum of disease detected and interval cancers is crucial to better understand the benefits and harms of screening. Although large retrospective studies might provide useful evidence by directly comparing test accuracy and spectrum of disease detected between different AI systems and by population subgroup, most retrospective studies are biased due to differential verification (ie, the use of different reference standards to verify the target condition among study participants). Enriched, multiple-reader, multiple-case, test set laboratory studies are also biased due to the laboratory effect (ie, radiologists' performance in retrospective, laboratory, observer studies is substantially different to their performance in a clinical environment). Therefore, assessment of the effect of incorporating any AI system into the breast screening pathway in prospective studies is required as it will provide key evidence for the effect of the interaction of medical staff with AI, and the impact on women's outcomes.
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Affiliation(s)
| | - Farah Seedat
- UK National Screening Committee, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Goda Kijauskaite
- UK National Screening Committee, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - John Marshall
- UK National Screening Committee, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Chris Hyde
- Exeter Test Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | | | - Alastair K Denniston
- Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Peter Garrett
- Department of Chemical Engineering and Analytical Science, University of Manchester, Manchester, UK
| | - Anne Mackie
- UK National Screening Committee, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Robert J Steele
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Tanaka A, Matsuo K, Kikuchi M, Kojima S, Hanada H, Mano T, Nakashima T, Hashiba K, Yamamoto T, Yamaguchi J, Nakayama N, Nomura O, Matoba T, Tahara Y, Nonogi H. Systematic Review and Meta-Analysis of Diagnostic Accuracy to Identify ST-Segment Elevation Myocardial Infarction on Interpretations of Prehospital Electrocardiograms. Circ Rep 2022; 4:289-297. [PMID: 35860351 PMCID: PMC9257459 DOI: 10.1253/circrep.cr-22-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The aim of this study was to assess and discuss the diagnostic accuracy of prehospital ECG interpretation through systematic review and meta-analyses. Methods and Results: Relevant literature published up to July 2020 was identified using PubMed. All human studies of prehospital adult patients suspected of ST-segment elevation myocardial infarction in which prehospital electrocardiogram (ECG) interpretation by paramedics or computers was evaluated and reporting all 4 (true-positive, false-positive, false-negative, and true-negative) values were included. Meta-analyses were conducted separately for the diagnostic accuracy of prehospital ECG interpretation by paramedics (Clinical Question [CQ] 1) and computers (CQ2). After screening, 4 studies for CQ1 and 6 studies for CQ2 were finally included in the meta-analysis. Regarding CQ1, the pooled sensitivity and specificity were 95.5% (95% confidence interval [CI] 82.5–99.0%) and 95.8% (95% CI 82.3–99.1%), respectively. Regarding CQ2, the pooled sensitivity and specificity were 85.4% (95% CI 74.1–92.3%) and 95.4% (95% CI 87.3–98.4%), respectively. Conclusions: This meta-analysis suggests that the diagnostic accuracy of paramedic prehospital ECG interpretations is favorable, with high pooled sensitivity and specificity, with an acceptable estimated number of false positives and false negatives. Computer-assisted ECG interpretation showed high pooled specificity with an acceptable estimated number of false positives, whereas the pooled sensitivity was relatively low.
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Affiliation(s)
- Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kunihiro Matsuo
- Department of Acute Care Medicine, Fukuoka University Chikushi Hospital
| | - Migaku Kikuchi
- Department of Cardiovascular Medicine, Emergency and Critical Care Center, Dokkyo Medical University
| | - Sunao Kojima
- Department of Internal Medicine, Sakurajyuji Yatsushiro Rehabilitation Hospital
| | - Hiroyuki Hanada
- Department of Emergency and Disaster Medicine, Hirosaki University
| | | | - Takahiro Nakashima
- Department of Emergency Medicine and Michigan Center for Integrative Research in Critical Care, University of Michigan
| | | | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | | | - Naoki Nakayama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Osamu Nomura
- Department of Emergency and Disaster Medicine, Hirosaki University
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Faculty of Medical Sciences
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Schünemann HJ, Reinap M, Piggott T, Laidmäe E, Köhler K, Pōld M, Ens B, Irs A, Akl EA, Cuello CA, Falavigna M, Gibbens M, Neamtiu L, Parmelli E, Jameleddine M, Pyke L, Verstijnen I, Alonso-coello P, Tugwell P, Zhang Y, Saz-parkinson Z, Kuchenmüller T, Moja L. The ecosystem of health decision making: from fragmentation to synergy. The Lancet Public Health 2022; 7:e378-90. [DOI: 10.1016/s2468-2667(22)00057-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022] Open
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Tuut MK, Burgers JS, van der Weijden T, Langendam MW. Do clinical practice guidelines consider evidence about diagnostic test consequences on patient-relevant outcomes? A critical document analysis. J Eval Clin Pract 2022; 28:278-287. [PMID: 34553815 PMCID: PMC9292948 DOI: 10.1111/jep.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Supporting evidence for diagnostic test recommendations in clinical practice guidelines (CPGs) should not only include diagnostic accuracy, but also downstream consequences of the test result on patient-relevant outcomes. The aim of this study is to assess the extent to which evidence-based CPGs about diagnostic tests cover all relevant test-treatment pathway components. METHODS We performed a systematic document analysis and quality assessment of publicly accessible CPGs about three common diagnostic tests: C-reactive protein, colonoscopy and fractional exhaled nitric oxide. Evaluation of the impact of the full test-treatment pathway (diagnostic accuracy, burden of the test, natural course of target condition, treatment effectiveness, and link between test result and administration of treatment) on patient relevant outcomes was considered best practice for developing medical test recommendations. RESULTS We retrieved 15 recommendations in 15 CPGs. The methodological quality of the CPGs varied from poor to excellent. Ten recommendations considered diagnostic accuracy. Four of these were funded on a systematic review and rating of the certainty in the evidence. None of the CPGs evaluated all steps of the test-treatment pathway. Burden of the test was considered in three CPGs, but without systematically reviewing the evidence. Natural course was considered in two CPGs, without a systematic review of the evidence. In three recommendations, treatment effectiveness was considered, supported with a systematic review and rating of the certainty in the evidence in one CPG. The link between test result and treatment administration was not considered in any CPG. CONCLUSIONS The included CPGs hardly seem to consider evidence about test consequences on patient-relevant outcomes. This might be explained by reporting issues and challenging methodology. Future research is needed to investigate how to facilitate guideline developers in explicit reliable consideration of all steps of a test-treatment pathway when developing diagnostic test recommendations.
