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.
ObjectiveTo explore the short-term effectiveness of Mako robot-assisted total hip arthroplasty (THA) via posterolateral approach.MethodsThe clinical data of 64 patients (74 hips) treated with Mako robot-assisted THA via posterolateral approach (robot group) between May 2020 and March 2021 were retrospectively analyzed and compared with the clinical data of 52 patients (55 hips) treated with traditional THA via posterolateral approach (control group) in the same period. There was no significant difference in general data such as gender, age, side, body mass index, disease type, and preoperative Harris score between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. Acetabular inclination angle, acetabular anteversion angle, and lower limbs discrepancy were measured after operation. At last follow-up, the improvement of hip pain and function was evaluated by visual analogue scale (VAS) score, Harris score, and forgetting joint score (FJS-12).ResultsIn the robot group, 3 patients (including 1 patient with acetabular fracture during operation) were converted to routine THA because the pelvic data array placed at the anterior superior iliac spine was loose, resulting in data error and unable to register the acetabulum; the other patients in the two groups completed the operation successfully. The operation time and intraoperative blood loss in the robot group were significantly higher than those in the control group (P<0.05). All patients were followed up 1-10 months, with an average of 4.6 months. In the robot group, 1 patient with ankylosing spondylitis had acetabular prosthesis loosening at 2 days after operation, underwent surgical revision, and 10 patients had lower limb intermuscular vein thrombosis; in the control group, 1 patient had left hip dislocation and 5 patients had lower extremity intermuscular vein thrombosis; there was no complication such as sciatic nerve injury, incision exudation, and periprosthetic infection in both groups. There was no significant difference in the incidence of complications between the robot group and the control group (17.2% vs.11.5%) (χ2=0.732, P=0.392). At last follow-up, the acetabular anteversion angle and FJS-12 score in the robot group were was significantly greater than those in the control group, and the lower limbs discrepancy was significantly less than that in the control group (P<0.05); there was no significant difference in acetabular inclination angle and VAS score between the two groups (P>0.05). The Harris scores of the two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference in the difference of pre- and post-operative score between the two groups (t=1.632, P=0.119).ConclusionCompared with traditional surgery, Mako robot-assisted THA can optimize the accuracy and safety of acetabular cup implantation, reduce the length difference of the lower limbs, and has a certain learning curve. Its long-term effectiveness needs further research to confirm.
ObjectiveTo systematically review the diagnostic value of optical coherence tomography angiography (OCTA) for primary open-angle glaucoma (POAG). MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases were electronically searched to collect diagnostic test on OCTA for POAG from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 15.0 software. ResultsA total of 12 diagnostic tests involving 993 subjects were included. Meta-analysis results showed that the sensitivity/specificity of OCTA for diagnosing peripapillary vessel density, retinal vessel density, and optic nerve fiber changes in patients with POAG were 0.77/0.92, 0.56/0.92, and 0.85/0.91, respectively, and the AUC of the SROC curve was 0.94, 0.92 and 0.95, respectively. ConclusionOCTA has high diagnostic accuracy for POAG. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
The correct and reasonable statistical analysis method can make the results of comparative diagnosis test accuracy more convincing. In this paper, the accuracy of diagnostic tests is divided into 2 forms: binary-scale outcomes and ordinal-scale/continuous-scale outcomes. Taking diagnostic indicators such as sensitivity, specificity, receiver operating characteristic (ROC) curves and area under curve (AUC) values as entry points, combined with examples, this paper introduced how to compare the diagnostic results of tests by parameter estimation and hypothesis testing, with the aim of providing references for the comparative diagnosis test accuracy.
ObjectiveTo study the method of rapid and accurate measurement of body temperature in dense population during the coronavirus disease 2019 pandemic.MethodsFrom January 27th to February 8th, 2020, subjects were respectively measured with two kinds of non-contact infrared thermometers (blue thermometer and red one) to measure the temperature of forehead, neck, and inner side of forearm under the conditions of 4–6℃ (n=152), 7–10℃ (n=103), and 11–25℃ (n=209), while the temperature of axillary was measured with mercury thermometer under the same conditions. Taking the mercury thermometer temperature as the gold standard, the measurement results with non-contact infrared thermometers were compared.ResultsAt 7–10℃, there was no statistical difference among the forehead temperatures measured by the two non-contact infrared thermometers and the axillary temperature (P>0.05); there was no difference among the temperature measured by blue thermometer on forehead, neck, and inner side of forearm (P>0.05); no difference was found between the temperature measured by the red thermometer on forehead and inner side of forearm (P>0.05), while there was statistical difference between the temperatures measured by the red thermometer on forehead and neck (P<0.05). Under the environment of 11−25℃, there was no statistical difference among the forehead temperatures measured by the two infrared thermometers and the axillary temperature (P>0.05); the difference between the temperatures of forehead and inner side of forearm measured by the blue thermometer was statistically significant (P<0.05), while no difference appeared between the forehead and neck temperatures measured by the blue thermometer (P>0.05); there was no statistical difference among the temperatures of three body regions mentioned above measured by the red thermometer (P>0.05). According to the manual, the allowable fluctuation range of the blue thermometer was 0.3℃, and that of the red one was 0.2℃. The mean differences in measured values between different measured sites of the two products were within the allowable fluctuation range. Therefore, the differences had no clinical significance in the environment of 7–25℃. Under the environment of 4–6℃, the detection rate of blue thermometer was 2.2% and that of the red one was 19.1%.ConclusionsThere is no clinical difference between the temperature measured by mercury thermometer and the temperature measured by temperature guns at 7–10 or 11–25℃, so temperature guns can be widely used. In order to maintain the maximum distance between the measuring and the measured persons and reduce the infection risk, it is recommended to choose the inner forearm for temperature measurement. Under the environment of ambient temperature 4–6℃, the detection rate of non-contact electronic temperature gun is low, requiring taking thermal measures for the instrument.
