ABSTRACT
The interpretation of diagnostic tests has had a remarkable progress in recent years with a tendency towards a more clinical and patient-oriented perspective. Here we emphasize the limitations of using the dichotomy positive/negative testing or cut-off points for normality in many of our medical decisions. We also introduce alternative methods to interpret diagnostic tests, specially in unusual circumstances, i.e., in the development of new diagnostic tests that may be better than the accepted gold standard or when there is no gold standard. Finally we analyze the different interpretations of false negative results that may modify the interpretation of subsequent testing in a patient.
Subject(s)
Diagnosis , Algorithms , False Negative Reactions , False Positive Reactions , Humans , Predictive Value of Tests , Reference Values , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
It is highly desirable to give always the best therapeutic alternative. However, the accomplishment of this goal is not always possible, leaving the physician with second, third or no therapeutic choice at all. The reasons for this may be economic, logistic, medical and cultural. In order to know what the patients are losing, we need to test how strong the scientific evidence is for the first choice option, and second, we have to consider the magnitude of improvement on clinical outcomes, comparing the best therapy and the next best available therapy. In many instances, the difference in clinical benefit is small and even negligible.
Subject(s)
Therapeutics , Choice Behavior , Cost-Benefit Analysis , European Union , Evaluation Studies as Topic , Health Care Costs , Humans , Patient Acceptance of Health Care , Practice Patterns, Physicians' , Professional Practice , Risk , Therapeutics/economics , Therapeutics/standardsABSTRACT
Screening programs may seem useful and effective. However, in many cases the benefit is not clear and may actually do more harm than good. Each time a clinician asks for an early diagnostic test, the scientific evidence and the attributed risks need to be defined. The effectiveness of any early diagnosis test relies on the characteristics of the test itself, the disease to be ruled-out, and the side effects of the test. Such effects may be physical and emotional and the outcomes may be against the well being of the patient. In general, if an early diagnostic test does not lead to improvement in the survival and/or morbidity of patients, its utilization is not justified.
Subject(s)
Diagnosis , Humans , Male , Patient Selection , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/diagnosis , Time FactorsABSTRACT
Clinical research in Internal Medicine has provided many scientific advances during the past few years. However, the newly generated information overrides the time available to read all of the medical literature regarding advances in Internal Medicine. The goal of this review is to summarize some of the most relevant improvements in clinical practice published over the last few years. From Cardiology to Pulmonology, the authors of this review expose in a succinct way what they and many of their peers consider to be the most transcendental information gathered from thousands of publications. The authors of this review article have attempted to avoid sensationalism by including facts instead of just simply optimistic preliminary findings that can mislead clinicians' decision making. The review is focused on information obtained through well-designed, prospective clinical trials and cohorts where the effectiveness of medical interventions and diagnostic procedures were tested.
