The value of the post-captopril aldosterone/renin ratio for the diagnosis of primary aldosteronism and the influential factors: A meta-analysis

Objective: The procedure for the captopril challenge test (CCT) in diagnosing primary aldosteronism (PA) is not standardized. We performed a meta-analysis to evaluate the controversial diagnostic value and influential factors of the post-captopril aldosterone/renin ratio (ARR). Methods: We searched literature in databases for eligible studies (until October 1, 2020). We extracted information regarding study and patient characteristics, CCT methods, outcome data. We pooled studies using the random-effect model. We performed meta-regression and six pre-specified subgroup analyses to explore heterogeneity. Results: Nineteen studies involving 4568 subjects were included. The pooled sensitivity and specificity were 0.825 (95% CI 0.804–0.844) and 0.919 (95% CI 0.908–0.928). The area under the summary receiver operating characteristic curve was 0.9487 (95% CI 0.9207–0.9767). Meta-regression revealed that heterogeneity might derive from time interval ( p = 0.0117) and study population ( p = 0.0033). Subgroup analyses showed significant differences between the subgroups stratified by the dose, posture, study region, time interval, cut-off value and study population for sensitivity and/or specificity ( p < 0.05). Conclusion: Post-captopril ARR is comparably valuable for diagnosing PA at cut-offs from 12.0 to 50.0. Conducting the CCT in the supine position with 25 mg of captopril may attain greater sensitivity. Conducting the CCT in the seated position with 50 mg of captopril may attain greater specificity. A 90-min time interval may perform best in both the sensitivity and specificity.

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Can Serum Glypican-3 Be a Biomarker for Effective Diagnosis of Hepatocellular Carcinoma? A Meta-Analysis of the Literature

Disease Markers ◽

10.1155/2014/127831 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Sheng-Li Yang ◽

Xiefan Fang ◽

Zao-Zao Huang ◽

Xiang-Jie Liu ◽

Zhi-Fan Xiong ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Diagnostic Value ◽

Healthy Individuals ◽

Subgroup Analyses ◽

Effective Diagnosis ◽

Diagnostic Index

Objective. This review is to evaluate the diagnostic value of serum GPC3 for hepatocellular carcinoma (HCC) due to conflicting results reported.Methods. NCBI PubMed and Embase were comprehensively searched for studies that have used serum GPC3 level as a diagnostic index for HCC. The quality of the included studies was assessed. Subgroup analyses were conducted to evaluate the sensitivity and specificity of GPC3 as a HCC marker. Statistical analysis was performed with the software STATA version 12.0.Results. A total of 22 studies were included. The qualities of included studies were relatively poor. Among them, 18 studies have shown that serum GPC3 is a specific biomarker for HCC, and the pooled sensitivity and specificity of these studies were 69 and 93%, respectively. The other 4 studies have reported conflicting results, which were not caused by races, infection status of HBV and HCV, or assay reagents but due to one common experimental design of enrolling liver cirrhosis patients as control subjects.Conclusions. This meta-analysis indicates that serum GPC3 is elevated in HCC patients compared with healthy individuals, but more studies are needed to evaluate its effectiveness to differentially diagnose HCC and liver cirrhosis.

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Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.601470 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zigang Liu ◽

Yongmei Zhao ◽

Ming Lei ◽

Guancong Zhao ◽

Dongcheng Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Ischemic Preconditioning ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Randomized Controlled ◽

Subgroup Analyses ◽

Meta Regression

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

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Magnetic Resonance Imaging for Surveillance of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Diagnostics ◽

10.3390/diagnostics11091665 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1665

Author(s):

Dong Hwan Kim ◽

Sang Hyun Choi ◽

Ju Hyun Shim ◽

So Yeon Kim ◽

Seung Soo Lee ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Magnetic Resonance ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Early Stage ◽

