CHARMS and PROBAST at your fingertips:a template for data extraction and risk of bias assessment in systematic reviews of predictive models

Background: Systematic reviews of studies of clinical prediction models are becoming increasingly abundant in the literature. Data extraction and risk of bias assessment are critical steps in any systematic review. CHARMS and PROBAST are the standard tools used for these steps in these reviews of clinical prediction models. Results: We developed an Excel template for data extraction and risk of bias assessment of clinical prediction models including both recommended tools. The template makes it easier for reviewers to extract data, to assess the risk of bias and applicability, and to produce results tables and figures ready for publication. Conclusion: We hope this template will simplify and standardize the process of conducting a systematic review of prediction models, and promote a better and more comprehensive reporting of these systematic reviews

Seminari comparatiu de llibres francesos, catalans i espanyols de Ciències Socials: Continguts i Competències

El passat 26 d’octubre a la Facultat de Ciències de l’Educació i Psicologia se celebrà el “Seminari comparatiu de llibres francesos, catalans i espanyols de Ciències Socials: Continguts i Competències”, sota la coordinació del professor Antoni Gavaldà, conduït per ell mateix i per la professora francesa Nicole Darmon, de l’Ecole Aérogare de Blagnac

Consumo de micronutrientes y tumores de vías urinarias en Córdoba, Argentina.

Introducción: Los micronutrientes contenidos en los alimentos de consumo habitual integran el modelo de red causal del cáncer aunque su evaluación conjunta es compleja debido a la interdependencia en el consumo habitual. Diversos estudios reportaron que ciertos nutrientes pueden modificar el riesgo de desarrollar tumores de vías urinarias (TVU), aunque dicha evidencia es aún limitada. Objetivo: Identificar asociaciones entre el consumo de vitaminas A, E, B6, C, fósforo, selenio y zinc procedentes de la dieta, y la presencia TVU en Córdoba, Argentina, entre 1999 y 2008, considerando la multicolinealidad entre sus consumos. Métodos: Se realizó un estudio caso-control que incluyó 129 casos con TVU confirmados histopatológicamente y 257 controles. Se administró a cada sujeto un formulario de frecuencia alimentaria previamente validado. La ingesta de vitaminas A, E, B6 y C, fósforo, selenio y zinc fueron las variables de interés, presentando alta correlación entre sí y provocando colinealidad. Por ello, fueron ajustados modelos de regresión logística múltiple y su adaptación ante la presencia de correlación vía estimación Ridge, para la obtención de los odds ratio (OR), previa inclusión de las covariables sexo, edad, índice de masa corporal (IMC), estrato socioeconómico, exposición ocupacional a carcinógenos, consumo de tabaco y consumo calórico. Resultados: Las vitaminas E y B6 evidenciaron un leve efecto protector (OR: 0,943, IC 95% 0,897-0,998 y OR: 0,730, IC 95% 0,457-1,167). El selenio resultó ligeramente promotor (OR: 1,012, IC 95% 1,001-1,023). Conclusión: Considerando la multicolinealidad es posible detectar de manera más precisa la modulación que algunos micronutrientes ejercen sobre el riesgo de TVU.Fil: Román, María Dolores. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Biologia Celular; Argentina;Fil: Roqué, Florencia Inés. Universidad Nacional de Cordoba. Facultad de Medicina. Escuela de Nutrición; Argentina;Fil: Muñoz, Sonia Edith. Consejo Nacional de Invest.cientif.y Tecnicas. Centro Cientifico Tecnol.conicet - Cordoba. Instituto de Investigaciones En Ciencias de la Salud; Argentina;Fil: Andreatta, María Marta. Consejo Nacional de Invest.cientif.y Tecnicas. Centro Cientifico Tecnol.conicet - Cordoba. Centro de Investigaciones y Estudio Sobre Cultura y Sociedad; Argentina;Fil: Navarro, Alicia. Universidad Nacional de Cordoba. Facultad de Medicina. Escuela de Nutrición; Argentina;Fil: Diaz, Maria del Pilar. Consejo Nacional de Invest.cientif.y Tecnicas. Centro Cientifico Tecnol.conicet - Cordoba. Instituto de Investigaciones En Ciencias de la Salud; Argentina

Meta-DiSc 2.0:a web application for meta-analysis of diagnostic test accuracy data

