scholarly journals Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

2012 ◽  
Vol 58 (12) ◽  
pp. 1636-1643 ◽  
Author(s):  
Patrick MM Bossuyt ◽  
Johannes B Reitsma ◽  
Kristian Linnet ◽  
Karel GM Moons
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Clinical Utility ◽  
Randomized Clinical Trials ◽  
Diagnostic Testing ◽  
Daily Practice ◽  
Technical Performance ◽  
Management Actions ◽  
Negative Results ◽  
Definition Of

Abstract Like any other medical technology or intervention, diagnostic tests should be thoroughly evaluated before their introduction into daily practice. Increasingly, decision makers, physicians, and other users of diagnostic tests request more than simple measures of a test's analytical or technical performance and diagnostic accuracy; they would also like to see testing lead to health benefits. In this last article of our series, we introduce the notion of clinical utility, which expresses—preferably in a quantitative form—to what extent diagnostic testing improves health outcomes relative to the current best alternative, which could be some other form of testing or no testing at all. In most cases, diagnostic tests improve patient outcomes by providing information that can be used to identify patients who will benefit from helpful downstream management actions, such as effective treatment in individuals with positive test results and no treatment for those with negative results. We describe how comparative randomized clinical trials can be used to estimate clinical utility. We contrast the definition of clinical utility with that of the personal utility of tests and markers. We show how diagnostic accuracy can be linked to clinical utility through an appropriate definition of the target condition in diagnostic-accuracy studies.

Translation: Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

2013 ◽  
Vol 3 (4) ◽  
pp. 269
Author(s):  
Patrick M.M. Bossuyt ◽  
Johannes B. Reitsma ◽  
Kristian Linnet ◽  
Karel G.M. Moons
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Clinical Utility

scholarly journals Use & Misuse of Water-filtered Tobacco Smoking Pipes in the World. Consequences for Public Health, Research & Research Ethics

2015 ◽  
Vol 9 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Kamal Chaouachi
Keyword(s):  
Public Health ◽  
Tobacco Smoking ◽  
Real Life ◽  
Great Majority ◽  
Daily Practice ◽  
Public Health Research ◽  
Global Epidemic ◽  
Negative Results ◽  
Definition Of ◽  
Meta Analyses

Background: The traditional definition of an “epidemic” has been revisited by antismoking researchers. After 400 years, Doctors would have realized that one aspect of an ancient cultural daily practice of Asian and African societies was in fact a “global “epidemic””. This needed further investigation particularly if one keeps in his mind the health aspects surrounding barbecues. Method: Here, up-to-date biomedical results are dialectically confronted with anthropological findings, hence in real life, in order to highlight the extent of the global confusion: from the new definition of an “epidemic” and “prevalence” to the myth of “nicotine “addiction”” and other themes in relation to water filtered tobacco smoking pipes (WFTSPs). Results: We found that over the last decade, many publications, -particularly reviews, “meta-analyses” and “systematic reviews”- on (WFTSPs), have actually contributed to fuelling the greatest mix-up ever witnessed in biomedical research. One main reason for such a situation has been the absolute lack of critical analysis of the available literature and the uncritical use of citations (one seriously flawed review has been cited up to 200 times). Another main reason has been to take as granted a biased smoking robot designed at the US American of Beirut whose measured yields of toxic chemicals may differ dozens of times from others' based on the same “protocol”. We also found that, for more than one decade, two other main methodological problems are: 1) the long-lived unwillingness to distinguish between use and misuse; 2) the consistent unethical rejection of biomedical negative results which, interestingly, are quantitatively and qualitatively much more instructive than the positive ones. Conclusion: the great majority of WFTSP toxicity studies have actually measured, voluntarily or not, their misuse aspects, not the use in itself. This is in contradiction with both the harm reduction and public health doctrines. The publication of negative results should be encouraged instead of being stifled.

scholarly journals Rational use of diagnostic tests for clinical decision making

2019 ◽  
Vol 65 (3) ◽  
pp. 452-459 ◽  
Author(s):  
Anna Maria Buehler ◽  
Bruna de Oliveira Ascef ◽  
Haliton Alves de Oliveira Júnior ◽  
Cleusa Pinheiro Ferri ◽  
Jefferson Gomes Fernandes
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Cross Sectional ◽  
Rational Use ◽  
Cross Sectional Design ◽  
The Impact