Meta Analysis ◽

Random Effects Model ◽

Resonance Imaging ◽

Meta Regression

Our meta-analysis aimed to evaluate the diagnostic performance of surveillance magnetic resonance imaging (sMRI) for detecting hepatocellular carcinoma (HCC), and to compare the diagnostic performance of sMRI between different protocols. Original articles about the diagnostic accuracy of sMRI for detecting HCC were found in major databases. The meta-analytic pooled sensitivity and specificity of sMRI for detecting HCC were determined using a bivariate random effects model. The pooled sensitivity and specificity of full MRI and abbreviated MRI protocols were compared using bivariate meta-regression. In the total seven included studies (1830 patients), the pooled sensitivity of sMRI for any-stage HCC and very early-stage HCC were 85% (95% confidence interval, 79–90%; I2 = 0%) and 77% (66–85%; I2 = 32%), respectively. The pooled specificity for any-stage HCC and very early-stage HCC were 94% (90–97%; I2 = 94%) and 94% (88–97%; I2 = 96%), respectively. The pooled sensitivity and specificity of abbreviated MRI protocols were 87% (80–94%) and 94% (90–98%), values that were comparable with those of full MRI protocols (84% [76–91%] and 94% [89–99%]; p = 0.83). In conclusion, sMRI had good sensitivity for detecting HCC, particularly very early-stage HCC. Abbreviated MRI protocols for HCC surveillance had comparable diagnostic performance to full MRI protocols.

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Comparative accuracy of pleural fluid unstimulated interferon-gamma and adenosine deaminase for diagnosing pleural tuberculosis: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0253525 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253525

Author(s):

Ashutosh Nath Aggarwal ◽

Ritesh Agarwal ◽

Sahajal Dhooria ◽

Kuruswamy Thurai Prasad ◽

Inderpaul Singh Sehgal ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Sensitivity And Specificity ◽

Interferon Gamma ◽

Meta Analysis ◽

Paired Data ◽

Ifn Γ ◽

Meta Regression

Objective We compared diagnostic accuracy of pleural fluid adenosine deaminase (ADA) and interferon-gamma (IFN-γ) in diagnosing tuberculous pleural effusion (TPE) through systematic review and comparative meta-analysis. Methods We queried PubMed and Embase databases to identify studies providing paired data for sensitivity and specificity of both pleural fluid ADA and IFN-γ for diagnosing TPE. We used hierarchical summary receiver operating characteristic (HSROC) plots and HSROC meta-regression to model individual and comparative diagnostic performance of the two tests. Results We retrieved 376 citations and included 45 datasets from 44 publications (4974 patients) in our review. Summary estimates for sensitivity and specificity for ADA were 0.88 (95% CI 0.85–0.91) and 0.91 (95% CI 0.89–0.92), while for IFN-γ they were 0.91 (95% CI 0.89–0.94) and 0.96 (95% CI 0.94–0.97), respectively. HSROC plots showed consistently greater diagnostic accuracy for IFN-γ over ADA across the entire range of observations. HSROC meta-regression using test-type as covariate yielded a relative diagnostic odds ratio of 2.22 (95% CI 1.68–2.94) in favour of IFN-γ, along with better summary sensitivity and specificity figures. No prespecified subgroup variable significantly influenced the summary diagnostic accuracy estimates. Conclusion Pleural fluid IFN-γ estimation has better diagnostic accuracy than ADA estimation for diagnosis of TPE.

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The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies

10.21203/rs.2.21254/v1 ◽

2020 ◽

Author(s):

jingjie zhao ◽

xinliang xu ◽

Hualin Jiang ◽

yi ding

Keyword(s):

Virtual Reality ◽

Meta Analysis ◽

Mean Difference ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Subgroup Analyses ◽

Degree Of Satisfaction ◽

Meta Regression ◽

Standardized Mean Difference ◽

Anatomy Teaching

Abstract Virtual reality (VR) is an innovation that permits the individual to discover and operate three-dimensional (3D) environment to gain practical understanding instantly. Recently, VR has been advanced as an encouraging tool in the course of clinical college. This research aimed to examine the general efficiency of VR for teaching medical anatomy. We executed a meta-analysis of randomized regulated studies of the performance of VR anatomy education. We browsed 5 databases from the year 1990 to 2019. Ultimately, 15 randomized controlled trials with a teaching outcome measure analysis were included. Tow authors separately chosen studies, extracted information, and examined the risk of bias. The primary outcomes were examination scores of the students. Secondary outcomes were the degree of satisfaction of the students. Random-effects models were used for the pooled evaluations. Standardized mean difference (SMD) was applied to assess the systematic results. The heterogeneity was determined by I2 statistics, and then was investigated by meta-regression and subgroup analyses. In this review, we screened and included fifteen randomized controlled researches (816 students). The pooled analysis of primary outcomes showed that VR improves test scores comparing with other approaches (standardized mean difference [SMD]= 0.53; 95% CI 0.09–0.97; I2= 87.8%). The high homogeneity indicated that the studies were different from each other. Therefore, we carried out meta-regression as well as subgroup analyses using 7 variables (year, country, learners, course, intervention, comparator, and duration). We found that VR improves postintervention test score of anatomy comparing with other types of teaching methods. Although the findings have high internal validity and limited, because of that anatomy teaching in medical universities appears to becoming a dilemma, VR may act as an efficient way to improve the learners’ level of anatomy knowledge. Future research should assess other factors like degree of satisfaction, cost-effectiveness, and adverse reactions when evaluating the teaching effectiveness of VR in anatomy.

