scholarly journals Nasopharyngeal Swabs vs. Nasal Aspirates for Respiratory Virus Detection: A Systematic Review

Pathogens ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1515
Author(s):  
Matthew F. Flynn ◽  
Martin Kelly ◽  
James S. G. Dooley
Keyword(s):  
Pathogen Detection ◽  
Sampling Method ◽  
Meta Analysis ◽  
Virus Detection ◽  
Risk Of Bias ◽  
Rapid Review ◽  
Test Accuracy ◽  
Anatomical Site ◽  
Respiratory Pathogens ◽  
Cross Sectional

Nasal pathogen detection sensitivities can be as low as 70% despite advances in molecular diagnostics. This may be linked to the choice of sampling method. A diagnostic test accuracy review for sensitivity was undertaken to compare sensitivity of swabbing to the nasopharynx and extracting nasal aspirates, using the PRISMA protocol, Cochrane rapid review methodology, and QUADAS-2 risk of bias tools, with meta-analysis of included studies. Sensitivities were calculated by a consensus standard of positivity by either method as the ‘gold standard.’ Insufficient sampling methodology, cross sectional study designs, and studies pooling samples across anatomical sites were excluded. Of 13 subsequently eligible studies, 8 had ‘high’ risk of bias, and 5 had ‘high’ applicability concerns. There were no statistical differences in overall sensitivities between collection methods for eight different viruses, and this did not differ with use of PCR, immunofluorescence, or culture. In one study alone, Influenza H1N1(2009) favored nasopharyngeal swabs, with aspirates having 93.3% of the sensitivity of swabs (p > 0.001). Similarly equivocal sensitivities were noted in reports detecting bacteria. The chain of sampling, from anatomical site to laboratory results, features different potential foci along which sensitivity may be lost. A fair body of evidence exists that use of a different sampling method will not yield more respiratory pathogens.

scholarly journals Nasopharyngeal aspirates vs. nasal swabs for the detection of respiratory pathogens: results of a rapid review protocol

2020 ◽  
Author(s):  
Matthew F. Flynn ◽  
Martin Kelly ◽  
James S. Dooley
Keyword(s):  
Pathogen Detection ◽  
Sampling Method ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Rapid Review ◽  
Test Accuracy ◽  
Anatomical Site ◽  
Respiratory Pathogens ◽  
Cross Sectional ◽  
Rapid Reviews

AbstractBackgroundNasal pathogen detection sensitivities are often as low as 70% despite advances in molecular diagnostics. It has been suggested that this is linked, in part, to the choice of sampling method.MethodsA diagnostic test accuracy review for sensitivity, using recently developed Cochrane methods for conducting rapid reviews, and the PRISMA protocol was undertaken, with QUADAS-2 risk of bias assessments and meta-analysis of included studies. Sensitivities were calculated by a consensus standard of positivity by either method as the gold standard. Insufficient and/or inaccurate, cross sectional or anatomical site pooling methodologies were excluded.ResultsOf 13 included studies, 8 had ‘high’ risk of bias, and 5 had ‘high’ applicability concerns. There were no statistical differences in pooled sensitivities between collection methods for 8 different viruses, and neither with use of PCR, Immunofluorescence nor culture. In a single study, Influenza H1N1 favoured nasopharyngeal swabs, with aspirates having 93.3% of the sensitivity of swabs (p>0.001). Similar equivocal sensitivities were noticed in detecting bacteria.ConclusionsThe chain of sampling, from anatomical site to laboratory results, features different potential foci along which sensitivity may be lost. A sufficient body of evidence exists that use of a different sampling method will not yield more respiratory pathogens. The new Cochrane Rapid Reviews guidance helped rapidly answer this relevant and timely clinical question.

scholarly journals A hierarchical bivariate meta-analysis of diagnostic test accuracy to provide direct comparisons of immunoassays vs. indirect immunofluorescence for initial screening of connective tissue diseases

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Michelle Elaine Orme ◽  
Carmen Andalucia ◽  
Sigrid Sjölander ◽  
Xavier Bossuyt
Keyword(s):  
Connective Tissue ◽  
Indirect Immunofluorescence ◽  
Meta Analysis ◽  
Connective Tissue Diseases ◽  
Test Accuracy ◽  
Initial Screening ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Mixed Effect Models

