scholarly journals A systematic review of brief screeners for suicidal behaviour in primary care

2019 ◽  
Author(s):  
Karoline Lukaschek ◽  
Milena Frank ◽  
Kathrin Halfter ◽  
Antonius Schneider ◽  
Jochen Gensichen
Keyword(s):  
Primary Care ◽  
Suicidal Ideation ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Suicidal Behaviour ◽  
Risk Of Bias ◽  
Diagnostic Test Accuracy ◽  
Cochrane Library ◽  
Test Accuracy ◽  
Index Tests

Abstract Background: As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. A brief instrument could help in identifying vulnerable patients. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. Methods: The databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results: We identified a total of 9 969 studies with our search strategy. After the selection process, six relevant studies fulfilled all criteria and were included. They used the following index tests: Kessler Psychological Distress Scale, Suicidal Ideation Screening Questionnaire, Suicidal Ideation Attributes Scale, Gate question suicide attempt, Gate question suicidal ideation, Feeling suicidal, Wishing you were dead, Thoughts of death and Patient-Health-Questionaire-9 - item 9. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions: The identified studies were heterogeneous regarding sample size, index test and reference standard. Even though screening of suicidal behaviour in primary care is already recommended by several guidelines, there are only few screeners in primary care that have been examined regarding their diagnostic accuracy. Although they can assist GPs in their judgement of suicidal behaviour of patients at risk, the final assessment is always based on the clinical judgement of the attending physician. Further diagnostic test accuracy studies of promising short questionnaires are needed. Registration: The study protocol was registered at PROSPERO (ID: CRD42019122173).

scholarly journals A systematic review of brief screeners for suicidal behaviour in primary care

2019 ◽  
Author(s):  
Karoline Lukaschek ◽  
Milena Frank ◽  
Kathrin Halfter ◽  
Antonius Schneider ◽  
Jochen Gensichen
Keyword(s):  
Primary Care ◽  
General Population ◽  
Diagnostic Accuracy ◽  
Suicidal Behaviour ◽  
Risk Of Bias ◽  
Reference Standards ◽  
Cochrane Library ◽  
Test Accuracy ◽  
Index Test ◽  
Screening Instruments

Abstract Background As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. Therefore, actively screening patients at risk should be an integral part of primary care services. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. A brief instrument could improve the identification of vulnerable patients and their subsequent referral to mental health specialist. Methods: The following databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results Six relevant studies fulfilled all criteria and were included. Each index test was only assessed in a single study. The studies each used different reference standards. Target conditions defined across the different studies were suicidal ideation, suicide plan, suicide attempt, and suicidal behaviour in general. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions Overall, only a few studies assessed screening instruments for suicidal behaviour in primary care or the general population. The identified studies were heterogeneous regarding sample size, index test, and reference standard. Since each index test was only evaluated in one study, their interpretability is limited. No uniform gold standard was found, as the studies identified used different reference standards. Although there are other promising short questionnaires, the majority has not yet been evaluated in primary care setting or the general population with regard to their diagnostic accuracy. A final assessment should always be based on the clinical judgement of the attending physician. Registration The study protocol was registered at PROSPERO (ID: CRD42019122173).

Quality Appraisal of Diagnostic Accuracy Studies in Fine-Needle Aspiration Cytology: A Survey of Risk of Bias and Comparability

2013 ◽  
Vol 137 (4) ◽  
pp. 566-575 ◽  
Author(s):  
Robert L. Schmidt ◽  
Rachel E. Factor ◽  
Benjamin L. Witt ◽  
Lester J. Layfield
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Needle Aspiration ◽  
Risk Of Bias ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
Needle Aspiration Cytology

Context.—The quality of diagnostic accuracy studies is determined by 2 key factors: risk of bias and comparability. Bias can distort accuracy estimates and poor reporting impairs comparability. While diagnostic accuracy studies for fine-needle aspiration cytology (FNAC) are frequently published, the methodologic issues associated with this body of literature have never been reviewed. Objective.—To assess the quality of design and reporting of diagnostic test accuracy studies in FNAC. Data Sources.—Diagnostic accuracy studies were identified by a Medline (US National Library of Medicine) search. Sixty-four FNAC diagnostic test accuracy studies were randomly selected for structured review with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) survey. Studies were divided between 2 time periods: 2000-2001 and 2009-2011. Conclusions.—Diagnostic test accuracy studies of FNAC suffer from numerous deficiencies in study design, which negatively affect the reliability of accuracy estimates.

Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy

2019 ◽  
Vol 75 (6) ◽  
pp. 1134-1142 ◽  
Author(s):  
Rachel C Ambagtsheer ◽  
Renuka Visvanathan ◽  
Elsa Dent ◽  
Solomon Yu ◽  
Timothy J Schultz ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Older People ◽  
Diagnostic Test ◽  
Community Dwelling ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Screening Instruments ◽  
Residential Care Facility ◽  
Index Tests

Abstract Background Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried’s Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. Methods DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility. We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. Results We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2–94.3]; Sp: 73.4% [66.5–79.6]) and REFS (Se: 87.5% [73.2–95.8]; Sp: 75.5% [68.8–81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. Conclusions Two screening instruments—the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.

scholarly journals Aeroallergen sensitisation for detecting asthma in primary care: a diagnostic test accuracy study

2021 ◽  
Author(s):  
Janwillem W.H. Kocks ◽  
Heinze J.H. Andringa ◽  
Ellen van Heijst ◽  
Renaud Louis ◽  
Inigo Ojanguren Arranz ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Test ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Accuracy Study

scholarly journals The diagnostic accuracy of isothermal nucleic acid point-of-care tests for human coronaviruses: A systematic review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Pakpoom Subsoontorn ◽  
Manupat Lohitnavy ◽  
Chuenjid Kongkaew
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Point Of Care ◽  
Meta Analysis ◽  
Isothermal Amplification ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Index Test ◽  
Point Of Care Tests

AbstractMany recent studies reported coronavirus point-of-care tests (POCTs) based on isothermal amplification. However, the performances of these tests have not been systematically evaluated. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy was used as a guideline for conducting this systematic review. We searched peer-reviewed and preprint articles in PubMed, BioRxiv and MedRxiv up to 28 September 2020 to identify studies that provide data to calculate sensitivity, specificity and diagnostic odds ratio (DOR). Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was applied for assessing quality of included studies and Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) was followed for reporting. We included 81 studies from 65 research articles on POCTs of SARS, MERS and COVID-19. Most studies had high risk of patient selection and index test bias but low risk in other domains. Diagnostic specificities were high (> 0.95) for included studies while sensitivities varied depending on type of assays and sample used. Most studies (n = 51) used reverse transcription loop-mediated isothermal amplification (RT-LAMP) to diagnose coronaviruses. RT-LAMP of RNA purified from COVID-19 patient samples had pooled sensitivity at 0.94 (95% CI: 0.90–0.96). RT-LAMP of crude samples had substantially lower sensitivity at 0.78 (95% CI: 0.65–0.87). Abbott ID Now performance was similar to RT-LAMP of crude samples. Diagnostic performances by CRISPR and RT-LAMP on purified RNA were similar. Other diagnostic platforms including RT- recombinase assisted amplification (RT-RAA) and SAMBA-II also offered high sensitivity (> 0.95). Future studies should focus on the use of un-bias patient cohorts, double-blinded index test and detection assays that do not require RNA extraction.

scholarly journals Use of Smartphones to Detect Diabetic Retinopathy: Scoping Review and Meta-Analysis of Diagnostic Test Accuracy Studies (Preprint)

2019 ◽  
Author(s):  
Choon Han Tan ◽  
Bhone Myint Kyaw ◽  
Helen Smith ◽  
Colin S Tan ◽  
Lorainne Tudor Car
Keyword(s):  
Diabetic Retinopathy ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Fundus Photography ◽  
Diabetic Patients ◽  
Test Accuracy ◽  
Reference Standard

