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Diagnostic accuracy of sonography for pleural effusion: systematic review

Question one
Paper 1: Diagnostic accuracy of sonography for pleural effusion: systematic review
Purpose of the study
The objective of the study was to examine the accuracy of sonography in the identification of pleural effusion by conducting a systematic review of secondary data. This represents the greatest level of evidence for examination on the precision of a diagnostic test (Rozycki, Pennington & Feliciano, 2001). Thoracic radiography was the primary strategy employed in the evaluation pleural effusion. A minimum of 175 milliliters of the pleural solution is critical in sensing when using the orthostatic posteroanterior radiographs. At least 75 milliliters of the liquid are required for detection when using the lateral radiographs. In this case, the fluids seem to accrue in the rear areas of the costophrenic recess (Webb & Higgins, 2004; Müller, 1993).
The method that is most sensible for identifying fluid in the pleural cavity is the lateral decubitus using horizontal beams. This can identify effusions as little as 5 milliliters (Moskowitz, Platt, Schachar & Mellins, 1973). However, not all patients are subjected to this radiographic evaluation. Patients under the intensive care unit and patients in emergency rooms who have experienced some degree of trauma (Lichtenstein et al, 2004).
Design and methodology
The study carried out systematic evaluation and review employing meta-analysis to the diagnostic precision of studies. Several researches have been conducted using different languages. The focus of these researches has been on the evaluation of precision in the identification of pleural effusions. The study used the citation standards that were perceived to be acceptable. The study calculated the tomography and drainage of the thoracic and any study that did not conform to the approved reference standards was omitted from the study. This study was carried out at the department of diagnostic imaging and subsequently at the Brazilian Cochrane center. It was also conducted in the discipline of emergency medicine and evidence based medicine. The department of medicine at the University of Sao Paulo also participated in the study (Grimberg, et al, 2010).
The studies were obtained from these sources, PubMed from the year 1966 to the year 2008; from EMBASE starting from 1980 in the year 2009; from the web science database starting from 1980 to 2008, and from the lilacs database from 1982 to 2008. The study used a general search formula, which was appropriate to the characteristics of each database, to identify researches that included the keywords and topics sonography and pleural effusion. Appropriate research references were also evaluated for potential studies. The study was carried out as a systematic review and meta-analysis of secondary data (Grimberg, et al, 2010).
Paper 2: Using Sonography to Characterize Renal Cell Carcinoma: Case Study of a Large Renal Mass
Purpose of the study
Renal cell carcinoma (RCC) accounts for about two percent of all elderly people’s malignancies and an average of about 85% of compact tumors in the kidney (Batista, et al 2009; Weinberg, 2006). However, the basic manifestations can only be revealed in about 10% of the incidents, and RCC is far more prospective to manifest with mild and nonspecific symptoms (Sadler, Anderson, Moss & Wilson, 2007). The initial treatment of choice has usually been radical nephrectomy due to the high possibility of solid masses being RCC and the high probability for metastases (Stec, et al, 2009). In the last three decades, sonography persists to assert its significance in identifying and determining renal cell carcinoma. Increased occurrence of RCC on frequent examination enhances the probability of identification of the RCC during its initial stages. This can probably lead to effective medical interventions (Singleton, 2011).
Design and methodology
The study presents a case study investigation of a clear RCC with multivariate metastases and makes use of recent literature in relation to the results of the diagnosis. The study is carried out in the form of a case study report on an elderly woman in her 60s. The woman presented herself to the family physician manifesting symptoms such as recent nausea with lack of appetite, chronic back pain, and frequent diarrhea. The lady had lost 20lbs in the recent month, and she was diagnosed with type 2 diabetes. On examination the blood tests also showed a low glomerular filtration rate (GFR) of about 29.9ml/min (MedlinePlus, 1997). A calculated tomography evaluation of the abdomen, chest, and sonogram where required (Singleton, 2011).
Question two
The paper on Diagnostic accuracy of sonography for pleural effusion: systematic review has more clinical relevance compared to the paper on Using Sonography to Characterize Renal Cell Carcinoma: Case Study of a Large Renal Mass. Notably, the former paper has a larger sample population than the second paper. This means that the findings can be widely applied to the general population unlike the second which focuses on a case study of one patient. The first paper is presented in the recommended IMRAD format while the second paper is not. The first paper is a systematic review and meta-analysis, which is the highest in the hierarchy of evidence. On the other hand, the second paper is a case study, which falls at the bottom of evidence hierarchy. Case studies are characterized by serious limitation issues which hamper their acceptance, they include lack of a control or comparioson groups and they rarely carry out retrospective reviews of the collected case notes. Systematic reviews entail a vigorous evaluation and analysis of data which tends to validate data generated as it involves the review of many documents and literature related to the subject matter. If evidence can not be measured then it ca not be validated.

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