SUMMARY OBJECTIVE: To assist clinicians to make adequate interpretation of scientific evidence from studies that evaluate diagnostic tests in order to allow their rational use in clinical practice. METHODS: This is a narrative review focused on the main concepts, study designs, the adequate interpretation of the diagnostic accuracy data, and making inferences about the impact of diagnostic testing in clinical practice. RESULTS: Most of the literature that evaluates the performance of diagnostic tests uses cross-sectional design. Randomized clinical trials, in which diagnostic strategies are compared, are scarce. Cross-sectional studies measure diagnostic accuracy outcomes that are considered indirect and insufficient to define the real benefit for patients. Among the accuracy outcomes, the positive and negative likelihood ratios are the most useful for clinical management. Variations in the study's cross-sectional design, which may add bias to the results, as well as other domains that contribute to decreasing the reliability of the findings, are discussed, as well as how to extrapolate such accuracy findings on impact and consequences considered important for the patient. Aspects of costs, time to obtain results, patients’ preferences and values should preferably be considered in decision making. CONCLUSION: Knowing the methodology of diagnostic accuracy studies is fundamental, but not sufficient, for the rational use of diagnostic tests. There is a need to balance the desirable and undesirable consequences of tests results for the patients in order to favor a rational decision-making approach about which tests should be recommended in clinical practice.

scholarly journals Clinical Use of Improved Diagnostic Testing for Detection of Prion Disease

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 789
Author(s):  
Mark P. Figgie ◽  
Brian S. Appleby
Keyword(s):  
Diagnostic Accuracy ◽  
Prion Disease ◽  
Clinical Utility ◽  
Prion Diseases ◽  
Diagnostic Testing ◽  
High Sensitivity ◽  
Clinical Use ◽  
Laboratory Markers ◽  
Disease Subtypes ◽  
Prognostic Data

Prion diseases are difficult to recognize as many symptoms are shared among other neurologic pathologies and the full spectra of symptoms usually do not appear until late in the disease course. Additionally, many commonly used laboratory markers are non-specific to prion disease. The recent introduction of second-generation real time quaking induced conversion (RT-QuIC) has revolutionized pre-mortem diagnosis of prion disease due to its extremely high sensitivity and specificity. However, RT-QuIC does not provide prognostic data and has decreased diagnostic accuracy in some rarer, atypical prion diseases. The objective of this review is to provide an overview of the current clinical utility of fluid-based biomarkers, neurodiagnostic testing, and brain imaging in the diagnosis of prion disease and to suggest guidelines for their clinical use, with a focus on rarer prion diseases with atypical features. Recent advancements in laboratory-based testing and imaging criteria have shown improved diagnostic accuracy and prognostic potential in prion disease, but because these diagnostic tests are not sensitive in some prion disease subtypes and diagnostic test sensitivities are unknown in the event that CWD transmits to humans, it is important to continue investigations into the clinical utility of various testing modalities.

scholarly journals Yield and Cost of Individual Common Diagnostic Tests in New Primary Care Outpatients in Japan

2002 ◽  
Vol 48 (1) ◽  
pp. 42-54 ◽  
Author(s):  
Yuzuru Takemura ◽  
Haku Ishida ◽  
Yuji Inoue ◽  
J Robert Beck
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
Cost Savings ◽  
Clinical Pathology ◽  
Panel Testing ◽  
Occult Disease ◽  
Definition Of ◽  
The Cost

Abstract Background:Appropriate diagnostic testing involves considerations of cost-effectiveness. We examined the cost-effectiveness of individual tests in a panel of tests defined by the Japan Society of Clinical Pathology. Methods: We studied 540 new, symptomatic primary care outpatients with a set of 30 common diagnostic tests [the Essential Laboratory Tests (2); ELT(2) panel] for clinical evaluation and identification of occult disease. A useful result (UR) of testing was defined as a finding that contributed to a change in a physician’s diagnosis or decision-making relating to a “tentative initial diagnosis” obtained from history and physical examination alone. Results: The ELT(2) panel testing yielded 398 URs and uncovered 261 occult diseases among 540 patients. In total, 1592 tests contributed to either UR-generation or discovery of occult disease. The cost per effective test (cost required per test that contributed to either definition of effectiveness) ranged from ¥108 (∼US$0.92) for total cholesterol to ¥6200 (∼$52.50) for chest x-ray. Contribution rates and the cost per effective test varied among disease categories. We restructured panel components considering the effectiveness of each test. Subsets of the ELT(2) would have improved cost-effectiveness and achieved cost savings in five of eight disease categories. Conclusions: Assembly of tests based on cost-effectiveness can improve clinical efficiency and decrease total cost of panel testing for selected patient groups.