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Affiliation(s)
- Mariska K Tuut
- School CAPHRI, Department of Family Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,PROVA, Varsseveld, The Netherlands
| | - Jako S Burgers
- School CAPHRI, Department of Family Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Trudy van der Weijden
- School CAPHRI, Department of Family Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Miranda W Langendam
- Department Epidemiology and Data Science, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
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Walsh T, Macey R, Ricketts D, Carrasco Labra A, Worthington H, Sutton A, Freeman S, Glenny A, Riley P, Clarkson J, Cerullo E. Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews. J Dent Res 2022; 101:261-269. [PMID: 34636266 PMCID: PMC8864327 DOI: 10.1177/00220345211042795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Detection and diagnosis of caries-typically undertaken through a visual-tactile examination, often with supporting radiographic investigations-is commonly regarded as being broadly effective at detecting caries that has progressed into dentine and reached a threshold where restoration is necessary. With earlier detection comes an opportunity to stabilize disease or even remineralize the tooth surface, maximizing retention of tooth tissue and preventing a lifelong cycle of restoration. We undertook a formal comparative analysis of the diagnostic accuracy of different technologies to detect and inform the diagnosis of early caries using published Cochrane systematic reviews. Forming the basis of our comparative analysis were 5 Cochrane diagnostic test accuracy systematic reviews evaluating fluorescence, visual or visual-tactile classification systems, imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies. Acceptable reference standards included histology, operative exploration, or enhanced visual assessment (with or without tooth separation) as appropriate. We conducted 2 analyses based on study design: a fully within-study, within-person analysis and a network meta-analysis based on direct and indirect comparisons. Nineteen studies provided data for the fully within-person analysis and 64 studies for the network meta-analysis. Of the 5 technologies evaluated, the greatest pairwise differences were observed in summary sensitivity points for imaging and all other technologies, but summary specificity points were broadly similar. For both analyses, the wide 95% prediction intervals indicated the uncertainty of future diagnostic accuracy across all technologies. The certainty of evidence was low, downgraded for study limitations, inconsistency, and indirectness. Summary estimates of diagnostic accuracy for most technologies indicate that the degree of certitude with which a decision is made regarding the presence or absence of disease may be enhanced with the use of such devices. However, given the broad prediction intervals, it is challenging to predict their accuracy in any future "real world" context.
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Affiliation(s)
- T. Walsh
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK,T. Walsh, Division of Dentistry, School of
Medical Sciences, The University of Manchester, Coupland 3 Building, Manchester
M13 9PL, UK.
| | - R. Macey
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - D. Ricketts
- Dundee Dental School, University of
Dundee, Dundee, UK
| | - A. Carrasco Labra
- Department of Evidence Synthesis and
Translation Research, Science and Research Institute, LLC, American Dental
Association, Chicago, IL, USA,Department of Oral and Craniofacial
Health Science, School of Dentistry, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
| | - H. Worthington
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - A.J. Sutton
- Department of Health Sciences,
University of Leicester, Leicester, UK
| | - S. Freeman
- Department of Health Sciences,
University of Leicester, Leicester, UK
| | - A.M. Glenny
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - P. Riley
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - J. Clarkson
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK,Dundee Dental School, University of
Dundee, Dundee, UK
| | - E. Cerullo
- Department of Health Sciences,
University of Leicester, Leicester, UK
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Wang L, Ling C, Lai P, Huang Y. Can The ‘Speed Bump Sign’ Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE. Life (Basel) 2022; 12:138. [PMID: 35207428 PMCID: PMC8875208 DOI: 10.3390/life12020138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/30/2021] [Accepted: 01/14/2022] [Indexed: 12/29/2022] Open
Abstract
Objectives: The ‘speed bump sign’ is a clinical symptom characterised by aggravated abdominal pain while driving over speed bumps. This study aimed to perform a diagnostic meta-analysis, rate the certainty of evidence (CoE) and analyse the applicability of the speed bump sign in the diagnosis of acute appendicitis. Materials and Methods: Four databanks and websites were systemically searched, and the Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias. Meta-analysis was assessed by MIDAS commands in Stata 15. Grading of Recommendations, Assessment, Development and Evaluation methodology was applied to examine the CoE. Results: Four studies with 343 participants were included. The pooled sensitivity and specificity were 0.94 (95% CI (confidence interval) = 0.83–0.98; I2 = 79%) and 0.49 (95% CI = 0.33–0.66; I2 = 67%), respectively. The area under the summary receiver operating characteristic curve was 0.78 (95% CI = 0.74–0.81). The diagnostic odds ratio was 14.1 (95% CI = 3.6–55.7). The pooled positive and negative likelihood ratios (LR (+) and LR (−)) were 1.84 (95% CI = 1.30–2.61) and 0.13 (95% CI = 0.04–0.41), respectively. According to Fagan’s nomogram plot, when the pretest probabilities were 25%, 50% and 75%, the related posttest probabilities increased to 38%, 65% and 85% calculated through LR (+), respectively, and the posttest probabilities were 4%, 12% and 28% calculated through LR (−), respectively. The overall CoEs were low and very low in sensitivity and specificity, respectively. Conclusion: Current evidence shows that the speed bump sign is a useful ‘rule-out’ test for diagnosing acute appendicitis. With good accessibility, the speed bump sign may be added as a routine part of taking the history of patients with abdominal pain.
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St Laurent CW, Rodheim K, Spencer RMC. A Systematic Review of the Relationships Between Physical Activity and Sleep in Early Childhood. Kinesiol Rev (Champaign) 2021; 11:121-137. [PMID: 35873529 PMCID: PMC9302480 DOI: 10.1123/kr.2020-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this systematic review was to examine the associations between physical activity and sleep in children aged less than 6 years. Articles were included if participants were primarily aged less than 6 years and study designs were observational or experimental. Study characteristics were extracted, and the Grading Recommendations Assessment, Development and Evaluation framework was used to assess study quality. Thirty-six studies (16 sleep, 16 physical activity, and three fitness outcomes) from 18 countries reported in 29 articles were included. The majority of sleep and physical activity outcome studies reported mixed effects with very low to low quality of evidence. Fitness outcome studies were limited, and therefore, evidence was insufficient. The high prevalence of mixed and null results could be related to study limitations. Importantly, this review points to the critical need for higher quality studies of sleep and physical activity in young children, which would support health recommendations and intervention strategies for healthier child development.
