Cholera diagnosis in human stool and detection in water: A systematic review and meta-analysis.

BACKGROUND: Cholera continues to pose a problem for low-resource, fragile and humanitarian contexts. Evidence suggests that 2.86 million cholera cases and 95,000 deaths due to cholera are reported annually. Without quick and effective diagnosis and treatment, case-fatality may be 50%. In line with the priorities of the Global Task Force on Cholera Control, we undertook a systematic review and meta-analysis of diagnostic test accuracy and other test characteristics of current tests for cholera detection in stool and water. METHODS: We searched 11 bibliographic and grey literature databases. Data was extracted on test sensitivity, specificity and other product information. Meta-analyses of sensitivity and specificity were conducted for tests reported in three or more studies. Where fewer studies reported a test, estimates were summarised through narrative synthesis. Risk of Bias was assessed using QUADAS-2. RESULTS: Searches identified 6,637 records; 41 studies reporting on 28 tests were included. Twenty-two tests had both sensitivities and specificities reported above 95% by at least one study, but there was, overall, wide variation in reported diagnostic accuracy across studies. For the three tests where meta-analyses were possible the highest sensitivity meta-estimate was found in the Cholera Screen test (98.6%, CI: 94.7%-99.7%) and the highest specificity meta-estimate in the Crystal VC on enriched samples (98.3%, CI: 92.8%-99.6%). There was a general lack of evidence regarding field use of tests, but where presented this indicated trends for lower diagnostic accuracy in field settings, with lesser-trained staff, and without the additional process of sample enrichment. Where reported, mean test turnaround times ranged from over 50% to 130% longer than manufacturer's specification. Most studies had a low to unclear risk of bias. CONCLUSIONS: Currently available Rapid Diagnostic Tests can potentially provide high diagnostic and detection capability for cholera. However, stronger evidence is required regarding the conditions required to secure these levels of accuracy in field use, particularly in low-resource settings. REGISTRATION: PROSPERO (CRD42016048428).

Oxford Knee Score and EQ-5d poorly predict patient's satisfaction following mechanically aligned total knee replacement: A cross-sectional study.

BACKGROUND: Patient satisfaction is increasingly used to measure the success of arthroplasty. Satisfaction with the outcome of a total knee replacement (TKR) is traditionally thought to be associated with improvements in functional status and quality of life measures. This study aims to answer the following questions: 1. What is the level of patient satisfaction, improvement in knee function and patient quality of life associated with mechanically aligned TKR? 2. What is the relationship between OKS, EQ-5d scores and 'outcome satisfaction'? HYPOTHESIS: TKR is associated with a significant improvement in function, satisfaction and quality of life and that there is a strong correlation between OKS, EQ-5d and 'outcome satisfaction'. METHOD: Five thousand eight hundred and ninety six patients underwent primary TKR between January 2010 and December 2017 and had complete preoperative and 2-year follow-up data for OKS, EQ-5d and satisfaction scores. Outcomes data were collected prospectively and recorded on our institutional database. Minimal clinically important difference (MCID) and the Patient acceptable symptomatic state (PASS) were calculated for OKS and EQ-5d, the association between OKS, EQ-5d and 'outcome satisfaction' was measured using regression analysis. RESULTS: The median 2-year 'outcome satisfaction' score was 90/100 with 79% of patients reporting excellent satisfaction (≥80/100) and 93.4% of patients satisfied (≥50/100). Postoperatively, median scores were 39 for OKS and 0.8 for EQ-5d. The mean increase in scores was 15.85 for OKS and 0.32 for EQ-5d. Satisfaction showed moderate positive correlation with postoperative OKS (r=0.69) and EQ-5D (0.58) scores, but weaker correlation with the change in OKS (r=0.57) and EQ-5d (r=0.32) scores from preoperative levels. DISCUSSION/CONCLUSION: Mechanically aligned TKR is overall a successful operation responsible of fair rate of patient satisfaction. OKS and EQ-5d are imperfect predictors for satisfaction as they are significantly influenced by patients' comorbidities. This should be taken into account when evaluating the success of an operation. LEVEL OF EVIDENCE: IIc; observational study (based on prospectively collected data from an institutional registry).

Disappointing Relationship between Functional Performance and Patient Satisfaction of UKA Patients: A Cross Sectional Study.

BACKGROUND: Following a Unicompartmental knee arthroplasty (UKA) satisfaction is often conflated with functional outcome. Recent studies have shown that satisfaction is not linked to functional outcome. The research questions were: (1) what is the relationship between satisfaction and functional performance and quality of life (absolute and gain values) after UKA? And (2) what is the level of satisfaction, function, and quality of life after UKA? HYPOTHESIS: There is a poor relationship between functional performance and patient satisfaction following UKA. METHODS: This was a retrospective study using a locally held arthroplasty register to identify patients who had undergone UKA between 2004 and 2017. Patient reported outcome measures (PROMs) were collected prospectively and included EQ-5D, Oxford Knee Score (OKS) and satisfaction score (based on a visual analogue score with 0 being worst and 100 being best). Patients with a complete set of pre-operative and 2-year post-operative outcome scores were included. Patients who subsequently underwent revision surgery were excluded. 1638 patients were identified, of which 896 were eligible for inclusion. The average age was 66.7 years old, with 46.3% of patients being female. RESULTS: There was a moderate to strong correlation between the absolute or relative values for OKS and the patient satisfaction following UKA (r=0.705 and r=0.522, respectively). The average pre-operative scores improved from a median of 23 (IQR 18-28) to 43 (IQR 35-46) (p<0.001) and from a median of 0.62 (IQR 0.186-0.691) to 0.85 (IQR 0.691 - 1) (p<0.001) for OKS and EQ-5D, respectively. In terms of satisfaction with outcome, 82.6% of patients were very satisfied and 4.4% were dissatisfied (scoring ≥80% and <50%, respectively). At 2 years, the PASS was met or surpassed by 73.1% and 54.9% (OKS and EQ-5D, respectively). The MCID was met or surpassed by 93% and 78% (OKS and EQ-5D, respectively). DISCUSSION/CONCLUSION: UKA is a successful procedure generating high levels of patient function and satisfaction. Because patients' OKS and EQ-5D scores may be influenced by comorbidities, those scores are of disappointing predictive value in estimating patient satisfaction, and therefore should not be used as a surrogate to determine the success of the UKA procedure. LEVEL OF EVIDENCE: III; Restrospective cohort study.