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Health Technology Assessment... Dec 2014Age-related macular degeneration is the most common cause of sight impairment in the UK. In neovascular age-related macular degeneration (nAMD), vision worsens rapidly... (Review)
Review
Optical coherence tomography for the diagnosis, monitoring and guiding of treatment for neovascular age-related macular degeneration: a systematic review and economic evaluation.
BACKGROUND
Age-related macular degeneration is the most common cause of sight impairment in the UK. In neovascular age-related macular degeneration (nAMD), vision worsens rapidly (over weeks) due to abnormal blood vessels developing that leak fluid and blood at the macula.
OBJECTIVES
To determine the optimal role of optical coherence tomography (OCT) in diagnosing people newly presenting with suspected nAMD and monitoring those previously diagnosed with the disease.
DATA SOURCES
Databases searched: MEDLINE (1946 to March 2013), MEDLINE In-Process & Other Non-Indexed Citations (March 2013), EMBASE (1988 to March 2013), Biosciences Information Service (1995 to March 2013), Science Citation Index (1995 to March 2013), The Cochrane Library (Issue 2 2013), Database of Abstracts of Reviews of Effects (inception to March 2013), Medion (inception to March 2013), Health Technology Assessment database (inception to March 2013).
REVIEW METHODS
Types of studies: direct/indirect studies reporting diagnostic outcomes.
INDEX TEST
time domain optical coherence tomography (TD-OCT) or spectral domain optical coherence tomography (SD-OCT).
COMPARATORS
clinical evaluation, visual acuity, Amsler grid, colour fundus photographs, infrared reflectance, red-free images/blue reflectance, fundus autofluorescence imaging, indocyanine green angiography, preferential hyperacuity perimetry, microperimetry. Reference standard: fundus fluorescein angiography (FFA). Risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic curves. A Markov model was developed (65-year-old cohort, nAMD prevalence 70%), with nine strategies for diagnosis and/or monitoring, and cost-utility analysis conducted. NHS and Personal Social Services perspective was adopted. Costs (2011/12 prices) and quality-adjusted life-years (QALYs) were discounted (3.5%). Deterministic and probabilistic sensitivity analyses were performed.
RESULTS
In pooled estimates of diagnostic studies (all TD-OCT), sensitivity and specificity [95% confidence interval (CI)] was 88% (46% to 98%) and 78% (64% to 88%) respectively. For monitoring, the pooled sensitivity and specificity (95% CI) was 85% (72% to 93%) and 48% (30% to 67%) respectively. The FFA for diagnosis and nurse-technician-led monitoring strategy had the lowest cost (£ 39,769; QALYs 10.473) and dominated all others except FFA for diagnosis and ophthalmologist-led monitoring (£ 44,649; QALYs 10.575; incremental cost-effectiveness ratio £ 47,768). The least costly strategy had a 46.4% probability of being cost-effective at £ 30,000 willingness-to-pay threshold.
LIMITATIONS
Very few studies provided sufficient information for inclusion in meta-analyses. Only a few studies reported other tests; for some tests no studies were identified. The modelling was hampered by a lack of data on the diagnostic accuracy of strategies involving several tests.
CONCLUSIONS
Based on a small body of evidence of variable quality, OCT had high sensitivity and moderate specificity for diagnosis, and relatively high sensitivity but low specificity for monitoring. Strategies involving OCT alone for diagnosis and/or monitoring were unlikely to be cost-effective. Further research is required on (i) the performance of SD-OCT compared with FFA, especially for monitoring but also for diagnosis; (ii) the performance of strategies involving combinations/sequences of tests, for diagnosis and monitoring; (iii) the likelihood of active and inactive nAMD becoming inactive or active respectively; and (iv) assessment of treatment-associated utility weights (e.g. decrements), through a preference-based study.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42012001930.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Cost-Benefit Analysis; Fluorescein Angiography; Humans; Macular Degeneration; Models, Econometric; Quality-Adjusted Life Years; Tomography, Optical Coherence; Visual Acuity
PubMed: 25436855
DOI: 10.3310/hta18690 -
Journal of Alzheimer's Disease : JAD 2023Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding which fluency task is more affected while developing AD. Most studies focus on SF assessment, given its connection with the temporoparietal amnesic system. PF is less reported, it is related to working memory, which is also impaired in probable and diagnosed AD. Differentiating between performance on these tasks might be informative in early AD diagnosis, providing an accurate linguistic profile.
