دورية أكاديمية

Conceptualization of category-oriented likelihood ratio: a useful tool for clinical diagnostic reasoning.

التفاصيل البيبلوغرافية
العنوان: Conceptualization of category-oriented likelihood ratio: a useful tool for clinical diagnostic reasoning.
المؤلفون: Moosapour H; Evidence-Based Medicine & Critical Thinking Working Team, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, IR Iran., Raza M, Rambod M, Soltani A
المصدر: BMC medical education [BMC Med Educ] 2011 Nov 17; Vol. 11, pp. 94. Date of Electronic Publication: 2011 Nov 17.
نوع المنشور: Case Reports; Comparative Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101088679 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6920 (Electronic) Linking ISSN: 14726920 NLM ISO Abbreviation: BMC Med Educ Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BioMed Central, [2001-
مواضيع طبية MeSH: Concept Formation* , Decision Making* , Diagnosis, Differential* , Likelihood Functions* , Problem Solving*, Adult ; Female ; Humans ; Models, Theoretical ; Probability ; Young Adult
مستخلص: Background: In the diagnostic reasoning process medical students and novice physicians need to be made aware of the diagnostic values of the clinical findings (including history, signs, and symptoms) to make an appropriate diagnostic decision. Diagnostic reasoning has been understood in light of two paradigms on clinical reasoning: problem solving and decision making. They advocate the reasoning strategies used by expert physicians and the statistical models of reasoning, respectively. Evidence-based medicine (EBM) applies decision theory to the clinical diagnosis, which can be a challenging topic in medical education.This theoretical article tries to compare evidence-based diagnosis with expert-based strategies in clinical diagnosis and also defines a novel concept of category-oriented likelihood ratio (LR) to propose a new model combining both aforementioned methods.
Discussion: Evidence-based medicine advocates the use of quantitative evidence to estimate the probability of diseases more accurately and objectively; however, the published evidence for a given diagnosis cannot practically be utilized in primary care, especially if the patient is complaining of a nonspecific problem such as abdominal pain that could have a long list of differential diagnoses. In this case, expert physicians examine the key clinical findings that could differentiate between broader categories of diseases such as organic and non-organic disease categories to shorten the list of differential diagnoses. To approach nonspecific problems, not only do the experts revise the probability estimate of specific diseases, but also they revise the probability estimate of the categories of diseases by using the available clinical findings.
Summary: To make this approach analytical and objective, we need to know how much more likely it is for a key clinical finding to be present in patients with one of the diseases of a specific category versus those with a disease not included in that category. In this paper, we call this value category-oriented LR.
References: Acad Med. 2005 Dec;80(12):1121-6. (PMID: 16306285)
Acad Med. 2000 May;75(5):528-9. (PMID: 10824804)
Br J Gen Pract. 1995 Jun;45(395):313-6. (PMID: 7619588)
Med Decis Making. 2008 Sep-Oct;28(5):668-80. (PMID: 18556634)
Acad Med. 1995 Mar;70(3):186-93. (PMID: 7873005)
Ann Intern Med. 1999 Jun 15;130(12):1005-13. (PMID: 10383350)
Med Educ. 2003 Aug;37(8):695-703. (PMID: 12895249)
Acad Med. 2008 Oct;83(10):906-9. (PMID: 18820518)
JAMA. 1999 Apr 7;281(13):1214-9. (PMID: 10199432)
Can Fam Physician. 2005 Nov;51:1578-9, 1582-3. (PMID: 16353835)
Med Teach. 2003 Mar;25(2):177-81. (PMID: 12745527)
BMJ. 2002 Mar 23;324(7339):729-32. (PMID: 11909793)
Acad Med. 1998 Oct;73(10 Suppl):S19-21. (PMID: 9795640)
BMJ. 2003 Nov 15;327(7424):1117. (PMID: 14615305)
Med Decis Making. 1991 Oct-Dec;11(4):233-9. (PMID: 1766327)
J Gen Intern Med. 1997 Mar;12(3):182-7. (PMID: 9100144)
Acad Med. 2003 Aug;78(8):775-80. (PMID: 12915363)
JAMA. 1992 May 20;267(19):2638-44. (PMID: 1573753)
Ann Saudi Med. 2006 May-Jun;26(3):211-5. (PMID: 16861864)
JAMA. 1994 Mar 2;271(9):703-7. (PMID: 8309035)
J Eval Clin Pract. 2008 Oct;14(5):775-9. (PMID: 19018910)
JAMA. 1996 Nov 20;276(19):1589-94. (PMID: 8918857)
BMJ. 2005 May 7;330(7499):1080-3. (PMID: 15879401)
JAMA. 2002 May 22-29;287(20):2701-10. (PMID: 12020306)
BMJ. 2004 Jul 17;329(7458):168-9. (PMID: 15258077)
World J Surg. 2005 May;29(5):561-6. (PMID: 15827842)
Acad Med. 2002 Nov;77(11):1158. (PMID: 12431935)
تواريخ الأحداث: Date Created: 20111119 Date Completed: 20120410 Latest Revision: 20211021
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC3341573
DOI: 10.1186/1472-6920-11-94
PMID: 22094044
قاعدة البيانات: MEDLINE
الوصف
تدمد:1472-6920
DOI:10.1186/1472-6920-11-94