Accuracy of Algorithms and Visual Inspection for Detection of Trigger Asynchrony in Critical Patients : A Systematic Review

Objective. This study aimed to summarize the accuracy of the different methods for detecting trigger asynchrony at the bedside in mechanically ventilated patients. Method. A systematic review was conducted from 1990 to 2020 in PubMed, Lilacs, Scopus, and ScienceDirect databases. The reference list of the identified studies, reviews, and meta-analyses was also manually searched for relevant studies. The reference standards were esophageal pressure catheter and/or electrical activity of the diaphragm. Studies were assessed following the QUADAS-2 recommendations, while the review was prepared according to the PRISMA criteria. Results. One thousand one hundred and eleven studies were selected, and four were eligible for analysis. Esophageal pressure was the predominant reference standard, while visual inspection and algorithms/software comprised index tests. The trigger asynchrony, ineffective expiratory effort, double triggering, and reverse triggering were analyzed. Sensitivity and specificity ranged from 65.2% to 99% and 80% to 100%, respectively. Positive predictive values reached 80.3 to 100%, while the negative predictive values reached 92 to 100%. Accuracy could not be calculated for most studies. Conclusion. Algorithms/software validated directly or indirectly using reference standards present high sensitivity and specificity, with a diagnostic power similar to visual inspection of experts.

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Pyrazinamide Susceptibility Testing in Mycobacterium tuberculosis: a Systematic Review with Meta-Analyses

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00630-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4499-4505 ◽

Cited By ~ 81

Author(s):

Kwok Chiu Chang ◽

Wing Wai Yew ◽

Ying Zhang

Keyword(s):

Systematic Review ◽

Mycobacterium Tuberculosis ◽

Dna Sequencing ◽

Sensitivity And Specificity ◽

Test Performance ◽

Multidrug Resistant ◽

Predictive Values ◽

Content Type ◽

Molecular Assays ◽

Meta Analyses

ABSTRACTStandard culture-based testing of the susceptibility ofMycobacterium tuberculosisto pyrazinamide is difficult to perform. This systematic review with meta-analyses evaluated the roles of molecular assays targetingpncAand of pyrazinamidase assays. PubMed and Embase were searched for relevant publications in English. Sensitivity and specificity were estimated in bivariate random-effects models. Of 128 articles identified, 73 sets of data involving culture isolates were initially included in meta-analyses. Summary estimates of sensitivity and specificity, respectively, were 87% and 93% for PCR-DNA sequencing (n= 29), 75% and 95% for PCR-single-stranded conformation polymorphism (SSCP) (n= 5), 96% and 97% for a mixture of other molecular assays (n= 6), and 89% and 97% for pyrazinamidase assays using the Wayne method (n= 33). The median prevalence (range) of pyrazinamide resistance was 51% (31% to 89%) in multidrug-resistantM. tuberculosisisolates and 5% (0% to 9%) in non-multidrug-resistant isolates. Excluding studies with possibly considerable false resistance in the reference assay gave the following estimates of sensitivity and specificity, respectively: 92% and 93% for PCR-DNA sequencing (n= 20), 98% and 96% for other molecular assays (n= 5), and 91% and 97% for the Wayne assay (n= 27). The Wayne assay had significant funnel plot asymmetry, so the test performance might have been overestimated. Considering the prevalence of pyrazinamide resistance in different clinical settings, PCR-DNA sequencing, and possibly other molecular assays targetingpncA, can detect pyrazinamide resistance in multidrug-resistantM. tuberculosisisolates, with predictive values largely exceeding 90%, and rule out pyrazinamide resistance in non-multidrug-resistant isolates, with predictive values exceeding 99%. Molecular assays are probably the way forward for detecting pyrazinamide resistance.

