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Critical Care (London, England) Sep 2014Delirium is common in adult intensive care, with validated tools for measurement, known risk factors and adverse neurocognitive outcomes. We aimed to determine what is... (Review)
Review
INTRODUCTION
Delirium is common in adult intensive care, with validated tools for measurement, known risk factors and adverse neurocognitive outcomes. We aimed to determine what is known about pediatric delirium in the pediatric intensive care unit (PICU).
METHODS
We conducted a systematic search for and review of studies of the accuracy of delirium diagnosis in children in the PICU. Secondary aims were to determine the prevalence, risk factors and outcomes associated with pediatric delirium. We created screening and data collection tools based on published recommendations.
RESULTS
After screening 145 titles and abstracts, followed by 35 full-text publications and reference lists of included publications, 9 reports of 5 studies were included. Each of the five included studies was on a single index test: (1) the Pediatric Anesthesia Emergence Delirium Scale (PAED; for ages 1 to 17 years), (2) the Pediatric Confusion Assessment Method for the Intensive Care Unit (p-CAM-ICU; for ages ≥ 5 years), (3) the Cornell Assessment of Pediatric Delirium (CAP-D; a modification of the PAED designed to detect hypoactive delirium), (4) the revised Cornell Assessment of Pediatric Delirium (CAP-D(R)) and (5) clinical suspicion. We found that all five studies had a high risk of bias on at least one domain in the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Sample size, sensitivity, specificity, and effectiveness (correct classification divided by total tests done) were: PAED 144, 91%, 98%, <91% (>16% of scores required imputation for missing data); p-CAM 68, 78%, 98%, 96%; CAP-D 50, 91%, 100%, 89%; CAP-D (R) 111, and of assessments 94%, 79%, <82% (it is not clear if any assessments were not included); and clinical suspicion 877, N/A (only positive predictive value calculable, 66%). Prevalence of delirium was 17%, 13%, 28%, 21%, and 5% respectively. Only the clinical suspicion study researchers statistically determined any risk factors for delirium (pediatric risk of mortality, pediatric index of mortality, ventilation, age) or outcomes of delirium (length of stay and mortality).
CONCLUSION
High-quality research to determine the accuracy of delirium screening tools in the PICU are required before prevalence, risk factors and outcomes can be determined and before a routine screening tool can be recommended. Direct comparisons of the p-CAM-ICU and CAP-D(R) should be performed.
Topics: Anesthesia; Child; Delirium; Humans; Intensive Care Units, Pediatric; Psychiatric Status Rating Scales
PubMed: 25672219
DOI: 10.1186/s13054-014-0489-x -
Journal of Vascular Surgery Dec 2017Duplex ultrasound (DUS) surveillance of infrainguinal vein bypass grafts is widely practiced, but the evidence of its effectiveness compared with other methods of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Duplex ultrasound (DUS) surveillance of infrainguinal vein bypass grafts is widely practiced, but the evidence of its effectiveness compared with other methods of surveillance remains unclear.
METHODS
Following an a priori protocol developed by the guidelines committee from the Society for Vascular Surgery, this systematic review and meta-analysis included randomized and nonrandomized comparative studies that enrolled patients who underwent infrainguinal arterial reconstruction and received DUS surveillance for follow-up compared with any other method of surveillance. The search included MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scopus through November 2016. Outcomes of interest included all-cause mortality, limb viability, and graft patency reports. Meta-analysis was performed using the random-effects model.
RESULTS
We included 15 studies. Compared with ankle-brachial index and clinical examination, DUS surveillance was not associated with a significant change in primary, secondary, or assisted primary patency or mortality. DUS surveillance was associated with a nonstatistically significant reduction in amputation rate (odds ratio, 0.70 [95% confidence interval, 0.23-2.13]). The quality of evidence was low because of imprecision (small number of events and wide confidence intervals) and high risk of bias in the primary literature.