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Affiliation(s)
- Christine W St Laurent
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Katrina Rodheim
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rebecca M C Spencer
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Institute of Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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32
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Jones LI, Taylor-Phillips S, Geach R, Harding SA, Marshall A, McKeown-Keegan S, Dunn JA. Re: The potential of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis. A reply. Clin Radiol 2021; 77:73-75. [PMID: 34848027 DOI: 10.1016/j.crad.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
- L I Jones
- North Bristol NHS Trust, Bristol, UK.
| | | | - R Geach
- North Bristol NHS Trust, Bristol, UK
| | | | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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33
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Nguyen HN, Kulkarni M, Jose J, Sisson A, Brandt ML, Sammer MB, Pammi M. Ultrasound for the diagnosis of malrotation and volvulus in children and adolescents: a systematic review and meta-analysis. Arch Dis Child 2021; 106:1171-1178. [PMID: 33879472 PMCID: PMC8526644 DOI: 10.1136/archdischild-2020-321082] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 02/01/2023]
Abstract
CONTEXT Despite the advantages of ultrasound (US), upper gastrointestinal contrast series (UGI) remains the first-line diagnostic modality in the diagnosis of midgut malrotation and volvulus in children. OBJECTIVE Evaluate the diagnostic accuracy of US in the diagnosis of malrotation with or without volvulus in children and adolescents aged 0-21 years, compared with the reference standard (diagnosis by surgery, UGI, CT, MRI, and clinical follow-up individually or as a composite). DATA SOURCES We searched the electronic databases Ovid-MEDLINE, Embase, Scopus, CINAHL, and the Cochrane library in October 2019 and updated on 18 August 2020. STUDY SELECTION Studies evaluating the diagnostic performance of US for diagnosis of midgut malrotation with or without volvulus in children (0-21 years). DATA EXTRACTION AND SYNTHESIS The data were extracted independently by two authors and a bivariate model was used for synthesis. RESULTS Meta-analysis of 17 cohort or cross-sectional studies and 2257 participants estimated a summary sensitivity of 94% (95% CI 89% to 97%) and summary specificity of 100% (95% CI 97% to 100%) (moderate certainty evidence) for the use of US for the diagnosis of malrotation with or without midgut volvulus compared with the reference standard. Subgroup analysis and meta-regression revealed better diagnostic accuracy in malrotation not complicated by volvulus, in the neonatal population and enteric fluid administration before US. CONCLUSIONS Moderate certainty evidence suggests excellent diagnostic accuracy and coupled with the advantages, a strong case exists for the use of abdominal US as the first-line diagnostic test for suspected midgut malrotation with or without volvulus in children and adolescents.
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Affiliation(s)
- HaiThuy N. Nguyen
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, Houston, Texas, USA,Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Madhulika Kulkarni
- Department of Pediatrics, Texas Children’s Hospital, Houston, Texas, USA,Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas, USA
| | - Jisha Jose
- Department of Pediatrics, Texas Children’s Hospital, Houston, Texas, USA,Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Sisson
- The Texas Medical Center Library, Houston, Texas, USA
| | - Mary L. Brandt
- Department of Surgery, Children’s Hospital of New Orleans, Louisiana, USA,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Marla B.K. Sammer
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, Houston, Texas, USA,Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohan Pammi
- Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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34
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Trinh M, Kalloniatis M, Nivison-Smith L. Should clinical automated perimetry be considered for routine functional assessment of early/intermediate age-related macular degeneration (AMD)? A systematic review of current literature. Ophthalmic Physiol Opt 2021; 42:161-177. [PMID: 34843120 PMCID: PMC9300202 DOI: 10.1111/opo.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
Purpose There is growing interest in functional testing for early/intermediate age‐related macular degeneration (iAMD). However, systematic evaluation of existing clinical functional tests is lacking. This systematic review examines evidence for using clinical automated perimetry in routine assessment of early/iAMD. Recent findings PubMed, Web of Science Core Collection, and Embase were searched from inception to October 2020 to answer, is there evidence of visual field defects in early/iAMD, and if so, are early/iAMD visual field defects linked to real‐world patient outcomes? Articles using clinical automated perimetry (commercially accessible and non‐modified devices/protocols) were included. Microperimetry was excluded as this has yet to be incorporated into clinical guidelines. The primary outcome was global visual field indices including mean deviation (MD), pattern standard deviation (PSD), mean sensitivity (MS) and frequency of defects. The secondary outcome was any real‐world patient outcome including quality of life and/or activities of daily living indices. Twenty‐six studies were eligible for inclusion and all studies were observational. There was consistent evidence of worsened MD, PSD, MS and frequency of defects for early/iAMD compared to normal eyes under photopic, low‐photopic and scotopic conditions. Meta‐analysis of studies using standard automated perimetry (SAP) under photopic conditions revealed worsened MD (−1.52dB [−2.27, −0.78 dB]) and MS (−1.47dB [−2, −0.94 dB]) in early/iAMD compared to normal eyes, representing large statistical effect sizes but non‐clinically meaningful reductions. There was insufficient data for meta‐analyses regarding other clinical automated perimetry protocols. Only one study assessed a real‐world patient outcome (on‐road driving performance), with no significant link to visual field outcomes in early/iAMD. Summary Significant reduction of global visual field indices is present in early/iAMD, but not clinically meaningful using SAP under photopic conditions. Translational relevance of visual field outcomes to patient outcomes in early/iAMD remains unclear. Thus, SAP under photopic conditions is unlikely to be useful for routine assessment of early/iAMD.
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Affiliation(s)
- Matt Trinh
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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35
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Foroutan F, Guyatt G, Trivella M, Kreuzberger N, Skoetz N, Riley RD, Roshanov PS, Alba AC, Sekercioglu N, Canelo C, Munn Z, Brignardello-Petersen R, Schünemann HJ, Iorio A. GRADE concept paper 2: Concepts for judging certainty on the calibration of prognostic models in a body of validation studies. J Clin Epidemiol 2021; 143:202-211. [PMID: 34800677 DOI: 10.1016/j.jclinepi.2021.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/16/2021] [Accepted: 11/10/2021] [Indexed: 12/23/2022]
Abstract
``In this paper, we highlight key concepts...'' is background.The sentence ``IN this paper, we highlight key concepts in evaluating the certainty of evidence regarding the calibration of prognostic models'' is methods. The rest is results and conclusion. Brognostic models combine several prognostic factors to provide an estimate of the likelihood (or risk) of future events in individual patients, conditional on their prognostic factor values. A fundamental part of evaluating prognostic models is undertaking studies to determine whether their predictive performance, such as calibration and discrimination, is reproduced across settings. Systematic reviews and meta-analyses of studies evaluating prognostic models' performance are a necessary step for selection of models for clinical practice and for testing the underlying assumption that their use will improve outcomes, including patient's reassurance and optimal future planning. In this paper, we highlight key concepts in evaluating the certainty of evidence regarding the calibration of prognostic models. Four concepts are key to evaluating the certainty of evidence on prognostic models' performance regarding calibration. The first concept is that the inference regarding calibration may take 1 of 2 forms: deciding whether 1 is rating certainty that a model's performance is satisfactory or, instead, unsatisfactory, in either case defining the threshold for satisfactory (or unsatisfactory) model performance. Second, inconsistency is the critical GRADE domain to deciding whether we are rating certainty in the model performance being satisfactory or unsatisfactory. Third, depending on whether 1 is rating certainty in satisfactory or unsatisfactory performance, different patterns of inconsistency of results across studies will inform ratings of certainty of evidence. Fourth, exploring the distribution of point estimates of observed to expected ratio across individual studies, and its determinants, will bear on the need for and direction of future research.
