Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Pretesting”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

The need for quasi-experimental methodology to evaluate pricing effects.

Family planning program managers may be easily misled by conclusions about the effects of price increases on the demand for services when the findings are based on pre-experiments such as the single-group pretest-posttest study, generally believed to be practical. This report presents financial and service data from clinics of the Asociación Pro-Bienestar de la Familia Ecuatoriana (APROFE) in Ecuador, which, analyzed according to the single-group pretest-posttest design, would suggest that the demand for intrauterine device services is inelastic. However, considerable demand elasticity is detected when data are analyzed according to more rigorous quasi-experimental designs. Using the single-group pretest-posttest design for pricing studies is too flawed to be considered practical. Wherever possible, strong designs should be used in operations research, especially in pricing studies.

Adult↗
PubMed1993

Comparing different types of performance feedback and computer-based instruction in teaching medical students how to diagnose acute abdominal pain.

PURPOSE: To examine the relative efficacies of three types of performance feedback used with computer-based instruction (CBI) in making diagnoses. METHOD: In 1990, 75 final-year medical students at The University of Queensland were pretested for domain knowledge and diagnostic skill in the area of acute abdominal pain. The students were also asked to indicate their confidence in each of their diagnoses. Following these pretests, the students were randomly divided into five groups of 15 students each. One group received traditional CBI, using a "question-and-explanation" format, to learn domain knowledge. The other four groups received one of two types of CBI to learn diagnostic accuracy, and these four groups received one of three types of performance feedback (which differed considerably in the amounts of information imparted). Then the students took posttests. One-way analysis of variance, Student's t-test, and the Tukey test were used to compare the performances of the different groups of students. RESULTS: Although the students in the traditional CBI group significantly improved their performance on multiple-choice questions (by 58%) compared with the other groups of students (6-10% improvement), these students did not improve their diagnostic performance. In contrast, the CBI groups that used simulated-patient cases and structured-performance feedback did improve their diagnostic accuracy (by as much as 16%, compared with a 1% decline for the traditional CBI group). Contrary to expectation, the different types of feedback were equally effective. Except for the students in the traditional CBI group, the students' confidence increased from pretest to posttest regardless of their performances. CONCLUSION: CBI that uses simulated-patient cases and structured-performance feedback seems to be efficient and effective compared with traditional CBI methods. However, care should be taken to ensure that students do not become overconfident of their abilities.

Abdominal Pain↗
PubMed1993

An evaluation of a school-based AIDS/HIV education program for young adolescents.

This study evaluated the efficacy of a school-based AIDS/human immunodeficiency virus (HIV) education program on 6th and 7th grade students. Using a quasi-experimental pretest-posttest control group design, a control group and an education group (intervention I) received both pretest and posttest questionnaires and a second education group (intervention II) was posttested only. Students were evaluated using a modified version of the Centers for Disease Control's Health Risk Survey. Students who received AIDS education were less likely (p < or = 0.0001) than the control group to report that they had changed their behavior to avoid getting AIDS, but thought they had a greater (p < or = 0.0002) chance of acquiring AIDS as an adult. In the intervention I group, males who had never received prior AIDS instruction were more worried about acquiring AIDS as an adult (p < or = 0.013). In the intervention II group, the education had a significant impact on the level of knowledge about AIDS/HIV infection (p < or = 0.0003) and the degree of tolerance toward students with AIDS (p < or = 0.0008), but the effect was not greater than the learning that occurred in the other 2 groups from testing alone. Students who were pretested were also less worried that they had been exposed to AIDS (p < or = 0.0001), more worried that they would die if they acquired AIDS (p < or = 0.05), and less likely to think AIDS patients should be isolated (p < or = 0.0005). Although this AIDS education program appeared to be moderately successful in this group of younger adolescents, significant learning also occurred fro testing alone.

Acquired Immunodeficiency Syndrome↗
PubMed1993

A controlled evaluation of computer assisted training simulations in geriatric dentistry.