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The role of Cardiac Magnetic Resonance (CMR) in the diagnosis of cardiomyopathy: A systematic review

Malawi Medical Journal ◽

10.4314/mmj.v31i3.14 ◽

2019 ◽

Vol 31 (3) ◽

pp. 240-244 ◽

Cited By ~ 1

Author(s):

Wang Zhaohui

Keyword(s):

Systematic Review ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Health Care Systems ◽

Heart Association ◽

High Sensitivity ◽

Current Therapy ◽

Predictive Values ◽

Care Systems ◽

European Society Of Cardiology

BackgroundMyocardial pathologies are significant causes of morbidity and mortality in patients worldwide. Ischemic and non-ischemic cardiomyopathies have become a worldwide epidemic of the 21st century with an increasing impact on health care systems. The 2012 European Society of Cardiology and 2013 American College of Cardiology Foundation/American Heart Association guidelines provide current therapy guidance to reduce mortality and morbidity.MethodsThis was a systematic review involving cardiac magnetic resonance (CMR) studies for the diagnosis of cardiomyopathy from January 2013 to April 2017. Out of 62 reviewed studies, only 12 were included in our study.ResultsThe average sensitivity and specificity of CMR in the diagnosis of cardiomyopathy was 86.75% (95% confidence interval [CI], 70.30% to 92.58%) and 81.75% (95% CI, 73.0% to 87.6%), respectively, and the positive predictive and negative predictive values were 80.17% and 86.75%, respectively.ConclusionDespite some limitations, our study shows that CMR has high sensitivity, specificity, and positive predictive value in diagnosing different types of cardiomyopathy. CMR may be used to differentiate types of cardiomyopathy, accurately quantify the chamber dimensions, volumes, and cardiac function, which make it useful for prognosis as well.

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Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales

The British Journal of Psychiatry ◽

10.1192/bjp.bp.116.182717 ◽

2017 ◽

Vol 210 (6) ◽

pp. 387-395 ◽

Cited By ~ 113

Author(s):

Gregory Carter ◽

Allison Milner ◽

Katie McGill ◽

Jane Pirkis ◽

Nav Kapur ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Meta Analysis ◽

Modifiable Risk Factors ◽

High Quality ◽

Policy Makers ◽

Predictive Values ◽

Effective Interventions ◽

Self Harm ◽

Meta Analyses

BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as ‘high risk’ to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9–7.9%), self-harm 26.3% (95% CI 21.8–31.3%) and self-harm plus suicide 35.9% (95% CI 25.8–47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3–22.3%) for high-quality studies, 32.5% (95% CI 26.1–39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5–35.6%) for psychiatric in-patients.ConclusionsNo ‘high-risk’ classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.

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Accuracy of Non-Contrast MRI for the Detection of Hepatocellular Carcinoma: A systematic review and meta-analysis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.3.5142 ◽

2022 ◽

Vol 38 (3) ◽

Author(s):

Liping Lu ◽

Xuming Pan

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

High Sensitivity ◽

Chronic Viral Hepatitis ◽

Significant Heterogeneity ◽

Chi Square ◽

Creative Commons

Non-contrast MRI is used for identifying patients with hepatocellular carcinoma (HCC), especially among high-risk patients with cirrhosis or chronic viral hepatitis. The accuracy of non-contrast MRI has been investigated with varying results. We performed this meta-analysis to consolidate the evidence on the accuracy of non-contrast MRI for the detection of HCC. We conducted a systematic search in the databases of PubMed Central, SCOPUS, MEDLINE, EMBASE and Cochrane from inception till November 2020. We used the STATA software “Midas” package for meta-analysis. We included 15 studies with 3,756 patients. The pooled sensitivity and specificity of non-contrast MRI for HCC detection were 84% (95%CI, 78%-88%) and 94% (95%CI, 91%-97%). The positive likelihood ratio was 14.9 (95% CI, 9.0-24.7) and the negative one 0.17 (0.12-0.23). The overall quality of the studies was high. We found significant heterogeneity based on chi-square test results and I2 statistic > 75%. Deek’s test showed the absence of publication bias. We found that non-contrast MRI has high sensitivity and specificity as a tool for detecting HCC. Studies exploring its accuracy in different ethnic populations are required to strengthen the evidence. doi: https://doi.org/10.12669/pjms.38.3.5142 How to cite this:Lu L, Pan X. Accuracy of Non-Contrast MRI for the Detection of Hepatocellular Carcinoma: A systematic review and meta-analysis. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5142 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Diagnostic Accuracy of Confocal Laser Endomicroscopy for the Diagnosis of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312390 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12390

