Read e-book online Barker, Burton and Zieve's Principles of Ambulatory Medicine PDF

By N. H. Fiebach, D. E. Kern, P. A. Thomas, R. C. Ziegelstein (eds.)

ISBN-10: 0781762278

ISBN-13: 9780781762274

Updated for its 7th variation, Principles of Ambulatory Medicine is the definitive reference for all clinicians taking care of grownup ambulatory sufferers. It presents in-depth insurance of the evaluation,management, and long term process all scientific difficulties addressed within the outpatient surroundings. an important concentration is on preventive care, grounded in very good patient-physician conversation. This variation good points elevated assurance of preventive care, relatively the impression of genetic trying out as a affliction predictor.

For effortless reference, the publication is geared up by means of physique process and every bankruptcy starts with an overview of key subject matters. References to randomized managed medical trials, meta-analyses, and consensus-based suggestions are boldfaced.

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Extra resources for Barker, Burton and Zieve's Principles of Ambulatory Medicine

Sample text

Explicitly, the diagnostic process follows certain steps. Step 1: Form a Hypothesis and Estimate Its Likelihood The estimate of likelihood is called the pretest probability (or prior probability); it simply represents the estimate of prevalence of the disease in a group of people similar to the patient at hand. Each hypothesized diagnosis and the estimate of its likelihood comes initially from evidence collected during the interview and physical examination and from the practitioner’s fund of knowledge from sources such as other patients, colleagues, textbooks, and journals.

Studies of diagnostic testing may have other problems, including verification bias (when those with a positive test result are more likely to have further evaluation), spectrum bias (when the population tested does not reflect those in whom the test will be used), and incorporation bias (when the results of the test under study are included among criteria to establish the reference standard). Sensitivity and specificity are not static properties of a test. As the cutoff value for an abnormal result is made more extreme, the test’s sensitivity decreases and its specificity increases.

The 2 × 2 table in Fig. 1 reveals much about these and related terms. Tests with high sensitivity have a low false-negative rate and are useful for “ruling out” a diagnosis (when they are negative). Conversely, tests with high specificity have a low false-positive rate and are useful for “ruling in” a diagnosis (when they are positive). One way of remembering this is with the mnemonics SnNOut (high sensitivity, negative result rules out) and SpPIn (high specificity, positive result rules in). However, it should be pointed out that these rules of thumb do not always hold up in actual practice; the ability of a sensitive test to rule out a diagnosis is reduced when the specificity is low (4).

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Barker, Burton and Zieve's Principles of Ambulatory Medicine by N. H. Fiebach, D. E. Kern, P. A. Thomas, R. C. Ziegelstein (eds.)


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