AbstractObjectivesTo compare indirect immunofluorescence (IIF) for antinuclear antibodies (ANA) against immunoassays (IAs) as an initial screening test for connective tissue diseases (CTDs).MethodsA systematic literature review identified cross-sectional or case-control studies reporting test accuracy data for IIF and enzyme-linked immunosorbent assays (ELISA), fluorescence enzyme immunoassay (FEIA), chemiluminescent immunoassay (CLIA) or multiplex immunoassay (MIA). The meta-analysis used hierarchical, bivariate, mixed-effect models with random-effects by test.ResultsDirect comparisons of IIF with ELISA showed that both tests had good sensitivity (five studies, 2321 patients: ELISA: 90.3% [95% confidence interval (CI): 80.5%, 95.5%] vs. IIF at a cut-off of 1:80: 86.8% [95% CI: 81.8%, 90.6%]; p = 0.4) but low specificity, with considerable variance across assays (ELISA: 56.9% [95% CI: 40.9%, 71.5%] vs. IIF 1:80: 68.0% [95% CI: 39.5%, 87.4%]; p = 0.5). FEIA sensitivity was lower than IIF sensitivity (1:80: p = 0.005; 1:160: p = 0.051); however, FEIA specificity was higher (seven studies, n = 12,311, FEIA 93.6% [95% CI: 89.9%, 96.0%] vs. IIF 1:80 72.4% [95% CI: 62.2%, 80.7%]; p < 0.001; seven studies, n = 3251, FEIA 93.5% [95% CI: 91.1%, 95.3%] vs. IIF 1:160 81.1% [95% CI: 73.4%, 86.9%]; p < 0.0001). CLIA sensitivity was similar to IIF (1:80) with higher specificity (four studies, n = 1981: sensitivity 85.9% [95% CI: 64.7%, 95.3%]; p = 0.86; specificity 86.1% [95% CI: 78.3%, 91.4%]). More data are needed to make firm inferences for CLIA vs. IIF given the wide prediction region. There were too few studies for the meta-analysis of MIA vs. IIF (MIA sensitivity range 73.7%–86%; specificity 53%–91%).ConclusionsFEIA and CLIA have good specificity compared to IIF. A positive FEIA or CLIA test is useful to support the diagnosis of a CTD. A negative IIF test is useful to exclude a CTD.

scholarly journals Overuse and underuse of cardiovascular diagnostic and therapeutic procedures for community-dwelling adults: a protocol for a systematic review

2021 ◽  
Vol 4 ◽  
pp. 99
Author(s):  
Dominic Quinn ◽  
David Byrne ◽  
Tom Fahey ◽  
Rose Anne Kenny ◽  
Christine McGarrigle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Cost Effective ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Cochrane Library ◽  
Healthcare Intervention ◽  
Cross Sectional ◽  
International Guidelines

Background: Potentially inappropriate care can result from overuse or underuse of treatments, tests, or procedures. Overuse is defined as the use of health services with no clear benefit to the recipient or where harms outweigh benefits and/or costs of care. Underuse is defined as failure to deliver an effective and cost-effective healthcare intervention. Cardiovascular procedures such as coronary artery bypass grafting, carotid endarterectomy, coronary angiography, and coronary angioplasty (with/without stenting) are potentially both underused and overused. This systematic review aims to identify rates of potential overuse and underuse of these cardiovascular procedures and explore any associated patient or healthcare system factors. Methods: A systematic review and meta-analysis will be conducted in accordance with the PRISMA guidelines. A systematic search of MEDLINE (via Ovid), Embase, Cumulative Index to Nursing and Allied Health Literature and the Cochrane library will be conducted using a predefined search strategy.  Eligible studies for inclusion will examine rates of overuse and underuse of cardiovascular procedures, measured against national/international guidelines, for adults aged ≥18 years. Primary observational studies including cross-sectional and cohort studies will be included. Titles, abstracts, and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standardised form. Risk of bias for all included studies will be assessed using a modified version of the Hoy risk of bias tool. Where adequate data exists, and if statistically appropriate, meta-analyses will be conducted. If statistical pooling of the data is not possible, the findings will be narratively summarised focusing on the review’s objectives. Conclusion: This systematic review will examine overuse and underuse of cardiovascular procedures for adults.  The results will help inform policy makers, researchers, patients, and clinicians in the appropriate use of these procedures, in line with international guidelines. Registration: This protocol has been submitted for registration on PROSPERO (CRD42021239041).