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Affiliation(s)
- Farid Foroutan
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada.
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada
| | - Marialena Trivella
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada; Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, UK; NK: Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School of Medicine, Keele University, Keele, United Kingdom
| | - Nina Kreuzberger
- NK: Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- NK: Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Pavel S Roshanov
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, UK
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Nigar Sekercioglu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada
| | - Carlos Canelo
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada; Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, UK; NK: Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School of Medicine, Keele University, Keele, United Kingdom
| | - Zachary Munn
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada; Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, UK; NK: Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School of Medicine, Keele University, Keele, United Kingdom
| | | | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamitlon, Canada
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Steiner T, Dichgans M, Norrving B, Aamodt AH, Berge E, Christensen H, Fuentes B, Khatri P, Korompoki E, Martí-Fabregas J, Quinn T, Toni D, Zedde M, Sacco S, Turc G. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J 2021; 6:CXXII-CXXXIV. [PMID: 34746429 DOI: 10.1177/23969873211024143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
The first European Stroke Organization (ESO) standard operating procedure (SOP) published in 2015 aimed at the implementation the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to provide evidence-based guidelines for stroke management. This second ESO-SOP is aiming at further increase of the practicability of ESO guidelines and its technical implications. Authors comprised of the members of the ESO guideline Board and ESO Executive Committee. The final document was agreed on by several internal reviews. The second SOP comprises of the following aspects: rational for the SOP, the introduction of expert consensus statements, types of guideline documents, structures involved and detailed description of the guideline preparation process, handling of financial and intellectual conflicts of interest (CoI), involvement of ESO members in the guideline process, review process, authorship and publication policy, updating of guidelines, cooperation with other societies, and dealing with falsified data. This second SOP supersedes the first SOP published in 2015.
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Affiliation(s)
- T Steiner
- Department of Neurology, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany.,Department of Neurology Hospital, Heidelberg University, Heidelberg, Germany
| | - M Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Norrving
- Department of Clinical Sciences Lund University Hospital and Lund University Departmnet of Neurology, Skane University Hospital, Lund, Sweden
| | - A H Aamodt
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - E Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - H Christensen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Madrid, Spain
| | - P Khatri
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - E Korompoki
- Division of Brain Science, Imperial College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - T Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Toni
- Departments of Neurological Sciences and Emergency, Unità di Trattamento Neurovascolare, University of Rome La Sapienza, Rome, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale - IRCCS, di Reggio Emilia, Reggio Emilia, Italy
| | - S Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - G Turc
- Neurology Department, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
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37
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Ng JY, Verma KD, Gilotra K. Quantity and quality of complementary and alternative medicine recommendations in clinical practice guidelines for type 2 diabetes mellitus: A systematic review. Nutr Metab Cardiovasc Dis 2021; 31:3004-3015. [PMID: 34627698 DOI: 10.1016/j.numecd.2021.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 01/17/2023]
Abstract
AIMS Approximately 70% of Americans with diabetes have used complementary and alternative medicine (CAM) in the past year. Healthcare providers often receive minimal training on these therapies and subsequently rely on clinical practice guidelines (CPGs) to supplement their knowledge about the safe and effective use of CAM for the treatment/management of type 2 diabetes mellitus (T2DM). The purpose of this systematic review is to determine the quantity and assess the quality of CAM recommendations in CPGs for the treatment and/or management of T2DM. DATA SYNTHESIS MEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to 2020, in addition to the Guidelines International Network and the National Center for Complementary and Integrative Health websites. CPGs containing treatment and/or management recommendations for T2DM were eligible; those with CAM recommendations were quality-assessed with the AGREE II instrument twice, once for the overall CPG and once for the CAM sections. Twenty-seven CPGs were deemed eligible, of which 7 made CAM recommendations. Mean scaled domain percentages were (overall, CAM): scope and purpose (89.7%, 79.8%), clarity of presentation (85.7%, 48.4%), stakeholder involvement (67.9%, 28.2%), applicability (54.8%, 20.2%), rigour of development (49.7%, 35.7%), and editorial independence (44.1%, 44.1%). CONCLUSIONS Quality varied within and across CPGs; domain scores across CAM sections generally scored lower than the overall CPG. Given that CAM therapies for T2DM are only represented in one-quarter of eligible CPGs and are of lower quality, a knowledge gap exists for healthcare providers who seek evidence-based information on this topic in order to effectively counsel inquiring patients.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Kiran D Verma
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Kevin Gilotra
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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38
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Schlegel A, Foley DP, Savier E, Flores Carvalho M, De Carlis L, Heaton N, Taner CB. Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation. Transplantation 2021; 105:1892-1903. [PMID: 34416750 DOI: 10.1097/tp.0000000000003825] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although the utilization of donation after circulatory death donors (DCDs) for liver transplantation (LT) has increased steadily, much controversy remains, and no common acceptance criteria exist with regard to donor and recipient risk factors and prediction models. A consensus conference was organized by International Liver Transplantation Society on January 31, 2020, in Venice, Italy, to review the current clinical practice worldwide regarding DCD-LT and to develop internationally accepted guidelines. The format of the conference was based on the grade system. International experts in this field were allocated to 6 working groups and prepared evidence-based recommendations to answer-specific questions considering the currently available literature. Working group members and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and recommendations provided by working group 2, covering the entire spectrum of donor and recipient risk factors and prediction models in DCD-LT.
