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Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can—and often does—lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use.

‘Third wave’ cognitive-behavioral therapies have given a boost to the study of resilience factors, such as self-compassion. To get an indication of the potential clinical relevance of self-compassion for somatoform disorder, this study examined whether self-compassion in patients with somatoform disorder is lower than in the general population, and whether self-compassion is associated with number of symptoms and health-related quality of life. Two-hundred-and-thirty-six participants with somatoform disorder and 236 subjects from the general population, matched on sex and age, filled out questionnaires regarding self-compassion (SCS), number of symptoms (PSC) and health-related quality of life (EQ-5D). The difference in self-compassion between the patient group (Mean 3.53, SD 0.96) and the general population (Mean 4.16, SD 0.98) was significant with a medium effect size (d = −0.65). Multiple regression analyses showed that having a somatoform disorder and low self-compassion were independently associated with number of symptoms and reduced health-related quality of life. The lower level of self-compassion in somatoform disorder and its association with more physical symptoms and lower health-related quality of life, indicate that self-compassion is a potential clinically relevant factor that may influence therapy outcome and that can be a therapeutic target in patients with somatoform disorder.

Item does not contain fulltext AIMS: Preoperative nasal Staphylococcus aureus screening and eradication reduces surgical site infections (SSIs) but its impact on reducing early prosthetic joint infection (PJI) remains controversial. This study aims to assess the effect of preoperative nasal S. aureus screening and eradication on the incidence of early PJI in general and S. aureus-induced early PJI. METHODS: All primary total hip arthroplasties (THA) and total knee arthroplasties (TKA) performed from January 2006 to April 2018 were retrospectively reviewed for the incidence of early PJI. Demographic parameters, risk factors for PJI (American Society of Anaesthesiologists classification, body mass index, smoking status, and diabetes mellitus) and implant types were collected. A preoperative screening and eradication protocol for nasal colonization of S. aureus was introduced in October 2010. The incidence of early PJI was compared before and after the implementation of the protocol. Missing data were imputed via multiple imputation by chained equations. Inverse probability weighting was used to account for differences between patients in both groups. Weighted univariate logistic regression was used to evaluate the incidence of early PJI for both groups. RESULTS: In total, 10,486 THAs and TKAs were performed in the research period. After exclusion, a cohort of 5,499 screened cases and 3,563 non-screened cases were available for analysis. Overall, no significant reduction in early PJI was found in the screened group (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.55 to 1.11; p = 0.173). However, the incidence of S. aureus-induced PJI was significantly reduced (OR 0.58, 95% CI 0.36 to 0.92; p = 0.027) in the screened group. CONCLUSION: A preoperative nasal S. aureus screening and eradication protocol did not significantly reduce the overall incidence of early PJI after THA or TKA. However, a decreased incidence of S. aureus-induced early PJI was established. These findings can help to establish better consensus around the value of these screening protocols. Cite this article: Bone Joint J 2020;102-B(10):1341-1348.

Trabajo presentado en la 2nd European conference on Xylella fastidiosa (how research can support solutions), celebrada en Ajaccio el 29 y 30 de octubre de 2019., Official surveillance of the Xylella fastidiosa(Xf) epidemic in Apulia shows how its front has moved northwards since 2013. However, assessing and modelling the impact of Xf remains difficult because little is known about the damage to the landscape behind the front lines.Sentinel-2 andother satellite sensors provide images of the Earth in wavelengths that are sensitive to the vegetation condition. To test their suitability for Xf damage mapping, we created a model that relies on the shift that Xf-affected olive orchards undergo from a tree-dominated landscape to one dominated by shallow-rooted, short-statured vegetation. This transition changes the way gross primary productivity, as approximated by vegetation indices, responds to meteorological conditions. Insituestimates made by plant pathologists in olive orchards confirmed that a new method based on satellite and meteorological data detected Xf damage severity (R2 = 0.6). Furthermore, this method can be used to map Xf damage every year across Apulia.We then tallied the individual olive trees lost since the first detection of Xf in 2013. We used aerial photographs from the summer of 2013 to delineate each olive tree in the region and photos of 2015 and 2018 to determine how many of them are now crownless, or gone altogether. We trained a Mask Region Convoluted Neural Network to delineate individual olive tree crowns in the 4-band photographs and it proved capable of accurately identifying crowns, irrespective of their size, shapes, proximity to neighbouring trees, or image resolution.Our results provide a unique view on the spread of Xf in Apulia over the past five years, a means of systematically monitoring Xf damage across orchards, and an estimate of the number of olive trees lost thus far. It illustrates how remote sensing can provide a quantitative baseline for addressing the environmental and economic damage of Xf.