Evidence-based diagnosis

2008 ◽  
Vol 13 (3_suppl) ◽  
pp. 57-63 ◽  
Author(s):  
Penny Whiting ◽  
Roger Harbord ◽  
Isabel de Salis ◽  
Matthias Egger ◽  
Jonathan Sterne
Keyword(s):  
Quality Assessment ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Diagnostic Process ◽  
Test Accuracy ◽  
Evidence Based ◽  
Literature Searching ◽  
Summary Receiver Operating Characteristic ◽  
Statistical Knowledge ◽  
Appropriate Treatment

Making an accurate diagnosis is essential to ensure that a patient receives appropriate treatment and correct information regarding their prognosis. Characteristics of diagnostic tests are quantified in test accuracy studies, but many such studies have methodological flaws. The HSRC evidence-based diagnosis programme has focused on methods for systematic reviews of test accuracy studies, and the wider context in which tests are ordered and interpreted. We carried out a range of projects relating to literature searching, quality assessment, meta-analysis, presentation of results, and interactions between doctors and patients during the diagnostic process. We have shown that systematic reviews of test accuracy studies should search a range of databases and that current diagnostic filters do not have sufficient accuracy to be used in test accuracy reviews. Summary quality scores should not be used in test accuracy reviews; the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews (QUADAS) tool for assessing test accuracy studies is acceptable for quality assessment. We have shown that the hierarchical summary receiver operating characteristic (HSROC) and bivariate models for meta-analysis of test accuracy are statistically equivalent in many circumstances, and have developed an add-on module for the statistical software package Stata that enables these statistically rigorous models to be fitted by those without expert statistical knowledge. Three areas that would benefit from further research are literature searching, synthesis of results from individual patient data and presentation of results.

scholarly journals Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 63
Author(s):  
Sung Nam Moon ◽  
Jung-Soo Pyo ◽  
Wu Seong Kang
Keyword(s):  
Computed Tomography ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Pelvic Trauma ◽  
Test Accuracy ◽  
Trauma Patients ◽  
Positive Finding ◽  
Summary Receiver Operating Characteristic ◽  
Contrast Extravasation ◽  
Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

scholarly journals Brief Psychotherapy for Depression: A Systematic Review and Meta-Analysis

2012 ◽  
Vol 43 (2) ◽  
pp. 129-151 ◽  
Author(s):  
Jason A. Nieuwsma ◽  
Ranak B. Trivedi ◽  
Jennifer McDuffie ◽  
Ian Kronish ◽  
Dinesh Benjamin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Problem Solving ◽  
Cognitive Behavioral Therapy ◽  
Systematic Reviews ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Behavioral ◽  
Evidence Based ◽  
Brief Psychotherapy ◽  
Problem Solving Therapy

Objective: Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number of studies have examined abbreviated psychotherapy protocols. The purpose of this study was to conduct a systematic review and meta-analysis to determine the efficacy of brief psychotherapy (i.e., < 8 sessions) for depression. Methods: We used combined literature searches in PubMed, EMBASE, PsycINFO, and an Internet-accessible database of clinical trials of psychotherapy to conduct two systematic searches: one for existing systematic reviews and another for randomized controlled trials (RCTs). Included studies examined evidence-based psychotherapy(s) of eight or fewer sessions, focused on adults with depression, contained an acceptable control condition, were published in English, and used validated measures of depressive symptoms. Results: We retained 2 systematic reviews and 15 RCTs evaluating cognitive behavioral therapy, problem-solving therapy, and mindfulness-based cognitive therapy. The systematic reviews found brief psychotherapies to be more efficacious than control, with effect sizes ranging from −0.33 to −0.25. Our meta-analysis found six to eight sessions of cognitive behavioral therapy to be more efficacious than control (ES −0.42, 95% CI −0.74 to −0.10, I2 = 56%). A sensitivity analysis controlled for statistical heterogeneity but showed smaller treatment effects (ES −0.24, 95% CI −0.42 to −0.06, I2 = 0%). Conclusions: Depression can be efficaciously treated with six to eight sessions of psychotherapy, particularly cognitive behavioral therapy and problem-solving therapy. Access to non-pharmacologic treatments for depression could be improved by training healthcare providers to deliver brief psychotherapies.

