ORCID Profile
0000-0001-7966-9708
Current Organisation
Bond University
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Publisher: Springer Science and Business Media LLC
Date: 09-03-2020
Publisher: BMJ
Date: 19-05-2005
Publisher: Annals of Family Medicine
Date: 03-2021
DOI: 10.1370/AFM.2609
Publisher: AMPCo
Date: 07-2001
Publisher: American Academy of Pediatrics (AAP)
Date: 04-2015
Abstract: Overdiagnosis and underdiagnosis of attention-deficit/hyperactivity disorder (ADHD) are widely debated, fueled by variations in prevalence estimates across countries, time, and broadening diagnostic criteria. We conducted a meta-analysis to: establish a benchmark pooled prevalence for ADHD examine whether estimates have increased with publication of different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and explore the effect of study features on prevalence. Medline, PsycINFO, CINAHL, Embase, and Web of Science were searched for studies with point prevalence estimates of ADHD. We included studies of children that used the diagnostic criteria from DSM-III, DSM-III-R and DSM-IV in any language. Data were extracted on s ling procedure, s le characteristics, assessors, measures, and whether full or partial criteria were met. The 175 eligible studies included 179 ADHD prevalence estimates with an overall pooled estimate of 7.2% (95% confidence interval: 6.7 to 7.8), and no statistically significant difference between DSM editions. In multivariable analyses, prevalence estimates for ADHD were lower when using the revised third edition of the DSM compared with the fourth edition (P = .03) and when studies were conducted in Europe compared with North America (P = .04). Few studies used population s ling with random selection. Most were from single towns or regions, thus limiting generalizability. Our review provides a benchmark prevalence estimate for ADHD. If population estimates of ADHD diagnoses exceed our estimate, then overdiagnosis may have occurred for some children. If fewer, then underdiagnosis may have occurred.
Publisher: Springer Science and Business Media LLC
Date: 09-05-2018
DOI: 10.1038/S41746-018-0021-9
Abstract: Mobile health apps aimed towards patients are an emerging field of mHealth. Their potential for improving self-management of chronic conditions is significant. Here, we propose a concept of “prescribable” mHealth apps, defined as apps that are currently available, proven effective, and preferably stand-alone, i.e., that do not require dedicated central servers and continuous monitoring by medical professionals. Our objectives were to conduct an overview of systematic reviews to identify such apps, assess the evidence of their effectiveness, and to determine the gaps and limitations in mHealth app research. We searched four databases from 2008 onwards and the Journal of Medical Internet Research for systematic reviews of randomized controlled trials (RCTs) of stand-alone health apps. We identified 6 systematic reviews including 23 RCTs evaluating 22 available apps that mostly addressed diabetes, mental health and obesity. Most trials were pilots with small s le size and of short duration. Risk of bias of the included reviews and trials was high. Eleven of the 23 trials showed a meaningful effect on health or surrogate outcomes attributable to apps. In conclusion, we identified only a small number of currently available stand-alone apps that have been evaluated in RCTs. The overall low quality of the evidence of effectiveness greatly limits the prescribability of health apps. mHealth apps need to be evaluated by more robust RCTs that report between-group differences before becoming prescribable. Systematic reviews should incorporate sensitivity analysis of trials with high risk of bias to better summarize the evidence, and should adhere to the relevant reporting guideline.
