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BMJ Open Oct 2022To investigate whether adding lactate to the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) improves the prediction of mortality in adult hospital...
OBJECTIVES
To investigate whether adding lactate to the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) improves the prediction of mortality in adult hospital patients, compared with qSOFA alone.
DESIGN
Systematic review in accordance with Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines.
DATA SOURCES
Embase, Medline, PubMed, SCOPUS, Web of Science, CINAHL and Open Grey databases were searched in November 2020.
ELIGIBILITY CRITERIA
Original research studies published after 2016 comparing qSOFA in combination with lactate (LqSOFA) with qSOFA alone in adult patients with sepsis in hospital. The language was restricted to English.
DATA EXTRACTION AND SYNTHESIS
Title and abstract screening, full-text screening, data extraction and quality assessment (using Quality Assessment of Diagnostic Accuracy Studies-2) were conducted independently by two reviewers. Extracted data were collected into tables and diagnostic test accuracy was compared between the two tests.
RESULTS
We identified 1621 studies, of which 11 met our inclusion criteria. Overall, there was a low risk of bias across all studies. The area under the receiver operating characteristic (AUROC) curve for qSOFA was improved by the addition of lactate in 9 of the 10 studies reporting it. Sensitivity was increased in three of seven studies that reported it. Specificity was increased in four of seven studies that reported it. Of the six studies set exclusively within the emergency department, five published AUROCs, all of which reported an increase following the addition of lactate. Sensitivity and specificity results varied throughout the included studies. Due to insufficient data and heterogeneity of studies, a meta-analysis was not performed.
CONCLUSIONS
LqSOFA is an effective tool for identifying mortality risk both in adult inpatients with sepsis and those in the emergency department. LqSOFA increases AUROC over qSOFA alone, particularly within the emergency department. However, further original research is required to provide a stronger base of evidence in lactate measurement timing, as well as prospective trials to strengthen evidence and reduce bias.
PROSPERO REGISTRATION NUMBER
CRD42020207648.
Topics: Adult; Humans; Organ Dysfunction Scores; Prognosis; Lactic Acid; Prospective Studies; Hospital Mortality; Sepsis
PubMed: 36270756
DOI: 10.1136/bmjopen-2021-060455 -
Frontiers in Veterinary Science 2022The urgency of preventing the increase of antimicrobial resistance has been emphasized by international authorities such as the World Health Organization, European...
INTRODUCTION
The urgency of preventing the increase of antimicrobial resistance has been emphasized by international authorities such as the World Health Organization, European Medicines Agency, and World Organization for Animal Health. Monitoring systems capable of reporting antimicrobial consumption data are regarded as a crucial pillar of this fight. The Vet-AMNet system was developed to collect and analyze national antimicrobial consumption data in Portuguese dairy farms to support the veterinary authority in stewardship actions and to assist both veterinarians and farmers in daily decisions related to antimicrobials.
METHODS
To evaluate the robustness of the system and other identified critical success factors, it was used to analyze antimicrobial consumption data available from the Dutch dairy cow sector over the period from 2012 to 2020. The data previously used for publications by the Netherlands Veterinary Medicines Institute (SDa) were imported and pre-processed by the Vet-AMNet system according to the SDa's standard operating procedure and the Dutch metrics to measure antimicrobial consumption were calculated.
RESULTS
By comparing the outputs with the figures generated by the system established in the Netherlands, the Portuguese system was validated. Antimicrobial consumption data from the Dutch dairy sector during the 9-year period will be presented in unpublished graphs and tables, where each molecule's pharmaceutical formulation, pharmacotherapeutic group and line of choice will be related and discussed, illustrating the evolution of sectorial antimicrobial consumption against a background of a strong national antimicrobial policy initiated by public-private cooperation and supported by legislation.
PubMed: 36590809
DOI: 10.3389/fvets.2022.984771 -
Diagnostics (Basel, Switzerland) Sep 2021The aim of the present study was to investigate the diagnostic performance of a trained convolutional neural network (CNN) for detecting and categorizing fissure...