The increasing number of geriatric dental patients and the development of treatment plans that require consideration of complex psychosocial, socioeconomic, and medical/medication factors necessitates a change in the traditional teaching of treatment planning. A computer-assisted instructional program was developed to simulate the dentist-geriatric patient interaction and to train students in clinical decision making for the geriatric patient. This study compared the effects of this program with a more traditional approach based on readings from the geriatric dentistry literature. Twenty third-year dental students were matched on grade point average and randomly assigned to the computer or literature-based groups. They were pretested using a clinical analogue of a geriatric patient and then instructed to use either the computer or literature-based educational units. The students were then post-tested on a second clinical analogue. Students performed similarly at pretest. At post-test, both the computer and literature-based subjects were found to have acquired significantly greater evaluation points, to make fewer errors, and to design more involved treatment plans than at pretest. Comparison of computer and literature-based subjects' performance revealed no significant main or interaction effects regarding type of educational unit used. Consistent nonsignificant trends were noted with the computer-based subjects out-performing literature-based subjects on each outcome variable. In addition, the computer-based subjects had more positive feelings about the educational unit than the literature-based subjects at a statistically significant level. These findings suggest that the computer program is an effective alternative method for developing clinical decision skills in students treating geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗
PubMed1996

Evaluation of a new rapid quantitative D-dimer assay in patients with clinically suspected deep vein thrombosis.

The sensitivity and specificity for deep vein thrombosis (DVT) of a new rapid, quantitative and precise (total imprecision < 10%) D-dimer assay suitable for individual measurements (VIDAS D-DIMER, bio-Mérieux, France) were evaluated in a consecutive series of 103 in- and out-patients submitted to serial compression ultrasonography (C-US) for the clinical suspicion of DVT (n = 66) or of DVT recurrence (n = 37) and symptoms lasting from 1 to 15 days. DVT was found in 22 patients at baseline testing and no patient with an initially negative C-US developed vein incompressibility at follow up. The time elapsed from the onset of symptoms was negatively associated with D-dimer levels both in patients with and in those without DVT. In the entire series of patients, the sensitivity of a positive D-dimer test ( > or = 1.0 microgram/ml) for the presence of DVT was 96% (21/22 patients, 95% confidence interval 75-100%) with a specificity of 75% (64-84%), a negative predictive value of 98% (90-100%), a positive predictive value of 51% (35-67%), and an overall accuracy of 80% (70-87%). A normal D-dimer value (0.22 microgram/ml) was observed in one patient with DVT and symptoms lasting from 15 days. The approach of withholding C-US testing in patients with symptoms lasting from less than 11 days and D-dimer levels below the cut-off value was compared to serial C-US testing alone in a cost-effectiveness analysis subdividing the 66 patients with a first episode according to their clinical pretest probability of DVT. Thrombosis was detected in 6.7% of the patients in the low probability group (n = 15), 16.7% of the patients in the moderate probability group (n = 24), 51.9% of the patients in the high probability group (n = 27) and 8.1% of patients with suspected DVT recurrence. Calculated cost-savings for each DVT diagnosed ranged from 5% in the high pretest probability group to 55% in the low pretest probability group and to 77% in patients with suspected DVT recurrence. The safety of avoiding C-US testing in symptomatic patients with a negative D-dimer test should be evaluated in clinical management studies.

Adult↗
PubMed1996

The effects of imagery on attitudes and moods in multiple sclerosis patients.

OBJECTIVE: To determine the efficacy of imagery for influencing attitudes and moods in multiple sclerosis patients. DESIGN: Experimental pretest-posttest, control-group. SETTING: Outpatient group in Central Pennsylvania. PATIENTS: 33 patients with mean ages of 43.93 years in the imagery group and 46.33 years in the control group. All subjects previously were identified with multiple sclerosis. INTERVENTION: Control group subjects followed their typical medical protocol and completed pretest and posttest measures. Imagery group subjects completed pretest and posttest measures and participated in a six-session group process that included brief exposure to relaxation training and ongoing work with biologically oriented imagery. Relaxation training and imagery were practiced on a daily basis. Imagery group subjects also produced imagery drawings, which were assessed after the third and sixth sessions. MAIN OUTCOME MEASURES: Profile of Mood States, State-Trait Anxiety Inventory, Health Attribution Test, Imagery Assessment Tool, and Multiple Sclerosis Symptom Checklist. MAIN RESULTS: Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery because of feedback obtained during the study. CONCLUSION: Use of the relaxation/imagery protocol led to clinically significant reductions in state anxiety. Imagery may be assessed through drawings that allow for positive modification of the imagery material to increase its utility and power.

Adult↗
PubMed1995

The effectiveness of a nutrition education program for family practice residents conducted by a family practice resident-dietitian.

BACKGROUND AND OBJECTIVES: Despite current interest in the role of diet in disease prevention, physicians frequently lack adequate nutrition knowledge. This project sought to test family practice residents' nutrition knowledge, heighten their understanding of nutrition concepts, and implement a method of teaching nutrition in a residency program. METHODS: Following a pretest, family practice residents participated in four teaching sessions during a 5-month period conducted by a fellow resident who was also a dietitian. The residents were asked to keep a 3-day diet diary, which was analyzed with nutrition analysis software. A posttest measure changes in nutrition knowledge and interest. Pretests and posttests were also given to a control group of residents at another campus of the same university-administered program. RESULTS: The intervention group's mean scores increased from 54.7% to 70% (P<.001). Residents who kept a diet diary increased their scores by 23.5%, compared with a 7.4% increase for those who did not. Scores for control-group residents who took both pretests and posttests fell from 43.4% to 42.1%. CONCLUSIONS: Residents who attended lectures conducted by a family practice resident- dietitian and examined their diets showed remarkable improvement in posttest scores of nutrition knowledge. Factors most influential in increasing residents' nutrition knowledge include increasing residents' interest in nutrition, involving them in a longitudinal series of lectures, and providing support for their knowledge and its application.

Adult↗
PubMedDate not supplied

A balancing act: the tension between case-finding and primary prevention strategies in New York State's voluntary HIV counseling and testing program in women's health care settings.

This study sought (1) to identify factors that influence women's willingness to accept voluntary HIV counseling and testing at New York State Family Planning Programs (FPPs) and Prenatal Care Assistance Programs (PCAPs) and (2) to evaluate the effectiveness of such a voluntary counseling and testing program. Telephone interviews elicited organizational-level data from 136 agencies; a combination of telephone and face-to-face interviews was used to gather provider data from 98 HIV counselors; and client data were gathered from 354 women in face-to-face interviews at counseling sites. Slightly fewer than 60% of women agreed to be counseled, and, of those, under half consented to an HIV test at the counseling site. Approximately two thirds of the women who were tested returned for their results and posttest counseling. Clients' recall of pretest counseling content was relatively poor. Bivariate and regression analyses suggest that client, provider, and organizational factors are all associated with rates of pretest counseling and testing. The current voluntary counseling and testing program is achieving only moderate success. Although a substantial number of clients accept HIV counseling, many women remain reluctant to consent to HIV testing, and many who accept testing do not return for their results. Moreover, among those who receive pretest counseling, many do not recall important informational content, which suggests variation may exist in the quality of counseling or that one-time HIV counseling interventions are insufficient to communicate complex information. Medical Subject Headings (MeSH): AIDS, HIV serodiagnosis, women's health, patient education.

AIDS Serodiagnosis↗
PubMed1997

Anonymous HIV testing using home collection and telemedicine counseling. A multicenter evaluation.

