Using Screening Tests to Predict Aberrant Use of Opioids in Chronic Pain Patients: Caveat Emptor

Screening tests represent a critical tool in chronic pain treatment for predicting aberrant opioid use, which has emerged as a significant public health issue. Nevertheless, there remains a significant potential for the misapplication of screeners in this context. The potential difficulties in evaluating the diagnostic efficiency of screeners have been well established, particularly with regard to the effect that the prevalence of a disorder has on predictive value. The wide range in the reported prevalence of aberrant opioid use behaviors makes it difficult to interpret data obtained from popular screeners for assessing the potential for the aberrant use of opioids. Given the prevalence of opioid problems, however, formulating clear clinical guidelines on such screeners appears highly important. The aims of the present report include: 1) providing a review of the salient issues necessary for interpreting diagnostic efficiency statistics of screening tests, 2) identifying the critical differences between sensitivity, specificity, and predictive value, and 3) discussing the characteristic effects that disease prevalence has on statistical prediction. The article also reviews key processes in screening measure development and highlights several key considerations relevant to their appropriate use in clinical decision-making.

Instruments to Identify Delirium in Patients Recovering From Anesthesia: A Scoping Review

PurposeTo identify the validated instruments used for screening and detecting postoperative delirium (POD) during Post Anesthesia Recovery (PAR) period, and the incidence and associated risk factors with POD.DesignA scoping review.MethodsThe study search occurred in May 2021 in the PubMed, Embase, Scopus, CINAHL, Web of Science and LILACS databases. Primary studies that used validated instruments for screening and detecting POD in the PAR period were included.FindingsA total of 38 articles were included. The most used instruments were CAM-ICU, Nu-DESC, and RASS. The instruments that screened and detected delirium earliest were the Nu-DESC and CAM-ICU. POD incidence was up to 20% in more than half of the included studies. Cardiovascular comorbidities, chronic kidney disease, low functional reserve, chronic obstructive pulmonary disease and postoperative pain were among the primary risk factors.ConclusionThe instrumentsshowing the greatest accuracy for screening and detecting POD in the PAR period were the Nu-DESC and CAM-ICU.     

Single- vs. Multiple-Item Instruments in the Assessment of Quality of Life in Patients with Advanced Cancer

Although multidimensional instruments are usually used to measure quality of life in advanced cancer patients, recent research suggests that single-item assessments can provide a reliable measure. Using the Functional Assessment of Cancer Therapy-General (FACT-G) instrument as a gold standard, we assessed the performance of the Edmonton Symptom Assessment System “feeling of well-being” (ESAS WB) item. We reviewed the data from 213 patients enrolled in six clinical trials. We determined the association between baseline ESAS WB and FACT-G total and subscale domain scores (Physical Well-being [PWB], Social/Family Well-being [SWB], Emotional Well-being [EWB], and Functional Well-being [FWB]. We also calculated the association between baseline (T1) and second (T2) observations of ESAS WB and of FACT-G total score. In addition, we predicted the change in FACT-G predicted by the ESAS WB score using regression analysis. Mean age was 60 (SD 12) years and 48% were female. The Spearman correlation coefficient of ESAS WB and FACT-G was ?0.48 (P < 0.0001). Correlations with FACT-G subscale domains were also highly significant, except for the SWB domain (P = 0.08). The Pearson correlation coefficient for T1–T2 in ESAS WB and FACT-G for 146 patients was ?0.36 (P < 0.0001). The change in ESAS WB corresponding to FACT-G published minimally important difference was ?0.24 for 3, ?1.55 for 5, and ?2.87 for 7, respectively. These results suggest that the single-item measure ESAS WB best reflects the total score on the FACT-G and PWB, EWB, and FWB domains but not on the SWB domain.     