OBJECTIVE
Compare SF and PF performance in healthy volunteers, volunteers with probable AD, and patients with AD diagnosis, considering the heterogeneity of age, gender, and educational level variables.
METHODS
A total of 8 studies were included for meta-analysis, reaching a sample size of 1,270 individuals (568 patients diagnosed with AD, 340 with probable AD diagnosis, and 362 healthy volunteers).
RESULTS
The three groups consistently performed better on SF than PF. When progressing to a diagnosis of AD, we observed a significant difference in SF and PF performance across our 3 groups of interest (p = 0.04). The age variable explained a proportion of this difference in task performance across the groups, and as age increases, both tasks equally worsen.
CONCLUSION
The performance of SF and PF might play a differential role in early AD diagnosis. These tasks rely on partially different neural bases of language processing. They are thus worth exploring independently in diagnosing normal aging and its transition to pathological stages, including probable and diagnosed AD.
Topics: Humans; Semantics; Alzheimer Disease; Verbal Behavior; Neuropsychological Tests; Linguistics
PubMed: 37482994
DOI: 10.3233/JAD-221272 -
Journal of Pediatric and Adolescent... Feb 2015The purpose of this article is to review the published literature and perform a systematic review to evaluate the effectiveness and feasibility of the use of a... (Review)
Review
STUDY OBJECTIVE
The purpose of this article is to review the published literature and perform a systematic review to evaluate the effectiveness and feasibility of the use of a hysteroscope for vaginoscopy or hysteroscopy in diagnosing and establishing therapeutic management of adolescent patients with gynecologic problems.
DESIGN
A systematic review.
SETTING
PubMed, Web of science, and Scopus searches were performed for the period up to September 2013 to identify all the eligible studies. Additional relevant articles were identified using citations within these publications.
PARTICIPANTS
Female adolescents aged 10 to 18 years.
RESULTS
A total of 19 studies were included in the systematic review. We identified 19 case reports that described the application of a hysteroscope as treatment modality for some gynecologic conditions or diseases in adolescents. No original study was found matching the age of this specific population.
CONCLUSIONS
A hysteroscope is a useful substitute for vaginoscopy or hysteroscopy for the exploration of the immature genital tract and may help in the diagnosis and treatment of gynecologic disorders in adolescent patients with an intact hymen, limited vaginal access, or a narrow vagina.
Topics: Adolescent; Child; Female; Genital Diseases, Female; Gynecological Examination; Humans; Hysteroscopes; Hysteroscopy; Vagina
PubMed: 25555298
DOI: 10.1016/j.jpag.2014.02.014 -
Obesity Reviews : An Official Journal... Dec 2016There is a need to accurately quantify levels of adiposity in order to identify overweight and obesity in children. This systematic review aimed to identify all... (Meta-Analysis)
Meta-Analysis Review
There is a need to accurately quantify levels of adiposity in order to identify overweight and obesity in children. This systematic review aimed to identify all diagnostic accuracy studies evaluating simple tests for obesity and adiposity, including body mass index (BMI), skin-fold thickness and waist circumference, compared against high-quality reference tests. Twenty-four cohort studies including 25,807 children were included. BMI had good performance when diagnosing obesity: a sensitivity of 81.9% (95% confidence interval [CI]: 73.0 to 93.8) for a specificity of 96.0% (95% CI: 93.8 to 98.1). It was less effective at diagnosing overweight (sensitivity: 76.3%, 95% CI: 70.2 to 82.4; specificity: 92.1% 95% CI: 90.0 to 94.3). When diagnosing obesity, waist circumference had similar performance (sensitivity: 83.8%; specificity: 96.5%). Skin-fold thickness had slightly poorer performance (sensitivity: 72.5%; specificity: 93.7%). Few studies considered any other tests. There was no conclusive evidence that any test was generally superior to the others. BMI is a good simple diagnostic test for identifying childhood adiposity. It identifies most genuinely obese and adipose children while misclassifying only a small number as obese. There was no conclusive evidence that any test should be preferred to BMI, and the extra complexity of skin-fold thickness tests does not appear to improve diagnostic accuracy.
