Ensuring test evaluation research is applicable in practice: investigating the effects of routine data on the validity of test accuracy meta-analyses

确保测试评估研究在实践中适用：调查常规数据对测试准确性荟萃分析有效性的影响

• 批准号: MR/N007999/1
• 负责人: Brian Harvey Willis
• 金额: $ 110.9万
• 依托单位: University of Birmingham
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN007999%2F1
• 关键词: Ensuring; test; evaluation; research; applicable

Diagnosis is a difficult process. A patient who presents to their doctor ill will often undergo a process which involves being asked questions, observed, examined and perhaps even having blood or imaging 'tests'. Each question asked or observation made is either a diagnostic test in its own right or part of one and is a necessary part of arriving at a diagnosis.But some tests are better than others and importantly probably no test is 100% accurate. Sometimes a test result may suggest a patient has normal health when they actually have disease or have disease when they have normal health. This happens to all tests and diagnostic test accuracy research is aimed at evaluating how often this happens, in other words, determining how accurate tests are.Essentially when a clinician decides upon a diagnosis they are consciously or otherwise invoking a probabilistic process where multiple tests are combined and the patient's diagnosis should be the one most probable given the combination of all the test results. However, for this process to be truly beneficial to the patient the clinician needs to know the accuracy of each of these tests and how likely the patient has disease before the diagnostic process has even started.This is where the difficulty lies for those who practise evidence-based medicine. Although the accuracy of many tests has been estimated by research studies, for individual tests the accuracy may vary significantly between studies. This variation may depend on who is applying the test, how it is being applied, which patient it is being applied to and most significantly of all, how the accuracy was measured in the study. When there are several studies there are methods which allow us to combine their results. These methods may also help determine the real reasons why the test's accuracy varies. However, in general, the studies report insufficient data of sufficient quality to enable such analyses to be either possible or comprehensive. Furthermore, from previous work, we have been able to demonstrate that in some cases the test accuracy reported by a study may be virtually impossible in some patient settings. This creates a problem for the doctor. How do they know which estimate of a test's accuracy to use if it varies greatly between studies and risks being nearly impossible for their own practice?We have already begun to develop methods which make it possible to determine whether results from a test study are likely to accurately represent a doctor's practice in general. This would mean that a doctor could confidently apply the research to their own practice without reservation. However, sometimes the research is not reflective of the different clinical settings seen in practice and a more specific solution is required. This may be done by collecting routine data from the doctor's own setting and using it to determine a feasible range of values for the test's accuracy. This method, in its current form, is used to exclude the studies 'least likely' to derive a plausible estimate of a test's accuracy for the doctor in their own practice.At the moment both methods are in development but potentially could be implemented into the real-world and used to improve diagnosis. There are clear patient benefits to improving diagnostic performance including reducing the number of patients treated unnecessarily and increasing the number treated appropriately. One of the aims of this research is to pilot integrating this method into General Practice to help diagnose infection. This could also help reduce the potential for antibiotic resistance by reducing the number of antibiotics prescribed inappropriately.However, before this is done the methods need to be fully investigated to determine their utility and limitations. It may be that other approaches afford greater patient benefit, and an evaluation of these with the methods already described, will be the focus of the proposed research.

