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Clinical Oral Investigations Nov 2021This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail.
MATERIAL AND METHODS
PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated.
RESULTS
From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited.
CONCLUSION
The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies.
CLINICAL RELEVANCE
BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.
Topics: Dental Caries Susceptibility; Diagnostic Tests, Routine; Reproducibility of Results; Sensitivity and Specificity; Transillumination
PubMed: 34480645
DOI: 10.1007/s00784-021-04113-1 -
Tropical Medicine & International... Nov 2022To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa.
METHODS
Systematic review and meta-analysis. Studies conducted in Africa that reported any information on the availability and affordability of short-acting, intermediate-acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random-effect model meta-analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively.
RESULTS
A total of 21 studies were included. The pooled availability of each drug was as follows: short-acting insulin 33.5% (95% CI: 17.8%-49.2%, I = 95.02%), intermediate-acting insulin 23.1% (95% CI: 6.3%-39.9%, I = 91.6%), premixed insulin 49.4% (95% CI: 24.9%-73.9%, I = 90.57%), glibenclamide 55.9% (95% CI: 43.8%-68.0%, I = 96.7%), and metformin 47.0% (95% CI: 34.6%-59.4%, I = 97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9%-61.1%, I = 97.43%), for HbA1c 24.6% (95% CI: 3.1%-46.1%, I = 91.64), and for lipid profile tests 35.7% (95% CI: 19.4%-51.9%, I = 83.77%). The median (IQR) affordability in days' wages was 7 (4.7-7.5) for short-acting insulin, 4.4 (3.9-4.9) for intermediate-acting insulin, 7.1 (5.8-16.7) for premixed insulin, 0.7 (0.7-0.7) for glibenclamide, and 2.1 (1.8-2.8) for metformin.
CONCLUSION
The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country-specific strategies are urgently needed to address these inequities in access and cost.
Topics: Humans; Diagnostic Tests, Routine; Glyburide; Glycated Hemoglobin; Health Services Accessibility; Drugs, Essential; Diabetes Mellitus; Costs and Cost Analysis; Insulin; Metformin; Insulin, Short-Acting; Lipids
PubMed: 36121433
DOI: 10.1111/tmi.13819 -
BMJ Open Feb 2018Health systems are currently subject to unprecedented financial strains. Inappropriate test use wastes finite health resources (overuse) and delays diagnoses and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Health systems are currently subject to unprecedented financial strains. Inappropriate test use wastes finite health resources (overuse) and delays diagnoses and treatment (underuse). As most patient care is provided in primary care, it represents an ideal setting to mitigate waste.
OBJECTIVE
To identify overuse and underuse of diagnostic tests in primary care.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES AND ELIGIBILITY CRITERIA
We searched MEDLINE and Embase from January 1999 to October 2017 for studies that measured the inappropriateness of any diagnostic test (measured against a national or international guideline) ordered for adult patients in primary care.
RESULTS
We included 357 171 patients from 63 studies in 15 countries. We extracted 103 measures of inappropriateness (41 underuse and 62 overuse) from included studies for 47 different diagnostic tests.The overall rate of inappropriate diagnostic test ordering varied substantially (0.2%-100%)%).17 tests were underused >50% of the time. Of these, echocardiography (n=4 measures) was consistently underused (between 54% and 89%, n=4). There was large variation in the rate of inappropriate underuse of pulmonary function tests (38%-78%, n=8).Eleven tests were inappropriately overused >50% of the time. Echocardiography was consistently overused (77%-92%), whereas inappropriate overuse of urinary cultures, upper endoscopy and colonoscopy varied widely, from 36% to 77% (n=3), 10%-54% (n=10) and 8%-52% (n=2), respectively.
CONCLUSIONS
There is marked variation in the appropriate use of diagnostic tests in primary care. Specifically, the use of echocardiography (both underuse and overuse) is consistently poor. There is substantial variation in the rate of inappropriate underuse of pulmonary function tests and the overuse of upper endoscopy, urinary cultures and colonoscopy.
PROSPERO REGISTRATION NUMBER
CRD42016048832.
Topics: Adult; Diagnostic Tests, Routine; Echocardiography; Endoscopy, Digestive System; Humans; Primary Health Care; Respiratory Function Tests; Unnecessary Procedures
PubMed: 29440142
DOI: 10.1136/bmjopen-2017-018557 -
International Journal of Environmental... Jul 2021The intrauterine environment is critical for healthy prenatal growth and affects neonatal survival and later health. Mercury is a toxic metal which can freely cross the... (Review)
Review
The intrauterine environment is critical for healthy prenatal growth and affects neonatal survival and later health. Mercury is a toxic metal which can freely cross the placenta and disrupt a wide range of cellular processes. Many observational studies have investigated mercury exposure and prenatal growth, but no prior review has synthesised this evidence. Four relevant publication databases (Embase, MEDLINE/PubMed, PsycINFO, and Scopus) were systematically searched to identify studies of prenatal mercury exposure and birth weight, birth length, or head circumference. Study quality was assessed using the NIH Quality Assessment Tool, and results synthesised in a narrative review. Twenty-seven studies met the review criteria, these were in 17 countries and used 8 types of mercury biomarker. Studies of birth weight (total = 27) involving populations with high levels of mercury exposure, non-linear methods, or identified as high quality were more likely to report an association with mercury, but overall results were inconsistent. Most studies reported no strong evidence of association between mercury and birth length (n = 14) or head circumference (n = 14). Overall, our review did not identify strong evidence that mercury exposure leads to impaired prenatal growth, although there was some evidence of a negative association of mercury with birth weight.