The approaches of rating the quality of evidence of systematic reviews of diagnostic accuracy tests are different from systematic reviews of interventional studies. This article systematically introduces the application of GRADE in systematic reviews of diagnostic accuracy tests by a case interpretation and analysis. In this article we present rating workflow in systematic reviews of diagnostic accuracy tests and introduce how to use the GDT website to display the rating results, and interpret the conclusion of systematic reviews based on GRADE results.
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.
Objective To compare the effectiveness of robot-assisted and traditional freehand screw placement in the treatment of atlantoaxial dislocation. Methods The clinical data of 55 patients with atlantoaxial dislocation who met the selection criteria between January 2021 and January 2024 were retrospectively analyzed. According to different screw placement methods, they were divided into the traditional group (using the traditional freedhand screw placement, 31 cases) and the robot group (using the Mazor X robot-assisted screw placement, 24 cases). There was no significant difference in gender, age, body mass index, etiology, and preoperative visual analogue scale (VAS) score, cervical spine Japanese Orthopaedic Association (JOA) score between the two groups (P>0.05). The operation time, intraoperative blood loss, operation cost, and intraoperative complications were recorded and compared between the two groups. The VAS score and cervical spine JOA score were used to evaluate the improvement of pain and cervical spinal cord function before operation and at 1 month after operation. CT examination was performed at 3 days after operation, and the accuracy of screw placement was evaluated according to Neo grading criteria. Results All the 55 patients successfully completed the operation. The operation time, intraoperative blood loss, and operation cost in the robot group were significantly higher than those in the traditional group (P<0.05). A total of 220 C1 and C2 pedicle screws were inserted in the two groups, and 94 were inserted in the robot group, with an accuracy rate of 95.7%, among them, 2 were inserted by traditional freehand screw placement due to bleeding caused by intraoperative slip. And 126 pedicle screws were inserted in the traditional group, with an accuracy rate of 87.3%, which was significantly lower than that in the robot group (P<0.05). There were 1 case of venous plexus injury in the robot group and 3 cases in the traditional group, which improved after pressure hemostasis treatment. No other intraoperative complication such as vertebral artery injury or spinal cord injury occurred in both groups. All patients were followed up 4-16 months with an average of 6.6 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). Postoperative neck pain significantly relieved in both groups, and neurological symptoms relieved to varying degrees. The VAS score and cervicle spine JOA score of both groups significantly improved at 1 month after operation when compared with preoperative scores (P<0.05), and there was no significant difference in the score change between the two groups (P>0.05). Conclusion In the treatment of atlantoaxial dislocation, the accuracy of robot-assisted screw placement is superior to the traditional freedhand screw placement.
Machine learning-based diagnostic tests have certain differences of measurement indicators with traditional diagnostic tests. In this paper, we elaborate the definitions, calculation methods and statistical inferences of common measurement indicators of machine learning-based diagnosis models in detail. We hope that this paper will be helpful for clinical researchers to better evaluate machine learning diagnostic models.
Objective To evaluate whether the paper titled “Application of tumor type M2 pyruvate kinase in the diagnosis of lung cancer” met the standards set in the STARD statement. Methods Based on each of the 25 items of STAndards for the Reporting of Diagnostic accuracy studies (STARD statement), the paper titled “Application of tumor type M2 pyruvate kinase in the diagnosis of lung cancer” was checked and evaluated. Results In the paper titled “Application of tumor type M2 pyruvate kinase in the diagnosis of lung cancer”, the reporting of 1 item of the STARD statement was adequately standardized, 7 items were relatively standardized, 5 items were inadequately standardized, 2 items were not standardized, and the other 10 were not reported. Conclusion Generally speaking, the reporting of diagnostic accuracy studies has not been standardized adequately in China. The methodological quality and applicability of diagnostic accuracy studies should be improved.