Diagnostic accuracy studies are, like other clinical studies, at risk of bias due to shortcomings in design and conduct, and the results of a diagnostic accuracy study may not apply to other patient ...groups and settings. Readers of study reports need to be informed about study design and conduct, in sufficient detail to judge the trustworthiness and applicability of the study findings. The STARD statement (Standards for Reporting of Diagnostic Accuracy Studies) was developed to improve the completeness and transparency of reports of diagnostic accuracy studies. STARD contains a list of essential items that can be used as a checklist, by authors, reviewers and other readers, to ensure that a report of a diagnostic accuracy study contains the necessary information. STARD was recently updated. All updated STARD materials, including the checklist, are available at http://www.equator-network.org/reporting-guidelines/stard. Here, we present the STARD 2015 explanation and elaboration document. Through commented examples of appropriate reporting, we clarify the rationale for each of the 30 items on the STARD 2015 checklist, and describe what is expected from authors in developing sufficiently informative study reports.
Although the genus Prevotella is part of the general human microbiota, species of this anaerobic gram-negative bacterium have been described as causes of persisting nonpuerperal breast abscesses. ...Collecting punctate samples and testing these samples for anaerobic bacteria is not part of the common diagnostic workflow in atypical breast abscesses. The causative anaerobic micro-organism can remain unclear and patients can be treated with multiple inadequate antibiotics and/or extensive surgical procedures. The aim of this cohort study of Prevotella induced breast abscesses is to gain more insights into the diagnostic procedures and treatment.
Medical charts of patients with a Prevotella induced breast abscess between 2015 and 2021, were retrospectively reviewed on patient characteristics, diagnostic procedures, treatment and outcome.
Twenty-one patients were included. Six subspecies of Prevotella were determined by culturing. High susceptibility was observed for amoxicillin/clavulanic acid (100%, n = 12). Nine patients (43%) were treated with antibiotics, eight patients (38%) with antibiotics and incision and drainage, and four patients (19%) with only incision and drainage. Recurrence was observed in nine patients (43%), of whom five patients were treated with antibiotics and three patients had surgery. The mean duration of antibiotic administration in patients with recurrence was significantly shorter compared to those without recurrence (5.6 days vs. 19.5 days, p = 0.039).
Specific anaerobic culturing should be common practice in atypical breast abscesses to confirm Prevotella species. The high recurrence rate emphasizes the need of further research for optimal treatment. Prolonged duration of antibiotics could be considered and amoxicillin/clavulanic acid seems to be the first choice.
•Prevotella has been described as a cause of persisting nonpuerperal breast abscesses.•It is essential to exclude cancer as soon as possible in atypical breast abscesses.•The diagnostic process of Prevotella is challenging.•Anaerobic culturing with a punctate/aspirate should be added to the diagnostic process.•Prolonged duration of antimicrobial therapy could be considered.
The National Institute for Health and Care Excellence (NICE) Diagnostics Assessment Programme (DAP) evaluates the cost-effectiveness of diagnostic technologies. A decision-making process benchmarking ...the incremental cost-effectiveness ratio (ICER) against a threshold while considering decision-modifying factors is common to NICE evaluations. This study investigated whether DAP decisions are consistent with the ICER thresholds described in the DAP manual, and to assess the impact of decision-modifying factors.
DAP evaluations published before March 2018 were reviewed, and the following items were extracted: diagnostic technologies evaluated, decision problems assessed, Diagnostics Advisory Committee (DAC) decisions, incremental quality-adjusted life years (QALYs), incremental costs, ICERs considered to be most plausible by the DAC, and decision justifications.
All 30 evaluations were reviewed; 8 were excluded because the DAC concluded there was “insufficient evidence” for decision making. In the remaining 22 evaluations, 91 decision problems were identified for further analysis, of which 52, 15, and 24 received “recommended,” “not recommended,” and “not recommended–only in research” guidance, respectively. The overall consistency rate of the DAC decisions with the £20 000/QALY threshold was 73.6%. Diagnostic technologies that were not recommended, despite an ICER less than £20 000/QALY, were associated with a larger number of decision-modifying factors favoring the comparator, versus recommended diagnostic technologies with ICERs less than £20 000/QALY. For technologies with ICERs greater than £20 000/QALY, the number of decision-modifying factors was comparable for positive and negative recommendations.
Most DAP decisions were consistent with the ICER threshold. However, cost-effectiveness was not the only determining factor in decision making; recommendations also considered patient- and healthcare-centric factors and uncertainty.
•The decisions from the National Institute for Health and Care Excellence (NICE) Diagnostics Assessment Programme (DAP) broadly follow the £20 000/quality-adjusted life year (QALY) threshold, indicating that the incremental cost-effectiveness ratio (ICER) threshold used by the DAP is consistent with the DAP manual.•This threshold appeared to be applied for technologies with ICERs falling in the northeast (NE) and southwest (SW) quadrants of the cost-effectiveness plane, indicating that the Diagnostics Advisory Committee (DAC) accepts technologies generating QALY gains associated with increased costs, as well as technologies generating QALY losses associated with cost savings.•Decision-modifying factors play a role in the DAP, as not all decisions were consistent with the £20 000/QALY threshold. A larger number of decision-modifying factors in favor of the diagnostic technology were observed in evaluations with ICERs above the £20 000/QALY threshold, that is, NE ICER > threshold or SW ICER < threshold, versus evaluations with ICERs below the £20 000/QALY threshold, ie, NE ICER < threshold or SW ICER > threshold, although the impact of decision-modifying factors was highly situation-specific.