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Affiliation(s)
- Andrea Schlegel
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
- Hepatobiliary Unit, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - David P Foley
- University of Wisconsin School of Medicine and Public Health, William S. Middleton VA Medical Center, Madison, WI
| | - Eric Savier
- Department of Hepatobiliary Surgery and Liver Transplantation, Sorbonne Université Pitié-Salpêtrière Hospital, Paris, France
| | - Mauricio Flores Carvalho
- Hepatobiliary Unit, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, Florence, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - C Burcin Taner
- Department of Transplant, Mayo Clinic Florida, Jacksonville, FL
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Brañez-Condorena A, Goicochea-Lugo S, Zafra-Tanaka JH, Becerra-Chauca N, Failoc-Rojas VE, Herrera-Añazco P, Taype-Rondan A. Performance of the CKD-EPI and MDRD equations for estimating glomerular filtration rate: a systematic review of Latin American studies. SAO PAULO MED J 2021; 139:452-463. [PMID: 34378734 PMCID: PMC9632528 DOI: 10.1590/1516-3180.2020.0707.r1.150321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The most-used equations for estimating the glomerular filtration rate (GFR) are the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations. However, it is unclear which of these shows better performance in Latin America. OBJECTIVE To assess the performance of two equations for estimated GFR (eGFR) in Latin American countries. DESIGN AND SETTING Systematic review and meta-analysis in Latin American countries. METHODS We searched in three databases to identify studies that reported eGFR using both equations and compared them with measured GFR (mGFR) using exogenous filtration markers, among adults in Latin American countries. We performed meta-analyses on P30, bias (using mean difference [MD] and 95% confidence intervals [95% CI]), sensitivity and specificity; and evaluated the certainty of evidence using the GRADE methodology. RESULTS We included 12 papers, and meta-analyzed six (five from Brazil and one from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and using MDRD-4 IDMS did not show differences in bias (MD: 0.55 ml/min/1.73m2; 95% CI: -3.34 to 4.43), P30 (MD: 4%; 95% CI: -2% to 11%), sensitivity (76% and 75%) and specificity (91% and 89%), with very low certainty of evidence for bias and P30, and low certainty of evidence for sensitivity and specificity. CONCLUSION We found that the performances of CKD-EPI-Cr IDMS and MDRD-4 IDMS did not differ significantly. However, since most of the meta-analyzed studies were from Brazil, the results cannot be extrapolated to other Latin American countries. REGISTRATION PROSPERO (CRD42019123434) - https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019123434.
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Affiliation(s)
- Ana Brañez-Condorena
- Undergraduate Student, Facultad de Medicina and Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud, Universidad Nacional Mayor de San Marcos, Lima, Peru.
| | - Sergio Goicochea-Lugo
- MD. Methodologist, EsSalud, Instituto de Evaluación de Tecnologías en Salud e Investigación, Lima, Peru.
| | | | - Naysha Becerra-Chauca
- Midwife. Methodologist, EsSalud, Instituto de Evaluación de Tecnologías en Salud e Investigación, Lima, Peru.
| | - Virgilio Efrain Failoc-Rojas
- MD, MSc. Methodologist, EsSalud, Instituto de Evaluación de Tecnologías en Salud e Investigación, Lima, Peru; and Researcher, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
| | - Percy Herrera-Añazco
- MD, MHEd. Researcher, Universidad Privada San Juan Bautista, Lima, Peru; and Assistant Manager, EsSalud, Instituto de Evaluación de Tecnologías en Salud e Investigación, Lima, Peru.
| | - Alvaro Taype-Rondan
- MD, MSc. Methodologist, EsSalud, Instituto de Evaluación de Tecnologías en Salud e Investigación, Lima, Peru; and Researcher, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
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Brañez-Condorena A, Soriano-Moreno DR, Navarro-Flores A, Solis-Chimoy B, Diaz-Barrera ME, Taype-Rondan A. Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0253899. [PMID: 34197527 PMCID: PMC8248624 DOI: 10.1371/journal.pone.0253899] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Geriatric Depression Scale (GDS) is a widely used instrument to assess depression in older adults. The short GDS versions that have four (GDS-4) and five items (GDS-5) represent alternatives for depression screening in limited-resource settings. However, their accuracy remains uncertain. OBJECTIVE To assess the accuracy of the GDS-4 and GDS-5 versions for depression screening in older adults. METHODS Until May 2020, we systematically searched PubMed, PsycINFO, Scopus, and Google Scholar; for studies that have assessed the sensitivity and specificity of GDS-4 and GDS-5 for depression screening in older adults. We conducted meta-analyses of the sensitivity and specificity of those studies that used the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases-10 (ICD-10) as reference standard. Study quality was assessed with the QUADAS-2 tool. We performed bivariate random-effects meta-analyses to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI) at each reported common cut-off. For the overall meta-analyses, we evaluated each GDS-4 version or GDS-5 version separately by each cut-off, and for investigations of heterogeneity, we assessed altogether across similar GDS versions by each cut-off. Also, we assessed the certainty of evidence using the GRADE methodology. RESULTS Twenty-three studies were included and meta-analyzed, assessing eleven different GDS versions. The number of participants included was 5048. When including all versions together, at a cut-off 2, GDS-4 had a pooled sensitivity of 0.77 (95% CI: 0.70-0.82) and a pooled specificity of 0.75 (0.68-0.81); while GDS-5 had a pooled sensitivity of 0.85 (0.80-0.90) and a pooled specificity of 0.75 (0.69-0.81). We found results for more than one GDS-4 version at cut-off points 1, 2, and 3; and for more than one GDS-5 version at cut-off points 1, 2, 3, and 4. Mostly, significant subgroup differences at different test thresholds across versions were found. The accuracy of the different GDS-4 and GDS-5 versions showed a high heterogeneity. There was high risk of bias in the index test domain. Also, the certainty of the evidence was low or very low for most of the GDS versions. CONCLUSIONS We found several GDS-4 and GDS-5 versions that showed great heterogeneity in estimates of sensitivity and specificity, mostly with a low or very low certainty of the evidence. Altogether, our results indicate the need for more well-designed studies that compare different GDS versions.
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Affiliation(s)
- Ana Brañez-Condorena
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | - David R. Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | | | - Blanca Solis-Chimoy
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | - Mario E. Diaz-Barrera
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, SOCEMUNT, Trujillo, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- * E-mail:
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St Laurent CW, Burkart S, Andre C, Spencer RMC. Physical Activity, Fitness, School Readiness, and Cognition in Early Childhood: A Systematic Review. J Phys Act Health 2021;:1-10. [PMID: 34140418 DOI: 10.1123/jpah.2020-0844] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early childhood is an important age for brain and cognitive development. Given the support of physical activity and fitness on cognition and academic performance in older children, more research has emerged recently focusing on younger children. In this systematic review, the authors review the relations between physical activity/fitness and academic-related (ie, school readiness and cognitive) outcomes in early childhood. METHODS A search was conducted from PubMed, PsycINFO, Web of Science, ERIC databases, and reference lists for articles that had participants aged less than 6 years were written in English, and were in peer-reviewed journals. Articles were excluded if the design was a case study or case series report. The Grading Recommendations Assessment, Development and Evaluation framework was followed to assess the quality of evidence by study design. RESULTS Sixty-eight articles reporting on 72 studies (29 observational and 43 experimental) were included. The majority of study effects were mixed, and the quality of evidence varied from very low to low. CONCLUSIONS A clear consensus about the role of physical activity and fitness on academic-related outcomes in early childhood is still lacking given the high heterogeneity in methodological approaches and overall effects. Additional high-quality studies are needed to determine what specific dosages of physical activity are impactful at this age.
