Objective
To assess the diagnostic test accuracy of the component‐resolved diagnosis device ImmunoCAP ISAC, compared with oral food challenge.
Design
Systematic review reported according to the ...PRISMA‐DTA recommendations.
Data sources
Medline, Embase and Cochrane Library databases were searched from inception to May 2019 and updated in March 2021.
Eligibility criteria for selecting studies
We included diagnostic test accuracy studies comparing ISAC component results as the index test with oral food challenge as the reference test, in people of any age suspected of IgE mediated food allergy to milk, egg, peanut, shrimp, hake, apple, peach, kiwi, melon, walnut, hazelnut, wheat or pineapple. Risk of bias was evaluated using the QUADAS‐2 tool.
Results
We screened 799 titles and included 11 studies – seven prospective and two retrospective cohort studies, two case–control studies. Included studies evaluated IgE to Gald1 (three studies, 300 participants, 140 with egg allergy), Bosd5 (three studies, 242 participants, 146 with milk allergy) and Arah1 or 2 (seven studies, 546 participants, 346 with peanut allergy). No studies were identified for other ISAC components. Risk of bias was high or unclear mainly due to inadequate blinding. Applicability was of high or unclear concern due to unclear thresholds, inappropriate exclusions and variable populations. Gald1 sensitivity ranged from 58 to 84%, specificity 87%–97%. Bosd5 sensitivity 24%–40%, specificity 94%–95%. Arah1 sensitivity 45%–91%, specificity 41%–93%. Arah2 sensitivity 70%–94%, specificity 75%–95%.
Conclusions
Diagnostic test accuracy information for ISAC components was only available for milk, egg and peanut. Specificity is generally higher than sensitivity, which contrasts with the performance of skin prick and standard specific IgE tests for diagnosing food allergy. Higher quality information is needed to determine the clinical utility of ISAC for food allergy diagnosis.
Systematic review registration
Not registered.
This systematic review assesses the diagnostic test accuracy of ImmunoCAP ISAC. Eleven studies evaluating Arah1, Arah2, Gald1 and Bosd5 were included. Risk of bias was high or unclear. Specificity is generally higher than sensitivity. Higher quality information is needed to determine the clinical utility of ISAC for food allergy diagnosis.
Background
The NKX2‐1‐related disorders (NKX2‐1‐RD) is a rare disorder characterized by choreiform movements along with respiratory and endocrine abnormalities. The European Reference Network of Rare ...Neurological Disorders funded by the European Commission conducted a systematic review to assess drug treatment of chorea in NKX2‐1‐RD, aiming to provide clinical recommendations for its management.
Methods
A systematic pairwise review using various databases, including MEDLINE, Embase, Cochrane, CINAHL, and PsycInfo, was conducted. The review included patients diagnosed with chorea and NKX2‐1‐RD genetic diagnosis, drug therapy as intervention, no comparator, and outcomes of chorea improvement and adverse events. The methodological quality of the studies was assessed, and the study protocol was registered in PROSPERO.
Results
Of the 1417 studies examined, 28 studies met the selection criteria, consisting of 68 patients. The studies reported 22 different treatments for chorea, including carbidopa/levodopa, tetrabenazine, clonazepam, methylphenidate, carbamazepine, topiramate, trihexyphenidyl, haloperidol, propranolol, risperidone, and valproate. No clinical improvements were observed with carbidopa/levodopa, tetrabenazine, or clonazepam, and various adverse effects were reported. However, most patients treated with methylphenidate experienced improvements in chorea and reported only a few negative effects. The quality of evidence was determined to be low.
Conclusions
The management of chorea in individuals with NKX2‐1‐RD presents significant heterogeneity and lack of clarity. While the available evidence suggests that methylphenidate may be effective in improving chorea symptoms, the findings should be interpreted with caution due to the limitations of the studies reviewed. Nonetheless, more rigorous and comprehensive studies are necessary to provide sufficient evidence for clinical recommendations.
Introduction
The outbreak of the COVID-19 global pandemic in 2020 has been a major challenge for the world’s population and governments. The lack of vaccines, the saturation of health systems, and ...its rapid spread forced governments to take non-pharmacological interventions (NPI) that had a high impact on the population. Assessing the efficacy of these measures is a challenge for health technology assessment bodies.
Methods
The main NPIs for which assessment was required were: mobility restrictions, social distancing, cancellation of events or reduction of seating capacity, closure or reduction of seating capacity in non-essential businesses, closure or limitation of seating capacity in educational establishments, and promotion of teleworking in potential jobs. The implementation of these measures at a global level provides a large population for the study of the impact of these measures. However, the challenges for their evaluation are numerous:
•
The joint implementation of these measures makes it difficult to evaluate them in an isolated manner.
