Understanding evidence-based diagnosis

AbstractThe real meaning of the word “diagnosis” is naming the disease that is causing a patient’s illness. The cognitive process of assigning this name is a mysterious combination of pattern recognition and the hypothetico-deductive approach that is only remotely related to the mathematical process of using test results to update the probability of a disease. What I refer to as “evidence-based diagnosis” is really evidence-based use of medical tests to guide treatment decisions. Understanding how to use test results to update the probability of disease can help us interpret test results more rationally. Also, evidence-based diagnosis reminds us to consider the costs and risks of testing and the dangers of over-diagnosis and over-treatment, in addition to the costs and risks of missing serious disease.

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Current Issues: Evidence-Based Practice for the Real World: Thoughts on Clinical Education in Communication Disorders

Perspectives on Administration and Supervision ◽

10.1044/aas20.3.100 ◽

2010 ◽

Vol 20 (3) ◽

pp. 100-105 ◽

Cited By ~ 3

Author(s):

Anne K. Bothe

Keyword(s):

Clinical Education ◽

Real World ◽

Evidence Based Practice ◽

Communication Disorders ◽

University Faculty ◽

Evidence Based ◽

Speech Language Pathology ◽

Basic Principles ◽

The Real ◽

Language Pathology

This article presents some streamlined and intentionally oversimplified ideas about educating future communication disorders professionals to use some of the most basic principles of evidence-based practice. Working from a popular five-step approach, modifications are suggested that may make the ideas more accessible, and therefore more useful, for university faculty, other supervisors, and future professionals in speech-language pathology, audiology, and related fields.

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Evidence-Based Practices in the Real World: The Transportability of Dinosaur School

PsycEXTRA Dataset ◽

10.1037/e688922007-001 ◽

2007 ◽

Author(s):

Evelyn R. Oka ◽

Rachelle A. Tomac ◽

Anna L. Wilkinson ◽

Anisa Goforth ◽

Danielle Palmer

Keyword(s):

Real World ◽

Evidence Based ◽

Evidence Based Practices ◽

The Real

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Do Guidelines for the Diagnosis and Monitoring of Diabetes Mellitus Fulfill the Criteria of Evidence-Based Guideline Development?

Clinical Chemistry ◽

10.1373/clinchem.2008.109082 ◽

2008 ◽

Vol 54 (11) ◽

pp. 1872-1882 ◽

Cited By ~ 17

Author(s):

Eva Nagy ◽

Joseph Watine ◽

Peter S Bunting ◽

Rita Onody ◽

Wytze P Oosterhuis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Methodological Quality ◽

Guideline Development ◽

Evidence Based ◽

Test Results ◽

Time Period ◽

Therapeutic Guidelines ◽

Therapeutic Recommendations ◽

Evidence Based Guideline

Abstract Background: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. Methods: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. Results: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. Conclusions: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.

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STUDENTS’ COGNITIVE PROCESSES IN SOLVING PROBLEM RELATED TO THE CONCEPT OF AREA CONSERVATION

Journal on Mathematics Education ◽

10.22342/jme.10.1.6339.21-36 ◽

2019 ◽

Vol 10 (1) ◽

pp. 21-36 ◽

Cited By ~ 2

Author(s):

Rooselyna Ekawati ◽

Ahmad Wachidul Kohar ◽

Elly Matul Imah ◽

Siti Maghfirotun Amin ◽

Shofan Fiangga

Keyword(s):

Problem Solving ◽

Cognitive Processes ◽

Cognitive Process ◽

Low Achievers ◽

High Achievers ◽

Seventh Graders ◽

Test Results ◽

Area Formula ◽

High Achiever ◽

Cyclic Processes

This study aimed to determine the cognitive process employed in problem-solving related to the concept of area conservation for seventh graders. Two students with different mathematical ability were chosen to be the subjects of this research. Each of them was the representative of high achievers and low achievers based on a set of area conservation test. Results indicate that both samples performed more cyclic processes on formulating solution planning, regulating solution part and detecting and correcting error during the problem-solving. However, it was found that the high achiever student performed some processes than those of low achiever. Also, while the high achiever student did not predict any outcomes of his formulated strategies, the low achiever did not carry out the thought process after detecting errors of the initial solution gained. About the concept of area conservation, the finding also reveals that within the samples’ cognitive processes, the use of area formula come first before students decided to look for another strategy such as doing ‘cut-rotate-paste’ for the curved planes, which do not have any direct formula. The possible causes of the results were discussed to derive some recommendation for future studies.

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“Designed” Dialogues: The Real Politics of Evidence-Based Practice and Education Policy Research in England: Susan L.Robertson and Roger Dale

Limitations and Possibilities of Dialogue among Researchers, Policymakers, and Practitioners ◽

10.4324/9780203463376-19 ◽

2003 ◽

pp. 238-254

Keyword(s):

Education Policy ◽

Evidence Based Practice ◽

Policy Research ◽

Evidence Based ◽

The Real

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Introduction to Palliative Care

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780190862374.003.0001 ◽

2019 ◽

pp. 3-4

Author(s):

Betty Rolling Ferrell

Keyword(s):

Palliative Care ◽

Healthcare Costs ◽

Payment System ◽

Chronic Illnesses ◽

Evidence Based ◽

Care Needs ◽

The Real ◽

Practical Information ◽

Palliative Care Needs ◽

Seriously Ill

This chapter serves as an introduction to the 5th edition of the Oxford Textbook of Palliative Care, designed to be an evidence-based resource for nurses to assist with the real challenges they face at the patient’s bedside. At a time when our population is aging, the healthcare payment system is uncertain, healthcare costs are escalating, and more people are faced with chronic illnesses, there is a pressing need to extend palliative care into an increasing range of settings. It is the intent of the authors and the editors to provide concise and practical information to assist nurses as they address the palliative care needs of the seriously ill and the dying and their families.

