The QUADAS-2, QUIPS, and PROBAST tools are not specific for prognostic accuracy studies and the use of these tools to assess the risk of bias in prognostic accuracy studies is prone to bias. Therefore, QUAPAS, a risk of bias assessment tool for prognostic accuracy studies, has recently been developed. The tool combines QUADAS-2, QUIPS, and PROBAST, and consists of 5 domains, 18 signaling questions, 5 risk of bias questions, and 4 applicability questions. This paper will introduce the content and usage of QUAPAS to provide inspiration and references for domestic researchers.
Objective To evaluate the accuracy of soluble triggering receptor expressed on myeloid cells-1 ( sTREM-1) as a diagnostic index for ventilator-associated pneumonia ( VAP) . Methods We searched the PubMed, EMBase, Cochrane Library,Wanfang Database, CNKI and VIP for clinical trials which assessed the diagnosis accuracy of sTREM-1 for VAP. The methodological quality of each study was assessed by the quality assessment for studies of diagnostic accuracy ( QUADAS) tool. The Meta-disc software was used to conduct merger analyses on sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. The heterogeneity test was performed and summary receiver operating characteristic ( SROC) curve was completed. Results 8 studies were included ( 180 VAP patients and 224 non-VAP patients) . The value of merger sensitivity, specificity, and diagnostic odds ratio were 0. 80, 0. 74, and 13. 89, respectively. The area under of SROC curve was 0. 857, with Q point at 0. 788. Conclusion sTREM-1 showed moderate accuracy for VAP diagnosis in adult mechanically ventilated patients, which should be combined with other diagnostic markers to further improve the sensitivity and specificity.
ObjectiveTo compare the investigation results of compliance and accuracy of hand hygiene in medical staff achieved by Hospital Infection Management Department and Department Infection Management Teams, and analyze the reasons for differences of the results and take measures to improve the investigation ability of hand hygiene in hospitals. MethodsWe statistically analyzed the results of compliance and accuracy of hand hygiene from January to December 2013 investigated by the infection management department and 25 infection management teams. Both the hospital and departments used "WHO Standard Observation Form". Single-blind method was used to observe the implementation of hand hygiene in medical staff. ResultsThe hospital infection management department investigation showed that hand hygiene compliance and accuracy were 64.97% and 87.78%, respectively, while the investigation by infection management teams showed that hand hygiene compliance and accuracy were 90.54% and 93.37%, respectively. The differences between the investigation results of two-level organizations were statistically significant (χ2=286.2, P<0.001; χ2=532.6, P<0.001). ConclusionWe should take measures to enforce the training of hand hygiene implementation and the observation method, and improve the guidance and assessment, promote investigators' working responsibility and observation ability, so that the survey data can accurately reflect the actual situation to urge medical staff to form good hand hygiene habits.
The mada package is a type of package that is especially used for implementing meta-analysis of diagnostic accuracy tests. This package is developed on basis of classical statistical theories and it can be used to calculate all relevant effect size of diagnostic accuracy tests; however, it does not provide pooled values of sensitivity and specificity. This article uses an example to introduce the whole functions of mada package in implementing meta-analysis of diagnostic accuracy tests, including data preparation, calculation implementation, result summary, and plots drawing.