The aim of the present study was to investigate the diagnostic performance of a trained convolutional neural network (CNN) for detecting and categorizing fissure sealants from intraoral photographs using the expert standard as reference. An image set consisting of 2352 digital photographs from permanent posterior teeth (461 unsealed tooth surfaces/1891 sealed surfaces) was divided into a training set ( = 1881/364/1517) and a test set ( = 471/97/374). All the images were scored according to the following categories: unsealed molar, intact, sufficient and insufficient sealant. Expert diagnoses served as the reference standard for cyclic training and repeated evaluation of the CNN (ResNeXt-101-32x8d), which was trained by using image augmentation and transfer learning. A statistical analysis was performed, including the calculation of contingency tables and areas under the receiver operating characteristic curve (AUC). The results showed that the CNN accurately detected sealants in 98.7% of all the test images, corresponding to an AUC of 0.996. The diagnostic accuracy and AUC were 89.6% and 0.951, respectively, for intact sealant; 83.2% and 0.888, respectively, for sufficient sealant; 92.4 and 0.942, respectively, for insufficient sealant. On the basis of the documented results, it was concluded that good agreement with the reference standard could be achieved for automatized sealant detection by using artificial intelligence methods. Nevertheless, further research is necessary to improve the model performance.
PubMed: 34573949
DOI: 10.3390/diagnostics11091608 -
Archives of Public Health = Archives... Mar 2022Although statistical procedures for pooling of several epidemiological metrics are generally available in statistical packages, those for meta-analysis of diagnostic...
BACKGROUND
Although statistical procedures for pooling of several epidemiological metrics are generally available in statistical packages, those for meta-analysis of diagnostic test accuracy studies including options for multivariate regression are lacking. Fitting regression models and the processing of the estimates often entails lengthy and tedious calculations. Therefore, packaging appropriate statistical procedures in a robust and user-friendly program is of great interest to the scientific community.
METHODS
metadta is a statistical program for pooling of diagnostic accuracy test data in Stata. It implements both the bivariate random-effects and the fixed-effects model, allows for meta-regression, and presents the results in tables, a forest plot and/or summary receiver operating characteristic (SROC) plot. For a model without covariates, it quantifies the unexplained heterogeneity due to between-study variation using an I statistic that accounts for the mean-variance relationship and the correlation between sensitivity and specificity. To demonstrate metadta, we applied the program on two published meta-analyses on: 1) the sensitivity and specificity of cytology and other markers including telomerase for primary diagnosis of bladder cancer, and 2) the accuracy of human papillomavirus (HPV) testing on self-collected versus clinician-collected samples to detect cervical precancer.
RESULTS
Without requiring a continuity correction, the pooled sensitivity and specificity generated by metadta of telomerase for the diagnosis of primary bladder cancer was 0.77 [95% CI, 0.70, 0.82] and 0.91 [95% CI, 0.75, 0.97] respectively. Metadta also allowed to assess the relative accuracy of HPV testing on self- versus clinician-taken specimens using data from comparative studies conducted in different clinical settings. The analysis showed that HPV testing with target-amplification assays on self-samples was as sensitive as on clinician-samples in detecting cervical pre-cancer irrespective of the clinical setting.
CONCLUSION
The metadta program implements state of art statistical procedures in an attempt to close the gap between methodological statisticians and systematic reviewers. We expect the program to popularize the use of appropriate statistical methods for diagnostic meta-analysis further.
PubMed: 35351195
DOI: 10.1186/s13690-021-00747-5 -
Orthopaedic Journal of Sports Medicine Feb 2021The physical examination of overweight patients can require specific adaptations. Orthopaedic literature on the impact of body mass index (BMI) on the physical...
BACKGROUND
The physical examination of overweight patients can require specific adaptations. Orthopaedic literature on the impact of body mass index (BMI) on the physical examination of the shoulder is virtually nonexistent.
PURPOSE
To assess whether BMI affects the sensitivity and specificity of common shoulder tests, using arthroscopy as a gold standard. We also examined the effects of BMI on the sensitivity and specificity of magnetic resonance imaging (MRI) of the shoulder for reference.
