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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 -
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 -
Frontiers in Endocrinology 2022Both anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Both anaplastic thyroid carcinoma (ATC) and thyroid lymphoma (TL) clinically present as rapidly enlarging neck masses. Unfortunately, in this situation, like in any other thyroid swelling, a routine fine-needle aspiration (FNA) cytology is the first and only diagnostic test performed at the initial contact in the average thyroid practice. FNA, however, has a low sensitivity in diagnosing ATC and TL, and by the time the often "inconclusive" result is known, precious time has evolved, before going for core-needle biopsy (CNB) or incisional biopsy (IB) as the natural next diagnostic steps.
OBJECTIVES
To determine the diagnostic value of CNB in the clinical setting of a rapidly enlarging thyroid mass, a systematic review and meta-analysis of the available data on CNB reliability in the differential diagnosis of ATC and TL.
METHODS
A PubMed, Embase and Web of Science database search was performed on June 23th 2021. Population of interest comprised patients who underwent CNB for clinical or ultrasonographical suspicion of ATC or TL, patients with a final diagnosis of ATC or TL after CNB, or after IB following CNB.
RESULTS
From a total of 17 studies, 166 patients were included. One hundred and thirty-six were diagnosed as TL and 14 as ATC following CNB. CNB, with a sensitivity and positive predictive value of 94,3% and 100% for TL and 80,1% and 100% for ATC respectively, proved to be superior to FNA (reported sensitivity for TL of 48% and for ATC of 61%). Furthermore, the need for additional diagnostic surgery after CNB was only 6.2% for TL and 17.6% for ATC.
CONCLUSIONS
Immediately performing CNB for a suspected diagnosis of ATC and TL in a rapidly enlarging thyroid mass is more appropriate and straightforward than a stepped diagnostic pathway using FNA first and awaiting the result before doing CNB.
Topics: Biopsy, Large-Core Needle; Humans; Lymphoma; Reproducibility of Results; Thyroid Carcinoma, Anaplastic; Thyroid Neoplasms; Thyroid Nodule
PubMed: 36204100
DOI: 10.3389/fendo.2022.971249 -
Academic Emergency Medicine : Official... Mar 2011The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)-performed ultrasound (US) for cholelithiasis in symptomatic... (Review)
Review
OBJECTIVES
The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)-performed ultrasound (US) for cholelithiasis in symptomatic emergency department (ED) patients.
METHODS
A search was conducted of MEDLINE, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conference proceedings. We included studies that prospectively assessed the diagnostic accuracy of emergency US (EUS) for cholelithiasis, compared to a criterion reference standard of radiology-performed ultrasound (RADUS), computed tomography (CT), magnetic resonance imaging (MRI), or surgical findings. Two authors independently performed relevance screening of titles and abstracts, extracted data, and performed the quality analysis. Disagreements were resolved by conference between the two reviewers. EUS performance was assessed with summary receiver operator characteristics curve (SROC) analysis, with independently pooled sensitivity and specificity values across included studies.
RESULTS
The electronic search yielded 917 titles; eight studies met the inclusion criteria, yielding a sample of 710 subjects. All included studies used appropriate selection criteria and reference standards, but only one study reported uninterpretable or indeterminate results. The pooled estimates for sensitivity and specificity were 89.8% (95% confidence interval [CI] = 86.4% to 92.5%) and 88.0% (95% CI = 83.7% to 91.4%), respectively.
CONCLUSIONS
This study suggests that in patients presenting to the ED with pain consistent with biliary colic, a positive EUS scan may be used to arrange for appropriate outpatient follow-up if symptoms have resolved. In patients with a low pretest probability, a negative EUS scan should prompt the clinician to consider an alternative diagnosis.
