Comparative Diagnosis Test Accuracy of Five Weighting Methods for Type 2 Diabetes Mellitus with Dampness-heat Syndrome / 中医杂志

ObjectiveTo compare the diagnostic accuracy of five different weighting methods of Chinese medicine syndrome and then analyze their diagnostic efficacy and characteristics， by taking Diagnostic Standard for Type 2 Diabetes Mellitus （T2DM） with Dampeness-heat Syndrome （abbreviated as diagnostic standard） as an example. MethodsData from expert questionnaire on the diagnostic standard and a cross-sectional survey of 1021 patients were collected. The comparative diagnostic test accuracy （CDTA） method was used to calculate the area under the ROC curve （AUC）， area under the PR curve （AUPR）， accuracy （ACC）， sensitivity， and specificity of five commonly used weighting methods in two categories， including knowledge-driven weighting methods （expert scoring synthesis method， analytic hierarchy process， and precedence chart method） and data-driven weighting methods （logistic regression contribution method and entropy weighting method）. ResultsAmong 1021 patients with T2DM， 389 cases were diagnosed as dampness-heat syndrome. The expert scoring synthesis method， analytic hierarchy process method， and precedence chart method were basically consistent in the weight scores of each item. The expert scoring comprehensive method， analytic hierarchy process method， and entropy weighting method have a smaller difference in the weight scores of each item， while there was larger difference in the weight scores of each item of the precedence chart method and the logistic regression contribution method. The AUC （95% CI）， AUPR， ACC， sensitivity， and specifi-city of the expert scoring synthesis method were 0.913 （0.893， 0.932）， 0.851， 0.870， 0.868 and 0.875， respectively； while those of the analytic hierarchy process method were 0.910 （0.890， 0.930）， 0.838， 0.879， 0.848 and 0.896； of the precedence chart method were 0.919 （0.900， 0.937）， 0.858， 0.875， 0.871 and 0.875； of the logistic regression contribution method were 0.867 （0.842， 0.891）， 0.792， 0.853， 0.769 and 0.898； and of the entropy weighting method were 0.895 （0.873， 0.916）， 0.820， 0.869， 0.802 and 0.908. ConclusionThe knowledge-driven weighting methods are better than the data-driven weighting methods in terms of diagnostic efficacy and reflecting expert experience.

The accuracy of widal test for typhoid fever diagnosis in Ethiopia: Systematic review and meta-analysis

Introduction: Widal agglutination test is a serologic investigation that is used to diagnose typhoidfever. This is an easy, fairly inexpensive, and readily available test it'ith questionable reliability. The test performance differs from setting to setting depending on the technique used and otherfactors. The accuracy ofthis test in Ethiopia is poorly understood. So, the aim of this scientific work was to analyze the accuracy of Widal agglutination in diagnosing typhoidfever in Ethiopia. Methods: We performed a systematic review and meta-analysis. Two electronic databases (PubMed/Medline and Google scholar) were searched using preset search strategv to find relevant studies. The methodological quality of the studies included was evaluated "'ith a QUADAS-2. We extracted important variables from the eligible articles. Statistical analysis was conducted using STATA version 14. The protocol of our systematic review and metaanalysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the record number CRD42020194252. Results: The electronic quests yielded 42 papers of which 8 "'ere eligible for analysis. The quality of these studies was rated to be moderate based on the QUADAS-2. The pooled sensitivity, specificity, and negative, andpositive predicthe values ofthe Widal test were 80.8%, 53.0%, 98.5%, and 2.1% respecth'ely. Conclusion: The "'idal agglutination test has average specificity, ven good negative predicth'e value, and ven poor positive predictive value for the diagnosis of typhoidfever. Depending on Widal to diagnose typhoid fever may lead to over-diagnosis of typhoid fever and related complications including inappropriate use of antibiotics. There is an urgent needfor quick and dependable tests for diagnosing typhoidfever, particularly in settings like Ethiopia M'here doing timely culture is notfeasible.

