BackgroundChlamydia trachomatis(CT) andNeisseria gonorrhoeae(GC) resulted in over 200 million new sexually transmitted infections last year. Self-sampling strategies alone or combined with digital innovations (ie, online, mobile or computing technologies supporting self-sampling) could improve screening methods. Evidence on all outcomes has not yet been synthesised, so we conducted a systematic review and meta-analysis to address this limitation.MethodsWe searched three databases (period: 1 January 2000–6 January 2023) for reports on self-sampling for CT/GC testing. Outcomes considered for inclusion were: accuracy, feasibility, patient-centred and impact (ie, changes in linkage to care, first-time testers, uptake, turnaround time or referrals attributable to self-sampling).We used bivariate regression models to meta-analyse accuracy measures from self-sampled CT/GC tests and obtain pooled sensitivity/specificity estimates. We assessed quality with Cochrane Risk of Bias Tool-2, Newcastle–Ottawa Scale and Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsWe summarised results from 45 studies reporting self-sampling alone (73.3%; 33 of 45) or combined with digital innovations (26.7%; 12 of 45) conducted in 10 high-income (HICs; n=34) and 8 low/middle-income countries (LMICs; n=11). 95.6% (43 of 45) were observational, while 4.4% (2 of 45) were randomised clinical trials.We noted that pooled sensitivity (n=13) for CT/GC was higher in extragenital self-sampling (>91.6% (86.0%–95.1%)) than in vaginal self-sampling (79.6% (62.1%–90.3%)), while pooled specificity remained high (>99.0% (98.2%–99.5%)).Participants found self-sampling highly acceptable (80.0%–100.0%; n=24), but preference varied (23.1%–83.0%; n=16).Self-sampling reached 51.0%–70.0% (n=3) of first-time testers and resulted in 89.0%–100.0% (n=3) linkages to care. Digital innovations led to 65.0%–92% engagement and 43.8%–57.1% kit return rates (n=3).Quality of studies varied.DiscussionSelf-sampling had mixed sensitivity, reached first-time testers and was accepted with high linkages to care. We recommend self-sampling for CT/GC in HICs but additional evaluations in LMICs. Digital innovations impacted engagement and may reduce disease burden in hard-to-reach populations.PROSPERO registration numberCRD42021262950.
Inhalation sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain an airway independently and continuously and respond to stimulation and command. Found to be safe for use in dentistry with positive outcomes, it is used to manage anxiety in pediatric patients during procedures. Aim of our study was to determine the frequency of usage of inhalation sedation as adjunctive management technique in children by Dentists. A Cross sectional study was conducted with pre-structured questionnaire given to Pedodontists and General dental practitioners in various Dental colleges and clinics in and around Mangalore. Total sample size was 72. Data was collected and analyzed using SPSS version 17.0 with the Test of Proportions. 32 out of 72 participants were trained in usage of Inhalation Sedation, out of which 14 used it regularly. Out of the 80.56% dentists not using it, majority said that expensive equipment, increased cost of treatment and potential complications were the main reasons for not using it. 59.72% of participants wanted to gain information, knowledge and undergo training in the usage of Inhalation Sedation.58.33% agreed to use it in their future dental career. 70.83% believed that knowledge and training to use Inhalation Sedation is integral part of dental curriculum for undergraduates. This study showed willingness of the dentists to provide Inhalation Sedation as a behavior management technique to their patients. The lack of training, costly equipment, increased cost of treatment are the main barriers to providing such services to the patients.
Background Testing remains critical to controlling the COVID-19 pandemic. Antigen-detecting rapid diagnostic tests (Ag-RDTs), which can be used at the point of care, have the potential to increase access to COVID-19 testing, particularly in settings with limited laboratory capacity. This systematic review synthesized literature on specific use cases and performance of Ag-RDTs for detecting SARS-CoV-2, for the first comprehensive assessment of Ag-RDT use in real-world settings. Methods We searched three databases (PubMed, EMBASE and medRxiv) up to 12 April 2021 for publications on Ag-RDT use for large-scale screening and surveillance of COVID-19, excluding studies of only presumptive COVID-19 patients. We tabulated data on the study setting, populations, type of test, diagnostic performance, and operational findings. We assessed risk of bias using QUADAS-2 and an adapted tool for prevalence studies. Results From 4313 citations, 39 studies conducted in asymptomatic and symptomatic individuals were included. Of 39 studies, 37 (94.9%) investigated lateral flow Ag-RDTs and 2 (5.1%) investigated multiplex sandwich chemiluminescent enzyme immunoassay Ag-RDTs. Six categories of testing initiatives were identified: mass screening (n=13), targeted screening (n=11), healthcare entry testing (n=6), at-home testing (n=4), surveillance (n=4) and prevalence survey (n=1). Sensitivity and specificity values by testing category are shown in the table. Ag-RDTs were noted as convenient, easy-to-use, and low cost, with a rapid turnaround time and high user acceptability. Risk of bias was generally low or unclear across studies. Conclusion During the first year of the COVID-19 pandemic, Ag-RDTs were used across a wide range of real-world settings for screening and surveillance of COVID-19 in both symptomatic and asymptomatic individuals. Ag-RDTs were fast and simple to run, but due to their often low sensitivity, careful consideration must be given to their implementation and interpretation. Ag-RDTs have subsequently been rolled out more broadly and recommended for COVID-19 self-testing. Disclosures Talya Underwood, MPhil, Oncotherapeutics: Medical writing.
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