EVIDENCE-BASED PHYSICAL DIAGNOSIS This page intentionally left blank EVIDENCE-BASED PHYSICAL DIAGNOSIS 3rd Edition Steven McGee, MD. Evidence-Based Physical Diagnosis. Steve McGee, MD. Professor, University of Washington. Alaska ACP and AKOMA March 31, Diagnosis today. PDF | The international call to practice evidence-based medicine was first ![ Graphic] McGee S. Evidence-Based Physical Diagnosis.
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Almost 10 years and a World Wide Web later, we now have McGee's book Evidence-Based Physical Diagnosis. The book's intent is “to explore the origins. Steven McGee-Evidence-Based Physical Diagnosis-Elsevier () _compressed - Download as PDF File .pdf), Text File .txt) or read online. Libro de steven. Evidence-Based Physical Diagnosis helps you choose the diagnostic approaches that have been proven most effective! Dr. Steven McGee puts the most current.
The medical history as a diagnostic technology
Kate Dimock Developmental Editor: Anne Snyder Publishing Services Managers: There is even a new chapter on examination of patients in the intensive care unit, an excellent example of how traditional physical examination and modern technology work together. I am indebted to many investigators who contributed extra information not included in their published work.
These include Dr. Waldo de Mattos who provided his original data on patients with chronic obstructive lung disease , Dr.
Aisha Lateef who provided raw data from her study on rela- tive bradycardia and dengue , Dr. Colin Grissom who supplied additional information on his technique of capillary refill time , Dr.
LeGal who answered questions about the modified Geneva score , Dr. Chiche who provided additional in- formation regarding the correct technique of passive leg elevation , Dr.
Torres- Russotto who described the correct technique for the finger rub test , and Dr. Kalantri who helped me understand the physical findings of pleural effusion.
Through the efforts of these and other investigators, physical examina- tion remains an essential clinical skill, one that complements the advanced technology of modern medicine and one vital to good patient care. We have a wonderfully rich tradition of physical diagnosis, and my hope is that this book will help square this tradition, now almost 2 centuries old, with the realities of modern diagnosis, which often rely more on tech- nologic tests such as clinical imaging and laboratory testing.
The tension between physical diagnosis and technologic tests has never been greater. Having taught physical diagnosis for 20 years, I frequently observe medical students downloading textbooks of physical diagnosis during their preclinical years, to study and master traditional physical signs, but then neglecting or even discarding this knowledge during their clinical years, after observing that modern diagnosis often takes place at a distance from the bedside.
Disregard for physical diagnosis also pervades our residency programs, most of which have formal x-ray rounds, pathology rounds, microbiology rounds, and clinical conferences addressing the nuances of laboratory tests. Calculating post-history probability using Bayes' theorem.
However, unlike the other diagnostic modalities a continuing absence of any specific focus on the medical history by senior clinicians or policymakers has resulted in some fundamental issues remaining unaddressed.
Box 2. Reliability or reproducibility is the extent to which repeated measurements of a stable phenomenon produce similar results.
Values greater than 0. The positive predictive value that is, the probability that the disease is present if the patient has, for example, a specific symptom often makes the most intuitive sense to clinicians, and yet is a constant source of misunderstanding between GPs and our secondary colleagues.
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It is imperative to be aware that the predictive value is affected by prevalence: as the prevalence falls, the number of false positives tends to increase, resulting in a lowering of the positive predictive value. The effect of prevalence can also be readily understood in relation to the odds ratio version of Bayes' theorem referred to earlier see Box 3 for detailed definitions.
Box 3. Bayesian terminology.
LRs indicate how many times more or less likely a result is in a patient with the disease compared to a patient free of disease. Positive LRs with the highest value argue most for disease when the clinical information is present that is, how the probability changes when the finding is present ; negative LRs with the value closest to zero argue the most against disease when that clinical information is absent that is, how the probability changes when the finding is absent.
Interestingly, Sox and colleagues have demonstrated that the posterior odds for coronary artery disease in two primary care populations was lower than in a referred arteriography population, even when patients with virtually identical clinical histories were compared.
A patient attending with dysuria might have a urinary tract infection but the positive likelihood ratio provided by this particular presenting symptom only amounts to 1. For the non-specific headache of temporal arteritis it seems that a temporal location only produces a positive likelihood ratio of 1. However, although an ESR between 61 and 80 confers an additional positive likelihood ratio of 1.Jaime Quintero Rosales.
Evidence-Based Physical Diagnosis
It is imperative to be aware that the predictive value is affected by prevalence: as the prevalence falls, the number of false positives tends to increase, resulting in a lowering of the positive predictive value. Dr Gretta Howard.
However, whereas there is a particular focus on endoscopy, imaging, pathology, and physiology testing, with the appointment of four clinical leads in these areas, the medical history has not been afforded any similar special prominence.
I am indebted to many investigators who contributed extra information not included in their published work.
Asniah Hadjiadatu Abdullah. Proposed mechanisms are suppressed vasodepressor systems prostaglandins, kallikrein- kinin , exaggerated pressor responses to vasoactive substances, and possible activa- tion of the renin-angiotensin system. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided i on procedures featured or ii by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications.
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