scholarly journals Comparative Effectiveness Research: Using Systematic Reviews and Meta-Analyses to Synthesize Empirical Evidence

2011 ◽  
Vol 25 (3) ◽  
pp. 191-209 ◽  
Author(s):  
Maria C. Katapodi ◽  
Laurel L. Northouse
Keyword(s):  
Systematic Reviews ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Research Question ◽  
Alternative Methods ◽  
Evidence Based ◽  
Effectiveness Research ◽  
Meta Analyses ◽  
Research Studies

The increased demand for evidence-based health care practices calls for comparative effectiveness research (CER), namely the generation and synthesis of research evidence to compare the benefits and harms of alternative methods of care. A significant contribution of CER is the systematic identification and synthesis of available research studies on a specific topic. The purpose of this article is to provide an overview of methodological issues pertaining to systematic reviews and meta-analyses to be used by investigators with the purpose of conducting CER. A systematic review or meta-analysis is guided by a research protocol, which includes (a) the research question, (b) inclusion and exclusion criteria with respect to the target population and studies, © guidelines for obtaining relevant studies, (d) methods for data extraction and coding, (e) methods for data synthesis, and (f ) guidelines for reporting results and assessing for bias. This article presents an algorithm for generating evidence-based knowledge by systematically identifying, retrieving, and synthesizing large bodies of research studies. Recommendations for evaluating the strength of evidence, interpreting findings, and discussing clinical applicability are offered.

scholarly journals The Evidence-Based Practice Silent Enemy: Retracted Articles and Their Use in Systematic Reviews

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 465
Author(s):  
Ivan Herrera-Peco ◽  
Azucena Santillán-García ◽  
José María Morán ◽  
Jessica Marian Goodman-Casanova ◽  
Daniel Cuesta-Lozano
Keyword(s):  
Systematic Reviews ◽  
Nursing Practice ◽  
Current Issue ◽  
Meta Analysis ◽  
Evidence Based ◽  
Adherence To Treatment ◽  
Research Activities ◽  
Meta Analyses ◽  
Evidence Based Nursing ◽  
Improve Health

Today, evidence-based nursing practice strives to improve health care, ensure adherence to treatment, improve health outcomes, and guarantee patient safety. The main scientific documents that nurses should consult, to obtain the best possible evidence, are systematic reviews and meta-analyses. However, this type of scientific document has a major issue if it uses retracted articles that could directly affect the consistency of the results shown in the reviews. The aim of this commentary is to present the current issue represented by the use of retracted articles in meta-analyses of systematic reviews and how researchers could detect them, through the use of different instruments, avoiding them, and providing a reliable SR or meta-analysis that could be useful for day-to-day clinical and research activities.

scholarly journals Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (20) ◽  
pp. 7515 ◽  
Author(s):  
Eunhye Jeong ◽  
Jinkyung Park ◽  
Juneyoung Lee
Keyword(s):  
Systematic Review ◽  
Diagnostic Test ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Summary Receiver Operating Characteristic ◽  
Bivariate Model ◽  
Data Synthesis