Author(s):

Sneha Sethi ◽

Xiangqun Ju ◽

Richard M. Logan ◽

Paul Sambrook ◽

Robert A. McLaughlin ◽

...

Keyword(s):

Systematic Review ◽

Squamous Cell Carcinoma ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

High Sensitivity ◽

Risk Of Bias ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Likelihood Ratios

Background: Advances in treatment approaches for patients with oral squamous cell carcinoma (OSCC) have been unsuccessful in preventing frequent recurrences and distant metastases, leading to a poor prognosis. Early detection and prevention enable an improved 5-year survival and better prognosis. Confocal Laser Endomicroscopy (CLE) is a non-invasive imaging instrument that could enable an earlier diagnosis and possibly help in reducing unnecessary invasive surgical procedures. Objective: To present an up to date systematic review and meta-analysis assessing the diagnostic accuracy of CLE in diagnosing OSCC. Materials and Methods. PubMed, Scopus, and Web of Science databases were explored up to 30 June 2021, to collect articles concerning the diagnosis of OSCC through CLE. Screening: data extraction and appraisal was done by two reviewers. The quality of the methodology followed by the studies included in this review was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random effects model was used for the meta-analysis. Results: Six studies were included, leading to a total number of 361 lesions in 213 patients. The pooled sensitivity and specificity were 95% (95% CI, 92–97%; I2 = 77.5%) and 93% (95% CI, 90–95%; I2 = 68.6%); the pooled positive likelihood ratios and negative likelihood ratios were 10.85 (95% CI, 5.4–21.7; I2 = 55.9%) and 0.08 (95% CI, 0.03–0.2; I2 = 83.5%); and the pooled diagnostic odds ratio was 174.45 (95% CI, 34.51–881.69; I2 = 73.6%). Although risk of bias and heterogeneity is observed, this study validates that CLE may have a noteworthy clinical influence on the diagnosis of OSCC, through its high sensitivity and specificity. Conclusions: This review indicates an exceptionally high sensitivity and specificity of CLE for diagnosing OSCC. Whilst it is a promising diagnostic instrument, the limited number of existing studies and potential risk of bias of included studies does not allow us to draw firm conclusions. A conclusive inference can be drawn when more studies, possibly with homogeneous methodological approach, are performed.

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Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20210365 ◽

2021 ◽

Author(s):

Davi de Sá Cavalcante ◽

Paulo Goberlânio de Barros Silva ◽

Francisco Samuel Rodrigues Carvalho ◽

Ana Rosa Pinto Quidute ◽

Lúcio Mitsuo Kurita ◽

...

Keyword(s):

Systematic Review ◽

Fractal Dimension ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Grey Literature ◽

High Sensitivity ◽

Total Sample ◽

Control Group ◽

Test Accuracy ◽

Osteoporosis Screening

Objective: To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis. Methods: This registered systematic review followed the PRISMA-DTA statement. High sensitivity search strategies were developed for six primary databases and grey literature. QUADAS-2 items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty. Results: From 1,034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate. Conclusions: This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.

