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Limiting the search date is a common approach utilised in therapeutic/interventional rapid reviews. Yet the accuracy of pooled estimates is unknown when applied to rapid reviews of diagnostic test accuracy studies. Data from all systematic reviews of diagnostic test accuracy studies published in the Cochrane Database of Systematic Reviews, until February 2022 were collected. Meta-analyses with at least five studies were included to emulate rapid reviews by limiting the search to the recent 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 35 and 40 years. The magnitude of the pooled area under the curve (AUC), sensitivity and specificity for the full meta-analysis and the rapid reviews were compared. A total of 846 diagnostic meta-analyses were included. When the search date was limited to the recent 10 and 15 years, more than 75% and 80% of meta-analyses presented less than 5% difference between the pooled AUC, sensitivity and specificity of the full meta-analysis and the rapid review. There was little gain in the precision of the pooled estimates when the emulated rapid reviews included more than 15 years in the search. Rapid reviews restricted by search date are a valid and reliable approach for diagnostic test accuracy studies. Robust evidence can be achieved by restricting the search date to the recent 10--15 years. Future studies need to examine the reduction in workload and time to finish the rapid reviews under different search date limits.

In evidence-based practice, new topics generally only have a few studies available for synthesis. As a result, the evidence of such meta-analyses raised substantial concerns. We investigated the robustness of the evidence from these earliest studies. Real-world data from the Cochrane Database of Systematic Reviews (CDSR) were collected. We emulated meta-analyses with the earliest 1 to 10 studies through cumulative meta-analysis from eligible meta-analyses. The magnitude and the direction of meta-analyses with the earliest few studies were compared to the full meta-analyses. From the CDSR, we identified 20,227 meta-analyses of binary outcomes and 7683 meta-analyses of continuous outcomes. Under the tolerable difference of 20% on the magnitude of the effects, the convergence proportion ranged from 24.24% (earliest 1 study) to 77.45% (earliest 10 studies) for meta-analyses of few earliest studies with binary outcomes. For meta-analyses of continuous outcomes, the convergence proportion ranged from 13.86% to 56.52%. In terms of the direction of the effects, even when only three studies were available at the earliest stage, the majority had the same direction as full meta-analyses; Only 19% for binary outcomes and 12% for continuous outcomes changed the direction as further evidence accumulated. Synthesizing evidence from the earliest studies is feasible to support urgent decision-making, and in most cases, the decisions would be reasonable. Considering the potential uncertainties, it is essential to evaluate the confidence of the evidence of these meta-analyses and update the evidence when necessary.

Background: The global increase in type 2 diabetes (T2D) poses a significant public health challenge worldwide. Due to the chronic and complex nature of the disease, management does not depend on pharmacotherapy alone; rather, a comprehensive medical and self-management plan is required. Diabetes Self-Management Education programs should address diabetes-specific behaviors and be grounded in patients' perceptions of their disease and its consequences. Aim: The study aims to understand perceptions of diabetes self-management (DSM) among persons of different nationalities with T2D living in Qatar. Method: A phenomenological qualitative study was implemented using four focus group interviews using Triandis Interpersonal Behavior Model to understand factors influencing DSM perceptions and behaviors. Therefore, deductive content analysis was used, also inductive content analysis used to find new emerging themes. Twenty-nine participants with T2D of 12 different nationalities were recruited. Results: Content analyses revealed that participants were mainly motivated to manage their diabetes by fear of future health complications--and the resulting impact on their families--triggered by witnessing these complications on other family members and friends. Factors that influenced DSM included cultural factors such as food content and holidays' customs, weather conditions, psychological distress, and social factors such as lack of family support. Furthermore, access to healthy food, number of working hours and time, and cost of DSM supplies were found to be among the barriers to DSM. Conclusion: Understanding and considering patients' perspectives is a core component of culturally competent and evidence-based DSM programs, and it should be considered in any DSM program.

In evidence synthesis, dealing with zero-events studies is an important and complicated task that has generated broad discussion. Numerous methods provide valid solutions to synthesizing data from studies with zero-events, either based on a frequentist or a Bayesian framework. Among frequentist frameworks, the one-stage methods have their unique advantages to deal with zero-events studies, especially for double-arm-zero-events. In this article, we give a concise overview of the one-stage frequentist methods. We conducted simulation studies to compare the statistical properties of these methods to the two-stage frequentist method (continuity correction) for meta-analysis with zero-events studies when double-zero-events studies were included. Our simulation studies demonstrated that the generalized estimating equation with unstructured correlation and beta-binomial method had the best performance among the one-stage methods. The random intercepts generalized linear mixed model showed good performance in the absence of obvious between-study variance. Our results also showed that the continuity correction with inverse-variance heterogeneous (IVhet) analytic model based on the two-stage framework had good performance when the between-study variance was obvious and the group size was balanced for included studies. In summary, the one-stage framework has unique advantages to deal with studies with zero events and is not susceptive to group size ratio. It should be considered in future meta-analyses whenever possible.