Under-recognition of delirium is an international problem. For the early detection of delirium, a feasible and valid screening tool for healthcare professionals is needed. This study aimed to present a scientific reason for using the 4 ‘A’s Test (4AT) through a systematic review and meta-analysis of studies on the diagnostic test accuracy. We systematically searched articles in the EMBASE, MEDLINE, CINAHL, and PsycINFO databases and selected relevant articles on the basis of the predefined inclusion criteria. The quality of the included articles was evaluated using the Quality Assessment of the Diagnostic Accuracy Studies-2 tool. We estimated the pooled values of diagnostic test accuracy by employing the bivariate model and the hierarchical summary receiver operating characteristic (HSROC) model in data synthesis. A total of 3729 patients of 13 studies were included in the analysis. The pooled estimates of sensitivity and specificity of the 4AT were 81.5% (95% confidence interval: 70.7%, 89.0%) and 87.5% (79.5%, 92.7%), respectively. Given the 4AT’s evidence of accuracy and practicality, we suggest healthcare professionals to utilize this tool for routine screening of delirium. However, for detecting delirium in the dementia population, further work is required to evaluate the 4AT with other cut-off points or scoring methods in order for it to be more sensitive and specific.

scholarly journals Diagnostic and prognostic implications of parafibromin immunohistochemistry in parathyroid carcinomaT

2019 ◽  
Vol 39 (4) ◽  
Author(s):  
Jung-Soo Pyo ◽  
Won Jin Cho
Keyword(s):  
Parathyroid Adenoma ◽  
Diagnostic Test ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Disease Free Survival ◽  
Diagnostic Test Accuracy ◽  
Parathyroid Hyperplasia ◽  
Test Accuracy ◽  
Summary Receiver Operating Characteristic ◽  
Prognostic Implications

Abstract The aim of the present study was to elucidate the diagnostic and prognostic implications of parafibromin immunohistochemistry (IHC) in parathyroid carcinoma (PC). We performed a meta-analysis to examine the rate of loss of parafibromin expression from 18 eligible studies. In addition, a diagnostic test accuracy review was conducted to investigate the diagnostic role of parafibromin in PC. The rates of loss of parafibromin expression were 0.522 (95% CI: 0.444–0.599), 0.291 (95% CI: 0.207–0.391), 0.027 (95% CI: 0.011–0.064), and 0.032 (95% CI: 0.008–0.119) in PC, atypical parathyroid adenoma (APA), parathyroid adenoma (PA), and parathyroid hyperplasia, respectively. In the diagnostic test accuracy review for diagnosis of PC, the pooled sensitivity and specificity of parafibromin IHC was 0.53 (95% CI: 0.46–0.59) and 0.96 (95% CI: 0.95–0.97), respectively. The diagnostic odds ratio and the area under curve on summary receiver operating characteristic curve was 25.31 (95% CI: 8.91–71.87) and 0.7954, respectively. In addition, the meta-analysis demonstrated that loss of parafibromin expression was significantly correlated with worse disease-free survival (hazard ratio: 2.832; 95% CI: 1.081–7.421). Loss of parafibromin IHC expression was significantly higher in PC than in APA, PA, and parathyroid hyperplasia. Parafibromin IHC could be useful for diagnosis and prediction of prognosis of PC in daily practice.

scholarly journals Performance of methods for meta-analysis of diagnostic test accuracy with few studies or sparse data

2015 ◽  
Vol 26 (4) ◽  
pp. 1896-1911 ◽  
Author(s):  
Yemisi Takwoingi ◽  
Boliang Guo ◽  
Richard D Riley ◽  
Jonathan J Deeks
Keyword(s):  
Hierarchical Models ◽  
Operating Characteristic ◽  
Meta Analysis ◽  
Sparse Data ◽  
Parameter Estimates ◽  
Test Accuracy ◽  
Summary Receiver Operating Characteristic ◽  
Bivariate Model ◽  
Logistic Regression Models ◽  
Meta Analyses