Technological advances in bovine mastitis diagnosis Duarte, Carla M.; Freitas, Paulo P.; Bexiga, Ricardo
Journal of Veterinary Diagnostic Investigation,
11/2015, Letnik:
27, Številka:
6
Book Review, Journal Article
Recenzirano
Bovine mastitis is an economic burden for dairy farmers and preventive control measures are crucial for the sustainability of any dairy business. The identification of etiological agents is necessary ...in controlling the disease, reducing risk of chronic infections and targeting antimicrobial therapy. The suitability of a detection method for routine diagnosis depends on several factors, including specificity, sensitivity, cost, time in producing results, and suitability for large-scale sampling of milk. This article focuses on current methodologies for identification of mastitis pathogens and for detection of inflammation, as well as the advantages and disadvantages of different methods. Emerging technologies, such as transcriptome and proteome analyses and nano- and microfabrication of portable devices, offer promising, sensitive methods for advanced detection of mastitis pathogens and biomarkers of inflammation. The demand for alternative, fast, and reliable diagnostic procedures is rising as farms become bigger. Several examples of technological and scientific advances are summarized which have given rise to more sensitive, reliable and faster diagnostic results.
The aim of this review was to examine the clinical process in psychiatry, with special reference to clinimetrics, a domain concerned with the measurement of clinical phenomena that do not find room ...in customary taxonomy.
A MEDLINE search from inception to August 2010 was performed for English-language articles using the keywords clinical judgment, clinimetric, staging, comorbidity, sequential treatment, and subclinical symptoms in relation to psychiatric illness. It was supplemented by a manual search of the literature.
Choice of assessment strategies was based on their established or potential incremental increase in clinical information compared to use of diagnostic criteria.
Contributions were evaluated according to the principles of clinimetrics.
Several innovative assessment strategies were identified: the use of diagnostic transfer stations with repeated assessments instead of diagnostic endpoints, subtyping versus integration of different diagnostic categories, staging methods, and broadening of clinical information through macroanalysis and microanalysis. The most representative examples were selected.
Current assessment strategies in psychiatric research do not reflect the sophisticated thinking that underlies clinical decisions in practice. The clinimetric perspective provides an intellectual home for the reproduction and standardization of these clinical intuitions.
Frailty is one of the most important concerns regarding our aging population. Evidence grows that the syndrome is linked to several important health outcomes. A general overview of frailty concepts ...and a comprehensive meta-analysis of their relation with negative health outcomes still lacks in literature, making it difficult for health care professionals and researchers to recognize frailty and the related health risks on the one hand and on the other hand to appropriately follow up the frailty process and take substantiated action. Therefore, this study aims to give an overview of the predictive value of the main frailty concepts for negative health outcomes in community-dwelling older adults.
This review and meta-analysis assembles prospective studies regarding the relation between frailty and any potential health outcome. Frailty instruments were subdivided into frailty concepts, so as to make comprehensive comparisons. Odds ratios (ORs), hazard ratios (HRs), and relative risk (RR) scores were extracted from the studies, and meta-analyses were conducted in OpenMeta Analyst software.
In total, 31 articles retrieved from PubMed, Web of Knowledge, and PsycInfo provided sufficient information for the systematic review and meta-analysis. Overall, (pre)frailty increased the likelihood for developing negative health outcomes; for example, premature mortality (OR 2.34 1.77-3.09; HR/RR 1.83 1.68-1.98), hospitalization (OR 1.82 1.53-2.15; HR/RR 1.18 1.10-1.28), or the development of disabilities in basic activities of daily living (OR 2.05 1.73-2.44); HR/RR 1.62 1.50-1.76).
Overall, frailty increases the risk for developing any discussed negative health outcome, with a 1.8- to 2.3-fold risk for mortality; a 1.6- to 2.0-fold risk for loss of activities of daily living; 1.2- to 1.8-fold risk for hospitalization; 1.5- to 2.6-fold risk for physical limitation; and a 1.2- to 2.8-fold risk for falls and fractures. The analyses presented in this study can be used as a guideline for the prediction of negative outcomes according to the frailty concept used, as well as to estimate the time frame within which these events can be expected to occur.
Background. Encephalitis continues to result in substantial morbidity and mortality worldwide. Advances in diagnosis and management have been limited, in part, by a lack of consensus on case ...definitions, standardized diagnostic approaches, and priorities for research. Methods. In March 2012, the International Encephalitis Consortium, a committee begun in 2010 with members worldwide, held a meeting in Atlanta to discuss recent advances in encephalitis and to set priorities for future study. Results. We present a consensus document that proposes a standardized case definition and diagnostic guidelines for evaluation of adults and children with suspected encephalitis. In addition, areas of research priority, including host genetics and selected emerging infections, are discussed. Conclusions. We anticipate that this document, representing a synthesis of our discussions and supported by literature, will serve as a practical aid to clinicians evaluating patients with suspected encephalitis and will identify key areas and approaches to advance our knowledge of encephalitis.
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