STUDY DESIGN
Cohort study (diagnosis); Level of evidence, 2.
METHODS
We analyzed the data of 116 consecutive patients who underwent shoulder arthroscopy for the treatment of rotator cuff tears, Bankart lesions, and superior labral anterior-posterior (SLAP) lesions. Preoperative BMI, physical examination of the shoulder findings, and MRI findings were extracted. Contingency tables and receiver operating characteristic curves were used to evaluate the sensitivity and specificity of provocative tests of the shoulder and MRI as well as their relationship to BMI.
RESULTS
The sensitivity and specificity of the Jobe supraspinatus test were 77.8% and 72.7% in patients with BMI ≤25, 82.6% and 70.6% in those with 25 < BMI ≤ 30, and 81.3% and 55.6% in those with BMI >30, respectively ( < .001). The apprehension and relocation tests demonstrated higher sensitivity and specificity for the overweight patients (25 < BMI ≤ 30) compared with the other BMI groups, with a sensitivity and specificity of 83.3% and 100% for the apprehension test and a sensitivity and specificity of 75% and 100% for the relocation test, respectively. The O'Brien, Speed, and Ebinger tests for SLAP tears had low accuracy and did not yield statistically significant results. MRI interpretation was found to be influenced by BMI in obese patients, especially when SLAP lesions were assessed.
CONCLUSION
Counterintuitively, tests for shoulder instability had greater specificity in overweight patients and should be encouraged, particularly in obese patients, in whom the specificity of shoulder MRI for the detection of a Bankart lesion is lower. The Jobe test was more sensitive but less specific in overweight patients. These findings may assist care providers in improving the interpretation of the shoulder examination of overweight patients and consequently lead to better treatment-related decisions.
PubMed: 33709009
DOI: 10.1177/2325967120985643 -
BMC Surgery Aug 2022Cancellations of cases are common; most of those cancellations are due to avoidable causes. It is a major cause of psychological trauma for patients and their families....
BACKGROUND
Cancellations of cases are common; most of those cancellations are due to avoidable causes. It is a major cause of psychological trauma for patients and their families. Although little is known in Ethiopia, the aim of this study is aimed to assess the prevalence and the cause of elective surgery cancellation.
METHODS
A cross-sectional prospective study design was conducted on 326 patients scheduled for elective surgery from October 1 to December 1st. All consecutive elective surgical cases scheduled during the study period were included in the study. Data were collected using a prepared and pretested questionnaire and entered into SPSS version 23 for analysis. The result of the study was reported in the form of text, tables, and graphs.
RESULT
During the study, 326 patients were scheduled for elective surgery, among those, 83(25.6%) of surgery was canceled. Patient-related (31.32%) and administrative-related (26.5%) factors were the two most causes of cancellation.
CONCLUSION
Patient-related and administrative-related factors were the leading causes of cancellation of elective surgical operations in our hospital. Concerned bodies should bring a sustainable change and improvement to prevent unnecessary cancellations and enhance cost-effectiveness through communications, careful planning and efficient utilization of the available hospital resources.
Topics: Appointments and Schedules; Cross-Sectional Studies; Elective Surgical Procedures; Ethiopia; Hospitals, University; Humans; Operating Rooms; Prospective Studies; Universities
PubMed: 35927654
DOI: 10.1186/s12893-022-01749-y -
Safety and Health At Work Jun 2023This study evaluated occupational exposure levels of doxorubicin in healthcare workers performing rotational intraperitoneal pressurized aerosol chemotherapy (PIPAC)...
BACKGROUND
This study evaluated occupational exposure levels of doxorubicin in healthcare workers performing rotational intraperitoneal pressurized aerosol chemotherapy (PIPAC) procedures.
METHODS
All samples were collected during PIPAC procedures applying doxorubicin to an experimental animal model (pigs). All procedures were applied to seven pigs, each for approximately 44 min. Surface samples ( = 51) were obtained from substances contaminating the PIPAC devices, surrounding objects, and protective equipment. Airborne samples were also collected around the operating table ( = 39). All samples were analyzed using ultra-high performance liquid chromatography-mass spectrometry.