Topics: Adiposity; Body Mass Index; Child; Humans; Overweight; Pediatric Obesity; Sensitivity and Specificity; Waist Circumference
PubMed: 27653184
DOI: 10.1111/obr.12462 -
Anticancer Research Oct 2016To meet the increasing demand of non-invasive tests for screening of gastric cancer (GC) risk, biomarker panel (GastroPanel®) (GP) was designed by Biohit Oyj as the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
To meet the increasing demand of non-invasive tests for screening of gastric cancer (GC) risk, biomarker panel (GastroPanel®) (GP) was designed by Biohit Oyj as the first serological test for stomach health. The aim of the present study was to perform a systematic review and meta-analysis of all studies on GP in diagnosis of atrophic gastritis (AG).
MATERIALS AND METHODS
Studies were eligible, if i) GP was used to diagnose biopsy-confirmed AG of the corpus (AGC) and/or antrum (AGA) and ii) exact numbers were available to enable calculating sensitivity (SE) and specificity (SP). Comprehensive Meta-Analysis software was used with maximum likelihood meta-regression (R analog). Effect size estimates (SE; SP, 95% confidence interval (CI)) were tested for homogeneity with Cochran's Q and I statistics. Potential publication bias was estimated by funnel plot statistics.
RESULTS
Altogether, 27 studies were eligible comprising of 8,654 patients from different geographic regions. Significant heterogeneity between studies reporting AGC (n=27) or AGA (n=13) warranted random effects (RE) model for summary statistics. GP performs better in diagnosing AGC than AGA with 70.2% vs. 51.6% pooled SE and 93.9% vs. 84.1% pooled SP, respectively. Limited number of studies erodes the Q test's power to detect true heterogeneity in meta-analysis stratified by geographic study origin. Few hypothetical missing studies had only marginal effect on pooled estimates of SE and SP.
CONCLUSION
This first meta-analysis of GP literature corroborates the statement of international experts, advocating GP in diagnosis and screening of AG. Due to its high specificity for both AGA and AGC, GastroPanel® is truly a test for stomach health.
Topics: Biomarkers; Gastritis, Atrophic; Humans; Sensitivity and Specificity
PubMed: 27798873
DOI: 10.21873/anticanres.11083 -
Oral Surgery, Oral Medicine, Oral... Jun 2018The aim of the study was to systematically identify criteria used to diagnose patients with trigeminal nerve injury. (Review)
Review
OBJECTIVE
The aim of the study was to systematically identify criteria used to diagnose patients with trigeminal nerve injury.
STUDY DESIGN
A systematic review of the literature registered in the PROSPERO database. Inclusion criteria were patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury.
RESULTS
In total, 28 articles were included. Diagnostic tests included clinical neurosensory tests (89%), thermal quantitative sensory testing (QST; 25%), electromyography (7%), and patient interview (14%). Neuropathic pain was assessed by using the visual analogue scale (39%); patient use of neuropathic medication (7%); questionnaires, including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing clinical neurosensory tests, application of diagnostic terms and diagnostic grading of nerve injury was found to be inconsistent among the included articles, making direct comparison of results difficult.
CONCLUSIONS
Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment, and outcome reporting among stakeholder organizations to improve knowledge in this field.
Topics: Humans; Neuralgia; Pain Measurement; Trigeminal Nerve Injuries; Trigeminal Neuralgia
PubMed: 29426749
DOI: 10.1016/j.oooo.2017.12.020 -
Annals of Surgical Oncology Mar 2022Upper gastrointestinal cancers are aggressive malignancies with poor prognosis, even following multimodality therapy. As such, they require timely and accurate... (Meta-Analysis)
Meta-Analysis
Diagnostic Performance of Artificial Intelligence-Centred Systems in the Diagnosis and Postoperative Surveillance of Upper Gastrointestinal Malignancies Using Computed Tomography Imaging: A Systematic Review and Meta-Analysis of Diagnostic Accuracy.
BACKGROUND
Upper gastrointestinal cancers are aggressive malignancies with poor prognosis, even following multimodality therapy. As such, they require timely and accurate diagnostic and surveillance strategies; however, such radiological workflows necessitate considerable expertise and resource to maintain. In order to lessen the workload upon already stretched health systems, there has been increasing focus on the development and use of artificial intelligence (AI)-centred diagnostic systems. This systematic review summarizes the clinical applicability and diagnostic performance of AI-centred systems in the diagnosis and surveillance of esophagogastric cancers.
METHODS
A systematic review was performed using the MEDLINE, EMBASE, Cochrane Review, and Scopus databases. Articles on the use of AI and radiomics for the diagnosis and surveillance of patients with esophageal cancer were evaluated, and quality assessment of studies was performed using the QUADAS-2 tool. A meta-analysis was performed to assess the diagnostic accuracy of sequencing methodologies.
RESULTS
Thirty-six studies that described the use of AI were included in the qualitative synthesis and six studies involving 1352 patients were included in the quantitative analysis. Of these six studies, four studies assessed the utility of AI in gastric cancer diagnosis, one study assessed its utility for diagnosing esophageal cancer, and one study assessed its utility for surveillance. The pooled sensitivity and specificity were 73.4% (64.6-80.7) and 89.7% (82.7-94.1), respectively.
CONCLUSIONS
AI systems have shown promise in diagnosing and monitoring esophageal and gastric cancer, particularly when combined with existing diagnostic methods. Further work is needed to further develop systems of greater accuracy and greater consideration of the clinical workflows that they aim to integrate within.
Topics: Artificial Intelligence; Esophageal Neoplasms; Humans; Sensitivity and Specificity; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 34762214
DOI: 10.1245/s10434-021-10882-6 -
Alternative Therapies in Health and... Sep 2023For patients with acute heart failure (AHF), the methods of clinical diagnosis of pulmonary edema mainly include clinical symptoms, laboratory results, and an imaging... (Meta-Analysis)
Meta-Analysis
CONTEXT
For patients with acute heart failure (AHF), the methods of clinical diagnosis of pulmonary edema mainly include clinical symptoms, laboratory results, and an imaging examination. The common diagnostic methods, such as chest X-rays and computerized tomography (CT) scanning, haven't been completely satisfactory.
OBJECTIVE
The study intended to systematically, quantitatively, and comprehensively evaluate the value of a lung (pulmonary) ultrasound, performed at a patient's bedside, in the diagnosis of acute heart failure (AHF), to provide an objective basis for its clinical application and further research.
DESIGN
The research team searched PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Cochrane Library, China Journal Full-text Database (CNKI), VIP Full-text Database, Wanfang Database, and China Biomedical Literature Database (CBM) for relevant literature, from January 2010 to the present, about the use of a lung ultrasound for diagnosis of AHF patients. The team used keywords to search literature: ultrasound, AHF diagnosis, cardiogenic pulmonary edema, ultrasonic examination, AHF diagnosis, and cardiogenic pulmonary edema. The research team then conducted a meta-analysis of the collected data according to the Cochrane Handbook 5.3 with RevMan 5.3 statistical software.
SETTING
The study took place at Jinan.
OUTCOME MEASURES
The research team: (1) evaluated the quality of the included studies; (2) examined the accuracy of a lung ultrasound in the diagnosis of AHF compared to computerized tomography (CT) as well as to the conventional ultrasonic cardiogram (echocardiogram) that a cardiologist performs; (3) determined the sensitivity, specificity, and predictive value of lung ultrasound using data from two of the included studies; (4) evaluated the data by drawing funnel charts; and (5) examined the publication bias of the included studies.
RESULTS
The research team selected six controlled clinical studies, with 345 data samples, for the meta-analysis. The team performed heterogeneity tests for the included research data. For the first test, the team compared the accuracy of lung ultrasound and CT in diagnosing AHF and found obvious heterogeneity, with χ2 = 11.40, df = 3, P = .010, and I2 = 74%. Based on an analysis using a random effects model, the team found no significant differences between the two methods in the diagnosis of AHF (P = .35). For the second test, the team compared the accuracy of lung ultrasound and an ultrasonic cardiogram in diagnosing AHF and found that the data didn't differ significantly, with χ2 = 0.08, df = 1, P = .78, I2 = 0%. Based on an analysis using a fixed effects model, the team found that the accuracy of the lung ultrasound in diagnosing AHF was significantly higher than that of ultrasonic cardiogram (P = .01). In the two studies, the sensitivity and specificity were high. The majority of the funnel charts were symmetrical, but a few were asymmetrical, suggesting a publication bias, which the heterogeneity in the studies and the limited number of examined examples may explain.
CONCLUSIONS
Lung ultrasound is of great value in the diagnosis of AHF. It's highly efficient, has prospects for broad clinical application, and is worth popularizing, benefiting patients. Scholars need to verify the current study's findings in follow-up studies and in more high-quality case-control trials.