BACKGROUND: Home human immunodeficiency virus (HIV) testing has been proposed as an alternative to conventional HIV testing. Despite debate over HIV type 1 (HIV-1) home test systems, these concerns have not to our knowledge been previously studied. OBJECTIVE: To evaluate the safety and efficacy of the Home Access Health Corp (Hoffman Estates, Ill) HIV-1 test system compared with traditional HIV-1 testing with venous blood. METHODS: A total of 1255 subjects were studied prospectively in a blinded, subject-as-control evaluation at 9 outpatient clinics using intent-to-treat analysis. Subjects were provided a home collection kit (Home Access Health Corp) to collect their own finger-stick blood spot samples for laboratory analysis. Subjects received pretest counseling by telephone and their comprehension was subsequently assessed. Subject-collected blood spot samples were compared with professionally drawn blood spot samples for adequacy (sufficient for completing the Food and Drug Administration-endorsed testing) and with venous samples for accuracy. Subjects called 3 days later for anonymous results and posttest counseling. Device safety was evaluated based on adverse events incidence. Subject comprehension of HIV information was measured. RESULTS: Subject-collected blood spot sample results were in complete agreement with venous blood sample results, demonstrating 100% sensitivity and 100% specificity compared with venous controls. Ninety-eight percent of subjects obtained testable blood spot specimens compared with phlebotomists. Following pretest counseling, subjects answered 96% of HIV risk questions correctly. There were no significant adverse events. CONCLUSION: Anonymous HIV-1 home collection kits with pretest and posttest telephone counseling can provide a safe and effective alternative to conventional venous HIV-1 antibody testing.

Adult↗
PubMed1997

Evaluation of previously patch-tested patients referred to a contact dermatitis clinic.

BACKGROUND: One of the frustrations for clinicians who use patch testing is the patient in whom screening patch tests does not yield a relevant result that improves patient outcome. Is it allergic contact dermatitis? Was an allergen missed? Is the screening allergen relevant after all? OBJECTIVE: The purpose of this study was to look at the subset of patients referred to a contact clinic who had previously undergone patch testing to seek answers to these questions for this population. METHOD: The charts of all 119 physician-referred patients seen in the contact clinic from February through August 1995 were reviewed. Information was gathered about the sites of dermatitis, previous patch testing results, current patch testing results (using the North American Contact Dermatitis Group series and supplemental allergens when indicated), and final diagnosis. RESULTS: Forty-three patients had previously undergone patch testing. Nineteen had been tested with the True Test and 24 with the screening series presumed to be Hermal. The sites of skin involvement were similar to the untested group (approximately 1/3 hands, 1/3 face/exposed sites, and 1/3 other). Eighteen pretested patients(42%) had been reported to have one or more positive patch tests, with the most frequently reported allergens, including neomycin (4), quaternium 15 (3), Balsam of Peru (3), fragrance (2), and formaldehyde (2). On repeat testing, 77% of the previous positives were again positive, and many were thought to be relevant. Nine of the 18 had additional allergens deemed relevant. Twenty-five pretested patients had been negative on initial patch testing. Eighteen of the 25 (72%) had positive allergens on repeat testing, and most were thought to be relevant. There were 17 reactions to screening allergens and 16 reactions to additional allergens or products. Variations noted with initial negative testing included use of systemic corticosteroids, patient self-removal of tests, and single 48-hour readings. Overall, 27 of 43 pretested patients (63%) were found to have relevant additional allergens with contact clinic evaluation. Screening allergens were underrecognized as being relevant by clinicians in practice. CONCLUSIONS: Patients suspected of having an allergic component to their dermatitis should be patch tested with the screening series of allergens. Interpretation of the relevance of the allergens and appropriate avoidance is a challenge. If screening allergen patch testing is negative or believed to be not relevant in a patient with persistent dermatitis, there may be a high yield on further patch test evaluation.

Dermatitis, Allergic Contact↗
PubMed1997

Interaction between the forced swimming test and fluoxetine treatment on extracellular 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in the rat.