诊断是一个艰难的过程。一个向医生提出生病的病人通常会经历一个过程，包括被问问题，观察，检查，甚至可能有血液或成像“测试”。每一个问题的提出或观察，要么是一个诊断测试本身的权利或一部分，是一个必要的一部分，以达到诊断。但有些测试比其他更好，重要的是可能没有测试是100%准确。有时测试结果可能表明病人有正常的健康，当他们实际上有疾病或有疾病时，他们有正常的健康。这发生在所有测试和诊断测试准确性研究的目的是评估这种情况发生的频率，换句话说，确定测试的准确性。本质上，当临床医生决定诊断时，他们有意识地或以其他方式调用概率过程，其中多个测试组合，患者的诊断应该是所有测试结果组合中最有可能的一个。然而，为了使这一过程真正对患者有益，临床医生需要在诊断过程开始之前就知道每一项检查的准确性以及患者患病的可能性。这就是循证医学的难点所在。虽然许多测试的准确性已经通过研究进行了估计，但对于单个测试，准确性在研究之间可能会有很大差异。这种变化可能取决于谁在应用测试，如何应用，应用于哪个患者，最重要的是，如何在研究中测量准确性。当有多项研究时，有一些方法可以让我们将它们的结果联合收割机。这些方法还可能有助于确定测试准确性变化的真实的原因。然而，总的来说，研究报告的数据质量不高，不足以使这种分析成为可能或全面。 此外，从以前的工作中，我们已经能够证明，在某些情况下，在某些患者环境中，研究报告的测试准确性实际上是不可能的。这给医生带来了麻烦。如果不同研究之间的准确性差异很大，而且他们自己的实践几乎不可能，他们如何知道使用哪个测试的准确性估计？我们已经开始研究一些方法，以便能够确定一项试验研究的结果是否可能准确地代表一名医生的一般做法。这意味着医生可以毫无保留地将研究应用于自己的实践。然而，有时研究并不能反映实践中看到的不同临床环境，需要更具体的解决方案。这可以通过从医生自己的设置中收集常规数据并使用它来确定测试准确度的可行范围来完成。这种方法，在其目前的形式，是用来排除研究“最不可能”得出一个合理的估计测试的准确性，为医生在自己的实践中.目前这两种方法都在开发中，但潜在的可以实施到现实世界中，并用于提高诊断.改善诊断性能对患者有明显的益处，包括减少不必要治疗的患者数量和增加适当治疗的患者数量。这项研究的目的之一是将这种方法整合到全科实践中，以帮助诊断感染。这也可以通过减少不适当的抗生素处方数量来帮助减少抗生素耐药性的可能性。然而，在此之前，需要对这些方法进行充分的研究，以确定它们的实用性和局限性。其他方法可能会给患者带来更大的益处，并且使用已经描述的方法对这些方法进行评估将是拟议研究的重点。

项目成果

Factors predicting statin prescribing for primary prevention: a historical cohort study.

• DOI: 10.3399/bjgp20x714065
• 发表时间: 2021
• 期刊: The British journal of general practice : the journal of the Royal College of General Practitioners
• 作者: Finnikin S;Willis BH;Ryan R;Evans T;Marshall T
• 通讯作者: Marshall T

Optimising a coordinate ascent algorithm for the meta-analysis of test accuracy studies

优化坐标上升算法以进行测试精度研究的荟萃分析

• DOI: 10.1101/2022.12.05.519131
• 发表时间: 2022
• 作者: Baragilly M

Risk of developing gallbladder cancer in patients with gallbladder polyps detected on transabdominal ultrasound: a systematic review and meta-analysis

经腹超声检测胆囊息肉患者患胆囊癌的风险：系统评价和荟萃分析

• DOI: 10.1259/bjr.20220152
• 发表时间: 2022
• 期刊: The British Journal of Radiology
• 作者: Foley K

Type 1 diabetes mellitus and risk of incident epilepsy: a population-based, open-cohort study.

• DOI: 10.1007/s00125-016-4142-x
• 发表时间: 2017-03
• 期刊: Diabetologia
• 影响因子: 8.2
• 作者: Dafoulas GE;Toulis KA;Mccorry D;Kumarendran B;Thomas GN;Willis BH;Gokhale K;Gkoutos G;Narendran P;Nirantharakumar K
• 通讯作者: Nirantharakumar K

Clustering functional data using forward search based on functional spatial ranks with medical applications.

• DOI: 10.1177/09622802211002865
• 发表时间: 2022-01
• 期刊: Statistical methods in medical research
• 影响因子: 2.3
• 作者: Baragilly M;Gabr H;Willis BH
• 通讯作者: Willis BH