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Dignifying Psychotherapy with Men: Developing Empathic and Evidence-Based Approaches That Suit the Real Needs of the Male Gender

The Palgrave Handbook of Male Psychology and Mental Health ◽

10.1007/978-3-030-04384-1_30 ◽

2019 ◽

pp. 623-645

Author(s):

John A. Ashfield ◽

Dennis S. Gouws

Keyword(s):

Male Gender ◽

Evidence Based ◽

The Real

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Integration of Germline Pharmacogenetics Into a Tumor Sequencing Program

JCO Precision Oncology ◽

10.1200/po.18.00011 ◽

2018 ◽

pp. 1-15 ◽

Cited By ~ 3

Author(s):

Daniel L. Hertz ◽

Andrew Glatz ◽

Amy L. Pasternak ◽

Robert J. Lonigro ◽

Pankaj Vats ◽

...

Keyword(s):

Genetic Information ◽

Clinical Laboratory ◽

Treatment Decisions ◽

Added Value ◽

Treatment Recommendation ◽

Evidence Based ◽

Patients With Cancer ◽

Retrospective Assessment ◽

Tumor Sequencing ◽

Evidence Based Guidelines

Purpose Evidence-based guidelines inform treatment decisions for patients for whom germline genetic information is available. Our real-time tumor sequencing program, which makes precision treatment decisions for patients with cancer, produces matched germline information, providing a unique opportunity to efficiently implement pharmacogenetics and benefit patients. Methods The germline genetic database from the Michigan Oncology Sequencing (MI-Oncoseq) program was searched for 21 clinically actionable polymorphisms in five cancer-relevant genes: TPMT, DPYD, CYP2C19, CYP3A5, and UGT1A1. Residual germline DNA was sent to an external Clinical Laboratory Improvement Amendments–approved laboratory for confirmatory genotyping. The medical records of MI-Oncoseq patients with actionable phenotypes were searched for receipt of relevant drugs and to determine whether having genetic information at the time of treatment would have led to a treatment recommendation. Results All nine variants in TPMT, DPYD, and CYP2C19 that were detected in MI-Oncoseq were confirmed by external genotyping. Genotype determinations could not be made for CYP3A5*3, UGT1A1*28, or UGT1A1*80. On the basis of retrospective assessment of 115 adult and pediatric patient records, 4.3% (n = 5) had a potentially clinically actionable phenotype for TPMT, DPYD, or CYP2C19 and received a relevant medication. After accounting for differences in adult and pediatric recommendations, three of these patients could have received a treatment recommendation at the time of prescribing. Conclusion Germline genotype determinations for TPMT, DPYD, and CYP2C19 can be used to make evidence-based treatment recommendations in MI-Oncoseq patients. Although the proportion of patients for whom recommendations can be made is small, this added value to MI-Oncoseq and patient care comes at no additional genotyping cost. Pharmacogenetic assessment should be integrated into tumor sequencing programs that genotype matched germline DNA; however, the complexity and additional cost of implementing pharmacogenetics remain challenging.

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Internal medicine, complexity, evidence based medicine, almost ‘‘without evidences’’

Italian Journal of Medicine ◽

10.4081/itjm.2009.191 ◽

2013 ◽

pp. 191-200

Author(s):

Roberto Nardi ◽

Tatiana Fabbri ◽

Gelorma Belmonte ◽

Paolo Leandri ◽

Magda Mazzetti ◽

...

Keyword(s):

Internal Medicine ◽

Evidence Based Medicine ◽

Models Of Care ◽

Evidence Based ◽

Suitable Alternative ◽

The Real ◽

Economic Problems ◽

Clinic Management ◽

Individualised Care ◽

Based Medicine

Background: Internal medicine has been defined as the specialty of the adult medical complex patients. Complexity science suggests that illness (and health) results from complex, dynamic, and unique interactions between different components of the overall system. In a patient, complexity involves the intricate entanglement of two or more systems (e.g.; body-diseases, family, socioeconomic status, therapies). Aim of the study: To evaluate the real applicability of Evidence Based Medicne (EBM) in clinical Departments of Internal Medicine and its critical perspectives. Discussion: Habitually the internist takes decisions in these situations: a) certainty (the ideal decision is adopted and the corresponding strategy follows), b) risk (the more suitable alternative selected can be the determination of the probable value or mathematical hope) and c) uncertainty, in which decisions linked to triple agents: beliefs and personal values of the doctors (I) for their patients (II) in the society (III). In the medical decisions there are often different factors that go beyond the field of technical and scientific knowledge (family, social, economic problems, etc.) and demanding an ethical analysis of the decision. Conclusions: The ‘‘evidence-based medicine’’, as other models of care, has — in itself — some limitations. ‘‘No evidence in medicine’’ matters that the postulates of the EBM are not always applicable to the real patients of Internal Medicine wards, mostly elderly, frail, complex, with comorbidities and polipharmacy, often with cognitive dysfunction and limitation of autonomy, with psycho-emotional, social and economic problems. The interacting effects of overall involved diseases/factors and their management require more complex and individualised care than simply the sum of separate guideline components. Further innovation is required to resolve the need to enhance integration of evidence with our patients’ values at the ‘‘bedside and/or clinic’’ management.

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