scholarly journals Risk of bias and limits of reporting in diagnostic accuracy studies for commercial point-of-care tests for respiratory pathogens

2018 ◽  
Vol 146 (6) ◽  
pp. 747-756
Author(s):  
J.M. Hughes ◽  
C. Penney ◽  
S. Boyd ◽  
P. Daley
Keyword(s):  
Diagnostic Accuracy ◽  
Test Performance ◽  
Point Of Care ◽  
Risk Of Bias ◽  
Financial Impact ◽  
Test Accuracy ◽  
Respiratory Pathogens ◽  
Study Results ◽  
Group A ◽  
Point Of Care Tests

AbstractCommercial point-of-care (POC) diagnostic tests for Group A Streptococcus, Streptococcus pneumoniae, and influenza virus have large potential diagnostic and financial impact. Many published reports on test performance, often funded by diagnostics companies, are prone to bias. The Standards for Reporting of Diagnostic Accuracy (STARD 2015) are a protocol to encourage accurate, transparent reporting. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool evaluates risk of bias and transportability of results. We used these tools to evaluate diagnostic test accuracy studies of POC studies for three respiratory pathogens. For the 96 studies analysed, compliance was <25% for 14/34 STARD 2015 standards, and 3/7 QUADAS-2 domains showed a high risk of bias. All reports lacked reporting of at least one criterion. These biases should be considered in the interpretation of study results.

scholarly journals Prevalence of smoking in adults with spinal cord stimulators: a systematic review and meta-analysis

2020 ◽  
Vol 45 (3) ◽  
pp. 214-218
Author(s):  
W Michael Hooten ◽  
Rajat N Moman ◽  
Jodie Dvorkin ◽  
E Morgan Pollard ◽  
Robalee Wonderman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Smoking Status ◽  
Meta Analysis ◽  
Vascular Diseases ◽  
Risk Of Bias ◽  
Future Research ◽  
Cross Sectional ◽  
Prevalence Studies ◽  
Pooled Prevalence

BackgroundSmoking adversely impacts pain-related outcomes of spinal cord stimulation (SCS). However, the proportion of SCS patients at risk of worse outcomes is limited by an incomplete knowledge of smoking prevalence in this population. Thus, the primary aim of this systematic review is to determine the prevalence of smoking in adults with chronic pain treated with SCS.MethodsA comprehensive search of databases from 1 January 1980 to 3 January 2019 was conducted. Eligible study designs included (1) randomized trials; (2) prospective and retrospective cohort studies; and (3) cross-sectional studies. The risk of bias was assessed using a tool specifically developed for prevalence studies. A total of 1619 records were screened, 19 studies met inclusion criteria, and the total number of participants was 10 838.ResultsThirteen studies had low or moderate risk of bias, and six had a high risk of bias. All 19 studies reported smoking status and the pooled prevalence was 38% (95% CI 30% to 47%). The pooled prevalence in 6 studies of peripheral vascular diseases was 56% (95% CI 42% to 69%), the pooled prevalence of smoking in 11 studies of lumbar spine diagnoses was 28% (95% CI 20% to 36%) and the pooled prevalence in 2 studies of refractory angina was 44% (95% CI 31% to 58%).ConclusionsThe estimated prevalence of smoking in SCS patients is 2.5 times greater than the general population. Future research should focus on development, testing and deployment of tailored smoking cessation treatments for SCS patients.

scholarly journals Farm living and risk of asthma, atopic eczema, respiratory and food allergy: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048736
Author(s):  
Johnstone Kuya ◽  
Ogban Omoronyia ◽  
Theopista Fokukora ◽  
Aduroja Posi Emmanuel ◽  
Olusegun Sunday Ewemooje ◽  
...  
Keyword(s):  
Food Allergy ◽  
Environmental Factors ◽  
Disease Risk ◽  
Data Extraction ◽  
Meta Analysis ◽  
Scientific Journal ◽  
Public Health Practice ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Cross Sectional