RESULTS
Among the surface samples, doxorubicin was detected in only five samples (9.8%) that were directly exposed to antineoplastic drug aerosols in the abdominal cavity originating from PIPAC devices. The telescopes showed concentrations of 0.48-5.44 ng/cm and the trocar showed 0.98 ng/cm in the region where the spraying nozzles were inserted. The syringe line connector showed a maximum concentration of 181.07 ng/cm, following a leakage. Contamination was not detected on the surgeons' gloves or shoes. Objects surrounding the operating table, including tables, operating lights, entrance doors, and trocar holders, were found to be uncontaminated. All air samples collected at locations where healthcare workers performed procedures were found to be uncontaminated.
CONCLUSIONS
Most air and surface samples were uncontaminated or showed very low doxorubicin concentrations during PIPAC procedures. However, there remains a potential for leakage, in which case dermal exposure may occur. Safety protocols related to leakage accidents, selection of appropriate protective equipment, and the use of disposable devices are necessary to prevent occupational exposure.
PubMed: 37389318
DOI: 10.1016/j.shaw.2023.04.002 -
Caries Research 2022We performed a systematic review to evaluate the success of machine learning algorithms in the diagnosis and prognostic prediction of dental caries. The review protocol...
We performed a systematic review to evaluate the success of machine learning algorithms in the diagnosis and prognostic prediction of dental caries. The review protocol was a priori registered in the PROSPERO, CRD42020183447. The search involved electronic bibliographic databases: PubMed/Medline, Scopus, EMBASE, Web of Science, and grey literature until December 2020. We excluded review articles, case series, case reports, editorials, letters, comments, educational methodologies, assessments of robotic devices, and articles with less than 10 participants or specimens. Two independent reviewers selected the studies and performed the assessment of the methodological quality based on standardized scales. We summarize data on the machine learning algorithms used; software; performance outcomes such as accuracy/precision, sensitivity/recall, specificity, area under the receiver operating characteristic curve (AUC), and positive/negative predictive values related to dental caries. Meta-analyses were not performed due to methodological differences. Our review included 15 studies (10 diagnostic studies and 5 prognostic prediction studies). Cross-sectional design studies were predominant (12). The most frequently used statistical measure of performance reported in diagnostic studies was AUC value, which ranged from 0.745 to 0.987. For most diagnostic studies, data from contingency tables were not available. Reported sensitivities were higher in low risk of bias prognostic prediction studies (median [IQR] of 0.996 [0.971-1.000] vs. unclear/high risk of bias studies 0.189 [0-0.340]; p value 0.025). While there were no significant differences in the specificity between these subgroups, we concluded that the use of these technologies for the diagnosis and prognostic prediction of dental caries, although promising, is at an early stage. The general applicability of the evidence was limited given that most models were developed outside the real clinical setting with a prevalence of unclear/high risk of bias. Researchers must increase the overall quality of their research protocols by providing a comprehensive report on the methods implemented.
Topics: Humans; Prognosis; Dental Caries; Cross-Sectional Studies; Machine Learning; Algorithms
PubMed: 35636386
DOI: 10.1159/000524167 -
Data in Brief Aug 2021Our associated paper presented a psychometric evaluation of the Wender Utah Rating Scale (WURS) and its abbreviated version, the WURS-25. Instead of actual factors...