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Morgan DJ, Pineles L, Owczarzak J, Magder L, Scherer L, Brown JP, Pfeiffer C, Terndrup C, Leykum L, Feldstein D, Foy A, Stevens D, Koch C, Masnick M, Weisenberg S, Korenstein D. Accuracy of Practitioner Estimates of Probability of Diagnosis Before and After Testing. JAMA Intern Med 2021; 181:747-755. [PMID: 33818595 PMCID: PMC8022260 DOI: 10.1001/jamainternmed.2021.0269] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Accurate diagnosis is essential to proper patient care. OBJECTIVE To explore practitioner understanding of diagnostic reasoning. DESIGN, SETTING, AND PARTICIPANTS In this survey study, 723 practitioners at outpatient clinics in 8 US states were asked to estimate the probability of disease for 4 scenarios common in primary care (pneumonia, cardiac ischemia, breast cancer screening, and urinary tract infection) and the association of positive and negative test results with disease probability from June 1, 2018, to November 26, 2019. Of these practitioners, 585 responded to the survey, and 553 answered all of the questions. An expert panel developed the survey and determined correct responses based on literature review. RESULTS A total of 553 (290 resident physicians, 202 attending physicians, and 61 nurse practitioners and physician assistants) of 723 practitioners (76.5%) fully completed the survey (median age, 32 years; interquartile range, 29-44 years; 293 female [53.0%]; 296 [53.5%] White). Pretest probability was overestimated in all scenarios. Probabilities of disease after positive results were overestimated as follows: pneumonia after positive radiology results, 95% (evidence range, 46%-65%; comparison P < .001); breast cancer after positive mammography results, 50% (evidence range, 3%-9%; P < .001); cardiac ischemia after positive stress test result, 70% (evidence range, 2%-11%; P < .001); and urinary tract infection after positive urine culture result, 80% (evidence range, 0%-8.3%; P < .001). Overestimates of probability of disease with negative results were also observed as follows: pneumonia after negative radiography results, 50% (evidence range, 10%-19%; P < .001); breast cancer after negative mammography results, 5% (evidence range, <0.05%; P < .001); cardiac ischemia after negative stress test result, 5% (evidence range, 0.43%-2.5%; P < .001); and urinary tract infection after negative urine culture result, 5% (evidence range, 0%-0.11%; P < .001). Probability adjustments in response to test results varied from accurate to overestimates of risk by type of test (imputed median positive and negative likelihood ratios [LRs] for practitioners for chest radiography for pneumonia: positive LR, 4.8; evidence, 2.6; negative LR, 0.3; evidence, 0.3; mammography for breast cancer: positive LR, 44.3; evidence range, 13.0-33.0; negative LR, 1.0; evidence range, 0.05-0.24; exercise stress test for cardiac ischemia: positive LR, 21.0; evidence range, 2.0-2.7; negative LR, 0.6; evidence range, 0.5-0.6; urine culture for urinary tract infection: positive LR, 9.0; evidence, 9.0; negative LR, 0.1; evidence, 0.1). CONCLUSIONS AND RELEVANCE This survey study suggests that for common diseases and tests, practitioners overestimate the probability of disease before and after testing. Pretest probability was overestimated in all scenarios, whereas adjustment in probability after a positive or negative result varied by test. Widespread overestimates of the probability of disease likely contribute to overdiagnosis and overuse.
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Affiliation(s)
- Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.,Veterans Affairs (VA) Maryland Healthcare System, Baltimore
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laura Scherer
- Adult and Child Consortium of Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora.,Division of Cardiology, University of Colorado School of Medicine, Aurora.,Center of Innovation for Veteran-Centered and Value-Driven Care, VA Denver, Denver, Colorado
| | - Jessica P Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Chris Pfeiffer
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland
| | - Chris Terndrup
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland
| | - Luci Leykum
- Department of Medicine, Dell Medical School, the University of Texas at Austin, Austin.,Department of Medicine, South Texas Veterans Health Care System, San Antonio
| | - David Feldstein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Andrew Foy
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Deborah Stevens
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Christina Koch
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Max Masnick
- Department of Informatics, Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Scott Weisenberg
- Division of Infectious Diseases, New York University Grossman School of Medicine, New York
| | - Deborah Korenstein
- Division of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Tsujimoto H. For Better Patient Safety: The Role of Ultrasonography in Gastric Tube Placement. Chest 2021; 159:2147-2148. [PMID: 34099124 DOI: 10.1016/j.chest.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki, General Medical Center.
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Izcovich A, Cuker A, Kunkle R, Neumann I, Panepinto J, Pai M, Seftel M, Cheung MC, Lottenberg R, Byrne M, Plovnick R, Terrell D, Holter-Chakrabarty JL, Djulbegovic B, Hicks LK, Wiercioch W, Nieuwlaat R, Schünemann HJ. A user guide to the American Society of Hematology clinical practice guidelines. Blood Adv 2020; 4:2095-110. [PMID: 32396622 DOI: 10.1182/bloodadvances.2020001755] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Since November 2018, Blood Advances has published American Society of Hematology (ASH) clinical practice guidelines on venous thromboembolism, immune thrombocytopenia, and sickle cell disease. More ASH guidelines on these and other topics are forthcoming. These guidelines have been developed using consistent processes, methods, terminology, and presentation formats. In this article, we describe how patients, clinicians, policymakers, researchers, and others may use ASH guidelines and the many related derivates by describing how to interpret information and how to apply it to clinical decision-making. Also, by exploring how these documents are developed, we aim to clarify their limitations and possible inappropriate usage.
