“8137944881379448Question 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). The initial strategy for the examination of pleural effusion employed was thoracic radiography. For orthostaticposteroanterior radiographs at least of 175ml of pleural liquid is required for detection. Lateral radiographs permit diagnosis with quantities commencing from 75ml because the fluids seem to accumulate in the subsequent areas of the costophrenic recess (Webb & Higgins 2004). Radiographs of the supine location reveal lower sensitivity and on occasions large effusions can be overlooked if they are bilateral (Mller 1993).
The method that is most sensible for identifying fluid in the pleural cavity is lateral decubitus using horizontal beams which can identify effusions commencing from 5ml (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. Studies were done in various languages that included Spanish Portuguese and English that assessed the accuracy of sonography for identifying pleural effusions. The study used the following 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 peoples malignancies and an average of about 85% of compact tumors in the kidney (Batista et al 2009). The basic trend of showing symptoms is flank pain hematuria and a palpable abdominal mass (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 results of RCC on frequent examination are making it more probable for RCC to be identified in its initial stages and probably more likely for 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. This is because 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. Paper one is a systematic review and meta-analysis which is the highest in the hierarchy of evidence while paper two is a case study which falls at the bottom of evidence hierarchy”

  

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