ObjectiveTo compare the safety and accuracy of manual and robot-assisted cortical bone trajectory (CBT) screws fixation in the treatment of lumbar degenerative diseases with osteoporosis.MethodsThe clinical data of 58 cases of lumbar degenerative disease with osteoporosis treated by CBT screw fixation between February 2017 and February 2019 were analyzed retrospectively. Among them, 29 cases were fixed with CBT screws assisted by robot (group A), 29 cases were fixed with CBT screws by hand (group B). There was no significant difference between the two groups in terms of gender, age, body mass index, lesion type, T-value of bone mineral density, and operative segment (P>0.05), with comparability. The accuracy of implant was evaluated by Kaito’s grading method, and the invasion of CBT screw to the superior articular process was evaluated by Babu’s method.ResultsThe operation time and intraoperative blood loss in group A were significantly less than those in group B (t=−8.921, P=0.000; t=−14.101, P=0.000). One hundred and sixteen CBT screws were implanted in the two groups. At 3 days after operation, according to the Kaito’s grading method, the accuracy of implant in group A was 108 screws of grade 0, 6 of grade 1, and 2 of grade 2; and in group B was 86 screws of grade 0, 12 of grade 1, and 18 of grade 2; the difference was significant (Z=4.007, P=0.000). There were 114 accepted screws (98.3%) in group A and 98 (84.5%) in group B, the difference was significant (χ2=8.309, P=0.009). At 3 days after operation, according to Babu’s method, there were 85 screws in grade 0, 3 in grade 1, and 2 in grade 2 in group A; and in group B, there were 91 screws in grade 0, 16 in grade 1, 5 in grade 2, and 4 in grade 3; the difference was significant (Z=7.943, P=0.000). No serious injury of spinal cord, nerve, and blood vessel was found in the two groups. One patient in group A had delayed cerebrospinal fluid leakage, and 2 patients in group B had mild anemia. Both groups were followed up 10-14 months (mean, 11.6 months). The neurological symptoms were improved, and no screw loosening or fracture was found during the follow-up.ConclusionCompared with manual implantation of CBT screw, robot-assisted spinal implant has higher accuracy, lower incidence of invasion of superior articular process, and strong holding power of CBT screw, which can be applied to the treatment of lumbar degenerative diseases with osteoporosis.
Previous methods of grading evidence for systematic reviews of diagnostic test accuracy have generally focused on assessing the certainty (quality) of evidence at the level of diagnostic indicators. When the question is not limited to follow the diagnostic test accuracy results themselves, the grading results may be inaccurate due to the lack of consideration of the downstream effects of the test accuracy in specific settings. To address these challenges, the GRADE working group conducted a series of studies focused on updating methods to explore or simulate important downstream effects of diagnostic test accuracy outcomes within a contextual framework. This paper aimed to introduce advances in the contextual framework of the GRADE approach to rate the certainty of evidence from systematic reviews of single diagnostic test accuracy.
The PRISMA-DTA Statement is an expanded checklist of the original PRISMA, which is aimed at improving the reporting quality of the systematic review or meta-analysis of diagnostic test accuracy studies. It was published on JAMA in January 2018. This paper explained it and provided reference for improving the reporting quality of systematic review/meta-analysis of DTA for Chinese authors.
By comparing the diagnostic accuracy of two or more tests in the same study, the one with the higher diagnostic accuracy can be screened. Therefore, it is extremely important to conduct the comparative diagnostic test accuracy study. This paper introduced the concept of the comparative diagnostic test accuracy study, compared it with single diagnostic test accuracy study, and described its role, study design, statistical analysis, current status, and challenges.
The kinematic model parameter deviation is the main factor affecting the positioning accuracy of neurosurgical robots. To obtain more realistic kinematic model parameters, this paper proposes an automatic parameters identification and accuracy evaluation method. First, an identification equation contains all robot kinematics parameter was established. Second, a multiple-pivot strategy was proposed to find the relationship between end-effector and tracking marker. Then, the relative distance error and the inverse kinematic coincidence error were designed to evaluate the identification accuracy. Finally, an automatic robot parameter identification and accuracy evaluation system were developed. We tested our method on both laboratory prototypes and real neurosurgical robots. The results show that this method can realize the neurosurgical robot kinematics model parameters identification and evaluation stably and quickly. Using the identified parameters to control the robot can reduce the robot relative distance error by 33.96% and the inverse kinematics consistency error by 67.30%.
Objective To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis.MethodsClinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients’ knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up.ResultsOne patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements (P<0.05). There was no significant difference between preoperative and postoperative PTSA (P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant (P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant (P<0.05).ConclusionFor patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.