CONCLUSIONS
A recommendation for routine DUS surveillance of infrainguinal vein grafts remains dependent on low-quality evidence. Considering that DUS offers the opportunity of early intervention and because of its noninvasive nature and low cost, vascular surgeons may incorporate DUS as they individualize the follow-up of lower extremity vein grafts.
Topics: Ankle Brachial Index; Graft Occlusion, Vascular; Humans; Limb Salvage; Lower Extremity; Odds Ratio; Peripheral Arterial Disease; Predictive Value of Tests; Risk Factors; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Grafting; Vascular Patency; Veins
PubMed: 29169544
DOI: 10.1016/j.jvs.2017.06.113 -
The Cochrane Database of Systematic... May 2016Midazolam is used for sedation before diagnostic and therapeutic medical procedures. It is an imidazole benzodiazepine that has depressant effects on the central nervous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Midazolam is used for sedation before diagnostic and therapeutic medical procedures. It is an imidazole benzodiazepine that has depressant effects on the central nervous system (CNS) with rapid onset of action and few adverse effects. The drug can be administered by several routes including oral, intravenous, intranasal and intramuscular.
OBJECTIVES
To determine the evidence on the effectiveness of midazolam for sedation when administered before a procedure (diagnostic or therapeutic).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL to January 2016), MEDLINE in Ovid (1966 to January 2016) and Ovid EMBASE (1980 to January 2016). We imposed no language restrictions.
SELECTION CRITERIA
Randomized controlled trials in which midazolam, administered to participants of any age, by any route, at any dose or any time before any procedure (apart from dental procedures), was compared with placebo or other medications including sedatives and analgesics.
DATA COLLECTION AND ANALYSIS
Two authors extracted data and assessed risk of bias for each included study. We performed a separate analysis for each different drug comparison.
MAIN RESULTS
We included 30 trials (2319 participants) of midazolam for gastrointestinal endoscopy (16 trials), bronchoscopy (3), diagnostic imaging (5), cardioversion (1), minor plastic surgery (1), lumbar puncture (1), suturing (2) and Kirschner wire removal (1). Comparisons were: intravenous diazepam (14), placebo (5) etomidate (1) fentanyl (1), flunitrazepam (1) and propofol (1); oral chloral hydrate (4), diazepam (2), diazepam and clonidine (1); ketamine (1) and placebo (3); and intranasal placebo (2). There was a high risk of bias due to inadequate reporting about randomization (75% of trials). Effect estimates were imprecise due to small sample sizes. None of the trials reported on allergic or anaphylactoid reactions. Intravenous midazolam versus diazepam (14 trials; 1069 participants)There was no difference in anxiety (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.39 to 1.62; 175 participants; 2 trials) or discomfort/pain (RR 0.60, 95% CI 0.24 to 1.49; 415 participants; 5 trials; I² = 67%). Midazolam produced greater anterograde amnesia (RR 0.45; 95% CI 0.30 to 0.66; 587 participants; 9 trials; low-quality evidence). Intravenous midazolam versus placebo (5 trials; 493 participants)One trial reported that fewer participants who received midazolam were anxious (3/47 versus 15/35; low-quality evidence). There was no difference in discomfort/pain identified in a further trial (3/85 in midazolam group; 4/82 in placebo group; P = 0.876; very low-quality evidence). Oral midazolam versus chloral hydrate (4 trials; 268 participants)Midazolam increased the risk of incomplete procedures (RR 4.01; 95% CI 1.92 to 8.40; moderate-quality evidence). Oral midazolam versus placebo (3 trials; 176 participants)Midazolam reduced pain (midazolam mean 2.56 (standard deviation (SD) 0.49); placebo mean 4.62 (SD 1.49); P < 0.005) and anxiety (midazolam mean 1.52 (SD 0.3); placebo mean 3.97 (SD 0.44); P < 0.0001) in one trial with 99 participants. Two other trials did not find a difference in numerical rating of anxiety (mean 1.7 (SD 2.4) for 20 participants randomized to midazolam; mean 2.6 (SD 2.9) for 22 participants randomized to placebo; P = 0.216; mean Spielberger's Trait Anxiety Inventory score 47.56 (SD 11.68) in the midazolam group; mean 52.78 (SD 9.61) in placebo group; P > 0.05). Intranasal midazolam versus placebo (2 trials; 149 participants)Midazolam induced sedation (midazolam mean 3.15 (SD 0.36); placebo mean 2.56 (SD 0.64); P < 0.001) and reduced the numerical rating of anxiety in one trial with 54 participants (midazolam mean 17.3 (SD 18.58); placebo mean 49.3 (SD 29.46); P < 0.001). There was no difference in meta-analysis of results from both trials for risk of incomplete procedures (RR 0.14, 95% CI 0.02 to 1.12; downgraded to low-quality evidence).