BACKGROUND Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphone ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible, and easier to use than conventional methods. OBJECTIVE This study aimed to determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. METHODS We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients, which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR to an accurate or commonly employed reference standard, such as indirect ophthalmoscopy, slit-lamp biomicroscopy, and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data, and assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies–2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines. RESULTS In all, nine studies involving 1430 participants were included. Most studies were of high quality, except one study with limited applicability because of its reference standard. The pooled sensitivity and specificity for detecting any DR was 87% (95% CI 74%-94%) and 94% (95% CI 81%-98%); mild nonproliferative DR (NPDR) was 39% (95% CI 10%-79%) and 95% (95% CI 91%-98%); moderate NPDR was 71% (95% CI 57%-81%) and 95% (95% CI 88%-98%); severe NPDR was 80% (95% CI 49%-94%) and 97% (95% CI 88%-99%); proliferative DR (PDR) was 92% (95% CI 79%-97%) and 99% (95% CI 96%-99%); diabetic macular edema was 79% (95% CI 63%-89%) and 93% (95% CI 82%-97%); and referral-warranted DR was 91% (95% CI 86%-94%) and 89% (95% CI 56%-98%). The area under SROC curve ranged from 0.879 to 0.979. The diagnostic odds ratio ranged from 11.3 to 1225. CONCLUSIONS We found heterogeneous evidence showing that smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference criteria and classification criteria and evaluate other available forms of smartphone ophthalmoscopy in primary care settings.

scholarly journals Use of smartphones for detecting diabetic retinopathy: a protocol for a scoping review of diagnostic test accuracy studies

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e028811 ◽  
Author(s):  
Choon Han Tan ◽  
Willie-Henri Quah ◽  
Colin S H Tan ◽  
Helen Smith ◽  
Lorainne Tudor Car
Keyword(s):  
Diabetic Retinopathy ◽  
Diagnostic Test ◽  
Scoping Review ◽  
Diagnostic Test Accuracy ◽  
Fundus Photography ◽  
Primary Data ◽  
Cochrane Library ◽  
Future Research ◽  
Diabetic Patients ◽  
Test Accuracy

IntroductionDiabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus and the leading cause of impaired vision in adults worldwide. Early detection and treatment for DR could improve patient outcomes. Traditional methods of detecting DR include the gold standard Early Treatment Diabetic Retinopathy Study seven standard fields fundus photography, ophthalmoscopy and slit-lamp biomicroscopy. These modalities can be expensive, difficult to access and require involvement of specialised healthcare professionals. With the development of mobile phone technology, there is a growing interest in their use for DR identification as this approach is potentially more affordable, accessible and easier to use. Smartphones can be employed in a variety of ways for ophthalmoscopy including the use of smartphone camera, various attachments and artificial intelligence for obtaining and grading of retinal images. The aim of this scoping review is to determine the diagnostic test accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients.Methods and analysisWe will perform an electronic search of MEDLINE, Embase and Cochrane Library for literature published from 2000 onwards. Two reviewers will independently analyse studies for eligibility and assess study quality using the QUADAS-2 tool. Data for a 2⨉2 contingency table will be extracted. If possible, we will pool sensitivity and specificity data using the random-effects model and construct a summary receiver operating characteristic curve. In case of high heterogeneity, we will present the findings narratively. Subgroup analysis and sensitivity analysis will be performed where appropriate.Ethics and disseminationThis scoping review aims to provide an overview of smartphone ophthalmoscopy in DR identification. It will present findings on the accuracy of smartphone ophthalmoscopy in detecting DR, identify gaps in the literature and provide recommendations for future research. This review does not require ethical approval as we will not collect primary data.

scholarly journals Understanding Sources of Bias in Diagnostic Accuracy Studies

2013 ◽  
Vol 137 (4) ◽  
pp. 558-565 ◽  
Author(s):  
Robert L. Schmidt ◽  
Rachel E. Factor
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Study Design ◽  
Reporting Quality ◽  
Risk Of Bias ◽  
Data Sources ◽  
Test Accuracy ◽  
Design Features ◽  
The Impact ◽  
Specific Diagnostic Test

Context.—Accuracy is an important feature of any diagnostic test. There has been an increasing awareness of deficiencies in study design that can create bias in estimates of test accuracy. Many pathologists are unaware of these sources of bias. Objective.—To explain the causes and increase awareness of several common types of bias that result from deficiencies in the design of diagnostic accuracy studies. Data Sources.—We cite examples from the literature and provide calculations to illustrate the impact of study design features on estimates of diagnostic accuracy. In a companion article by Schmidt et al in this issue, we use these principles to evaluate diagnostic studies associated with a specific diagnostic test for risk of bias and reporting quality. Conclusions.—There are several sources of bias that are unique to diagnostic accuracy studies. Because pathologists are both consumers and producers of such studies, it is important that they be aware of the risk of bias.

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