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The heterogeneity between countries and regions of the pandemic situation at the time when these measures are initiated and terminated.
•
The different accuracy in the application of the measures.
•
Heterogeneity in the quality and accessibility of public health services for citizens.
Results
Outcome variables to assess the effectiveness of these measures should include parameters related to:
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Incidence variables: the number of new or accumulated cases in a given time range, the variation in the number of cases in a given time range and the proportion of positive tests.
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Transmission variables: the basic reproductive number (R0) and the effective reproductive number (Rt).
•
Severity and mortality variables: the number or variation of hospitalizations, the number or variation of intensive care unit (ICU) hospitalizations and the number or variation of deaths.
Conclusions
The large number of available data, the heterogeneity of the measures, the differences between populations, the numerous outcome variables and the possible inclusion of mathematical modelling studies, are a methodological challenge for the HTA bodies.
BackgroundAtrial fibrillation (AF), which is associated with cryptogenic stroke, is the most common sustained arrhythmia in the general population. Because AF is asymptomatic and intermittent, its ...detection rate increases with the duration of monitoring. The objective of this study is to review the available evidence on the safety, efficacy, effectiveness and cost-effectiveness of AF diagnosis by prolonged monitoring with an implantable Holter monitor in adult patients with idiopathic or cryptogenic stroke of suspected cardioembolic origin, compared to conventional monitoring.MethodsTwo independent reviewers performed a systematic review of the literature, identifying relevant studies through a structured search of Medline (Ovid), EMBASE, Web of Science and Cochrane Library and the databases of national and international health technology assessment agencies. The quality of the included studies was assessed with AGREE-II, AMSTAR-2 and CHEC. GRADE criteria were used to summarise the evidence.ResultsFour of the 211 papers identified were included: 1 clinical practice guideline, 2 systematic reviews, and 1 economic evaluation. The quality of the evidence reviewed was low. An implantable Holter monitor might be more effective in detecting AF than conventional monitoring. Serious adverse events were similar in both groups. The economic evaluation suggests that the technology is cost-effective.ConclusionsThe available evidence suggests the diagnostic superiority of the implantable Holter monitor over the traditional Holter monitor. Due to the low quality of the evidence, further and higher quality studies on these technologies are needed before solid conclusions can be drawn.
Health libraries: sharing through gaming Gómez-Sánchez, Alicia Fátima; Kerdelhue, Gaétan; Isabel-Gómez, Rebeca ...
Journal of the European Association for Health Information and Libraries,
09/2019, Letnik:
15, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Information science is a fast-changing field, and medical librarians need to develop their roles to meet the users’new requirements. The professional development becomes a major challenge, not only ...regarding the core activities, but also in the way librarians and users can learn in a more innovative way. In order to invent new tools for training, a group of librarians with different backgrounds decided to create a game inspired by the “Bucket ofdoom”, which is described as a “Card game that meets storytelling with a sprinkling of comedy”. This adapted version for health libraries will face players with real professional situations. To overcome each challenge and have fun, librarians must use their experience and imagination with a high dose of creativity and humour.
The history of European health technology assessment (HTA) goes back more than 30 years. Almost as old as HTA agencies themselves is the desire to achieve European collaboration. This gained further ...impetus with the establishment of the European Network of Health Technology Assessment (EUnetHTA) in 2006. In this context, the field of information management faced specific challenges. Although these services are an integral part of HTA and information specialists play a key role here, this field is often not adequately represented in the HTA agencies within EUnetHTA. Furthermore, the organization of HTA production, including the types of HTAs produced, as well as funding, varies considerably. In order to meet these different conditions, information specialists have created various products and defined processes. With the EUnetHTA guideline, a common methodological understanding for the production of rapid Relative Effectiveness Assessments now exists. Furthermore, the Standard Operating Procedures map the complex information retrieval processes within EUnetHTA in a hands-on manner. The newly established Information Specialist Network (ISN) will in future ensure that information specialists are involved in all EUnetHTA assessments and that the methods are applied consistently in all assessments. In addition, the steering committee of the ISN manages enquiries and can be contacted to discuss methodological issues. Major barriers such as heterogeneity in the daily work of the EUnetHTA members can only be overcome through more collaboration and training.
Chimeric antigen receptor (CAR) T cell–related HLH/MAS is an unusual manifestation of severe cytokine release syndrome (CRS) with poor prognosis and a challenging diagnosis. The establishment of ...specific diagnosis criteria is essential, and the combination of several techniques for CAR T‐cell follow‐up, allows a more precise management of this complication.
Cytokine release syndrome after CAR T‐cell therapy can evolve into CAR T cell–related HLH/MAS with high mortality and a challenging diagnosis. Combining different diagnosis techniques for CAR T‐cell follow‐up allows a more accurate diagnosis and targeted treatment.
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