术后患者对护理行为关怀性评价分析

目的 了解术后患者对护理行为关怀性的评价.方法 使用经翻译并修订的"关怀行为评价量表"对福州某三级甲等医院术后患者就护理行为关怀性评价进行调查,并采用SPSS 11.5统计软件进行统计学分析.结果 在6个类别护理行为中,术后患者认为"满足基本需要的护理"最具有关怀性,"支持、保护、矫正性环境的提供"次之.术后患者认为最具关怀性的护理行为是"准时给患者治疗及发药":最缺乏关怀性的护理行为是"了解患者在医院以外的生活情况".不同文化程度、不同手术部位的患者,对护理行为关怀性的评价不同,差异均有统计学意义(P<0.05).结论 术后患者有其特殊性,最需要满足基本需要的护理,表达性的护理同样需要重视,只有两者结合,才能更好地为患者服务.     

QUADAS评价:一种用于诊断性研究的质量评价工具(修订版)

背景 QUADAS是一种新近发展起来的诊断性研究的质量评价工具。虽然已有系统评价采用了QUADAS,但尚未得以正式确证。本研究的目的是评价QUADAS的有效性和实用性。方法3位评价者采用QUADAS独立评价30项研究的质量。比较每位评价者的评分与最终结论之间的意见一致度。这主要是通过比较所有QUADAS条目的总分和每个单项的得分来实现的。20位曾在其系统评价中使用过QUADAS的评价者就其使用经验完成一份简短的问卷。结果就所有条目而言,每位评价者的评分与最终结论之间的意见一致度分别达到了91%、90%和85%。就单项QUADAS条目而言,一致度在50%至100%之间,中位值是90%。与难以解释的试验结果和退出病例相关的条目,评分结果差异最大。有关QUADAS内容的反馈意见普遍较好,仅少数评价者提出了有关QUADAS涵盖面、使用便利性、评分说明的清晰度及有效性方面的问题。结论QUADAS内容本身无需作大的修改。评价过程的主要困难出现在难以解释的试验结果和退出病例这2个条目的评分上。对这些条目的评分指南提出了修改意见。评价者必需根据其系统评价制定相应的评分指南,并确保所有评价者都清楚如何评分。评价者还应考虑是否所有的QUADAS条目都与其系统评价相关,以及其他质量条目是否应作为其系统评价的评价部分。     

我国关于肿瘤化疗患者预期性恶心呕吐干预性研究文献方法学质量评价

目的分析我国肿瘤化疗患者预期性恶心呕吐干预性研究的现状,为今后的研究提供依据和方向。方法以"预期性恶心呕吐"、"胃肠道反应"、"化疗"为主题词,对中国期刊全文数据库(CNKI)、万方数据库、维普数据库(VIP)及中国生物医学数据库(CBM)关于肿瘤化疗患者预期性恶心呕吐研究的护理文献检索;采用EndNote X3软件查重,对符合纳入排除标准的文献采用改良后的Jadad量表进行方法学质量评价,采用CONSORT声明2010版本对文献报告质量进行综合评价。结果共检索出10篇有关预期性恶心呕吐的干预性研究,干预方法涉及中医护理、心理干预及音乐疗法等。本次纳入的文献方法学质量极低,Jadad评分均低于2分,只有1项研究使用随机数字表进行随机分配,其他文献均只提及"随机"字样;无1篇采用分配隐藏、盲法及失访与退出的报道。纳入研究报告书写欠规范,主要体现在忽视随机方法的阐述、缺乏盲法、分配隐藏的使用、样本量无具体的估算方法、缺乏依从性、病例脱落及失访情况的分析及忽视不良反应的报告等。结论国内有关肿瘤化疗患者预期性恶心呕吐干预性研究较少;文献方法学质量较差,报告书写欠规范,因此,应加强预期性恶心呕吐干预性研究的方法学研究,注重报告的书写规范,以提高科研质量,满足循证需求。     