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James PD, Connell NT, Ameer B, Di Paola J, Eikenboom J, Giraud N, Haberichter S, Jacobs-Pratt V, Konkle B, McLintock C, McRae S, R Montgomery R, O'Donnell JS, Scappe N, Sidonio R, Flood VH, Husainat N, Kalot MA, Mustafa RA. ASH ISTH NHF WFH 2021 guidelines on the diagnosis of von Willebrand disease. Blood Adv 2021; 5:280-300. [PMID: 33570651 DOI: 10.1182/bloodadvances.2020003265] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/23/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND von Willebrand disease (VWD) is the most common inherited bleeding disorder known in humans. Accurate and timely diagnosis presents numerous challenges. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF), and the World Federation of Hemophilia (WFH) are intended to support patients, clinicians, and other health care professionals in their decisions about VWD diagnosis. METHODS ASH, ISTH, NHF, and WFH established a multidisciplinary guideline panel that included 4 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Outcomes and Implementation Research Unit at the University of Kansas Medical Center (KUMC) supported the guideline-development process, including performing or updating systematic evidence reviews up to 8 January 2020. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subsequently subject to public comment. RESULTS The panel agreed on 11 recommendations. CONCLUSIONS Key recommendations of these guidelines include the role of bleeding-assessment tools in the assessment of patients suspected of VWD, diagnostic assays and laboratory cutoffs for type 1 and type 2 VWD, how to approach a type 1 VWD patient with normalized levels over time, and the role of genetic testing vs phenotypic assays for types 2B and 2N. Future critical research priorities are also identified.
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Yang B, Mustafa RA, Bossuyt PM, Brozek J, Hultcrantz M, Leeflang MMG, Schünemann HJ, Langendam MW. GRADE Guidance: 31. Assessing the certainty across a body of evidence for comparative test accuracy. J Clin Epidemiol 2021; 136:146-156. [PMID: 33864930 DOI: 10.1016/j.jclinepi.2021.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/27/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This article provides GRADE guidance on how authors of evidence syntheses and health decision makers, including guideline developers, can rate the certainty across a body of evidence for comparative test accuracy questions. STUDY DESIGN AND SETTING This guidance extends the previously published GRADE guidance for assessing certainty of evidence for test accuracy to scenarios in which two or more index tests are compared. Through an iterative brainstorm-discussion-feedback process within the GRADE working group, we developed a guidance accompanied by practical examples. RESULTS Rating the certainty of evidence for comparative test accuracy shares many concepts and ideas with the existing GRADE guidance for test accuracy. The rating in comparisons of test accuracy requires additional considerations, such as the selection of appropriate comparative study designs, additional criteria for judging risk of bias, and the consequences of using comparative measures of test accuracy. Distinct approaches to rating certainty are required for comparative test accuracy studies and between-study (indirect) comparisons. CONCLUSION This GRADE guidance will support transparent assessment of the certainty for a body of comparative test accuracy evidence.
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Affiliation(s)
- Bada Yang
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Reem A Mustafa
- Michael G. De Groote Cochrane Canada and McMaster GRADE centres, Department of Health Research Methods, Evidence, and Impact, 1280 Main Street West, McMaster University, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Jan Brozek
- Michael G. De Groote Cochrane Canada and McMaster GRADE centres, Department of Health Research Methods, Evidence, and Impact, 1280 Main Street West, McMaster University, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, 1280 Main Street West, McMaster University, Hamilton, Ontario L8S4K1, Canada
| | - Monica Hultcrantz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, SE-102 33, Stockholm, Sweden
| | - Mariska M G Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Holger J Schünemann
- Michael G. De Groote Cochrane Canada and McMaster GRADE centres, Department of Health Research Methods, Evidence, and Impact, 1280 Main Street West, McMaster University, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, 1280 Main Street West, McMaster University, Hamilton, Ontario L8S4K1, Canada
| | - Miranda W Langendam
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Abstract
BACKGROUND There is a need to standardize monitoring in obstetric research of twin pregnancies. Identification of birth weight discordance (BWD), defined as a difference in the birth weights of twins, is a well-documented phenomenon in twin pregnancies. Ultrasound for the diagnosis of BWD informs complex decision making including whether to intervene medically (via laser photo coagulation) or deliver the twins to avoid fetal morbidities or even death. The question is, how accurate is this measurement? OBJECTIVES To determine the diagnostic accuracy (sensitivity and specificity) of ultrasound estimated fetal weight discordance (EFWD) of 20% and 25% using different estimated biometric ultrasound measurements compared with the actual BWD as the reference standard in twin pregnancies. SEARCH METHODS The search for this review was performed on 15 March 2019. We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), seven other databases, conference proceedings, reference lists and contacted experts. There were no language or date restrictions applied to the electronic searches, and no methodological filters to maximize sensitivity. SELECTION CRITERIA We selected cohort-type studies with delayed verification that evaluated the accuracy of biometric measurements at ultrasound scanning of twin pregnancies that had been proposed for the diagnosis of estimated BWD, compared to BWD measurements after birth as a reference standard. In addition, we only selected studies that considered twin pregnancies and applied a reference standard for EFWD for the target condition of BWD. DATA COLLECTION AND ANALYSIS We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility, and extracted data to create 2 × 2 tables. Two review authors independently performed quality assessment using the QUADAS-2 tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 39 eligible studies with a median study sample size of 140. In terms of risk of bias, there were many unclear statements regarding patient selection, index test and use of proper reference standard. Twenty-one studies (53%) were of methodological concern due to flow and timing. In terms of applicability, most studies were of low concern. Ultrasound for diagnosis of BWD in twin pregnancies at 20% cut-off Twenty-two studies provided data for a BWD of 20% and the summary estimate of sensitivity was 0.51 (95% CI 0.42 to 0.60), and the summary estimate of specificity was 0.91 (95% CI 0.89 to 0.93) (8005 twin pregnancies; very low-certainty evidence). Ultrasound for diagnosis of BWD in twin pregnancies at 25% cut-off Eighteen studies provided data using a BWD discordance of 25%. The summary estimate of sensitivity was 0.46 (95% CI 0.26 to 0.66), and the summary estimate of specificity was 0.93 (95% CI 0.89 to 0.96) (6471 twin pregnancies; very low-certainty evidence). Subgroup analyses were possible for both BWD of 20% and 25%. The diagnostic accuracy did not differ substantially between estimation by abdominal circumference and femur length but femur length had a trend towards higher sensitivity and specificity. Subgroup analyses were not possible by sex of twins, chorionicity or gestational age due to insufficient data. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that EFWD identified by ultrasound has low sensitivity but good specificity in detecting BWD in twin pregnancies. There is uncertain diagnostic value of EFWD; this review suggests there is insufficient evidence to support this index as the sole measure for clinical decision making to evaluate the prognosis of twins with growth discordance. The diagnostic accuracy of other measures including amniotic fluid index and umbilical artery Doppler resistive indices in combination with ultrasound for clinical intervention requires evaluation. Future well-designed studies could also evaluate the impact of chorionicity, sex and gestational age in the diagnostic accuracy of ultrasound for EFWD.