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Sensitivity and Specificity of Sheard and Percival’s Criteria for the Diagnosis of Young People with Near-heterophoria

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6399 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1128-1134

Author(s):

Saif Hassan Alrasheed ◽

Amel Mohamed Yousif ◽

Majid A. Moafa ◽

Abd Elaziz Mohamed Elmadina ◽

Mohammad Alobaid

Keyword(s):

Young People ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Binocular Vision ◽

Predictive Value ◽

High Sensitivity ◽

The Other ◽

Cross Sectional ◽

Predictive Values ◽

Low Sensitivity

BACKGROUND: Sheard and Percival assumed that symptoms from latent strabismus can be avoided if the relevant fusional vergence is adequate to support the heterophoria. AIM: The aim of the study was to determine the sensitivity and specificity of Sheard’s and Percival’s criterion for the diagnosis of heterophoria. METHODS: A cross-sectional hospital-based study was performed at Al-Neelain Eye Hospital Khartoum, Sudan from February to October 2019. Heterophoria was measured using Maddox Wing and fusional vergence using a prism bar. Thereafter, Sheard’s and Percival’s criteria were used for the diagnosis of heterophoria. RESULTS: A total of 230 participants (age = 15–30 years; mean age = 19.34 ± 3.325 years) were recruited for this study. The Sheard’s criteria showed a high sensitivity of 87.2% and a low specificity of 8.0% for the diagnosing of exophoria, with positive and negative predictive values of 65.5% and 26%, respectively. The criteria showed a relatively low sensitivity of 77.8% and a specificity of 9.0% in the diagnosis of esophoria, with a positive and negative predictive values of 56% and 20%, respectively. Percival criteria showed high sensitivity 84.2% and low specificity 9.1% in diagnosing esophoria, with a positive and negative predictive value of 61.5% and 25%, respectively. On the other hand, the criteria showed low sensitivity 67.4% and specificity 13.8% in diagnosing exophoria, with positive and negative predictive value 61.9% and 17%, respectively. CONCLUSION: Sheard’s and Percival’s criteria are useful in diagnosing binocular vision problems. Sheard’s criteria are accurate in diagnosing near exophoria and Percival’s criteria are more accurate in diagnosing near esophoria. Therefore, these criteria provide good clues and predictions for the diagnosis of binocular vision problems.

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Do social relationships mediate or moderate social inequalities in health? A systematic review protocol

10.21203/rs.3.rs-89905/v1 ◽

2020 ◽

Author(s):

Nadia Khaliq ◽

Anne McMunn ◽

Carolina Machuca-Vargas ◽

Anja Heilmann

Keyword(s):

Systematic Review ◽

Health Inequalities ◽

Social Relationships ◽

English Language ◽

Social Inequalities ◽

Data Extraction ◽

Meta Analysis ◽

Database Search ◽

Reference List ◽

Meta Analyses

Abstract IntroductionExplanations for health inequalities include material, behavioural and psychosocial pathways. Social relationships are an important determinant of health, and research has consistently found that a lack of support networks may diminish favourable health outcomes. There is some evidence that social network structures, partly shaped by socioeconomic factors, contribute to health inequalities. This protocol will summarise the systematic review process.Methods and analysesThe Systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic database search of MEDLINE, Embase Classic + Embase, and PsychINFO using the OvidSP platform will be undertaken. Articles published in the English language that have quantitatively assessed the role of social relationships in mediating or moderating health inequalities will be included and any health outcome (mental/physical) will be considered. The database search will be supplemented by reference list screening of all relevant full-text articles identified through the search. Two independent reviewers will be responsible for screening of articles, data extraction and assessment of bias. Studies will be risk assessed for bias using a modified version of the Newcastle-Ottawa Quality Assessment Scale. It is anticipated that the eligible studies will be highly variable; therefore, a meta-analysis will only be considered if the available data of the selected studies are similar. If the studies are too heterogeneous, a narrative synthesis of the extracted data will be presented. ConclusionThe results of the systematic review will examine the link between social relationships and health inequalities. The findings of the review will identify gaps in knowledge where further research is needed. Systematic review registrationPROSPERO CRD42020181706

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The effectiveness of serious games in alleviating anxiety: A systematic review and meta-analysis (Preprint)

10.2196/preprints.29137 ◽

2021 ◽

Author(s):

Alaa Abd-alrazaq ◽

Mohannad Alajlani ◽

Dari Alhuwail ◽

Jens Schneider ◽

Laila Akhu-Zaheya ◽

...

