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Systematic reviews and meta-analyses of test accuracy: developing methods that meet practitioners’ needs

Davenport, Clare Frances (2012)
Ph.D. thesis, University of Birmingham.

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Testing can be a substantial driver of health care costs. Increase in test use over recent decades has occurred despite disappointing results from test accuracy evaluations. Poor quality and reporting of primary test accuracy studies and difficulties with understanding and application of test accuracy information are purported to be important contributors to this observed evidence ‘gap’.

The objectives of this thesis were to:
* Systematically review evidence concerning the understanding and application of test accuracy metrics.
* Undertake primary research building on the review of understanding and application.
* Assess whether the contribution of test accuracy reviews to the test accuracy evidence base is compromised by deficiencies in their contextual fit, or of included primary studies.

Existing research concerned with understanding and application of test accuracy information is not driven by the needs of decision makers. Contrary to the prevailing view in the literature, findings of original research from this thesis demonstrate that probability revision is not a feature of diagnostic decision making. Choice of test accuracy metric however was shown to have a profound influence on diagnostic decision making. Deficiencies in question formulation and contextualisation of test accuracy reviews are undermining their contribution to the test accuracy evidence base.

Type of Work:Ph.D. thesis.
Supervisor(s):Hyde, Christopher and MacArthur, Christine
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Health and Population Sciences, Department of Public Health, Epidemiology and Biostatistics
Subjects:RA0421 Public health. Hygiene. Preventive Medicine
RC Internal medicine
Institution:University of Birmingham
ID Code:3427
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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