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Heliyon Apr 2023Insertion of a double-lumen endotracheal tube (DLT) is the most commonly used method for one-lung ventilation (OLV). This meta-analysis was aimed at investigating the...
OBJECTIVES
Insertion of a double-lumen endotracheal tube (DLT) is the most commonly used method for one-lung ventilation (OLV). This meta-analysis was aimed at investigating the performance of lung ultrasound in assessing the DLT position in OLV.
METHODS
Electronic databases were searched for related trials from inception to October 2022. The primary outcome was the performance of ultrasound or clinical evaluation in confirming the correctness of the DLT position, using fiberoptic bronchoscopy or intraoperative direct visualization of lung collapse as the gold standard. The secondary outcome was the time required to confirm or adjust the DTL position.
RESULTS
Five randomized controlled trials and three observational studies involving 771 patients were included in the meta-analysis. The pooled sensitivity and specificity of ultrasound were 0.93 (95% confidence interval [CI]: 0.79-0.98) and 0.61 (95% CI: 0.41-0.77), respectively, while those of clinical evaluation were 0.93 (95% CI: 0.73-0.99) and 0.35 (95% CI: 0.25-0.47), respectively. The pooled procedure duration was 122.27 s (95% CI: 20.85-223.69) with ultrasound and 112.03 s (95% CI: 95.30-128.76) with clinical evaluation. The area under the curve for discriminating the DLT position was 0.86 (95% CI: 0.82-0.88) for ultrasound and 0.52 (95% CI: 0.48-0.57) for clinical evaluation.
CONCLUSIONS
Compared to clinical evaluation, ultrasound has a similar sensitivity but a better specificity for confirming the correctness of the DLT position. Ultrasound is an acceptable imaging tool for assessing DTL placement in OLV.
PubMed: 37128322
DOI: 10.1016/j.heliyon.2023.e15458 -
BMJ Open Mar 2023The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.
OBJECTIVE
The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.
DESIGN/METHODS
A systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947-November 2021) and EMBASE (1947-November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.
MAIN OUTCOME MEASURES
Sensitivity, specificity and likelihood ratios (LRs).
RESULTS
We found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators.
CONCLUSION
Sensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD.
PROSPERO REGISTRATION NUMBER
CRD42018091675.
Topics: Adult; Humans; Heart Auscultation; Ultrasonography; Auscultation; Echocardiography; Heart Valve Diseases
PubMed: 36963797
DOI: 10.1136/bmjopen-2022-068121 -
European Heart Journal. Digital Health Jun 2022High blood pressure (BP) is the commonest modifiable cardiovascular risk factor, yet its monitoring remains problematic. Wearable cuffless BP devices offer potential... (Review)
Review
AIMS
High blood pressure (BP) is the commonest modifiable cardiovascular risk factor, yet its monitoring remains problematic. Wearable cuffless BP devices offer potential solutions; however, little is known about their validity and utility. We aimed to systematically review the validity, features and clinical use of wearable cuffless BP devices.
METHODS AND RESULTS
We searched MEDLINE, Embase, IEEE Xplore and the Cochrane Database till December 2019 for studies that reported validating cuffless BP devices. We extracted information about study characteristics, device features, validation processes, and clinical applications. Devices were classified according to their functions and features. We defined devices with a mean systolic BP (SBP) and diastolic BP (DBP) biases of <5 mmHg as valid as a consensus. Our definition of validity did not include assessment of device measurement precision, which is assessed by standard deviation of the mean difference-a critical component of ISO protocol validation criteria. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. A random-effects model meta-analysis was performed to summarise the mean biases for SBP and DBP across studies. Of the 430 studies identified, 16 studies (15 devices, 974 participants) were selected. The majority of devices (81.3%) used photoplethysmography to estimate BP against a reference device; other technologies included tonometry, auscultation and electrocardiogram. In addition to BP and heart rate, some devices also measured night-time BP ( = 5), sleep monitoring ( = 3), oxygen saturation ( = 3), temperature ( = 2) and electrocardiogram ( = 3). Eight devices showed mean biases of <5 mmHg for SBP and DBP compared with a reference device and three devices were commercially available. The meta-analysis showed no statistically significant differences between the wearable and reference devices for SBP (pooled mean difference = 3.42 mmHg, 95% CI: -2.17, 9.01, I 95.4%) and DBP (pooled mean = 1.16 mmHg, 95% CI: -1.26, 3.58, I 87.1%).
CONCLUSION
Several cuffless BP devices are currently available using different technologies, offering the potential for continuous BP monitoring. The variation in standards and validation protocols limited the comparability of findings across studies and the identification of the most accurate device. Challenges such as validation using standard protocols and in real-life settings must be overcome before they can be recommended for uptake into clinical practice.
PubMed: 36713001
DOI: 10.1093/ehjdh/ztac021 -
International Journal of Environmental... Dec 2022To investigate the most common physical examination tests (PET) for the screening for referral of patients with back or chest pain caused by serious pathology. (Review)
Review
OBJECTIVE
To investigate the most common physical examination tests (PET) for the screening for referral of patients with back or chest pain caused by serious pathology.
METHODS
A systematic review was conducted. Searches were performed on seven electronic databases between June 2020 and December 2021. Only studies evaluating patients with back and/or chest pain with clear reporting of PETs and prompt patient referrals were included.
RESULTS
316 full texts were included, and these studies had a total of 474/492 patients affected by a serious disease. Only 26 studies of them described suspicion of serious disease due to at least one positive PET. Cardiac/pulmonary auscultation and heartbeats/blood pressure measurements were the most frequently reported tests. None of the reported studies included physiotherapists and chiropractors who reported the use of various tests, such as: cardiac and pulmonary auscultation, lung percussion, costovertebral angle tenderness, and lymph node palpation, highlighting a lack of attention in measuring vital parameters. On the contrary, doctors and nurses reported the assessment of the range of motion of the thoracolumbar spine and hip less frequently.
CONCLUSIONS
Appropriate reporting of PETs is sparse, and their utilization is heterogeneous among different healthcare professionals. Further primary studies are needed to describe PETs results in patients suffering from back and/or chest pain.
Topics: Humans; Low Back Pain; Chest Pain; Thorax; Physical Examination; Referral and Consultation
PubMed: 36554298
DOI: 10.3390/ijerph192416418 -
The Cochrane Database of Systematic... Aug 2022Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely... (Review)
Review
BACKGROUND
Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.
OBJECTIVES
To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.
SEARCH METHODS
For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.
SELECTION CRITERIA
Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.
MAIN RESULTS
We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.
AUTHORS' CONCLUSIONS
The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.
Topics: Adult; Auscultation; Humans; Music; Quality of Life; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 36000763
DOI: 10.1002/14651858.CD010459.pub3 -
Children (Basel, Switzerland) May 2022Determining the neonatal heart rate immediately after birth is unsatisfactory. Auscultation is inaccurate and provides no documented results. The use of foetal Doppler... (Review)
Review
Determining the neonatal heart rate immediately after birth is unsatisfactory. Auscultation is inaccurate and provides no documented results. The use of foetal Doppler ultrasound has been recognised as a possible method of determining the neonatal heart rate after birth over the last nine years. This review includes all published studies of this approach, looking at accuracy, speed of results, and practical application of the approach. Precordial Doppler ultrasound has been shown to be as accurate as ECG and more accurate than oximetry for the neonatal heart rate, and provides quicker results than either ECG or oximetry. There is the potential for a much improved determination and documentation of the neonatal heart rate using this approach.
PubMed: 35626893
DOI: 10.3390/children9050717 -
International Journal of Cardiology Jul 2022Most countries in South Asia are endemic for rheumatic heart disease (RHD). We aimed to estimate the pooled prevalence of RHD in South Asia from population-based... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Most countries in South Asia are endemic for rheumatic heart disease (RHD). We aimed to estimate the pooled prevalence of RHD in South Asia from population-based screening studies.
METHODS
A systematic strategy was developed and used to search online databases for articles which described the prevalence of RHD in the South Asia region. Articles published in the English language between 1991 and 2021 were included in the review after fulfilling eligibility criteria.
RESULTS
The pooled prevalence of RHD in South Asia was 2.79 per 1000 (95% Confidence interval (CI): 1.30-4.83) according to studies using auscultation followed by echocardiography of suspected cases and 18.28 per 1000 (95% CI: 11.59-26.44) for studies using echocardiography screening of all participants. The highest prevalence of 8.0 per 1000 (95% CI: 0.71-22.74) was observed in Pakistan, whereas the lowest prevalence of 0.32 per 1000 (95% CI: 0.18-0.48) was observed in Bangladesh. The prevalence of RHD has decreased to 2.30 per 1000 from 3.06 per 1000 by 24.84% in 30 years (1991-2021). The prevalence is more than twice higher using WHF criteria compared to WHO criteria. We observed no sex-related differences in prevalence (p = 0.16).
CONCLUSIONS
The prevalence of RHD is still high in the South Asian population. Recent studies utilizing echocardiographic screening have identified subclinical cases of RHD, reflecting the significant burden of the disease in this region. More population-based echocardiography screening studies in every country in South Asia are required to estimate the accurate prevalence of the disease.