Our associated paper presented a psychometric evaluation of the Wender Utah Rating Scale (WURS) and its abbreviated version, the WURS-25. Instead of actual factors scores, we employed "item averages" calculated by the average score of each item comprising that factor. We did not present a factor analysis of the WURS-25. Herein we identify items of the full WURS that are redundant or not part of any of the scale's five factors. Removing these items produced a shortened version, the WURS-45. We performed a logistic regression using actual factor loadings as well as factors based on item averages, and compared major depressive disorder (MDD) to generalized anxiety disorder (GAD) patients in the same analysis. We performed exploratory factor analysis with the WURS-45 items. We then performed logistic regressions and Receiver Operating Characteristics (ROC) analyses with the WURS-45 and WURS-25 factors. No increase in specificity or sensitivity arose when actual factors scores were used as opposed to factor scores from item averages. MDD and GAD ROC curves were very similar, supporting combining MDD with GAD patients into a single group. WURS-45 factors paralleled those derived from the full WURS. ROC curves, logistic regression and confusion tables showed the WURS-45 preserved the excellent diagnostic separation produced by the full WURS. Similar analyses showed WURS-25 scoring using its three factors improved its diagnostic utility. The WURS-45 has reduced redundancy with minimal loss in discriminatory power. Analysis of the WURS-25 using factor scores boosts its performance. Both versions of the scale provide clinical information describing childhood ADHD and are useful in separating adult patients with ADHD from those with MDD or GAD.
PubMed: 34235235
DOI: 10.1016/j.dib.2021.107232 -
BMC Cancer Apr 2024As comprehensive surgical management for gastric cancer becomes increasingly specialized and standardized, the precise differentiation between ≤T1 and ≥T2 gastric... (Meta-Analysis)
Meta-Analysis
BACKGROUND
As comprehensive surgical management for gastric cancer becomes increasingly specialized and standardized, the precise differentiation between ≤T1 and ≥T2 gastric cancer before endoscopic intervention holds paramount clinical significance.
OBJECTIVE
To evaluate the diagnostic efficacy of contrast-enhanced gastric ultrasonography in differentiating ≤T1 and ≥T2 gastric cancer.
METHODS
PubMed, Web of Science, and Medline were searched to collect studies published from January 1, 2000 to March 16, 2023 on the efficacy of either double contrast-enhanced gastric ultrasonography (D-CEGUS) or oral contrast-enhanced gastric ultrasonography (O-CEGUS) in determining T-stage in gastric cancer. The articles were selected according to specified inclusion and exclusion criteria, and the quality of the included literature was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale. Meta-analysis was performed using Stata 12 software with data from the 2 × 2 crosslinked tables in the included literature.
RESULTS
In total, 11 papers with 1124 patients were included in the O-CEGUS analysis, which revealed a combined sensitivity of 0.822 (95% confidence interval [CI] = 0.753-0.875), combined specificity of 0.964 (95% CI = 0.925-0.983), and area under the summary receiver operating characteristic (sROC) curve (AUC) of 0.92 (95% CI = 0.89-0.94). In addition, five studies involving 536 patients were included in the D-CEGUS analysis, which gave a combined sensitivity of 0.733 (95% CI = 0.550-0.860), combined specificity of 0.982 (95% CI = 0.936-0.995), and AUC of 0.93 (95% CI = 0.91-0.95). According to the I and P values of the forest plot, there was obvious heterogeneity in the combined specificities of the included papers. Therefore, the two studies with the lowest specificities were excluded from the O-CEGUS and D-CEGUS analyses, which eliminated the heterogeneity among the remaining literature. Consequently, the combined sensitivity and specificity of the remaining studies were 0.794 (95% CI = 0.710-0.859) and 0.976 (95% CI = 0.962-0.985), respectively, for the O-CEDUS studies and 0.765 (95% CI = 0.543-0.899) and 0.986 (95% CI = 0.967-0.994), respectively, for the D-CEGUS studies. The AUCs were 0.98 and 0.99 for O-CEGUS and D-CEGUS studies, respectively.
CONCLUSION
Both O-CEGUS and D-CEGUS can differentiate ≤T1 gastric cancer from ≥T2 gastric cancer, thus assisting the formulation of clinical treatment strategies for patients with very early gastric cancer. Given its simplicity and cost-effectiveness, O-CEGUS is often favored as a staging method for gastric cancer prior to endoscopic intervention.
Topics: Humans; Stomach Neoplasms; Ultrasonography; Sensitivity and Specificity; ROC Curve
PubMed: 38580944
DOI: 10.1186/s12885-024-12210-z