Topics: Cholelithiasis; Diagnosis, Differential; Emergency Medicine; Emergency Service, Hospital; Humans; Point-of-Care Systems; ROC Curve; Sensitivity and Specificity; Ultrasonography
PubMed: 21401784
DOI: 10.1111/j.1553-2712.2011.01012.x -
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 -
Nutrients Nov 2022Metabolic dysfunction-associated fatty liver disease (MAFLD) has been related to a series of harmful health consequences. The triglyceride-glucose index (TyG index)... (Meta-Analysis)
Meta-Analysis Review
The Diagnostic and Prognostic Value of the Triglyceride-Glucose Index in Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD): A Systematic Review and Meta-Analysis.
Metabolic dysfunction-associated fatty liver disease (MAFLD) has been related to a series of harmful health consequences. The triglyceride-glucose index (TyG index) appears to be associated with MAFLD. However, no consistent conclusions about the TyG index and incident MAFLD have been reached. PubMed, MEDLINE, Web of Science, EMBASE and the Cochrane Library were searched. Sensitivities, specificities and the area under the receiver operating characteristic (AUC) with a random-effects model were used to assess the diagnostic performance of the TyG index in NAFLD/MAFLD participants. Potential threshold effects and publication bias were evaluated by Spearman’s correlation and Deeks’ asymmetry test, respectively. A total of 20 studies with 165725 MAFLD participants were included. The summary receiver operator characteristic (SROC) curve showed that the sensitivity, specificity and AUC were 0.73 (0.69−0.76), 0.67 (0.65, 0.70) and 0.75 (0.71−0.79), respectively. Threshold effects (r = 0.490, p < 0.05) were confirmed to exist. Subgroup analyses and meta-regression showed that some factors including country, number of samples, age and disease situation were the sources of heterogeneity (p < 0.05). Our meta-analysis suggests that the TyG index can diagnose and predict MAFLD patients with good accuracy. The number of studies remains limited, and prospective studies are needed.
Topics: Humans; Prognosis; Triglycerides; Glucose; Non-alcoholic Fatty Liver Disease; ROC Curve
PubMed: 36500999
DOI: 10.3390/nu14234969 -
Respiratory Care Apr 2013Flexible bronchoscopic procedures are currently the most often employed technique for demonstrating granulomatous inflammation in sarcoidosis. Conventional... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Flexible bronchoscopic procedures are currently the most often employed technique for demonstrating granulomatous inflammation in sarcoidosis. Conventional transbronchial needle aspiration (TBNA) has been used for over 3 decades; however, it remains an underutilized technique, primarily due to the wide variations in the reported success rates and unconfirmed safety concerns. Herein we perform a systematic review and meta-analysis of studies to estimate the diagnostic yield and safety of TBNA in sarcoidosis.
METHODS
We searched the PubMed and EmBase databases for studies (1980 to January 2012) reporting the efficacy of TBNA in sarcoidosis. The quality of studies was assessed using the QualSyst tool. The efficacy of TBNA in individual studies was calculated as proportions and 95% CIs, and the results were pooled using a random effects model. Heterogeneity and publication bias were assessed for the individual outcomes.
RESULTS
Our search yielded 21 studies (915 patients). The diagnostic yield of TBNA ranged from 6-90%, with the pooled efficacy being 62% (95% CI 52-71%) by the random effects model. TBNA was not associated with any major complication. The diagnostic yield increased to 83% if transbronchial lung biopsy (TBLB) was additionally performed, albeit with increased complications. There was evidence of heterogeneity and publication bias, which significantly decreased on sensitivity analysis after exclusion of retrospective studies.
CONCLUSIONS
TBNA is an efficacious and safe procedure in the diagnosis of sarcoidosis. The performance of TBLB adds to the efficacy of TBNA. Hence, a combination of TBNA and TBLB should be routinely employed in diagnosis of sarcoidosis in those with enlarged mediastinal lymph nodes.