IntroductionAsthma and allergic disorders are of global concern and risk for their development results from the interplay of genetic and environmental factors. Among numerous environmental factors identified to influence the disease risk, the role of exposure to a farming environment has gained interest in recent times, but the underlying evidence is conflicting. The review aims to comprehensively identify, critically appraise and synthesise evidence from studies investigating the association between farm living and risk of asthma and allergic diseases in children and adults.Methods and analysisWe will identify relevant analytical observational epidemiological studies, including cross-sectional, case-control and cohort studies, by searching PubMed, Cochrane Library, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Global Health Library, Web of Science, Scopus and Embase. Screening of identified records, data extraction from eligible studies and risk of bias assssment of eligible studies will be independently undertaken by two reviewers, with arbitration by a third reviewer. The Effective Public Health Practice Project will be employed for the risk of bias assessment. Estimates from studies judged to be clinically, methodologically and statistically homogeneous will be synthesised using random-effects meta-analysis. Heterogeneity will be assessed using the I-squared statistic. We will consider objectively measured or self-reported asthma, atopic dermatitis/eczema, allergic rhinitis, wheeze, and food allergy as primary outcomes.Ethics and disseminationAs this study is based solely on the published literature, no ethics approval is required. The study findings will be presented at scientific meetings related to the field of asthma and allergy and will be published in an international peer-reviewed scientific journal.PROSPERO registration numberCRD42020208805.

scholarly journals A protocol for rapid evidence synthesis into soil loosening as an intervention to ameliorate compaction caused by dairy farming and the impacts of this for productivity and sustainability

2018 ◽  
Author(s):  
Helen Kendall ◽  
Amy Taylor ◽  
Mark Reed ◽  
Gavin Stewart
Keyword(s):  
Search Strategy ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Risk Of Bias ◽  
Rapid Review ◽  
Dairy Production ◽  
Inclusion Criteria ◽  
Data Synthesis

This is a protocol for a rapid review of the effectiveness of soil loosening to ameliorate compaction caused by cattle treading from dairy production on UK dairy farms. The review will synthesise relevant literature that explores the impacts that can be derived from mechanical soil loosening for improved soil quality, productivity (i.e. yield) and the environment. The protocol outlines the rationale, objectives, inclusion criteria, search strategy and screening processes for the meta-analysis, and the plans for data extraction, risk of bias and data synthesis approaches.

scholarly journals A rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections in community settings

2020 ◽  
Vol 5 ◽  
pp. 266 ◽  
Author(s):  
Sarah Beale ◽  
Andrew Hayward ◽  
Laura Shallcross ◽  
Robert W. Aldridge ◽  
Ellen Fragaszy
Keyword(s):  
Viral Load ◽  
Meta Analysis ◽  
Random Effect ◽  
Rapid Review ◽  
Community Settings ◽  
Cross Sectional ◽  
Symptom Monitoring ◽  
Viral Shedding ◽  
Symptom Status

Background: Cross-sectional studies indicate that up to 80% of active SARS-CoV-2 infections may be asymptomatic. However, accurate estimates of the asymptomatic proportion require systematic detection and follow-up to differentiate between truly asymptomatic and pre-symptomatic cases. We conducted a rapid review and meta-analysis of the asymptomatic proportion of PCR-confirmed SARS-CoV-2 infections based on methodologically appropriate studies in community settings. Methods: We searched Medline and EMBASE for peer-reviewed articles, and BioRxiv and MedRxiv for pre-prints published before 25/08/2020. We included studies based in community settings that involved systematic PCR testing on participants and follow-up symptom monitoring regardless of symptom status. We extracted data on study characteristics, frequencies of PCR-confirmed infections by symptom status, and (if available) cycle threshold/genome copy number values and/or duration of viral shedding by symptom status, and age of asymptomatic versus (pre)symptomatic cases. We computed estimates of the asymptomatic proportion and 95% confidence intervals for each study and overall using random effect meta-analysis.  Results: We screened 1138 studies and included 21. The pooled asymptomatic proportion of SARS-CoV-2 infections was 23% (95% CI 16%-30%). When stratified by testing context, the asymptomatic proportion ranged from 6% (95% CI 0-17%) for household contacts to 47% (95% CI 21-75%) for non-outbreak point prevalence surveys with follow-up symptom monitoring. Estimates of viral load and duration of viral shedding appeared to be similar for asymptomatic and symptomatic cases based on available data, though detailed reporting of viral load and natural history of viral shedding by symptom status were limited. Evidence into the relationship between age and symptom status was inconclusive. Conclusion: Asymptomatic viral shedding comprises a substantial minority of SARS-CoV-2 infections when estimated using methodologically appropriate studies. Further investigation into variation in the asymptomatic proportion by testing context, the degree and duration of infectiousness for asymptomatic infections, and demographic predictors of symptom status are warranted.

