National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study)

Background: Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications. The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Methods/design. Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma 3 cm, located between 115 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane i

Polyp miss rate determined by tandem colonoscopy: a systematic review

BACKGROUND AND AIMS: Colonoscopy is the best available method to detect and remove colonic polyps and therefore serves as the gold standard for less invasive tests such as virtual colonoscopy. Although gastroenterologists agree that colonoscopy is not infallible, there is no clarity on the numbers and rates of missed polyps. The purpose of this systematic review was to obtain summary estimates of the polyp miss rate as determined by tandem colonoscopy. METHODS: An extensive search was performed within PUBMED, EMBASE, and the Cochrane Library databases to identify studies in which patients had undergone two same-day colonoscopies with polypectomy. Random effects models based on the binomial distribution were used to calculate pooled estimates of miss rates. RESULTS: Six studies with a total of 465 patients could be included. The pooled miss rate for polyps of any size was 22% (95% CI: 19-26%; 370/1,650 polyps). Adenoma miss rate by size was, respectively, 2.1% (95% CI: 0.3-7.3%; 2/96 adenomas > or =10 mm), 13% (95% CI: 8.0-18%; 16/124 adenomas 5-10 mm), and 26% (95% CI: 27-35%; 151/587 adenomas 1-5 mm). Three studies reported data on nonadenomatous polyps: zero of eight nonadenomatous polyps > or =10 mm were missed (0%; 95% CI: 0-36.9%) and 83 of 384 nonadenomatous polyps or =10 mm, but the miss rate increases significantly in smaller sized polyps. The available evidence is based on a small number of studies with heterogeneous study designs and inclusion criteri

Investment needs to achieve SDGs: An overview

Estimating the investments needed to achieve the Sustainable Development Goals (SDGs) is key to mobilising the financial resources to achieve them. Despite an increasing body of research to estimate the capital and operational costs towards achieving various related SDG targets individually and collectively, an overview of the total estimated investment needs at the global scale has not been conducted since the adoption of SDGs in 2015. This study provides such an overview. Estimates for investment needs are found for nine goals: SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 4 (quality education), SGD 6 (clean water and sanitation), SDG7 (access to energy), SDG 9 (infrastructure), SDG 13 (climate action), SDG 14 (life below water), and SDG 15 (life on land). The reviewed studies vary significantly in terms of applied methodology, the assumed targets that need to be achieved, and presented estimates, but overall they indicate significantly higher investment needs to achieve all covered SDGs than previous estimates suggest. For most SDGs, annual investment needs are in the order of hundreds of billion USD annually, and for SDG6 and SDG13 estimates of a trillion or more are reported

Evidence of bias and variation in diagnostic accuracy studies

BACKGROUND: Studies with methodologic shortcomings can overestimate the accuracy of a medical test. We sought to determine and compare the direction and magnitude of the effects of a number of potential sources of bias and variation in studies on estimates of diagnostic accuracy. METHODS: We identified meta-analyses of the diagnostic accuracy of tests through an electronic search of the databases MEDLINE, EMBASE, DARE and MEDION (1999-2002). We included meta-analyses with at least 10 primary studies without preselection based on design features. Pairs of reviewers independently extracted study characteristics and original data from the primary studies. We used a multivariable meta-epidemiologic regression model to investigate the direction and strength of the association between 15 study features on estimates of diagnostic accuracy. RESULTS: We selected 31 meta-analyses with 487 primary studies of test evaluations. Only 1 study had no design deficiencies. The quality of reporting was poor in most of the studies. We found significantly higher estimates of diagnostic accuracy in studies with nonconsecutive inclusion of patients (relative diagnostic odds ratio [RDOR] 1.5, 95% confidence interval [CI] 1.0-2.1) and retrospective data collection (RDOR 1.6, 95% CI 1.1-2.2). The estimates were highest in studies that had severe cases and healthy controls (RDOR 4.9, 95% CI 0.6-37.3). Studies that selected patients based on whether they had been referred for the index test, rather than on clinical symptoms, produced significantly lower estimates of diagnostic accuracy (RDOR 0.5, 95% CI 0.3-0.9). The variance between meta-analyses of the effect of design features was large to moderate for type of design (cohort v. case-control), the use of composite reference standards and the use of differential verification; the variance was close to zero for the other design features. INTERPRETATION: Shortcomings in study design can affect estimates of diagnostic accuracy, but the magnitude of the effect may vary from one situation to another. Design features and clinical characteristics of patient groups should be carefully considered by researchers when designing new studies and by readers when appraising the results of such studies. Unfortunately, incomplete reporting hampers the evaluation of potential sources of bias in diagnostic accuracy studie