Hierarchical models such as the bivariate and hierarchical summary receiver operating characteristic (HSROC) models are recommended for meta-analysis of test accuracy studies. These models are challenging to fit when there are few studies and/or sparse data (for example zero cells in contingency tables due to studies reporting 100% sensitivity or specificity); the models may not converge, or give unreliable parameter estimates. Using simulation, we investigated the performance of seven hierarchical models incorporating increasing simplifications in scenarios designed to replicate realistic situations for meta-analysis of test accuracy studies. Performance of the models was assessed in terms of estimability (percentage of meta-analyses that successfully converged and percentage where the between study correlation was estimable), bias, mean square error and coverage of the 95% confidence intervals. Our results indicate that simpler hierarchical models are valid in situations with few studies or sparse data. For synthesis of sensitivity and specificity, univariate random effects logistic regression models are appropriate when a bivariate model cannot be fitted. Alternatively, an HSROC model that assumes a symmetric SROC curve (by excluding the shape parameter) can be used if the HSROC model is the chosen meta-analytic approach. In the absence of heterogeneity, fixed effect equivalent of the models can be applied.

scholarly journals Automation of literature screening using machine learning in medical evidence synthesis: a diagnostic test accuracy systematic review protocol

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuelun Zhang ◽  
Siyu Liang ◽  
Yunying Feng ◽  
Qing Wang ◽  
Feng Sun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Digital Library ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Test Accuracy ◽  
Evidence Based ◽  
Medical Evidence ◽  
Evidence Collection ◽  
Automatic Methods

Abstract Background Systematic review is an indispensable tool for optimal evidence collection and evaluation in evidence-based medicine. However, the explosive increase of the original literatures makes it difficult to accomplish critical appraisal and regular update. Artificial intelligence (AI) algorithms have been applied to automate the literature screening procedure in medical systematic reviews. In these studies, different algorithms were used and results with great variance were reported. It is therefore imperative to systematically review and analyse the developed automatic methods for literature screening and their effectiveness reported in current studies. Methods An electronic search will be conducted using PubMed, Embase, ACM Digital Library, and IEEE Xplore Digital Library databases, as well as literatures found through supplementary search in Google scholar, on automatic methods for literature screening in systematic reviews. Two reviewers will independently conduct the primary screening of the articles and data extraction, in which nonconformities will be solved by discussion with a methodologist. Data will be extracted from eligible studies, including the basic characteristics of study, the information of training set and validation set, and the function and performance of AI algorithms, and summarised in a table. The risk of bias and applicability of the eligible studies will be assessed by the two reviewers independently based on Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Quantitative analyses, if appropriate, will also be performed. Discussion Automating systematic review process is of great help in reducing workload in evidence-based practice. Results from this systematic review will provide essential summary of the current development of AI algorithms for automatic literature screening in medical evidence synthesis and help to inspire further studies in this field. Systematic review registration PROSPERO CRD42020170815 (28 April 2020).

scholarly journals A bibliometric analysis of systematic review/meta-analysis on dry eye disease

2019 ◽  
Author(s):  
Yonggang Zhang ◽  
An Ping ◽  
Shuyuan Lyu
Keyword(s):  
Systematic Review ◽  
Dry Eye ◽  
Systematic Reviews ◽  
Core Collection ◽  
Meta Analysis ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
Evidence Based ◽  
Meta Analyses ◽  
Number Of Citations

Abstract Background There was no citation analysis about systematic review/meta-analysis published on dry eye disease (DED). The objective of this study was to identify the citations of systematic review/meta-analysis published on DED and to provide information on the achievement and development of evidence-based dry eye research.Methods Web of Knowledge Core Collection was searched for all systematic review/meta-analysis relevant to DED. The number of citations, authorship, year, journal, country, and institution were analyzed for each study.Results A total of 29 systematic reviews/meta-analyses on DED published between 2009 and 2017 were included. The number of citations ranged from 0 to 63, with a medium of 8 citations. These systematic reviews/meta-analyses were from 10 countries, and 15 of them were from China. They were published in 21 journals. Ocular Surface published most studies (n =4), followed by International Journal of Ophthalmology (n =3). The journal with highest impact factor was Nutrition Reviews (IF=5.291 in 2016).Conclusion The citations of systematic reviews/meta-analyses on DED are still low. Further systematic reviews/meta-analyses are needed for providing more evidence for DED.

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