Keyword(s):

Systematic Review ◽

Serious Games ◽

Behavioral Therapy ◽

Risk Of Bias ◽

Anxiety Level ◽

Reference List ◽

Clinically Significant ◽

Meta Analyses ◽

Quality Evidence

BACKGROUND Anxiety is one of the mental disorders characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the non-pharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety was investigated by several systematic reviews, however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness of serious games in alleviating anxiety through summarizing the results of previous studies and providing an up-to-date review. METHODS We carried out a systematic review of randomized controlled trials (RCTs). We searched 7 databases: MEDLINE, CINAHL, PsycINFO, ACM Digital Library IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. RESULTS Out of 935 citations retrieved, 33 studies were included in this review. Of those, 22 RCTs were eventually included in meta-analyses. Very low quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on the anxiety level as compared to conventional exercises (P=0.70) and no intervention (P=0.27), respectively. While 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy (CBT) games on the anxiety level when compared with no intervention (P=0.01), the quality of the evidence reported was low. Likewise, low quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on the anxiety level when compared with conventional video games (P=0.03). CONCLUSIONS This review shows that serious games have the potential in alleviating anxiety levels. However, our findings remain inconclusive mainly due to the high risk of bias in the individual studies included, the low quality of meta-analyzed evidence, few studies included in some meta-analyses, patients without anxiety recruited in most studies, and using purpose-shifted serious games in most studies. Therefore, serious games should be deemed as complementary to existing interventions. To have adequate and robust evidence, researchers should use serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit a diverse population of patients with anxiety, and minimize the risk of bias by following the recommended guidelines for conducting and reporting RCTs.

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Corrected ESR/Albumin Ratio as a Simple, Practical Marker Predicts the Severity in Egyptian Ulcerative Colitis Patients

The Open Biomarkers Journal ◽

10.2174/1875318302111010008 ◽

2021 ◽

Vol 11 (1) ◽

pp. 8-16

Author(s):

Shimaa El Sharawy ◽

Hemat El-Horany ◽

Ibrahim Amer

Keyword(s):

Ulcerative Colitis ◽

Sensitivity And Specificity ◽

Area Under The Curve ◽

High Sensitivity ◽

Clinical Activity ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Predictive Values ◽

Albumin Ratio ◽

Egyptian Patients

Background: Serum biomarkers are commonly used for diagnosing and monitoring the disease activity of Ulcerative Colitis (UC) patients. However, their role in predicting disease severity among Egyptian patients is unknown. Objectives: The aim of this study was to correlate these biomarkers with clinical, endoscopic and histologic severity. Methods: This is a cross-sectional survey where 55 patients with UC were included to measure corrected Erythrocyte Sedimentation Rate (ESR), hematocrit (Hct), corrected ESR/albumin ratio and albumin, as well as colonoscopy and biopsy. Sensitivity and specificity, positive and negative predictive values were correlated with clinical, endoscopic, histologic severity. Results: The mean age of patients was 33 ± 8.4 years. In total, 27 (49.1%) were males and 28 (50.9%) were females. Area Under the Curve (AUC) values for the diagnosis of severe clinical disease were 0.947, 0.932, 0.727 and 0.685 for corrected ESR/albumin ratio, corrected ESR, Hct and albumin, respectively. Cut-off value to determine endoscopic severity for Hct was 34 (sensitivity: 88.89%, specificity: 83.78%, PPV: 72.7%, NPV: 93.9%, AUC: 0.963, p<0.001). Conclusion: Corrected ESR/albumin ratio was the best predictor of severe clinical activity of UC disease. Hct may be a marker of endoscopic and histological severity due to its high sensitivity and specificity as a diagnostic test.

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