Publisher: University Library System, University of Pittsburgh
Date: 20-07-2021
Abstract: Objective: The decisions and processes that may compose a systematic search strategy have not been formally identified and categorized. This study aimed to (1) identify all decisions that could be made and processes that could be used in a systematic search strategy and (2) create a hierarchical framework of those decisions and processes.Methods: The literature was searched for documents or guides on conducting a literature search for a systematic review or other evidence synthesis. The decisions or processes for locating studies were extracted from eligible documents and categorized into a structured hierarchical framework. Feedback from experts was sought to revise the framework. The framework was revised iteratively and tested using recently published literature on systematic searching.Results: Guidance documents were identified from expert organizations and a search of the literature and Internet. Data were extracted from 74 eligible documents to form the initial framework. The framework was revised based on feedback from 9 search experts and further review and testing by the authors. The hierarchical framework consists of 119 decisions or processes sorted into 17 categories and arranged under 5 topics. These topics are “Skill of the searcher,” “Selecting information to identify,” “Searching the literature electronically,” “Other ways to identify studies,” and “Updating the systematic review.”Conclusions:The work identifies and classifies the decisions and processes used in systematic searching. Future work can now focus on assessing and prioritizing research on the best methods for successfully identifying all eligible studies for a systematic review.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2014
Publisher: Wiley
Date: 21-05-2002
DOI: 10.1002/SIM.1183
Abstract: What causes heterogeneity in systematic reviews of controlled trials? First, it may be an artefact of the summary measures used, of study design features such as duration of follow-up or the reliability of outcome measures. Second, it may be due to real variation in the treatment effect and hence provides the opportunity to identify factors that may modify the impact of treatment. These factors may include features of the population such as: severity of illness, age and gender intervention factors such as dose, timing or duration of treatment and comparator factors such as the control group treatment or the co-interventions in both groups. The ideal way to study causes of true variation is within rather than between studies. In most situations however, we will have to make do with a study level investigation and hence need to be careful about adjusting for potential confounding by artefactual factors such as study design features. Such investigation of artefactual and true causes of heterogeneity form essential steps in moving from a combined effect estimate to application to particular populations and in iduals.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.JCLINEPI.2022.04.022
Abstract: Methods to quantify overdiagnosis of screen detected cancer have been developed, but methods for quantifying overdiagnosis of noncancer conditions (whether symptomatic or asymptomatic) have been lacking. We aimed to develop a methodological framework for quantifying overdiagnosis that may be used for asymptomatic or symptomatic conditions and used gestational diabetes mellitus as an ex le of how it may be applied. We identify two earlier definitions for overdiagnosis, a narrower prognosis-based definition and a wider utility-based definition. Building on the central importance of the concepts of prognostic information and clinical utility of a diagnosis, we consider the following questions: within a target population, do people found to have a disease using one diagnostic strategy but found not to have the disease using another diagnostic strategy (so called 'additional diagnoses'), have an increased risk of adverse clinical outcomes without treatment (prognosis evidence), and/or a decreased risk of adverse outcomes with treatment (utility evidence)? Using Causal Directed Acyclic Graphs and fair umpires, we illuminate the relationships between diagnostics strategies and the frequency of overdiagnosis. We then use the ex le of gestational diabetes mellitus to demonstrate how the Fair Umpire framework may be applied to estimate overdiagnosis. Our framework may be used to quantify overdiagnosis in noncancer conditions (and in cancer conditions) and to guide further studies on this topic.
Publisher: American Medical Association (AMA)
Date: 21-04-2015
Publisher: AMPCo
Date: 03-2002
Publisher: AMPCo
Date: 03-2001
Publisher: University Library System, University of Pittsburgh
Date: 04-2020
Abstract: Background: Searching for studies to include in a systematic review (SR) is a time- and labor-intensive process with searches of multiple databases recommended. To reduce the time spent translating search strings across databases, a tool called the Polyglot Search Translator (PST) was developed. The authors evaluated whether using the PST as a search translation aid reduces the time required to translate search strings without increasing errors.Methods: In a randomized trial, twenty participants were randomly allocated ten database search strings and then randomly assigned to translate five with the assistance of the PST (PST-A method) and five without the assistance of the PST (manual method). We compared the time taken to translate search strings, the number of errors made, and how close the number of references retrieved by a translated search was to the number retrieved by a reference standard translation.Results: Sixteen participants performed 174 translations using the PST-A method and 192 translations using the manual method. The mean time taken to translate a search string with the PST-A method was 31 minutes versus 45 minutes by the manual method (mean difference: 14 minutes). The mean number of errors made per translation by the PST-A method was 8.6 versus 14.6 by the manual method. Large variation in the number of references retrieved makes results for this outcome unreliable, although the number of references retrieved by the PST-A method was closer to the reference standard translation than the manual method.Conclusion: When used to assist with translating search strings across databases, the PST can increase the speed of translation without increasing errors. Errors in search translations can still be a problem, and search specialists should be aware of this.