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Uptake of referrals for women with positive perinatal depression screening results and the effectiveness of interventions to increase uptake: a systematic review and meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000554 ◽

2020 ◽

Vol 29 ◽

Cited By ~ 1

Author(s):

WQ Xue ◽

KK Cheng ◽

D Xu ◽

X Jin ◽

WJ Gong

Keyword(s):

Uptake Rate ◽

Observational Studies ◽

Perinatal Depression ◽

Meta Analysis ◽

Depression Screening ◽

Site Assessment ◽

Uptake Rates ◽

Subgroup Analyses ◽

Quasi Experimental ◽

Meta Regression

Abstract Aims Perinatal depression threatens the health of maternal women and their offspring. Although screening programs for perinatal depression exist, non-uptake of referral to further mental health care after screening reduces the utility of these programs. Uptake rates among women with positive screening varied widely across studies and little is known about how to improve the uptake rate. This study aimed to systematically review the available evidence on uptake rates, estimate the pooled rate, identify interventions to improve uptake of referral and explore the effectiveness of those interventions. Methods This systematic review has been registered in PROSPERO (registration number: CRD42019138095). We searched Pubmed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, Wanfang Database and VIP Databases from database inception to January 13, 2019 and scanned reference lists of relevant researches for studies published in English or Chinese. Studies providing information on uptake rate and/or effectiveness of interventions on uptake of referral were eligible for inclusion. Studies were excluded if they did not report the details of the referral process or did not provide exact uptake rate. Data provided by observational studies and quasi-experimental studies were used to estimate the pooled uptake rate through meta-analysis. We also performed meta-regression and subgroup analyses to explore the potential source of heterogeneity. To evaluate the effectiveness of interventions, we conducted descriptive analyses instead of meta-analyses since there was only one randomised controlled trial (RCT). Results Of 2302 records identified, 41 studies were eligible for inclusion, including 39 observational studies (n = 9337), one quasi-experimental study (n = 43) and one RCT (n = 555). All but two studies were conducted in high-income countries. The uptake rates reported by included studies varied widely and the pooled uptake rate of referral was 43% (95% confidence intervals [CI] 35–50%) by a random-effect model. Meta-regression and subgroup analyses both showed that referral to on-site assessment or treatment (60%, 95% CI 51–69%) had a significantly higher uptake rate than referral to mental health service (32%, 95% CI 23–41%) (odds ratio 1.31, 95% CI 1.13–1.52). The included RCT showed that the referral intervention significantly improved the uptake rate (p ＜ 0.01). Conclusions Almost three-fifths of women with positive screening results do not take up the referral offers after perinatal depression screening. Referral to on-site assessment and treatment may improve uptake of referral, but the quality of evidence on interventions to increase uptake was weak. More robust studies are needed, especially in low-and middle-income countries.

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Is Sensory Loss an Understudied Risk Factor for Frailty? A Systematic Review and Meta-analysis

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa171 ◽

2020 ◽

Vol 75 (12) ◽

pp. 2461-2470

Author(s):

Benjamin Kye Jyn Tan ◽

Ryan Eyn Kidd Man ◽

Alfred Tau Liang Gan ◽

Eva K Fenwick ◽

Varshini Varadaraj ◽

...