AUTHORS' CONCLUSIONS
We found no high-quality evidence to determine if midazolam, when administered as the sole sedative agent prior to a procedure, produces more or less effective sedation than placebo or other medications. There is low-quality evidence that intravenous midazolam reduced anxiety when compared with placebo. There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo. Intranasal midazolam did not reduce the risk of incomplete procedures, although anxiolysis and sedation were observed. There is moderate-quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures.
Topics: Administration, Intranasal; Administration, Oral; Adult; Anxiety; Child; Chloral Hydrate; Diagnostic Techniques and Procedures; Diazepam; Humans; Hypnotics and Sedatives; Injections, Intravenous; Midazolam; Randomized Controlled Trials as Topic; Therapeutics
PubMed: 27198122
DOI: 10.1002/14651858.CD009491.pub2 -
Pain Research & Management 2021The study explored the clinical influence, effectiveness, limitations, and human comparison outcomes of machine learning in diagnosing (1) dental diseases, (2)...
PURPOSE
The study explored the clinical influence, effectiveness, limitations, and human comparison outcomes of machine learning in diagnosing (1) dental diseases, (2) periodontal diseases, (3) trauma and neuralgias, (4) cysts and tumors, (5) glandular disorders, and (6) bone and temporomandibular joint as possible causes of dental and orofacial pain.
METHOD
Scopus, PubMed, and Web of Science (all databases) were searched by 2 reviewers until 29 October 2020. Articles were screened and narratively synthesized according to PRISMA-DTA guidelines based on predefined eligibility criteria. Articles that made direct reference test comparisons to human clinicians were evaluated using the MI-CLAIM checklist. The risk of bias was assessed by JBI-DTA critical appraisal, and certainty of the evidence was evaluated using the GRADE approach. Information regarding the quantification method of dental pain and disease, the conditional characteristics of both training and test data cohort in the machine learning, diagnostic outcomes, and diagnostic test comparisons with clinicians, where applicable, were extracted.
RESULTS
34 eligible articles were found for data synthesis, of which 8 articles made direct reference comparisons to human clinicians. 7 papers scored over 13 (out of the evaluated 15 points) in the MI-CLAIM approach with all papers scoring 5+ (out of 7) in JBI-DTA appraisals. GRADE approach revealed serious risks of bias and inconsistencies with most studies containing more positive cases than their true prevalence in order to facilitate machine learning. Patient-perceived symptoms and clinical history were generally found to be less reliable than radiographs or histology for training accurate machine learning models. A low agreement level between clinicians training the models was suggested to have a negative impact on the prediction accuracy. Reference comparisons found nonspecialized clinicians with less than 3 years of experience to be disadvantaged against trained models.
CONCLUSION
Machine learning in dental and orofacial healthcare has shown respectable results in diagnosing diseases with symptomatic pain and with improved future iterations and can be used as a diagnostic aid in the clinics. The current review did not internally analyze the machine learning models and their respective algorithms, nor consider the confounding variables and factors responsible for shaping the orofacial disorders responsible for eliciting pain.
