Chapter 003 Decision-Making in Clinical Medicine (Part 11) docx

Chapter 003. Decision-Making in Clinical Medicine (Part 11) docx

... are on an ACE inhibitor. Routine measurement and reporting of such quality indicators can Reilly BM et al: Translating clinical research into clinical practice: Impact of using prediction ... little or no supporting evidence and, thus, reflect the expert consensus of the guideline panel. In part to protect against errors by individual panels, the final step in guideline construction ... Refining clinical diagnosis with likelihood ratios. Lancet 365:1500, 2005 [PMID: 15850636] Haynes RB et al: Clinical Epidemiology: How to Do Clinical Practice Research. Philadelphia, Lippincott...

Chapter 003. Decision-Making in Clinical Medicine (Part 7) docx

... whereas test specificity will be higher in outpatients. times more likely in a patient with the disease than in a patient without it. Most tests in medicine have likelihood ratios for a positive ... finding of a reversible exercise-induced perfusion defect has both a sensitivity and specificity of 90%, yielding a likelihood ratio for a positive test of 9.0 [0.90/(1 – 0.90)]. If we again ... change management. In fact, the test has moved us from being fairly certain that the patient did not have CAD to being completely undecided (a 50:50 chance of disease). In a patient with a...

Chapter 003. Decision-Making in Clinical Medicine (Part 8) docx

... considered, their relevant Chapter 003. Decision-Making in Clinical Medicine (Part 8) Statistical Prediction Models Bayes' theorem, as presented above, deals with a clinical prediction problem ... of HIV infection and the prevalence and incidence of HIV infection in the population targeted. This model, which required over 75 separate data points, provides novel insights into a clinical ... enhance understanding of the most important questions that deserve particular attention in clinical decision-making instead of the small handful of data that clinicians can manage in their heads...

Chapter 065. Gene Therapy in Clinical Medicine (Part 3) docx

... 065. Gene Therapy in Clinical Medicine (Part 3) Long-Term Expression in Genetic Disease: In Vivo Gene Transfer with Recombinant Adeno-Associated Viral (AAV) Vectors Recombinant AAV vectors ... by mutations in several different genes; ~15% of cases of LCA are due to a mutation in a gene, RPE65, encoding a retinal pigment epithelial protein. In dogs with a null mutation in RPE65, sight ... disease. Preclinical studies with recombinant AAV vectors infused into skeletal muscle or liver have resulted in long-term (>5 years) expression of factor VIII or factor IX in the hemophilic...

Chapter 003. Decision-Making in Clinical Medicine (Part 1) doc

... Chapter 003. Decision-Making in Clinical Medicine (Part 1) Harrison's Internal Medicine > Chapter 3. Decision-Making in Clinical Medicine Decision-Making in Clinical Medicine: ... Uncertainty is compounded by the information overload that characterizes modern medicine. Today's experienced clinician needs close to 2 million pieces of information to practice medicine. ... Despite the great technological advances of medicine over the last century, uncertainty still plays a pivotal role in all aspects of medical decision-making. We may know that a patient does not...

Chapter 003. Decision-Making in Clinical Medicine (Part 2) pdf

... Chapter 003. Decision-Making in Clinical Medicine (Part 2) The following three examples introduce the subject of clinical reasoning:  A 46-year-old man presents to his internist ... therefore more influential on clinical judgments. The third commonly used cognitive shortcut, the anchoring heuristic, involves estimating a probability by starting from a familiar point (the anchor) ... the sort encountered daily in clinical medicine, with great efficiency. Clinicians rely on three basic types of heuristics. When assessing a particular patient, clinicians often weigh the probability...

Chapter 003. Decision-Making in Clinical Medicine (Part 3) ppt

... disease is the underlying cause. The absence of a resting Chapter 003. Decision-Making in Clinical Medicine (Part 3) Diagnostic Hypothesis Generation Cognitive scientists studying the thought ... make teaching diagnostic reasoning difficult is that expert clinicians do not follow a fixed pattern in patient examinations. From the outset, they are generating, refining, and discarding diagnostic ... examiner to the exclusion of all other inputs until answered, allowing the examiner to move on to the next specific question. Negative findings are often as important as positive ones in establishing...

Chapter 003. Decision-Making in Clinical Medicine (Part 4) doc

... influence this role include the physician's knowledge, training, and experience. It is obvious that physicians cannot practice evidence-based medicine (EBM; described later in the chapter) if ... therapy in their heart failure patients because they are more familiar with what the targets are (as defined by large clinical trials), have more familiarity with the specific drugs (including ... are less likely to overreact to foreseeable problems in therapy such as a rise in creatinine levels or symptomatic hypotension. Other intriguing research has shown a wide distribution of acceptance...

Chapter 003. Decision-Making in Clinical Medicine (Part 5) pptx

... patients Chapter 003. Decision-Making in Clinical Medicine (Part 5) Economic Incentives Economic incentives are closely related to the other two categories of practice-modifying factors. Financial ... understanding of the patient's problem qualifies as a diagnostic test. Thus, even the history and physical examination can be considered a form of diagnostic test. In clinical medicine, it ... can exert both stimulatory and inhibitory influences on clinical practice. In general, physicians are paid on a fee-for-service, capitation, or salary basis. In fee-for-service, the more the...

Chapter 003. Decision-Making in Clinical Medicine (Part 6) doc

... predictive value is best avoided in favor of the more informative posttest probability. Chapter 003. Decision-Making in Clinical Medicine (Part 6) Calculating sensitivity and specificity ... response in a treadmill exercise test) to the exclusion of other potentially relevant data. In addition, ROC area comparisons do not simulate the way test information is actually used in clinical ... measure of the information content of a test. Values range from 0.5 (no diagnostic information at all, test is equivalent to flipping a coin) to 1.0 (perfect test). In the testing literature,...

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