BACKGROUND: Diagnostic evidence of the accuracy of a test for identifying a target condition of interest can be estimated using systematic approaches following standardized methodologies. Statistical methods for the meta-analysis of diagnostic test accuracy (DTA) studies are relatively complex, presenting a challenge for reviewers without extensive statistical expertise. In 2006, we developed Meta-DiSc, a free user-friendly software to perform test accuracy meta-analysis. This statistical program is now widely used for performing DTA meta-analyses. We aimed to build a new version of the Meta-DiSc software to include statistical methods based on hierarchical models and an enhanced web-based interface to improve user experience. RESULTS: In this article, we present the updated version, Meta-DiSc 2.0, a web-based application developed using the R Shiny package. This new version implements recommended state-of-the-art statistical models to overcome the limitations of the statistical approaches included in the previous version. Meta-DiSc 2.0 performs statistical analyses of DTA reviews using a bivariate random effects model. The application offers a thorough analysis of heterogeneity, calculating logit variance estimates of sensitivity and specificity, the bivariate I-squared, the area of the 95% prediction ellipse, and the median odds ratios for sensitivity and specificity, and facilitating subgroup and meta-regression analyses. Furthermore, univariate random effects models can be applied to meta-analyses with few studies or with non-convergent bivariate models. The application interface has an intuitive design set out in four main menus: file upload; graphical description (forest and ROC plane plots); meta-analysis (pooling of sensitivity and specificity, estimation of likelihood ratios and diagnostic odds ratio, sROC curve); and summary of findings (impact of test through downstream consequences in a hypothetical population with a given prevalence). All computational algorithms have been validated in several real datasets by comparing results obtained with STATA/SAS and MetaDTA packages. CONCLUSION: We have developed and validated an updated version of the Meta-DiSc software that is more accessible and statistically sound. The web application is freely available at www.metadisc.es

Eficacia, seguridad y utilidad de la genisteína en pacientes con síndrome de Sanfilippo