Publisher: National Institute for Health and Care Research
Date: 07-2009
DOI: 10.3310/HTA13320
Abstract: To assess the accuracy in diagnosing heart failure of clinical features and potential primary care investigations, and to perform a decision analysis to test the impact of plausible diagnostic strategies on costs and diagnostic yield in the UK health-care setting. MEDLINE and CINAHL were searched from inception to 7 July 2006. 'Grey literature' databases and conference proceedings were searched and authors of relevant studies contacted for data that could not be extracted from the published papers. A systematic review of the clinical evidence was carried out according to standard methods. In idual patient data (IPD) analysis was performed on nine studies, and a logistic regression model to predict heart failure was developed on one of the data sets and validated on the other data sets. Cost-effectiveness modelling was based on a decision tree that compared different plausible investigation strategies. Dyspnoea was the only symptom or sign with high sensitivity (89%), but it had poor specificity (51%). Clinical features with relatively high specificity included history of myocardial infarction (89%), orthopnoea (89%), oedema (72%), elevated jugular venous pressure (70%), cardiomegaly (85%), added heart sounds (99%), lung crepitations (81%) and hepatomegaly (97%). However, the sensitivity of these features was low, ranging from 11% (added heart sounds) to 53% (oedema). Electrocardiography (ECG), B-type natriuretic peptides (BNP) and N-terminal pro-B-type natriuretic peptides (NT-proBNP) all had high sensitivities (89%, 93% and 93% respectively). Chest X-ray was moderately specific (76-83%) but insensitive (67-68%). BNP was more accurate than ECG, with a relative diagnostic odds ratio of ECG/BNP of 0.32 (95% CI 0.12-0.87). There was no difference between the diagnostic accuracy of BNP and NT-proBNP. A model based upon simple clinical features and BNP derived from one data set was found to have good validity when applied to other data sets. A model substituting ECG for BNP was less predictive. From this a simple clinical rule was developed: in a patient presenting with symptoms such as breathlessness in whom heart failure is suspected, refer directly to echocardiography if the patient has a history of myocardial infarction or basal crepitations or is a male with ankle oedema otherwise, carry out a BNP test and refer for echocardiography depending on the results of the test. On the basis of the cost-effectiveness analysis carried out, such a decision rule is likely to be considered cost-effective to the NHS in terms of cost per additional case detected. The cost-effectiveness analysis further suggested that, if likely benefit to the patient in terms of improved life expectancy is taken into account, the optimum strategy would be to refer all patients with symptoms suggestive of heart failure directly for echocardiography. The analysis suggests the need for important changes to the NICE recommendations. First, BNP (or NT-proBNP) should be recommended over ECG and, second, some patients should be referred straight for echocardiography without undergoing any preliminary investigation. Future work should include evaluation of the clinical rule described above in clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 26-04-2017
Publisher: Public Library of Science (PLoS)
Date: 03-06-2015
Publisher: BMJ
Date: 02-2006
DOI: 10.1136/EBM.11.1.5
Publisher: Wiley
Date: 23-06-2015
Publisher: John Wiley & Sons, Ltd
Date: 31-01-2013
Publisher: John Wiley & Sons, Ltd
Date: 26-01-2004
Publisher: Elsevier BV
Date: 05-2023
Publisher: Springer Science and Business Media LLC
Date: 12-11-2019
DOI: 10.1186/S12888-019-2337-7
Abstract: Widening definitions of health conditions have the potential to affect millions of people and should only occur when there is strong evidence of benefit. In the last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5 Committee changed the Attention Deficit Hyperactivity Disorder (ADHD) age of onset criterion in two ways: raising the age of symptom onset and removing the requirement for symptoms to cause impairment. Given concerns about ADHD prevalence and treatment rates, we aimed to evaluate the evidence available to support these changes using a recently developed Checklist for Modifying Disease Definitions. We identified and analysed research informing changes to the DSM-IV-TR ADHD age of onset criterion. We compared this evidence to the evidence recommended in the Checklist for Modifying Disease Definitions. The changes to the DSM-IV-TR age of onset criterion were based on a literature review (publicly available as a 2 page document with online table of included studies), which we appraised as at high risk of bias. Estimates of the change in ADHD prevalence resulting from change to the age of onset criterion were based on a single study that included only a small number of children with ADHD ( n = 68) and only assessed the impact of change to the age component of the criterion. No evidence was used by, or available to the Committee regarding the impact on prevalence of removal of the requirement for impairment, or the effect of the criterion changes on diagnostic precision, the prognosis of, or the potential benefits or harms for in iduals diagnosed by the new, but not old criterion. The changes to the age of onset criterion were based on minimal research evidence that suffered from either high risk of bias or poor applicability. The minimal documentation available makes it difficult to judge the rigor of the process behind the criterion changes. Use of the Checklist for Modifying Disease Definitions would assist future proposed modifications of the DSM ADHD criteria, provide guidance on the studies needed to inform potential changes and would improve the transparency and documentation of the process.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-045343
Abstract: To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. Systematic review. Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). 3097 unique references were identified, and 81 studies across 20 countries included, reporting on million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. CRD42020203729.
Publisher: JMIR Publications Inc.