Topics: Biomarkers; Birth Weight; Diagnostic Tests, Routine; Female; Humans; Infant, Newborn; Maternal Exposure; Mercury; Placenta; Pregnancy
PubMed: 34281082
DOI: 10.3390/ijerph18137140 -
Sexually Transmitted Infections Dec 2022Current rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Current rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests (RDTs) which can better distinguish an active infection of syphilis or yaws.
METHODS
We conducted a systematic review and meta-analysis, searching five databases between January 2010 and October 2021 (with an update in July 2022). A generalised linear mixed model was used to conduct a bivariate meta-analysis for the pooled sensitivity and specificity. Heterogeneity was assessed using the I statistic. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) to assess the risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to evaluate the certainty of evidence.
RESULTS
We included 17 studies for meta-analyses. For syphilis, the pooled sensitivity and specificity of the treponemal component were 0.93 (95% CI: 0.86 to 0.97) and 0.98 (95% CI: 0.96 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.90 (95% CI: 0.82 to 0.95) and 0.97 (95% CI: 0.92 to 0.99), respectively. For yaws, the pooled sensitivity and specificity of the treponemal component were 0.86 (95% CI: 0.66 to 0.95) and 0.97 (95% CI: 0.94 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.80 (95% CI: 0.55 to 0.93) and 0.96 (95% CI: 0.92 to 0.98), respectively.
CONCLUSIONS
RDTs that can differentiate between active and previously treated infections could optimise management by providing same-day treatment and reducing unnecessary treatment.
PROSPERO REGISTRATION NUMBER
CRD42021279587.
Topics: Humans; Yaws; Syphilis; Diagnostic Tests, Routine; Sensitivity and Specificity
PubMed: 36180209
DOI: 10.1136/sextrans-2022-055546 -
PLoS Neglected Tropical Diseases Oct 2022To determine the diagnostic validity of the enzyme-linked immunosorbent assay (ELISA) and Rapid Diagnostic Tests (RDT) among individuals with suspected chronic Chagas... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the diagnostic validity of the enzyme-linked immunosorbent assay (ELISA) and Rapid Diagnostic Tests (RDT) among individuals with suspected chronic Chagas Disease (CD).
METHODOLOGY
A search was made for studies with ELISA and RDT assays validity estimates as eligibility criteria, published between 2010 and 2020 on PubMed, Web of Science, Scopus, and LILACS. This way, we extracted the data and assessed the risk of bias and applicability of the studies using the QUADAS-2 tool. The bivariate random effects model was also used to estimate the overall sensitivity and specificity through forest-plots, ROC space, and we visually assessed the heterogeneity between studies. Meta-regressions were made using subgroup analysis. We used Deeks' test to assess the risk of publication bias.
RESULTS
43 studies were included; 27 assessed ELISA tests; 14 assessed RDTs; and 2 assessed ELISA and RDTs, against different reference standards. 51.2 % of them used a non-comparative observational design, and 46.5 % a comparative clinical design ("case-control" type). High risk of bias was detected for patient screening and reference standard. The ELISA tests had a sensitivity of 99% (95% CI: 98-99) and a specificity of 98% (95% CI: 97-99); whereas the Rapid Diagnostic Tests (RDT) had values of 95% (95% CI: 94-97) and 97% (95% CI: 96-98), respectively. Deeks' test showed asymmetry on the ELISA assays.
CONCLUSIONS
ELISA and RDT tests have high validity for diagnosing chronic Chagas disease. The analysis of these two types of evidence in this systematic review and meta-analysis constitutes an input for their use. The limitations included the difficulty in extracting data due to the lack of information in the articles, and the comparative clinical-type design of some studies.