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Affiliation(s)
- Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Michigan, USA
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Sharifah Halimah Jaafar
- Department of Obstetrics and Gynaecology, Regency Specialist Hospital, Johor Bahru, Malaysia
| | - Iosief Abraha
- Servizio Immunotrasfusionale, Azienda Unita' Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Mohaddesseh Noura
- Department of Midwifery/Nursing, Golestan University of Medical Sciences, Gorgan, Iran
| | - Cassandra R Ross
- School of Health Sciences, Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Ng JY, Parakh ND. A systematic review and quality assessment of complementary and alternative medicine recommendations in insomnia clinical practice guidelines. BMC Complement Med Ther 2021; 21:54. [PMID: 33557810 PMCID: PMC7869239 DOI: 10.1186/s12906-021-03223-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background Sleep disorders encompass a wide range of conditions which affect the quality and quantity of sleep, with insomnia being a specific type of sleep disorder of focus in this review. Complementary and alternative medicine (CAM) is often utilized for various sleep disorders. Approximately 4.5% of individuals diagnosed with insomnia in the United States have used a CAM therapy to treat their condition. This systematic review identifies the quantity and assesses the quality of clinical practice guidelines (CPGs) which contain CAM recommendations for insomnia. Methods MEDLINE, EMBASE and CINAHL were systematically searched from 2009 to 2020, along with the Guidelines International Network, the National Center for Complementary and Integrative Health website, the National Institute for Health and Care Excellence, and the Emergency Care Research Institute. CPGs which focused on the treatment and/or management of insomnia in adults were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Results From 277 total results, 250 results were unique, 9 CPGs mentioned CAM for insomnia, and 6 out of the 9 made CAM recommendations relevant to insomnia. Scaled domain percentages from highest to lowest were scope and purpose, clarity of presentation, editorial independence, stakeholder involvement, rigour of development, and applicability. Quality varied within and across CPGs. Conclusions The CPGs which contained CAM recommendations for insomnia and which scored well could be used by health care professionals and patients to discuss the use of CAM therapies for the treatment/management of insomnia, while CPGs which scored lower could be improved in future updates according to AGREE II. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03223-3.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Nandana D Parakh
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Nagasawa K, Iwata M, Nihashi T, Terasawa T. Diagnostic accuracy, yield, and comparative effectiveness of whole-body computed tomography in blunt trauma: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24205. [PMID: 33466198 PMCID: PMC7808510 DOI: 10.1097/md.0000000000024205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Controversies emerge over routine performances of whole-body computed tomography (WBCT) in patients with blunt polytrauma. The existing randomized and non-randomized evidence is inconclusive, and during observations of non-trauma, incidental findings, detected by WBCT, have left uncertainty regarding their consequences and optimal management. Additionally, previous meta-analyses have failed to address the limitations of primary studies and issues associated with incidental findings. Therefore, we planned a new systematic review to address these points. METHODS We will search the PubMed, EMBASE, and Cochrane Central databases from inception to December 31, 2020, with no language restriction and perform full-text evaluation of potentially relevant articles. We will include prospective and retrospective studies with a single-gate design that assessed diagnostic accuracy and/or yield of WBCT to detect traumatic injuries, and studies that assessed incidental findings detected by WBCT. Additionally, we will include randomized controlled trials and non-randomized comparative studies that assessed the effectiveness of WBCT against conventional care, including selective computed tomography (CT). Studies of patients of all ages with blunt traumatic injuries, assessed at an emergency department, will be included. Two reviewers will extract data and rate the study validity via standard quality assessment tools. The primary outcome of interest will be reduction in mortality. Our secondary outcomes will include diagnostic accuracy and yield, detection of incidental findings and clinical outcomes associated with these detections, and improvement in other non-mortality clinical outcomes. We will qualitatively assess study, patient, and intervention characteristics and clinical outcomes. If appropriate, we will perform random-effects model meta-analyses to obtain summary estimates. Finally, we will assess the certainty of evidence by the grading the quality of evidence and strength of recommendations. ETHICS AND DISSEMINATION Ethics approval is not applicable, as this is a secondary analysis of publicly available data. The review results will be submitted for publication in peer-reviewed journals. PROSPERO REGISTRATION CRD42020187852.
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Affiliation(s)
- Kyohei Nagasawa
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya
| | - Mitsunaga Iwata
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi
| | - Takashi Nihashi
- Department of Radiology, National Center for Geriatrics and Gerontology, Obu
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Teruhiko Terasawa
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi
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50
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Tan J, Li L, Huang X, Yang C, Liang X, Zhao Y, Xie J, Chen R, Wang D, Xie S. Associations between gastro-oesophageal reflux disease and a range of diseases: an umbrella review of systematic reviews and meta-analyses. BMJ Open 2020; 10:e038450. [PMID: 33380477 PMCID: PMC7780720 DOI: 10.1136/bmjopen-2020-038450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Numerous meta-analyses have revealed the association between gastro-oesophageal reflux disease (GORD) and a range of diseases; however, the certainty of the evidence remains unclear. This study aimed to summarise and assess the certainty of evidence derived from meta-analyses. METHODS Embase, PubMed, Web of Science, Cochrane Databases of Systematic Reviews, CNKI and Wangfang databases from their inception to 22 February 2020 were queried for systematic reviews and meta-analyses on the association between GORD and various diseases. The methodological quality of the included studies was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), and evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Statistical analysis was conducted using Stata V.15. RESULTS Ten publications with associations between GORD and different types of diseases were included. There was high heterogeneity (I2 >75%) among seven independent meta-analyses. Evidence for publication bias in two independent meta-analyses was also observed. According to the AMSTAR 2 approach, the methodological quality was high for 20% of meta-analyses, moderate for 10%, low for 40% and critically low for 30%. Based on GRADE approach, the certainty of evidence was high for the association between GORD and higher risk of chronic obstructive pulmonary disease (COPD) exacerbation (OR 5.37; 95% CI 2.71 to 10.64) and higher prevalence of oesophageal adenocarcinoma (OR 4.57; 95% CI 3.89 to 5.36), and it was moderate for the association between GORD and higher chronic rhinosinusitis prevalence (OR 2.16; 95% CI 1.37 to 3.48). CONCLUSION The association between GORD and a range of diseases was extensively studied, and our findings revealed a high certainty of evidence of the association between GORD and an increased risk of COPD exacerbation as well as increased prevalence of oesophageal adenocarcinoma. Further investigations using systematic reviews and meta-analyses of high methodological quality that include prospective large cohort studies and adjusted confounders are warranted. PROSPERO REGISTRATION NUMBER CRD42019122264.
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Affiliation(s)
- JinJing Tan
- Graduate School, Jiang Xi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
- Department of Administration, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Liqun Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Xiaoyan Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Chengning Yang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Xue Liang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yina Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Jieru Xie
- Department of Center of Preventive Disease Treatment, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Ran Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Daogang Wang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Sheng Xie
- Department of Administration, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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