Date: 09-2017
DOI: 10.2196/RESPROT.8362
Publisher: Royal College of General Practitioners
Date: 31-03-2014
Publisher: AMPCo
Date: 09-2001
Publisher: Hogrefe Publishing Group
Date: 2002
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.JCLINEPI.2004.09.011
Abstract: Methods to identify studies for systematic reviews of diagnostic accuracy are less well developed than for reviews of intervention studies. This study assessed (1) the sensitivity and precision of five published search strategies and (2) the reliability and accuracy of reviewers screening the results of the search strategy. We compared the results of the search filters with the studies included in two systematic reviews, and assessed the interobserver reliability of two reviewers screening the list of articles generated by a search strategy. In the first review, the search strategy published by van der Weijden had the greatest sensitivity, and in the second, four search strategies had 100% sensitivity. There was "substantial" agreement between two reviewers, but in the first review each reviewer working on their own would have missed one paper eligible for inclusion in the review. Ascertainment intersection techniques indicate that it is unlikely that further papers have been missed in the screening process. Published search strategies may miss papers for reviews of diagnostic test accuracy. Papers are not easily identified as studies of diagnostic test accuracy, and the lack of information in the abstract makes it difficult to assess the eligibility for inclusion in a systematic review.
Publisher: AMPCo
Date: 02-2001
Publisher: AMPCo
Date: 08-2001
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.JPEDS.2008.04.023
Abstract: To determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever. Systematic review of diagnostic accuracy studies. We included studies comparing the diagnostic accuracy of CRP with microbiologic confirmation of (a) serious bacterial and (b) bacterial infection. For differentiating between serious bacterial infection and benign or nonbacterial infection (6 studies), the pooled estimate of sensitivity was 0.77 (95% CI, 0.68, 0.83) specificity, 0.79 (95% CI, 0.74, 0.83) positive likelihood ratio, 3.64 (95% CI, 2.99, 4.43) and negative likelihood ratio, 0.29 (95% CI, 0.22, 0.40). In multivariate analysis, CRP is an independent predictor of serious bacterial infection. 3 studies investigating the accuracy of CRP for diagnosing bacterial infection could not be pooled, but all showed a lower sensitivity compared with studies using serious bacterial infection as the reference diagnosis. CRP provides moderate and independent information for both ruling in and ruling out serious bacterial infection in children with fever at first presentation. Poor sensitivity means that CRP cannot be used to exclude all bacterial infection.
Publisher: Massachusetts Medical Society
Date: 03-07-2003
DOI: 10.1056/NEJMOA022226
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JCLINEPI.2015.05.006
Abstract: Scoring systems are developed to assist clinicians in making a diagnosis. However, their uptake is often limited because they are cumbersome to use, requiring information on many predictors, or complicated calculations. We examined whether, and how, simplifications affected the performance of a validated score for identifying adults with chest pain in an emergency department who have low risk of major adverse cardiac events. We simplified the Emergency Department Assessment of Chest pain Score (EDACS) by three methods: (1) giving equal weight to each predictor included in the score, (2) reducing the number of predictors, and (3) using both methods--giving equal weight to a reduced number of predictors. The diagnostic accuracy of the simplified scores was compared with the original score in the derivation (n = 1,974) and validation (n = 909) data sets. There was no difference in the overall accuracy of the simplified versions of the score compared with the original EDACS as measured by the area under the receiver operating characteristic curve (0.74 to 0.75 for simplified versions vs. 0.75 for the original score in the validation cohort). With score cut-offs set to maintain the sensitivity of the combination of score and tests (electrocardiogram and cardiac troponin) at a level acceptable to clinicians (99%), simplification reduced the proportion of patients classified as low risk from 50% with the original score to between 22% and 42%. Simplification of a clinical score resulted in similar overall accuracy but reduced the proportion classified as low risk and therefore eligible for early discharge compared with the original score. Whether the trade-off is acceptable, will depend on the context in which the score is to be used. Developers of clinical scores should consider simplification as a method to increase uptake, but further studies are needed to determine the best methods of deriving and evaluating simplified scores.
Publisher: Wiley
Date: 15-01-2014
Abstract: Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge. Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort. Statistical coefficients were converted to whole numbers to create a score. Clinician feedback was used to improve the clinical plausibility and the usability of the final score (Emergency Department Assessment of Chest pain Score [EDACS]). EDACS was combined with electrocardiogram results and troponin results at 0 and 2 h to develop an ADP (EDACS-ADP). The score and EDACS-ADP were validated and tested for reproducibility in separate cohorts of patients. In the derivation (n = 1974) and validation (n = 608) cohorts, the EDACS-ADP classified 42.2% (sensitivity 99.0%, specificity 49.9%) and 51.3% (sensitivity 100.0%, specificity 59.0%) as low risk of major adverse cardiac events, respectively. The intra-class correlation coefficient for categorisation of patients as low risk was 0.87. The EDACS-ADP identified approximately half of the patients presenting to the ED with possible cardiac chest pain as having low risk of short-term major adverse cardiac events, with high sensitivity. This is a significant improvement on similar, previously reported protocols. The EDACS-ADP is reproducible and has the potential to make considerable cost reductions to health systems.
No related grants have been discovered for Sharon Sanders.