Diagnostic test accuracy: application and practice using R software / 한국역학회지

The objective of this paper is to describe general approaches of diagnostic test accuracy (DTA) that are available for the quantitative synthesis of data using R software. We conduct a DTA that summarizes statistics for univariate analysis and bivariate analysis. The package commands of R software were “metaprop” and “metabin” for sensitivity, specificity, and diagnostic odds ratio; forest for forest plot; reitsma of “mada” for a summarized receiver-operating characteristic (ROC) curve; and “metareg” for meta-regression analysis. The estimated total effect sizes, test for heterogeneity and moderator effect, and a summarized ROC curve are reported using R software. In particular, we focus on how to calculate the effect sizes of target studies in DTA. This study focuses on the practical methods of DTA rather than theoretical concepts for researchers whose fields of study were non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.

Diagnostic Test Accuracy Review of Cytology for Squamous Intraepithelial Lesion and Squamous Cell Carcinoma of Uterine Cervix

BACKGROUND: Even though cervico-vaginal smears have been used as a primary screening test for cervical carcinoma, the diagnostic accuracy has been controversial. The present study aimed to evaluate the diagnostic accuracy of cytology for squamous intraepithelial lesion (SIL) and squamous cell carcinoma (SqCC) of the uterine cervix through a diagnostic test accuracy (DTA) review. METHODS: A DTA review was performed using 38 eligible studies that showed concordance between cytology and histology. In the DTA review, sensitivity, specificity, diagnostic odds ratio (OR), and the area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. RESULTS: In the comparison between abnormal cytology and histology, the pooled sensitivity and specificity were 93.9% (95% confidence interval [CI], 93.7%–94.1%) and 77.6% (95% CI, 77.4–77.8%), respectively. The diagnostic OR and AUC on the SROC curve were 8.90 (95% CI, 5.57–14.23) and 0.8148, respectively. High-grade squamous intraepithelial lesion (HSIL) cytology had a higher sensitivity (97.6%; 95% CI, 94.7%–97.8%) for predicting HSIL or worse histology. In the comparison between SqCC identified on cytology and on histological analysis, the pooled sensitivity and specificity, diagnostic OR, and AUC were 92.7% (95% CI, 87.3%–96.3%), 87.5% (95% CI, 87.2%–87.8%), 865.81 (95% CI, 68.61–10,925.12), and 0.9855, respectively. Geographic locations with well-organized screening programs had higher sensitivity than areas with insufficient screening programs. CONCLUSION: These results indicate that cytology had a higher sensitivity and specificity for detecting SIL and SqCC of the uterine cervix during primary screening.

Diagnostic test accuracy: application and practice using R software / 한국역학회지

The objective of this paper is to describe general approaches of diagnostic test accuracy (DTA) that are available for the quantitative synthesis of data using R software. We conduct a DTA that summarizes statistics for univariate analysis and bivariate analysis. The package commands of R software were “metaprop” and “metabin” for sensitivity, specificity, and diagnostic odds ratio; forest for forest plot; reitsma of “mada” for a summarized receiver-operating characteristic (ROC) curve; and “metareg” for meta-regression analysis. The estimated total effect sizes, test for heterogeneity and moderator effect, and a summarized ROC curve are reported using R software. In particular, we focus on how to calculate the effect sizes of target studies in DTA. This study focuses on the practical methods of DTA rather than theoretical concepts for researchers whose fields of study were non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.

Clinicopathological Significance and Diagnostic Accuracy of c-MET Expression by Immunohistochemistry in Gastric Cancer: A Meta-Analysis

