Articles: sensitivity-specificity.
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The clinical reasoning process for decision-making in medicine is complex and involves multiple factors, including diagnostic probabilities, study characteristics, costs, and patient preferences. This article highlights the role of pre-test probability in calculating the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests and also likelihood ratios. ⋯ The notion of treatment and diagnostic thresholds is introduced, emphasizing their impact on medical decision-making. Finally, it underscores that diagnostic tests should only be requested if their results can change clinical management, promoting a rational and cost-effective approach to medical practice.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisDiagnostic test accuracy of self-administered cognitive assessment tools for dementia.
Dementia is a chronic and progressive clinical syndrome that can present with a range of cognitive and behavioural symptoms. Global prevalence is projected to increase due to ageing populations, particularly in resource-limited settings, with significant associated health and social care costs. There is a critical need for accurate cognitive assessment as part of the diagnostic workup for dementia. Although self-administered cognitive assessment tools are not diagnostic, they can be used to assess cognition. The role of these tests is uncertain, and their diagnostic test accuracy remains unclear, but they may be useful tools in circumstances where face-to-face assessment may be difficult. ⋯ There is insufficient evidence to recommend the use of any single self-administered cognitive assessment tool. The tools had test accuracy scores that are similar to the range seen with standard pencil and paper cognitive screening tests conducted by clinicians. Further research on the optimal test and threshold score, and how that may be impacted by setting, language, and educational level is needed.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisThe effect of sample site and collection procedure on identification of SARS-CoV-2 infection.
Sample collection is a key driver of accuracy in the diagnosis of SARS-CoV-2 infection. Viral load may vary at different anatomical sampling sites and accuracy may be compromised by difficulties obtaining specimens and the expertise of the person taking the sample. It is important to optimise sampling accuracy within cost, safety and accessibility constraints. ⋯ When used with RT-PCR, there is no evidence for a difference in sensitivity of self-collected gargle or deep-throat saliva samples compared to nasopharyngeal samples collected by healthcare workers when used with RT-PCR. Use of these alternative, self-collected sample types has the potential to reduce cost and discomfort and improve the safety of sampling by reducing risk of transmission from aerosol spread which occurs as a result of coughing and gagging during the nasopharyngeal or oropharyngeal sample collection procedure. This may, in turn, improve access to and uptake of testing. Other types of saliva, nasal, oral and oropharyngeal samples are, on average, less sensitive compared to healthcare worker-collected nasopharyngeal samples, and it is unlikely that sensitivities of this magnitude would be acceptable for confirmation of SARS-CoV-2 infection with RT-PCR. When used with Ag-RDTs, there is no evidence of a difference in sensitivity between nasal samples and healthcare worker-collected nasopharyngeal samples for detecting SARS-CoV-2. The implications of this for self-testing are unclear as evaluations did not report whether nasal samples were self-collected or collected by healthcare workers. Further research is needed in asymptomatic individuals, children and in Ag-RDTs, and to investigate the effect of operator expertise on accuracy. Quality assessment of the evidence base underpinning these conclusions was restricted by poor reporting. There is a need for further high-quality studies, adhering to reporting standards for test accuracy studies.
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Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site. ⋯ Ignoring this aspect of thoracolumbar management often contributes to the development of posttraumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the level of the injured vertebra, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to show the importance of segmental sagittal alignment and the vertebral level on patient outcomes.
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To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental illness. Therefore, the aim of this systematic review was to identify screening tools that either take a multiple-mental disorder or a transdiagnostic approach. As primary and secondary outcomes, diagnostic accuracy and time efficiency were investigated. ⋯ The eleven identified screening tools can support general practitioners to identify patients with mental health problems. However, there was great heterogeneity concerning their diagnostic scope of psychopathology. Further screening tools for primary care are needed that target broad constructs of mental illness, such as transdiagnostic factors or personality dysfunction.