Diagnostics and Treatments of COVID-19: A Living Systematic Review of Economic Evaluations

ObjectivesAs healthcare systems continue to respond to the COVID-19 pandemic, cost-effectiveness evidence will be needed to identify which tests and treatments for COVID-19 offer value for money. We sought to review economic evaluations of diagnostic tests and treatments for COVID-19, critically appraising the methodological approaches used and reporting cost-effectiveness estimates, using a “living” systematic review approach.MethodsKey databases (including MEDLINE, EconLit, Embase) were last searched on July 12, 2021. Gray literature and model repositories were also searched. Only full economic evaluations published in English were included. Studies were quality assessed and data were extracted into standard tables. Results were narratively summarized. The review was completed by 2 reviewers independently, with disagreements resolved through discussion with a senior reviewer.ResultsOverall, 3540 records were identified, with 13 meeting the inclusion criteria. After quality assessment, 6 were excluded because of very severe limitations. Of the 7 studies included, 5 were cost-utility analyses and 2 were cost-effectiveness analyses. All were model-based analyses. A total of 5 evaluated treatments (dexamethasone, remdesivir, hypothetical) and 2 evaluated hypothetical testing strategies. Cost-effectiveness estimates were sensitive to the treatment effect on survival and hospitalization, testing speed and accuracy, disease severity, and price.ConclusionsPresently, there are few economic evaluations for COVID-19 tests and treatments. They suggest treatments that confer a survival benefit and fast diagnostic tests may be cost effective. Nevertheless, studies are subject to major evidence gaps and take inconsistent analytical approaches. The evidence may improve for planned updates of this “living” review.     

Component-Resolved Diagnosis of Hazelnut Allergy in Children

Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges.     

中医诊断的特色和优势

通过与西医诊断相比较,对中医诊断的原理与思维特点、辨证的优点与不足、辨证与辨病的结合、中医诊断研究的现状与展望等问题进行了论述,从中阐明了中医诊断的特色与优势。     

Cox模型影响点识别诊断统计量的模拟研究

目的 探讨Cox比例风险模型影响点的有效识别方法 .方法 通过Monte-Carlo模拟研究,比较了六种诊断统计量及相应诊断图对影响点的诊断效能.结果 模拟研究表明,加权score残差、似然距离和最大影响曲率及其诊断图可从模型拟合不同角度有效识别影响点.结论 影响分析应是Cox模型分析的一个重要组成部分,加权score残差、似然距离和最大影响曲率是有效识别影响点的诊断统计量.     

《实验诊断学》教材的评析与发展

本文回顾了卫生部组织编写的《诊断学》教材第1版至第6版中实验诊断篇的基本内容，介绍了其他5个版本《实验诊断学》教材的特点，提出了实验诊断学教材编写应当考虑的因素：①注重“三基”培养；②体现本学科领域的新进展；③加强双语教学；④编排内容和组织形式不断完善；⑤针对不同专业学生，教材编写应当有所侧重。     

声学密度定量技术在诊断急性期非典型川崎病中的应用

目的:探讨声学密度定量技术在诊断急性期非典型川崎病中的临床意义。方法:研究对象分3组:典型川崎病组34例(A组),非典型川崎病组31例(B组),正常对照组30例。应用HP5500型超声诊断仪测定左、右冠状动脉壁背向散射积分(IBS),以心包壁的IBS作为参照,用冠脉壁IBS和心包IBS比值作为校正值(IBS%)。结果:A组和B组的冠脉壁IBS值、IBS%值差异无显著性(P>0.05);A组和B组的冠脉壁IBS值、IBS%值均显著大于正常对照组(P<0.01),对冠脉壁IBS进行ROC分析,得到冠脉壁IBS最佳截点为41.5,据其诊断急性期川崎病的敏感性为93%,特异性为95%,准确性为94%。结论:声学密度定量技术有助于急性期川崎病的诊断,尤其对临床表现和冠脉病变不典型川崎病的诊断有重要价值。     

中医四诊信息数字化研究现状评析

本综述客观评析了中医望、闻、问、切四诊研究现状及存在问题，提出在探索四诊信息数字化研究中建立中医四诊信息规范化采集和分析的方法，完善中医四诊检测系统，建立中医四诊特征信息数据库，以及建立计算机判读量化分类方法，同时利用数据库平台对中医四诊信息进行融合分析，综合判断等构想，以获取有关中医病性、病位的客观诊断依据。     

Assessment of Rapid MinION Nanopore DNA Virus Meta-Genomics Using Calves Experimentally Infected with Bovine Herpes Virus-1

Bovine respiratory disease (BRD), which is the leading cause of morbidity and mortality in cattle, is caused by numerous known and unknown viruses and is responsible for the widespread use of broad-spectrum antibiotics despite the use of polymicrobial BRD vaccines. Viral metagenomics sequencing on the portable, inexpensive Oxford Nanopore Technologies MinION sequencer and sequence analysis with its associated user-friendly point-and-click Epi2ME cloud-based pathogen identification software has the potential for point-of-care/same-day/sample-to-result metagenomic sequence diagnostics of known and unknown BRD pathogens to inform a rapid response and vaccine design. We assessed this potential using in vitro viral cell cultures and nasal swabs taken from calves that were experimentally challenged with a single known BRD-associated DNA virus, namely, bovine herpes virus 1. Extensive optimisation of the standard Oxford Nanopore library preparation protocols, particularly a reduction in the PCR bias of library amplification, was required before BoHV-1 could be identified as the main virus in the in vitro cell cultures and nasal swab samples within approximately 7 h from sample to result. In addition, we observed incorrect assignment of the bovine sequence to bacterial and viral taxa due to the presence of poor-quality bacterial and viral genome assemblies in the RefSeq database used by the EpiME Fastq WIMP pathogen identification software.