Cribado

Cribado
  • 文章类型: Systematic Review
    目的:间质性肺病(ILD)在类风湿关节炎(RA)患者中常见,并与显著的发病率和死亡率相关。这篇综述的目的是确定RA患者ILD的不同筛查方法。
    方法:我们在Pubmed中进行了系统搜索,Embase和Cochrane图书馆截至2020年4月,并手动搜索了检索到的文章的参考文献。搜索仅限于人类和以英语发表的文章,西班牙语或法语。我们选择了任何设计的研究,其中:(a)人群包括成年RA患者;(b)干预是任何ILD筛查方法;(c)评估筛查方法的有效性或可靠性。或描述了一种筛选方法。两名审阅者通过标题和摘要独立筛选文章,然后使用特定的数据提取表提取信息。
    结果:纳入25项研究,共2593例患者。最常用的ILD筛查工具是肺的高分辨率计算机断层扫描(HRCT)。电子听诊,生化标志物,支气管肺泡灌洗(BAL),还评估了肺功能检查(PFTs)和肺部超声检查.在不同的研究中,电子听诊和肺部超声检查的准确性高于PFTs,BAL和生化标记。
    结论:HRCT是RA患者ILD筛查最敏感的工具。鉴于其无害性和高灵敏度,肺部超声检查可能成为未来的首选工具。
    OBJECTIVE: Interstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. The aim of this review was to identify the different screening methods for ILD in patients with RA.
    METHODS: We ran a systematic search in Pubmed, Embase and Cochrane Library up to April 2020 and did a hand search of the references of the retrieved articles. The search was limited to humans and articles published in English, Spanish or French. We selected studies with any design where: (a) the population included adult patients with RA; (b) the intervention was any screening method for ILD; and (c) validity or reliability of the screening method were evaluated, or a screening method was described. Two reviewers independently screened the articles by title and abstract and subsequently extracted the information using a specific data extraction form.
    RESULTS: 25 studies were included with a total of 2593 patients. The most frequently used tool for ILD screening was high resolution computed tomography (HRCT) of the lung. Electronic auscultation, biochemical markers, bronchoalveolar lavage (BAL), pulmonary function tests (PFTs) and lung ultrasonography were also evaluated. Across the different studies, electronic auscultation and lung ultrasonography achieved higher accuracy than PFTs, BAL and biochemical markers.
    CONCLUSIONS: HRCT resulted as the most sensitive tool for ILD screening in patients with RA. Given its harmlessness and high sensitivity, lung ultrasonography may become the first-choice tool in the future.
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  • 文章类型: Journal Article
    OBJECTIVE: The aim of this study was to assess the available evidence on the validity, diagnostic accuracy and clinical utility of the multitarget DNA test in faeces (Cologuard™) for screening for colorectal cancer (CRC).
    METHODS: A systematic review was performed by consulting MedLine, EMBASE and Web of Science to July 2014. Studies on diagnostic tests were selected that evaluated the test in asymptomatic adults who underwent CRC screening. The quality and risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. The level of evidence was defined according to the National Institute for Health and Clinical Excellence. A qualitative synthesis was conducted.
    RESULTS: A total of 299 literature references were identified, including 1 synthesis report and 5 diagnostic test studies. Three of the 5 studies had a case-control design in Sackett phase II and were of moderate quality, and 2 had a prospective design in Sacket phase III and were of high quality. The sensitivity for detecting CRC was greater than 90%, but only 40% for detecting advanced adenomas. The test provided conclusive diagnostic evidence to rule out CRC (negative likelihood ratio, LR-: 0.02-0.09), although it was not useful for ruling out advanced adenoma (LR-: 0.5-0.7).
    CONCLUSIONS: The Cologuard™ test is a valid screening test for ruling out cancerous lesions but is suboptimal for ruling out precancerous lesions. There is no evidence in terms of mortality, survival or cost-effectiveness.
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  • 文章类型: Journal Article
    OBJECTIVE: To describe interval cancers (IC) and the sensitivity of colorectal cancer (CRC) screening programmes.
    METHODS: A systematic review of the literature was conducted through a MEDLINE (PubMed) search. The search strategy combined the terms \'interval cancer\', \'false negative\', \'mass screening\', \'screening\' \'early detection of cancer\', \'colorectal cancer\' and \'bowel cancer\'. Inclusion criteria consisted of population-based screening programmes, original articles written in English or Spanish and publication dates between 1999/01/01 and 2015/02/28. A narrative synthesis of the included articles was performed detailing the characteristics of the screening programmes, the IC rate, and the information sources used in each study.
    RESULTS: Thirteen articles were included. The episode sensitivity of CRC screening programmes ranged from 42.2% to 65.3% in programmes using the guaiac test and between 59.1% and 87.0% with the immunochemical test. We found a higher proportion of women who were diagnosed with IC and these lesions were mainly located in the proximal colon.
    CONCLUSIONS: There is wide variability in the IC rate in CRC programmes. To ensure comparability between programmes, there is a need for consensus on the working definition of IC and the methods used for their identification and quantification.
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  • 文章类型: Journal Article
    OBJECTIVE: To estimate and compare the diagnostic validity of tomosynthesis and digital mammography for screening and diagnosing breast cancer.
    METHODS: We systematically searched MedLine, EMBASE, and Web of Science for the terms breast cancer, screening, tomosynthesis, mammography, sensitivity, and specificity in publications in the period comprising June 2010 through February 2013. We included studies on diagnostic tests and systematic reviews. Two reviewers selected and evaluated the articles. We used QUADAS 2 to evaluate the risk of bias and the NICE criteria to determine the level of evidence. We compiled a narrative synthesis.
    RESULTS: Of the 151 original studies identified, we selected 11 that included a total of 2475 women. The overall quality was low, with a risk of bias and follow-up and limitations regarding the applicability of the results. The level of evidence was not greater than level II. The sensitivity of tomosynthesis ranged from 69% to 100% and the specificity ranged from 54% to 100%. The negative likelihood ratio was good, and this makes tomosynthesis useful as a test to confirm a diagnosis. One-view tomosynthesis was no better than two-view digital mammography, and the evidence for the superiority of two-view tomosynthesis was inconclusive.
    CONCLUSIONS: The results for the diagnostic validity of tomosynthesis in the diagnosis of breast cancer were inconclusive and there were no results for its use in screening.
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