Problems in English Communicating Skills for Learners of English

2018 ◽  
Vol 9 (07) ◽  
pp. 20484-20491
Author(s):  
Dr. Ishag Adam Hassan Ahmed
Keyword(s):  
Reading Comprehension ◽  
English Language ◽  
Communicative Competence ◽  
Daily Practice ◽  
Small Component ◽  
Curriculum Review ◽  
Comprehension Skills ◽  
Definition Of ◽  
The University ◽  
Reading Comprehension Skills

This paper is devoted to presenting the methods in English communicating skills for Learners of English in general and the problems specific to University of Bahri. English language major’s graduates then; it discusses the notion of communicative competence, and defines strategic competence. It also briefly deals with the various definitions of communication strategies and taxonomies of conversation strategies. Also, I give brief definition of the word conversation, that is the act of talking together or exchange ideas, opinions, skills, and information. As accustomed, speaking is natural and automatic but communication is an art which must be learned and practiced. Also the aim of this paper is to present you with suitable suggestions about how you can solve problems while reading English? In order to comply with this objective: we considered two variables. The first one is that within our daily practice at the university we have students with different abilities while reading English. Therefore, we need to help them increase the ability in reading comprehension. However, we don’t have enough teachers and needed resources to supply them with the help they need. The second variable is related to the fact that at University there are different centers where the students’ skills can improve and their reading comprehension skills deficiencies could be overcome by getting help from the teachers. This study is small component of a larger curriculum review exercise. The findings of study in general suggest that both students and English language lecturers were in agreement that Sudanese students had a problem in writing and speaking English and due to that the conversational problems are raised.      Finally, the paper concludes by representing the pedagogical implications of conversation strategies.

The role of serum periostin in the diagnosis of asthma: A meta-analysis

2020 ◽  
Vol 41 (4) ◽  
pp. 240-247
Author(s):  
Lei Yang ◽  
Qingtao Zhao ◽  
Shuyu Wang
Keyword(s):  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Summary Receiver Operating Characteristic ◽  
True Negative ◽  
Negative Results ◽  
Noninvasive Biomarker ◽  
Sensitivity Specificity ◽  
Serum Periostin

Background: Serum periostin has been proposed as a noninvasive biomarker for asthma diagnosis and management. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. Methods: This meta-analysis aimed to evaluate the diagnostic accuracy of periostin level in the clinical determination of asthma. Several medical literature data bases were searched for relevant studies through December 1, 2019. The numbers of patients with true-positive, false-positive, false-negative, and true-negative results for the periostin level were extracted from each individual study. We assessed the risk of bias by using Quality Assessment of Diagnostic Accuracy Studies 2. We used the meta-analysis to produce summary estimates of accuracy. Results: In total, nine studies with 1757 subjects met the inclusion criteria. The pooled estimates of sensitivity, specificity, and diagnostic odds ratios for the detection of asthma were 0.58 (95% confidence interval [CI], 0.38‐0.76), 0.86 (95% CI, 0.74‐0.93), and 8.28 (95% CI, 3.67‐18.68), respectively. The area under the summary receiver operating characteristic curve was 0.82 (95% CI, 0.79‐0.85). And significant publication bias was found in this meta‐analysis (p = 0.39). Conclusion: Serum periostin may be used for the diagnosis of asthma, with moderate diagnostic accuracy.