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Longitudinal Studies ◽

Meta Analysis ◽

Sensory Loss ◽

Cross Sectional ◽

Sensory Impairments ◽

Subgroup Analyses ◽

Meta Regression ◽

Meta Analyses

Abstract Background Age-related sensory loss and frailty are common conditions among older adults, but epidemiologic research on their possible links has been inconclusive. Clarifying this relationship is important because sensory loss may be a clinically relevant risk factor for frailty. Methods In this systematic review and meta-analysis, we searched 3 databases for observational studies investigating 4 sensory impairments—vision (VI), hearing (HI), smell (SI), and taste (TI)—and their relationships with frailty. We meta-analyzed the cross-sectional associations of VI/HI each with pre-frailty and frailty, investigated sources of heterogeneity using meta-regression and subgroup analyses, and assessed publication bias using Egger’s test. Results We included 17 cross-sectional and 7 longitudinal studies in our review (N = 34,085) from 766 records. Our cross-sectional meta-analyses found that HI and VI were, respectively, associated with 1.5- to 2-fold greater odds of pre-frailty and 2.5- to 3-fold greater odds of frailty. Our results remained largely unchanged after subgroup analyses and meta-regression, though the association between HI and pre-frailty was no longer significant in 2 subgroups which lacked sufficient studies. We did not detect publication bias. Longitudinal studies largely found positive associations between VI/HI and frailty progression from baseline robustness, though they were inconclusive about frailty progression from baseline pre-frailty. Sparse literature and heterogenous methods precluded meta-analyses and conclusions on the SI/TI–frailty relationships. Conclusions Our meta-analyses demonstrate significant cross-sectional associations between VI/HI with pre-frailty and frailty. Our review also highlights knowledge gaps on the directionality and modifiability of these relationships and the impact of SI/TI and multiple sensory impairments on frailty.

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Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis

Journal of Clinical Microbiology ◽

10.1128/jcm.01816-15 ◽

2015 ◽

Vol 53 (12) ◽

pp. 3738-3749 ◽

Cited By ~ 87

Author(s):

Caroline Chartrand ◽

Nicolas Tremblay ◽

Christian Renaud ◽

Jesse Papenburg

Keyword(s):

Systematic Review ◽

Respiratory Syncytial Virus ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Reference Standard ◽

Rt Pcr ◽

Test Sensitivity ◽

Subgroup Analyses ◽

Syncytial Virus

Respiratory syncytial virus (RSV) rapid antigen detection tests (RADT) are extensively used in clinical laboratories. We performed a systematic review and meta-analysis to evaluate the accuracy of RADTs for diagnosis of RSV infection and to determine factors associated with accuracy estimates. We searched EMBASE and PubMed for diagnostic-accuracy studies of commercialized RSV RADTs. Studies reporting sensitivity and specificity data compared to a reference standard (reverse transcriptase PCR [RT-PCR], immunofluorescence, or viral culture) were considered. Two reviewers independently extracted data on study characteristics, diagnostic-accuracy estimates, and study quality. Accuracy estimates were pooled using bivariate random-effects regression models. Heterogeneity was investigated with prespecified subgroup analyses. Seventy-one articles met inclusion criteria. Overall, RSV RADT pooled sensitivity and specificity were 80% (95% confidence interval [CI], 76% to 83%) and 97% (95% CI, 96% to 98%), respectively. Positive- and negative-likelihood ratios were 25.5 (95% CI, 18.3 to 35.5) and 0.21 (95% CI, 0.18 to 0.24), respectively. Sensitivity was higher in children (81% [95% CI, 78%, 84%]) than in adults (29% [95% CI, 11% to 48%]). Because of this disparity, further subgroup analyses were restricted to pediatric data (63 studies). Test sensitivity was poorest using RT-PCR as a reference standard and highest using immunofluorescence (74% versus 88%;P< 0.001). Industry-sponsored studies reported significantly higher sensitivity (87% versus 78%;P= 0.01). Our results suggest that the poor sensitivity of RSV RADTs in adults may preclude their use in this population. Furthermore, industry-sponsored studies and those that did not use RT-PCR as a reference standard likely overestimated test sensitivity.

