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Diagnosis In General Practice: Using Probabilistic Reasoning, Jenny Doust
Diagnosis In General Practice: Using Probabilistic Reasoning, Jenny Doust
Jenny Doust
Diagnostic tests—whether clinical signs, imaging, or laboratory tests—are imperfect: there is always a possibility that test results are inaccurate and our diagnosis is wrong. However, we need to make decisions about whether to treat or not to treat patients, and so we need to feel confident that our diagnosis is above a certain threshold before we decide to treat a patient and below a certain threshold if we decide to withhold treatment. The threshold depends on the disease and the potential harms and benefits of treating or not treating patients. Unless we have clear strategies to cope with the uncertainties …
Evaluating Diagnostic Tests—Should The Same Methods Apply?, Jenny Doust, Jonathon Craig
Evaluating Diagnostic Tests—Should The Same Methods Apply?, Jenny Doust, Jonathon Craig
Jenny Doust
It is now accepted wisdom by regulators, purchasers, journal editors, and clinicians that the true effects of health care interventions can only be evaluated by well-designed randomized controlled trials. The study by Rutten et al,¹ reports the results of a randomized controlled trial of N-terminal pro-brain natriuretic peptide in an emergency department in the Netherlands. Given that this is the third randomized controlled trial assessing the effectiveness and cost effectiveness of a natriuretic peptide in an emergency department setting,²,³ it is important to ask whether diagnostic tests should always be evaluated by randomized controlled trials or are other study types …
Acute Respiratory Infections, Sharon Sanders, Jenny Doust, Chris Del Mar
Acute Respiratory Infections, Sharon Sanders, Jenny Doust, Chris Del Mar
Jenny Doust
Extract: Acute respiratory infections may be classified in several different ways: by their symptoms (fever, sore throat, cough, ear pain, runny nose); by their clinical manifestations (coryza, pharyngitis, tonsillitis, epiglottitis, otitis media, influenza, bronchitis, pneumonia); or by causative organism. Furthermore, their symptoms and sometimes the whole clinical picture may be shared by conditions that are not infections (asthma, allergic rhinitis). Some of this complexity is shown in Figure 46.1. Elucidating the exact location or responsible organism is usually clinically unhelpful. In this chapter, we focus on diagnostic questions that have the greatest impact on the patient with an acute respiratory …
Why Do Doctors Use Treatments That Do Not Work? For Many Reasons - Including Their Inability To Stand Idle And Do Nothing., Jenny Doust, Chris Del Mar
Why Do Doctors Use Treatments That Do Not Work? For Many Reasons - Including Their Inability To Stand Idle And Do Nothing., Jenny Doust, Chris Del Mar
Jenny Doust
Why do we still use ineffective treatments? One reason is that our expectations for the benefits of treatment are too high. Also clinical experience can be a poor judge of what does and does not work - hence the need for randomised controlled trials. Even when empiricism is satisfied we can be misled by looking at the wrong outcome. Indeed some treatments have harms that outweigh their benefits and are not evident in trials. Much of the clinical examination and diagnostic testing is more of a ritual than diagnostically useful. Doctors must be willing to continually question their own managements …
Check Unit: Evidence Based Medicine, Chris Del Mar, Jenny Doust
Check Unit: Evidence Based Medicine, Chris Del Mar, Jenny Doust
Jenny Doust
Extract: This is an updated version of an original check unit on evidence based medicine (EBM) written by Chris Del Mar, Paul Glasziou and Chris Silagy in 1999. Our aim for this unit is to present a practical strategy in learning to use EBM in our every day practice. To practise EBM means to make clinical decisions based on the best evidence currently available. It sounds simple, however, the ‘devil’ is in the detail! Exactly how do we go about it? On completion of this unit we hope that participants will: • appreciate the role that EBM can play in …
Systematic Review And Individual Patient Data Meta-Analysis Of Diagnosis Of Heart Failure, With Modelling Of Implications Of Different Diagnostic Strategies In Primary Care, J. Mant, J. Doust, A. Roalfe, P. Barton, M. Cowie, P. Glasziou, D. Mant, R. Mcmanus, R. Holder, J. Deeks, K. Fletcher, M. Qume, S. Sohanpal, S. Sanders, F. Hobbs
Systematic Review And Individual Patient Data Meta-Analysis Of Diagnosis Of Heart Failure, With Modelling Of Implications Of Different Diagnostic Strategies In Primary Care, J. Mant, J. Doust, A. Roalfe, P. Barton, M. Cowie, P. Glasziou, D. Mant, R. Mcmanus, R. Holder, J. Deeks, K. Fletcher, M. Qume, S. Sohanpal, S. Sanders, F. Hobbs
Jenny Doust
Objectives: To assess the accuracy in diagnosing heart failure of clinical features and potential primary care investigations, and to perform a decision analysis to test the impact of plausible diagnostic strategies on costs and diagnostic yield in the UK health-care setting. Data sources: MEDLINE and CINAHL were searched from inception to 7 July 2006. ‘Grey literature’ databases and conference proceedings were searched and authors of relevant studies contacted for data that could not be extracted from the published papers. Review methods: A systematic review of the clinical evidence was carried out according to standard methods. Individual patient data (IPD) analysis …