Dietary interventions in mild cognitive impairment and dementia

2019 ◽  
Vol 21 (1) ◽  
pp. 69-82 ◽  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Functional Outcomes ◽  
Clinical Utility ◽  
Randomized Clinical Trials ◽  
Dietary Intervention ◽  
Nutritional Supplements ◽  
Dietary Interventions ◽  
Dietary Counseling ◽  
Nutritional Elements

Dietary intervention is an enticing approach in the fight against cognitive impairment. Nutritional supplements and dietetic counseling are relatively easy and benign interventions, but research has not yet yielded irrefutable evidence as to their clinical utility. Heterogeneity in the results of available clinical studies, as well as methodological and practical issues, does not allow replication and generalization of findings. The paper at hand reviews only randomized clinical trials of single nutrients, multi-nutrient formulations and dietary counseling in mild cognitive impairment and dementia of the Alzheimer's type focusing on both cognitive and functional outcomes. Thus far, folate, vitamin E, Ω-3 fatty acids, and certain multi-nutrient formulations have shown some preliminary promising results; larger, well-designed trials are needed to confirm these findings before nutritional elements can be incorporated in recommended clinical guidelines.

Chronic Wasting Disease Options of Surveillance in Carpathian Cervids: from the Identification of Characteristic Microscopic Pathologic Changes to Prionic Seeded Conversion and Amplification Assays

2001 ◽  
Vol 71 (3) ◽  
pp. 480-486
Author(s):  
Florica Barbuceanu ◽  
Stelian Baraitareanu ◽  
Stefania-Felicia Barbuceanu ◽  
Gabriel Predoi
Keyword(s):  
Enzyme Immunoassay ◽  
Diagnostic Tests ◽  
Chronic Wasting Disease ◽  
Rapid Diagnostic Tests ◽  
Diagnostic Methods ◽  
Wasting Disease ◽  
Western Immunoblotting ◽  
Negative Results ◽  
Antigen Capture ◽  
Confirmatory Tests

This paper describes the current diagnostic methods of Chronic Wasting Disease (CWD) in cervides used between 2013 and 2017 in Romania. The active surveillance of CWD involves the targeted groups screening by using rapid diagnostic tests (e.g., antigen capture enzyme immunoassay). If the first test does not provide certain negative results, then the confirmatory methods have been used, i.e. histopathology, immunohistochemistry and Western immunoblotting. These tests did not lead to the detection of CWD prions (PrPCWD) in Romania. This may be due to the absence or insufficient quantity of PrPCWD in samples, below the threshold of confirmatory tests.

scholarly journals Cardiotoxic effects and myocardial injury: the search for a more precise definition of drug cardiotoxicity

2021 ◽  
Vol 59 (1) ◽  
pp. 51-57
Author(s):  
Daniela Maria Cardinale ◽  
Martina Zaninotto ◽  
Carlo Maria Cipolla ◽  
Claudio Passino ◽  
Mario Plebani ◽  
...  
Keyword(s):  
Early Detection ◽  
Myocardial Injury ◽  
Randomized Clinical Trials ◽  
Imaging Techniques ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Imaging Techniques ◽  
Ventricular Ejection Fraction ◽  
Early Evaluation ◽  
Definition Of

AbstractDrug-induced cardiotoxicity is a major clinical problem; cardiotoxic drugs may induce both cardiac dysfunction and myocardial injury. Several recent studies reported that cardiac troponins measured with high-sensitivity methods (hs-cTn) can enable the early detection of myocardial injury related to chemotherapy or abuse of drugs that are potentially cardiotoxic. Several authors have some concerns about the standard definition of cardiotoxicity, in particular, regarding the early evaluation of chemotherapy cardiotoxicity in cancer patients. Several recent studies using the hs-cTn assay indicate that myocardial injury may precede by some months or years the diagnosis of heart failure (HF) based on the evaluation of left ventricular ejection fraction (LVEF). Accordingly, hs-cTn assay should considered to be a reliable laboratory test for the early detection of asymptomatic or subclinical cardiotoxic damage in patients undergoing cancer chemotherapy. In accordance with the Fourth Universal Definition of Myocardial Infarction and also taking into account the recent experimental and clinical evidences, the definition of drug-cardiotoxicity should be updated considering the early evaluation of myocardial injury by means of hs-cTn assay. It is conceivable that the combined use of hs-cTn assay and cardiac imaging techniques for the evaluation of cardiotoxicity will significantly increase both diagnostic sensitivity and specificity, and also better prevent chemotherapy-related left ventricular (LV) dysfunction and other adverse cardiac events. However, large randomized clinical trials are needed to evaluate the cost/benefit ratio of standardized protocols for the early detection of cardiotoxicity using hs-cTn assay in patients receiving chemotherapy for malignant diseases.

Sign in / Sign up

Export Citation Format

Share Document