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MON-221 Seated Saline Suppression Testing Is Comparable to Captopril Challenge Test for the Diagnosis of Primary Aldosteronism: A Prospective Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.069 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jinbo Hu ◽

Bin Liu ◽

Ying Song ◽

Wenwen He ◽

Qingfeng Cheng ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Prospective Study ◽

Multiple Regression ◽

Sensitivity And Specificity ◽

Primary Aldosteronism ◽

Sodium Intake ◽

Challenge Test ◽

Regression Analyses ◽

False Diagnosis ◽

A Prospective Study

Abstract Abstract: Objective: Saline suppression testing (SST) and captopril challenge test (CCT) are commonly used confirmatory tests for primary aldosteronism (PA). Seated SST (SSST) is reported to be superior to recumbent SST (RSST). Whether SSST is better than CCT remains unclear. Therefore we conducted a prospective study to compare the diagnostic accuracy of SSST and CCT. Methods: Hypertensive patients with high risk of PA were consecutively included. Patients with aldosterone-renin ratio≥1.0 ng•dl-1/μIU•ml-1 were asked to complete SSST, CCT and fludrocortisone suppression test (FST). Using FST as the reference standard (plasma aldosterone concentration [PAC] post-FST ≥6.0 ng•dl-1), area under the receiver-operator characteristic curves (AUC), sensitivity and specificity of SSST and CCT were calculated, and multiple regression analyses were conducted to identify potential factors for false diagnosis. Results: A total of 183 patients diagnosed as PA and 48 as essential hypertension completed the study. Using PAC post-SSST and PAC post-CCT to confirm PA, SSST and CCT had comparable AUCs (AUCSSST 0.83 [0.78,0.88] vs. AUCCCT 0.86 [0.81,0.90], P=0.308). Setting PAC post-SSST and post-CCT at 8.5 ng•dl-1 and 11 ng•dl-1, respectively, the sensitivity and specificity of SSST [0.71 (95%CI 0.64 to 0.77) and 0.82(0.68,0.90)] and CCT [0.73(0.66,0.79) and 0.80(0.66,0.89)] were not significantly different. In the multiple regression analyses, 1SD increment of sodium intake resulted in 40% lower risk of false diagnosis in SSST. Conclusions: SSST and CCT have comparable diagnostic accuracy. Insufficient sodium intake decreases the diagnostic efficiency of SSST but not CCT. Since the CCT is simpler and cheaper, it is preferable to the SSST.

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Metadta: A Stata Command for Meta-analysis and Meta-regression of Diagnostic Test Accuracy Data – A Tutorial.

10.21203/rs.3.rs-721114/v1 ◽

2021 ◽

Author(s):

Victoria Nyawira Nyaga ◽

Marc Arbyn

Keyword(s):

Bladder Cancer ◽

Diagnostic Test ◽

Sensitivity And Specificity ◽

Fixed Effects ◽

Meta Analysis ◽

Diagnostic Test Accuracy ◽

Forest Plot ◽

Test Accuracy ◽

Statistical Procedures ◽

Meta Regression

Abstract BackgroundAlthough statistical procedures for pooling of several epidemiological metrics are generally available in statistical packages, those for meta-analysis of diagnostic test accuracy studies including options for multivariate regression are lacking. Fitting regression models and the processing of the estimates often entails lengthy and tedious calculations. Therefore, packaging appropriate statistical procedures in a robust and user-friendly program is of great interest to the scientific community. Methodsmetadta is a statistical program for pooling of diagnostic accuracy test data in Stata. It implements both the bivariate random-effects and fixed-effects model, allows for meta-regression, and presents the results in tables, a forest plot and/or summary receiver operating characteristic (SROC) plot. For a model without covariates, it also quantifies heterogeneity using an I2 statistic that accounts for the mean-variance relationship, and correlation between sensitivity and specificity, a typical characteristic of diagnostic data. To demonstrate metadta, we applied the program on two published meta-analyses on: 1) the sensitivity and specificity of cytology and other markers including telomerase for primary diagnosis of bladder cancer; and 2) the accuracy of human papillomavirus testing on self-collected versus clinician-collected samples to detect cervical precancer.ResultsWithout requiring a continuity correction, metadta generated a pooled sensitivity and specificity of 0.77 [95% CI: 0.70, 0.82] and 0.91 [95% CI: 0.75, 0.97] respectively of telomerase for the diagnosis of primary bladder cancer. metadta allowed to assess the relative accuracy of human Papilloma virus (HPV) testing on self- versus clinician-taken specimens in matched studies taking into account two covariates. Under the condition of using assays based on target-amplification, HPV tests were similarly sensitive to detect cervical pre-cancer, irrespective of clinical setting. ConclusionThe metadta program implements state of art statistical procedures in an attempt to close the gap between methodological statisticians and systematic reviewers. With metadta, we hope to popularize even further, the use of appropriate statistical methods for diagnostic meta-analysis.

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