Topics: Algorithms; Artificial Intelligence; Diagnostic Tests, Routine; Facial Pain; Humans; Machine Learning; Pain Management
PubMed: 33986900
DOI: 10.1155/2021/6659133 -
BMC Health Services Research Dec 2017Dengue fever is rapidly expanding geographically, with about half of the world's population now at risk. Among the various diagnostic options, rapid diagnostic tests... (Review)
Review
BACKGROUND
Dengue fever is rapidly expanding geographically, with about half of the world's population now at risk. Among the various diagnostic options, rapid diagnostic tests (RDTs) are convenient and prompt, but limited in terms of accuracy and availability.
METHODS
A systematic review was conducted of published data on the use of RDTs for dengue with respect to their economic impact. The search was conducted with combinations of key search terms, including "((Dengue[Title]) AND cost/economic)" and "rapid diagnostic test/assay (or point-of-care)". Articles with insufficient report on cost/economic aspect of dengue RDTs, usually on comparison of different RDTs or assessment of novel rapid diagnostic tools, were excluded. This review has been registered in the PROSPERO International prospective register of systematic reviews (registry #: CRD42015017775).
RESULTS
Eleven articles were found through advanced search on Pubmed. From Embase and Web of Science, two and 14 articles were obtained, respectively. After removal of duplicate items, title screening was done on 21 published works and 12 titles, including 2 meeting abstracts, were selected for abstract review. For full-text review, by two independent reviewers, 5 articles and 1 meeting abstract were selected. Among these, the abstract was referring to the same study results as one of the articles. After full text review, two studies (two articles and one abstract) were found to report on cost-wise or economic benefits of dengue RDTs and were selected for data extraction. One study found satisfactory performance of IgM-based Panbio RDT, concluding that it would be cost-effective in endemic settings. The second study was a modeling analysis and showed that a dengue RDT would not be advantageous in terms of cost and effectiveness compared to current practice of antibiotics prescription for acute febrile illness.
CONCLUSIONS
Despite growing use of RDTs in research and clinical settings, there were limited data to demonstrate an economic impact. The available two studies reached different conclusions on the cost-effectiveness of dengue RDTs, although only one of the two studies reported outcomes from cost-effectiveness analysis of dengue and the other was considering febrile illness more generally. Evidence of such an impact would require further quantitative economic studies.
Topics: Anti-Bacterial Agents; Cost-Benefit Analysis; Dengue; Diagnostic Tests, Routine; Fever; Humans; Point-of-Care Systems; Prospective Studies
PubMed: 29284474
DOI: 10.1186/s12913-017-2789-8 -
The International Journal of... Nov 2017To reduce transmission and improve patient outcomes, rapid diagnosis and treatment of rifampicin-resistant tuberculosis (RR-TB) is required. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To reduce transmission and improve patient outcomes, rapid diagnosis and treatment of rifampicin-resistant tuberculosis (RR-TB) is required.
OBJECTIVE
To conduct a systematic review and meta-analysis assessing time to treatment for RR-TB and variability using diagnostic testing methods and treatment delivery approach.
DESIGN
Studies from 2000 to 2015 reporting time to second-line treatment initiation were selected from PubMed and published conference abstracts.
RESULTS
From 53 studies, 83 cohorts (13 034 patients) were included. Overall weighted mean time to treatment from specimen collection was 81 days (95%CI 70-91), and was shorter with ambulatory (57 days, 95%CI 40-74) than hospital-based treatment (86 days, 95%CI 71-102). Time to treatment was shorter with genotypic susceptibility testing (38 days, 95%CI 27-49) than phenotypic testing (108 days, 95%CI 98-117). The mean percentage of diagnosed patients initiating treatment was 76% (95%CI 70-83, range 25-100).
CONCLUSION
Time to second-line anti-tuberculosis treatment initiation is extremely variable across studies, and often unnecessarily long. Reduced delays are associated with genotypic testing and ambulatory treatment settings. Routine monitoring of the proportion of diagnosed patients initiating treatment and time to treatment are necessary to identify areas for intervention.