We used in vivo microdialysis to examine extracellular levels of 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in the striatum and the lateral septum during the forced swimming test, (FST) a behavioral test conducted in rats that is commonly used to predict the effect of antidepressant drugs. The forced swimming test consisted of a 15-min pretest swim and a 5-min test swim 24 hr later. The antidepressant fluoxetine (20 mg/kg s.c.) or saline was administered 23.5, 5 and 1 hr before the test swim. In the striatum, the pretest swim increased 5-HT in both treatment groups. On the second day, the test swim had no effect on 5-HT in saline-treated rats but slightly decreased striatal 5-HT in fluoxetine-treated rats. In the lateral septum, the pretest swim decreased 5-HT in both treatment groups. On the second day, the test swim had no effect on 5-HT in saline-treated rats but decreased lateral septum 5-HT in fluoxetine-treated rats. Ratings of behavior showed that fluoxetine treatment increased swimming behavior and decreased immobility during the test swim. Immobility was positively correlated and swimming was negatively correlated with changes in extracellular 5-HT in the lateral septum but not in the striatum. Therefore, fluoxetine treatment altered adaptation of the regional response of extracellular 5-HT ordinarily produced in the FST, reversing the 5-HT response to the initial swim in the striatum and restoring the response to the initial swim in the lateral septum.

Animals↗
PubMed1997

Developing curricula to promote preventive medicine skills. The Teaching Immunization for Medical Education (TIME) Project. TIME Development Committee.

CONTEXT: Vaccines are underused in the United States, resulting in needless morbidity. Many experts have concluded that clinician education is critical to increasing the nation's vaccination rates. OBJECTIVE: To develop and evaluate case-based curricular materials on immunizations that promote preventive medicine skills. DESIGN: Before-and-after trial of an educational intervention. SETTING AND PARTICIPANTS: Medical schools and primary care residency programs from 20 institutions across the United States participated in the Teaching Immunization for Medical Education (TIME) project. INTERVENTION: A multidisciplinary team developed learning objectives, abstracted clinical cases, and created case-based modules that use contextual learning and small-group interaction to solve clinical and public health problems. The case-based methods are multistation clinical teaching scenarios (MCTS) and problem-based learning (PBL). MAIN OUTCOME MEASURES: Knowledge gained by learners from pretest to posttest and the overall ratings of the sessions by learners and facilitators based on evaluation questionnaires. RESULTS: Pretest and posttest results were obtained on a total of 1122 learners for all modules combined. For the MCTS method, mean scores increased from the 10-item pretest to the posttest by 3.1 items for measles, 3.8 for influenza, 1.8 for hepatitis B, 3.9 for pertussis, 1.9 for adult vaccination, 1.9 for childhood vaccination, and 2.6 for Haemophilus influenzae type b (P<.01 for each). For the PBL method, mean scores increased by 3.4 items for measles, 3.3 for influenza, 2.6 for hepatitis B, and 2.5 for pertussis (P<.01 for each). Most learners (MCTS, 98%; PBL, 89%) and most facilitators (MCTS, 97%; PBL, 100%) rated the sessions overall as very good or good. CONCLUSIONS: Use of TIME modules increases knowledge about immunizations, an essential step to improving vaccination practices of future clinicians. Given the realities of decreased faculty time and budgets, educators face major challenges in developing case-based curricula that prepare learners for the 21st century. Nationally tested libraries of cases such as the TIME modules address this dilemma.

Adult↗
PubMedDate not supplied

A comparison of prostate knowledge of African-American and Caucasian men: changes from prescreening baseline to postintervention.