Topics: Biopsy, Needle; Bronchoscopy; Humans; Predictive Value of Tests; Risk Assessment; Sarcoidosis, Pulmonary
PubMed: 23050747
DOI: 10.4187/respcare.02101 -
Endoscopy May 2014Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant. The objective of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND STUDY AIMS
Demand for endoscopic procedures worldwide has increased while the number of physicians trained to perform endoscopy has remained relatively constant. The objective of this study was to characterize non-physician performance of lower and upper endoscopic procedures.
PATIENTS AND METHODS
Bibliographical searches were conducted in Medline, EMBASE, and Cochrane Library databases. Studies were included where patients underwent flexible sigmoidoscopy, colonoscopy, or upper endoscopy done by a non-physician (nurse, nurse practitioner, physician assistant) and outcome measures were reported (detection of polyps, adenomas, cancer, and/or adverse events). Pooled rates were calculated for specific outcomes and rate ratios were determined for selected comparison groups.
RESULTS
Most studies involved nurses performing flexible sigmoidoscopies for colorectal cancer screening. Nurses and nurse-practitioners/physician assistants performing flexible sigmoidoscopies showed pooled polyp detection rates of 9.9 % and 23.7 %, adenoma detection rates of 2.9 % and 7.2 %, colorectal cancer detection rates of 1.3 % and 1.2 %, and adverse event rates of 0.3 and 0 per 1000 sigmoidoscopies, respectively. There was no significant difference between polyp and adenoma detection rates in sigmoidoscopy performance studies comparing nurses or nurse-practitioners/physician assistants with physicians. For the 3 studies of non-physician performance of colonoscopy, pooled adenoma detection rate was 26.4 %, cecal intubation rate was 93.5 %, and adverse event rate was 2.2 /1000 colonoscopies. In the few studies examining upper endoscopies, 99.4 % of upper endoscopy procedures performed by nurses were successful with no reported adverse events.
CONCLUSION
Available studies suggest that when non-physicians perform endoscopic procedures, especially lower endoscopies, outcomes and adverse events are in line with those of physicians.
Topics: Clinical Competence; Endoscopy, Gastrointestinal; Gastrointestinal Diseases; Humans; Nurse Practitioners; Nurses; Physician Assistants; Practice Patterns, Nurses'
PubMed: 24627086
DOI: 10.1055/s-0034-1365310 -
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 -
International Journal of Gynaecology... Mar 2016Cervical cancer screening is offered to women to identify and treat cervical intraepithelial neoplasia (CIN). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cervical cancer screening is offered to women to identify and treat cervical intraepithelial neoplasia (CIN).
OBJECTIVES
To support WHO guidelines, a systematic review was performed to compare test accuracy of the HPV test, cytology (cervical smear), and unaided visual inspection with acetic acid (VIA); and to determine test accuracy of HPV and colposcopy impression.
SEARCH STRATEGY
Medline and Embase were searched up to September 2012, and experts were contacted for references.
SELECTION CRITERIA
Studies of at least 100 nonpregnant women (aged ≥18years) not previously diagnosed with CIN were included.
DATA COLLECTION AND ANALYSIS
Two investigators independently screened and collected data. Pooled sensitivity and specificity, and absolute differences were calculated, and the quality of evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
MAIN RESULTS
High to moderate quality evidence was found. The greatest difference in overtreatment occurred with VIA instead of the cervical smear (58 more per 1000 women). Differences in missed treatment ranged from 2-5 per 1000 women. For 1000 women screened positive and then sent to colposcopy, 464 would be falsely diagnosed with CIN grade 2-3 and treated.
CONCLUSIONS
Although differences in sensitivity between tests could be interpreted as large, absolute differences in missed diagnoses were small. By contrast, small differences in specificity resulted in fairly large absolute differences in overtreatment.
Topics: Acetic Acid; Colposcopy; Early Detection of Cancer; Female; Humans; Papanicolaou Test; Papillomaviridae; Sensitivity and Specificity; Uterine Cervical Neoplasms; Vaginal Smears; Uterine Cervical Dysplasia
PubMed: 26851054
DOI: 10.1016/j.ijgo.2015.07.024