Topics: Humans; Diagnostic Tests, Routine; Sensitivity and Specificity; Chagas Disease; Enzyme-Linked Immunosorbent Assay; Reference Standards
PubMed: 36256676
DOI: 10.1371/journal.pntd.0010860 -
Microvascular Research May 2023Up to 30 % of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), and diagnosis can be difficult. Nailfold capillaroscopy (NC) is an easily applicable,... (Review)
Review
Up to 30 % of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), and diagnosis can be difficult. Nailfold capillaroscopy (NC) is an easily applicable, non-invasive procedure to assess skin microcirculation. This systematic review investigates NC as diagnostic tool for PsO and PsA, including correlations between NC outcome measures to clinical and laboratory outcome measures. This systematic review was built on the PICO and PRISMA guidelines. In total 22 relevant studies were found Searching in the Web of Science, PubMed and Embase, latest update June 13th, 2022. The following NC outcome measures are found to be significantly more prevalent in PsO patients than healthy controls: reduced density, reduced length and more abnormal morphology. Likewise, in PsA patients, reduced density, more abnormal morphology, more microhaemorrhages and fewer hairpin shapes are found to be significantly more prevalent. Results were non-conclusive in terms of disease activity and duration with NC findings. Random-effects meta-analysis showed a significant reduction of density in PsO patients compared to healthy controls (studies: 6, n = 249; SMD = -0.91; 95 % CI [-1.41, -0.40], p = 0.0058, heterogeneity I=74 %, AUC = 0.740) and in PsA patients compared to healthy controls (studies: 5, n = 130; SMD = -1.22; 95 % CI [-2.38, -0.06], p = 0.0432, heterogeneity I=89 %, AUC = 0.806). No NC outcome measures were overall conclusive in differentiating PsO from PsA. Considering the conflicting results and small sample sizes further large-scale research on the identification of capillaroscopic changes in PsO and PsA and correlations with standardised clinical and laboratory outcome measures are necessary.
Topics: Humans; Arthritis, Psoriatic; Diagnostic Tests, Routine; Health Status; Microscopic Angioscopy; Psoriasis
PubMed: 36657709
DOI: 10.1016/j.mvr.2023.104476 -
Korean Journal of Radiology Mar 2022
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Clinical Infectious Diseases : An... Jan 2022The emergence and spread of Plasmodium falciparum parasites that lack HRP2/3 proteins and the resulting decreased utility of HRP2-based malaria rapid diagnostic tests...
BACKGROUND
The emergence and spread of Plasmodium falciparum parasites that lack HRP2/3 proteins and the resulting decreased utility of HRP2-based malaria rapid diagnostic tests (RDTs) prompted the World Health Organization and other global health stakeholders to prioritize the discovery of novel diagnostic biomarkers for malaria.
METHODS
To address this pressing need, we adopted a dual, systematic approach by conducting a systematic review of the literature for publications on diagnostic biomarkers for uncomplicated malaria and a systematic in silico analysis of P. falciparum proteomics data for Plasmodium proteins with favorable diagnostic features.
RESULTS
Our complementary analyses led us to 2 novel malaria diagnostic biomarkers compatible for use in an RDT format: glyceraldehyde 3-phosphate dehydrogenase and dihydrofolate reductase-thymidylate synthase.
CONCLUSIONS
Overall, our results pave the way for the development of next-generation malaria RDTs based on new antigens by identifying 2 lead candidates with favorable diagnostic features and partially de-risked product development prospects.
Topics: Antigens, Protozoan; Biomarkers; Diagnostic Tests, Routine; Humans; Malaria; Malaria, Falciparum; Plasmodium falciparum; Protozoan Proteins; Sensitivity and Specificity
PubMed: 34718455
DOI: 10.1093/cid/ciab251 -
Computers in Biology and Medicine Dec 2023Artificial intelligence (AI) has potential uses in healthcare including the detection of health conditions and prediction of health outcomes. Past systematic reviews had... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Artificial intelligence (AI) has potential uses in healthcare including the detection of health conditions and prediction of health outcomes. Past systematic reviews had reviewed the accuracy of artificial neural networks (ANN) on Electrocardiogram (ECG) readings but that of other AI models on other Acute Coronary Syndrome (ACS) detection tools remains unclear.
METHODS
Nine electronic databases were searched from 2012 to 31 August 2022 including grey literature search and hand searching of references of included articles. Risk of bias was assessed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Test characteristics namely true positives, false positives, true negatives, and false negatives were extracted from all included articles into a 2x2 table. Study-specific estimates of sensitivity and specificity were pooled using hierarchical summary receiver operating characteristic (HSROC) model and displayed using a forest plot and HSROC curve.
RESULTS
66 studies were included in the review. A total of 518,931 patients were included whose mean ages varied from 32.62 to 70 years old. In 66 studies, the sensitivity and specificity of AI-based detection for ACS screening ranged from 64 % to 100 % and 65 %-100 %, respectively. The overall quality of evidence was low due to the inclusion of case-control studies.
CONCLUSION
Results of the study inform the potential of using AI-assisted ACS detection for accurate diagnosis and prompt treatment for ACS. Adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) guideline and having more cohort studies for future Diagnostic Test Accuracy (DTA) studies are necessary to improve the quality of evidence of AI-based detection of ACS.
Topics: Humans; Adult; Middle Aged; Aged; Artificial Intelligence; Acute Coronary Syndrome; Sensitivity and Specificity; ROC Curve; Diagnostic Tests, Routine
PubMed: 37925910
DOI: 10.1016/j.compbiomed.2023.107636