Archive for the ‘Pulmonary Medicine’ Category

In the final analysis, however, relative diagnostic accuracies of competing tests are not the ultimate measure of a test’s clinical value. The incremental value of a test is defined by how a test interacts with other available diagnostic approaches in terms of relative diagnostic accuracy, relative costs, feasibility, and patient risk or invasiveness. These measures of incremental value of the evaluated diagnostic tests were provided by only a small proportion […]

Methodologic Standards for Diagnostic Test Research in Pulmonary Medicine: OutcomeDeficiencies were also noted in study design and data analysis techniques when the articles reported the results of head-to-head comparisons of two or more tests relative to a reference standard. Head-to-head comparisons of diagnostic tests require that all of the evaluated tests be […]

More than 80% of studies fulfilled the standards for reporting indeterminate or uninterpretable test results, but only 67% of articles indicated how indeterminate results were incorporated into measures of test accuracy. Exclusion of indeterminate or uninterpretable results from analysis results in considerable bias unless they occur in a random manner. Studies also commonly failed in 83% of instances to provide information on the reproducibility of diagnostic test results in detail […]

Methodologic Standards for Diagnostic Test Research in Pulmonary Medicine: Study populationNinety percent (90%) of articles evaluated diagnostic tests in indicated rather than convenience populations of patients. Unfortunately, only 54% of the articles described the techniques used to enter patients into the studies, which would allow an assessment of the degree to which sampling bias affected […]

Most of the reviewed articles also failed to ensure against test review bias. This bias occurs when a lack of suitable blinding of the reviewers who interpret the evaluated test or the reference standard results prevents an independent assessment. Test review bias is especially serious in investigations wherein the reference standard requires subjective interpretation and prior knowledge of the results of the new diagnostic test would influence the reference standard […]

Methodologic Standards for Diagnostic Test Research in Pulmonary Medicine: Study ratersStudy raters
Kappa values for the assessed standards between the two primary raters ranged from 0.72 to 0.92 (“substantial” to “almost perfect agreement”).
Discussion
The increasing number, cost, and sophistication of diagnostic tests and their significant impact on patient […]

Table 2 shows the proportion of studies that fulfilled the standards for study design. The denominator used to calculate proportions was 41 studies except if a standard applied only to a subgroup of the 41 study articles. The first 12 of the 13 standards listed in Table 2 applied to all of the study articles. Articles were examined to determine the number of articles that fulfilled >1 of these 12 […]

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.