Genisteína; Síndrome de Sanfilippo; Sistema Nacional de SaludGenisteïna; Síndrome de Sanfilippo: Sistema Nacional de SalutGenistein; Sanfilippo disease; National Health SystemAntecedentes La genisteína es una terapia de reducción del sustrato propuesta para la mucopolisacaridosis tipo III (MPS III) o enfermedad de Sanfilippo. Objetivos Evaluar la eficacia, la seguridad y la utilidad de la genisteína en pacientes con MPS III con el fin de valorar la incorporación de la genisteína a la cartera común de servicios del Sistema Nacional de Salud (SNS). Métodos Revisión de la literatura científica elaborada a partir de un protocolo preespecificado, de acuerdo con directrices metodológicas estandarizadas. Informe de los hallazgos de la revisión de acuerdo con la declaración PRISMA. En enero de 2018 se diseñó y ejecutó una búsqueda en bases de datos bibliográficos, registros de estudios en curso y fuentes de información específicos de enfermedades raras. Se incluyeron estudios sin limitación de diseño en los que se evaluara el efecto de la genisteína en cualquier dosis y formato de administración en personas de cualquier edad con MPS III. A partir de dos investigadores se seleccionaron de manera independiente los estudios a incluir en el informe, y se evaluaron críticamente con herramientas de valoración del riesgo de sesgo de ensayos clínicos y de valoración de la calidad metodológica de los ensayos no controlados y estudios observacionales. Se extrajeron los datos descriptivos de los estudios y los resultados referidos a los desenlaces de interés de la revisión. Se recopilaron los hallazgos de la revisión para los principales desenlaces de interés en tablas de síntesis de la evidencia, en las que se incluyó una clasificación de la calidad de la evidencia. Finalmente, se elaboraron conclusiones sobre la inclusión de la genisteína en la cartera común de servicios del SNS junto a la identificación de lagunas de conocimiento. Resultados La búsqueda ofreció 837 referencias de las cuales se incluyeron 10 estudios (2 ensayos aleatorizados, 6 ensayos no controlados, 1 observacional no controlado y 1 reporte de caso). Los estudios incluyeron un total de 162 personas con un diagnóstico de MPS III. La mayoría de los estudios evaluaron una dosis baja de genisteína (entre los 5 y los 15 mg/kg/día) y solo dos estudios administraron una dosis alta de genisteína pura sintética (150 mg/kg/día). La duración del tratamiento fue variable en los estudios, entre 6 meses y 3 años. Todos los estudios valoraron los resultados inmediatamente después del tratamiento. Las dosis bajas de genisteína mostraron mejoras de poca o nula relevancia clínica en escalas neurocognitivas a los 12 meses de tratamiento (calidad de la evidencia muy baja, motivada por el sesgo de los estudios y la imprecisión de los resultados). Un ensayo clínico aleatorizado no mostró diferencias entre una dosis de 10 mg/kg/día de genisteína y placebo en una escala de comportamiento a los 6 meses de tratamiento, ni en ninguna de sus subescalas. Una extensión del estudio mostró que los pacientes tratados con genisteína mejoraban en la subescala de ansiedad tras un año de seguimiento (calidad de la evidencia baja, motivada por la imprecisión de los resultados y su heterogeneidad). Los estudios sobre dosis bajas de genisteína no describieron efectos adversos (calidad de la evidencia baja, motivada por el sesgo de los estudios y la imprecisión de los resultados). Un ensayo clínico no controlado no mostró diferencias en una escala de discapacidad al comparar las puntuaciones entre el inicio del estudio y las de los 12 meses de tratamiento con dosis altas de genisteína (calidad de la evidencia muy baja, motivada por el sesgo de los estudios y la imprecisión de los resultados). Este ensayo solamente registró nueve eventos adversos graves, de los cuales solo uno fue valorado como posiblemente relacionado con la genisteína. La mayoría de los eventos adversos no graves identificados se consideraron asociados con el trastorno subyacente (calidad de la evidencia baja, motivada por la imprecisión de los resultados). Conclusiones La dosis baja de genisteína ha mostrado una nula relevancia clínica mientras que los datos sobre la dosis alta son insuficientes. Los resultados consistentemente negativos sobre variables fisiológicas en las dosis bajas del tratamiento sugieren que no es apropiado realizar más estudios con estas dosis. En la actualidad está pendiente la publicación de los resultados de un ensayo clínico aleatorizado controlado con placebo (EudraCT 2013-001479- 18) de la dosis de genisteína de 150 mg/kg/día que tiene como variable principal de interés el nivel de heparán sulfato en líquido cefalorraquídeo. Si los resultados de este estudio fueran negativos, probablemente no estaría justificado seguir investigando sobre el posible beneficio del tratamiento. Aun si los resultados fueran positivos, se deberían realizar estudios adicionales que evaluaran el impacto de la dosis alta en desenlaces importantes para los pacientes, como los desenlaces comportamentales o neurocognitivos. Con los datos disponibles en la actualidad en la literatura, se concluye que la genisteína no debe incluirse en la cartera común de servicios del SNS. Con relación a la práctica clínica, se concluye que los profesionales sanitarios deberían conocer la limitada evidencia sobre el efecto de la genisteína en la MPS III e informar a las familias de personas con MPS III de la nula relevancia clínica de la dosis baja de genisteína y la ausencia de datos sobre el impacto de la dosis alta. Esta información debe servir de base para que los padres puedan tomar una decisión informada e individualizada en relación con el uso de la genisteína.Background Genistein is a substrate reduction therapy proposed for the treatment of mucopolysaccharidosis type III (MPS III), or Sanfilippo disease. Objectives To assess the efficacy, safety and usefulness of genistein in patients with MPS III in order to evaluate its possible incorporation into the service portfolio of the Spanish National Health System (NHS). Methods Review of the scientific literature based on a pre-specified protocol and following standardized methodological guidelines. The findings were reported in accordance with the PRISMA statement. In January 2018, bibliographic databases, registers of ongoing studies and specific information sources were searched for rare diseases. Studies evaluating the effect of genistein at any dose and presentation, in individuals of any age with MPS III were included, without limitations on design. Two investigators independently selected the studies to be included in the review, and evaluated them critically using a risk of bias assessment tool specific for clinical trials and a methodological quality assessment tool for uncontrolled trials and observational studies. Descriptive data from the studies and the results for the outcomes of interest of the review were extracted. The findings of the review for the main outcomes of interest are compiled in Summary of Evidence tables, which also include a classification of the quality of the evidence. Finally, the conclusions regarding the inclusion of genistein in the Spanish NHS service portfolio are presented and current knowledge gaps are identified. Results The search retrieved 837 references, from which 10 studies were included (two randomized trials, six uncontrolled clinical trials, one uncontrolled observational study and one case report). The studies included a total of 162 individuals with a diagnosis of MPS III. Most studies evaluated a low dose of genistein (between 5 and 15 mg/kg/day) and only two administered a high dose of synthetic pure genistein (150 mg/kg/day). Duration of genistein treatment in the studies varied between six months and three years, and all studies assessed the results immediately after treatment. Low doses of genistein showed improvements on neurocognitive scales of little or no clinical relevance after 12 months of treatment (very low quality of evidence, due to the methodological limitations of the studies and the imprecision of the results). A randomized clinical trial showed no difference on a behavioural scale (or on any of its subscales) between a dose of 10 mg/kg/day of genistein and placebo after six months of treatment. An extension of the study showed that patients treated with genistein presented improvements on the anxiety subscale after one year of followup (low quality of evidence, due to the imprecision of the results and their heterogeneity). Studies of low doses of genistein did not describe adverse effects (low quality of evidence, due to methodological limitations and imprecise results). An uncontrolled clinical trial did not show differences on a disability scale when comparing the change in scores between baseline and after 12 months of treatment with high doses of genistein (very low quality of evidence, due the methodological limitations of the studies and the imprecision of the results). This trial recorded only nine serious adverse events, of which only one was determined as possibly related to genistein. The majority of nonserious adverse events identified were attributed to the underlying disorder (low quality of evidence, due to the imprecision of the results). Conclusions: Low doses of genistein show no clinical relevance, while the data on high doses are insufficient. The consistently negative results for physiological variables with low doses of the treatment argue against the performance of further studies with these doses. The publication of the results of a randomized placebo-controlled clinical trial (EudraCT 2013-001479-18) testing the effects of a genistein dose of 150 mg/kg/day on the level of heparan sulfate in cerebrospinal fluid as the main variable is still pending. If the results of this study are negative, there would be no justification for continuing to investigate the possible benefits of the treatment. Even if the results were positive, additional studies would be needed to evaluate the impact of high doses on patient-important outcomes, such as behavioural or neurocognitive outcomes. Based on the data currently available in the literature, we do not support the inclusion of genistein in the Spanish NHS service portfolio. With regard to clinical practice, we conclude that health professionals should be aware of the limited evidence on the effect of genistein in MPS III; they should inform families of the lack of clinical relevance of low doses of genistein, and of the absence of data on the impact of high doses. This information should serve as a basis for parents to make an informed and individualized decision regarding its use

Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI)

Background: Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. Objectives: To determine the accuracy of the Mini Mental State Examination for the early detection of dementia in people with mild cognitive impairment. Search methods: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. Selection criteria: We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer’s dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. Data collection and analysis: We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. Main results: In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer’s disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. Authors' conclusions: Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.Fil: Arévalo Rodriguez, Ingrid. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública; EspañaFil: Smailagic, Nadja. Cambridge Institute Of Public Health; Reino UnidoFil: Roqué Figuls, Marta. Institut Dinvestigació Biomèdica Sant Pau; EspañaFil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Sanchez Perez, Erick. Hospital Infantil Universitario de San José; ColombiaFil: Giannakou, Antri. Bristol Medical School; Reino UnidoFil: Pedraza, Olga L.. Hospital Infantil Universitario de San José; ColombiaFil: Bonfill Cosp, Xavier. Universitat Autònoma de Barcelona; EspañaFil: Cullum, Sarah. University of Auckland; Nueva Zeland

Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of randomized clinical trials

Older adults; Physical activity; AdherenceAdultos mayores; Actividad física; AdherenciaAdults majors; Activitat física; AdherènciaExercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.The present study was funded by United States Department of Health & Human Services National Institutes of Health (NIH), USA, and NIH National Institute on Aging (NIA), USA, (K24 AG057728)

Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI).

BACKGROUND: Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. OBJECTIVES: To determine the diagnostic accuracy of the MMSE at various thresholds for detecting individuals with baseline MCI who would clinically convert to dementia in general, Alzheimer's disease dementia or other forms of dementia at follow-up. SEARCH METHODS: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. SELECTION CRITERIA: We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. DATA COLLECTION AND ANALYSIS: We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. MAIN RESULTS: In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. AUTHORS' CONCLUSIONS: Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia

Evaluación y abordaje de la fibromialgia: actualización de las evidencias científicas

Fibromialgia; Revisión sistemática; Guías de práctica clínicaFibromiàlgia; Revisió sistemàtica; Guies de pràctica clínicaFibromyalgia; Systematic review; Clinical Practice GuidelinesEl objetivo es desarrollar un documento de síntesis de la literatura científica que identifique, evalúe y resuma la mejor evidencia disponible referente a la FM: diagnóstico, pruebas complementarias, tratamiento. Presentar datos epidemiológicos de la FM a nivel estatal y europeo.L'objectiu és desenvolupar un document de síntesi de la literatura científica que identifiqui, avaluï i resumeixi la millor evidència disponible referent a la FM: diagnòstic, proves complementàries, tractament. Presentar dades epidemiològiques de la FM a nivell estatal i europeu.To offer a summary of the scientific literature, presenting the best available evidence regarding the diagnosis and treatment of FM and the complementary tests that should be administered. To provide epidemiological data on FM in Spain and in Europe as a whole