TY - JOUR T1 - Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score JF - BMC Med Y1 - 2011 A1 - Aalbers, Jolien A1 - O'Brien, K A1 - Chan, Wai-Sun A1 - Falk, G A1 - Teljeur, C A1 - Dimitrov, B A1 - Fahey, T KW - Adult KW - Diagnosis, Differential KW - Humans KW - Pharyngitis KW - Predictive Value of Tests KW - Primary Health Care KW - Streptococcal Infections KW - Streptococcus pyogenes AB - BACKGROUND: Stratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms. METHODS: A systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used. RESULTS: A total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37). CONCLUSIONS: Individual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care. VL - 9 UR - http://www.biomedcentral.com/1741-7015/9/67 ER - TY - JOUR T1 - Injection of botulinum toxin for treatment of chronic lateral epicondylitis: systematic review and meta-analysis JF - Semin Arthritis Rheum Y1 - 2011 A1 - Galvin, R A1 - Callaghan, Claire A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Fahey, T KW - Botulinum Toxins, Type A KW - Chronic Disease KW - Databases, Bibliographic KW - Finger Injuries KW - Humans KW - Injections, Intramuscular KW - Movement KW - Neuromuscular Agents KW - Outpatients KW - Pain KW - Randomized Controlled Trials as Topic KW - Tennis Elbow KW - Treatment Outcome AB - In this article in Seminars in Arthritis and Rheumatism, Kalichman and coworkers examine the impact of the botulinum toxin injections in the management of lateral epicondylitis ( 1). We would like to add to the findings of this systematic review in 2 ways: first, we use a different method of pooling the data that allows us to present the findings in a clinically meaningful manner. Second, we also examine 2 randomized controlled trials (RCTs) that compare an active comparator to BoNT-A injections ( 2 and 3). We have summarized the 6 trials in Table 1 VL - 40 UR - http://www.sciencedirect.com/science/article/pii/S0049017211000151 IS - 6 ER - TY - Generic T1 - A systematic review of the diagnostic accuracy of signs and symptoms and the validation of the Centor score in predicting group A haemolytic streptococcal pharyngitis in adults in primary care. 12th Annual Scientific Meeting of the Association of Universi Y1 - 2009 A1 - O'Brien, K A1 - Aalbers, Jolien A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Falk, G A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/AalbersJ/Strep%20throat%20poster%20audgpi%20v2.ppt ER - TY - Generic T1 - Botulinum Toxin injection in the treatment of tennis elbow – a systematic and meta-analysis: a preliminary study. 13th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 19 March 2010, RCSI, Dublin, Irel Y1 - 2010 A1 - Callaghan, Claire A1 - Galvin, R A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/posters/TE.pdf ER - TY - Generic T1 - A Systematic Review of the diagnostic accuracy of signs and symptoms and the validation of the Centor score in predicting group A β-haemolytic streptococcal pharyngitis in adults in primary care. SAPC Conference, 8-10 July 2009, University of Dundee, UK Y1 - 2009 A1 - O'Brien, K A1 - Aalbers, Jolien A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Falk, G A1 - Teljeur, C A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/AalbersJ/Presentation%20Sore%20Throat%2015%20Jan.ppt ER - TY - Generic T1 - The effectiveness of botulinum toxin injection in the management of lateral epicondylitis: a systematic review. Irish Society of Chartered Physiotherapists conference 12 – 13 November 2010. HRB Centre for Primary Care Research., Dublin Y1 - 2010 A1 - Galvin, R A1 - Callaghan, Claire A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/HISI_RCSI_Pres.ppt ER - TY - Generic T1 - Systematic review of the diagnostic accuracy of signs & symptoms and validation of the Centor Score in predicting group A b-haemolytic streptococcal pharyngitis in adults in Primary Care. International Forum for Diagnostic, HRB Centre, Dublin Y1 - 2010 A1 - O'Brien, K A1 - Aalbers, Jolien A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Teljeur, C A1 - Falk, G A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER -