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Diagnostic Tests Toolkit Diagnostic Tests Toolkit Finding the evidence for diagnostic tests Establishing an evidence-based methodology to assess the effectiveness of diagnostic tests has posed problems for many years. Now that the framework is in place health professionals can find and appraise the evidence for themselves. With Diagnostic Tests Toolkit clinicians and junior researchers can interpret the evidence for the effectiveness of different types of diagnostic tests, or develop their own research using the successful 'step-by-step' format of the Toolkit series. Written by renowned…mehr
Diagnostic Tests Toolkit Diagnostic Tests Toolkit Finding the evidence for diagnostic tests Establishing an evidence-based methodology to assess the effectiveness of diagnostic tests has posed problems for many years. Now that the framework is in place health professionals can find and appraise the evidence for themselves. With Diagnostic Tests Toolkit clinicians and junior researchers can interpret the evidence for the effectiveness of different types of diagnostic tests, or develop their own research using the successful 'step-by-step' format of the Toolkit series. Written by renowned clinical researchers, this is the first basic guide to evidence-based diagnosis. It is equally valuable to starters in clinical research and those needing a quick refresher on the core elements of evidence-based diagnosis.
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Matthew Thompson Oxford Centre for Monitoring and Diagnosis, Department of Primary Care Health Sciences, University of Oxford, UK & Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA Ann Van den Bruel Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Series Editors: Carl Heneghan, Centre for Evidence-Based Medicine, Oxford, UK, Rafael Perera, Department of Primary Care, University of Oxford, UK; Douglas Badenoch, Minervation Ltd, Edinburgh, UK
Inhaltsangabe
Acknowledgements viii Introduction ix Chapter 1 Diagnosis in evidence-based medicine 1 Diagnosis and screening 1 Screening 3 Symptoms 3 Signs and elicited symptoms 4 Bedside or point-of-care testing 4 Laboratory tests 4 Basic structure of studies of diagnostic tests 4 Further reading 5 Chapter 2 Evaluating new diagnostic tests 6 Technical accuracy ('Can it work?') 7 Place in the clinical pathway ('Where does the test fi t in the existing clinical pathway?') 9 Ability of the test to diagnose or exclude the target condition ('Does it work in patients?') 10 The effect of the test on patient outcomes ('Are patients better off?') 12 Cost-effectiveness ('Is it worth the cost?') 14 Further reading 15 Chapter 3 Asking an answerable clinical question 16 Defining a clinical question for diagnostic tests - PIRT 16 Further reading 17 Chapter 4 Finding the evidence: how to get the most from your searching 18 Combine textwords and thesaurus 20 Search filters for diagnostic accuracy studies 20 Further reading 21 Chapter 5 Selecting relevant studies 22 Selecting relevant studies 22 Assessing validity 23 What is the difference between bias and variability in diagnostic studies? 23 The 'ideal' diagnostic study 24 Flow charts of patients 24 Chapter 6 Sources of bias in diagnostic studies 26 Spectrum bias (also known as selection bias) 26 Verification bias (also called referral or work-up bias) 28 Incorporation bias 29 Observer (or test review bias) bias 30 Differential reference bias (double gold standard) 31 What are the effects of the different design-related biases? 32 Further reading 33 Chapter 7 Measures of discrimination of diagnostic tests 34 Two by two tables 34 Outcome measures 36 Which measure should you use and why? 38 The effect of prevalence on predictive values 40 Effect of time on diagnostic accuracy 41 Effect of severity of the target condition on diagnostic accuracy 42 The referral fi lter 42 Rules of thumb for interpreting likelihood ratios 44 Further reading 52 Chapter 8 Using diagnostic information in clinical practice 53 Validity of data 54 Problem-solving strategies that clinicians use in diagnosis 55 Action thresholds versus testing thresholds ('Will the test change my management?') 57 Methods for combining test results 58 Multivariable analyses 60 How are clinical prediction rules developed? 62 How to select a prediction rule for clinical practice 64 Further reading 65 Chapter 9 Screening tests 66 What are screening tests? 66 Different types of screening 66 Ideal study design for screening tests 68 Over-diagnosis 74 Further reading 74 Chapter 10 Systematic reviews of diagnostic test accuracy studies 75 The research question 75 The literature search 76 Assess the quality of individual studies included in the review 79 Summarizing the results of diagnostic studies 80 Combining data and interpreting meta-analyses of diagnostic studies 85 Acknowledgements 88 Further reading 88 Appendix 1 Evidence-based medicine - a glossary of terms 90 Appendix 2 Further reading 96 Books 96 Useful websites 96 Useful journal articles 96 Index 98
Acknowledgements viii Introduction ix Chapter 1 Diagnosis in evidence-based medicine 1 Diagnosis and screening 1 Screening 3 Symptoms 3 Signs and elicited symptoms 4 Bedside or point-of-care testing 4 Laboratory tests 4 Basic structure of studies of diagnostic tests 4 Further reading 5 Chapter 2 Evaluating new diagnostic tests 6 Technical accuracy ('Can it work?') 7 Place in the clinical pathway ('Where does the test fi t in the existing clinical pathway?') 9 Ability of the test to diagnose or exclude the target condition ('Does it work in patients?') 10 The effect of the test on patient outcomes ('Are patients better off?') 12 Cost-effectiveness ('Is it worth the cost?') 14 Further reading 15 Chapter 3 Asking an answerable clinical question 16 Defining a clinical question for diagnostic tests - PIRT 16 Further reading 17 Chapter 4 Finding the evidence: how to get the most from your searching 18 Combine textwords and thesaurus 20 Search filters for diagnostic accuracy studies 20 Further reading 21 Chapter 5 Selecting relevant studies 22 Selecting relevant studies 22 Assessing validity 23 What is the difference between bias and variability in diagnostic studies? 23 The 'ideal' diagnostic study 24 Flow charts of patients 24 Chapter 6 Sources of bias in diagnostic studies 26 Spectrum bias (also known as selection bias) 26 Verification bias (also called referral or work-up bias) 28 Incorporation bias 29 Observer (or test review bias) bias 30 Differential reference bias (double gold standard) 31 What are the effects of the different design-related biases? 32 Further reading 33 Chapter 7 Measures of discrimination of diagnostic tests 34 Two by two tables 34 Outcome measures 36 Which measure should you use and why? 38 The effect of prevalence on predictive values 40 Effect of time on diagnostic accuracy 41 Effect of severity of the target condition on diagnostic accuracy 42 The referral fi lter 42 Rules of thumb for interpreting likelihood ratios 44 Further reading 52 Chapter 8 Using diagnostic information in clinical practice 53 Validity of data 54 Problem-solving strategies that clinicians use in diagnosis 55 Action thresholds versus testing thresholds ('Will the test change my management?') 57 Methods for combining test results 58 Multivariable analyses 60 How are clinical prediction rules developed? 62 How to select a prediction rule for clinical practice 64 Further reading 65 Chapter 9 Screening tests 66 What are screening tests? 66 Different types of screening 66 Ideal study design for screening tests 68 Over-diagnosis 74 Further reading 74 Chapter 10 Systematic reviews of diagnostic test accuracy studies 75 The research question 75 The literature search 76 Assess the quality of individual studies included in the review 79 Summarizing the results of diagnostic studies 80 Combining data and interpreting meta-analyses of diagnostic studies 85 Acknowledgements 88 Further reading 88 Appendix 1 Evidence-based medicine - a glossary of terms 90 Appendix 2 Further reading 96 Books 96 Useful websites 96 Useful journal articles 96 Index 98
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