Diagnostic Accuracy of Tuning Fork Tests for Hearing Loss: A Systematic Review

2018 ◽  
Vol 159 (2) ◽  
pp. 220-230 ◽  
Author(s):  
Elizabeth A. Kelly ◽  
Bin Li ◽  
Meredith E. Adams
Keyword(s):  
Systematic Review ◽  
Hearing Loss ◽  
Diagnostic Accuracy ◽  
Tuning Fork ◽  
Conductive Hearing Loss ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Test Accuracy ◽  
Significant Heterogeneity ◽  
Conductive Hearing

Objective (1) To determine the diagnostic accuracy of tuning fork tests (TFTs; Weber and Rinne) for assessment of hearing loss as compared with standard audiometry. (2) To identify the audiometric threshold at which TFTs transition from normal to abnormal, thus indicating the presence of hearing loss. Data Sources PubMed, Ovid Medline, EMBASE, Web of Science, Cochrane, and Scopus and manual bibliographic searches. Review Methods A systematic review of studies reporting TFT accuracy was performed according to a standardized protocol. Two independent evaluators corroborated the extracted data and assessed risk of bias. Results Seventeen studies with 3158 participants, including adults and children, met inclusion criteria. The sensitivity and specificity of the Rinne test for detecting conductive hearing loss ranged from 43% to 91% and 50% to 100%, respectively, for a 256-Hz fork and from 16% to 87% and 55% to 100% for a 512-Hz fork. The audiometric thresholds at which tests transition from normal to abnormal ranged from 13 to 40 dB of conductive hearing loss for the Rinne test and from 2.5 to 4 dB of asymmetry for the Weber test. Significant heterogeneity in TFT methods and audiometric thresholds to define hearing loss precluded meta-analysis. There is high risk of bias in patient selection for a majority of the studies. Conclusion Variability exists in the reported test accuracy measurements of TFTs for clinical screening, surgical candidacy assessments, and estimation of hearing loss severity. Clinicians should remain mindful of these differences and optimize these techniques in specific clinical applications to improve TFT accuracy.

scholarly journals Use of dating sites and applications by women and their risk of sexually transmitted infections: a systematic review and meta-analysis protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038738
Author(s):  
Janice França Queiroz ◽  
Kleyton Santos Medeiros ◽  
Ayane Cristine Alves Sarmento ◽  
Michelly Nóbrega Monteiro ◽  
Ricardo Ney Cobucci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sexually Transmitted Infections ◽  
Meta Analysis ◽  
Unprotected Sex ◽  
Risk Of Bias ◽  
Published Data ◽  
Cross Sectional ◽  
Sexually Transmitted ◽  
Sexual Behaviours ◽  
Risky Sexual Behaviours

IntroductionThe use of social networks has been increasing worldwide. Mobile websites and applications (apps) allow people to network more quickly and have more partners for sex. This can facilitate risky sexual behaviours, such as having multiple partners and unprotected sex, which can lead to a higher incidence of sexually transmitted infections. This systematic review/meta-analysis will assess the effects of the use of dating sites and apps by women on their level of engagement in risky sexual behaviours and their incidence of sexually transmitted infections.Methods and analysisThe Cochrane Central Controlled Trials Registry, ClinicalTrials.gov, MEDLINE, Embase, SciELO, Web of Science, Scopus and Cumulative Index to Nursing & Allied Health Literature will be searched for cross-sectional studies, clinical trials and observational studies published between January 1990 and July 2020. This systematic review and meta-analysis will include studies investigating the use of mobile apps by women, risky sexual behaviour and sexually transmitted infections. The outcome will be an increase in new cases of sexually transmitted infections and HIV among women using dating sites and apps. Three independent reviewers will select the studies and extract data from the original articles. The risk of bias will be assessed using the Cochrane risk of bias tool and Risk Of Bias in Non-randomized Studies of Interventions. Data synthesis will be performed using Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will compute the I2 statistic. In addition, a quantitative synthesis will be carried out if the included studies are sufficiently homogeneous.Ethics and disseminationThis study will be a review of the published data, and thus ethical approval is not required. The findings of this systematic review will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019120494.

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