Considering the probable differential diagnosis

@#Differential diagnosis is the method of limiting the possible causes of the patient’s symptoms before making a final diagnosis. For experienced clinicians, it is the process of using clinical experience alongside the patient’s symptoms and test results to prioritize the list of possibilities until the diagnosis can be identified with confidence.

Diagnostic models of the pre-test probability of stable coronary artery disease: A systematic review

A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models. Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included. Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted. Ten studies involving the development of 12 models and two studies focusing on external validation were identified. Seven models were validated internally, and seven models were validated externally. Discrimination varied between studies that were validated internally (C statistic 0.66-0.81) and externally (0.49-0.87). Only one study presented reclassification indices. The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables. Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes. Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes.

Assessment on antibody test for diagnosis performance of heparin induced thrombocytopenia / 临床检验杂志

Objective To assess the antibody test for the diagnosis performance of heparin induced thrombocytopenia(HIT).Methods 52 plasma samples of patients with HIT,126 plasma samples of heparin treated patients without HIT and 50 plasma samples of healthy individuals were collected from 2014 September to 2016 November.According to thrombosis,the patients were further divided into two groups:isolated HIT group without thrombosis (30 cases) and heparin induced thrombocytopenia with thrombosis (HITY) group (22 cases).The whole HIT antibody in plasma was assayed by using ACL-TOP 700 coagulation analyzer and reagent (HemosIL HIT-AbPF4-H).The IgG-specific HIT antibody in plasma was assayed by using ACL AcuStar chemiluminescent analyzer and reagent (HemosIL AcuStar HIT-IgGPF4-H).Results The levels of whole antibody and IgG-specific antibody in the patients of heparin control group was higher than those in healthy control (U value was 1 644.0 and 1 911.0,respectively,P ＜ 0.01).The levels of two HIT antibodies in HIT patients group were higher than those in the patients of heparin control group (U value was 550.0 and 4.7,respectively,P ＜ 0.01).ROC curve showed that the sensitivities of both whole antibody and IgG-specific antibody were 100％,and up-regulating the cut-off value could improve the specificity of both tests.The positive incidence of the whole antibody was 27.8％ in the heparin control group and 100％ in HIT patients group while the cut-off value was 1.50 U/mL.The positive incidence of IgG-specific antibody was 0 in the heparin control group and 100％ in the HIT patients group while the cut-off value was 1.51 U/mL.While the cut-off value of IgG-specific antibody was 2.32 U/mL,the diagnosis sensitivity of thrombosis assessment was 90.9％ and the specificity was 80.0％.In case the cut-off value exceeded 2.32 U/mL,the accumulating risk of HIT increased significantly in HIT patients within 15 days (Log-rank x2 =56.577,P ＜ 0.01).Conclusion The whole antibody and IgG-specific antibody could contribute to excluding diagnosis,diagnosis or risk assessment for the suspected HIT patients.