001 General considerations in clinical medicine

... involves skill in clinical decision-making The first goal of this chapter is to provide an introduction to the study of clinical reasoning Equally bewildering to the student ... experience in the care of patients The third goal of this chapter is to provide a brief overview of some of the tools of evidence-based medicine Clinical Decision-Making Clinical Reasoning The mo...

Ngày tải lên: 06/07/2014, 08:20

... of 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 ... the patterns most prevalent in clinical medicine, must work much harder to achieve the same result and is often at risk of missing the important clinical problem in a sea of co...

Ngày tải lên: 06/07/2014, 08:20

... make teaching diagnostic reasoning difficult is that expert clinicians not follow a fixed pattern in patient examinations From the outset, they are generating, refining, and discarding diagnostic ... the 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 e...

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... 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 they are unfamiliar with ... 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 (inc...

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... assist in making clinical decisions in the presence of uncertainty are reviewed Quantitative Methods to Aid Clinical Decision-Making The process of medical decision-making can be divided into two ... patients In summary, expert clinical decision-making can be appreciated as a complex interplay between cognitive devices used to simplify large amounts of complex information in...

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... quantitative 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, ... response in a treadmill exercise test) to the exclusion of other potentially relevant data In addition, ROC area comparisons not simulate the way test information is actually used i...

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... 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 result between ... the 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 ... to change management In fact,...

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... 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 ... promise, particularly in correcting drug dosing and in promoting adherence to guidelines The full impact of these approaches will only be evaluable when computers are fully integrated into med...

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... during the 1970s (the last time these patients were routinely treated with medicine alone) would be extremely misleading since the quality of "medical therapy" has made huge improvements in the ... different physicians In short, the assumption is that there is an element of randomness (in the sense of disorder rather than in the formal statistical sense) to clinical management In...

Ngày tải lên: 06/07/2014, 08:20

... [PMID: 12052127] Del Mar C et al: Clinical Thinking: Evidence, Communication and Decision Making Malden, Mass., Blackwell, 2006 Grimes DA et al: Refining clinical diagnosis with likelihood ratios ... Translating clinical research into clinical practice: Impact of using prediction rules to make decisions Ann Intern Med 144:201, 2006 [PMID: 16461965] Sanders GD et al: Cost-effectiveness...

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... time-consuming and requires skills and training that most clinicians not possess Thus, the best starting point for most EBM searches is the identification of recent systematic overviews of the problem in ... Tools for Finding the Evidence in Evidence-Based Medicine Name Descriptio n Web Address Availab ility Eviden Comprehe http://www.ovid.com electronic Subscrip ce-Based nsive tion Me...

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... though they may be seeing other specialists The internist has an important role in educating patients about the indications, benefits, risks, and limitations of genetic testing in the management of ... also influence the severity of infirmity, effect of treatment, and progression of disease The primary care clinician is now faced with the role of recognizing and co...

Ngày tải lên: 07/07/2014, 01:20

... the relative risk ranges from two- to fivefold, underscoring the importance of family history for these prevalent disorders Pending further advances in genetic testing, the key to assessing the ... individual will vary depending on the size of the pedigree, the number of unaffected relatives, and the types of diagnoses, as well as the ages of disease onset within...

Ngày tải lên: 07/07/2014, 01:20

... cancer, representing another confounding variable in the pedigree analysis Some of the aforementioned features of the family history are illustrated in Fig 64-1 In this example, the proband, a ... whether based on family history, characteristic physical findings, or biochemical testing Careful clinical assessment can define the phenotype, thereby preventing unnecessary t...

Ngày tải lên: 07/07/2014, 01:20

... established disease, genetic testing for susceptibility to chronic disease is being increasingly integrated into the practice of medicine In most cases, however, the discovery of disease-associated genes ... analysis of the gene of interest In addition, PCR enables genetic testing on minimal amounts of DNA extracted from a wide range of tissue sources including leuko...

Ngày tải lên: 07/07/2014, 01:20