PURPOSE: This study was undertaken to determine if a community screening program designed to overcome key barriers (lack of awareness, cost of program, ease of access to care) could successfully impact on African-American males' knowledge, attitudes, and behaviors regarding prostate cancer screening. The focus of this report is knowledge. To date, there are no reported studies that examine differences in knowledge from a prescreening baseline to a postintervention level for minority participants. PATIENTS AND METHODS: A total of 944 men were enrolled in the study in a 20-month period. Prostate screening and education were offered as a new service at an existing senior health clinic. In addition, mass screenings were offered approximately monthly at various locations in the community (including senior community centers, senior apartment complexes, and some public housing projects). Screening included both the digital rectal examination and the prostate specific antigen test. A brief questionnaire was administered during client intake (the pretest) and repeated after the education and screening participation (the posttest). Test items targeted three constructs: (1) etiology, (2) risk status, and (3) clinical factors. RESULTS: The largest difference on pretest scores between the racial groups resulted from clinical factor knowledge. African-American men were significantly less likely than Caucasian men to correctly identify early symptoms of prostate cancer and the basic components of a prostate checkup. Although scores were initially significantly lower for African-American participants, these differences were not evident after program involvement. There was a significant increase in knowledge level for all men when comparing pretest and posttest scores. Significant improvement was noted for each test item, with the exception of one key item. Even after participation in the program, African-American men were still more likely to believe that "pain" was the first symptom of prostate cancer. DISCUSSION: An item-by-item analysis revealed that there was only one test item in which program participation did not "correct" knowledge. African-American men were still more likely to believe that pain was the first symptom that would alert them to the presence of cancer. The screening program included information (both printed and oral content) that emphasized the importance of routine screening to detect cancer at an early stage, because most men would experience no symptoms. The only other reported study that examined knowledge documented similar findings with respect to an understanding of symptomology. These findings can be used to direct or guide the educational component of future screening programs that hope to target African-American men.

Black or African American↗
PubMed1998

The effects of concentric versus eccentric isokinetic strength training of the rotator cuff in the plane of the scapula at various speeds.

This study compares the effects of three modes of isokinetic resistance training at the shoulder--concentric, eccentric, and a combination of both concentric and eccentric, with a group that received no training at all. Twenty-eight healthy volunteers (male and females), 18 to 36 years of age, with no history of shoulder pathology, were randomly assigned to one of four groups; concentric training, eccentric training, a combination of both concentric and eccentric training, or control (no training). Testing and training of the dominant shoulder was performed on an isokinetic dynamometer. All subjects were pretested and post-tested both concentrically and eccentrically for humeral internal/external rotation and abduction at speeds of 60 degrees/sec and 120 degrees/sec. Each training session consisted of a total of twelve sets of ten maximal repetitions, and was repeated three times a week for four weeks. The absolute and percent difference in peak force and peak torque for each group between the pretest and post-test was calculated for each combination of position, mode, and speed. A significant difference between the concentric/eccentric group and the eccentric group was found for abduction (p < 0.05). The eccentric group showed a significantly greater increase from the pretest to post-test for absolute differences in peak force and peak torque compared to the concentric/eccentric group (p < 0.05).

Adolescent↗
PubMed1994

An experimental evaluation of an incentive program to reduce serum cholesterol levels among health fair participants.

OBJECTIVE: To evaluate the impact of a health fair and incentive program on the reduction of serum cholesterol levels among participants. DESIGN: Pretest-posttest control group design, with a 6-month delay between pretest and posttest screenings. SETTING: Health fair program for employees of a large midwestern school district. PARTICIPANTS: Volunteer sample among persons with serum cholesterol levels above 5.17 mmol/L (200 mg/dL). Participants were randomly assigned to experimental (N = 29) and comparison groups (N = 34). INTERVENTION: The intervention consisted of four components: a health fair, health risk information, announcement of follow-up screening, and an incentive program. The incentive program consisted of five $100 cash prizes for reducing serum cholesterol levels by 20% or below 5.17 mmol/L (200 mg/dL). The comparison group received only the first three components. MAIN OUTCOME MEASURE: Serum cholesterol levels were measured by a venipuncture, nonfasting, chemical analysis process. RESULTS: The experimental group showed a 13.2% reduction in serum cholesterol levels, and the comparison group exhibited an 11.3% reduction (P < .05). CONCLUSIONS: A health fair, consisting of information on the level of risk and how to reduce risk, and announcement of follow-up screening and incentives can reduce the risk for cardiovascular disease.

Adult↗
PubMed1996

Impact of advance directive videotape on patient comprehension and treatment preferences.