PURPOSE: The aim of the present study was to elucidate the clinicopathological significance and diagnostic accuracy of immunohistochemistry (IHC) for determining the mesenchymal epidermal transition (c-MET) expression in patients with gastric cancer (GC). MATERIALS AND METHODS: The present meta-analysis investigated the correlation between c-MET expression as determined by IHC and the clinicopathological parameters in 8,395 GC patients from 37 studies that satisfied the eligibility criteria. In addition, a concordance analysis was performed between c-MET expression as determined by IHC and c-MET amplification, and the diagnostic test accuracy was reviewed. RESULTS: The estimated rate of c-MET overexpression was 0.403 (95% confidence interval [CI], 0.327~0.484) and it was significantly correlated with male patients, poor differentiation, lymph node metastasis, higher TNM stage, and human epidermal growth factor receptor 2 (HER2) positivity in IHC analysis. There was a significant correlation between c-MET expression and worse overall survival rate (hazard ratio, 1.588; 95% CI, 1.266~1.992). The concordance rates between c-MET expression and c-MET amplification were 0.967 (95% CI, 0.916~0.987) and 0.270 (95% CI, 0.173~0.395) for cases with non-overexpressed and overexpressed c-MET, respectively. In the diagnostic test accuracy review, the pooled sensitivity and specificity were 0.56 (95% CI, 0.50~0.63) and 0.79 (95% CI, 0.77~0.81), respectively. CONCLUSIONS: The c-MET overexpression as determined by IHC was significantly correlated with aggressive tumor behavior and positive IHC status for HER2 in patients with GC. In addition, the c-MET expression status could be useful in the screening of c-MET amplification in patients with GC.

Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part I. General Guidance and Tips

In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods.

Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part II. Statistical Methods of Meta-Analysis

Meta-analysis of diagnostic test accuracy studies differs from the usual meta-analysis of therapeutic/interventional studies in that, it is required to simultaneously analyze a pair of two outcome measures such as sensitivity and specificity, instead of a single outcome. Since sensitivity and specificity are generally inversely correlated and could be affected by a threshold effect, more sophisticated statistical methods are required for the meta-analysis of diagnostic test accuracy. Hierarchical models including the bivariate model and the hierarchical summary receiver operating characteristic model are increasingly being accepted as standard methods for meta-analysis of diagnostic test accuracy studies. We provide a conceptual review of statistical methods currently used and recommended for meta-analysis of diagnostic test accuracy studies. This article could serve as a methodological reference for those who perform systematic review and meta-analysis of diagnostic test accuracy studies.

Clinical Trials and Accuracy of Diagnostic Tests

Most clinicians understand clinical trials as the evaluation process for new medicine before their use. However, clinical trials can also be applied to laboratory diagnostic tests (LDTs) to verify diagnostic accuracy and efficacy before their clinical laboratory implementation for patients. The clinical trial of LDT has two distinctive characteristics that are different from the case of pharmaceuticals and thus worth special consideration. One of them is the level of evidence. The well-designed randomized controlled trials (RCTs) are known to provide the best evidence to prove the clinical efficacy of any pharmaceutical products. However, RCTs lose practicality when applied to LDTs due to various issues including ethical complications. For this reason, comparative study format is considered more feasible approach for LDTs. In addition pharmaceuticals and LDTs are different in that the user's intervention is not required for the former but critical to the latter. Moreover, in the case of pharmaceuticals, end-products are produced by manufacturers before being used by clinicians. However, in LDTs, once reagents and instruments are provided by manufacturers, they are first utilized by clinical laboratories to produce test results in order for clinicians to use them later. In other words, when it comes to LDTs, clinical laboratories play the role of manufacturers, providing reliable test results with improved quality assurance. Considering the distinctive characteristics of LDTs, we would like to offer detailed suggestions to successfully perform clinical trials in LDTs, which include analytical performance measures, clinical test performance measures, diagnostic test accuracy measures, clinical effectiveness measures, and post-implementation surveillance.