Topics: Ambulatory Care; Antitubercular Agents; Genotype; Hospitalization; Humans; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Rifampin; Time-to-Treatment; Tuberculosis, Multidrug-Resistant
PubMed: 29037299
DOI: 10.5588/ijtld.17.0230 -
Malaria Journal Apr 2023Health facilities' availability of malaria diagnostic tests and anti-malarial drugs (AMDs), and the correctness of treatment are critical for the appropriate case... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Health facilities' availability of malaria diagnostic tests and anti-malarial drugs (AMDs), and the correctness of treatment are critical for the appropriate case management, and malaria surveillance programs. It is also reliable evidence for malaria elimination certification in low-transmission settings. This meta-analysis aimed to estimate summary proportions for the availability of malaria diagnostic tests, AMDs, and the correctness of treatment.
METHODS
The Web of Science, Scopus, Medline, Embase, and Malaria Journal were systematically searched up to 30th January 2023. The study searched any records reporting the availability of diagnostic tests and AMDs and the correctness of malaria treatment. Eligibility and risk of bias assessment of studies were conducted independently in a blinded way by two reviewers. For the pooling of studies, meta-analysis using random effects model were carried out to estimate summary proportions of the availability of diagnostic tests, AMDs, and correctness of malaria treatment.
RESULTS
A total of 18 studies, incorporating 7,429 health facilities, 9,745 health workers, 41,856 febrile patients, and 15,398 malaria patients, and no study in low malaria transmission areas, were identified. The pooled proportion of the availability of malaria diagnostic tests, and the first-line AMDs in health facilities was 76% (95% CI 67-84); and 83% (95% CI 79-87), respectively. A pooled meta-analysis using random effects indicates the overall proportion of the correctness of malaria treatment 62% (95% CI 54-69). The appropriate malaria treatment was improved over time from 2009 to 2023. In the sub-group analysis, the correctness of treatment proportion was 53% (95% CI 50-63) for non-physicians health workers and 69% (95% CI 55-84) for physicians.
CONCLUSION
Findings of this review indicated that the correctness of malaria treatment and the availability of AMDs and diagnostic tests need improving to progress the malaria elimination stage.
Topics: Humans; Antimalarials; Diagnostic Tests, Routine; Malaria; Case Management; Health Personnel
PubMed: 37072759
DOI: 10.1186/s12936-023-04555-w -
Bulletin of the World Health... Jul 2022To evaluate the clinical accuracy of rapid diagnostic tests for the detection of Ebola virus. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the clinical accuracy of rapid diagnostic tests for the detection of Ebola virus.
METHODS
We searched MEDLINE®, Embase® and Web of Science for articles published between 1976 and October 2021 reporting on clinical studies assessing the performance of Ebola virus rapid diagnostic tests compared with reverse transcription polymerase chain reaction (RT-PCR). We assessed study quality using the QUADAS-2 criteria. To estimate the pooled sensitivity and specificity of these rapid diagnostic tests, we used a bivariate random-effects meta-analysis.
FINDINGS
Our search identified 113 unique studies, of which nine met the inclusion criteria. The studies were conducted in the Democratic Republic of the Congo, Guinea, Liberia and Sierra Leone and they evaluated 12 rapid diagnostic tests. We included eight studies in the meta-analysis. The pooled sensitivity and specificity of the rapid tests were 86% (95% confidence interval, CI: 80-91) and 95% (95% CI: 91-97), respectively. However, pooled sensitivity decreased to 83% (95% CI: 77-88) after removing outliers. Pooled sensitivity increased to 90% (95% CI: 82-94) when analysis was restricted to studies using the RT-PCR from altona Diagnostics as gold standard. Pooled sensitivity increased to 99% (95% CI: 67-100) when the analysis was restricted to studies using whole or capillary blood specimens.
CONCLUSION
The included rapid diagnostic tests did not detect all the Ebola virus disease cases. While the sensitivity and specificity of these tests are moderate, they are still valuable tools, especially useful for triage and detecting Ebola virus in remote areas.