OBJECTIVE: To examine the effects of an advance directive videotape on patient comprehension of advance directive concepts and preferences for resuscitation. DESIGN: Pilot study, randomized cohort trial. SETTING: Extended Care and Rehabilitation Center, Veterans Affairs Medical Center, Durham, NC. PARTICIPANTS: Thirty-six residents of the center; mean age, 69 years. INTERVENTIONS: Sixteen subjects observed an advance directive videotape, and 20 subjects observed a health-relative videotape. All subjects received written material and counseling on advance directives. MEASUREMENT: Structured interviews were conducted at three time points relative to the educational program (pretest, posttest, delayed posttest), measuring comprehension of two advance directive concepts (living will and cardiopulmonary resuscitation) and resuscitation preferences based on hypothetical clinical vignettes. Mean comprehension and mean resuscitation preference scores were derived for each time point. RESULTS: The mean comprehension score improved an average of 1.6 points for all subjects from pretest to delayed posttest (P < .001); however, score changes were not significantly different between the two video groups (P = .39). Mean resuscitation preference scores were stable over time, and there were no significant score differences between the two video groups. CONCLUSION: The advance directive videotape did not significantly affect resuscitation preferences or comprehension of selected advance directive concepts.

Advance Directives↗
PubMed1999

Diagnosis of thyroid disease in hospitalized patients: a systematic review.

BACKGROUND: The optimal approach for the diagnosis of hypothyroidism and hyperthyroidism in hospitalized patients is controversial. OBJECTIVES: To estimate the prevalence of undiagnosed thyroid disease among inpatients, review the usefulness of clinical signs and symptoms, and elucidate the characteristics of the sensitive thyrotropin (thyroid-stimulating hormone) (sTSH) test in this population. METHODS: We undertook a systematic review of the literature by conducting a MEDLINE search covering January 1966 through December 1996. Searching was conducted in duplicate and independently. Specific inclusion and exclusion criteria were predetermined. RESULTS: Prevalence of thyroid disease among inpatients is approximately 1% to 2% and is similar to the outpatient population. Absence of clinical features of thyroid disease lowers the pretest likelihood and makes screening even less useful. Presence of clinical features, especially those specific for thyroid disease (eg, goiter), may increase the pretest likelihood and increase the yield of testing. Acute illness reduces the specificity of second-generation sTSH tests for thyroid disease. The positive likelihood ratio associated with an abnormal sTSH test result in ill inpatients is about 10 compared with about 100 in outpatients. CONCLUSION: In unselected general medical, geriatric, or psychiatric inpatient populations, sTSH testing provides a low yield of true-positive and many false-positive results.

Diagnosis, Differential↗
PubMed2006

Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis.

BACKGROUND: Patients with suspected thoracic aortic dissection require early and accurate diagnosis. Aortography has been replaced by less invasive imaging techniques including transesophageal echocardiography (TEE), helical computed tomography (CT), and magnetic resonance imaging (MRI); however, accuracies have varied from trial to trial, and which imaging technique should be applied to which risk population remains unclear. We systematically reviewed the diagnostic accuracy of these imaging techniques in patients with suspected thoracic aortic dissection. METHODS: Published English-language reports on the diagnosis of thoracic aortic dissection by TEE, helical CT, or MRI were identified from electronic databases. Sensitivity, specificity, and positive and negative likelihood ratios were pooled in a random-effects model. RESULTS: Sixteen studies involving a total of 1139 patients were selected. Pooled sensitivity (98%-100%) and specificity (95%-98%) were comparable between imaging techniques. The pooled positive likelihood ratio appeared to be higher for MRI (positive likelihood ratio, 25.3; 95% confidence interval, 11.1-57.1) than for TEE (14.1; 6.0-33.2) or helical CT (13.9; 4.2-46.0). If a patient had shown a 50% pretest probability of thoracic aortic dissection (high risk), he or she had a 93% to 96% posttest probability of thoracic aortic dissection following a positive result of each imaging test. If a patient had a 5% pretest probability of thoracic aortic dissection (low risk), he or she had a 0.1% to 0.3% posttest probability of thoracic aortic dissection following a negative result of each imaging test. CONCLUSION: All 3 imaging techniques, ie, TEE, helical CT, and MRI, yield clinically equally reliable diagnostic values for confirming or ruling out thoracic aortic dissection.

Aortic Dissection↗