Escala de atitudes frente à tatuagem: elaboração e evidências de validade e precisão / Scale of attitudes towards tattoos: production and proof of validity and accuracy

Construiu-se uma medida de atitudes diante da tatuagem, reunindo evidências de sua validade fatorial e confiabilidade. A Escala de Atitudes frente à Tatuagem foi testada em dois estudos. No Estudo 1, participaram 273 estudantes universitários equitativamente distribuídos quanto ao gênero, com idade média de 25 anos, que responderam à Escala de Atitudes frente à Tatuagem e perguntas demográficas. Verificou-se que seus itens apresentaram poder discriminativo satisfatório, assim como emergiu a estrutura unifatorial esperada, com alfa de Cronbach de 0,96. No Estudo 2, participaram 245 estudantes universitários, a maioria do gênero masculino (55 por cento), com idade média de 21 anos. Todos responderam à Escala de Atitudes frente à Tatuagem e à perguntas demográficas. Por meio de análise fatorial confirmatória, corroborou-se a estrutura unifatorial indicada previamente, com alfa de Cronbach de 0,93. Conclui-se que esse instrumento reúne evidências de validade fatorial e confiabilidade, podendo ser empregado para medir atitudes diante da tatuagem entre estudantes universitários.

The authors built and checked for evidence of the factorial validity and reliability of a scale for measuring attitudes towards tattoos. The Attitudes Towards Tattoos Scale was tested in two studies. In Study 1, participants comprised 273 undergraduate students, equally distributed with respect to gender, with an average age of 25. They answered the Attitudes Towards Tattoos Scale and demographic questions. It was found that the items showed adequate discriminative power, and the expected unifactorial structure was identified, with Cronbach's Alpha (α) of 0.96. 245 undergraduate students participated In Study 2, most of them male (55 percent), with an average age of 21. They answered the Attitudes Towards Tattoos Scale and demographic questions. Based on confirmatory factor analysis, the unifactorial structure found in the previous study was corroborated, and an α of 0.93 was observed. These findings suggest the Attitudes Towards Tattoos Scale presents evidence of factorial validity and reliability, and may be used among undergraduate students to measure attitudes towards tattoos.

Does ST-segment depression combined with R wave amplitude change improve the test accuracy of the EKG during exercise testing? / 대한내과학회지

BACKGROUND: Exercise electrocardiogram is the most widely used non-invasive test in those patients suspected of having coronary artery disease. However, sensitivity and specificity of this test are not satisfactory, especially when the exercise induced ST-segment depression is used as a single criterion of myocardial ischemia. Although many investigators have tried to improve diagnostic accuracy with R-wave amplitude change in addition to ST-segment depression, controversy exists whether this new criteria improve the test accuracy for coronary artery disease or not. The purpose of this study is to determine the test accuracy of R-wave amplitude change induced by exercise combined with the conventional ST-segment criterion for myocardial ischemia. METHODS: We reviewed our records of patients who visited to Korea University Anam Hospital with chest pain from January, 1998 to July, 1999. We included 130 patients with chest pain who had a tredmill test followed by a coronary angiography within 2 months. Patients with change in ST-segment depression (delta STD)> or = 1.00 mm and delta STD> or = 1.00 mm with R wave amplitude decrease (-delta R)> or = 1.00 mm in the same lead in any of 12 leads and delta STD> or = 1.00 mm with R wave amplitude increase (+delta R)> or = 1.00 mm in the same lead in any of 12 leads were compared. According to the findings of coronary angiograms, patients were divided into 4 groups ; normal coronary artery group, mild coronary artery stenosis group (> or = 30% to or = 50% to or = 70%). RESULTS: Fifty three patients (40.7%) had normal coronary angiograms and 77 patients (59.3%) had coronary artery stenosis. There was no significant difference in gender and age. But, patients with coronary artery stenosis had more diabetes mellitus, hyperlipidemia, smoking, previous myocardial infarction history and angina during exercise testing than those without coronary artery stenosis. The sensitivity of exercise EKG is significantly decreased when combined with delta R (delta STD, 74.0%, delta STD with -delta R, 45.5%, delta STD with +delta R, 30.0%, p<0.01), but the The test accuracy is delta STD; 73.7%, delta STD with -delta R; 61.5%, delta STD with +delta R; 57.7%. CONCLUSION: When ST-segment depression is combined with R-wave amplitude change as a marker for myocardial ischemia, the specificity is increased, but the test accuracy of exercise EKG is not improved.