Rapid reviews have been widely employed to support timely decision-making, and limiting the search date is the most popular approach in published rapid reviews. We assessed the accuracy and workload of search date limits on the meta-analytical results to determine the best rapid strategy. The meta-analyses data were collected from the Cochrane Database of Systematic Reviews (CDSR). We emulated the rapid reviews by limiting the search date of the original CDSR to the recent 40, 35, 30, 25, 20, 15, 10, 7, 5, and 3 years, and their results were compared to the full meta-analyses. A random sample of 10% was drawn to repeat the literature search by the same timeframe limits to measure the relative workload reduction (RWR). The relationship between accuracy and RWR was established. We identified 21,363 meta-analyses of binary outcomes and 7683 meta-analyses of continuous outcomes from 2693 CDSRs. Our results suggested that under a maximum tolerance of 5% and 10% on the bias of magnitude, a limit on the recent 20 years can achieve good accuracy and at the same time save the most workload. Under the tolerance of 15% and 20% on the bias, a limit on the recent 10 years and 15 years could be considered. Limiting the search date is a valid rapid method to produce credible evidence for timely decisions. When conducting rapid reviews, researchers should consider both the accuracy and workload to make an appropriate decision.

Background Evidence about the clinical impact of rapid diagnostic tests (RDTs) for the diagnosis of bloodstream infections is limited, and whether RDT are superior to conventional blood cultures (B Cs) embedded within antimicrobial stewardship programs (ASPs) is unknown. Methods We performed network meta-analyses using results from studies of patients with bloodstream infection with the aim of comparing the clinical impact of RDT (applied on positive BC broth or whole blood) to conventional BC, both assessed with and without ASP with respect to mortality, length of stay (LOS), and time to optimal therapy. Results Eighty-eight papers were selected, including 25 682 patient encounters. There was an appreciable amount of statistical heterogeneity within each meta-analysis. The network meta-analyses showed a significant reduction in mortality associated with the use of RDT + ASP versus BC alone (odds ratio [OR], 0.72; 95% confidence interval [CI],.59–.87) and with the use of RDT + ASP versus BC + ASP (OR, 0.78; 95% CI,.63–.96). No benefit in survival was found associated with the use of RDT alone nor with BC + ASP compared to BC alone. A reduction in LOS was associated with RDT + ASP versus BC alone (OR, 0.91; 95% CI,.84–.98) whereas no difference in LOS was shown between any other groups. A reduced time to optimal therapy was shown when RDT + ASP was compared to BC alone (−29 hours; 95% CI, −35 to −23), BC + ASP (−18 hours; 95% CI, −27 to −10), and to RDT alone (−12 hours; 95% CI, −20 to −3). Conclusions The use of RDT + ASP may lead to a survival benefit even when introduced in settings already adopting effective ASP in association with conventional BC. [ABSTRACT FROM AUTHOR]

Background Bloodstream infections (BSIs) produced by antibiotic-resistant bacteria (ARB) cause a substantial disease burden worldwide. However, most estimates come from high-income settings and thus are not globally representative. This study quantifies the excess mortality, length of hospital stay (LOS), intensive care unit (ICU) admission, and economic costs associated with ARB BSIs, compared to antibiotic-sensitive bacteria (ASB), among adult inpatients in low- and middle-income countries (LMICs). Methods and findings We conducted a systematic review by searching 4 medical databases (PubMed, SCIELO, Scopus, and WHO's Global Index Medicus; initial search n = 13,012 from their inception to August 1, 2022). We only included quantitative studies. Our final sample consisted of n = 109 articles, excluding studies from high-income countries, without our outcomes of interest, or without a clear source of bloodstream infection. Crude mortality, ICU admission, and LOS were meta-analysed using the inverse variance heterogeneity model for the general and subgroup analyses including bacterial Gram type, family, and resistance type. For economic costs, direct medical costs per bed-day were sourced from WHO-CHOICE. Mortality costs were estimated based on productivity loss from years of potential life lost due to premature mortality. All costs were in 2020 USD. We assessed studies' quality and risk of publication bias using the MASTER framework. Multivariable meta-regressions were employed for the mortality and ICU admission outcomes only. Most included studies showed a significant increase in crude mortality (odds ratio (OR) 1.58, 95% CI [1.35 to 1.80], p < 0.001), total LOS (standardised mean difference 'SMD' 0.49, 95% CI [0.20 to 0.78], p < 0.001), and ICU admission (OR 1.96, 95% CI [1.56 to 2.47], p < 0.001) for ARB versus ASB BSIs. Studies analysing Enterobacteriaceae, Acinetobacter baumanii, and Staphylococcus aureus in upper-middle-income countries from the African and Western Pacific regions showed the highest excess mortality, LOS, and ICU admission for ARB versus ASB BSIs per patient. Multivariable meta-regressions indicated that patients with resistant Acinetobacter baumanii BSIs had higher mortality odds when comparing ARB versus ASB BSI patients (OR 1.67, 95% CI [1.18 to 2.36], p 0.004). Excess direct medical costs were estimated at $12,442 (95% CI [$6,693 to $18,191]) for ARB versus ASB BSI per patient, with an average cost of $41,103 (95% CI [$30,931 to $51,274]) due to premature mortality. Limitations included the poor quality of some of the reviewed studies regarding the high risk of selective sampling or failure to adequately account for relevant confounders. Conclusions We provide an overview of the impact ARB BSIs in limited resource settings derived from the existing literature. Drug resistance was associated with a substantial disease and economic burden in LMICs. Although, our results show wide heterogeneity between WHO regions, income groups, and pathogen-drug combinations. Overall, there is a paucity of BSI data from LMICs, which hinders implementation of country-specific policies and tracking of health progress., Author(s): Kasim Allel 1,2,3,4,*, Jennifer Stone 5, Eduardo A. Undurraga 4,6,7,8, Lucy Day 1, Catrin E. Moore 9, Leesa Lin 10,11,12, Luis Furuya-Kanamori 13, Laith Yakob 1,2 Introduction Antibiotic-resistant bacteria [...]