Topics: Humans; Pulmonary Edema; Echocardiography; Lung; Ultrasonography; Heart Failure
PubMed: 37347689
DOI: No ID Found -
European Journal of Trauma and... Jun 2022Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We... (Review)
Review
PURPOSE
Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature.
METHODS
We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Demographics, peri-operative variables, and postoperative outcomes were analyzed. A systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases was also performed to identify publications regarding SA following LA.
RESULTS
A total of 2,019 patients underwent LA; 5 (0.25%) developed SA after a median of 292 days. The most common symptom at presentation was right lower quadrant pain. Four SA (80%) occurred in patients with a history of complicated appendicitis at index operation. All patients were diagnosed with computed tomography and underwent completion stump appendectomy by laparoscopy. No postoperative complications were recorded. A total of 55 studies with 76 cases of SA after LA were identified in the systematic review. Most SA (98.7%) underwent surgery: 52% by laparoscopic approach and 36% through an open approach. Stump appendectomy was performed in 94.4% cases and an extended resection in 5.6%.
CONCLUSION
Although SA is a rare complication after LA, a high index of clinical suspicious and imaging studies are key for early diagnosis and treatment. A laparoscopic resection of the inflamed appendiceal stump is feasible, safe, and highly effective. A minority of patients with severe cecum compromise may need extended resections or conversion to open surgery.
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy; Postoperative Complications; Retrospective Studies
PubMed: 34085112
DOI: 10.1007/s00068-021-01707-y -
The Lancet. Global Health Aug 2017The performance of laboratory tests to diagnose pulmonary tuberculosis is dependent on the quality of the sputum sample tested. The relative merits of sputum collection... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
The performance of laboratory tests to diagnose pulmonary tuberculosis is dependent on the quality of the sputum sample tested. The relative merits of sputum collection methods to improve tuberculosis diagnosis are poorly characterised. We therefore aimed to investigate the effects of sputum collection methods on tuberculosis diagnosis.
METHODS
We did a systematic review and meta-analysis to investigate whether non-invasive sputum collection methods in people aged at least 12 years improve the diagnostic performance of laboratory testing for pulmonary tuberculosis. We searched PubMed, Google Scholar, ProQuest, Web of Science, CINAHL, and Embase up to April 14, 2017, to identify relevant experimental, case-control, or cohort studies. We analysed data by pairwise meta-analyses with a random-effects model and by network meta-analysis. All diagnostic performance data were calculated at the sputum-sample level, except where authors only reported data at the individual patient-level. Heterogeneity was assessed, with potential causes identified by logistic meta-regression.
FINDINGS
We identified 23 eligible studies published between 1959 and 2017, involving 8967 participants who provided 19 252 sputum samples. Brief, on-demand spot sputum collection was the main reference standard. Pooled sputum collection increased tuberculosis diagnosis by microscopy (odds ratio [OR] 1·6, 95% CI 1·3-1·9, p<0·0001) or culture (1·7, 1·2-2·4, p=0·01). Providing instructions to the patient before sputum collection, during observed collection, or together with physiotherapy assistance increased diagnostic performance by microscopy (OR 1·6, 95% CI 1·3-2·0, p<0·0001). Collecting early morning sputum did not significantly increase diagnostic performance of microscopy (OR 1·5, 95% CI 0·9-2·6, p=0·2) or culture (1·4, 0·9-2·4, p=0·2). Network meta-analysis confirmed these findings, and revealed that both pooled and instructed spot sputum collections were similarly effective techniques for increasing the diagnostic performance of microscopy.
INTERPRETATION
Tuberculosis diagnoses were substantially increased by either pooled collection or by providing instruction on how to produce a sputum sample taken at any time of the day. Both interventions had a similar effect to that reported for the introduction of new, expensive laboratory tests, and therefore warrant further exploration in the drive to end the global tuberculosis epidemic.
FUNDING
Wellcome Trust, Joint Global Health Trials consortium, Innovation For Health and Development, and Bill & Melinda Gates Foundation.
Topics: Humans; Microscopy; Mycobacterium tuberculosis; Network Meta-Analysis; Odds Ratio; Physical Therapy Modalities; Sensitivity and Specificity; Specimen Handling; Sputum; Time Factors; Tuberculosis, Pulmonary
PubMed: 28625793
DOI: 10.1016/S2214-109X(17)30201-2