Suchergebnisse

AbstractBackgroundRapid reviews (RRs) have been used to provide timely evidence for policymakers, health providers, and the public in several healthcare scenarios, most recently during the coronavirus disease 2019 pandemic. Despite the essential role of diagnosis in clinical management, data about how to perform RRs of diagnostic tests are scarce. We aimed to explore the views and perceptions of experts in evidence synthesis and diagnostic evidence about the value of methods used to accelerate the review process.MethodsWe performed semistructured interviews with a purposive sample of experts in evidence synthesis and diagnostic evidence. We carried out the interviews in English between July and December 2021. Initial reading and coding of the transcripts were performed using NVIVO qualitative data analysis software.ResultsOf a total of 23 invited experts, 16 (70%) responded. We interviewed all 16 participants representing key roles in evidence synthesis. We identified 14 recurring themes including the review question, characteristics of the review team, and use of automation, as the topics with the highest number of quotes. Some participants considered several methodological "shortcuts" to be ineffective or risky, such as automating quality appraisal, using only one reviewer for diagnostic data extraction and only performing descriptive analysis. The introduction of limits might depend on whether the test being assessed is a new test, the availability of alternative tests, the needs of providers and patients, and the availability of high‐quality systematic reviews.ConclusionsOur findings suggest that organizational strategies (e.g., defining the review question, availability of a highly experienced team) may have a role in conducting RRs of diagnostic tests. Several methodological shortcuts were considered inadequate for accelerating the review process, though they need to be assessed in well‐designed studies. Improved reporting of RRs would support evidence‐based decision‐making and help users of RRs understand their limitations.

We aimed to evaluate the evidence on screening and treatment for two parasitic infections—schistosomiasis and strongyloidiasis—among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle–Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.

We aimed to evaluate the evidence on screening and treatment for two parasitic infections-schistosomiasis and strongyloidiasis-among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle-Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.