Background Casual sex during travel is a major preventable factor in the global transmission of sexually transmissible infections (STI). Pre-travel consults present an excellent opportunity for practitioners to educate travellers about sexual and reproductive health (SRH) and safety. This scoping review aims to explore and understand the extent to which SRH is included in pre-travel consultations. Methods PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline and Web of Science were systematically searched for primary research articles exploring whether health care practitioners (HCP) included SRH in pre-travel consultations. Extracted findings were synthesized and presented in narrative form. Results Findings across 13 articles suggest HCPs infrequently broached SRH in pre-travel consultations with HCP discomfort, and lack of time and resources presented as key barriers. Urban practice settings, HCP experience, training in travel medicine and traveller characteristics such as sexual orientation were positively associated with discussions about SRH. SRH advice reported was general in nature, primarily focusing on safer sex, condoms or unspecified STI advice. Risk assessments based solely on age or stereotypes around sexual preferences led to key aspects of SRH care being missed for some (e.g. SRH was less likely to be discussed with older travellers). Conclusions HCPs frequently miss opportunities to integrate SRH into pre-travel consultations. Strategies to promote HCP confidence and awareness present a promising means to boost the frequency and quality of SRH advice disseminated. Integrating culturally safe and responsive SRH history-taking and advice into pre-travel consultations may contribute to global reductions in STI transmission and promote traveller SRH well-being. [ABSTRACT FROM AUTHOR]

Background Malaria continues to pose a significant burden in endemic countries, many of which lack access to molecular surveillance. Insights from malaria cases in travellers returning to non-endemic areas can provide valuable data to inform endemic country programmes. To evaluate the potential for novel global insights into malaria, we examined epidemiological and molecular data from imported malaria cases to Australia. Methods We analysed malaria cases reported in Australia from 2012 to 2022 using National Notifiable Disease Surveillance System data. Molecular data on imported malaria cases were obtained from literature searches. Results Between 2012 and 2022, 3204 malaria cases were reported in Australia. Most cases (69%) were male and 44% occurred in young adults aged 20–39 years. Incidence rates initially declined between 2012 and 2015, then increased until 2019. During 2012–2019, the incidence in travellers ranged from 1.34 to 7.71 per 100 000 trips. Cases were primarily acquired in Sub-Saharan Africa (n  = 1433; 45%), Oceania (n  = 569; 18%) and Southern and Central Asia (n  = 367; 12%). The most common countries of acquisition were Papua New Guinea (n  = 474) and India (n  = 277). Plasmodium falciparum accounted for 58% (1871/3204) of cases and was predominantly acquired in Sub-Saharan Africa, and Plasmodium vivax accounted for 32% (1016/3204), predominantly from Oceania and Asia. Molecular studies of imported malaria cases to Australia identified genetic mutations and deletions associated with drug resistance and false-negative rapid diagnostic test results, and led to the establishment of reference genomes for P. vivax and Plasmodium malariae. Conclusions Our analysis highlights the continuing burden of imported malaria into Australia. Molecular studies have offered valuable insights into drug resistance and diagnostic limitations, and established reference genomes. Integrating molecular data into national surveillance systems could provide important infectious disease intelligence to optimize treatment guidelines for returning travellers and support endemic country surveillance programmes. [ABSTRACT FROM AUTHOR]