Topics: Echocardiography; Humans; Mass Screening; Pakistan; Prevalence; Rheumatic Heart Disease
PubMed: 35504739
DOI: 10.1016/j.ijcard.2022.04.010 -
Journal of Global Health 2022Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource...
BACKGROUND
Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis.
METHODS
In this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians' acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed.
RESULTS
A total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia.
CONCLUSIONS
This systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.
Topics: Auscultation; Child; Humans; Lung; Pneumonia; Respiratory Sounds
PubMed: 35493777
DOI: 10.7189/jogh.12.04033 -
Scandinavian Journal of Trauma,... Nov 2021Auscultating for breath sounds to assess for pneumothorax in the helicopter emergency medical services (HEMS) settings can be extremely challenging. Thoracic point of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Auscultating for breath sounds to assess for pneumothorax in the helicopter emergency medical services (HEMS) settings can be extremely challenging. Thoracic point of care ultrasound (POCUS) offers a seemingly more useful visual (rather than audible) alternative. This review critically and quantitatively evaluates the use of thoracic POCUS for pneumothorax in the HEMS setting.
METHODS
A systematic literature review with meta-analysis was conducted. Only papers reporting on patients undergoing POCUS for pneumothorax in the helicopter or pre-hospital setting were included. Primary outcome was accuracy, focusing on sensitivity and specificity. Secondary outcome was practicality. PubMed, Embase and the Cochrane Library were searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess validity of studies.
RESULTS
Twelve studies reporting on n = 1,936 images from medical and trauma patients were included in qualitative synthesis. Studies were nearly all observational designs. Most images were acquired by nurses or paramedics who were previously novices to ultrasound. The reference standard was predominantly CT. Specificity results were unanimously precise and very high, whereas sensitivity results were imprecise and extremely variable. Meta-analysis of eight studies involving n = 1,713 images yielded pooled sensitivity 61% (95% CI: 27-87%; I = 94%) and pooled specificity 99% (95% CI: 98-100%; I = 89%). Six studies involving n = 315 images reported practicality. The highest or second highest categorisation of image quality was reported in around half of those images.
CONCLUSION
Thoracic POCUS is highly specific but has extremely variable sensitivity for pneumothorax when performed in the HEMS setting. This is from purely a diagnostic (not clinical) perspective. Sensitivity increases when only clinically significant pneumothoraces are considered. Case reports reveal thoracic POCUS can appropriately alter treatment and triage decisions, but only for a small number of patients. It appears predominantly useful in mitigating against unnecessary interventions. More research reporting patient focused outcomes is required. In the meantime, thoracic POCUS appears to offer a more appropriate visual alternative to auscultation for breath sounds when assessing for pneumothorax in the HEMS setting.
Topics: Aircraft; Emergency Medical Services; Humans; Pneumothorax; Point-of-Care Systems; Ultrasonography
PubMed: 34801070
DOI: 10.1186/s13049-021-00977-0 -
Reumatologia Clinica Dec 2022Interstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. The aim of this review...
AIMS
Interstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. The aim of this review was to identify the different screening methods for ILD in patients with RA.
METHODS
We ran a systematic search in Pubmed, Embase and Cochrane Library up to April 2020 and did a hand search of the references of the retrieved articles. The search was limited to humans and articles published in English, Spanish or French. We selected studies with any design where: (a) the population included adult patients with RA; (b) the intervention was any screening method for ILD; and (c) validity or reliability of the screening method were evaluated, or a screening method was described. Two reviewers independently screened the articles by title and abstract and subsequently extracted the information using a specific data extraction form.
RESULTS
25 studies were included with a total of 2593 patients. The most frequently used tool for ILD screening was high resolution computed tomography (HRCT) of the lung. Electronic auscultation, biochemical markers, bronchoalveolar lavage (BAL), pulmonary function tests (PFTs) and lung ultrasonography were also evaluated. Across the different studies, electronic auscultation and lung ultrasonography achieved higher accuracy than PFTs, BAL and biochemical markers.
CONCLUSIONS
HRCT resulted as the most sensitive tool for ILD screening in patients with RA. Given its harmlessness and high sensitivity, lung ultrasonography may become the first-choice tool in the future.
Topics: Adult; Humans; Reproducibility of Results; Lung Diseases, Interstitial; Arthritis, Rheumatoid; Lung; Biomarkers
PubMed: 34776393
DOI: 10.1016/j.reumae.2021.07.002