Topics: Diagnostic Tests, Routine; Ebolavirus; Hemorrhagic Fever, Ebola; Humans; Reverse Transcriptase Polymerase Chain Reaction; Sensitivity and Specificity
PubMed: 35813519
DOI: 10.2471/BLT.21.287496 -
Journal of Medical Internet Research Dec 2021Interpretation of capsule endoscopy images or movies is operator-dependent and time-consuming. As a result, computer-aided diagnosis (CAD) has been applied to enhance... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Interpretation of capsule endoscopy images or movies is operator-dependent and time-consuming. As a result, computer-aided diagnosis (CAD) has been applied to enhance the efficacy and accuracy of the review process. Two previous meta-analyses reported the diagnostic performance of CAD models for gastrointestinal ulcers or hemorrhage in capsule endoscopy. However, insufficient systematic reviews have been conducted, which cannot determine the real diagnostic validity of CAD models.
OBJECTIVE
To evaluate the diagnostic test accuracy of CAD models for gastrointestinal ulcers or hemorrhage using wireless capsule endoscopic images.
METHODS
We conducted core databases searching for studies based on CAD models for the diagnosis of ulcers or hemorrhage using capsule endoscopy and presenting data on diagnostic performance. Systematic review and diagnostic test accuracy meta-analysis were performed.
RESULTS
Overall, 39 studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of ulcers (or erosions) were .97 (95% confidence interval, .95-.98), .93 (.89-.95), .92 (.89-.94), and 138 (79-243), respectively. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of hemorrhage (or angioectasia) were .99 (.98-.99), .96 (.94-0.97), .97 (.95-.99), and 888 (343-2303), respectively. Subgroup analyses showed robust results. Meta-regression showed that published year, number of training images, and target disease (ulcers vs erosions, hemorrhage vs angioectasia) was found to be the source of heterogeneity. No publication bias was detected.
CONCLUSIONS
CAD models showed high performance for the optical diagnosis of gastrointestinal ulcer and hemorrhage in wireless capsule endoscopy.
Topics: Capsule Endoscopy; Computers; Diagnostic Tests, Routine; Hemorrhage; Humans; Ulcer
PubMed: 34904949
DOI: 10.2196/33267 -
Translational Andrology and Urology Mar 2022There are differences in specificity and sensitivity of different routine urine tests for urinary tract infection, so meta-analysis was used to compare the diagnostic...
BACKGROUND
There are differences in specificity and sensitivity of different routine urine tests for urinary tract infection, so meta-analysis was used to compare the diagnostic value of various urine analysis and detection methods in urinary tract infection, including bacterial culture, urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods.
METHODS
The PubMed, Embase, Cochrane Library, SpringerLink, CNKI, and Wanfang databases were searched from inception to December 2021. Two system assessors independently screened the literature according to the inclusion and exclusion criteria. RevMan version 5.3 (the Cochrane Collaboration) and Meta-DiSc were used to calculate the combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic ratio (DOR) of the diagnostic tests and draw summary receiver operating characteristic (SROC) curves.
RESULTS
A total of 14 documents were included according to the inclusion and exclusion criteria. There was a significant statistical difference between the urine sediment microscopy group and the urine normalization group in urine leucocyte detection (OR =2.15, 95% CI: 1.29-3.56, P=0.003, I=19%, Z=2.95), urine erythrocyte test (OR =1.87, 95% CI: 1.13-3.09, P=0.01, I=0%, Z=2.45), quantitative determination of urinary protein composition (OR =2.32, 95% CI: 1.27-4.23, P=0.006, I30%, Z=2.73), and determination of urinary enzymes (OR =1.67, 95% CI: 1.03-2.72, P=0.04, I0%, Z=2.07).
DISCUSSION
When examining red and white blood cells in urinary tract infection diagnosis, urine dry chemistry is superior to automated urinalysis in terms of area under the curve (AUC), Sen, Spe, etc. When examining urine bacteria, urine dry chemistry can be recommended for urine bacteria screening, with bacterial culture required for confirmation.
PubMed: 35402195
DOI: 10.21037/tau-22-65