QUADAS的制定:用于系统评价中评价诊断性研究质量的工具

背景在以系统评价为基石的循证医学时代,需要有恰当的质量评价工具。对诊断性研究的评价目前尚缺乏系统开发且经过验证的评价工具。本研究的目的是采用共识决策法整合经验证据和专家意见,制定在系统评价时用于评价原始诊断性研究质量的工具。方法按照循证原则,我们在之前发表的3篇诊断性研究文献的综述的基础上,初选出一些条目形成列表,然后通过Delphi流程逐步调整列表,形成质量评价工具。参与Delphi流程的都是诊断性研究领域的专家。结果共有9位诊断学领域的专家参与Delphi流程。经过4轮Delphi流程后,专家们对哪些条目应纳入评价工具达成共识,我们把这个评价工具命名为QUADAS。纳入条目从最初的28个减少到14个,涵盖了疾病谱、金标准、疾病进展偏倚(disease progression bias)、证实偏倚(verification bias)、评价偏倚、临床评价偏倚、合并偏倚、试验的实施、病例退出以及不确定结果。QUADAS工具中的每个条目都配有评分细则。结论本研究项目开发出了用于诊断性试验系统评价的循证质量评价工具。下一步工作是确定其适用性和有效性。     

Creation and Critique of Studies of Diagnostic Accuracy: Use of the STARD and QUADAS Methodological Quality Assessment Tools

Abstract

Clinical special tests are a mainstay of orthopaedic diagnosis. Within the context of the evidence-based practice paradigm, data on the diagnostic accuracy of these special tests are frequently used in the decision-making process when determining the diagnosis, prognosis, and selection of appropriate intervention strategies. However, the reported diagnostic utility of these tests is significantly affected by study methodology of diagnostic accuracy studies. Methodological shortcomings can influence the outcome of such studies, and this in turn will affect the clinician's interpretation of diagnostic findings. The methodological issues associated with studies investigating the diagnostic utility of clinical tests have mandated the development of the STARD (Standards for Reporting of Diagnostic Accuracy) and QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criterion lists. The purpose of this paper is to outline the STARD and QUADAS criterion lists and to discuss how these methodological quality assessment tools can assist the clinician in ascertaining clinically useful information from a diagnostic accuracy study.     

我国天疱疮治疗性研究的文献评价

目的：了解我国天疱疮治疗性研究的一般状况,特别是RCT/CCT的现状,以及能否为临床提供可靠的研究依据.方法：按循证医学标准对4种杂志采用人工检索方法逐篇查阅,记录所有天疱疮的治疗性研究,分析其中的RCT/CCT.结果：共查阅104卷544期,纳入临床治疗性文献76篇,其中叙述性研究66篇（88.20%）,并分析了RCT/CCT共9篇.结论：我国天疱疮治疗性研究RCT/CCT的数量少、质量不理想,有待进一步研究.     

Diagnostic Accuracy of Prehospital Clinical Prediction Models to Identify Short-term Outcomes in Patients with Acute Coronary Syndromes: A Systematic Review

Background

Although cardiac risk prediction is widely used in various clinical settings, its potential role in enhancing prehospital triage is yet to be understood.

Objective

To systematically review the diagnostic accuracy of short-term clinical prediction models for potential use in a prehospital population with suspected acute coronary syndrome.

Methods

Eleven electronic medical databases were searched from 1990 to the end of August 2010 for all English-language observational and interventional studies. An online search strategy tool was used to identify grey-literature studies. Eligibility criteria were: 1) an unselected population of adult acute coronary syndrome patients; 2) recruited within the Emergency Department or Emergency Medical Services; 3) reported multivariate analysis encompassing patient history or physical examination; 4) reported short-term outcome measures; 5) were not solely computer protocols; and 6) were not reliant on tests unavailable out of the hospital. Data extraction was conducted by a single reviewer and verified by a second reviewer. Study quality was assessed independently by two reviewers using a validated quality assessment tool.

Results

A total of seven clinical prediction models were identified. Only two models reported were derived from a prehospital study population. Six clinical prediction models described good discriminate abilities (c-statistic) of 0.72 to 0.87. Among the range of independent predictors identified, electrocardiogram abnormalities, age, heart rate, and systolic blood pressure provided the strongest prognostic information.

Conclusion

The models identified provided reasonable diagnostic accuracy for determining short-term outcomes. Methodological weaknesses and variability in the populations investigated limit their use in clinical practice.